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1.
J Urol ; : 101097JU000000000000068502, 2020 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-31895630
2.
J Urol ; : 101097JU0000000000000691, 2019 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-31821098

RESUMO

OBJECTIVES: To study the effect of oxybutynin treatment on the bladder and upper urinary tract outcomes following posterior urethral valve (PUV) ablation in infancy. MATERIALS AND METHODS: Infants less than 12 months diagnosed with PUV and treated with primary endoscopic valve ablation (EVA), were screened for eligibility. Patients treated with urinary diversion and those with other conditions that could affect the lower urinary tract function were excluded. Patients were randomized to either oxybutynin treatment (0.2 mg/kg TDS) till toilet training or active observation. The study endpoints were serum creatinine (Sr.Cr), eGFR, hydronephrosis and vesicoureteral reflux (VUR) resolution, febrile UTI and toilet training. RESULTS: Between December 2013 and September 2015, a total of 49 infants (24 in oxybutynin and 25 in the observation group) were enrolled and completed at least one year of follow-up. Oxybutynin was discontinued before toilet training in 5 patients (flushing in two, bladder and upper tract dilation in two and cognitive changes in one patient). After a median follow-up of 44.2 (12-57.6) months, median Sr.Cr and eGFR were not significantly different between both groups (p=0.823 and 0.722, respectively). Renal units in the oxybutynin group had a higher likelihood of hydronephrosis improvement (61.9% vs. 34.8%, p=0.011) and VUR resolution (62.5% vs. 25%, p=0.023). Febrile UTI (29.2% vs. 40%, p=0.404), achievement (70.8% vs. 76%, p=0.748) or age at toilet training (p=0.247) were not different between oxybutynin and observation groups, respectively. CONCLUSION: Oxybutynin enhances hydronephrosis and VUR resolution following primary EVA in infancy, but periodic monitoring is warranted.

3.
Arab J Urol ; 17(4): 265-269, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31723443

RESUMO

Objective: To validate an Arabic version of the Overactive Bladder Symptom Score (OABSS) questionnaire. Patients and methods: In all, 301 patients were evaluated using the Arabic-translated OABSS. They were divided into four groups: 112 patients with OAB symptoms, 115 healthy individuals with no OAB symptoms, 38 with bladder outlet obstruction (BOO) associated with storage lower urinary tract symptoms (LUTS), and 36 with BOO without storage LUTS. The reliability of the Arabic version was evaluated for internal consistency using Cronbach's α test. Interdomain associations were examined using Spearman's correlation coefficient (r). The discrimination validity was evaluated using the Mann-Whitney test. Results: Higher internal consistency was found for all OABSS domains in the OAB and BOO groups. There were strong correlations between all domains in the OAB group (P < 0.001). Similarly, there were strong correlations between all domains in the BOO group. For discrimination validity, scores were statistically significant higher for all OABSS domains and overall total scores in the OAB and BOO groups compared with their control groups (P < 0.001). Conclusion: The Arabic version of OABSS is a reliable and valid instrument that can be used to evaluate symptoms and health-related quality of life in Arabic patients with OAB. Clinical trial no. (clinicaltrials.gov NCT03533062) Abbreviations : BOO: bladder outlet obstruction; OAB: overactive bladder; OABSS: Overactive Bladder Symptom Score questionnaire; (U)UI: (urgency) urinary incontinence.

4.
J Urol ; : 101097JU0000000000000685, 2019 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-31763948

RESUMO

PURPOSE: To assess the efficacy of EH-sparing Greenlight Laser photoselective vaporization of the prostate (GL.PVP) in preserving antegrade ejaculation and urodynamic relief of obstruction in comparison to standard GL.PVP through preliminary clinical trial. METHODS: Standard GL.PVP was classically performed in 24 patients. EH-sparing GL.PVP was performed with preservation of the paracollicular and supracollicular tissue present proximal to verumontanum in 25 patients. Patients were assessed at baseline and at 1, 3, 6 and 12 months postoperatively using Ej-MSHQ and IIEF-15. IPSS, uroflow and PVR were reported at each follow-up visit. Standard urodynamic study (UDS) was performed at 6 months. RESULTS: Antegrade ejaculation was reported in 85% after EH-sparing GL.PVP and in 31.6% after standard GL.PVP (P=0.001). Significant reduction in EJ-MSHQ score was reported after standard GL.PVP at 6 and 12 months (P<0.001, <0.001) with no significant difference after EH-sparing GL.PVP, (P=0.18, P=0.078) respectively. The median EJ-MSHQ score was 28.5 (1-33), 27 (1-33) in EH-sparing GL.PVP and 9.5 (1-35), 9 (0-33) in standard GL.PVP group at 6 (P=0.005) and 12 months (p<0.001) respectively. Both groups showed decline in mean total IIEF-15 score at 1 year however, this decline was statistically significant only after standard GL.PVP (p =0.001). All urinary outcome measures showed comparable significant improvement at all follow up points. Postoperative urodynamic assessment showed significant comparable (P=0.97) decline in bladder outlet obstruction index from median 64 (21-207) to 23.5 (10-53) (P=0.005) following EH-sparing GL.PVP and from 87 (38:186) to 19.5 (7-51) (P=0.001) in the standard GL.PVP. At one year, overall retreatment rate was comparable between the two groups (p=0.26). CONCLUSIONS: In well-informed sexually interested patients, EH-sparing GL.PVP procedure is feasible and effective for treatment of small to moderate sized BPH with superior sexual function related outcome. Short-term relief of obstruction is objectively comparable to standard GL.PVP.

5.
Int Neurourol J ; 23(3): 240-248, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31607104

RESUMO

PURPOSE: To evaluate the efficacy and safety of re-treatment with anticholinergics on refractory idiopathic overactive bladder (OAB) previously treated with intravesical botulinum neurotoxin type A (BTX-A) injections. METHODS: One hundred patients were initially managed by intravesical injections of 100 IU of BTX-A. After the effects of BTX-A faded, patients were randomized into 2 groups: group A patients received solifenacin (10 mg) for 12 weeks (study group), while group B patients received placebo treatment for 12 weeks (control group), then subsequently received solifenacin (10 mg) for another 6 weeks. All patients underwent preoperative urodynamic testing. Patients were asked to complete the validated overactive bladder symptoms score (OABSS) and incontinence quality of life (I-QoL) instruments after the effects of intravesical BTX-A faded and at 12 weeks of follow-up. Univariate and multivariate analyses of the factors affecting treatment response were conducted. RESULTS: At 12 weeks of follow-up, in group A, all OABSS items, including the total score, had improved significantly (P<0.0001). Group A had lower frequency and amplitude of detrusor overactivity and detrusor leak point pressure (P<0.0001, P=0.03, and P=0.01, respectively). Cystometric capacity also increased significantly (P=0.007), as did all I-QoL parameters. In a comparison of patients with failed treatment and patients with successful treatment, female sex, repeated intravesical BTX-A injections, and increased bladder capacity were statistically significant (P=0.001, P=0.0001, and P=0.002, respectively). Repeated intravesical BTX-A injections and increased bladder capacity were independent factors predicting treatment success. CONCLUSION: In patients with refractory idiopathic OAB, reuse of anticholinergics could be an effective treatment option in patients after the effects of BTX-A fade. Repeated intravesical BTX-A injections and increased cystometric capacity could affect treatment response.

6.
Artigo em Inglês | MEDLINE | ID: mdl-31647172

RESUMO

PURPOSE: To assess the efficacy of Thiele massage (TM) as monotherapy for nonulcerative interstitial cystitis/bladder pain syndrome (IC/BPS). METHODS: A prospective evaluation of 40 women with IC/BPS who underwent TM was conducted. TM was initially administrated by a physiotherapist and then self-administrated at home twice weekly for 16 weeks. Patients were assessed every 4 weeks on an outpatient basis. Assessment tools included 3-day voiding diaries, the Likert visual analog scale (VAS) for pain, and the Interstitial Cystitis Symptom Index (ICSI) and the Interstitial Cystitis Problem Index (ICPI) of the O'Leary-Sant questionnaire. Sexual function was assessed using the Female Sexual Function Index (FSFI). RESULTS: Thirty-six patients completed the study with a mean age ± SD 41.31 ± 9.93 (range 21-60 years). The mean duration of illness ± SD was 81.29 ± 34.55 (range 12-300 months). Perception of pain was higher than at basal level according to Likert VAS (9.2 ± 1.5 vs 9.8 ± 0.5, P = .018). The ICSI and ICPI questionnaires were deteriorated (16.83 ± 2.57 vs 12.89 ± 3.50, P = .015 and 15.75 ± 0.94 vs 14.31 ± 2.55, P < .001, respectively). TM had no significant impact on the total score of FSFI (P = .119); however, there was a negative impact on the lubrication domain with more dryness (0.045). CONCLUSIONS: TM is not an effective option as monotreatment modality for nonulcerative IC/BPS. An attempt of physiotherapy should be integrated in a multidisciplinary treatment.

7.
Arab J Urol ; 17(3): 216-220, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31489238

RESUMO

Objective: To evaluate the efficacy and safety of botulinum toxin A (BoNT-A) instillation in the bladder under the effect of low-energy shockwaves (LESWs) for the treatment of refractory idiopathic overactive bladder (OAB). Patients and methods: A preliminary clinical study was conducted, including 15 patients with refractory OAB, between September 2016 and July 2017. Intravesical instillation of 100 IU of BoNT-A was done followed by LESWs (3000 shocks over 10 min) exposure to the supra-pubic area. Patients were followed-up by urine analysis, urine culture, post-void residual urine volume (PVR), and Overactive Bladder Symptom Score (OABSS) at 1, 2 and 3 months. Results: There were statistically significant improvements in all OABSS domains and the total score after 1 and 2 months of treatment (P < 0.05). Whereas, only the nocturia domain remained significantly improved after 3 months (P = 0.02). There was no significant increase in PVR throughout the study period (P > 0.05) and none of the patients required clean intermittent catheterisation. Two, two and three patients developed urinary tract infections after 1, 2 and 3 months, respectively. Conclusion: Intravesical instillation of BoNT-A and LESWs is safe and effective method for the treatment of refractory OAB with a durable response for 2 months. Abbreviations: BoNT-A: botulinum toxin A; CIC: clean intermittent catheterisation; DO: detrusor overactivity; LESWs: low-energy shockwaves; OAB: overactive bladder; OABSS: Overactive Bladder Symptom Score; Qmax: maximum urinary flow rate; QoL: quality of life; UUI: urgency urinary incontinence.

8.
Int J Surg Case Rep ; 57: 122-125, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30952024

RESUMO

INTRODUCTION: There is no reported data for patients with malignant bladder Botox® injection related outcomes. Herein, we reported effect of Botox® injection in case of BCG cystitis. In addition, reporting of rare incidence of both primary neuroendocrine differentiation of bladder tumor and primary ovarian paraganglioma post cystectomy. PRESENTATION OF CASE: A-64 years old female presented with sever irritative lower urinary tract symptoms (LUTS) post vesical BCG installation for carcinoma in situ. Patient's symptoms were relieved after Botox® bladder injection after anticholinergics failure. One year later, she came back with hematuria. Cystoscopy showed nodular bladder lesion. Hypertension episodes were noticed during cystoscopic resection. Pathological examination showed presence of muscle invasive transitional cell carcinoma (TCC) with neuroendocrine differentiation. Patient underwent radical cystectomy and pathology was associated with incidentally discovered primary ovarian paraganglioma. DISCUSSION: Intravesical BCG is a standard adjuvant treatment for carcinoma in situ with 75% induced cystitis as a local side effect. The International Bladder Cancer Group's recommendation for BCG cystitis included many agents, these treatment options had very limited outcomes. The existence of paraganglioma in the female genital tract described rarely <1% in the vagina, uterus, vulva and ovary with only few reports. The same as paraganglioma small cell differentiation of vesical urothelial tumor is a rare entity with no reported cases of simultaneous occurrence and to differentiate each other as primary or metastatic. CONCLUSION: Bladder Botox® injection could be offered as a treatment for overactive bladder-like symptoms in malignant cystitis. Neuroendocrine tumors are with a rare entity could be happened instantaneously in urogenital tract.

9.
BJU Int ; 2019 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-30946525

RESUMO

OBJECTIVES: To assess the effect of tolterodine in the treatment of nocturnal urinary incontinence (NUI) after ileal orthotopic neobladder (ONB). PATIENTS AND METHODS: This is a prospective randomised placebo-controlled crossover study (clinicaltrials.gov: NCT02877901). Patients with NUI after ONB were randomly allocated into two equal groups. Group T received 4 mg extended-release tolterodine at bed-time and Group P received placebo for 4 weeks followed by 2 weeks of washout, then crossed over to the alternate therapy for 4 weeks. Patients were assessed by the number of pads used per night (PPN) and with the Arabic version of the International Consultation on Incontinence Modular Questionnaire-Short Form (ICIQ-SF) at both phases of the study. The outcomes were the rate of NUI improvement and medication adverse events. RESULTS: Out of 172 patients, 150 and 122 patients were evaluated at both phases of the study. The mean ICIQ-SF scores and PPN were significantly decreased in Group T compared to Group P in both study phases (P < 0.001). In Group T, 15 (10%) and 11 (9%) patients became dry after the first allocation and crossover, respectively. In Group T, 60 (77.9%) patients reported improvement vs four (5.5%) in Group P (P < 0.001) after the first allocation. Similarly, 46 (73%) and seven (11.9%) patients showed improvement in groups T and P after the crossover, respectively (P < 0.001). Dry mouth occurred in 31 (20.8%) patients. CONCLUSIONS: Tolterodine seems to be a good choice for treatment of NUI after radical cystectomy and ONB. However, further studies are needed to delineate the long-term effects and the associated urodynamic characteristics.

10.
Exp Clin Transplant ; 15(3): 277-281, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28587588

RESUMO

OBJECTIVES: We report on the long-term follow-up of managing allograft stones at a single tertiary referral institution and review the relevant literature. MATERIALS AND METHODS: A retrospective analysis of renal allograft recipient charts was performed to identify patients who developed allograft lithiasis between 1974 and 2009. Patient and stone characteristics, diagnoses, treatments, and outcomes were described. RESULTS: Sixteen patients developed 22 stones after a median follow-up of 170 months (range, 51-351 mo). The mean (standard deviation) and median diameter of the stones were 13.8 (8.5) mm and 11 mm. Among these, 3 stones were treated conservatively, 3 by shock-wave lithotripsy, and 7 by cystolitholapaxy. Seven patients underwent percutaneous treatment in the form of percutaneous nephrostomy tube fixation and spontaneous passage of stone (1 stone), shock-wave lithotripsy (1 stone), antegrade stenting (1 stone), and percutaneous nephrolithotomy (6 stones). All patients were stone free after treatment, except for 2 patients whose stones were stable and peripheral on long-term follow-up. CONCLUSIONS: Allograft lithiasis requires a multimodal treatment tailored according to stone and graft characteristics. Protocols regarding spontaneous passage can be adopted if there is no harm to the graft and the patient is compliant. Careful attention to the anatomy during percutaneous nephrostomy tube placement is mandatory to avoid intestinal loop injury. A more attentive follow-up is required for early stone management.


Assuntos
Transplante de Rim/efeitos adversos , Litotripsia , Nefrolitíase/terapia , Nefrolitotomia Percutânea , Adulto , Aloenxertos , Intervalo Livre de Doença , Egito , Feminino , Humanos , Litotripsia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Nefrolitíase/diagnóstico , Nefrolitíase/etiologia , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/instrumentação , Recidiva , Estudos Retrospectivos , Stents , Fatores de Tempo , Resultado do Tratamento
11.
Minerva Urol Nefrol ; 69(3): 262-270, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27681660

RESUMO

BACKGROUND: Enough data about health related quality of life (HRQOL) after radical cystectomy (RC) and urinary diversion (UD) in women is still lacking. The objectives are to evaluate HRQOL in women after RC and orthotopic neobladder (ONB) versus ileal loop conduit (IC) and to assess the impact of urinary continence. METHODS: The study included 145 women who underwent RC and came for routine follow-up. HRQOL was assessed by two questionnaires (EORTC-QLQ-C30and FACT-Bl). ONB group was stratified to: totally continent, with nocturnal incontinence (NI) and patients in chronic urinary retention (CUR) and maintained on CIC. The orthotopic group (as a whole and its 3 subgroups) was compared to IC. RESULTS: ONB group included 22 continent women, 35 with NI and 27 in CUR and on CIC. There were no statistically significant differences between ONB and IC groups in all domains of the two questionnaires. However, continent women showed statistically significant better most of EORTC-QLQ-C30 scales and emotional well-being, functional well-being, bladder cancer subscale and FACT-Bl total Score (P˂0.05) than IC group. Similarly, women in CUR showed statistically significant better global health and physical functioning EORTC-QLQ-C30 scores (P values=0.0001, 0.01) and all domains of FACT-Bl. On the other hand, women with NI showed statistically significant lower values in all domains of the EORTC-QLQ-C30 and FACT-Bl than IC group. CONCLUSIONS: In women, HRQOL is better after ONB than IC as long as continence status is preserved. If incontinence is expected, IC may be a better option for UD.


Assuntos
Cistectomia/métodos , Enurese Noturna/fisiopatologia , Cistectomia/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Qualidade de Vida , Resultado do Tratamento , Derivação Urinária/efeitos adversos , Derivação Urinária/métodos , Retenção Urinária/fisiopatologia
12.
Scand J Urol ; 50(6): 433-438, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27589558

RESUMO

OBJECTIVE: The aim of this study was to review different management modalities and outcome of patients presenting with late intestinal obstruction (IO) after radical cystectomy (RC) or palliative cystectomy (PC). MATERIALS AND METHODS: Files of patients who presented with IO between January 1978 and June 2014 were reviewed. Patients who developed IO following either RC or PC more than 30 days after surgery were included. Patients' characteristics and management protocols were evaluated. Predictors for failure of conservative management and unfavorable outcome after surgical explorations were evaluated. Symptom-free and overall survival rates of patients with malignant IO was were recorded. RESULTS: The prevalence of IO was 2.8% after RC (118 out of 4199 patients) and 10% after PC (nine out of 87). Colonic diversions had the highest prevalence (6.2%), followed by ileal loop conduit (2.9%); the lowest prevalences followed Kock pouch and ileal W neobladder (1.7% and 1.6%, respectively). Postoperative urinary leakage from a ureteroenteric anastomosis was the only predictor for surgical intervention (p = 0.039). Nine cases had been explored for malignant obstruction (eight after RC and one after PC). The mean ± SD elapsed time before death was 3.6 ± 2 months (range 0.5-17 months). CONCLUSIONS: Urinary diversion with colonic segments carries more risk for the development of IO in comparison with ileal segments. Postoperative urinary leakage after cystectomy and urinary diversion may be a contributory factor for surgical exploration in cases with late IO.


Assuntos
Cistectomia/efeitos adversos , Obstrução Intestinal/etiologia , Cuidados Paliativos , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/efeitos adversos , Adulto , Idoso , Fístula Anastomótica/etiologia , Fístula Anastomótica/cirurgia , Colo/cirurgia , Tratamento Conservador , Intervalo Livre de Doença , Feminino , Humanos , Íleo/cirurgia , Obstrução Intestinal/terapia , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Estruturas Criadas Cirurgicamente , Taxa de Sobrevida , Neoplasias da Bexiga Urinária/complicações , Derivação Urinária/métodos
13.
Urol Ann ; 8(1): 95-8, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26834412

RESUMO

"Inflammatory pseudotumor" (IPT) has infrequently been reported in the medical journals. A retrospective analysis was conducted among more than 2,000 bladder tumor cases from January 1999 to December 2012 looking for patients with IPT in the final diagnosis. Six patients were found with median tumor size of 3.5 cm (range: 3-8 cm); computed tomography and/or magnetic resonance imaging was used to diagnose the tumor. All patients had complete resection of the tumors. On a median follow-up of 6 years (range: 2-10 years), no recurrences for IPT have been observed in all patients. We concluded that IPT is a rare disease of the urinary bladder and should be regarded with a high degree of suspicion. Although an extensive workup may be needed for definite diagnosis, it is worth to avoid unnecessary chemoradiotherapy or radical surgeries.

14.
Urology ; 85(5): 1039-1044, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25917730

RESUMO

OBJECTIVE: To evaluate efficacy and safety of superior hypogastric plexus neurolysis (SHN) for treatment of interstitial cystitis (IC)-bladder pain syndrome (BPS) in comparison with bladder hydrodistention (HD). MATERIALS AND METHODS: In a prospective study, 24 female patients were randomly allocated to receive either SHN or HD. Patients were evaluated by recording the O'Leary-Sant IC symptom indices, IC problem indices, pain visual analog scale (VAS), number of daytime frequency, and nocturia. Pressure flow study was conducted for all patients. Intraoperative and postoperative changes and adverse events were recorded. RESULTS: Basal IC symptom indices, IC problem indices, and VAS scores were comparable between both groups (P = .31, .63, and .94, respectively). There was no statistically significant difference between both groups with respect to urodynamic parameters. Only pain VAS at first week was improved in SHN in comparison with HD (P = .012). Thereafter, all parameters were significantly improved in favor of the HD group at 2- and 4-week visits. Adverse events in both groups were ranked as Grade 1 Clavien-Dindo classification including transient hematuria in the HD group and transient back ache in the SHN group. CONCLUSION: Despite effective pain control in cases with IC-BPS after SHN, it lacks durability. It seems that SHN in its current form is not to be a suitable line of treatment for IC-BPS. Multimodality treatment would be needed for proper control of patients' symptoms.


Assuntos
Cistite Intersticial/terapia , Plexo Hipogástrico , Bloqueio Nervoso , Adulto , Anestesia , Feminino , Humanos , Pessoa de Meia-Idade , Bloqueio Nervoso/métodos , Estudos Prospectivos , Bexiga Urinária , Água , Adulto Jovem
15.
Int J Urol ; 21(10): 999-1004, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24861882

RESUMO

OBJECTIVES: To report a high-volume institution experience with salvage techniques for vascular accidents during live donor renal allotransplantation. METHODS: Between March 1976 and January 2011, 2208 recipients underwent live donor renal allotransplantation. A retrospective review of recipients with vascular accidents - renal artery thrombosis and renal vein thrombosis - was carried out. Salvage procedures were recorded and their outcomes were assessed. RESULTS: A total of 23 (1%) vascular accidents occurred, including renal artery thrombosis and renal vein thrombosis in 19 (0.8%) and four (0.18%) recipients, respectively. All renal artery thrombosis patients were treated by open revascularization and the graft was salvaged in 12 patients (63%). Two renal vein thrombosis events were resolved by percutaneous catheter-directed thrombolytic therapy. Of the other two allografts, one was salvaged by thrombectomy and revascularization, and the other was lost. On univariable analysis, older recipients (P = 0.003), pretransplant hypertension (P = 0.001), more human leukocyte antigen mismatches (≥3; P = 0.036), shorter ischemia time (≤45 min; P = 0.004) and longer time to diagnosis (>3.5 days; P = 0.013) were significantly associated with non-salvage of the graft after vascular accidents. Nevertheless, none of these variables were significant on the multivariable analysis. Over a median follow up of 35 months, the median (range) serum creatinine was 2 mg/dL (range 0.8-8.8 mg/dL), and 11 (79%) recipients were living with functioning grafts. CONCLUSIONS: Despite the devastating complications, vascular accidents are salvageable and revascularization is crucial for graft salvage. Angiographic percutaneous techniques are viable alternatives for renal vein thrombosis.


Assuntos
Sobrevivência de Enxerto , Transplante de Rim/efeitos adversos , Obstrução da Artéria Renal/terapia , Veias Renais , Terapia de Salvação , Terapia Trombolítica , Trombose/terapia , Adolescente , Adulto , Fatores Etários , Aloenxertos , Criança , Creatinina/sangue , Feminino , Sobrevivência de Enxerto/imunologia , Antígenos HLA , Humanos , Hipertensão/complicações , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Obstrução da Artéria Renal/diagnóstico , Obstrução da Artéria Renal/etiologia , Estudos Retrospectivos , Trombectomia , Trombose/diagnóstico , Trombose/etiologia , Fatores de Tempo , Isquemia Quente , Adulto Jovem
16.
Int J Urol ; 21(9): 887-92, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24684718

RESUMO

OBJECTIVES: To assess health-related quality of life, and the impact of night-time incontinence and chronic urinary retention on health-related quality of life in women with bladder cancer after radical cystectomy and orthotopic neobladder. METHODS: The study included 74 women who underwent radical cystectomy and orthotopic neobladder, and completed 1 year of follow up. Health-related quality of life was evaluated using the questionnaires of the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire and the Functional Assessment of Cancer Therapy bladder cancer-specific form. Health-related quality of life was compared with an age-matched control group. The impact of night-time incontinence and chronic urinary retention on health-related quality of life was assessed. RESULTS: The study group included 18 completely continent patients with spontaneous voiding, 29 with night-time incontinence and 27 with chronic urinary retention. The study group was statistically significantly lower in all domains of health-related quality of life than the control group. In all domains of the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire and Functional Assessment of Cancer Therapy bladder cancer-specific form, completely continent women were comparable with those with chronic urinary retention. Women with night-time incontinence had a significantly worse health-related quality of life than completely continent women, shown by the mean global health score (P = 0.038), social functioning score (P = 0.012), pain European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire score (P = 0.04), and functional well-being Functional Assessment of Cancer Therapy bladder cancer-specific form (P = 0.049) score. CONCLUSIONS: After radical cystectomy and orthotopic neobladder in women, health-related quality of life is lower than that of the normal population. Night-time incontinence has a negative impact on social life and most domains of health-related quality of life. Thus, night-time incontinence has a higher social impact than chronic urinary retention.


Assuntos
Cistectomia , Complicações Pós-Operatórias/etiologia , Qualidade de Vida , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária , Incontinência Urinária/etiologia , Retenção Urinária/etiologia , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
17.
Int Urol Nephrol ; 46(2): 317-22, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23928927

RESUMO

PURPOSE: To compare the clinical, pathological and oncological outcome of EAML with classic angiomyolipoma (AML). METHODS: A retrospective review of patients' files with a diagnosis of AML was conducted. Both classic and epithelioid AML were compared as regard the patients' demographics, mode of presentation, tumor features and follow-up data. The accuracy of preoperative radiological diagnosis of EAML and the postoperative pathological data were evaluated. RESULTS: Between November 1988 and July 2012, 1,502 renal masses were treated. Forty-two patients (2.8 %) had renal AML of whom 12 patients (28.6 %) had epithelioid morphology. All the patients with EAML were symptomatic on presentation compared to 16.7 % asymptomatic patients with classic AML. Specific diagnosis of EAML was not suggested based on preoperative radiological evaluation. In one patient, there was a venous tumor extension into the right renal vein; another patient had a solitary pulmonary nodule. Pathological data of EAML patients showed wide areas of necrosis (4 patients), atypia (6 patients), increased mitotic figures (2 patients), nuclear anaplasia, enlarged nuclei and prominent nucleoli (3 patients), and multilobulated multinucleated giant cells (5 patients). At a median follow-up period of 12 and 9 months for EAML and classic AML groups, respectively, one patient with EAML had evidence of both local recurrence and distant metastasis 3 months following open radical nephrectomy. CONCLUSION: Epithelioid AML is potentially aggressive and usually present as a symptomatic renal mass. It may be misdiagnosed as malignant renal mass on preoperative radiological evaluation.


Assuntos
Angiomiolipoma/patologia , Células Epitelioides/patologia , Neoplasias Renais/patologia , Recidiva Local de Neoplasia/etiologia , Inoculação de Neoplasia , Adolescente , Adulto , Idoso , Angiomiolipoma/diagnóstico por imagem , Angiomiolipoma/cirurgia , Feminino , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Índice Mitótico , Necrose/patologia , Metástase Neoplásica , Nefrectomia , Radiografia , Estudos Retrospectivos , Carga Tumoral , Adulto Jovem
19.
Infect Agent Cancer ; 8(1): 24, 2013 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-23809295

RESUMO

OBJECTIVE: The present study was designed to determine the possible impact of hepatitis C virus (HCV) infection on the expression of telomerase (TERT), retinoblastoma (RB1), E2F3, TP53, CDKN1A (p21) and fibroblast growth factor receptor- 3 (FGFR3) genes in patients with bladder cancer (BC). MATERIALS AND METHODS: 100 patients with bladder cancer (15 female and 85 male) were divided into 2 groups; Group I: 50 HCV negative subjects (age range 36-79), and Group II: 50 HCV positive subjects (age range 42-80). Expressions of the telomerase, retinoblastoma (Rb), E2F3, TP53 and FGFR3 genes were tested by immunohistochemistry and real time PCR in tumour tissues and healthy bladder tissues. Also, telomerase activity was assessed by telomeric repeats amplification protocol (TRAP). RESULTS: Bladder tumors associated with HCV infection were of high grade and invasive squamous cell carcinomas (SCCs). Expressions of hTERT, Rb, E2F3, TP53 and FGFR3 as well as telomerase activity were significantly higher in bladder tissues of HCV-infected patients compared with bladder tissues of non infected patients (p<0.05). On the contrary, CDKN1A (p21) expression was significantly lower in bladder tissues of HCV-infected patients compared to bladder tissues of non infected patients (p<0.05). CONCLUSION: The expressions of hTERT, Rb, E2F3, TP53 and FGFR3 as well as the activity of telomerase were significantly high in malignant bladder tissues associated with HCV infection. On the other hand, CDKN1A (p21) expression was low in bladder tissues of HCV-infected subjects. Moreover, there was a positive correlation between HCV infection and expression of telomerase, E2F3, TP53 and FGFR3. There was a negative correlation between HCV infection and expression of Rb and p21.

20.
Saudi J Anaesth ; 7(1): 61-7, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23717235

RESUMO

BACKGROUND: Paravertebral block (PVB) has been an established technique for providing analgesia to the chest and abdomen. We conducted the current study to compare single-dose PVB versus single-dose epidural blockade (EP) for pain relief after renal surgery. METHODS: Eighty patients scheduled for renal surgery were randomly assigned into two groups according to the analgesic technique, PVB group or EP group. General anesthesia was induced for all patients. Postoperative pain was assessed over 24 h using 10-cm visual analog scale (VAS). Postoperative total pethidine consumption was recorded. Any postoperative events, such as nausea, vomiting, shivering, or respiratory complications, were recorded. Hemodynamics and blood gasometry were also recorded. RESULTS: EP group showed significant decrease of both heart rate and mean blood pressure at most of the operative periods when compared with PVB group. There was no difference in total rescue analgesic consumption. Postoperative VAS showed no significant difference between the studied groups. Postoperative events were comparable in both the groups. CONCLUSION: Single injection PVB resulted in similar analgesia but greater hemodynamic stability than epidural analgesia in patients undergoing renal surgery, therefore this technique may be recommended for patients with coexisting circulatory disease.

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