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1.
Can Urol Assoc J ; 8(11-12): E906-9, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25553164

RESUMO

INTRODUCTION: We compare percutaneous nephrolithotomy (PCNL) and open surgery in the treatment of staghorn stones in children. METHODS: We retrospectively reviewed the electronic records of children who underwent treatment for staghorn stones between September 2000 and August 2013. They were divided between Group 1 (patients who underwent PCNL) and Group 2 (patients who underwent open surgery). We compared stone-free and complications rates, need for multiple procedures, and hospital stay. RESULTS: The study included 41 patients (35 boys and 6 girls), with mean age 7.4 ± 3.1 years (range: 2-15). Of these 41 patients, 26 had unilateral renal stone and 15 had bilateral renal stones. The total number of treated renal units was 56: 28 underwent PCNL and 28 underwent open surgery. The complication rate was comparable for both groups (32% for open surgery vs. 28.6%, p = 0.771). Multiple procedures were more needed in PCNL group (60.7% vs. 32% in open surgery, p = 0.032). The stone-free rate was 71.4% after PCNL and 78.6% after open surgery (p = 0.537). A significant difference was observed in shorter hospital stay after PCNL (5 vs. 8.8 days, p < 0.001). Our study's limitations include its retrospective design and relatively small sample size. CONCLUSIONS: For the treatment of staghorn stones in children, PCNL was comparable to open surgery in complication and stone-free rates. PCNL had the advantage of a shorter hospital stay and open surgery showed a decreased need for multiple procedures.

2.
Urology ; 76(4): 946-51, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20708784

RESUMO

OBJECTIVES: Bilateral Wilms' tumors represent a therapeutic challenge. The primary aim of management is eradication of the neoplasm and preservation of renal function. We present our experience in the management of such cases in a single-center experience. METHODS: This was a retrospective study of 22 patients with histologically proven bilateral nephroblastoma who were treated from 1993 to 2008 at our center. Of the 22 patients, 12 were girls and 10 were boys, with a median age of 3 years (range 1-9); 19 had a synchronous presentation and 3 a metachronous presentation. Of the 22 patients, 6 underwent initial surgical resection followed by chemotherapy and 16 underwent initial biopsy and preoperative chemotherapy. The final oncologic and renal outcomes were assessed. RESULTS: The median follow-up period was 3 years (range 1-11). Of the 22 patients, 8 died, for an overall survival rate of 63.5%. The survival for the initial chemotherapy and initial surgery groups was essentially similar. Of all the variables studied, unfavorable histologic findings had a significant negative effect on survival. Of the 5 patients with unfavorable histologic findings, 4 died during the follow-up period. The median volume of preserved renal parenchyma was 40%. All patients had good renal function during follow-up, except for 1 patient who had undergone bilateral nephrectomy. CONCLUSIONS: Bilateral Wilms' tumors impose 2 conflicting issues: elimination of the pathology and preservation of the renal function. Currently, treatment regimens involving initial chemotherapy followed by conservative surgery can achieve these goals in an important proportion of patients.


Assuntos
Neoplasias Renais/epidemiologia , Neoplasias Primárias Múltiplas/epidemiologia , Segunda Neoplasia Primária/epidemiologia , Tumor de Wilms/epidemiologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante , Criança , Pré-Escolar , Terapia Combinada , Dactinomicina/administração & dosagem , Doxorrubicina/administração & dosagem , Egito/epidemiologia , Etoposídeo/administração & dosagem , Feminino , Seguimentos , Humanos , Ifosfamida/administração & dosagem , Lactente , Estimativa de Kaplan-Meier , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/cirurgia , Masculino , Mesna/administração & dosagem , Terapia Neoadjuvante , Neoplasias Primárias Múltiplas/tratamento farmacológico , Neoplasias Primárias Múltiplas/cirurgia , Segunda Neoplasia Primária/tratamento farmacológico , Segunda Neoplasia Primária/cirurgia , Nefrectomia/métodos , Nefrectomia/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento , Vincristina/administração & dosagem , Tumor de Wilms/tratamento farmacológico , Tumor de Wilms/cirurgia
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