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1.
Urology ; 121: 58-65, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30031005

RESUMO

OBJECTIVE: To assess the non-inferiority of Low-power Holmium laser enucleation of the prostate (LP-HoLEP) to high-power (HP-HoLEP) for enucleation efficiency pertaining to the advantages of lower cost and minimal postoperative dysuria, storage symptoms, and negative sexual impact. PATIENTS AND METHODS: HoLEP was performed using 100W Versapulse, Luminis Inc., with 2J/25Hz for LP-HoLEP (61 patients) and 2J/50Hz for HP-HoLEP (60 patients). Two surgeons with different experience performed equal number of both procedures. Non-inferiority of enucleation efficiency (enucleated weight/min) was evaluated. All perioperative parameters were recorded and compared. Dysuria was assessed at 2 weeks by dysuria visual analog scale, urinary (Q.max and IPSS) and sexual (sexual health inventory for men score) outcome measures were evaluated at 1, 4, and 12 months. RESULTS: Baseline and perioperative parameters were comparable between the two groups. Mean enucleation efficiency was 1.42±0.6 vs 1.47±0.6 gm/min, P = .6 following LP-HoLEP and HP-HoLEP, respectively. Patients reported postoperative dysuria similarly in both groups as per dysuria visual analog scale. There was significant comparable improvement in IPSS (international prostate symptom score) and Q.max in both groups at different follow-up points. At one year, median IPSS and Q.max were comparable in both groups (P = .4 and .7 following LP-HoLEP and HP-HoLEP, respectively). Median postoperative reduction in prostate specific antigen was 89% (42:99) following LP-HoLEP vs 81% (62:94) after HP-HoLEP, P = .92. Both groups showed comparable perioperative and late postoperative complications. There were no statistically significant changes in the last follow-up sexual health inventory for men score in comparison to baseline score. CONCLUSION: LP-HoLEP is non-inferior to HP-HoLEP in terms of all efficiency parameters regardless level of surgeon experience.


Assuntos
Disuria , Terapia a Laser , Lasers de Estado Sólido/uso terapêutico , Complicações Pós-Operatórias , Hiperplasia Prostática , Qualidade de Vida , Disfunções Sexuais Fisiológicas , Ressecção Transuretral da Próstata , Idoso , Disuria/diagnóstico , Disuria/etiologia , Disuria/psicologia , Humanos , Terapia a Laser/efeitos adversos , Terapia a Laser/instrumentação , Terapia a Laser/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/psicologia , Próstata/diagnóstico por imagem , Próstata/patologia , Próstata/cirurgia , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/psicologia , Hiperplasia Prostática/cirurgia , Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/psicologia , Ressecção Transuretral da Próstata/efeitos adversos , Ressecção Transuretral da Próstata/instrumentação , Ressecção Transuretral da Próstata/métodos , Resultado do Tratamento , Escala Visual Analógica
3.
Urology ; 83(5): 1011-5, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24612617

RESUMO

OBJECTIVE: To evaluate the long-term functional outcome of percutaneous nephrolithotomy (PNL) for calculi in solitary kidneys and to determine factors leading to renal function deterioration. MATERIALS AND METHODS: The computerized files of patients with solitary kidneys who underwent PNL between January 2002 and December 2009 were retrospectively reviewed. Patients with follow-up <2 years were excluded. Complications, secondary procedures, and stone-free rates were recorded. Changes in the renal function were judged by comparing preoperative and postoperative estimated glomerular filtration rates. Preoperative, intraoperative, and postoperative factors that may affect renal function were tested using univariate and multivariate analyses to define risk factors for deterioration of renal function on long-term follow-up. RESULTS: The study included 200 patients (133 men [66.5%] and 67 women [33.5%] with mean age 52.3 ± 11.7 years). Complications were reported in 34 patients (17%). Severe bleeding was noticed in 10 patients (5%). The overall stone-free rate was 89.5%. After a mean follow-up of 3 ± 1.4 years (range, 2-8), there was significant improvement of the estimated glomerular filtration rate from 57 to 64 mL/min (P <.001). Thirty-one patients (15.5%) showed deterioration of the renal function. Multiple punctures and postoperative bleeding were independent risk factors for renal function deterioration (odds ratio was 3.7 and 4.5, respectively). CONCLUSION: PNL for calculi in solitary kidneys provided significant improvement in renal function at long-term follow-up. Multiple punctures and severe bleeding are independent risk factors for deterioration of the kidney function.


Assuntos
Cálculos Renais/cirurgia , Rim/anormalidades , Rim/fisiopatologia , Nefrostomia Percutânea , Feminino , Seguimentos , Humanos , Cálculos Renais/complicações , Cálculos Renais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
4.
Urology ; 79(6): 1236-41, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22465085

RESUMO

OBJECTIVE: To determine factors affecting the stone-free rate and complications of percutaneous nephrolithotomy (PNL) for treatment of staghorn stones. METHODS: The computerized database of patients who underwent PNL for treatment of staghorn stones between January 2003 and January 2011 was reviewed. All perioperative complications were recorded and classified according to modified Clavien classification system. The stone-free rate was evaluated with low-dose noncontrast computed tomography (CT). Univariate and multivariate statistical analyses were performed to determine factors affecting stone-free and complication rates. RESULTS: The study included 241 patients (125 male and 116 female) with a mean age of 48.7 ±14.3 years. All patients underwent 251 PNL (10 patients had bilateral stones). The stone-free rate of PNL monotherapy was 56% (142 procedures). At 3 months, the stone-free rate increased to 73% (183 kidneys) after shock wave lithotripsy. Independent risk factors for residual stones were complete staghorn stone and presence of secondary calyceal stones (relative risks were 2.2 and 3.1, respectively). The complication rate was 27% (68 PNL). Independent risk factors for development of complications were performance of the procedure by urologists other than experienced endourologist and positive preoperative urine culture (relative risks were 2.2 and 2.1, respectively). CONCLUSION: Factors affecting the incidence of residual stones after PNL are complete staghorn stones and the presence of secondary calyceal stones. Complications are significantly high if PNL is not performed by an experienced endourologist or if preoperative urine culture is positive.


Assuntos
Cálculos Renais/cirurgia , Nefrostomia Percutânea , Adulto , Feminino , Humanos , Cálculos Renais/epidemiologia , Cálculos Renais/urina , Masculino , Pessoa de Meia-Idade , Nefrostomia Percutânea/efeitos adversos , Nefrostomia Percutânea/métodos , Complicações Pós-Operatórias , Fatores de Risco
5.
Arab J Urol ; 10(3): 324-9, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26558044

RESUMO

OBJECTIVE: To present the results of percutaneous nephrolithotomy (PCNL) for treating staghorn stones. PATIENTS AND METHODS: A database was compiled from the computerised files of patients who underwent PCNL for staghorn stones between 1999 and 2009. The study included 238 patients (128 males and 110 females) with a mean (SD) age of 48.9 (14) years, who underwent 242 PCNLs, and included staghorn stones that were present in the renal pelvis and branched into two or more major calyces. PCNL was performed or supervised by an experienced endourologist. All perioperative complications were recorded. The stone-free status was evaluated after PCNL and again after 3 months. RESULTS: Multiple tracts were needed in 35.5% of the procedures, and several sessions of PCNL were needed in 30% of patients. There were perioperative complications in 54 procedures (22%); blood transfusion was needed in 34 patients (14%). The stone-free rate for PCNL monotherapy was 56.6% (137 patients). Secondary procedures were required for 51 patients (21%), and included shock-wave lithotripsy for 49 and ureteroscopy for two. The 3-month stone-free rate was 72.7% (176 patients). Multiple tracts resulted in an insignificantly higher overall complication rate than with a single tract (P = 0.219), but the reduction in the haemoglobin level was statistically significant with multiple tracts (P = 0.001). CONCLUSIONS: PCNL for staghorn stones must be done by an experienced endourologist in a specialised centre with all the facilities for stone management and treatment of possible complications. The patients must be informed about the range of stone-free and complication rates, and the possibility of multiple sessions or secondary procedures.

6.
Scand J Urol Nephrol ; 45(2): 97-101, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21082875

RESUMO

OBJECTIVE: To determine factors affecting the success of bilateral same-session ureteroscopy (BSU) in the treatment of ureteral calculi. MATERIAL AND METHODS: From January 2003 to December 2008, BSU was carried out in 89 patients (178 renal units). A successful outcome was considered when both ureters were free of stones without intraoperative complications. Stone-free rate was evaluated with a kidney-ureter-bladder plain X-ray or non-contrast computed tomography. Factors interfering with successful completion of BSU were tested using univariate (chi-squared test and t test) and multivariate (logistic regression) analyses. Data on unilateral ureteroscopy for the treatment of multiple ureteral calculi carried out in 105 patients during the same period were compared with BSU. RESULTS: Intraoperative complications were recorded in 11 procedures (6.2%) in the form of ureteral perforation in three and mucosal injury in eight. After BSU, 153 renal units were stone free (86%) as 17 had residual fragments, stones migrated to the kidney in six and failure was encountered in two. A successful outcome was observed in 62 patients (70%). Stone impaction, stones located in the proximal ureter and stone surface area were the significant risk factors for unsuccessful BSU (relative risks 3.6, 3.3 and 1.47, respectively). Compared with unilateral ureteroscopy, no difference were found with regard to complication rate (6.7%, p = 0.5) or stone-free rate (80%, p = 0.2). CONCLUSIONS: Bilateral same-session ureteroscopy is a safe and effective procedure in the management of bilateral ureteral stones. Proximal ureteral calculi, large and impacted stones carry the highest risk of unsuccessful results.


Assuntos
Cálculos Ureterais/cirurgia , Ureteroscopia/efeitos adversos , Ureteroscopia/métodos , Adolescente , Adulto , Idoso , Feminino , Humanos , Incidência , Complicações Intraoperatórias , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Ureter/lesões , Adulto Jovem
7.
BJU Int ; 108(5): 750-4, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21166763

RESUMO

OBJECTIVE: • To study long-term results of percutaneous nephrolithotomy (PNL) for treatment of staghorn stones. PATIENTS AND METHODS: • The records of patients who underwent PNL for staghorn stones between January 1998 and January 2008 were retrospectively reviewed. • Patients who completed follow-up for one year or more were included. Follow-up with KUB and renal ultrasonography were performed every 3-6 months. • Renal radioisotopic scan was performed for patients who had already undergone this study before doing PNL. RESULTS: • The study included 122 patients (69 male and 53 female) with mean age 47.6 ± 14.5 years (5-74). They underwent 126 PNL. • Perioperative complications were encountered in 28 procedures (22%). The mean period of follow-up was 3.5 ± 2.3 years (1-11.3). Among 71 stone-free kidneys, 18 (25%) developed stone recurrence. Of 55 kidneys with residuals at the start of follow-up, 36 (65%) showed growth of these residuals. • Preoperative and postoperative renograms were performed for 71 patients. • At the last follow-up, differential GFR was stable in 53 (74.5%), improved in 12 (17%) and deteriorated in 6 (8.5%). Among patients with deteriorated renal function, 3 had undergone embolization to control severe bleeding, one developed secondary UPJO, and one had recurrent stone obstructing the kidney. CONCLUSION: • Long-term functional results of PNL for staghorn stones are satisfactory as 91.5% of kidneys showed stable or improved GFR. Long-term follow-up is mandatory especially for patients with residual stones.


Assuntos
Cálculos Renais/cirurgia , Nefrostomia Percutânea , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Cálculos Renais/fisiopatologia , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Nefrostomia Percutânea/métodos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
8.
Urology ; 74(2): 273-7, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19501888

RESUMO

OBJECTIVES: To evaluate the role of percutaneous nephrolithotomy in management of the patients with autosomal dominant polycystic kidney disease and associated nephrolithiasis. METHODS: A total of 19 patients with autosomal dominant polycystic kidney disease and upper urinary tract stones were included in the study. One patient had bilateral renal stones. Most of the stones were located in the renal pelvis and/or calices with a stone size >2 cm in the largest diameter. All patients were treated by percutaneous nephrolithotomy at 2 centers. Therefore, 20 percutaneous nephrolithotomy procedures were performed. Most of the procedures were performed in 1 stage by the urology team under fluoroscopic guidance; 6 cases were done in 2 stages. The success rate and morbidity and mortality of the technique and hospital stay were recorded. RESULTS: The pelvicaliceal system was successfully approached in all cases but 1. The overall stone-free rate was 89.4%. Renal function improved in the patients who presented with azotemia and was stable in the others. No patient died. Complications occurred in 3 procedures and consisted of mild postoperative hematuria in 1, bleeding through the nephrostomy tube in 1, and low-grade fever in 1. The mean hospital stay was 3 days. CONCLUSIONS: Percutaneous nephrolithotomy is a safe and effective method for the treatment of patients with autosomal dominant polycystic kidney disease and associated upper urinary tract stones.


Assuntos
Cálculos Renais/cirurgia , Nefrostomia Percutânea , Rim Policístico Autossômico Dominante/complicações , Adulto , Idoso , Feminino , Fluoroscopia , Humanos , Cálculos Renais/complicações , Cálculos Renais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Rim Policístico Autossômico Dominante/diagnóstico por imagem , Radiografia Intervencionista
9.
Urology ; 73(6): 1184-7, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19362338

RESUMO

OBJECTIVES: To use a matched-pair analysis design to compare the safety and efficacy of shock wave lithotripsy (SWL) and ureteroscopy (URS). Controversy still exists regarding whether SWL or URS is the best management of upper ureteral calculi. METHODS: We reviewed the records of patients with a single radiopaque upper ureteral stone treated by URS or SWL from January 2003 to December 2005. SWL was performed as an outpatient procedure using the electromagnetic lithotripter (Dornier Lithotripter S). URS was performed using an 8F or 8.5F semirigid ureteroscope. Intracorporeal lithotripsy with pneumatic or holmium laser energy was used when needed. A matched-pair analysis was performed using 3 parameters (sex, stone size, and degree of hydronephrosis). The success rates, retreatment rates, auxiliary procedures, and complications were compared in each group. RESULTS: A total of 427 patients were treated for upper ureteral stones. Forty-three matched pairs were identified and compared. The success rate was 83.7% for SWL vs 88.4% for URS (P = .8). The retreatment rate was significantly greater in the SWL group than in the URS group (65% vs 2.3%, respectively; P < .001). The need for auxiliary procedures was equal in both groups (16.3%). The complication rate was 14% in the URS group and 4.7% in the SWL group (P = .1). CONCLUSIONS: SWL and semirigid URS are highly effective in the treatment of proximal ureteral stones <20 mm. The results of our study showed that SWL was safer and less invasive, but that URS was more effective and resulted in a lower retreatment rate.


Assuntos
Litotripsia , Cálculos Ureterais/terapia , Ureteroscopia , Adulto , Desenho de Equipamento , Feminino , Humanos , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Cálculos Ureterais/patologia , Ureteroscópios
10.
J Urol ; 181(3): 1158-62, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19152940

RESUMO

PURPOSE: We determined the factors predicting unfavorable results of semirigid ureteroscopy for ureteral calculi. MATERIALS AND METHODS: We reviewed the computerized files of 841 patients who underwent a total of 908 ureteroscopic procedures for ureteral stones from January 2003 through December 2006. A semirigid 6/7.5Fr ureteroscope was used in pediatric patients and an 8/10Fr or 8.5/11.5Fr ureteroscope was used in adults. Patients with favorable results were those who became stone-free after a single ureteroscopic procedure without any complications. They were compared with patients who had unfavorable results using univariate (chi-square and t tests) and multivariate (logistic regression) statistical tests to identify risk factors for unfavorable results. RESULTS: The study included 567 males and 274 females with a mean age of 48.5 years (range 2 to 81). The complication rate was 6.7% (61 procedures). The stone-free rate after a single ureteroscopic intervention was 87% (791 procedures). Favorable results were documented in 751 procedures (82.7%). Significant factors for unfavorable results were proximal ureteral stones, ureteroscopy done by surgeons other than experienced endourologists, stone impaction and stone width (relative risk 4, 2.5, 1.8 and 1.2, respectively). CONCLUSIONS: Semirigid ureteroscopy is a safe and highly effective treatment modality for ureteral stones.


Assuntos
Cálculos Ureterais/terapia , Ureteroscópios , Ureteroscopia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Adulto Jovem
11.
J Urol ; 180(2): 676-80, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18554648

RESUMO

PURPOSE: This study was conducted to evaluate the safety and efficacy of the supracostal approach for percutaneous nephrolithotomy in pediatric patients. MATERIALS AND METHODS: We retrospectively reviewed 60 percutaneous nephrolithotomy procedures done in 50 children (32 boys and 18 girls) between 2000 and 2007. Mean patient age was 7 +/- 4 years (range 9 months to 14 years). Noncontrast computerized tomography was the primary radiological investigation for most of the cases. The subcostal approach was used in 40 procedures, and the supracostal approach (above the 12th rib) was required in 20. We compared both approaches regarding preoperative characteristics, stone-free and complication rates, and the need for auxiliary procedures. RESULTS: The preoperative characteristics of the patients, urinary tracts and stones were comparable for both treatment groups. There were no major complications. Significant bleeding requiring blood transfusion was observed in 3 patients (5%), transient fever in 3 (5%) and urinary leakage through the nephrostomy site in 3 (5%). The distribution of complications among subcostal and supracostal approaches was comparable. Of the 60 renal units 46 (77%) were stone-free after percutaneous nephrolithotomy at discharge from the hospital. Of the remaining 14 units 9 (15%) were stone-free after shock wave lithotripsy and 5 (8%) had insignificant residual stones. Therefore, the overall stone-free rate at 3 months was 92.5%. Comparing the subcostal and supracostal approaches, there were no significant differences between hospital stays, complication rates, unplanned auxiliary procedures, and stone-free rates at discharge home and at 3-month followup. CONCLUSIONS: Percutaneous nephrolithotomy for treating renal stones in children provides a high degree of safety and efficacy whether a supracostal or subcostal approach is used.


Assuntos
Cálculos Renais/cirurgia , Litotripsia/métodos , Nefrostomia Percutânea/métodos , Adolescente , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Seguimentos , Humanos , Lactente , Cálculos Renais/diagnóstico por imagem , Tempo de Internação , Litotripsia/efeitos adversos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Nefrostomia Percutânea/efeitos adversos , Dor Pós-Operatória/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Probabilidade , Radiografia Intervencionista , Estudos Retrospectivos , Medição de Risco , Gestão da Segurança , Resultado do Tratamento
12.
Urology ; 71(3): 408-12, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18342174

RESUMO

OBJECTIVES: To evaluate the functional and morphological effects of postpercutaneous nephrolithotomy (PCNL) superselective renal angiographic embolization. METHODS: Between January 1995 and March 2006, superselective renal angiography was needed to control severe bleeding after 41 of 4095 PCNL procedures (1%). We evaluated the short-term effects of embolization after 3 months with renal ultrasonography (RUS), dimercaptosuccinic acid (DMSA) renal scan, and estimation of serum creatinine. We evaluated long-term morphological and functional effects with RUS, DMSA renal scan, and excretory urography (IVU). RESULTS: Bleeding was controllable with superselective embolization in 38 patients (93%). Six of them developed early postembolization complications, in the form of perinephric hematoma in 4 and urinary leakage in 2 patients. At 3 months, serum creatinine levels increased in 3 of 9 patients with a solitary kidney, but none required renal replacement therapy. Long-term follow-up was completed for 30 patients for a mean period of 3.9 +/- 2.3 years. We performed IVU for 27 patients. Among them, 2 renal units (7%) showed no dye excretion. DMSA scans showed homogeneous distribution of radiotracer with no evidence of photopenic areas in 6 renal units (20%). The mean percentage of DMSA uptake by the corresponding kidney improved from 25 +/- 9% at the 3-month scans to 34 +/- 11% at the last follow-up scans (P <0.001). CONCLUSIONS: The short-term deleterious effects of superselective renal embolization for post-PCNL renal vascular injuries were more pronounced in patients with a solitary kidney. However, the long-term follow-up showed functional and morphological improvements.


Assuntos
Embolização Terapêutica , Rim/irrigação sanguínea , Rim/diagnóstico por imagem , Nefrostomia Percutânea/efeitos adversos , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Fatores de Tempo
13.
J Endourol ; 21(10): 1131-6, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17949310

RESUMO

PURPOSE: To present the combination of laparoscopy and nephroscopy for the treatment of stones in pelvic ectopic kidneys. PATIENTS AND METHODS: The series included seven male and four female patients (mean age 43 +/- 9 years). Laparoscopy-assisted percutaneous nephrolithotomy (PCNL) was performed for caliceal stones in five patients after failure of shockwave lithotripsy, while laparoscopic pyelolithotomy was performed for large or branched renal pelvic stones in six patients. RESULTS: The mean operative time was 164 +/- 30 minutes. There were neither complications nor conversions to open surgery. The stone-free rate was 91% (10 patients). One patient had a residual caliceal fragment that was treated with shockwave lithotripsy. The mean hospital stay was 3.5 +/- 0.7 days. CONCLUSION: The combination of laparoscopy and nephroscopy is feasible, safe, and effective for the treatment of stones in pelvic kidneys.


Assuntos
Cálculos Renais/cirurgia , Laparoscopia/métodos , Nefrostomia Percutânea/métodos , Adulto , Feminino , Humanos , Complicações Intraoperatórias , Rim/anormalidades , Cálices Renais/cirurgia , Tempo de Internação , Litotripsia , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
14.
J Urol ; 178(3 Pt 1): 916-20; discussion 920, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17632136

RESUMO

PURPOSE: Despite evidence that urologists can safely acquire percutaneous renal access for percutaneous nephrolithotomy, many centers still rely on interventional radiologists to obtain renal access. In this study we evaluated percutaneous access for percutaneous nephrolithotomy obtained by interventional radiologists or urologists, and compared access outcomes and complications. MATERIALS AND METHODS: The surgical records of 1,121 patients with 1,155 stone bearing kidneys treated with percutaneous nephrolithotomy between 1999 and 2003 were reviewed. Patients were stratified according to percutaneous renal access into 509 patients with 661 access procedures performed by urologists and 612 patients with 612 access procedures performed by interventional radiologists. RESULTS: Both groups were comparable except there was a higher incidence of multiple stones in the urologist access group. Urologists had a significantly greater rate of using multiple and supracostal tracts compared to radiologists. The stone-free rates were 83.4% and 86.1% for urologist and radiologist access groups, respectively (p = 0.1). Major complications were seen in 74 patients (6.6%). Both groups had similar complication rates except for significant bleeding in the urology group (4.3%) compared with 2.1% in the radiology cohort (p = 0.02). Further multivariate analysis showed that bleeding was not related to the type of access whether performed by urologist or radiologist. CONCLUSIONS: The urologist is able to safely and effectively obtain percutaneous renal access for percutaneous nephrolithotomy as a single stage procedure. Despite more complex stones and higher access difficulty in the urology access group, access related complications and stone-free rates were comparable. We recommend percutaneous access training in urology training programs.


Assuntos
Cálculos Renais/cirurgia , Nefrostomia Percutânea , Radiologia Intervencionista , Urologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Litotripsia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Nefrostomia Percutânea/efeitos adversos
15.
J Urol ; 177(2): 576-9, 2007 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-17222636

RESUMO

PURPOSE: We identified risk factors predicting severe bleeding due to percutaneous nephrolithotomy. MATERIALS AND METHODS: Computerized data on 2,909 patients who underwent a total of 3,878 percutaneous nephrolithotomy procedures between January 1995 and December 2005 were retrospectively reviewed. Data on patients who experienced severe bleeding requiring angiographic renal embolization were compared with those on other patients using univariate and multivariate analyses. We tested the characteristics of patients, kidneys and stones together with details of the operative procedure and surgeon experience. RESULTS: Severe bleeding complicated a total of 39 procedures (1%) in 25 males and 14 females with a mean age of 50.7 +/- 12.6 years. Associated morbidity included shock in 6 patients and perirenal hematoma in 4. Renal angiography revealed pseudoaneurysm in 20 patients, arteriovenous fistula in 9, the 2 lesions in 8 and arterial laceration in 2. Bleeding could be controlled with superselective embolization in 36 patients (92.3%). Followup was available on 33 patients (mean 21 +/- 15 months). Renal function was stable in all patients except 3 who had a post-embolization increase in serum creatinine, of whom all had a solitary kidney and none required renal replacement therapy. Significant risk factors for severe bleeding were upper caliceal puncture, solitary kidney, staghorn stone, multiple punctures and inexperienced surgeon. CONCLUSIONS: Percutaneous nephrolithotomy should be performed by an experienced endourologist in patients at risk for severe bleeding, such as those with a solitary kidney or staghorn stones.


Assuntos
Embolização Terapêutica , Nefrostomia Percutânea/efeitos adversos , Hemorragia Pós-Operatória/terapia , Artéria Renal , Adulto , Idoso , Idoso de 80 Anos ou mais , Embolização Terapêutica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Artéria Renal/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
16.
Eur Urol ; 52(1): 199-204, 2007 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-17161525

RESUMO

OBJECTIVE: The surgical management of renal and upper ureteral calculi presents unique challenges in obese patients. We reviewed our recent experience with percutaneous nephrolithotomy (PNL) in obese patients to determine the safety and outcome of this procedure in such group of patients. PATIENTS AND METHODS: The surgical records of 1121 patients treated with PNL between 2000 and 2004 were reviewed. Patients were stratified into four groups according to the World Health Organization classification of body mass index (BMI): <25 (average), 25-29.9 (overweight), 30-39.9 (obese), and >40 kg/m(2) (morbidly obese). The outcomes of PNL in these four groups were compared. RESULTS: A total of 1287 procedures were performed on 1155 renal units (1.1 procedures per renal unit). The overall stone-free rate was 85.1% and the mean hospital stay was 3.3+/-2.6 d. Major complications were seen in 72 patients (6.4%). No statistically significant differences were found in decrease in haemoglobin concentration, hospital stay, and complication rate among the four study groups. The need for auxiliary procedures and stone-free rates were comparable. CONCLUSIONS: PNL in obese and morbidly obese patients yields a stone-free rate that is comparable to that achieved in nonobese patients. The complication rate and length of hospital stay are also similar.


Assuntos
Índice de Massa Corporal , Cálculos Renais/terapia , Nefrostomia Percutânea/métodos , Obesidade/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Cálculos Renais/complicações , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
17.
Scand J Urol Nephrol ; 40(5): 385-90, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-17060085

RESUMO

OBJECTIVE: To determine prognostic variables which influence late recurrence after initially successful percutaneous endopyelotomy for secondary ureteropelvic junction obstruction (UPJO). MATERIAL AND METHODS: Between July 1987 and March 2002, 67 patients with secondary UPJO were treated with percutaneous endopyelotomy at our center. Long-term follow-up data were available for 50 patients with initially successful results (42 after a single treatment and eight after repeated endopyelotomy). Follow-up excretory urography and diuretic renal scans were performed for objective evaluation. Late recurrence was diagnosed if obstruction developed after > 1 year of follow-up. Univariate (Kaplan-Meier method) and multivariate (Cox regression model) analyses of pre-, peri- and postoperative factors were carried out for detection of significant variables affecting the late recurrence rate. RESULTS: The follow-up period ranged from 1.27 to 13.85 years (mean 6 +/- 4.3 years). Late recurrence of UPJO was observed in seven cases (14%): 4/42 initially successful cases (9.5%) and 3/8 cases of repeated endopyelotomy (37.5%). In univariate analysis, the significant factors were severity of stenosis at the UPJ (p = 0.04), preoperative serum creatinine (p = 0.04), repetition of endopyelotomy (p = 0.03) and development of postoperative complications (p = 0.02). In multivariate analysis, all of the above factors, with the exception of severity of stenosis at the UPJ, were independent significant factors affecting late recurrence. CONCLUSIONS: As late recurrence was observed in 14% of cases after percutaneous endopyelotomy, long-term follow-up is needed, especially in patients with elevated preoperative serum creatinine, those in whom postoperative complications developed and those in whom a first attempt at endopyelotomy failed.


Assuntos
Nefrostomia Percutânea , Obstrução Ureteral/cirurgia , Adulto , Idoso , Creatinina/sangue , Feminino , Seguimentos , Humanos , Pelve Renal/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Prognóstico , Recidiva , Reoperação , Estudos Retrospectivos , Índice de Gravidade de Doença , Stents , Fatores de Tempo , Resultado do Tratamento , Obstrução Ureteral/diagnóstico
18.
Urology ; 68(3): 500-4, 2006 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16979745

RESUMO

OBJECTIVES: To present our experience in percutaneous management of large upper tract stones after urinary diversion. METHODS: From October 1984 to March 2005, 20 percutaneous nephrolithotomy and 4 antegrade ureteroscopy procedures were performed in 17 men and 7 women, with a mean age of 53.5 years. The urinary diversions were an ileal W neobladder, hemi-Kock pouch, ileal conduit, and rectal bladder in 10, 7, 4, and 3 patients, respectively. The median interval between diversion and stone management was 1.5 years. Success was defined as a stone-free, nonobstructed renal unit at 3 months after the intervention. Follow-up was performed every 6 months with intravenous urography or noncontrast computed tomography for diagnosis of stone recurrence and evaluation of renal morphology. RESULTS: Renal punctures were guided with ultrasonography in 18 patients (75%) and fluoroscopy in 6 patients. One intraoperative complication (4.16%) and two postoperative complications (8.3%) occurred. All patients with ureteral stones became stone free after one procedure. Auxiliary procedures were needed in 5 patients after percutaneous nephrolithotomy; 2 patients required a second session and 3 needed extracorporeal shock wave lithotripsy. The overall success rate was 87.5% (21 patients). One patient with treatment failure underwent open surgery, and two with small residual fragments were followed up. Long-term follow-up data were available for 15 patients. The stone recurrence rate was 33.3% (5 patients) after a median follow-up of 40 months (range 14 to 132). Recurrent stones were treated with extracorporeal shock wave lithotripsy. CONCLUSIONS: The results of our study have demonstrated that percutaneous treatment of large upper tract stones after urinary diversion offers a high success rate with minimal morbidity. However, regular follow-up after treatment is recommended.


Assuntos
Cálculos Renais/etiologia , Cálculos Renais/terapia , Nefrostomia Percutânea , Cálculos Ureterais/etiologia , Cálculos Ureterais/terapia , Ureteroscopia , Derivação Urinária/efeitos adversos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
19.
J Urol ; 176(2): 706-10, 2006 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16813924

RESUMO

PURPOSE: We compared the results of percutaneous nephrolithotomy and shock wave lithotripsy for the treatment of 1 to 2 cm renal stones in children. MATERIALS AND METHODS: The study included 166 children with renal stones 1 to 2 cm. A total of 75 patients (82 kidneys) were treated with percutaneous nephrolithotomy and 91 (93 kidneys) were treated with shock wave lithotripsy. Mean followup was 31 +/- 10 months (range 6 to 84). Both groups were compared regarding stone-free rate, re-treatment rate, complications and incidence of stone recurrence. RESULTS: Both groups were comparable regarding preoperative characteristics. Of the units treated with percutaneous nephrolithotomy 4 (4.9%) were associated with minor complications. Stone-free rate after a single session of percutaneous nephrolithotomy was 86.6% (71 units), and the remaining 11 kidneys with residual stones were successfully treated with repeat percutaneous nephrolithotomy in 7 and shock wave lithotripsy in 4. Therefore, a total of 78 units (95%) were stone-free after percutaneous nephrolithotomy monotherapy, and the overall stone-free rate at 3 months was 100%. Of the patients undergoing shock wave lithotripsy 1 (1.1%) had development of steinstrasse and was successfully treated with ureteroscopy. The overall re-treatment rate after shock wave lithotripsy was 55%. A total of 79 units (84.9%) were stone-free after shock wave lithotripsy monotherapy, whereas 7 (7.5%) with no gross response to treatment were treated with percutaneous nephrolithotomy and 7 with insignificant stones less than 4 mm were followed. Therefore, the overall stone-free rate at 3 months was 92.5%. The differences in stone-free rates and re-treatment rates significantly favored percutaneous nephrolithotomy, while the incidence of complications and stone recurrence at last followup were not significantly different between the groups. CONCLUSIONS: For treatment of 1 to 2 cm renal stones in children percutaneous nephrolithotomy is better than shock wave lithotripsy, yielding higher stone-free and lower re-treatment rates.


Assuntos
Cálculos Renais/terapia , Litotripsia , Nefrostomia Percutânea , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos
20.
Scand J Urol Nephrol ; 40(3): 225-31, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16809265

RESUMO

OBJECTIVE: Gynecological and obstetric surgeries are not uncommon causes of iatrogenic injury of the urinary tract. Herein, we retrospectively report our experience with these injuries over the last 18 years. MATERIAL AND METHODS: Between 1985 and 2003, 120 females (mean age 34.2+/-13.7 years) were included in this study. The types of injury were as follows: vesicovaginal fistula, n=90; ureterovaginal fistula, n=14, ureteric ligation, n=13, vesicouterine fistula, n=2; and ureterouterine fistula, n=1. Definitive repair of such injuries was performed in all cases, including 10 cases of recurrent vesicovaginal fistulae which were treated by means of augmentation cystoplasty or urinary diversion. All patients were evaluated regarding the time and type of surgical intervention and early and late postoperative complications, including failure of primary repair. RESULTS: Of the 80 cases of vesicovaginal fistulae treated with definitive repair, 12 (13.3%) showed recurrence of the fistula. Early ureteric deligation and early or delayed ureteroneocystostomy or ureteric replacement were successful in all cases with ureteric injury. There was no loss of kidney function following the trauma or its repair. CONCLUSIONS: It is mandatory for gynecologists and obstetricians to pay careful attention to the anatomy of the urinary tract in order to avoid its iatrogenic injury. Endourologic means were successful in enabling first aid management of some of these injuries. Early exploration is indicated in cases of ureteric obstruction that present early after trauma. Augmentation cystoplasty, urinary diversion or ileal replacement are indicated in only a few cases.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos Obstétricos/efeitos adversos , Sistema Urinário/lesões , Fístula Vesicovaginal/etiologia , Adulto , Feminino , Humanos , Doença Iatrogênica , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fístula Urinária/etiologia , Fístula Urinária/cirurgia , Sistema Urinário/cirurgia , Fístula Vaginal/etiologia , Fístula Vaginal/cirurgia , Fístula Vesicovaginal/cirurgia
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