Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 68
Filtrar
Filtros adicionais











País/Região como assunto
Intervalo de ano
1.
Int. braz. j. urol ; 45(3): 581-587, May-June 2019. tab
Artigo em Inglês | LILACS-Express | ID: biblio-1012333

RESUMO

ABSTRACT Introduction: The main aim of stone surgery is to establish stone free status. Performing flexible nephroscopy is an effective tool in this manner. The aim of this study was to evaluate the role of retrograde flexible nephroscopy for detection of residual fragments following percutaneous nephrolithotomy (PNL) in comparison with antegrade approach. Materials and Methods: Data of 137 patients underwent ECIRS was collected prospectively. In all cases following stone clearance, collecting system was checked for residual fragments. First antegrade than retrograde flexible nephroscopy was performed and success rates to reach all calices and detection of residual fragments were noted. All patients underwent CT and success rate of antegrade and retrograde approaches were compared. PPV and NPV of retrograde approach to detect residual fragments were calculated. Results: Antegrade and retrograde nephroscopy successfully accessed all of the calices in 101 (73.7%) and 130 (94.9%) patients respectively (p<0.0001). Residual fragments were observed in 18 (13.1%) patients following antegrade flexible nephroscopy. Retrograde approach identified residual stones in 17 more cases. These cases were treated with flexible nephroscopy or secondary percutaneous tract. Postoperative CT revealed residual stones in 10 (7.3%) patients. PPV and NPV of retrograde flexible nephroscopy were 83.3% and 96.2%. Conclusions: Flexible nephroscopy effectively detects residual fragments following PNL. Retrograde approach was more successful than antegrade approach to reach all calices. We recommend performing retrograde flexible nephroscopy following PNL especially in complex cases as it has the potential to increase SFR, decrease the need for second look surgery and unnecessary postoperative imaging.

2.
Urology ; 128: 1-4, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30878682

RESUMO

The incidence of second primary cancer detection in patients with prostate cancer undergoing cross-sectional imaging for staging workup is 1.5%.1 Concomitant prostate cancer and clear-cell renal cell carcinoma is a rare condition. The coexistence of 2 synchronous neoplasm is highly infrequent. In this case, we present a combined robot-assisted operation for both procedures concurrently with a port strategy allowing reuse of ports.

3.
Int Braz J Urol ; 45(3): 581-587, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30901169

RESUMO

INTRODUCTION: The main aim of stone surgery is to establish stone free status. Performing fl exible nephroscopy is an effective tool in this manner. The aim of this study was to evaluate the role of retrograde fl exible nephroscopy for detection of residual fragments following percutaneous nephrolithotomy (PNL) in comparison with antegrade approach. MATERIALS AND METHODS: Data of 137 patients underwent ECIRS was collected prospectively. In all cases following stone clearance, collecting system was checked for residual fragments. First antegrade than retrograde fl exible nephroscopy was performed and success rates to reach all calices and detection of residual fragments were noted. All patients underwent CT and success rate of antegrade and retrograde approaches were compared. PPV and NPV of retrograde approach to detect residual fragments were calculated. RESULTS: Antegrade and retrograde nephroscopy successfully accessed all of the calices in 101 (73.7%) and 130 (94.9%) patients respectively (p<0.0001). Residual fragments were observed in 18 (13.1%) patients following antegrade fl exible nephroscopy. Retrograde approach identifi ed residual stones in 17 more cases. These cases were treated with fl exible nephroscopy or secondary percutaneous tract. Postoperative CT revealed residual stones in 10 (7.3%) patients. PPV and NPV of retrograde fl exible nephroscopy were 83.3% and 96.2%. CONCLUSIONS: Flexible nephroscopy effectively detects residual fragments following PNL. Retrograde approach was more successful than antegrade approach to reach all calices. We recommend performing retrograde fl exible nephroscopy following PNL especially in complex cases as it has the potential to increase SFR, decrease the need for second look surgery and unnecessary postoperative imaging.


Assuntos
Endoscopia/métodos , Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Adulto , Endoscopia/instrumentação , Desenho de Equipamento , Feminino , Humanos , Cálculos Renais/diagnóstico por imagem , Cálices Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/instrumentação , Estudos Prospectivos , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
4.
Urol J ; 2019 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-30636274

RESUMO

INTRODUCTION: To investigate the prognostic role of time to castration resistance(TTCR) in patients who have received solely Docetaxel chemotherapy regimen(DCR) for castration resistant prostate cancer(CRPC). Methods: Between Jan 2004 and Dec 2015, data of 162 patients who have received DCR for CRPC are detected. Patients were divided into three groups according to TTCR: Group 1(?12 months), group 2(13-24 months), and group 3(>24 months). Data of age, clinical stage, Gleason grade(GG), previous treatments, site of metastases, Prostate-specific antigen (PSA) values, TTCR, overall survival, biochemical progression free survival(PFS) and PSA response to docetaxel were recorded. RESULT: The mean age of the 162 patients was 74.4±8.5. Data on mean age, type of castration, adding estramustine to docetaxel, secondary hormonal manipulation, Gleason grade, clinical T stage at initial diagnosis and site of metastases were comparable between three groups. All PSA values were statistically significant higher in group 1 than other groups. PSA response to docetaxel was 59.2% in all patient and it was worse in group 1 than other groups(P=.009). Two years OS rates were 7.6%, 25% and 32.3% in group 1, 2 and 3, respectively. Median survival rates were 7, 14 and 23 months in group 1, 2 and 3, respectively, and this difference was statistically significant (P=.016). On multivariate analysis, TTCR was found to be independent prognostic factor for overall survival and response to docetaxel treatment. CONCLUSION: TTCR appears to be an independent prognostic factor for patients who are candidates for DCR.

5.
Urol J ; 2018 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-30345496

RESUMO

PURPOSE: To compare of changes in glomerular filtration rate (GFR) in patients who underwent radical cystectomy(RC) and multimodal treatment(MMT). MATERIALS AND METHODS: We identified 472 consecutive patients who underwent RC or treated with MMT for muscle invasive bladder cancer(MIBC) at our institution, between January 1995 and December 2010. After excluding the patients who died within 5 years or without 5 years of follow-up, 175 and 59 patients who were treated with RC and MMT, respectively were included to the study. GFR was measured before treatment and every 6 months after treatment till the end of 60th months. RESULTS: The mean age and mean baseline GFR were 66.5±5.7 and 85.1±18.2 mL/min/1.73m2, respectively for all patients. We detected statistically significant higher decrease rates for GFRs in MMT group compared to RC group at every follow up period till 42nd months. Renal function decreasing was found to be more prominent during first year of follow-up (79.1 to 65.9 mL/min/1.73m2) in MMT group. However, GFR decreased more regularly in RC group (~4 mL/min/1.73m2 per year). MMT, lower baseline GFR, Diabetes Mellitus, hypertension, and ureteroenteric anastomotic stricture development were associated with low GFR under 60 and 45 ml/min at the end of five years. CONCLUSION: Decreased renal function is noted in many MIBC patients after RC or MMT in the long-term follow-up. Renal function deterioration is more prominent within the first year after MMT.

6.
Can Urol Assoc J ; 12(11): E475-E479, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29989888

RESUMO

INTRODUCTION: Kidney displacement may alter the quality of renal puncture during percutaneous nephrolithotomy (PCNL). The aim of this study was to identify the rate of kidney displacement and parameters associated with kidney displacement in patients who underwent supine mini-PCNL. METHODS: Data of 98 consecutive patients who underwent mini-PCNL was collected prospectively. The patients were grouped as displacement-positive vs. -negative. The parameters collected were age, gender, body mass index, side of the kidney, punctured calyx, fluoroscopy time to successful puncture and tract dilation, stone-free and complication rates, stone diameter, length of the renal artery, and quantity of peri-renal and abdominal fat. Groups were compared for the above listed parameters and logistic regression analysis was performed to identify factors associated with kidney displacement. RESULTS: There were 34 and 64 patients in the displacement-positive and -negative groups, respectively. Groups were similar for stone-free and complication rates. Fluoroscopy time to puncture and tract dilation were longer in the displacement-positive group. Groups were different for renal artery length and peri-renal fat measurements. In multivariate analysis, lower pole puncture, renal artery length, and peri-renal fat measurement were found to be independent predictors of kidney displacement. CONCLUSIONS: Kidney displacement does not alter the success and complication rates, but is associated with longer fluoroscopy times during supine PCNL. In the current study, parameters in preoperative non-contrast computerized tomography (NCCT) associated with kidney displacement were identified. We recommend surgeons evaluate and take into account these parameters during preoperative planning to establish better outcomes and diminish fluoroscopy times.

7.
Artigo em Inglês | MEDLINE | ID: mdl-29745629

RESUMO

BACKGROUND: The aim of this study is to evaluate predictive factors of 68Gallium (68Ga) Prostate-Specific Membrane Antigen (PSMA) Positron Emission Tomography (PET)/Computed Tomography (CT) positivity. METHODS: Relationships between serum Prostate Specific Antigen (PSA), Lactate dehydrogenase (LDH) and alkaline phosphatase (ALP) levels, Gleason Score (GS) and positivity of 68Ga PSMA PET in patients who underwent 68Ga PSMA PET/CT for restaging for PCa were evaluated retrospectively. RESULTS: One hundred and four (median age: 67; range: 51-88) patients were included in this study. Of these patients, PSMA PET was positive in 75 (72%) patients. Mean serum PSA levels for PET negative and positive groups were 0.76±1.00 and 180.85±324.93 ng/ml (p<0.001). The sensitivity and specificity of 68Ga PSMA PET/CT for detection of disease recurrence were calculated as 92% and 80%, respectively, for the 1.4 ng/ml PSA cut-off and 92% and 90%, respectively, for the 2 ng/ml PSA cut-off values. The positivity rates for patients with PSA levels <1.4 ng/ml and ≥1.4 ng/ml were 21% and 90%, respectively (p<0.001). CONCLUSIONS: 68Ga PSMA PET/CT seems to be a highly sensitive in patients with early PSA recurrence. Patients with higher GS and early PSA recurrence could benefit from 68Ga PSMA PET/CT.

8.
Neurourol Urodyn ; 37(1): 257-262, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28480984

RESUMO

INTRODUCTION: Intravesical glucosaminoglycan (GAG) replacement therapies are commonly used in the treatment of bladder pain syndrome (BPS)/interstitial cystitis (IC). Different intravesical glucosaminoglycan products are currently available. In this prospective study, clinical efficacy of chondroitin sulfate and hyaluronic acid are compared in patients with BPS/IC. METHODS: Patients were randomized to CS and HA groups. All patients were evaluated for visual analogue pain scale (VAS), interstitial cystitis symptom index (ICSI), interstitial cystitis problem index (ICPI), voiding diary for frequency/nocturia, and mean urine volume per void at the beginning of the therapy and after 6 months. All patients had a potassium sensitivity test (PST) initially. Wilcoxon and Mann-Whitney U tests were used for statistical analysis. RESULTS: There were 21 patients in both groups. Mean age of patients in CS and HA groups were 47.10 and 48.90, respectively(P > 0.05). Before treatment, Parson's test was positive in 64.3% of patients (27/42) with no difference between groups. VAS of pain, ICSI, ICPI, frequency at 24 h and nocturia results have improved significantly at both treatment arms. Intravesical CS was also found superior to intravesical HA in terms of 24 h frequency, nocturia and ICPI (P < 0.05). No severe adverse effects were reported. CONCLUSIONS: Data comparing clinical efficiencies of different GAG therapies are very limited. In this study, intravesical CS was found superior to intravesical HA in terms of 24 h frequency, nocturia and ICPI in patients with BPS/IC in short term follow-up. To provide a definitive conclusion on superiority of one GAG therapy to others, further evaluation with long term follow up is required.

9.
Turk J Urol ; 43(2): 171-175, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28717542

RESUMO

OBJECTIVE: Hydronephrosis developing following ureteroscopy (URS) is an important issue associated with the long-term postoperative renal functions. Studies investigating the role of postoperative imaging revealed conflicting results. In this study, we aimed to determine the incidence and predictors of hydronephrosis following semirigid URS. MATERIAL AND METHODS: We evaluated the results of 455 patients who underwent U RS a nd postoperative imaging with non-contrast computed tomography (CT). Primary endpoints of the study were to determine the frequency of development of hydronephrosis and factors associated with the development of hydronephrosis. Logistic regression analysis was used to define factors effecting on the development of hydronephrosis. RESULTS: Postoperative non-contrast CT revealed hydronephrosis in 81 (17.8%) patients. Stone-free status was achieved in 415 (91.2%) patients. Univariate analysis revealed history of ipsilateral URS (p=0.001), duration of operation (p=0.022), presence of multiple stones (p=0.001), and occurrence of a renal colic episode postoperatively (p=0.013) as the parameters associated with increased risk of postoperative hydronephrosis. In the multivariate analysis, history of ipsilateral URS (OR: 2.724, p=0.017) and presence of multiple stones (OR: 2.116, p=0.032) were found to be the independent prognostic markers of developing postoperative hydronephrosis. CONCLUSION: Ipsilateral hydronephrosis following URS develops in a significant number of patients. In patients with history of ipsilateral hydronephrosis and multiple stones, risk of development of postoperative hydronephrosis is higher, therefore physicians should be keep these parameters in mind in the decision making process of selective imaging postoperatively.

10.
J Endourol ; 31(7): 725-728, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28467724

RESUMO

INTRODUCTION: Stone disease is an important health problem, and patients have different treatment choices. Shared decision making is recommended for deciding the treatment type, but patient education is necessary. Decision aids (DAs) are used for this aim, and herein, we developed a novel DA for patients with symptomatic nonlower pole renal stones <20 mm in diameter. MATERIALS AND METHODS: The DA development process was established based on the recommended guides. General characteristics of the stone disease and details of the shockwave lithotripsy and retrograde intrarenal surgery were included in the content of the DA. The DA was further revised based on the suggestions of different physician groups and patients. The DA was evaluated by three physicians (Delphi assessment-International Patient Decision Aid Standards [IPDAS] Collaboration standards) and 25 patients (questionnaire of six questions with five-point Likert scale). RESULTS: The DA was designed as a booklet, and Delphi group assessment resulted in a total score of 50/54. Patient evaluation of the DA resulted in favorable outcomes, and patients generally recommended its use by other patients. CONCLUSIONS: This novel DA for patients with a symptomatic nonlower pole renal stone <20 mm showed promising results and was well accepted by the patients. We believe that this DA will have a positive impact on patients' level of knowledge. Increased level of knowledge will also improve the patients' contribution to the shared decision-making process. A further prospective randomized trial to compare with the standard patient informing process is also planned.


Assuntos
Tomada de Decisões , Técnicas de Apoio para a Decisão , Cálculos Renais/terapia , Educação de Pacientes como Assunto/métodos , Adulto , Feminino , Humanos , Cálculos Renais/cirurgia , Litotripsia , Masculino , Pessoa de Meia-Idade , Folhetos , Participação do Paciente , Satisfação do Paciente
11.
Urolithiasis ; 45(6): 603-608, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28357451

RESUMO

INTRODUCTION: Percutaneous nephrolithotomy (PNL) is the primary treatment modality for management of staghorn stones. PNL in supine position has important advantages over prone positon. However, studies comparing prone and supine positions for PNL in staghorn stone patients have conflicting results, and the aim of the current study was to compare prone and supine positions for PNL in staghorn stone cases. PATIENTS AND METHODS: Data of patients underwent PNL for staghorn stones in supine or prone position by a single urologist were collected prospectively. The supine and prone position groups were compared for stone free rate (SFR) and complication rates. All patients were evaluated with NCCT for evaluation of SFR. Chi-square test was used to compare categorical variables and Student t test was applied for continuous variables of the treatment groups. RESULTS: The groups were similar for demographic and stone-related characteristics. Multi-caliceal and intercostal access was more common in prone position. Operation duration was significantly shorter and hemoglobin drop was significantly less in supine group. SFR was 64.1 and 60.4% in the supine and prone groups, respectively (p = 0.72). Complication rates were similar in the two groups but Clavien III complications were observed in two patients in the prone group. CONCLUSIONS: PNL in supine position is an effective treatment for management of staghorn stones. The need for multi-caliceal and intercostal puncture is less when combined with retrograde intrarenal surgery. PNL in supine position should be considered as primary treatment option in staghorn stone cases.


Assuntos
Nefrolitotomia Percutânea/métodos , Posicionamento do Paciente/métodos , Complicações Pós-Operatórias/epidemiologia , Adulto , Feminino , Humanos , Cálices Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Decúbito Ventral , Estudos Prospectivos , Cálculos Coraliformes , Decúbito Dorsal , Resultado do Tratamento
12.
Minerva Urol Nefrol ; 69(4): 342-348, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27733750

RESUMO

BACKGROUND: Primary treatment of choice for advanced germ cell tumors is 3 to 4 cycles of combination bleomycin-etoposide-cisplatin (BEP) chemotherapy. Although most patients treated for advanced germ cell tumors (GCT) will be cured, approximately 30% will fail to achieve a durable complete response (CR). Thrombocytosis has been found to be related with significantly shorter survival in many cancers. However, its role in testicular cancer patients has not been studied previously. The objective of this study was to investigate the relationship between thrombocytosis and chemotherapy response in patients with metastatic testicular cancer. METHODS: Records of 113 patients with advanced stage testicular cancer were reviewed. Treatment outcomes were classified as complete clinical response (cCR), partial clinical response (pCR), complete pathological response (cPR) and treatment failure and the relationship with thrombocytosis was investigated. Logistic regression analysis was performed to identify factors associated with treatment failure. RESULTS: Totally 103 patients met the eligibility criteria. Thrombocytosis was detected in 26 (25.2%) patients. Treatment failure was observed in 14 (53.8%) and 28 (36.4%) of the patients in the thrombocytosis and non-thrombocytosis groups respectively (P=0.037). Thrombocytosis and IGCCCG high-risk group are found as independent prognostic factors for treatment failure in multivariate analysis. CONCLUSIONS: Thrombocytosis is seen in 25% of patients with testicular GCT and it is found to be associated with poorer chemotherapy response in metastatic patients. It can be used to predict the response to chemotherapy.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Testiculares/tratamento farmacológico , Neoplasias Testiculares/patologia , Trombocitose , Adulto , Biomarcadores , Feminino , Humanos , Masculino , Metástase Neoplásica , Valor Preditivo dos Testes , Prognóstico , Resultado do Tratamento , Adulto Jovem
13.
Urol Oncol ; 35(1): 35.e15-35.e19, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27692834

RESUMO

OBJECTIVE: To evaluate the oncologic outcomes of nephron-sparing surgery (NSS) for localized chromophobe renal cell carcinoma (cRCC). MATERIAL AND METHODS: We performed a multicenter international study involving the French Network for Research on Kidney Cancer (UroCCR) and 5 international teams. Data from 808 patients treated with NSS between 2004 and 2014 for non-clear cell RCCs were analyzed. RESULTS: We included 234 patients with cRCC. There were 123 (52.6%) females. Median age was 61 (23-88) years. Median tumor size was 3 (1-11)cm. A positive surgical margin was identified in 14 specimens (6%). Pathologic stages were T1, T2, and T3a in 202 (86.3%), 9 (3.8%), and 23 (9.8%) cases, respectively. After a mean follow-up of 46.6 ± 36 months, 2 (0.8%) patients experienced a local recurrence. No patient had metastatic progression, and no patient died from cancer. Three-years estimated cancer-free survival and cancer-specific survival were 99.1% and 100%, respectively. CONCLUSION: Oncological results of NSS for localized cRCC are excellent. In this series, only 2 patients had a local recurrence, and no patient had metastatic progression or died from cancer.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Recidiva Local de Neoplasia , Néfrons , Tratamentos com Preservação do Órgão , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/patologia , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Renais/patologia , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Neoplasia Residual , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
14.
J Endourol ; 30(9): 1009-16, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27392789

RESUMO

INTRODUCTION: Triple D score was recently developed for prediction of extracorporeal shockwave lithotripsy (SWL) outcomes. However, it has not been validated. SWL in elderly patients results in lower success and higher complication rates. We aimed at externally validating Triple D score in a population ≥65 years of age. PATIENTS AND METHODS: We retrospectively analyzed the data of 182 patients ≥65 years of age who underwent SWL for renal or ureteral stones and were evaluated with non-contrast computed tomography before SWL. Stone volume (SV), skin-to-stone distance (SSD), and stone density were measured, and cutoff values were determined with receiver operator characteristic analysis. Triple D scores were calculated, and success rates were determined for each score. RESULTS: Mean SV, SSD, and stone density values were significantly higher in patients with failed outcomes compared with those with successful outcomes in both renal and ureteral cases. Cutoff values of 187.5 mm(3), 10.5 cm, and 675 HU for renal stones and of 185 mm(3), 11.5 cm, and 785 HU for ureteral stones were detected. Success rates of 95.5% and 95% were detected for patients with a Triple D score of 3 in the renal and ureteral stone groups, respectively. Success rates of patients with a Triple D score of 0 were 20% and 25% in the renal and ureteral stone groups, respectively. CONCLUSIONS: Triple D score correlated well with SWL outcomes in patients ≥65 years of age, and it is externally validated. Various factors may deal with cutoff levels of involved parameters. Therefore, we suggest that each institution determines its unique cutoff levels for SV, SSD, and stone density parameters and calculates the Triple D score for its patients with respect to these cutoff levels to predict the success after SWL and aid in decision making.


Assuntos
Cálculos Renais/diagnóstico por imagem , Cálculos Renais/terapia , Litotripsia/métodos , Tomógrafos Computadorizados , Cálculos Ureterais/diagnóstico por imagem , Cálculos Ureterais/terapia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Valores de Referência , Estudos Retrospectivos , Pele/diagnóstico por imagem , Resultado do Tratamento
15.
Int Braz J Urol ; 42(2): 334-8, 2016 Mar-Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27256188

RESUMO

INTRODUCTION: To evaluate possible factors that can guide the clinician to predict potential cases refractoriness to medical treatment for giggle incontinence (GI) and to examine the effectiveness of different treatment modalities. MATERIAL AND METHODS: The data of 48 children referred to pediatric urology outpatient clinic between 2000 and 2013 diagnosed as GI were reviewed. Mean age, follow-up, GI frequency, associated symptoms, medical and family history were noted. Incontinence frequency differed between several per day to less than once weekly. Children were evaluated with uroflowmetry-electromyography and post-void residual urine. Clinical success was characterized as a full or partial response, or nonresponse as defined by the International Children's Continence Society. Univariate analysis was used to find potential factors including age, sex, familial history, GI frequency, treatment modality and dysfunctional voiding to predict children who would possibly not respond to treatment. RESULTS: Mean age of the patients was 8.4 years (range 5 to 16). Mean follow-up time and mean duration of asymptomatic period were noted as 6.7±1.4 years and 14.2±2.3 months respectively. While 12 patients were treated with only behavioral urotherapy (Group-1), 11 patients were treated with alpha-adrenergic blockers and behavioral urotherapy (Group-2) and 18 patients with methylphenidate and behavioral urotherapy (Group-3). Giggle incontinence was refractory to eight children in-group 1; six children in-group 2 and eight children in-group 3. Daily GI frequency and dysfunctional voiding diagnosed on uroflowmetry-EMG were found as outstanding predictive factors for resistance to treatment modalities. CONCLUSIONS: A variety of therapies for GI have more than 50% failure rate and a standard treatment for GI has not been established. The use of medications to treat these patients would not be recommended, as they appear to add no benefit to symptoms and may introduce severe adverse effects.


Assuntos
Antagonistas Adrenérgicos alfa/uso terapêutico , Terapia Comportamental/métodos , Inibidores da Captação de Dopamina/uso terapêutico , Metilfenidato/uso terapêutico , Incontinência Urinária de Urgência/terapia , Adolescente , Criança , Pré-Escolar , Terapia Combinada , Feminino , Seguimentos , Humanos , Riso , Modelos Logísticos , Masculino , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
16.
J Endourol ; 30(8): 850-5, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27189236

RESUMO

INTRODUCTION: In this study, we aimed to investigate the effect of prestenting on success and complication rates of pediatric ureterorenoscopy (URS) procedures. PATIENTS AND METHODS: We retrospectively analyzed the data of 251 pediatric URS cases. Forty-seven of the patients were prestented. Success and complication rates of the prestented and nonprestented groups were compared and further analysis was performed with respect to stone location (renal vs ureteral) and size (7-mm cutoff). Multivariate analysis was performed to define factors associated with success rates. RESULTS: Mean age of the population was 8.9 years. Success rate of the entire population was 80.5% and significant difference between prestented and nonprestented groups was detected (91.5% vs 77.9%, p = 0.04). Higher success rates of the prestented group were also observed in ureteral stones (94.1% vs 79.5%, p = 0.04) and stones >7 mm (84.6% vs 74.1%, p = 0.72). Prestented group showed higher success rates in kidney stones, but the difference was insignificant (84.6% vs 74.1%, p = 0.72). Prestenting was also identified as an independent predictor of success in multivariate analysis. Complication rate in the prestented group was also lower, but the difference was not significant (8.5% vs 14.7%, p = 0.347). CONCLUSIONS: Prestenting was found to increase the success rate of URS in cases of larger stones and ureteral stones in pediatric population. Prestenting also provides lower, but insignificant, complication rates. However, this procedure also has significant disadvantages. Based on the results of current study, we cannot recommend routine prestenting in pediatric cases. Instead, we recommend an attempt to treat the stone in the first session and place a stent in case of failed procedure to utilize potential benefits of prestenting while avoiding disadvantages.


Assuntos
Cálculos Renais/cirurgia , Rim/cirurgia , Complicações Pós-Operatórias/epidemiologia , Stents , Ureter/cirurgia , Cálculos Ureterais/cirurgia , Ureteroscopia/métodos , Criança , Pré-Escolar , Estudos de Coortes , Endoscopia/métodos , Feminino , Humanos , Pelve Renal/cirurgia , Masculino , Análise Multivariada , Estudos Retrospectivos
18.
Int Braz J Urol ; 42(1): 96-100, 2016 Jan-Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27136473

RESUMO

OBJECTIVES: In this study it is aimed to compare the success and complication rates of SWL and RIRS in treatment of HSK stone disease. MATERIALS AND METHODS: In this retrospective study data of 67 patients treated with either SWL (n=44) or RIRS (n=23) for stone disease in HSK between May 2003 to August 2014 was investigated. age, gender, stone size and multiplicity, stone free status, renal colic episodes and complication rates of the SWL and RIRS groups were compared. RESULTS: Mean age of the population was 42.5±8.2 (range: 16-78) years and mean stone size was 16.9±4.1 mm. SWL and RIRS groups were similar with regard to demographic characteristics and stone related characteristics. SFR of the SWL and RIRS groups were 47.7%(21/44 patients) and 73.9% (17/23 patients) respectively (p=0.039). Renal colic episodes were observed in 3 and 16 patients in the RIRS and SWL groups respectively (p=0.024). No statistically significant complications were observed between the SWL (8/44 patients) and RIRS (4/23) groups (p=0.936). CONCLUSIONS: In HSK patients with stone disease, both SWL and RIRS are effective and safe treatment modalities. However RIRS seems to maintain higher SFRs with comparable complication rates.


Assuntos
Rim Fundido/cirurgia , Cálculos Renais/cirurgia , Litotripsia/métodos , Ureteroscopia/métodos , Adolescente , Adulto , Idoso , Intervalo Livre de Doença , Feminino , Humanos , Complicações Intraoperatórias , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Período Perioperatório , Complicações Pós-Operatórias , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
19.
Int. braz. j. urol ; 42(2): 334-338, Mar.-Apr. 2016. tab
Artigo em Inglês | LILACS-Express | ID: lil-782856

RESUMO

ABSTRACT Introduction: To evaluate possible factors that can guide the clinician to predict potential cases refractoriness to medical treatment for giggle incontinence (GI) and to examine the effectiveness of different treatment modalities. Material and methods: The data of 48 children referred to pediatric urology outpatient clinic between 2000 and 2013 diagnosed as GI were reviewed. Mean age, follow-up, GI frequency, associated symptoms, medical and family history were noted. Incontinence frequency differed between several per day to less than once weekly. Children were evaluated with uroflowmetry-electromyography and post-void residual urine. Clinical success was characterized as a full or partial response, or nonresponse as defined by the International Children's Continence Society. Univariate analysis was used to find potential factors including age, sex, familial history, GI frequency, treatment modality and dysfunctional voiding to predict children who would possibly not respond to treatment. Results: Mean age of the patients was 8.4 years (range 5 to 16). Mean follow-up time and mean duration of asymptomatic period were noted as 6.7±1.4 years and 14.2±2.3 months respectively. While 12 patients were treated with only behavioral urotherapy (Group-1), 11 patients were treated with alpha-adrenergic blockers and behavioral urotherapy (Group-2) and 18 patients with methylphenidate and behavioral urotherapy (Group-3). Giggle incontinence was refractory to eight children in-group 1; six children in-group 2 and eight children in-group 3. Daily GI frequency and dysfunctional voiding diagnosed on uroflowmetry-EMG were found as outstanding predictive factors for resistance to treatment modalities. Conclusions: A variety of therapies for GI have more than 50% failure rate and a standard treatment for GI has not been established. The use of medications to treat these patients would not be recommended, as they appear to add no benefit to symptoms and may introduce severe adverse effects.

20.
Int. braz. j. urol ; 42(1): 96-100, Jan.-Feb. 2016. tab
Artigo em Inglês | LILACS-Express | ID: lil-777336

RESUMO

ABSTRACT Objectives In this study it is aimed to compare the success and complication rates of SWL and RIRS in treatment of HSK stone disease. Materials and methods In this retrospective study data of 67 patients treated with either SWL (n=44) or RIRS (n=23) for stone disease in HSK between May 2003 to August 2014 was investigated. age, gender, stone size and multiplicity, stone free status, renal colic episodes and complication rates of the SWL and RIRS groups were compared. Results Mean age of the population was 42.5±8.2 (range: 16-78) years and mean stone size was 16.9±4.1 mm. SWL and RIRS groups were similar with regard to demographic characteristics and stone related characteristics. SFR of the SWL and RIRS groups were 47.7%(21/44 patients) and 73.9% (17/23 patients) respectively (p=0.039).Renal colic episodes were observed in 3 and 16 patients in the RIRS and SWL groups respectively (p=0.024). No statistically significant complications were observed between the SWL (8/44 patients) and RIRS (4/23) groups (p=0.936). Conclusions In HSK patients with stone disease, both SWL and RIRS are effective and safe treatment modalities. However RIRS seems to maintain higher SFRs with comparable complication rates.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA