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1.
Investig Clin Urol ; 61(2): 216-223, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32158973

RESUMO

Purpose: Renal cell carcinoma is a heterogeneous kidney cancer, and over 403,000 cases were reported worldwide in 2018. Current methods for studying renal cell carcinoma are limited to two-dimensional (2D) culture of primary cell lines and patient-derived xenograft models. Numerous studies have suggested that 2D culture poorly represents the diversity, heterogeneity, and drug-resistance of primary tumors. The time and cost associated with patient-derived xenograft models poses a realistic barrier to their clinical utility. As a biomimetic model, patient-derived three-dimensional (3D) organoid culture can overcome these disadvantages and bridge the gap between in vitro cell culture and in vivo patient-derived xenograft models. Here, we establish a patient-derived 3D organoid culture system for clear cell renal cell carcinoma and demonstrate the biomimetic characteristics of our model with respect to both primary kidney cancer and conventional 2D culture. Materials and Methods: Normal renal tissues and tumor tissues were collected from patients with clear cell renal cell carcinoma. The dissociated cells were cultured as conventional 2D culture and 3D organoid culture. The biomimetic characteristic of the two cultures were compared. Results: Compared with 2D culture, the 3D organoid cultures retained the characteristic lipid-rich, clear cell morphology of clear cell renal cell carcinoma. Carbonic anhydrase 9 and vimentin were validated as biomarkers of renal cell carcinoma. Expression of the two validated biomarkers was more enhanced in 3D organoid culture. Conclusions: Patient-derived 3D organoid culture retains the characteristics of renal cell carcinoma with respect to morphology and biomarker expression.

2.
World J Urol ; 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31925552

RESUMO

PURPOSE: The delivery of precision medicine is a primary objective for both clinical and translational investigators. Patients with newly diagnosed prostate cancer (PCa) face the challenge of deciding among multiple initial treatment modalities. The purpose of this study is to utilize artificial neural network (ANN) modeling to predict survival outcomes according to initial treatment modality and to develop an online decision-making support system. METHODS: Data were collected retrospectively from 7267 patients diagnosed with PCa between January 1988 and December 2017. The analyses included 19 pretreatment clinicopathological covariates. Multilayer perceptron (MLP), MLP for N-year survival prediction (MLP-N), and long short-term memory (LSTM) ANN models were used to analyze progression to castration-resistant PCa (CRPC)-free survival, cancer-specific survival (CSS), and overall survival (OS), according to initial treatment modality. The performances of the ANN and the Cox-proportional hazards regression models were compared using Harrell's C-index. RESULTS: The ANN models provided higher predictive power for 5- and 10-year progression to CRPC-free survival, CSS, and OS compared to the Cox-proportional hazards regression model. The LSTM model achieved the highest predictive power, followed by the MLP-N, and MLP models. We developed an online decision-making support system based on the LSTM model to provide individualized survival outcomes at 5 and 10 years, according to the initial treatment strategy. CONCLUSION: The LSTM ANN model may provide individualized survival outcomes of PCa according to initial treatment strategy. Our online decision-making support system can be utilized by patients and health-care providers to determine the optimal initial treatment modality and to guide survival predictions.

3.
Eur Radiol ; 30(2): 798-805, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31471753

RESUMO

PURPOSE: To assess image quality and diagnostic accuracy of low-dose computed tomography (CT) angiography using adaptive statistical iterative reconstruction V (ASiR-V) for evaluating the anatomy of renal vasculature in potential living renal donors. MATERIALS AND METHODS: Eighty of 100 potential living renal donors were prospectively enrolled and underwent multiphase CT angiography (e.g., unenhanced, arterial, and venous phases) to evaluate the kidney for donation. Either low-dose using ASiR-V or standard protocol was randomly applied. Image quality was analyzed qualitatively and quantitatively with contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR). Renal artery and vein number, early branching vessel from renal arteries, and drainage of left-sided ascending lumbar vein to left renal vein were assessed. Reference standard for renal vasculature was surgical confirmation. RESULTS: Size-specific dose estimate of low-dose CT angiography (9.5 ± 0.8 mGy) was significantly lower than standard CT angiography (22.7 ± 4.1 mGy) (p < 0.001). Thus, radiation dose was reduced by 58.2% with low-dose CT. Both CNR and SNR of low-dose CT were significantly higher than those of standard CT (p < 0.001). Between the two CT methods, image quality was similar qualitatively (p > 0.05). Of 80 participants, 44 (55.0%) underwent nephrectomy. Both CT methods accurately predicted the anatomy of renal vasculature (standard CT, 100% for all variables; low-dose CT, 96.6% for renal vessel number or early branching vessel and 85.7% for drainage of left-sided ascending lumbar vein to left renal vein; p > 0.05 for all comparisons). CONCLUSION: Low-dose CT angiography using ASiR-V is useful to evaluate renal vasculature for potential living renal donors. KEY POINTS: • In this prospective study, adaptive statistical iterative reconstruction V (ASiR-V) allowed 58.2% dose reduction while maintaining diagnostic image quality for renal vessels. • As compared with the standard protocol, the dose with ASiR-V was significantly lower (9.5 ± 0.8 mGy) than with standard computed tomography (CT) angiography (22.7 ± 4.1 mGy). • Low-dose CT using ASiR-V is useful for living donor evaluation before nephrectomy.

4.
J Endourol ; 34(2): 169-174, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31686524

RESUMO

Background: Robotic laparoendoscopic single-site (LESS) partial nephrectomy is not widely used because of its limitations, and true single-site surgery has not previously been possible. To investigate the feasibility of partial nephrectomy using the novel SP surgical system, compare perioperative outcomes using this system and the previous Xi single-site platform (XiSSP), and describe how true single-site partial nephrectomy is possible with the SP system. Methods: Retrospective chart review of patients undergoing robotic partial nephrectomy by a single surgeon using the SP surgical system or XiSSP from December 14, 2016 to June 14, 2019. For the SP system, a GelPOINT access platform was placed through a single periumbilical incision. A 25-mm multichannel robotic port and assistant's ports were placed in the GelSeal cap. No additional incisions were required for the assistant or liver traction. The primary outcomes were intraoperative and postoperative complications. Results: Fourteen patients underwent single-site partial nephrectomy with the SP surgical system (n = 9) or XiSSP (n = 5). No limitations were noted for accessing tumors in the upper aspect of the kidney using the SP system. One case of tumor fracture occurred with the SP system, and one case of conversion to multiport robotic surgery occurred with the XiSSP. The postoperative course was uneventful in all patients; only Clavien-Dindo 1 complications occurred. Conclusions: True single-site partial nephrectomy was performed safely with the SP surgical system. The SP system resolved many limitations associated with LESS and the XiSSP.

5.
Investig Clin Urol ; 60(6): 425-431, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31692952

RESUMO

Purpose: The aim of this study was to determine the suitability of serum prolyl hydroxylase-3 (PHD3) as a diagnostic or monitoring biomarker of renal cell carcinoma (RCC). Materials and Methods: Between October 2013 and March 2015, we prospectively recruited study participants. The RCC group consisted of 56 patients who underwent radical or partial nephrectomy. The control group included 56 healthy kidney donors and 13 patients with benign renal masses. Blood from the RCC patients was sampled prior to surgery and again 1 and 3 months after the operation. Serum PHD3 levels were measured via enzyme-linked immunosorbent assay and compared between RCC patients and controls. Results: RCC patients had higher serum PHD3 levels than controls (0.79±0.17 ng/mL vs. 0.73±0.09 ng/mL, p=0.023), with an area under curve (AUC) of 0.668. With a cutoff value of 0.761 ng/ml, the sensitivity, specificity, positive predictive value, and negative predictive value were 66.1%, 68.1%, 28.8%, and 37.3%, respectively. No significant difference in PHD3 level was observed between healthy kidney donors and patients with benign renal masses. The predictive performance of PHD3 was improved in subgroup analyses of RCC patients with a tumor size >2 cm (n=40) or clear-cell histology (n=44), with AUCs of 0.709 and 0.688, respectively. Among 37 patients with PHD3 levels greater than the cutoff value of 0.761 ng/mL, the postoperative PHD3 levels at 1 and 3 months were significantly lower than the preoperative PHD3 levels (both p<0.001). Conclusions: Serum PHD3 represents a novel RCC biomarker that shows acceptable diagnostic performance.

6.
Transplant Proc ; 51(8): 2543-2548, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31473006

RESUMO

OBJECTIVES: In this study, we evaluated the occurrence of proteinuria in living kidney donors during the immediate postdonation period, aiming to determine its clinical significance in renal function recovery. PATIENTS AND METHODS: We enrolled living kidney donors with predonation protein excretion rate (PER) < 150 mg/24 h. Participants were divided into 2 groups according to immediate postdonation PER (4 days after nephrectomy): non-microproteinuria (non-mPr; PER < 150 mg/24 h), n = 244; and immediate postdonation microproteinuria (ImPr; PER ≥ 150 mg/24 h), n = 605. RESULTS: Estimated glomerular filtration rate (eGFR) did not differ significantly between groups immediately after nephrectomy but was consistently lower in the ImPr group 1 week to 1 year postdonation (1-year postdonation eGFR: ImPr group, 63.6 ± 12.1 mL/min/1.73 m2; non-mPr group, 68.6 ± 12.3 mL/min/1.73 m2; P = .001). Immediate postdonation microproteinuria was an independent predictor of eGFR at 1 year postdonation (ß [standard error] = -2.68 [1.15], 95% confidence interval -4.94 to -0.42, P = .02), along with predonation eGFR, age, and sex. Immediate postdonation microproteinuria was more common in donors who were older or male and occurred in 71.3% of kidney donors, suggesting renal injury in this period. CONCLUSIONS: Although proteinuria generally resolves, its impact persists and can impair renal function recovery. Donors who are older and male are more likely to undergo immediate hyperfiltration after donation.


Assuntos
Transplante de Rim , Doadores Vivos , Nefrectomia/efeitos adversos , Complicações Pós-Operatórias/fisiopatologia , Proteinúria/fisiopatologia , Coleta de Tecidos e Órgãos/efeitos adversos , Adulto , Feminino , Taxa de Filtração Glomerular , Humanos , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Proteinúria/epidemiologia , Proteinúria/etiologia , Recuperação de Função Fisiológica , Coleta de Tecidos e Órgãos/métodos
7.
Transplant Proc ; 51(8): 2527-2532, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31473010

RESUMO

OBJECTIVES: To study the outcome of living kidney donors with prediabetes and to evaluate the utilization of baseline HbA1c to identify donors at high risk for developing diabetes during the postdonation follow-up period. PATIENTS AND METHODS: Living kidney donors with prospectively collected preoperative fasting glucose and HbA1c results were included in the study. Donors were categorized to the high-risk group when both results were in the prediabetic range, the low-risk group when only 1 result was in the prediabetic range, and the control group when both results were normal. RESULTS: Ninety-three donors were followed for 75.9 ± 23.3 months. A higher proportion of donors in the high-risk group progressed to diabetes compared with donors in the low-risk and control groups (31.3% vs 6.5% vs 0.0%, respectively; P < .001). Donors with prediabetes were not at a higher risk for new-onset hypertension (4.4% vs 10.0% vs 7.7%, in control, low-risk, and high-risk groups, respectively; P = .519) or microproteinuria (7.3% vs 10.3% vs 0.0%, in control, low-risk, and high-risk groups, respectively; P = .478) and exhibited equivalent postdonation renal function compared with donors with normal glucose metabolism. CONCLUSIONS: HbA1c can identify donors with prediabetes who are at risk for progression to diabetes. Our results indicate that carefully accepted donors with prediabetes are not at increased risk of renal function deterioration in the immediate postdonation period.


Assuntos
Diabetes Mellitus/sangue , Seleção do Doador/métodos , Hemoglobina A Glicada/análise , Doadores Vivos/estatística & dados numéricos , Estado Pré-Diabético/sangue , Jejum/sangue , Feminino , Humanos , Transplante de Rim , Masculino , Pessoa de Meia-Idade , Fatores de Risco
8.
Transplant Proc ; 51(8): 2533-2538, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31471015

RESUMO

Kidney transplants from living donors have increased, but few studies have examined the long-term risks of live donor nephrectomy. This is the first study to report the blood pressure (BP) changes associated with cardiovascular disease and linked to chronic kidney disease (CKD) 1 year after live donor nephrectomy. This study examined a prospective cohort of patients who underwent donor nephrectomy between March 1, 2006, and December 31, 2016, at the Severance Hospital, Seoul, South Korea. CKD was defined as a glomerular filtration rate (GFR) of < 60 mL/min/1.73m2. Patients with a history of hypertension or CKD or an estimated GFR < 60 mL/min/1.73m2 were excluded; those examined after 1 year post-nephrectomy were included in the study population. Among 420 patients who underwent donor nephrectomy, 137 (32.6%) developed a first-time onset of a GFR < 60 mL/min/1.73m2 by the first year after surgery. After propensity score-matching the age, systolic BP (P < .001) and pulse pressure (P = .006) were significantly associated with the groups with newly developed CKD. Systolic BP and pulse pressure decreased significantly at 1 year after donor nephrectomy. These differences decreased after donor nephrectomy, possibly lowering the risk of cardiovascular disease.


Assuntos
Pressão Sanguínea , Transplante de Rim , Doadores Vivos , Nefrectomia/efeitos adversos , Coleta de Tecidos e Órgãos/efeitos adversos , Adulto , Doenças Cardiovasculares/etiologia , Feminino , Taxa de Filtração Glomerular/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Pontuação de Propensão , Estudos Prospectivos , Insuficiência Renal Crônica/etiologia , República da Coreia
9.
Transplant Proc ; 51(8): 2539-2542, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31447190

RESUMO

PURPOSE: We aim to see the rate of progression to chronic kidney disease stage III after living donor nephrectomy in a single institution annually. METHODS: Between May 2006 and July 2017, a total of 753 living kidney donors who were followed up more than 6 months were enrolled in the study. We divided normal function vs chronic kidney disease III at 6 months postoperatively. We compared the incidence rate of chronic kidney disease stage III annually. For analysis, the entire period was divided into Era 1 (2006-2008), Era 2 (2009-2011), Era 3 (2012-2014), and Era 4 (2015-2017). RESULTS: During the period, the incidence of chronic kidney disease stage III was 258 living donors (34.3%). The prevalence of chronic kidney disease stage III was 39.3%, 36.6%, 35.5%, and 29.3% in Era 1, Era 2, Era 3, and Era 4, respectively. The rate of chronic kidney disease stage III incidence serially decreased as the era passed (P = .046). There was no difference in age, smoking status, drinking status, body mass index, preoperative cholesterol, and uric acid among the eras. However, preoperative estimated glomerular filtration rate was 90.86 (SD, 4.12), 94.47 (SD, 16.62), 103.82 (SD, 0.68), and 105.66 (SD, 19.57) mL/min/1.73 m2 in Era 1, Era 2, Era 3, and Era 4, respectively (P = .001). CONCLUSIONS: The incidence of chronic kidney disease stage III in living kidney donors for the last 3 years (Era 4) has decreased compared with the past (Era 1 and 2). The reason for this might be the effect of the change in the living donor guideline. Also, pre- and postoperative management method had an effect on renal function at 6 months.


Assuntos
Doadores Vivos , Nefrectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Insuficiência Renal Crônica/etiologia , Coleta de Tecidos e Órgãos/efeitos adversos , Adulto , Progressão da Doença , Feminino , Taxa de Filtração Glomerular , Humanos , Incidência , Rim/fisiopatologia , Transplante de Rim , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Prevalência , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Coleta de Tecidos e Órgãos/métodos
10.
Investig Clin Urol ; 60(4): 326-330, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31294143

RESUMO

Purpose: Laparoendoscopic single-site surgery (LESS) reduces the limited invasiveness of conventional laparoscopy while providing superior cosmetic results. However, LESS remains a challenging surgical technique, even in robotic surgery, primarily due to the lack of triangulation and limited instrument movement. The da Vinci SP surgical system (Intuitive Surgical) was recently introduced to overcome these limitations. We describe our initial experience with pure single-site robot-assisted pyeloplasty (RAP) for ureteropelvic junction obstruction (UPJO) using the da Vinci SP surgical system. Materials and Methods: Three consecutive patients who were diagnosed with UPJO underwent RAP with the da Vinci SP surgical system from December 2018 to February 2019 at our institution. The surgical technique involved reproducing the steps of multi-port RAP. A 30-mm umbilical incision was made and the GelPOINT was inserted. The multichannel robotic port and the assistant's port were placed through the GelSeal cap. In all patients, Anderson-Hynes dismembered pyeloplasty was performed. The ureteral double J stent was inserted antegrade, and the drain was not placed. Results: The procedures were successfully completed using a pure single-site approach. There was no need for additional port placement or conversion to laparoscopic or open surgery. Total operative time in the three patients was 139, 180, and 213 minutes, respectively. No intraoperative complications occurred, and blood loss was minimal. The postoperative course of all patients was uneventful with no complications greater than Clavien-Dindo grade I surgical complications. Conclusions: Pure single-site RAP using the da Vinci SP surgical system is feasible and safe.

11.
World J Urol ; 2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31346763

RESUMO

PURPOSE: To evaluate the clinical and tumor characteristics in patients undergoing selective artery embolization (SAE) for bleeding after partial nephrectomy (PN). METHODS: We retrospectively evaluated patients who underwent SAE from 2076 patients who underwent PN. The clinical and tumor characteristics of these patients were analyzed using entire data and propensity score matching (PSM). 76 patients who underwent PN (control, n = 38 patients; SAE, n = 38) were enrolled in PSM. RESULTS: SAE was performed in 41 patients who underwent open (19/1171), laparoscopic (4/60), and robot-assisted PN (18/845). The median period from PN to SAE was 12 days (interquartile range 8-24 day). The most common symptom of 31 (75.61%) patients was gross hematuria, followed by flank pain (3/41). Follow-up imaging revealed large pseudoaneurysm in 7 asymptomatic patients. The main reason for SAE on angiography was pseudoaneurysm (32/41), followed by arteriovenous fistula (5/41). Technical and clinical success was achieved in all patients. There was no statistical difference in the estimated glomerular filtration rate after 1 year, surgical methods, or baseline characteristics between the two groups. Conversely, there was statistically significant difference in ischemic time in the entire data and PSM. In the embolization group, renal masses showed statistically significant endophytic (p = 0.006) and posterior (p = 0.028) characteristics. CONCLUSIONS: SAE is an effective method for controlling postoperative bleeding while preserving renal function after PN. And, we suggest more attentive postoperative surveillance about vascular complications in patients with longer ischemia time or renal masses with endophytic and posterior locations.

12.
Clin Genitourin Cancer ; 17(4): 299-305.e1, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31204211

RESUMO

BACKGROUND: Advanced clear-cell renal-cell carcinoma (ccRCC), which is the most common subtype of kidney cancer, is considered to be lethal despite recent advancements in therapeutic agents. The benefit of adjuvant or neoadjuvant therapy with currently available agents remains controversial. We investigated the clinical implications of DNA damage response (DDR) pathway for locally advanced ccRCC. PATIENTS AND METHODS: Localized ccRCC cases were selected from the Provisional TCGA (The Cancer Genome Atlas) database. Presence of mutation or copy-number alteration of DDR pathway-related genes were evaluated. Disease-free survival and overall survival according to disease progression were evaluated. RESULTS: From TCGA database, 312 cases were identified of a localized ccRCC with full data on mutation and copy-number alteration. Alteration in the DDR pathway was present in 25.0% of cases. Female subjects were more likely to have alterations in the DDR pathway (34.6% vs. 48.7%, P = .026). DDR pathway alteration was associated with decreased disease-free survival in cases of locally advanced T3-4 disease (median, 123.7 vs. 23.0 months, T3 and T4 disease, P = .031). The association was more prominent in cases of T3a disease (normal group median not reached, altered group median 17.7 months, P < .001). DDR pathway alteration was an independent factor predicting a shorter disease-free survival on Cox regression analysis (odds ratio = 4.41; 95% confidence interval, 1.47∼13.28; P = .008). CONCLUSION: Alteration in the DDR pathway was associated with increased recurrence in locally advanced ccRCC, and investigation of therapeutic agents targeting the DDR pathway for this population should be considered.

13.
Urology ; 130: 205-208, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31059727

RESUMO

OBJECTIVES: To evaluate the efficacy and functionality of robotic telerounding among Korean patients using the RP-7 robot system and a questionnaire survey comparing the results of robotic telerounding and standard rounding in Korean patients. METHODS: A total of 40 patients who underwent urologic minimally invasive video-assisted minilaparotomy surgery, laparoscopic and robotic surgery, and endoscopic surgery were recruited. The patients were divided into 2 groups - telerounding (20) and standard rounding (20) - and underwent robotic telerounding and standard rounding. We assessed the patients using a 24-item questionnaire to evaluate the efficacy and functionality of their hospital care. RESULTS: The hospital factors such as self-rated health, assistance, and pain control scores showed no statistically significant differences between groups. Patient satisfaction showed a statistically significant difference in MD confidence, medical communication, explanation understanding, explanation satisfaction, mutual communication, and mutual response. In the telerounding group, participants were satisfied with the audio and video qualities and believed that the robotic telerounding provided better care, and 85% of patients preferred telerounding in the absence of the attending physician. CONCLUSION: Robotic telerounding can provide efficient and cost-effective medical rounding by reducing inconvenience and labor cost with greater patient satisfaction with postoperative care. However, there is no statistically significant difference in the hospital factors and postoperative morbidity. In addition, the patients doubted that the robotic telerounding could replace standard rounding due to the Eastern culture.


Assuntos
Satisfação do Paciente , Robótica , Visitas com Preceptor/métodos , Telemedicina , Procedimentos Cirúrgicos Urológicos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , República da Coreia , Autorrelato
14.
Medicine (Baltimore) ; 98(17): e15367, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31027124

RESUMO

Video-assisted mini-laparotomy surgery (VAMS), a hybrid of open and laparoscopic surgical techniques, is an important surgical approach in the field of partial nephrectomy. The learning curve for VAMS partial nephrectomy has not been studied to date; we therefore, evaluated this learning curve.We prospectively evaluated 20 consecutive patients who underwent VAMS partial nephrectomy performed by a single surgeon (YEY) between March 2015 and December 2016. The learning curve was evaluated using the cumulative sum method. The measure of surgical performance was composed of 3 parameters (total operation time [Op time], warm ischemic time [WIT], and estimated blood loss [EBL]).Among the 20 patients who underwent VAMS partial nephrectomy, the mean age was 54.6 years. The mean Op time and WIT were 172.5 and 28.8 minutes, respectively. The learning curve for the Op time, WIT, and EBL consisted of 3 unique phases: phase 1 (the first 7 cases), phase 2 (the next 5 to 7 cases), and phase 3 (all subsequent cases). Phase 1 represents the initial learning curve, and the phase 2 plateau represents the period of expert competency. Phase 3 represents when one is competent in VAMS partial nephrectomy.The learning curve for VAMS partial nephrectomy is relatively short and after a learning curve of approximately 7 cases, the surgeon became familiar with VAMS partial nephrectomy; after 12 to 14 cases, the surgeon became competent in this procedure.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Laparotomia , Curva de Aprendizado , Nefrectomia , Cirurgia Vídeoassistida , Perda Sanguínea Cirúrgica , Feminino , Humanos , Laparotomia/educação , Laparotomia/métodos , Masculino , Pessoa de Meia-Idade , Nefrectomia/educação , Nefrectomia/métodos , Duração da Cirurgia , Estudos Retrospectivos , Cirurgiões/educação , Fatores de Tempo , Cirurgia Vídeoassistida/educação
15.
BJU Int ; 123(5): 869-876, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30347133

RESUMO

OBJECTIVES: To evaluate the clinical implications of postoperative urinary neutrophil gelatinase-associated lipoprotein (NGAL) changes and the association between urinary NGAL (uNGAL) and renal function in living kidney donors. SUBJECTS, PATIENTS AND METHODS: We included 76 healthy adults who underwent donor nephrectomy between December 2013 and November 2014. Perioperative serum creatinine (sCr), uNGAL, serum NGAL (sNGAL), and urinary microalbumin were prospectively measured until 6 months postoperatively. Patients with chronic kidney disease (CKD) due to medical disorders who visited our outpatient clinic during the same period were included for comparison. RESULTS: The mean (SD) preoperative uNGAL of donors was 5 (5.17) ng/mL. uNGAL (corrected for urinary creatinine) was maximal at 1-2 days postoperatively, decreased on postoperative day 3, and stabilised by 7 days after surgery. Postoperative uNGAL was not associated with sex, age, or preoperative renal function. When corrected for sNGAL to compensate for the systemic increase in NGAL with major surgery, uNGAL on days 1-3 postoperatively was negatively correlated with sCr. Postoperatively, donor uNGAL remained higher than preoperatively for up to 6 months but was significantly lower than in patients with medical CKD with similar glomerular filtration rates. CONCLUSION: Acute kidney injury due to hyperfiltration of remnant kidney after donor nephrectomy was maximal within 1-2 days postoperatively. The rise in uNGAL during this period in donors was negatively correlated with postoperative sCr levels. Decreased renal function after nephrectomy differs from that of medical CKD.


Assuntos
Testes de Função Renal/métodos , Transplante de Rim , Lipocalina-2/urina , Doadores Vivos , Insuficiência Renal Crônica/urina , Adulto , Biomarcadores/urina , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Nefrectomia , Estudos Prospectivos , Insuficiência Renal Crônica/fisiopatologia , Insuficiência Renal Crônica/cirurgia
16.
J Laparoendosc Adv Surg Tech A ; 29(1): 1-11, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30307365

RESUMO

BACKGROUND: Treatment of totally endophytic renal tumors is a technically demanding surgery. While few studies show promising perioperative and short-term outcomes of robot-assisted partial nephrectomy (RAPN), its long-term outcomes remain undetermined. MATERIALS AND METHODS: A retrospective analysis of 89 patients with totally endophytic renal tumors undergoing either RAPN (n = 52) or open partial nephrectomy (OPN; n = 37) in a tertiary-care institution between 2005 and 2015 was performed. Primary endpoint was to describe our transperitoneal RAPN surgical technique, while secondary endpoint was to compare the 5-year chronic kidney disease (CKD)-free survival, cancer-specific survival (CSS), and metastasis-free survival (MFS) rates between RAPN and OPN. RESULTS: The median follow-up was 59 and 53 months for RAPN and OPN, respectively. Apart from increased prevalence of high complex tumors among RAPN cases (RAPN, 38.5% versus OPN, 16.2%; P = .037), and lower median eGFR (RAPN, 86 versus OPN 96 mL/minute/1.73 m2; P = .032), the remaining demographic characteristics were similar between the groups. At latest follow-up, the rates of local recurrence (P = .577), distant metastasis (P = .854), and cancer death (P = .187), and CKD upstaging ≥stage 3 (P = .728) did not differ between groups. The 5-year CKD upstaging-free survival was 96.2% versus 94.6% (log-rank, P = .746), MFS was 95.8% versus 97.1% (P = .876), and CSS was 100% versus 93.8% (log-rank, P = .102) when stratified by RAPN and OPN, respectively. CONCLUSION: RAPN is a safe and feasible option for treatment of totally endophytic renal tumors. Despite the increased prevalence of high tumor complexity and lower baseline renal function in the RAPN group, it achieved equivalent long-term oncologic control and functional outcome compared to OPN.


Assuntos
Neoplasias Renais/cirurgia , Nefrectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Rim/patologia , Rim/cirurgia , Neoplasias Renais/complicações , Neoplasias Renais/mortalidade , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/cirurgia , Nefrectomia/efeitos adversos , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/etiologia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Taxa de Sobrevida , Resultado do Tratamento
17.
PLoS One ; 13(10): e0206447, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30379927

RESUMO

Cell-culture methods that simplify the inherent complexities of the kidney have not sufficiently reproduced its true characteristics. Although reports indicate that organoid methodology surpasses traditional cell culture in terms of reproducing the nature of organs, the study of human kidney organoids have been confined to pluripotent stem cells. Furthermore, it has not yet progressed beyond the developmental state of embryonic kidney even after complicate additional differentiation processes. We here describe the kidney organotypic culture method that uses adult whole kidney tissues but mainly differentiates into tubular cells. This model was validated based on the retention of key kidney organotypic-specific features: 1) expression of Tamm-Horsfall protein; 2) dome-like organoid configurations, implying directed transport of solutes and water influx; and 3) organoid expression of neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) in response to nephrotoxic injury (i.e., gentamicin and cisplatin exposure). This 3D-structured organoid prototype of the human renal tubule may have applications in developing patient-specific treatments for kidney diseases.


Assuntos
Túbulos Renais/citologia , Modelos Biológicos , Técnicas de Cultura de Tecidos , Proliferação de Células , Humanos
18.
Int J Urol ; 25(12): 1006-1014, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30276864

RESUMO

OBJECTIVES: Our aim was to evaluate the predictors of biochemical recurrence after Retzius-sparing robot-assisted radical prostatectomy. METHODS: The study cohort consisted of 359 consecutive non-metastatic prostate cancer patients who underwent Retzius-sparing robot-assisted radical prostatectomy between November 2012 and January 2016. According to the National Comprehensive Cancer Network prostate cancer risk classification, 164 patients (45.7%) had high- or very high-risk prostate cancer. No patient received adjuvant therapy until documented biochemical recurrence. Biochemical recurrence-free survival was estimated using the Kaplan-Meier method. Univariable and multivariable Cox proportional hazards regression models were used to determine variables predictive of biochemical recurrence. RESULTS: The median follow-up period was 26 months (interquartile range 19-38 months). The overall biochemical recurrence rate was 14.8%, and the median time to biochemical recurrence was 11 months (interquartile range 6-22 months). The 3-year biochemical recurrence-free survival probability was 71.2%, 72.1%, 88.7%, 82.3% and 95.7% in very high-, high-, intermediate-, low- and very low-risk prostate cancer, respectively (log-rank, P < 0.001). On multivariable analysis, preoperative prostate-specific antigen (hazard ratio 1.03, 95% confidence interval 1.02-1.04; P < 0.0001), percentage of maximum core involvement on biopsy (hazard ratio 1.02, 95% confidence interval 1.01-1.03; P = 0.029) and clinical stage ≥T3a (hazard ratio 2.12, 95% confidence interval 1.02-4.39; P = 0.043) were predictors of biochemical recurrence, whereas pathological Gleason score ≥8 (hazard ratio 5.63, 95% confidence interval 1.62-19.61; P = 0.007) and pathological tumor volume (hazard ratio 1.08, 95% confidence interval 1.04-1.20; P < 0.001) were the main pathological predictors of biochemical recurrence. CONCLUSIONS: Retzius-sparing robot-assisted radical prostatectomy confers effective biochemical recurrence control at the mid-term follow-up period. Preoperative prostate-specific antigen, advanced clinical stage and higher Gleason score were important predictors of biochemical recurrence after Retzius-sparing robot-assisted radical prostatectomy. Long-term oncological safety still needs to be established.


Assuntos
Recidiva Local de Neoplasia/diagnóstico , Tratamentos com Preservação do Órgão/efeitos adversos , Prostatectomia/efeitos adversos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Idoso , Intervalo Livre de Doença , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Recidiva Local de Neoplasia/sangue , Estadiamento de Neoplasias , Tratamentos com Preservação do Órgão/métodos , Período Pré-Operatório , Próstata/patologia , Próstata/cirurgia , Antígeno Prostático Específico/sangue , Prostatectomia/métodos , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/patologia , Fatores de Risco , Procedimentos Cirúrgicos Robóticos/métodos
19.
Investig Clin Urol ; 59(5): 348-354, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30182081

RESUMO

Endoscopic combined intrarenal surgery (ECIRS) with simultaneous retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) has been proposed as a new surgical treatment to overcome the disadvantage of RIRS and PCNL monotherapies in the treatment of renal stone. One of advantages of ECIRS is that it can increase stone-free rates in complex renal stone within single-session. Intermediate-supine position in real-time simultaneous ECIRS can prevent an anesthesiologic problem, and patient's burden is small even for long-term operation. Thus, we will share the experience and advantages of real-time simultaneous ECIRS and introduce techniques to increase the stone-free rate.


Assuntos
Endoscopia/métodos , Cálculos Renais/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea , Decúbito Dorsal , Irrigação Terapêutica
20.
Yonsei Med J ; 59(8): 975-981, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30187705

RESUMO

PURPOSE: To evaluate the efficacy and safety of robotic procedures performed using the da Vinci Robotic Surgical System at a single institute. MATERIALS AND METHODS: We analyzed all robotic procedures performed at Severance Hospital, Yonsei University Health System (Seoul, Korea). Reliability and mortality rates of the robotic surgeries were also investigated. RESULTS: From July 2005 to December 2013, 10267 da Vinci robotic procedures were performed in seven different departments by 47 surgeons at our institute. There were 5641 cases (54.9%) of general surgery, including endocrine (38.0%), upper (7.7%) and lower gastrointestinal tract (7.5%), hepato-biliary and pancreatic (1.2%), and pediatric (0.6%) surgeries. Urologic surgery (33.0%) was the second most common, followed by otorhinolaryngologic (7.0%), obstetric and gynecologic (3.2%), thoracic (1.5%), cardiac (0.3%), and neurosurgery (0.1%). Thyroid (40.8%) and prostate (27.4%) procedures accounted for more than half of all surgeries, followed by stomach (7.6%), colorectal (7.5%), kidney and ureter (5.1%), head and neck (4.0%), uterus (3.2%), thoracic (1.5%), and other (2.9%) surgeries. Most surgeries (94.5%) were performed for malignancies. General and urologic surgeries rapidly increased after 2005, whereas others increased slowly. Thyroid and prostate surgeries increased rapidly after 2007. Surgeries for benign conditions accounted for a small portion of all procedures, although the numbers thereof have been steadily increasing. System malfunctions and failures were reported in 185 (1.8%) cases. Mortality related to robotic surgery was observed for 12 (0.12%) cases. CONCLUSION: Robotic surgeries have increased steadily at our institution. The da Vinci Robotic Surgical System is effective and safe for use during surgery.


Assuntos
Falha de Equipamento/estatística & dados numéricos , Mortalidade , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , República da Coreia/epidemiologia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Cirurgiões
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