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1.
Transplant Proc ; 51(6): 1773-1778, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31255355

RESUMO

INTRODUCTION: Accepting donors with renal lesion amenable for pre-transplant management with no suspected long-term harm seems to expand the live-donor pool. We aimed to assess the long-term outcome of live-donor renal transplantation with incidentally discovered renal angiomyolipoma (AML) during routine evaluation of donors. PATIENTS AND METHODS: A retrospective evaluation of incidentally discovered AML, during live-related-donor evaluation, was performed. The tumor criteria were retrieved. In cases with exophytic tumor, a back-table, partial nephrectomy was done with frozen section to exclude malignancy. Endophytic lesions were kept in situ and transplanted. Both donor and recipient were followed up by periodic imaging. RESULTS: Among 2925 cases, 6 AML with a median volume of 0.96 (range, 0.5-2) cm2 were identified. The median recipients' age was 21 (range, 10-38) years and the median donors' age was 48 (range, 45-50). Two AML were exophytic and back-table partial nephrectomy was performed, while 4 were endophytic and kept in situ, and the kidney was transplanted. After a median follow-up of 82 (range, 25-150) months, 4 patients were alive with functioning grafts and 2 resumed hemodialysis 5 and 7 years after transplantation. There was no evidence of increase in the AML size or newly developed AML in the grafts. All donors were alive with normal renal function (mean ± standard deviation, serum creatinine was 0.9 ± 0.2 mg/dL) and none developed new AML in the remaining kidney. CONCLUSION: Incidentally discovered AML during live-donor evaluation is not a contraindication of donation after proper counseling of the couples and regular, periodic follow-up.


Assuntos
Angiomiolipoma/diagnóstico , Seleção do Doador , Neoplasias Renais/diagnóstico , Transplante de Rim/efeitos adversos , Nefrectomia/efeitos adversos , Coleta de Tecidos e Órgãos/efeitos adversos , Adolescente , Adulto , Idoso , Criança , Contraindicações de Procedimentos , Feminino , Humanos , Achados Incidentais , Rim/cirurgia , Transplante de Rim/métodos , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos , Estudos Retrospectivos , Coleta de Tecidos e Órgãos/métodos , Transplantes/cirurgia , Resultado do Tratamento , Adulto Jovem
2.
World J Urol ; 35(8): 1241-1246, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28013344

RESUMO

OBJECTIVES: To compare the intraoperative surgeon perspective for detection of residual fragments (RFs) after percutaneous nephrolithotomy (PNL) with postoperative NCCT. METHODS: A prospective study of adult patients who underwent PNL between March and September 2014 was conducted. Stone complexity was evaluated using the Guy's stone score (GSS). All patients were evaluated by pre- and postoperative NCCT. After the procedure, the surgeon had been asked whether there were residual stones or not. The sensitivity, specificity and predictive values were tested against postoperative NCCT. Predictors of accurate intraoperative assessment were determined using univariate and multivariate statistical analyses. RESULTS: The study included 306 consecutive patients. The surgeons reported no residual stones in 236 procedures; of whom 170 (72%) were reported stone-free by NCCT. On the other hand, 65 out of 70 procedures (93%) reported with residual stones by the surgeons were true by NCCT. The sensitivity was 50% and the NPV was 72%, while the specificity was 97% and the PPV was 93%. On multivariate analysis, only lower GSS (p < 0.001) was independently associated with true negative surgeon opinion. CONCLUSIONS: Although there was a high surgeon ability to detect post-PNL residual stones, postoperative imaging is mandatory because of the high false negative rates and low NPV. The surgeon opinions can be judged only in stones with lower GSS. The NPV could be enhanced if a consistent definition of clinically significant RFs is introduced.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Adulto , Feminino , Humanos , Cuidados Intraoperatórios , Cálculos Renais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Prognóstico , Estudos Prospectivos , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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