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1.
Int. braz. j. urol ; 45(3): 581-587, May-June 2019. tab
Artigo em Inglês | LILACS-Express | ID: biblio-1012333

RESUMO

ABSTRACT Introduction: The main aim of stone surgery is to establish stone free status. Performing flexible nephroscopy is an effective tool in this manner. The aim of this study was to evaluate the role of retrograde flexible nephroscopy for detection of residual fragments following percutaneous nephrolithotomy (PNL) in comparison with antegrade approach. Materials and Methods: Data of 137 patients underwent ECIRS was collected prospectively. In all cases following stone clearance, collecting system was checked for residual fragments. First antegrade than retrograde flexible nephroscopy was performed and success rates to reach all calices and detection of residual fragments were noted. All patients underwent CT and success rate of antegrade and retrograde approaches were compared. PPV and NPV of retrograde approach to detect residual fragments were calculated. Results: Antegrade and retrograde nephroscopy successfully accessed all of the calices in 101 (73.7%) and 130 (94.9%) patients respectively (p<0.0001). Residual fragments were observed in 18 (13.1%) patients following antegrade flexible nephroscopy. Retrograde approach identified residual stones in 17 more cases. These cases were treated with flexible nephroscopy or secondary percutaneous tract. Postoperative CT revealed residual stones in 10 (7.3%) patients. PPV and NPV of retrograde flexible nephroscopy were 83.3% and 96.2%. Conclusions: Flexible nephroscopy effectively detects residual fragments following PNL. Retrograde approach was more successful than antegrade approach to reach all calices. We recommend performing retrograde flexible nephroscopy following PNL especially in complex cases as it has the potential to increase SFR, decrease the need for second look surgery and unnecessary postoperative imaging.

2.
Int Braz J Urol ; 45(3): 581-587, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30901169

RESUMO

INTRODUCTION: The main aim of stone surgery is to establish stone free status. Performing fl exible nephroscopy is an effective tool in this manner. The aim of this study was to evaluate the role of retrograde fl exible nephroscopy for detection of residual fragments following percutaneous nephrolithotomy (PNL) in comparison with antegrade approach. MATERIALS AND METHODS: Data of 137 patients underwent ECIRS was collected prospectively. In all cases following stone clearance, collecting system was checked for residual fragments. First antegrade than retrograde fl exible nephroscopy was performed and success rates to reach all calices and detection of residual fragments were noted. All patients underwent CT and success rate of antegrade and retrograde approaches were compared. PPV and NPV of retrograde approach to detect residual fragments were calculated. RESULTS: Antegrade and retrograde nephroscopy successfully accessed all of the calices in 101 (73.7%) and 130 (94.9%) patients respectively (p<0.0001). Residual fragments were observed in 18 (13.1%) patients following antegrade fl exible nephroscopy. Retrograde approach identifi ed residual stones in 17 more cases. These cases were treated with fl exible nephroscopy or secondary percutaneous tract. Postoperative CT revealed residual stones in 10 (7.3%) patients. PPV and NPV of retrograde fl exible nephroscopy were 83.3% and 96.2%. CONCLUSIONS: Flexible nephroscopy effectively detects residual fragments following PNL. Retrograde approach was more successful than antegrade approach to reach all calices. We recommend performing retrograde fl exible nephroscopy following PNL especially in complex cases as it has the potential to increase SFR, decrease the need for second look surgery and unnecessary postoperative imaging.


Assuntos
Endoscopia/métodos , Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Adulto , Endoscopia/instrumentação , Desenho de Equipamento , Feminino , Humanos , Cálculos Renais/diagnóstico por imagem , Cálices Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/instrumentação , Estudos Prospectivos , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
3.
Urol J ; 2019 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-30636274

RESUMO

INTRODUCTION: To investigate the prognostic role of time to castration resistance(TTCR) in patients who have received solely Docetaxel chemotherapy regimen(DCR) for castration resistant prostate cancer(CRPC). Methods: Between Jan 2004 and Dec 2015, data of 162 patients who have received DCR for CRPC are detected. Patients were divided into three groups according to TTCR: Group 1(?12 months), group 2(13-24 months), and group 3(>24 months). Data of age, clinical stage, Gleason grade(GG), previous treatments, site of metastases, Prostate-specific antigen (PSA) values, TTCR, overall survival, biochemical progression free survival(PFS) and PSA response to docetaxel were recorded. RESULT: The mean age of the 162 patients was 74.4±8.5. Data on mean age, type of castration, adding estramustine to docetaxel, secondary hormonal manipulation, Gleason grade, clinical T stage at initial diagnosis and site of metastases were comparable between three groups. All PSA values were statistically significant higher in group 1 than other groups. PSA response to docetaxel was 59.2% in all patient and it was worse in group 1 than other groups(P=.009). Two years OS rates were 7.6%, 25% and 32.3% in group 1, 2 and 3, respectively. Median survival rates were 7, 14 and 23 months in group 1, 2 and 3, respectively, and this difference was statistically significant (P=.016). On multivariate analysis, TTCR was found to be independent prognostic factor for overall survival and response to docetaxel treatment. CONCLUSION: TTCR appears to be an independent prognostic factor for patients who are candidates for DCR.

4.
Neurourol Urodyn ; 37(1): 257-262, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28480984

RESUMO

INTRODUCTION: Intravesical glucosaminoglycan (GAG) replacement therapies are commonly used in the treatment of bladder pain syndrome (BPS)/interstitial cystitis (IC). Different intravesical glucosaminoglycan products are currently available. In this prospective study, clinical efficacy of chondroitin sulfate and hyaluronic acid are compared in patients with BPS/IC. METHODS: Patients were randomized to CS and HA groups. All patients were evaluated for visual analogue pain scale (VAS), interstitial cystitis symptom index (ICSI), interstitial cystitis problem index (ICPI), voiding diary for frequency/nocturia, and mean urine volume per void at the beginning of the therapy and after 6 months. All patients had a potassium sensitivity test (PST) initially. Wilcoxon and Mann-Whitney U tests were used for statistical analysis. RESULTS: There were 21 patients in both groups. Mean age of patients in CS and HA groups were 47.10 and 48.90, respectively(P > 0.05). Before treatment, Parson's test was positive in 64.3% of patients (27/42) with no difference between groups. VAS of pain, ICSI, ICPI, frequency at 24 h and nocturia results have improved significantly at both treatment arms. Intravesical CS was also found superior to intravesical HA in terms of 24 h frequency, nocturia and ICPI (P < 0.05). No severe adverse effects were reported. CONCLUSIONS: Data comparing clinical efficiencies of different GAG therapies are very limited. In this study, intravesical CS was found superior to intravesical HA in terms of 24 h frequency, nocturia and ICPI in patients with BPS/IC in short term follow-up. To provide a definitive conclusion on superiority of one GAG therapy to others, further evaluation with long term follow up is required.

5.
Int Braz J Urol ; 442018 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-31268641

RESUMO

OBJECTIVES: To evaluate the efficacy of a novel decision aid (DA) in improving the patients' level of knowledge and decreasing decisional conflicts while deciding for SWL vs. RIRS in case of a symptomatic renal stone < 2 cm. MATERIALS AND METHODS: In this prospective randomized study patients were randomized to receive either standard informing process (group 1, n=57) or DA (group 2, n=58). Level of knowledge was assessed with a questionnaire of 10 questions before and after patient informing process. Level of decisional conflict was assessed with a previously validated scoring system. Logistic regression analysis was performed to identify factors associated with adequate level of knowledge. RESULTS: Level of knowledge increased significantly in both groups after patient informing process. The increase was significantly more prominent in group 2 (p=0.045). Percentage of patients with adequate knowledge was also higher in group 2 (56.1%vs.74.1%, p=0.04). Mean decisional conflict scale score (higher score indicates higher decisional conflict level) was also significantly higher in group1 (14.7±14.5 vs. 10.1±13.7, p=0.045). Multivariate logistic regression analysis revealed higher education level (college degree) and use of DA as factors associated with adequate level of knowledge. CONCLUSIONS: In the current study, The DA was shown to have a positive impact on level of knowledge and diminish the level of decisional conflict for patients with a symptomatic non-lower pole renal stone < 20 mm. We recommend development and use of DAs for particular clinic scenarios to aid in education of patients and shared decision making process in stone disease clinics.

6.
J Endourol ; 31(7): 725-728, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28467724

RESUMO

INTRODUCTION: Stone disease is an important health problem, and patients have different treatment choices. Shared decision making is recommended for deciding the treatment type, but patient education is necessary. Decision aids (DAs) are used for this aim, and herein, we developed a novel DA for patients with symptomatic nonlower pole renal stones <20 mm in diameter. MATERIALS AND METHODS: The DA development process was established based on the recommended guides. General characteristics of the stone disease and details of the shockwave lithotripsy and retrograde intrarenal surgery were included in the content of the DA. The DA was further revised based on the suggestions of different physician groups and patients. The DA was evaluated by three physicians (Delphi assessment-International Patient Decision Aid Standards [IPDAS] Collaboration standards) and 25 patients (questionnaire of six questions with five-point Likert scale). RESULTS: The DA was designed as a booklet, and Delphi group assessment resulted in a total score of 50/54. Patient evaluation of the DA resulted in favorable outcomes, and patients generally recommended its use by other patients. CONCLUSIONS: This novel DA for patients with a symptomatic nonlower pole renal stone <20 mm showed promising results and was well accepted by the patients. We believe that this DA will have a positive impact on patients' level of knowledge. Increased level of knowledge will also improve the patients' contribution to the shared decision-making process. A further prospective randomized trial to compare with the standard patient informing process is also planned.


Assuntos
Tomada de Decisões , Técnicas de Apoio para a Decisão , Cálculos Renais/terapia , Educação de Pacientes como Assunto/métodos , Adulto , Feminino , Humanos , Cálculos Renais/cirurgia , Litotripsia , Masculino , Pessoa de Meia-Idade , Folhetos , Participação do Paciente , Satisfação do Paciente
7.
Urolithiasis ; 45(6): 603-608, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28357451

RESUMO

INTRODUCTION: Percutaneous nephrolithotomy (PNL) is the primary treatment modality for management of staghorn stones. PNL in supine position has important advantages over prone positon. However, studies comparing prone and supine positions for PNL in staghorn stone patients have conflicting results, and the aim of the current study was to compare prone and supine positions for PNL in staghorn stone cases. PATIENTS AND METHODS: Data of patients underwent PNL for staghorn stones in supine or prone position by a single urologist were collected prospectively. The supine and prone position groups were compared for stone free rate (SFR) and complication rates. All patients were evaluated with NCCT for evaluation of SFR. Chi-square test was used to compare categorical variables and Student t test was applied for continuous variables of the treatment groups. RESULTS: The groups were similar for demographic and stone-related characteristics. Multi-caliceal and intercostal access was more common in prone position. Operation duration was significantly shorter and hemoglobin drop was significantly less in supine group. SFR was 64.1 and 60.4% in the supine and prone groups, respectively (p = 0.72). Complication rates were similar in the two groups but Clavien III complications were observed in two patients in the prone group. CONCLUSIONS: PNL in supine position is an effective treatment for management of staghorn stones. The need for multi-caliceal and intercostal puncture is less when combined with retrograde intrarenal surgery. PNL in supine position should be considered as primary treatment option in staghorn stone cases.


Assuntos
Nefrolitotomia Percutânea/métodos , Posicionamento do Paciente/métodos , Complicações Pós-Operatórias/epidemiologia , Adulto , Feminino , Humanos , Cálices Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Decúbito Ventral , Estudos Prospectivos , Cálculos Coraliformes , Decúbito Dorsal , Resultado do Tratamento
8.
J Endourol ; 30(9): 1009-16, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27392789

RESUMO

INTRODUCTION: Triple D score was recently developed for prediction of extracorporeal shockwave lithotripsy (SWL) outcomes. However, it has not been validated. SWL in elderly patients results in lower success and higher complication rates. We aimed at externally validating Triple D score in a population ≥65 years of age. PATIENTS AND METHODS: We retrospectively analyzed the data of 182 patients ≥65 years of age who underwent SWL for renal or ureteral stones and were evaluated with non-contrast computed tomography before SWL. Stone volume (SV), skin-to-stone distance (SSD), and stone density were measured, and cutoff values were determined with receiver operator characteristic analysis. Triple D scores were calculated, and success rates were determined for each score. RESULTS: Mean SV, SSD, and stone density values were significantly higher in patients with failed outcomes compared with those with successful outcomes in both renal and ureteral cases. Cutoff values of 187.5 mm(3), 10.5 cm, and 675 HU for renal stones and of 185 mm(3), 11.5 cm, and 785 HU for ureteral stones were detected. Success rates of 95.5% and 95% were detected for patients with a Triple D score of 3 in the renal and ureteral stone groups, respectively. Success rates of patients with a Triple D score of 0 were 20% and 25% in the renal and ureteral stone groups, respectively. CONCLUSIONS: Triple D score correlated well with SWL outcomes in patients ≥65 years of age, and it is externally validated. Various factors may deal with cutoff levels of involved parameters. Therefore, we suggest that each institution determines its unique cutoff levels for SV, SSD, and stone density parameters and calculates the Triple D score for its patients with respect to these cutoff levels to predict the success after SWL and aid in decision making.


Assuntos
Cálculos Renais/diagnóstico por imagem , Cálculos Renais/terapia , Litotripsia/métodos , Tomógrafos Computadorizados , Cálculos Ureterais/diagnóstico por imagem , Cálculos Ureterais/terapia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Valores de Referência , Estudos Retrospectivos , Pele/diagnóstico por imagem , Resultado do Tratamento
9.
World J Urol ; 34(6): 847-51, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26462931

RESUMO

PURPOSE: Although the role of second transurethral resection of bladder tumor (TURB) is well established in high-risk non-muscle-invasive bladder cancer, to the best of our knowledge, there is no study regarding the role of a second transurethral resection (TUR) after a complete first TURB in multimodal therapy (MMT). The aim of this study was to evaluate the role of a second TUR on disease-specific survival (DSS) and overall survival (OS) rates in muscle-invasive bladder cancer (MIBC) patients who were treated with MMT. METHODS: We assessed the data of 90 patients (stage T2-4, N0-1, M0 urothelial cancer) who were treated with MMT at our clinic between January 2000 and June 2014. Patients with incomplete initial TURB were excluded. A total of 43 patients had a second TUR before starting radiochemotherapy of MMT (group 1), and 47 patients (group 2) were treated with MMT without having a second TUR. The impact of second TUR on DSS and OS rates was the primary outcome measure of the study. RESULTS: Mean (SD, range) age and mean follow-up of the patients were 65.1 (7.1, 52-81) years and 60.3 (38.3, 6-159) months, respectively. The two groups were similar with regard to sex, age, presence of hydronephrosis, lymph node involvement and stage. The 5-year DSS rate was better in group 1 compared to group 2 (68 vs. 41 %) (p = 0.046). The 5-year OS rates of the patients were 63.7 and 40.1 % in groups 1 and 2, respectively (p = 0.054). Multivariate analysis revealed that second TUR, lymph node involvement, presence of hydronephrosis and tumor stage were independent prognostic factors for DSS. CONCLUSIONS: Second TUR should be performed in patients with MIBC who are going to be treated with bladder-preserving MMT protocols.


Assuntos
Cistectomia/métodos , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Liso , Invasividade Neoplásica , Tratamentos com Preservação do Órgão , Reoperação , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Uretra , Neoplasias da Bexiga Urinária/mortalidade
10.
Can Urol Assoc J ; 9(11-12): E789-94, 2015 Nov-Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26600886

RESUMO

INTRODUCTION: We evaluated the prognostic effects of hematologic parameters of preoperative leukocytosis and neutrophil-to-lymphocyte ratio (NLR) in patients who underwent radical cystectomy for bladder cancer. METHODS: We retrospectively reviewed the medical records of 363 patients who underwent radical cystectomy for bladder cancer between January 1990 and June 2013. In total, 286 patients were included in the study. Age, gender, pathologic stage, lymph node involvement, preoperative hydronephrosis, histologic sub-type, surgical margin status, and lymphovascular invasion were recorded for each patient. Univariate and multivariate analysis were performed to determine the prognostic value of the preoperative clinical and laboratory parameters on disease-specific survival (DSS). Additionally, the correlation between leukocytosis and other factors were evaluated. RESULTS: According to the univariate analysis preoperative leukocytosis and NLR were detected as negative prognostic factors on DSS. Preoperative leukocytosis, NLR, stage, lymph node involvement, histologic subtype, grade and age were independent prognostic factors for DSS, on multivariate analysis. Patients with leukocytosis had higher stage, grade and lymphovascular invasion. CONCLUSIONS: Inexpensive, reproducible, and readily available peripheral blood count components of white blood cell count and NLR were independent prognostic factors, which can stratify DSS risks in bladder cancer patients who underwent radical cystectomy.

11.
Turk J Urol ; 41(3): 152-4, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26516600

RESUMO

Primitive neuroectodermal tumor (PNET) of the kidney is rare. Mostly patients with renal PNET are young adults and the survival rates are poor. Although radiological and pathological investigations, differential diagnosis from other kidney tumours is very difficult. The treatment is often delayed because of difficulties with diagnosis. In most cases of renal PNET, as in this case, prognosis is poor. Particularly, in young adults with large renal masses, it must be diagnosed and treatment should be started immediately.

12.
Int Urogynecol J ; 26(11): 1673-7, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26082193

RESUMO

INTRODUCTION: Our purpose was to determine whether vaginal hernia is a predisposing factor for incisional hernia (IH) in a cohort of women with symptomatic pelvic organ prolapse (POP) who underwent corrective repair by open mesh sacrocolpopexy (MSC) and had long-term follow-up to determine their rate of subsequent IH. METHODS: Following IRB approval, the charts of women entered into a longitudinal database and who underwent open MSC at a tertiary institution were reviewed. Data collected included demographics, MSC and IH details, and long-term outcome. Patients were excluded if the follow-up after MSC was < 1 year. Data were reviewed by a neutral investigator who was not involved in patient care (FA). RESULTS: From 1999 to 2012, 75 of 88 women met inclusion criteria, with mean follow-up of 65 (48-84) months. Thirteen were either lost to follow-up or had follow-up < 1 year. Seven women underwent symptomatic IH repair, with a mean onset of IH diagnosis after MSC at 18 (range 8-72) months. Five repairs were done via an open approach, and two were repaired laparoscopically. No IH recurrence was noted at a mean of 41 (range 14-75) months after IH repair. No risk factors were identified in the IH group compared with those who did not form a secondary IH. CONCLUSIONS: In this longitudinal series, IH after open MSC occurred in 9.3%, a rate comparable with that reported in women undergoing abdominal procedures through midline or Pfannenstiel incisions.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Hérnia Incisional/etiologia , Prolapso de Órgão Pélvico/cirurgia , Doenças Vaginais/etiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hérnia Incisional/epidemiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Texas/epidemiologia , Doenças Vaginais/epidemiologia
13.
Int Braz J Urol ; 41(1): 86-90, 2015 Jan-Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25928513

RESUMO

INTRODUCTION: Achieving stone free status (SFS) is the goal of stone surgery. In this study it is aimed to compare effectiveness of unenhanced helical computerized tomography (UHCT), KUB and ultrasonography (US) for detection of residual RFs and predicition of stone releated events following percutaneous nephrolitotomy (PNL). MATERIALS AND METHODS: Patients underwent PNL for radiopaque stones between November 2007 and February 2010 were followed. Patients were examined within 24-48 hours after the procedure by KUB, US and UHCT. For stone size 4 mm was accepted as cut off level of significance.Sensitivity and specificity of KUB and US for detection of RFs and value of them for prediction of stone related events were calculated. RESULTS: SFS was achieved in 95 patients (54.9%) and when cut off value of 4 mm for RFs was employed, SFS was achieved in 131 patients (75.7%). Sensitivity was 70.5% for KUB, and 52.5% for US. UHCT was shown to be significantly more efficient for detection of RFs compared to both KUB (p=0.01) and US (p=0.001). When cut off level of 4 mm employed, sensitivity of KUB and US increased to 85.7% and 57.1%. Statistical significant superiority of UHCT still remained (p value vs. KUB: 0.03 and p value vs. US: 0.008). CONCLUSION: UHCT is the most sensitive diagnostic tool for detecting RFs after PNL. It has higher sensitivity regardless of stone size compared to KUB and US. Additionally UHCT has higher capability of predicting occurrence of stone related events.


Assuntos
Cálculos Renais/diagnóstico por imagem , Nefrostomia Percutânea/métodos , Tomografia Computadorizada Espiral/métodos , Adulto , Feminino , Humanos , Cálculos Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Valores de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Resultado do Tratamento , Ultrassonografia
14.
Korean J Urol ; 56(2): 138-42, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25685301

RESUMO

PURPOSE: To evaluate the outcomes of rigid ureterorenoscopy (URS) for renal pelvic stones (RPS) sized 1 to 2 cm and to determine the predictive factors for the requirement for flexible URS (F-URS) when rigid URS fails. MATERIALS AND METHODS: A total of 88 patients were included into the study. In 48 patients, the RPS were totally fragmented with rigid URS and F-URS was not required (group 1). In 40 patients, rigid URS was not able to access the renal pelvis or fragmentation of the stones was not completed owing to stone position or displacement and F-URS was utilized for retrograde intrarenal surgery (RIRS) (group 2). The predictive factors for F-URS requirement during RIRS for RPS were evaluated. Both groups were compared regarding age, height, sex, body mass index, stone size, stone opacity, hydronephrosis, and previous treatments. RESULTS: The mean patient age was 48.6±16.5 years and the mean follow-period was 39±11.5 weeks. The overall stone-free rate in the study population was 85% (75 patients). In groups 1 and 2, the overall stone-free rates were 83% (40 patients) and 87% (35 patients), respectively (p>0.05). The independent predictors of requirement for F-URS during RIRS were male gender, patient height, and higher degree of hydronephrosis. CONCLUSIONS: Rigid URS can be utilized in selected patients for the fragmentation of RPS sized 1 to 2 cm with outcomes similar to that of F-URS. In case of failure of rigid URS, F-URS can be performed successfully in this group of patients.


Assuntos
Cálculos Renais/cirurgia , Pelve Renal/cirurgia , Ureteroscopia/métodos , Adulto , Idoso , Desenho de Equipamento , Feminino , Humanos , Cálculos Renais/patologia , Cálculos Renais/terapia , Pelve Renal/patologia , Litotripsia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Falha de Tratamento , Resultado do Tratamento , Ureteroscópios
15.
Ther Adv Urol ; 7(1): 3-8, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25642290

RESUMO

OBJECTIVE: In this study we aimed to compare photoselective vaporization (PVP) with the GreenLight 120-W Laser and monopolar transurethral resection as surgical treatments of prostates less than 80 cc in men with obstructive benign prostatic hyperplasia. METHODS: From February 2009 to March 2012 we allocated 101 patients with a prostate glands of less than 80 cc; patients were randomly assigned for surgical treatment with monopolar transurethral resection of the prostate (TURP) (n = 62) or PVP (n = 39). Serum prostate specific antigen (PSA), International Prostate Symptom Score (IPSS), Sexual Health Inventory for Men (SHIM), maximum flow rate (Qmax) postmicturition residual (PMR), transrectal ultrasound volumes (TRUS), postvoid urine residual (PVR), complications, re-operations and hospitalization time were collected. The patients were seen in the follow up at 6, 12 and 24 months. RESULTS: Median age was 69 (56-87) years old in the TURP group and 67 (51-87) years old in the PVP group. Mean preoperative prostate volume was 55 cc (40-72) and 60 cc (41-75) cc in the TURP group versus the PVP group. There was no statistically difference in subjectively (IPSS, SHIM) and objectively (Qmax-PMR) parameters and postoperatively complication rates between the two groups (p > 0.05). A significant difference was observed in the PVP group with a 2 (1-4) days hospital stay compared with 5 (3-9) days for the TURP group (p < 0.001). CONCLUSION: Prostate PVP and TURP are effective surgical treatments for benign prostatic hyperplasia. Postoperative functional improvements were durable and equivalent in the two groups. The two techniques have a similar complication rate.

16.
Can Urol Assoc J ; 8(9-10): E610-4, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25295131

RESUMO

INTRODUCTION: Patients with a history of bladder pain syndrome/interstitial cystitis (BPS/IC) and who responded poorly or unsatisfactorily with previous treatment were compared taking intravesical hyaluronic acid (HA) or hyaluronic acid-chondroitin sulphate (HA-CS). METHODS: Patients were treated with intravesical instillation with 50 mL sterile sodium hyalurinic acid (Hyacyst, Syner-Med, Surrey, UK) (n = 32) and sodium hyaluronate 1.6% sodium chondroitin sulphate 2% (Ialuril, Aspire Pharma, UK) (n = 33). Intravesical instillations were performed weekly in first month, every 15 days in the second month and monthly in third and fourth months, for a total of 8 doses. Patients were evaluated using a visual analog pain scale (VAS), interstitial cystitis symptom index (ICSI), interstitial cystitis problem index (ICPI), voiding diary for frequency/nocturia, cystometric bladder capacity and voided volume at the beginning and at 6 months. All patients had a potassium sensitivity test (PST) initially. Wilcoxon and Mann-Whitney U tests were used for statistical analysis. RESULTS: In total, 53 patients met the study criteria. There were 30 patients in the HA-CS group (mean age: 48.47) and 23 patients in the HA group (mean age: 49.61) (p > 0.05). The initial PST was positive in 71.7% patients (38/53) overall with no difference between groups (p > 0.05). Responses for VAS, ICCS, ICPS, 24-hour frequency/nocturia statistically improved in both groups at 6 months. There was no significant difference in symptomatic improvement (p > 0.05). Eight patients had mild adverse events. CONCLUSION: HA and HA/CS instillation can be effective in BPS/IC patients who do not respond to conservative treatment. An important limitation of our study is that the HA dosage of the 2 treatment arms were different. It would be more appropriate with same HA dosage in both groups; however, there was no commercially available glycosaminoglycan (GAG) substance with same HA dosage for single and combination therapy. Large, long-term randomized studies are required to determine if there is a difference between these treatments.

17.
Can J Urol ; 21(4): 7358-64, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25171279

RESUMO

INTRODUCTION: To describe urodynamic study (UDS) findings in middle-aged and older women with various lower urinary tract symptoms (LUTS) who were found to have a normal study interpretation. MATERIALS AND METHODS: Following institutional review board approval, UDS tracings of non-neurogenic women who were tested for various LUTS and whose study was interpreted as normal were reviewed. Demographic data, indications for UDS, and UDS parameter findings were extracted. UDS was conducted according to an established protocol using a 6F dual-lumen catheter (ICS guidelines) with a Laborie system and interpreted with a pre-existing template to standardize each reading. The fill-void study was frequently repeated during the same UDS session to confirm normal findings. Study interpretation was done by a neutral reviewer with UDS expertise. RESULTS: From 2000-2012, 42 middle-aged women, who had been coded as having a normal study, were retrospectively reviewed from a database of over 2200 studies. The majority were Caucasian, with mean age 63 (range 42-85), mean body mass index 24.5 (20-37), mean parity 2 (0-4), and 67% were post-menopausal. Of the 42 patients, 28 underwent a second fill-void study. UDS findings were reported based on clinical indication for UDS: 1) incontinence, 2) pelvic organ prolapse, or 3) other LUTS symptoms. UDS findings were consistent between first and second studies. CONCLUSIONS: UDS parameters from a cohort of middle-aged and older women with normal findings could serve as reference values when interpreting urodynamic studies or for designing an age-comparable nomogram.


Assuntos
Envelhecimento/fisiologia , Micção/fisiologia , Urodinâmica/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Sintomas do Trato Urinário Inferior/fisiopatologia , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/fisiopatologia , Valores de Referência , Incontinência Urinária/fisiopatologia
18.
Korean J Urol ; 55(5): 354-9, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24868341

RESUMO

PURPOSE: In the treatment of interstitial cystitis, intravesical hyaluronic acid application may be suggested as a treatment option. In this randomized prospective study, the authors aimed to identify whether instilling the hyaluronic acid with electromotive drug administration (EMDA) would increase the tissue uptake and improve the efficacy. MATERIALS AND METHODS: The data of 31 patients who had been diagnosed with bladder pain syndrome/interstitial cystitis (BPS/IC) between 2004 and 2005 were examined. The patients were randomized to two groups: patients in group A received hyaluronic acid directly with a catheter and patients in group B received hyaluronic acid with EMDA. The patients were followed for 24 months and the two groups were compared at certain time intervals. The primary end points of the study were visual analogue scale (VAS) score, global response assessment, and micturition frequency in 24 hours. RESULTS: There were 6 males and 25 females. The two groups were similar in baseline parameters. The decrease in VAS score and the micturition frequency in 24 hours were significantly lower with EMDA at months 6 and 12. The difference between the two groups was not significant at months 1 and 24. Also, treatment with EMDA, positive KCl test, and pretreatment voiding frequency >17 were associated with higher response rates. CONCLUSIONS: Hyaluronic acid installation is an effective glycosaminoglycan substitution therapy in patients with BPS/IC. Instillation of hyaluronic acid via EMDA can improve the efficacy of the treatment; however, lack of long-term efficacy is the major problem with this glycosaminoglycan substitution therapy.

19.
BJU Int ; 114(4): 595-600, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24655232

RESUMO

OBJECTIVE: To determine preoperative predictive factors of postoperative complications of ureteric re-implantation in children by using the modified Clavien classification system (MCCS), which has been widely used for complication rating of surgical procedures. PATIENTS AND METHODS: In all, 383 children who underwent ureteric re-implantation for vesico-ureteric reflux (VUR) and obstructing megaureters between 2002 and 2011 were included in the study. Intravesical and extravesical ureteric re-implantations were performed in 338 and 45 children, respectively. Complications were evaluated according to the MCCS. Univariate and multivariate analyses were used to determine predictive factors affecting complication rates. RESULTS: In all, 247 girls and 136 boys were studied. The mean (sd) age was 46 (25) months and the mean (sd) follow-up was 49.4 (27.8) months. The mean (sd) hospitalisation time was 4.7 (1.6) days. Complications occurred in 76 (19.8%) children; 34 (8.9%) were MCCS grade I, 22 (5.7%) were grade II and 20 (5.2%) were grade III. Society of Fetal Urology (SFU) grade 3-4 hydronephrosis, obstructing megaureters, a tailoring-tapering and folding procedure, refractory voiding dysfunction and a duplex system were statistically significant predictors of complications on univariate analysis. Prior injection history, paraureteric diverticula, stenting, gender, age, operation technique (intra vs extravesical) were not significant predictors of complications. In the multivariate analysis refractory voiding dysfunction, a tailoring-tapering and folding procedure, obstructing megaureters (diameter of >9 mm) and a duplex system were statistically significant predictors of complications. CONCLUSION: Ureteric re-implantation remains a valid option for the treatment of certain patients with VUR. Refractory voiding dysfunction, a tailoring-tapering and folding procedure, obstructing megaureters (diameter of >9 mm) and associated duplex systems were the main predictive factors for postoperative complications. Use of a standardised complication grading system, such as the MCCS, should be encouraged to allow the valid comparison of complication rates between series.


Assuntos
Reimplante/efeitos adversos , Ureter/cirurgia , Obstrução Ureteral/cirurgia , Refluxo Vesicoureteral/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Reimplante/classificação , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Obstrução Ureteral/etiologia , Obstrução Ureteral/patologia , Refluxo Vesicoureteral/etiologia , Refluxo Vesicoureteral/patologia
20.
Int Urol Nephrol ; 46(8): 1521-6, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24677002

RESUMO

PURPOSE: The purpose of the study was to investigate the effect of ABO blood groups and Rhesus (Rh) factor on prognosis of patients undergoing radical cystectomy. MATERIALS AND METHODS: In this study, total number of 290 patients who underwent radical cystectomy between January 1990 and September 2012 were evaluated retrospectively. Patients were grouped as O and non-O according to ABO antigens; also positive and negative according to Rh factor. Parameters such as age, sex, stage, lymph node involvement and positive surgical margins were investigated. Disease-free and overall survival rates have been compared. Multivariate analysis were performed to determine independent prognostic factors. RESULTS: A total of 260 (89.7 %) male and 30 (10.3 %) female patients participated in the study. Mean follow-up was 37.7 ± 18.9 months. A total of 180 patients were non-O (62.1 %),while the 110 patients had the blood group O (37.9 %). The number of Rh positive and negative patients were 247 (85.2 %) and 43 (14.8 %), respectively. According to the univariate and multivariate analyses, ABO blood groups and Rh factor did not exhibit any significant impact on overall and disease-specific survival. CONCLUSION: ABO blood group and Rh factor were not associated with the prognosis of bladder cancer patients who underwent radical cystectomy. However, prospective studies are needed in larger patient series for further evaluations.


Assuntos
Sistema do Grupo Sanguíneo ABO/sangue , Carcinoma/sangue , Carcinoma/cirurgia , Sistema do Grupo Sanguíneo Rh-Hr/sangue , Neoplasias da Bexiga Urinária/sangue , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Carcinoma/secundário , Cistectomia , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Metástase Linfática , Masculino , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias da Bexiga Urinária/patologia
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