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1.
World J Urol ; 2018 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-30105456

RESUMO

PURPOSE: Shock wave lithotripsy (SWL) in treatment of bladder and urethral stones was not precisely determined. The objective of this study is to compare the efficacy and safety of SWL versus visual cystolitholapaxy in the management of calcular acute urine retention. METHODS: From March 2015 to February 2017, a randomised controlled study was conducted on 100 patients for whom urethral catheter fixed for acute retention of urine due to urethral or vesical radio-opaque stone(s) ≤ 2 cm. Patients were randomised to either SWL group (n = 50) or visual cystolitholapaxy (endoscopy group) (n = 50). RESULTS: No statistically significant differences between the pre-operative parameters of both groups were found. The mean stone diameter was 12.2 ± 3 mm and 12.2 ± 3.2 mm in SWL and endoscopy groups, respectively (p value = 0.4). The overall success rates of SWL group were 94% (47 of 50 patients) and endoscopy group were 98% (49 of 50 patients). SWL failed in 3 patients (6%); these 3 patients underwent cystolitholapaxy and were rendered free of stones. Intra-operative and post-operative complications were comparable between both groups (p value = 0.5 and 1, respectively). One patient had bladder perforation in the endoscopy group and was managed conservatively. CONCLUSIONS: SWL mono-therapy is safe, non-invasive and as effective as visual cystolitholapaxy in management of patients presenting with acute urine retention by vesical or urethral stones 2 cm or less and could be useful for patients unwilling/unfit for general anaesthesia.

2.
Urology ; 117: 131-136, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29649545

RESUMO

OBJECTIVE: To demonstrate the long-term outcome of a contemporary series of 64 children who underwent complete primary repair of bladder exstrophy (CPRE) in a single tertiary referral center. MATERIALS AND METHODS: Between 1998 and 2012, 64 children, 47 boys and 17 girls, were identified. Only 60 of the 64 cases were available for follow-up. The follow-up was done by renal bladder ultrasound and serum creatinine every 3 months and voiding cystourethrogram from 6 to 12 months postoperatively. Continence was defined as dryness ≥3 hours. RESULTS: Median (range) follow-up is 14 years (from 5 to 19 years). Voided continence was achieved in 14 children (23%) after CPRE only. Additionally, 6 children were continent after bladder neck reconstruction (BNR) and 2 after bladder neck injection (BNI), raising the percentage of voided continence to 36%. The remaining 38 (64%) patients were using clean intermittent catheterization. All cases were continent at last assessment. The results of BNR or BNI were better in de novo than in redo cases (P <.05). The percentage of cases that needed augmentation ileocystoplasty in combination with multiple bladder neck procedures was lower in both female and de novo cases (P <.05). CONCLUSION: The percentage of children with classic bladder exstrophy who underwent CPRE who will achieve continence with volitional voiding via the urethra is 36%. The continence results after BNR and BNI are better in de novo cases than in redo ones. Continence in female and de novo cases is more likely to be achieved with lower number of continence procedures.

3.
J Pediatr Surg ; 53(8): 1461-1463, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29680277

RESUMO

OBJECTIVE: To detect whether grafting the incised plate during Snodgrass repair would improve outcome. MATERIALS AND METHODS: Sixty patients with primary distal hypospadias were included. Patients were equally randomized using closed envelop method to either Snodgrass or grafted tubularized incised plate repair (GTIP). All operations were performed by a single surgeon. All intaroperative data were recorded. All patients were followed up for 1 year. Success was defined as slit shaped meatus at the tip of the glans with no stenosis, fistula or diverticulum. RESULTS: All 60 patients were evaluated at 1 year of follow-up. Mean age at surgery was 40±15months. Both groups were comparable as regard to patients' age, meatus location, length and width and depth of urethral plate and glans width. Success was documented in 29/30 patients (96.7%) in the Snodgrass group. The only complication was meatal stenosis in one patient, whereas success was documented in 28/30 patients (93.3%) in the GTIP group. The two failures were secondary to partial glans dehiscence. Success rate was not statistically different. Flow rate data at 1 year showed insignificant difference between both groups as regards Q-max and voiding time. The only statistically significant difference between both groups was a longer operative time 106±12min in the GTIP group compared to only 77±9 for the Snodgrass group (p = 0.005). CONCLUSIONS: Snodgrass and GTIP techniques for primary distal hypospadias repair have similar outcome. With a significantly shorter operative time, Snodgrass repair remains the first choice for primary distal hypospadias repair. TYPE OF THE STUDY: Prospective randomized study. LEVEL OF EVIDENCE: Level I.


Assuntos
Hipospadia/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos , Uretra/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Pré-Escolar , Fístula/cirurgia , Seguimentos , Humanos , Lactente , Masculino , Estudos Prospectivos , Resultado do Tratamento
4.
Indian J Crit Care Med ; 21(9): 589-593, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28970659

RESUMO

CONTEXT: The partial pressure of venous to arterial carbon dioxide gradient (PCO2 gap) is considered as an alternative marker of tissue hypoperfusion and has been used to guide treatment for shock. AIMS: The aim of this study was to investigate the prognostic value of venous-to-arterial carbon dioxide difference during early resuscitation of patients with septic shock and compared it with that of lactate clearance and Acute Physiology and Chronic Health Evaluation II (APACHE-II) score. SETTINGS AND DESIGN: Forty patients admitted to one Intensive Care Unit were enrolled. SUBJECTS AND METHODS: APACHE-II score was calculated on admission. An arterial blood gas, central venous, and lactate samples were obtained on admission and after 6 h, and lactate clearance was calculated. Patients were classified retrospectively into Group I (survivors) and Group II (nonsurvivors). Pv-aCO2 difference in the two groups was evaluated. STATISTICAL ANALYSIS USED: Data were fed to the computer and analyzed using IBM SPSS software package version 20.0. RESULTS: At T0, Group II showed high PCO2 gap (8.37 ± 1.36 mmHg) than Group I (7.55 ± 0.95 mmHg) with statistically significant difference (P = 0.030). While at T6, Group II showed higher PCO2 gap (9.48 ± 1.47 mmHg) with statistically significant difference (P < 0.001) and higher mean lactate values (62.71 ± 23.66 mg/dl) with statistically significant difference (P < 0.001) than Group I where PCO2 gap and mean lactate values became much lower, 5.91 ± 1.12 mmHg and 33.61 ± 5.80 mg mg/dl, respectively. Group I showed higher lactate clearance (25.42 ± 6.79%) with statistically significant difference (P < 0.001) than Group II (-69.40-15.46%). CONCLUSIONS: High PCO2 gap >7.8 mmHg after 6 h from resuscitation of septic shock patients is associated with high mortality.

5.
Urology ; 108: 171-174, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28705578

RESUMO

Cloacal duplication is an exceedingly rare group of anomalies with a limited number of cases reported so far. The anomaly may be confined to partial bladder duplication or it may involve complete duplication of the urogenital tract, hindgut, spine, lower limbs, and vascular structures. Every case is unique and ought to be approached individually. By means of imaging studies and endoscopy, anatomic details should be carefully defined before endorsing surgical correction. A satisfactory outcome can be achieved in the majority of cases. In this report, we describe 3 girls with cloacal duplication, and review pertinent imaging and surgical management.


Assuntos
Cloaca/anormalidades , Gerenciamento Clínico , Procedimentos Cirúrgicos Reconstrutivos/métodos , Anormalidades Urogenitais/cirurgia , Procedimentos Cirúrgicos Urogenitais/métodos , Criança , Pré-Escolar , Cloaca/diagnóstico por imagem , Cloaca/cirurgia , Cistoscopia , Feminino , Humanos , Lactente , Imagem por Ressonância Magnética , Doenças Raras , Ultrassonografia , Anormalidades Urogenitais/diagnóstico
6.
Ren Fail ; 39(1): 77-82, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27788614

RESUMO

RATIONAL: Septic acute kidney injury (AKI) is a prevalent complication in intensive care units with an increased incidence of complications. OBJECTIVE: The aim of the present study was to assess the use of high-resolution melting curve (HRM) analysis in investigating whether the genetic polymorphisms; -308 G/A of tumor necrosis factor-α (TNF-α), and -1082 G /A of Interleukin-10 (IL-10) genes may predispose patients diagnosed with severe sepsis to the development of AKI. METHODS: One hundred and fifty patients with severe sepsis participated in the present study; only sixty-six developed AKI. Both polymorphisms were studied using HRM analysis. MAIN FINDINGS: The low producer genotype of both studied polymorphism of TNF-α and IL-10 genes was associated with AKI. Using logistic regression analysis, the low producer genotypes remained an independent risk factor for AKI. A statistically significant difference was detected between both studied groups as regards the low producer genotype in both TNF-α (-308 G/A) and interleukin-10 (IL-10) (-1082 G/A) polymorphisms being prevalent in patients developing AKI. Principle conclusions: The low producer genotypes of both TNF-α (-308 G/A) and IL-10 (-1082 G/A) polymorphisms could be considered a risk factor for the development of AKI in critically ill patients with severe sepsis, thus management technique implemented for this category should be modulated rescuing this sector of patients from the grave deterioration to acute kidney injury. Using HRM for genotyping proved to be a highly efficient, simple, cost-effective genotyping technique that is most appropriate for the routine study of large-scale samples.


Assuntos
Lesão Renal Aguda/genética , Interleucina-10/genética , Polimorfismo Genético , Sepse/complicações , Fator de Necrose Tumoral alfa/genética , Lesão Renal Aguda/etiologia , Feminino , Frequência do Gene , Predisposição Genética para Doença , Humanos , Unidades de Terapia Intensiva , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco
7.
Urology ; 101: 161-162, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27993712

RESUMO

Bladder neck closure (BNC) is the ultimate bladder neck reconstruction. If reconstruction fails, closure must be considered as it gives the highest continence rate. The vast majority of BNCs are performed through an abdominal approach (either transvesical or extravesical approach), but perineal approach remains an option for BNC with considerable success rate. Perineal hernia, which is defined as protrusion of abdominal contents through the perineal defect, is a very rare complication after urologic procedures. We report a case of perineal hernia post perineal BNC.


Assuntos
Epispadia/cirurgia , Hérnia/etiologia , Herniorrafia/métodos , Períneo , Complicações Pós-Operatórias/etiologia , Telas Cirúrgicas , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Criança , Hérnia/diagnóstico , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Reoperação , Tomografia Computadorizada por Raios X , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/cirurgia , Urografia
8.
Scand J Urol ; 50(6): 433-438, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27589558

RESUMO

OBJECTIVE: The aim of this study was to review different management modalities and outcome of patients presenting with late intestinal obstruction (IO) after radical cystectomy (RC) or palliative cystectomy (PC). MATERIALS AND METHODS: Files of patients who presented with IO between January 1978 and June 2014 were reviewed. Patients who developed IO following either RC or PC more than 30 days after surgery were included. Patients' characteristics and management protocols were evaluated. Predictors for failure of conservative management and unfavorable outcome after surgical explorations were evaluated. Symptom-free and overall survival rates of patients with malignant IO was were recorded. RESULTS: The prevalence of IO was 2.8% after RC (118 out of 4199 patients) and 10% after PC (nine out of 87). Colonic diversions had the highest prevalence (6.2%), followed by ileal loop conduit (2.9%); the lowest prevalences followed Kock pouch and ileal W neobladder (1.7% and 1.6%, respectively). Postoperative urinary leakage from a ureteroenteric anastomosis was the only predictor for surgical intervention (p = 0.039). Nine cases had been explored for malignant obstruction (eight after RC and one after PC). The mean ± SD elapsed time before death was 3.6 ± 2 months (range 0.5-17 months). CONCLUSIONS: Urinary diversion with colonic segments carries more risk for the development of IO in comparison with ileal segments. Postoperative urinary leakage after cystectomy and urinary diversion may be a contributory factor for surgical exploration in cases with late IO.


Assuntos
Cistectomia/efeitos adversos , Obstrução Intestinal/etiologia , Cuidados Paliativos , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/efeitos adversos , Adulto , Idoso , Fístula Anastomótica/etiologia , Fístula Anastomótica/cirurgia , Colo/cirurgia , Tratamento Conservador , Intervalo Livre de Doença , Feminino , Humanos , Íleo/cirurgia , Obstrução Intestinal/terapia , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Estruturas Criadas Cirurgicamente , Taxa de Sobrevida , Neoplasias da Bexiga Urinária/complicações , Derivação Urinária/métodos
9.
J Stroke Cerebrovasc Dis ; 25(11): 2756-2761, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27554074

RESUMO

BACKGROUND: Stroke is a leading cause of death and disability worldwide. Among all poststroke complications, pneumonia constitutes a major complication with a strong impact on morbidity and mortality. To identify patients at high risk of stroke-associated pneumonia (SAP) and to tailor a prophylactic approach, a reliable scoring model for prediction may be useful in daily stroke care. OBJECTIVES: This study aimed to compare the performance of the Age, Atrial fibrillation, Dysphagia, Sex, Stroke Severity (A2DS2) score, the acute ischemic stroke-associated pneumonia score (AIS-APS), and the Preventive ANtibacterial THERapy in acute Ischemic Stroke (PANTHERIS) score in predicting SAP. METHODS: Seventy consecutive patients with ischemic stroke admitted to the Critical Care Medicine Department of Alexandria Main University Hospital were included. Patients were prospectively followed up for primary outcome of pneumonia within the first 7 days after admission diagnosed by the Centers for Disease Control and Prevention criteria. Accuracy in predicting outcome measures was assessed by calculating the area under receiver operating characteristic curve (AUC). RESULTS: Twenty-six (37.1%) patients developed pneumonia by the seventh day; the A2DS2 score AUC was .847 (95% CI: .741-.922), and the AIS-APS AUC was .798 (95% CI: .685-.884). The PANTHERIS score AUC was .715 (95% CI: .595-.817). The A2DS2 score AUC was significantly higher than the AIS-APS and the PANTHERIS score AUCs (P = .048 and P = .009 respectively), and the AIS-APS AUC was significantly higher than the PANTHERIS score AUC (P = .044). CONCLUSIONS: The A2DS2 score is a valid tool for the prediction of SAP based on routinely collected data, and among the 3 studied scores, it shows the best performance in predicting SAP.


Assuntos
Isquemia Encefálica/diagnóstico , Indicadores Básicos de Saúde , Pneumonia/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Fatores Etários , Idoso , Área Sob a Curva , Fibrilação Atrial/epidemiologia , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/terapia , Transtornos de Deglutição/epidemiologia , Avaliação da Deficiência , Egito/epidemiologia , Feminino , Nível de Saúde , Mortalidade Hospitalar , Hospitais Universitários , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pneumonia/diagnóstico , Pneumonia/mortalidade , Pneumonia/prevenção & controle , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Fatores de Tempo
10.
J Crit Care ; 34: 74-6, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27288614

RESUMO

BACKGROUND: The management of mechanically ventilated patients depends on a combination of clinical skills and measurement of physiological parameters. OBJECTIVES: We evaluated the role of mitral annular plane systolic excursion (MAPSE) in the determination of left ventricular systolic function (LVSF) in mechanically ventilated obese patients. METHODS: A convenient sample of 60 of 68 obese, mechanically ventilated patients in the intensive care unit were included in the study. Transthoracic echocardiogram MAPSE measurement (averaged from 3 consecutive cycles) on 2 separate days, vs the eyeball ejection fraction (classic clinical method) on 2 separate days, and vs the biplane Simpson (classic research and consultative echocardiogram method) on 2 separate days was obtained. In patients with non sinus rhythm, measurements were collected over 5 to 10 heartbeats. RESULTS: There was a significant positive correlation between MAPSE and LVSF assessment using the eyeball method and Simpson method (r= 0.89 and 0.87, respectively; P< .001). Mitral annular plane systolic excursion was significantly shorter in duration (P< .001). CONCLUSIONS: Mitral annular plane systolic excursion is useful, an easier technique, and shorter in duration compared with the eyeball method in the determination of LVSF in mechanically ventilated obese patients.


Assuntos
Ecocardiografia/métodos , Ventrículos do Coração/diagnóstico por imagem , Valva Mitral/diagnóstico por imagem , Obesidade , Respiração Artificial , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Volume Sistólico , Sístole , Disfunção Ventricular Esquerda/fisiopatologia
12.
Neurourol Urodyn ; 35(4): 497-502, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25663249

RESUMO

AIMS: Post-exstrophy incontinence is a challenge because continence is difficult to achieve and more difficult to maintain. Feasibility and outcomes of a bulbourethral sling to treat post-exstrophy incontinence is shown in this report. METHODS: A retropubic bulbourethral sling was applied to male patients with incontinence post-exstrophy-epispadius repair. The study included children with total (continuous) incontinence who underwent multiple previous anti-incontinence procedures, ranging from bladder neck injection to bladder neck reconstruction. Preoperative assessment includes urinalysis, renal US, VCUG, 1-hr pad test and urodynamics. The bulbourethral sling applied is made of polypropylene and is suspended by 4 pairs of nylon sutures, to support the bulbar urethra within its covering muscles with the sutures tied on the rectus muscles. Continence was evaluated as well as adverse events. RESULTS: Seventeen children, (median age 8.7 years) completed 24-month of follow up. All had CPRE. Five children (29.27%) were dry. Four micturated through the urethra and one by catheterizing his cutaneous stoma every 3-4 hr. In none, PVR exceeded 10% of expected capacity. Four children underwent re-tightening 1-4 weeks after removal of urethral catheter. Perineal wound dehiscence occurred in one, perineal/suprapubic pain in seven and epididymo-orchitis in one child. CONCLUSION: The current technique is promising for difficult cases of incontinence after CPRE. It is safe, as no serious adverse events occurred during follow up period. It is economic and re-tightening is easy to perform. Neurourol. Urodynam. 35:497-502, 2016. © 2015 Wiley Periodicals, Inc.


Assuntos
Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Slings Suburetrais , Uretra/cirurgia , Incontinência Urinária/cirurgia , Adolescente , Criança , Pré-Escolar , Seguimentos , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Bexiga Urinária/cirurgia , Incontinência Urinária/etiologia , Urodinâmica
13.
J Urol ; 194(5): 1414-9, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25986509

RESUMO

PURPOSE: We sought to evaluate long-term outcomes of the Bricker conduit urinary diversion in children. MATERIALS AND METHODS: We retrospectively reviewed the database of a single tertiary center for children who had undergone ileal conduit between 1981 and 2011. Patients followed for less than 1 year were excluded. Patient files were reviewed for demographics, diversion indication, preoperative imaging, surgical details, hospital readmissions and followup data. Renal function at baseline and last followup was assessed by estimated glomerular filtration rate, calculated using the modified Schwartz or MDRD (Modified Diet in Renal Disease) formula. Growth charts elucidated patient growth patterns, while an internally designed quality of life questionnaire demonstrated patient and family satisfaction with the procedure. RESULTS: We evaluated 29 children who underwent Bricker conduit at a median age of 10 years (range 2 to 18) and were followed for a median of 91 months (16 to 389). Neuropathic bladder was the underlying diagnosis in 72.4% of cases. Hydronephrosis improved or remained stable in 39 of 55 studied renal units (70.9%). Although no statistically significant difference was observed between mean ± SD baseline (64.5 ± 46 ml/minute/1.73 m(2)) and last followup estimated glomerular filtration rate (54.1 ± 44.9 ml/minute/1.73 m(2)), chronic kidney disease stage had worsened in 13 patients (44.8%), end-stage kidney disease had developed in 11 patients and 9 patients had died. Six patients underwent undiversion after stabilization of renal function. Linear growth was negatively affected in 12 patients (41.4%), and 85% reported poor quality of life. A total of 19 hospital readmissions were required in 14 patients to treat diversion related complications. CONCLUSIONS: The Bricker conduit does not seem to halt renal deterioration in children. Negative impact on growth and quality of life, and the anticipated rate of complications are significant limitations of the procedure in the pediatric population.


Assuntos
Íleo/cirurgia , Nefropatias/cirurgia , Complicações Pós-Operatórias/epidemiologia , Qualidade de Vida , Derivação Urinária/métodos , Adolescente , Criança , Pré-Escolar , Egito/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Derivação Urinária/psicologia
14.
Urology ; 85(4): 896-9, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25669733

RESUMO

OBJECTIVE: To test the predictive value of distal ureteral diameter (UD) on reflux resolution after endoscopic injection in children with primary vesicoureteral reflux (VUR). MATERIALS AND METHODS: This was a retrospective review of patients diagnosed with primary VUR between 2009 and 2012 who were managed by endoscopic injection. Seventy preoperative and postoperative voiding cystourethrograms were reviewed. The largest UD within the false pelvis was measured. The UD was divided by the L1-L3 vertebral body distance to get the UD ratio (UDR). One radiologist interpreted the findings of voiding cystourethrography in all patients. Clinical outcome was defined as reflux resolution. RESULTS: Seventy patients were enrolled in this series (17 boys and 53 girls). Mean age was 5.9 years (1.2-13 years). Grade III presented in 37 patients (53%), and 33 patients (47%) were of grade IV. Mean distal UD was 5.5 mm (2.5-13 mm). Mean UDR was 37.8% (18%-70%). Macroplastique injection was performed in all. Subureteric injection was performed in 60 patients (86%), whereas intraureteric injection was performed in 10 patients. No postoperative complications were detected. The effect of grade, UD, and UDR on success after endoscopic injection was tested. UD and UDR were significant predictors of reflux resolution on logistic regression analysis (P <.007 and .001, respectively). CONCLUSION: UDR provides an objective measurement of VUR and appears as a predictive tool of success after endoscopic injection.


Assuntos
Dimetilpolisiloxanos/administração & dosagem , Ureter/anatomia & histologia , Agentes Urológicos/administração & dosagem , Refluxo Vesicoureteral/tratamento farmacológico , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Vértebras Lombares/anatomia & histologia , Vértebras Lombares/diagnóstico por imagem , Masculino , Valor Preditivo dos Testes , Radiografia , Estudos Retrospectivos , Ureter/diagnóstico por imagem , Ureteroscopia , Refluxo Vesicoureteral/diagnóstico por imagem
15.
Urology ; 85(1): 195-8, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25444630

RESUMO

OBJECTIVE: To report our experience with different approaches for management of pouch stones in children with ileal-based urinary reservoir. PATIENTS AND METHODS: Charts of children who underwent ileal-based urinary reservoirs between 2000 and 2009 were retrospectively reviewed. Patients who were diagnosed with reservoir calculi were identified; medical records were reviewed for patients' demographics, diversion details, stone criteria, mode of treatment, perioperative complications, and recurrence rate. RESULTS: We identified 26 children with pouch stones after urinary diversion. There were 11 boys (42%) and 15 girls (58%). Mean age was 11 years (range, 4-16 years). Mean time for diagnosis was 42 months (24-120 months). Pouch stones were asymptomatic in 10 patients (38%). Fifteen cases were postbladder augmentation and 11 cases postcontinent cutaneous diversion. The mean stone size was 4 cm (range, 1-10 cm), and mean Hounsfield Unit was 585 (205-1090). Seventeen children (65%) had positive urine culture result, whereas 9 children were sterile. Seven children (27%) required open poucholithotomy, whereas 19 patients (73%) were managed endoscopically. Percutaneous approach was done in 5 children, whereas urethral access was used in 7 children. Mechanical extraction was performed in 12 cases, and stone disintegration was required in 7 cases. Eight children developed stone recurrence. Mean time for recurrence was 11 months (range, 3-19 months). Six children were after endoscopic disintegration, and all required redo endoscopic extraction. Stone analysis was available in 15 patients (struvite stones in 10 cases and calcium phosphate in 5 cases). CONCLUSION: Pouch stones are established long-term complication of urinary diversion. Open and endoscopic approaches are valid treatment strategies.


Assuntos
Íleo/cirurgia , Complicações Pós-Operatórias/terapia , Bexiga Urinária/cirurgia , Cálculos Urinários/terapia , Coletores de Urina , Adolescente , Anastomose Cirúrgica , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estudos Retrospectivos
16.
Urol Int ; 93(4): 406-10, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25139453

RESUMO

OBJECTIVE: To study the predictive value of 6 ultrasonographic (USG) parameters for early detection of children at risk of recurrent obstruction. PATIENTS AND METHODS: A prospective nonrandomized study included all patients who underwent pyeloplasty between 2010 and 2012. All of the patients had completed at least 6 months of follow-up and preoperative and postoperative USG imaging data were available. The primary outcome was the correlation between USG and diuretic scintigraphic parameters. The secondary outcome was the predictive ability of the pelvicalyceal system parameters, measured by USG, of parenchymal growth after surgery. RESULTS: Sixty-eight patients were evaluated. The mean age was 3.6 years (range 0.1-12). The mean (± standard deviation) differential renal function improved from 37.4 ± 11 ml/min to 37.7 ± 14 ml/min, which was a difference of no statistical significance. On the other hand, the mean (± SD) half-time (T1/2) significantly improved. After constructing a linear regression model of the 4 USG parameters and the parenchymal growth, the model explained 57.2% of the variance in parenchymal growth after pyeloplasty. The calyx-to-parenchyma ratio change was the largest unique contribution for explaining the variance in parenchymal growth, followed by anteroposterior diameter and calyceal dilatation. CONCLUSION: We proved that calyx-to-parenchyma ratio, anteroposterior diameter and calyceal dilatation are independent predictors of early success after pyeloplasty.


Assuntos
Rim/diagnóstico por imagem , Obstrução Ureteral/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Fatores Etários , Criança , Pré-Escolar , Diurese , Feminino , Humanos , Lactente , Rim/crescimento & desenvolvimento , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Radiografia , Recuperação de Função Fisiológica , Stents , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/fisiopatologia , Procedimentos Cirúrgicos Urológicos/instrumentação
17.
Urology ; 83(5): 1145-8, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24485997

RESUMO

OBJECTIVE: To evaluate the long-term outcomes of perineal anastomotic urethroplasty for post-traumatic pediatric posterior urethral strictures. METHODS: We retrospectively reviewed the medical records of 65 boys who had a perineal anastomotic urethroplasty for post-traumatic posterior urethral strictures between 1991 and 2010. Patients were followed up for a mean (range) of 78 (13-210) months by a history, urinary flow rate estimate, retrograde urethrography, and voiding cystourethrography. Regression analysis was done to assess the predictors of success after urethroplasty. RESULTS: The mean (range) age of the patients was 9.3 (3-16) years. The estimated radiographic stricture length before surgery was 2.4 (1-5) cm. All patients presented with a suprapubic cystostomy tube and scheduled for delayed or repeated correction of a urethral stricture. Twenty boys (30%) had failed previous attempts of repair elsewhere. Mean interval between the original trauma and repair in new cases, and since the last repair in recurrent cases, was 7 months. The perineal anastomotic repair was successful in 58 of 65 (89%) patients. All treatment failures were at the anastomosis and were within the first year. Failed repairs were successfully managed endoscopically in 5 patients and by repeat perineal anastomotic repair in the remaining 2. All boys are continent. There was no chordee or urethral diverticula during the follow-up. CONCLUSION: One-stage perineal anastomotic repair of post-traumatic urethral strictures in boys is feasible with minimal morbidity. Denovo cases and surgeon experience are the predictors of success after urethroplasty.


Assuntos
Períneo/cirurgia , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Adolescente , Anastomose Cirúrgica/métodos , Criança , Pré-Escolar , Humanos , Masculino , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos/métodos
18.
J Urol ; 192(1): 194-9, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24518781

RESUMO

PURPOSE: Staging of childhood renal tumors is crucial for treatment planning and outcome prediction. We sought to identify whether computerized tomography could accurately predict the local stage of childhood renal tumors. MATERIALS AND METHODS: We retrospectively reviewed our database for patients diagnosed with childhood renal tumors and treated surgically between 1990 and 2013. Inability to retrieve preoperative computerized tomography, intraoperative tumor spillage and nonWilms childhood renal tumors were exclusion criteria. Local computerized tomography stage was assigned by a single experienced pediatric radiologist blinded to the pathological stage, using a consensus similar to the Children's Oncology Group Wilms tumor staging system. Tumors were stratified into up-front surgery and preoperative chemotherapy groups. The radiological stage of each tumor was compared to the pathological stage. RESULTS: A total of 189 tumors in 179 patients met inclusion criteria. Computerized tomography staging matched pathological staging in 68% of up-front surgery (70 of 103), 31.8% of pre-chemotherapy (21 of 66) and 48.8% of post-chemotherapy scans (42 of 86). Computerized tomography over staged 21.4%, 65.2% and 46.5% of tumors in the up-front surgery, pre-chemotherapy and post-chemotherapy scans, respectively, and under staged 10.7%, 3% and 4.7%. Computerized tomography staging was more accurate in tumors managed by up-front surgery (p <0.001) and those without extracapsular extension (p <0.001). CONCLUSIONS: The validity of computerized tomography staging of childhood renal tumors remains doubtful. This staging is more accurate for tumors treated with up-front surgery and those without extracapsular extension. Preoperative computerized tomography can help to exclude capsular breach. Treatment strategy should be based on surgical and pathological staging to avoid the hazards of inaccurate staging.


Assuntos
Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Tomografia Computadorizada por Raios X , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estadiamento de Neoplasias/métodos , Valor Preditivo dos Testes , Estudos Retrospectivos
19.
Arab J Urol ; 12(2): 130-6, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26019937

RESUMO

OBJECTIVES: To review our 10-year experience with uncommon testicular tumours in children (prepubertal testicular and paratesticular), to review previous reports, and to determine the appropriate management of these rare tumours, specifically the role of testicular-sparing surgery. PATIENTS AND METHODS: We retrospectively reviewed all cases of testicular tumours managed at our institution between 1999 and 2009. Boys aged <16 years were included in the study. The patients' characteristics, presentation, the diagnostic tools, tumour markers, mode of treatment, pathological findings and outcome were assessed. We reviewed previous reports that addressed testicular and paratesticular tumours in prepubertal boys, using a Medline/PubMed search. RESULTS: From 80 patients, 13 boys (median age 8.7 years) presented with testicular tumours (16%) and were included in the study. Two boys presented with precocious puberty and one with gynaecomastia. The level of α-fetoprotein was high in three boys, and the human chorionic gonadotrophin level was elevated in one, and both markers were high in one. Testicular-sparing surgery was performed in three boys. Six of the 13 tumours were malignant and seven were benign. None of the patients developed a recurrence or testicular atrophy after testicular-sparing surgery. From the review of previous reports we devised an evidence-based algorithm for managing prepubertal testicular tumours. CONCLUSIONS: Paediatric testicular tumours are rare but they require an inguinal approach for either orchidectomy or testicular-sparing surgery; we recommend the latter option as long as frozen sections are analysed and a safety margin is maintained.

20.
Urology ; 82(6): 1405-9, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24139350

RESUMO

OBJECTIVE: To evaluate the prognostic role of antenatal diagnosis of posterior urethral valves (PUVs) on ultimate renal function. METHODS: Between 1990 and 2010, 315 patients with PUVs were diagnosed and treated at 2 separate tertiary centers. Primary valve ablation was performed in all patients except 18, who underwent initial vesicostomy. Patients were divided into two groups: group 1 included 144 patients who were diagnosed antenatally, and group 2 included 171 patients with a postnatal diagnosis. Long-term functional and radiologic outcomes were assessed. RESULTS: Follow-up was a median 5.5 years (range, 2-15 years). Mean age at ablation was 2.5 years (range, 1 day-15 years). Chronic kidney disease developed at the end of follow-up in 96 patients (30%): 27 (19%) in group 1 and 69 (40%) in group 2 (P <.05). The mean nadir serum creatinine was 0.6 and 0.8 mg/dL in groups 1 and 2, respectively, and the mean final serum creatinine was 0.9 and 1.7 mg/dL, respectively (P <.05). Persistent upper tract dilatation was noted in 43% of group 1 patients and in 69% of group 2 patients (P <.05). CONCLUSION: The potential for recovering renal function is believed to be significant in patients in whom early detection of PUVs and, hence, early intervention was performed. Antenatal screening and detection of these patients might play a significant role in protecting the upper tract and reducing the incidence of chronic kidney disease.


Assuntos
Insuficiência Renal Crônica/diagnóstico , Uretra/anormalidades , Adolescente , Anti-Infecciosos/uso terapêutico , Criança , Pré-Escolar , Creatinina/sangue , Feminino , Humanos , Incidência , Lactente , Masculino , Gravidez , Diagnóstico Pré-Natal , Prognóstico , Insuficiência Renal Crônica/epidemiologia , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Refluxo Vesicoureteral/tratamento farmacológico
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