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1.
Artigo em Inglês | MEDLINE | ID: mdl-31594736

RESUMO

INTRODUCTION: The objective of this study was to determine the efficiency of 1-year maintenance intravesical chemotherapy (MIC) in reducing bladder recurrence (BR) after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma compared with single intravesical instillation (SIC). PATIENTS AND METHODS: Between January 2015 and May 2017, patients who underwent RNU were randomized to receive SIC (epirubicin 50 mg) or MIC (once weekly for 6 weeks plus once monthly for 1 year). The primary outcome was the rate of histologically proven BR. The secondary outcomes included chemotherapy-related toxicities and disease-specific survival (DSS). Thirty-five patients in each arm were required to achieve a power of 80%. RESULTS: A total of 38 (SIC) and 36 (MIC) patients were analyzed. In SIC, BR developed in 5 (13.2%) over a median follow-up of 3 months (range, 3-6 months) compared with 9 (25%) patients over 12 months (range, 3-28 months) in MIC (P = .08). The 6- and 12-month BR-free survivals were the same (86.8%) in SIC versus 88.9% and 83.3% in MIC, respectively (P = .2). Lymphovascular invasion was significantly associated with BR (P = .04). Post-RNU intravesical chemotherapy regimens did not alter DSS. Blood transfusion and advanced tumor stage were independent predictors for DSS. No significant medication toxicity was reported. CONCLUSIONS: Following RNU, MIC did not change the natural course of BR beyond a single instillation apart from potentially delaying its occurrence. Lymphovascular invasion and blood transfusion were associated with worse BR and DSS outcomes, respectively.

2.
BJU Int ; 2019 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-30946525

RESUMO

OBJECTIVES: To assess the effect of tolterodine in the treatment of nocturnal urinary incontinence (NUI) after ileal orthotopic neobladder (ONB). PATIENTS AND METHODS: This is a prospective randomised placebo-controlled crossover study (clinicaltrials.gov: NCT02877901). Patients with NUI after ONB were randomly allocated into two equal groups. Group T received 4 mg extended-release tolterodine at bed-time and Group P received placebo for 4 weeks followed by 2 weeks of washout, then crossed over to the alternate therapy for 4 weeks. Patients were assessed by the number of pads used per night (PPN) and with the Arabic version of the International Consultation on Incontinence Modular Questionnaire-Short Form (ICIQ-SF) at both phases of the study. The outcomes were the rate of NUI improvement and medication adverse events. RESULTS: Out of 172 patients, 150 and 122 patients were evaluated at both phases of the study. The mean ICIQ-SF scores and PPN were significantly decreased in Group T compared to Group P in both study phases (P < 0.001). In Group T, 15 (10%) and 11 (9%) patients became dry after the first allocation and crossover, respectively. In Group T, 60 (77.9%) patients reported improvement vs four (5.5%) in Group P (P < 0.001) after the first allocation. Similarly, 46 (73%) and seven (11.9%) patients showed improvement in groups T and P after the crossover, respectively (P < 0.001). Dry mouth occurred in 31 (20.8%) patients. CONCLUSIONS: Tolterodine seems to be a good choice for treatment of NUI after radical cystectomy and ONB. However, further studies are needed to delineate the long-term effects and the associated urodynamic characteristics.

3.
Int Urol Nephrol ; 50(11): 2007-2014, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30232721

RESUMO

AIM: To evaluate the role of low-intensity extra corporeal shock wave therapy (LI-ESWT) in penile rehabilitation (PR) post nerve-sparing radical cystoprostatectomy (NS-RCP). MATERIALS AND METHODS: This study included 152 sexually active men with muscle invasive bladder cancer. After bilateral NS-RCP with orthotopic diversion by a single expert surgeon between June 2014 and July 2016, 128 patients were available categorized into three groups: LI-ESWT group (42 patients), phosphodiesterase type-5 inhibitors (PDE5i) group (43 patients), and control group (43 patients). RESULTS: Mean age was 53.2 ± 6.5 years. Mean ± SD follow-up period was 21 ± 8 months. During first follow-up FU1, all patients of the three groups had insufficient erection for vaginal penetration; with decrease of preoperative IIEF-EF mean score from 27.9 to 6.9. Potency recovery rates at 9 months were 76.2%, 79.1%, and 60.5% in LI-ESWT, PDE5i, and control groups, respectively. There was statistically significant increase in IIEF-EF and EHS scores during all follow-up periods in all the study groups (p < 0.001). However, there was no significant difference between the three groups during all follow-up periods. Statistical evaluation showed no significant difference in continence and oncological outcomes during all follow-up points among the three groups (p = 0.55 and 0.07, respectively). CONCLUSIONS: During last follow-up, 16% more patients in LI-ESWT group had recovery of potency as compared to the control group. Although the difference is not statistically significant, but of clinical importance. LI-ESWT is safe as oral PDE5i in penile rehabilitation post nerve-sparing radical cystoprostatectomy.

4.
Int. braz. j. urol ; 44(4): 726-733, July-Aug. 2018. tab
Artigo em Inglês | LILACS-Express | ID: biblio-954086

RESUMO

ABSTRACT Introduction: Acute kidney injury (AKI) after major surgeries is associated with significant morbidity and mortality. We aim to report incidence, predictors and associated comorbidities of AKI after radical cystectomy in a large cohort of patients. Materials and Methods: We conducted a retrospective analysis of 1000 patients who underwent open radical cystectomy in a tertiary referral center. Perioperative serum creatinine measurements were used to define AKI according to the RIFLE criteria (as Risk, Injury and Failure). The predictors of AKI after surgery were determined using univariate and multivariate analyses. Results: Out of 988 evaluable patients, AKI developed in 46 (4.7%). According to RIFLE criteria; AKI-Risk, AKI-Injury and AKI-Failure occurred in 26 (2.6%), 9 (0.9%) and 11 (1.1%) patients, respectively. Multivariate analysis showed that performing nephroureterectomy with cystectomy (Odds ratio [OR]: 4.3; 95% Confidence interval [CI]: 1.3-13.6; p=0.01) and the development of high grade complications (OR: 3.8; 95% CI 1.9-7.2; p<0.0001) were independently associated with AKI. Conclusions: AKI is a significant morbidity after radical cystectomy and the term should be included during routine cystectomy morbidity assessment.

6.
Int Braz J Urol ; 44(4): 726-733, 2018 Jul-Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29757568

RESUMO

INTRODUCTION: Acute kidney injury (AKI) after major surgeries is associated with significant morbidity and mortality. We aim to report incidence, predictors and associated comorbidities of AKI after radical cystectomy in a large cohort of patients. MATERIALS AND METHODS: We conducted a retrospective analysis of 1000 patients who underwent open radical cystectomy in a tertiary referral center. Perioperative serum creatinine measurements were used to define AKI according to the RIFLE criteria (as Risk, Injury and Failure). The predictors of AKI after surgery were determined using univariate and multivariate analyses. RESULTS: Out of 988 evaluable patients, AKI developed in 46 (4.7%). According to RIFLE criteria; AKI-Risk, AKI-Injury and AKI-Failure occurred in 26 (2.6%), 9 (0.9%) and 11 (1.1%) patients, respectively. Multivariate analysis showed that performing nephroureterectomy with cystectomy (Odds ratio [OR]: 4.3; 95% Confidence interval [CI]: 1.3-13.6; p=0.01) and the development of high grade complications (OR: 3.8; 95% CI 1.9-7.2; p<0.0001) were independently associated with AKI. CONCLUSIONS: AKI is a significant morbidity after radical cystectomy and the term should be included during routine cystectomy morbidity assessment.


Assuntos
Lesão Renal Aguda/etiologia , Cistectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Derivação Urinária/efeitos adversos , Creatinina/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Centros de Atenção Terciária , Resultado do Tratamento
7.
Arab J Urol ; 15(3): 216-222, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29071155

RESUMO

OBJECTIVE: To review the incidence, predictors and prognosis of bladder cancer recurrence after management of upper tract urothelial carcinoma (UTUC). PATIENTS AND METHODS: We retrospectively reviewed patients who were surgically treated for UTUC from 1983 to 2013. The tumours were categorised according to the 1997 Tumour-Node-Metastasis (TNM) staging and the three-tiered World Health Organization grading systems. The primary endpoint was the occurrence of any intravesical recurrence after treatment. We studied the possible risk factors that may contribute to development of intravesical recurrence, as well as the prognosis of the patients who had recurrence. RESULTS: In all, 297 patients were eligible for analysis. Recurrent bladder tumours occurred in 139 patients (46.8%). The mean (range) time to recurrence after surgery was 33 (6-300) months. Neither sex, past history of bladder tumours, concomitant bladder tumour, the side of the tumour, UTUC stage, grade, presence of carcinoma in situ or multicentricity at the time of diagnosis of UTUC, were significant predictors of intravesical tumour recurrence. Ureteric tumour was the only identified risk factor (P = 0.02). Post-treatment bladder recurrence was a significant predictor of later urethral recurrence (P = 0.002). CONCLUSIONS: In our present series, bladder cancer recurrence of urothelial malignancy occurred in nearly half of the patients after surgical management of UTUC. Ureteric tumour was the only identifiable risk factor, thus patients with ureteric tumours may benefit from prophylactic intravesical chemoimmunotherapy. Bladder recurrence does not appear to affect the cancer-specific survival after surgical management of UTUC.

8.
Exp Clin Transplant ; 15(3): 277-281, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28587588

RESUMO

OBJECTIVES: We report on the long-term follow-up of managing allograft stones at a single tertiary referral institution and review the relevant literature. MATERIALS AND METHODS: A retrospective analysis of renal allograft recipient charts was performed to identify patients who developed allograft lithiasis between 1974 and 2009. Patient and stone characteristics, diagnoses, treatments, and outcomes were described. RESULTS: Sixteen patients developed 22 stones after a median follow-up of 170 months (range, 51-351 mo). The mean (standard deviation) and median diameter of the stones were 13.8 (8.5) mm and 11 mm. Among these, 3 stones were treated conservatively, 3 by shock-wave lithotripsy, and 7 by cystolitholapaxy. Seven patients underwent percutaneous treatment in the form of percutaneous nephrostomy tube fixation and spontaneous passage of stone (1 stone), shock-wave lithotripsy (1 stone), antegrade stenting (1 stone), and percutaneous nephrolithotomy (6 stones). All patients were stone free after treatment, except for 2 patients whose stones were stable and peripheral on long-term follow-up. CONCLUSIONS: Allograft lithiasis requires a multimodal treatment tailored according to stone and graft characteristics. Protocols regarding spontaneous passage can be adopted if there is no harm to the graft and the patient is compliant. Careful attention to the anatomy during percutaneous nephrostomy tube placement is mandatory to avoid intestinal loop injury. A more attentive follow-up is required for early stone management.


Assuntos
Transplante de Rim/efeitos adversos , Litotripsia , Nefrolitíase/terapia , Nefrolitotomia Percutânea , Adulto , Aloenxertos , Intervalo Livre de Doença , Egito , Feminino , Humanos , Litotripsia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Nefrolitíase/diagnóstico , Nefrolitíase/etiologia , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/instrumentação , Recidiva , Estudos Retrospectivos , Stents , Fatores de Tempo , Resultado do Tratamento
9.
Int Urol Nephrol ; 49(8): 1327-1334, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28501912

RESUMO

PURPOSE: To evaluate the long-term renal function outcome of management of retroperitoneal fibrosis (RPF)-induced ureteral obstruction. METHODS: Thirty-six patients with idiopathic RPF-induced ureteral obstruction were classified according to the management type into two groups, group A; managed by indwelling JJ stent and group B managed by ureterolysis and omental wrapping (UOR). The primary outcome was to define the long-term outcome of management on RF. It was evaluated by changes in serum creatinine and estimated GFR (eGFR) using Modification of Diet in Renal Disease equation where 20% changes in eGFR is considered significant. The second outcome is to compare the outcomes between both groups. RESULTS: After 27.5 (1-124) months, median (range) follow-up, median (range) serum creatinine increased significantly from 1.5 (0.8-8.1) to 1.6 (1-12.1) mg/dl (p value =0.04) and eGFR showed non-statistical significant reduction from 43 (5-110) to 41 (5-88) ml/min/1.73 m2 (p value =0.3). Eight (22.2%), 12 (34.4%) and 16 (44.4%) patients showed stable, increased and decreased eGFR. Group A showed statistically significant increased serum creatinine and insignificant decreased eGFR (p value =0.04 and 0.09), while group B showed statistically insignificant changes in serum creatinine and eGFR (p value =0.5 and 0.9). In group B, nine (21.4%) renal units are still harboring JJ stents. CONCLUSION: For idiopathic RPF, UOR avoided indwelling ureteral stents in 78.6% of renal units with apparent better long-term renal function outcome.


Assuntos
Fibrose Retroperitoneal/complicações , Stents , Obstrução Ureteral/fisiopatologia , Obstrução Ureteral/cirurgia , Adulto , Creatinina/sangue , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/etiologia , Estudos Retrospectivos , Fatores de Tempo , Obstrução Ureteral/etiologia
10.
Scand J Urol ; 51(2): 165-169, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28351191

RESUMO

OBJECTIVES: The aim of this study was to report the incidence, severity, outcome and risk factors of acute kidney injury (AKI) following percutaneous nephrolithotomy (PNL) in solitary kidneys. METHODS: The study included consecutive adult patients who underwent PNL for treatment of calculi in a solitary kidney between May 2012 and July 2015. Patients with congenital renal anomalies or with stages 4 and 5 chronic kidney disease (CKD) were excluded. Serum creatinine levels were measured the day before PNL, daily after PNL for 2-5 days and after 3 months. AKI was depicted according to changes in early postoperative serum creatinine levels and its severity was determined based on the Acute Kidney Injury Network (AKIN) classification. The outcome of AKI was evaluated after 3 months by changes in the stage of CKD. Univariate and multivariate statistical analyses were conducted to determine risk factors for developing AKI. RESULTS: The study included 100 patients (62 males) with a mean ± SD age of 50 ± 11.7 years. Complications were reported for 27 patients. AKI developed in 25 patients; at the 3 month follow-up, 23 of them (92%) had completely recovered from AKI and two (8%) had developed stage 4 CKD. Independent risk factors for developing AKI were multiple PNL tracts and postoperative ureteric obstruction (relative risks were 14 and 22, respectively). CONCLUSIONS: The incidence of AKI was 25% after PNL for a solitary kidney. The likelihood of renal function recovery was 92%. Multiple PNL tracts and postoperative ureteric obstruction were risk factors for developing AKI.


Assuntos
Lesão Renal Aguda/etiologia , Lesão Renal Aguda/fisiopatologia , Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/efeitos adversos , Lesão Renal Aguda/sangue , Adolescente , Adulto , Idoso , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/fisiopatologia , Fatores de Risco , Índice de Gravidade de Doença , Adulto Jovem
11.
Minerva Urol Nefrol ; 69(3): 262-270, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27681660

RESUMO

BACKGROUND: Enough data about health related quality of life (HRQOL) after radical cystectomy (RC) and urinary diversion (UD) in women is still lacking. The objectives are to evaluate HRQOL in women after RC and orthotopic neobladder (ONB) versus ileal loop conduit (IC) and to assess the impact of urinary continence. METHODS: The study included 145 women who underwent RC and came for routine follow-up. HRQOL was assessed by two questionnaires (EORTC-QLQ-C30and FACT-Bl). ONB group was stratified to: totally continent, with nocturnal incontinence (NI) and patients in chronic urinary retention (CUR) and maintained on CIC. The orthotopic group (as a whole and its 3 subgroups) was compared to IC. RESULTS: ONB group included 22 continent women, 35 with NI and 27 in CUR and on CIC. There were no statistically significant differences between ONB and IC groups in all domains of the two questionnaires. However, continent women showed statistically significant better most of EORTC-QLQ-C30 scales and emotional well-being, functional well-being, bladder cancer subscale and FACT-Bl total Score (P˂0.05) than IC group. Similarly, women in CUR showed statistically significant better global health and physical functioning EORTC-QLQ-C30 scores (P values=0.0001, 0.01) and all domains of FACT-Bl. On the other hand, women with NI showed statistically significant lower values in all domains of the EORTC-QLQ-C30 and FACT-Bl than IC group. CONCLUSIONS: In women, HRQOL is better after ONB than IC as long as continence status is preserved. If incontinence is expected, IC may be a better option for UD.


Assuntos
Cistectomia/métodos , Enurese Noturna/fisiopatologia , Cistectomia/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Qualidade de Vida , Resultado do Tratamento , Derivação Urinária/efeitos adversos , Derivação Urinária/métodos , Retenção Urinária/fisiopatologia
12.
World J Urol ; 35(8): 1241-1246, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28013344

RESUMO

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


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Adulto , Feminino , Humanos , Cuidados Intraoperatórios , Cálculos Renais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Prognóstico , Estudos Prospectivos , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Resultado do Tratamento
13.
Int J Surg ; 36(Pt D): 693-697, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27856353

RESUMO

Urolithiasis in the context of renal transplant is a quite rare event that requires keeping a higher index of suspicion and vigilance. Donors with incidentally discovered asymptomatic renal stones "donor gifted lithiasis" are potentially considered for donation should they are not recurrent stone formers and in the absence of active biochemical disorders. Stone clearance from the donors can be done before donation using shock wave lithotripsy and/or flexible ureteroscopy. Ex vivo ureteroscopy at time of transplant is equally feasible and safe. A variety of anatomical, metabolic and surgical factors contribute to de novo lithiasis after transplantation. Diagnosis is challenging as the transplanted kidney is denervated and the presentation is consequently, atypical. Endourological armamentarium is readily present within the hands of the urologists for adequately addressing the stones and including shock wave lithotripsy, percutaneous nephrolithotomy and flexible ureteroscopy. Whilst all endourological techniques have proven feasibility and safety, they are surgically demanding and requiring high-volume expertise to be adequately performed. The longterm outcome in terms of stone recurrence or the effect on graft survival is favorable. Finally, formidable counselling as well as postoperative monitoring for both donors and recipients is crucial to minimize urolithiasis-related morbidity.


Assuntos
Transplante de Rim , Doadores Vivos , Transplantados , Urolitíase/diagnóstico , Sobrevivência de Enxerto , Humanos , Litotripsia/métodos , Nefrostomia Percutânea , Resultado do Tratamento , Ureteroscopia/métodos , Urolitíase/terapia
14.
Arab J Urol ; 14(2): 108-14, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27489737

RESUMO

OBJECTIVES: To investigate the effect of stone fragmentation on late stone recurrence by comparing the outcome of extracorporeal shockwave lithotripsy (ESWL) and non-fragmenting percutaneous nephrolithotomy (PCNL), and to investigate factors contributing to recurrent calculi. PATIENTS AND METHODS: We evaluated stone recurrence in 647 patients who initially achieved a stone-free status after ESWL and compared the outcomes to 137 stone-free patients treated with PCNL without stone fragmentation. Patients were evaluated every 3 months during the first year and every 6 months thereafter to censorship or time of first new stone formation. Stone recurrence rates were calculated using the Kaplan-Meier method. The effects of demographics, stone characteristics, and intervention on the recurrence rate were studied using the log-rank test and the Cox-regression analysis. RESULTS: For ESWL the recurrence rates were 0.8%, 35.8% and 60.1% after 1, 5 and 10 years, which were comparable to the 1.5%, 35.5% and 74.9%, respectively found in the PCNL group (P = 0.57). Stone burden (>8 mm) and a previous history of stone disease were significantly associated with higher recurrence rates regardless of the method of stone intervention (P = 0.02 and P = 0.01, respectively). In the ESWL group, a stone length of >8 mm showed a higher recurrence rate (P = 0.007). In both the ESWL and PCNL groups, there was a significant shift from baseline stone location, with an increased tendency for most new stones to recur in the calyces as opposed to the pelvis. CONCLUSIONS: In comparison with PCNL, ESWL does not increase long-term stone recurrence in patients who become stone-free. The stone burden appears to be the primary factor in predicting stone recurrence after ESWL.

15.
Int J Urol ; 23(10): 861-865, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27545102

RESUMO

OBJECTIVES: To compare treatment-related outcomes of ureteral stenting with an external versus double J stent in patients with orthotopic reservoirs after radical cystectomy. METHODS: Patients undergoing radical cystectomy and orthotopic neobladder were randomized into two groups; group I patients received external stents, whereas group II received double J stents. In both groups, preoperative parameters were recorded, and patients were assessed regarding urinary tract infection, urinary leakage, upper tract deterioration, readmission and hospital stay. RESULTS: A total of 48 and 45 patients were randomized in the external stent group and double J group, respectively. Both groups were comparable in terms of age, sex, associated comorbidity and oncological status. Early urinary leak was observed in two patients (4.2%) in the external stent group, and in two patients (4.4%) in the double J group (P = 0.95). None of our patients developed ureteral strictures in the external stent group, and one patient did in the double J group (P = 0.3). Positive urine culture (58.3%, 51.1%) as well as febrile urinary tract infections (2.1%, 6.7%) were comparable between both groups, respectively (P = 0.43, 0.28). Wound complications (12.5%, 8.9%) and stent-related complications (2.1%, 0%) were comparable between both groups, respectively (P = 0.57, 0.33). The mean hospital stay was 17.5 days (range 14-32 days) and 14.6 days (range 10-42 days) in both groups, respectively (P = 0.001), with comparable re-admission rates (P = 0.95). CONCLUSIONS: Incorporation of double J stents in orthotopic urinary diversion is a safe alternative to the routinely used external stenting.


Assuntos
Cistectomia , Stents , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária , Anastomose Cirúrgica , Drenagem , Humanos
16.
Can J Physiol Pharmacol ; 94(9): 936-46, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27411029

RESUMO

The present study investigated the effects of combination of ischemic preconditioning (Ipre) and adipose-derived mesenchymal stem cells (ADMSCs) on renal ischemia-reperfusion (I-R) injury in rats. 90 male Sprague Dawley rats were divided into 5 equal groups; sham operated, control (45 min left renal ischemia), Ipre group as control group with 3 cycles of Ipre just before renal ischemia, ADMSCs-treated group (as control with ADMSCs 10(6) cells in 0.1 mL via penile vein 60 min before ischemia time), and Ipre + ADMSCs group as ADMCs group with 3 cycles of Ipre. Ipre and ADMSCs groups showed significant decrease in serum creatinine and blood urea nitrogen (BUN) and caspase-3 and CD45 expression in kidney and significant increase in HIF-1α, SDF-1α, CD31, and Ki67 expressions in kidney compared with the control group (p < 0.05). Moreover, the Ipre + ADMSCs group showed significant decrease in serum BUN and caspase-3 and CD45 expression in kidney with significant increase in HIF-1α, SDF-1α, CD31, and Ki67 expression in kidney compared with the Ipre and ADMCs groups (p < 0.05). We concluded that Ipre potentiates the renoprotective effect of ADMSCs against renal I/R injury probably by upregulation of HIF-1α, SDF-1α, CD31, and Ki67 and downregulation of caspase-3 and CD45.


Assuntos
Tecido Adiposo/citologia , Precondicionamento Isquêmico , Rim/metabolismo , Rim/patologia , Transplante de Células-Tronco Mesenquimais , Traumatismo por Reperfusão/metabolismo , Traumatismo por Reperfusão/patologia , Animais , Nitrogênio da Ureia Sanguínea , Caspase 3/biossíntese , Quimiocina CXCL12/biossíntese , Creatinina/sangue , Subunidade alfa do Fator 1 Induzível por Hipóxia/biossíntese , Antígeno Ki-67/biossíntese , Antígenos Comuns de Leucócito/biossíntese , Masculino , Molécula-1 de Adesão Celular Endotelial a Plaquetas/biossíntese , Ratos , Traumatismo por Reperfusão/sangue
17.
Urol Ann ; 8(1): 95-8, 2016 Jan-Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26834412

RESUMO

"Inflammatory pseudotumor" (IPT) has infrequently been reported in the medical journals. A retrospective analysis was conducted among more than 2,000 bladder tumor cases from January 1999 to December 2012 looking for patients with IPT in the final diagnosis. Six patients were found with median tumor size of 3.5 cm (range: 3-8 cm); computed tomography and/or magnetic resonance imaging was used to diagnose the tumor. All patients had complete resection of the tumors. On a median follow-up of 6 years (range: 2-10 years), no recurrences for IPT have been observed in all patients. We concluded that IPT is a rare disease of the urinary bladder and should be regarded with a high degree of suspicion. Although an extensive workup may be needed for definite diagnosis, it is worth to avoid unnecessary chemoradiotherapy or radical surgeries.

18.
Curr Urol Rep ; 17(3): 21, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26874533

RESUMO

The standard treatment of non-muscle invasive bladder cancer (NMIBC) is transurethral resection (TUR) commonly using a monopolar electrocautery system. This system requires high energy and voltage to allow an electric current to run from the loop to the patient's skin. The heat generated leads to desiccation of small cells and difficulty to perform adequate histological analysis for severely cauterized pieces of tissues. On contrary, the electric current in bipolar systems does not traverse the patient and hence lower energy and voltage are used and minimal tissue damage is anticipated. In addition, the use of saline as an irrigant fluid eliminates the potential TUR syndrome from excess hypotonic fluid reabsorption. Furthermore, the lower energy dissipates as heat in tissues contributing to adequate hemostasis. This review presents the most recent studies and evidence on the differences between monopolar and bipolar systems for TUR of NMIBC as regards the perioperative and long-term outcomes.


Assuntos
Neoplasias da Bexiga Urinária/cirurgia , Hemorragia , Humanos , Ressecção Transuretral da Próstata/métodos , Resultado do Tratamento , Neoplasias da Bexiga Urinária/patologia , Cateterismo Urinário
19.
Gen Physiol Biophys ; 35(1): 77-86, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26612920

RESUMO

The mechanisms underlying the renoprotective effect for remote limb ischemic preconditioning (rIPC) against renal ischemia/reperfusion injury need further elucidation. In our work, one hundred and twenty male Sprague Dawley rats were randomized into 3 groups; sham, I/R group (left renal 45 min ischemia) and rIPC (as I/R group with 3 cycles of left femoral ischemic PC just before renal ischemia). Rats were sacrificed at 2 h, 24 h, 48 h and 7 days. Serum creatinine and urea were measured at the baseline and endpoints. Also, histopathological examination and assessment of the expression of inflammatory cytokines e.g. TNF-α, IL-1ß and ICAM-1 and antioxidant genes: Nrf2, HO-1 and NQO-1 and anti-apoptotic gene Bcl-2 in left kidney were done by the end of experiment. The results of this study demonstrated that, rIPC caused significant improvement in serum creatinine and BUN levels and in the expression of antioxidant genes and Bcl-2 antiapoptotic gene with significant attenuation of pro-inflammatory cytokines and histopathological damage score at all-time points compared to I/R group (p ≤ 0.05). In conclusion, inhibition of inflammatory cytokine (TNF-α, IL-1ß and ICAM-1) formation and activation of antioxidant genes: Nrf2, HO-1 and NQO-1 and anti-apoptotic gene Bcl-2 could be possible underlying mechanisms for the renoprotective effect of rIPC.


Assuntos
Antioxidantes/metabolismo , Citocinas/imunologia , Fatores Imunológicos/sangue , Precondicionamento Isquêmico/métodos , Nefropatias/fisiopatologia , Traumatismo por Reperfusão/fisiopatologia , Animais , Proteínas Reguladoras de Apoptose , Membro Posterior/irrigação sanguínea , Nefropatias/sangue , Nefropatias/prevenção & controle , Testes de Função Renal , Masculino , Ratos , Ratos Sprague-Dawley , Traumatismo por Reperfusão/sangue , Traumatismo por Reperfusão/prevenção & controle , Resultado do Tratamento
20.
Arab J Urol ; 13(4): 258-63, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26609444

RESUMO

OBJECTIVES: To assess the probability of spontaneous stone passage and its predictors after drainage of obstructed kidney by JJ stent, as insertion of an internal ureteric stent is often used for renal drainage in cases of calcular ureteric obstruction. PATIENTS AND METHODS: Between January 2011 and June 2013, patients for whom emergent drainage by ureteric stents were identified. The patients' demographics, presentation, and stone characteristics were reviewed. The primary endpoint for this study was stone-free status at the time of stent removal, where all patients underwent non-contrast spiral computed tomography (NCCT) before stent removal. Ureteroscopic stone extraction was performed for CT detectable ureteric stones at the time of stent removal. Potential factors affecting the need for ureteroscopic stone extraction at the time of stent removal were assessed using univariate and multivariate statistical analyses. RESULTS: Emergent ureteric stents were undertaken in 196 patients (112 males, 84 females) with a mean (SD) age of 53.7 (16.2) years, for renal obstruction drainage. At the time of stent removal, 83 patients (42.3%) were stone free; with the remaining 113 patients (57.7%) undergoing ureteroscopic stone extraction. On multivariate analysis, stone width [odds ratio (OR) 15.849, 95% confidence interval (CI) 2.83; P = 0.002) and radio-opaque stones (OR 12.035, 95% CI 4.65; P < 0.001) were independent predictors of the need for ureteroscopic stone extraction at the time of stent removal. CONCLUSION: Spontaneous ureteric stone passage is possible after emergent drainage of an obstructed kidney by ureteric stenting. Stone opacity, larger stone width, and positive preoperative urine culture are associated with a greater probability of requiring ureteroscopic stone extraction after emergent drainage by ureteric stenting.

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