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


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.

J Pediatr Urol ; 7(3): 252-6, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21527220


OBJECTIVE: Urolithiasis in children can cause considerable morbidity. Our aim was to evaluate the impact of intervention on the recoverability of kidney functions. MATERIALS AND METHODS: This prospective study included 93 children (66 boys and 27 girls) with median age of 3 years (range 0-14). Inclusion criteria were presence of anuria, oliguria, serum creatinine >2 mg% and/or hyperkalemia ≥ 6 mmol/L. The mean duration of anuria or oliguria was (mean ± SE) 5.3 ± 0.4 days. On presentation, mean plasma creatinine was 6.5 ± 0.29 mg/dl with a mean estimated glomerular filtration rate (eGFR) of 14 ml/min and creatinine clearance (CC) of 8.24 ml/min. Dialysis was performed in 21 (22.6%) patients. When condition allowed, emergency surgery was performed. RESULTS: Mean follow up was 1.5 years with compliance of 82%. At the end of treatment, 83% of patients had complete clearance of calculi. Mean plasma creatinine after treatment was 3.3 ± 0.35 mg/dl with an average GFR of 24.5 ml/min. After treatment renal function returned to normal in 57%, improved in 27% and deteriorated in 16% of children. Renal function recoverability rate was 94.6%. Chronic renal failure developed in 3 (3.2%) patients and 2 (2.2%) patients died. When absolute plasma creatinine concentration [P(cr)] improved 20-50% the eGFR and CC were doubled, and when improved 50-70% eGFR and CC tripled. Beyond 70% improvement in [P(cr)], eGFR and CC improved 7-8 times. Using Spearman's correlation, the mode of presentation and the type of management had a significant correlation with renal function outcome (P = 0.019 and 0.013 respectively). CONCLUSION: Urgent management of calcular anuria both medically and surgically is the cornerstone for favorable outcome. The mode of presentation and the type of management are significant factors affecting final renal function outcome.

Anuria/fisiopatologia , Cálculos Renais/complicações , Rim/fisiopatologia , Recuperação de Função Fisiológica , Adolescente , Anuria/etiologia , Criança , Pré-Escolar , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular , Humanos , Lactente , Cálculos Renais/fisiopatologia , Falência Renal Crônica/epidemiologia , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos
Urology ; 76(4): 946-51, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20708784


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.

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
J Urol ; 181(6): 2684-7; discussion 2687-8, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19375100


PURPOSE: Vesical stones are common in children in developing countries. Cystolithotomy is the traditional treatment but a percutaneous approach has been advocated. The aim of this study was to evaluate retrospectively our experience with percutaneous cystolithotomy, cystolitholapaxy and open cystolithotomy in children with bladder stones. MATERIALS AND METHODS: A total of 107 children (96 boys and 11 girls) with vesical stones were treated at our center between January 1992 and March 2008. Mean patient age at the time of diagnosis was 5 years (range 2 to 15). The patients were stratified retrospectively into 2 groups according to the procedure of stone removal. Group 1 (53 patients) underwent open cystolithotomy, and group 2 (54) underwent endourological treatment via the transurethral route (27) or the suprapubic approach (27). Stone size ranged from 0.7 to 5 cm (mean 2.8). RESULTS: In all cases the stones were removed successfully. Operative time was comparable in both groups. The hospital stay was significantly shorter after endourological procedures compared to open surgery (2.6 vs 4.8 days, p <0.05). In the open surgery group 1 patient had a small intestinal injury that necessitated repair, while in the endourological group 2 patients had urinary extravasation (1 urethral and 1 vesical). There were no early or late complications in group 1. In comparison, 4 patients (7.4%) in group 2 had early complications in the form of persistent urinary leakage from the suprapubic site and 1 patient had a bulbous urethral stricture 1 year after transurethral stone disintegration. CONCLUSIONS: Open and endourological management of vesical stones in children is efficient, with a low incidence of complications. Endourological management offers a shorter hospital stay compared to open surgery. However, open cystolithotomy seems to be safer.

Cistectomia/métodos , Cistoscopia , Cálculos da Bexiga Urinária/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estudos Retrospectivos