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1.
Int Braz J Urol ; 45(6): 1153-1160, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808403

RESUMO

PURPOSE: To identify the factors increased fluoroscopy time during percutaneous nephrolithotomy and investigate the relationship between the 3D segmentation volume ratio of stone to renal collecting system and fluoroscopy time. MATERIALS AND METHODS: Data from 102 patients who underwent percutaneous nephrolithotomy were analyzed retrospectively. Volume segmentation of both the renal collecting system and stones were obtained from 3D segmentation software with the images on CT data. Analyzed stone volume (ASV), renal collecting system volume (RCSV) measured and the ASV-to-RCSV ratio was calculated. Several parameters were evaluated for their predictive ability with regard to fl uoroscopy time. RESULTS: The stone-free rate was 55.9% after the percutaneous nephrolithotomy. Complications occurred in 31(30.4%) patients. The mean fluoroscopy time was 199.4±151.1 seconds. The fl uoroscopy time was significantly associated with the ASV-to-RCSV ratio (p<0.001, r=0.614). The single tract was used in 77 ( 75.5%) cases while multiple tracts were used in 25 (24.5%) cases. Fluoroscopy time was significantly associated with multiple access (p<0.001, r=0.689). On univariate linear regression analysis, longer fluoroscopy time was related with increased stone size, increased stone volume, increased number of access, increased calyx number with stone, increased ASV-to-RCSV, increased operative time and decreased stone essence. On multivariate linear regression analysis, the number of access and the ASV-to-RCSV were independent predictors of fluoroscopy time during percutaneous nephrolithotomy. CONCLUSIONS: The distribution of the stone burden volume in the pelvicalyceal system is a significant predictor for prolonged fluoroscopy time during percutaneous nephrolithotomy. Measures to decrease FT could be benefi cial in patients with a high ASV-to-RCSV ratio for precise preoperative planning.


Assuntos
Fluoroscopia/métodos , Cálculos Renais/patologia , Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Adulto , Índice de Massa Corporal , Intervalo Livre de Doença , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Exposição à Radiação , Estudos Retrospectivos , Fatores de Risco , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento
2.
Int Braz J Urol ; 45(6): 1161-1166, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808404

RESUMO

PURPOSE: To compare two-shift operation mode and single player mode different impact on surgical results and operator comfort in flexible ureteroscopic holmium laser lithotripsy for renal calculi larger than 1.5cm. MATERIALS AND METHODS: From december 2017 to december 2018, 92 patients with renal calculi admitted to Qilu Hospital and were treated through fl exible ureteroscopy. They were randomized in two-shift group (n=50) and single player group (n=42). The operative time, blood loss, hospitalization stay after operation, residual fragments (≥4mm) rate, fragmentation speed, postoperative complications and operator's fatigue score were compared. RESULTS: There was no significant difference between two groups regarding age, gender, illness side, stone size, blood loss, operative time, postoperative hospitalization stay, complications, etc (p >0.05). The fragmentation speed was 44.5±20.0mm3/min in two-shift group compared with 34.2±17.3mm3/min in single player group (p=0.037). Residual fragments (≥4mm) rate after fi rst surgery was 18% in two-shift group, while the residual fragments (≥4mm) rate was 40.5% after first surgery in single player group (p=0.017). The total fatigue score of two-shift group was 8.4 compared to 29.9 in single player group (p <0.001). CONCLUSION: In flexible ureteroscopic holmium laser lithotripsy for the treatment of renal calculi larger than 1.5cm, two-shift operation mode can raise the fragmentation speed and stone clearance rate, as well as signifi cantly lower operator's fatigue level and improve operator's comfort.


Assuntos
Cálculos Renais/cirurgia , Lasers de Estado Sólido/uso terapêutico , Litotripsia a Laser/métodos , Ureteroscopia/métodos , Adulto , Desenho de Equipamento , Ergonomia , Feminino , Humanos , Cálculos Renais/patologia , Tempo de Internação , Litotripsia a Laser/instrumentação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias , Reprodutibilidade dos Testes , Resultado do Tratamento , Ureteroscopia/instrumentação
3.
Actas urol. esp ; 43(10): 521-525, dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185257

RESUMO

Objetivos: El objetivo de este estudio fue evaluar el rol de la aplicación de fluoroscopia en pacientes intervenidos mediante cirugía retrógrada intrarrenal y su efecto sobre los resultados quirúrgicos. Material y métodos: Los pacientes que ingresaron en nuestro centro con diagnóstico de cálculos renales se dividieron en 2 grupos. En el grupo 1 se utilizó fluoroscopia de rutina en todos los casos (n: 58). En el grupo 2 se ejecutó el mismo procedimiento sin fluoroscopia (n: 67). Posteriormente se compararon los resultados de los 2 grupos. Resultados: No hubo diferencias estadísticamente significativas entre los 2 grupos en términos de tiempo quirúrgico, tasa libre de cálculos, complicaciones, necesidad de analgésicos, requerimiento de nuevo tratamiento y escala visual analógica. Conclusión: El uso de fluoroscopia no altera la frecuencia de complicaciones ni la tasa libre de cálculos. Creemos que el uso de fluoroscopia no es indispensable en los casos en los que se consigue acceso a la pelvis renal (especialmente en procedimientos de ureteroscopia semirrígida) y que su uso debe ser limitado para evitar un aumento innecesario de exposición a la radiación


Objectives: The aim of this study was to evaluate the role of the use of fluoroscopy in patients undergoing retrograde intrarenal surgery and the effect on surgical outcomes. Material and methods: The patients who were admitted to our center with the diagnosis of kidney stones were divided into 2 groups. In group 1, routine fluoroscopy was used in all cases (n: 58). In group 2, the same procedure was performed without fluoroscopy (n: 67) and the results of the 2 groups were compared. Results: There were no statistically significant differences between the 2 groups in terms of operation time, stone-free rate, complication rate, need for analgesic and re-treatment requirement and Visual Analogic Scale score. Conclusion: The use of fluoroscopy does not alter the complication frequency and stone-free rate. We think that the use of fluoroscopy is not mandatory in cases in which renal pelvis access is achieved especially with semirigid ureteroscopy and that unnecessary fluoroscopy increases radiation exposure


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Fluoroscopia , Cálculos Renais/cirurgia , Avaliação de Resultado de Intervenções Terapêuticas , Nefrostomia Percutânea/métodos , Escala Visual Analógica , Ureteroscopia , Complicações Intraoperatórias , Procedimentos Cirúrgicos Urológicos/métodos
4.
Rev Med Suisse ; 15(673): 2198-2201, 2019 Nov 27.
Artigo em Francês | MEDLINE | ID: mdl-31778049

RESUMO

Percutaneous nephrolithotomy (PCNL) was at first indicated for larger renal stones. Technological progress allowed a significant improvement of the available equipment, mostly to miniaturize the devices. However, this should not affect the stone clearance. Many different techniques arised aiming to reduce the complications of PCNL, in particular the risk of haemorrhage. As it becomes less invasive, the indications are greatly expanded, and a growing number of patients will benefit from it in the future. This explains the significance of knowing this procedure in continual development in greater detail.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea , Humanos , Miniaturização , Resultado do Tratamento
5.
Medicine (Baltimore) ; 98(48): e18165, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770263

RESUMO

RATIONALE: Crossed renal ectopia (CRE) is a rare congenital anomaly that is frequently associated with gastrointestinal, cardiovascular, genital and bone malformations. To the best of our knowledge, only 35 cases of crossed renal ectopia involving calculi and 30 cases of CRE associated with renal carcinoma have been reported to date. PATIENT CONCERNS: Here, we present 2 cases of crossed renal ectopia. A 59-year-old woman with diabetes presented to our hospital with abdominal pain. The second patient was a 24-year-old woman who complained with abdominal pain with a duration of 1 day. DIAGNOSES: On the basis of abdominal ultrasonography, we suspected a solitary kidney both in the two patients. Combined with retrograde pyelography and 3D computed tomography, case 1 was diagnosed as an S-shaped right-to-left crossed-fused ectopic kidney with many stones in the left (normal) renal pelvis and case 2 was confirmed to have lump right-to-left crossed-fused renal ectopia with two 3-mm stones in the renal pelvis of the 2 kidneys. INTERVENTIONS: Case 1 underwent percutaneous nephrolithotomy while case 2 refused to undergo surgery and underwent conservative treatment for pain relief. OUTCOMES: Two patients have been followed up and have no stones recurrence. LESSONS: Crossed fused renal ectopia is easily misdiagnosed as a solitary kidney. CRE is so rare that the recognition of the disease needs to be improved and effective treatment should be taken timely. According to the two cases and literature review, minimally invasive surgery has become increasingly common to treat CRE with stones and carcinoma.


Assuntos
Dor Abdominal , Rim Fundido , Cálculos Renais , Rim , Nefrolitotomia Percutânea/métodos , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adulto , Diagnóstico Diferencial , Erros de Diagnóstico/prevenção & controle , Feminino , Rim Fundido/complicações , Rim Fundido/diagnóstico , Rim Fundido/fisiopatologia , Humanos , Rim/anormalidades , Rim/diagnóstico por imagem , Rim/cirurgia , Cálculos Renais/complicações , Cálculos Renais/diagnóstico , Cálculos Renais/fisiopatologia , Cálculos Renais/cirurgia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ultrassonografia/métodos , Urografia/métodos
6.
Urology ; 134: 62-65, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31536740

RESUMO

OBJECTIVE: To evaluate feasibility of percutaneous nephrolithotomy (PCNL) for complex nephrolithiasis in patients 80 years of age and older compared to younger individuals. METHODS: From an institutional IRB-approved database, 1,647 patients were identified who underwent PCNL from 1999 to 2019. Patients were stratified by age: group 1 (20-59), group 2 (60-79), and group 3 (>80). Statistics were performed using chi-square and ANOVA to compare outcomes. RESULTS: Of the 1,647 patients, median age was 46, 66, and 83, respectively (P <0.0001). Three patients within group 3 were 90 or older. Females made up 54%, 46%, 56% of patients (P = 0.02). Average stone size with SD was 2.6 ± 2.2, 2.5 ± 2.3, 2.2± 1.9 cm for each group (P = 0.06). Mean preoperative hemoglobin (Hgb) was significantly lower in the 80+ group (13.8, 13.4, 13.1 g/dL, P <.0001). Change in Hgb was not significantly different. There were more Clavien II-IV complications (10.4, 14.4, 28.8%; P = 0.02) and transfusions (2.3, 4.7, 10.2%; P <0.001) in the elderly. The most common complications in the 80+ group were bleeding related (10.1%). No difference in readmission rates or ICU admissions was noted. CONCLUSION: PCNL is feasible in the extremely elderly; however with a higher rate of complications and longer hospitalizations. No long-term sequelae or deaths in the 80 and older cohort were seen. This study allows us to appropriately counsel older patients on a realistic postoperative course and supports use of PCNL as the best means of long-term survival.


Assuntos
Cálculos Renais , Nefrolitotomia Percutânea , Hemorragia Pós-Operatória , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Hemoglobinas/análise , Humanos , Cálculos Renais/sangue , Cálculos Renais/epidemiologia , Cálculos Renais/cirurgia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/métodos , Hemorragia Pós-Operatória/sangue , Hemorragia Pós-Operatória/mortalidade , Hemorragia Pós-Operatória/terapia , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Estados Unidos/epidemiologia
7.
J Laparoendosc Adv Surg Tech A ; 29(11): 1492-1496, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31549927

RESUMO

Objective: To evaluate the experience and result of combined laparoscope and flexible ureteroscope (f-URS) pyelolithotomy in dealing with large-burden complex renal calculi in children <1 year old. Methods: Eleven patients (7 males and 4 females) <1 year old were retrospectively reviewed between December 2015 and May 2017, who had been diagnosed with renal calculi and received combined laparoscope and f-URS pyelolithotomy. The operations were carried out under general anesthesia. Patient' characteristics, presenting symptoms, operative times, and blood loss, stone-free rate, and postoperative complications were all collected retrospectively. Results: All 11 patients received combined laparoscope and f-URS pyelolithotomy. All operations went smoothly without conversion record and blood transfusion. Average time consumed was 109 minutes (55-187 minutes), and blood loss reported was 16 mL (10-25 mL). Average hospital stay after operation was 7 days (5-11 days). On mean follow-up of 6-12 months, no symptomatic urinary tract infections and urinary calculi were detected. Conclusion: Laparoscope combined f-URS pyelolithotomy is considered safe in the treatment of large-burden multiple renal calculi in infant patients with a high stone clearance rate. It has certain advantages in the treatment of renal calculi in infants <1 year old, and it could be an alternative treatment when other treatments fail or are unavailable.


Assuntos
Cálculos Renais/cirurgia , Laparoscopia , Ureteroscopia , Perda Sanguínea Cirúrgica , Feminino , Humanos , Lactente , Laparoscopia/efeitos adversos , Tempo de Internação , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Ureteroscópios , Ureteroscopia/efeitos adversos , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Procedimentos Cirúrgicos Urológicos/métodos
8.
Urology ; 134: 66-71, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31487511

RESUMO

OBJECTIVE: To analyze the outcomes of upper pole access during percutaneous nephrolithotomy (PCNL), an option pole often avoided due to the concern for pleural injury. METHODS: We retrospectively collected data on patients undergoing PCNL at our institution. Patients were divided into 3 groups according to access: supracostal upper calyx (group 1), subcostal upper calyx (group 2), and nonupper calyx (group 3). Preoperative imaging was reviewed to assess stone burden, Hounsfield units (HU), location, and Guy's Stone Score. Patients were considered stone-free if residual fragments were 3 mm or smaller on CT scan. RESULTS: We analyzed 329 PCNLs (left: 174; right: 155). Stones had a median size of 32 mm, 800 HU, and Guy's Stone Score of 2. Groups 1, 2, and 3 had 119, 108, and 102 patients, respectively. The 90-day complication rate was 20.4% (7.9% Clavien 3-4). Group 1 patients, with higher BMI and larger stones, had higher SFR than group 3 (89.9% vs 79.4%, P = .038), but with a significantly higher risk of complications (P = .001). Within group 1, left PCNL (7.0% vs 24.2%, P = .016) and BMI ≥30 (6.9% vs 25.0%, P = .013) carried a lower risk of chest tube insertion. There was no difference in complications between groups 2 and 3 (1.9% vs 2.9%). CONCLUSION: Upper pole access is safe and effective, particularly if done below the ribs. Supracostal access is an effective option to achieve higher stone-free rates in complex stones, while carrying a risk of significant hydrothorax, particularly on the right side and in nonobese patients.


Assuntos
Hidrotórax , Complicações Intraoperatórias , Cálculos Renais , Nefrolitotomia Percutânea , Pleura/lesões , Cuidados Pré-Operatórios/métodos , Adulto , Índice de Massa Corporal , Feminino , Humanos , Hidrotórax/etiologia , Hidrotórax/prevenção & controle , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Cálculos Renais/diagnóstico por imagem , Cálculos Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/métodos , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X/métodos , Estados Unidos
9.
Urologe A ; 58(11): 1289-1297, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31501985

RESUMO

Ureterorenoscopy and percutaneous nephrolitholapaxy are minimally invasive procedures and are the standard procedures for the treatment of kidney stones and ureteral calculi. To achieve an adequate view, in both methods an optimal and sufficient irrigation flow is necessary. The intrarenal pressure is influenced by the irrigation pressure and irrigation volume and has to be controlled. Pathologically elevated intrarenal pressure can lead to irreversible damage of the kidneys. Lasers are frequently used for stone fragmentation. It has been shown in studies that the laser energy can lead to an increase in the temperature and that thermal effects can also damage the kidneys. This article provides the surgeon with an overview about the effects of temperature and pressure changes during ureterorenoscopy and percutaneous nephrolitholapaxy and how damages can be avoided.


Assuntos
Temperatura Alta/efeitos adversos , Cálculos Renais/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Nefrostomia Percutânea/métodos , Pressão/efeitos adversos , Cálculos Ureterais/cirurgia , Ureteroscopia/métodos , Humanos , Cálculos Renais/diagnóstico , Resultado do Tratamento , Cálculos Ureterais/diagnóstico
10.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 41(4): 492-500, 2019 Aug 30.
Artigo em Chinês | MEDLINE | ID: mdl-31484611

RESUMO

To compare the accuracy of SHA.LIN,S.T.O.N.E.nephrolithometry scoring system,and Clinical Research Office of the Endourological Society(CROES)nephrolithometry nomogram in predicting percutaneous nephrolithotomy(PCNL)outcomes including stone free rate(SFR)and perioperative status. Methods The clinical data of 90 patients with nephrolithiasis undergoing PCNL in department of urology,China-Japan Friendship Hospital from January 2015 to March 2018 were retrospectively analyzed.The general data,stone characteristics,operation approaches,and perioperative variables were recorded.SHA.LIN,S.T.O.N.E.score,and CROES nomogram were assigned according to the computed tomography(CT)findings before surgery.Stone free status was evaluated by kidney-ureter-bladder one month after PCNL.The relationships of SHA.LIN score,S.T.O.N.E.score,and CROES score with SFR,postoperative complications,operation time(OT),length of hospital stay(LOS),estimated blood loss(EBL),and decrease of hemoglobin was evaluated.Receiver operating characteristic(ROC)curves were used to analyze the predictive accuracy. Results The SFR was 72.2%(65/90)and postoperative complications occurred in 33 cases(36.7%).The mean OT was(103.1±39.6)min,the mean EBL was(46.1±53.0)ml,the mean LOS was(15.3±5.2)d,the mean postoperative LOS was(8.5±3.4)d,and the mean decrease of hemoglobin was(16.1±10.2)g/L.Stone-free patients had significantly lower SHA.LIN score(8.23 vs. 10.36,P=0.000)and S.T.O.N.E.score(7.05 vs.8.16,P=0.000)and significantly higher CROES score(188.50 vs. 143.89,P=0.000)compared to patients with residual fragments.All these scores were not significantly associated with complications(P>0.05).On the other hand,all these scores were significantly correlated with OT,EBL,and decrease of hemoglobin(SHA.LIN:POT=0.006,PEBL=0.028,Pdecrease of hemoglobin=0.014;S.T.O.N.E.:POT=0.012,PEBL=0.047,Pdecrease of hemoglobin=0.011;and CROES:POT=0.040,PEBL=0.045,Pdecrease of hemoglobin=0.013).SHA.LIN(P=0.001)and S.T.O.N.E.(P=0.005)scores were associated with LOS.Logistic regression analysis revealed that SHA.LIN(OR=2.491),S.T.O.N.E.(OR=3.030),and CROES(OR=0.973)scores were significantly associated with stone-free status.ROC curves in predicting SFR showed that there was significant difference in the areas under the curves(AUC)for the SHA.LIN vs. S.T.O.N.E.score [0.808(95% CI=0.711-0.905)vs. 0.748(95% CI=0.632-0.864),P=0.047].AUC for the CROES score [0.770(95% CI=0.664-0.877)] showed no significantly different for the SHA.LIN score or the S.T.O.N.E.score(P>0.05). Conclusions All these three scoring systems have good predictive accuracy for SFR.SHA.LIN is more precise than S.T.O.N.E.in predicting SFR.However,they can not predict postoperative complications.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea , Nomogramas , China , Hemoglobinas/análise , Humanos , Tempo de Internação , Duração da Cirurgia , Complicações Pós-Operatórias , Prognóstico , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
11.
Urology ; 133: 46-49, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31472203

RESUMO

OBJECTIVE: To determine stone clearance rates using endoscopic combined intrarenal surgery (ECIRS) and assess the accuracy of intraoperative prediction of stone-free (SF) status compared to postoperative CT scan. METHODS: A single institution, prospectively maintained database of ECIRS was queried for procedures performed 8/2017 to 1/2018. Retrograde access was performed using a ureteral sheath and flexible ureteroscope. Percutaneous nephrolithotomy was performed through a 30fr or 18fr sheath in prone position. Residual stone status was estimated at the end of each procedure and was verified with postoperative CT scan. SF was defined as no single stone >2mm3 on CT. RESULTS: One hundred and ten procedures were reviewed. Average age was 58.9 ± 12.6 years (range 26-87) and 69 (63%) were male. The mean stone size was 33.3 ± 23.5 mm (range 4-140 mm). Ninty-three patients (84.5%) were endoscopically estimated to be SF, of which 84 (90% of predicted SF cohort, 76% of total cohort) were confirmed SF via CT scan. The sensitivity for estimating SF status with ECIRS was 65.4% (95%CI 44.3%-82.8%), specificity was 100% (95%CI 95.7%-100.0%) and accuracy was 91.8% (95%CI 85.0%-96.2%). SF patients had significantly smaller stones than those with residual fragments (28.5 ± 2.1 vs 48.4 ± 5.7mm, P <.0001). On logistic regression, the factors associated with residual stones were preoperative stone burden (OR 1.03 per mm, 95%CI 1.01-1.05, P = .0004) and fluoroscopy time (OR 1.01 per minute, 95%CI 1.0-1.02, P = .0081). CONCLUSION: ECIRS accurately predicts clinical SF status and may obviate the need for additional CT scans. Consistent with prior studies, the primary determinant of residual stone after percutaneous nephrolithotomy is initial stone size.


Assuntos
Cálculos Renais/cirurgia , Rim/cirurgia , Nefrolitotomia Percutânea , Tomografia Computadorizada por Raios X , Ureteroscopia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Valor Preditivo dos Testes , Estudos Prospectivos , Indução de Remissão , Reprodutibilidade dos Testes
13.
Int Braz J Urol ; 45(5): 956-964, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31408287

RESUMO

PURPOSE: We aimed to compare the outcomes of supine and prone miniaturized percutaneous nephrolithotomy (m-PNL) in the treatment of lower pole, middle pole and renal pelvic stones. MATERIALS AND METHODS: 54 patients who performed supine m-PNL between January 2017 and March 2018 and 498 patients who performed prone m-PNL between April 2015 and January 2018 were included in the study. Of the 498 patients, 108 matching 1: 2 in terms of age, gender, body mass index, American Association of Anesthesiology score, stone size, stone localization and hydronephrosis according to the supine m-PNL group were selected as prone m-PNL group. The patients with solitary kidney, upper pole stone, urinary system anomaly or skeletal malformation and pediatric patients (<18 years old) were excluded from the study. The success was defined as 'complete stone clearance' and was determined according to the 1st month computed tomography. RESULTS: The operation time and fluoroscopy time in supine m-PNL was significantly shorter than prone m-PNL group (58.1±45.9 vs. 80.1±40.0 min and 3.0±1.7 min vs. 4.9±4.5 min, p=0.025 and p=0.01, respectively). When post-operative complications were compared according to the modified Clavien-Dindo classification, overall and subgroup complication rates were comparable between groups. There was no significant difference between the groups in terms of the success rates (supine m-PNL; 72.2%, prone m-PNL; 71.3%, p=0.902). CONCLUSIONS: Supine m-PNL procedure is more advantageous in terms of operation time and fluoroscopy time in the treatment of lower pole, middle pole and renal pelvic stones.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Posicionamento do Paciente/métodos , Decúbito Ventral , Decúbito Dorsal , Adulto , Feminino , Fluoroscopia/métodos , Humanos , Cálculos Renais/patologia , Pelve Renal/cirurgia , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Duração da Cirurgia , Reprodutibilidade dos Testes , Estatísticas não Paramétricas , Resultado do Tratamento
14.
Med Sci Monit ; 25: 5878-5885, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31389405

RESUMO

BACKGROUND Advances in percutaneous nephrolithotomy (PCNL) have resulted in smaller devices that cause less trauma and bleeding, while flexible ureterorenoscopy (f-URS) allows access to any calyces. These methods are often used in isolation, but used in combination they may improve treatment of complex renal calculi. This study assessed the effectiveness and complications of f-URS combined with super-mini-PCNL (SMP) to treat complex renal calculi. MATERIAL AND METHODS A retrospective cohort analysis was made of patients with unilateral complex renal stones treated between March 2013 and December 2016. Patients were grouped according to surgical procedure: SMP (SMP Group), f-URS holmium laser lithotripsy (f-URS Group), and combined SMP and f-URS (Combined Group). The postoperative complications and complete stone-free rate were analyzed and compared among the 3 groups. RESULTS A total of 140 patients with complex renal stones were included: 40 patients in the SMP Group, 55 in the f-URS Group, and 45 in the Combined Group. The complete stone-free rate 3 days after the procedure was 77.5% in the SMP Group, 78.2% in the f-URS Group, and 97.8% in the Combined Group (p=0.010). The operation time, intraoperative blood loss, and hospitalization time of the Combined Group were all significantly lower than those in the SMP Group but higher than those in the f-URS Group. The follow-up was 9 months (range, 6-12 months). There were no medium-term complications reported. CONCLUSIONS SMP combined with f-URS holmium laser lithotripsy in the prone position is an effective treatment for complex renal calculi.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Ureteroscopia/métodos , Adulto , Idoso , Perda Sanguínea Cirúrgica , Estudos de Coortes , Feminino , Humanos , Rim/patologia , Cálculos Renais/terapia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias , Decúbito Ventral , Estudos Retrospectivos , Resultado do Tratamento
15.
Urology ; 132: 63-68, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31310774

RESUMO

OBJECTIVE: To define computed tomography (CT) predictors of residual fragments after retrograde intrarenal surgery (RIRS) for kidney stones up to 20 mm in patients never submitted to surgical procedures for stone removal. METHODS: From August 2016 to August 2017, symptomatic adult patients with kidney stones less than 20 mm treated by RIRS had their pre- and postoperative CT prospectively evaluated in search for predictors of residual stone fragments. Stone size, stone volume, number of stones, stone density, and location were evaluated in preoperative CT and analyzed as predictors for residual stone fragments on 90 POD CT. Stone location was represented by the infundibulopelvic angle (IPA) measured for each stone on preoperative noncontrast CT using multiplanar reconstruction. RESULTS: Ninety-two patients were successfully submitted to RIRS. Bilateral procedures were performed in 23 patients (25%) resulting in 115 renal units operated. Operative time was 54.5 ± 26.7 minutes (mean ± SD) and 96.7% (89/92) of the patients were discharged up to 12 hours after the procedure. Postoperative CT demonstrated stone-free in 86 of 115 (74.8%), 0-2 mm in 10 of 115 (8.7%), and > 2 mm residual fragments in 19 of 115 (16.5%) procedures. Logistic regression analysis revealed steep IPA was a predictor for any residual stone fragment after RIRS for kidney stones < 20 mm (P= .012). ROC curve showed that IPA < 41° was associated with a higher chance of residual fragments after RIRS. CONCLUSION: IPA < 41° is associated with a higher chance of residual fragments after RIRS for kidney stones up to 20 mm.


Assuntos
Cálculos Renais/patologia , Cálculos Renais/cirurgia , Rim/cirurgia , Tomografia Computadorizada por Raios X , Procedimentos Cirúrgicos Urológicos/métodos , Adolescente , Adulto , Idoso , Feminino , Humanos , Cálculos Renais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Período Pré-Operatório , Estudos Prospectivos , Indução de Remissão , Resultado do Tratamento , Adulto Jovem
16.
Arch Ital Urol Androl ; 91(2)2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31266278

RESUMO

OBJECTIVE: To compare the retroperitoneal with the transperitoneal approach in a series of patients underwent to robotic-assisted pyelolithotomy (RP). MATERIALS AND METHODS: From January 2015 to December 2018 we evaluated 20 patients subjected to robotic pyelolithotomy; 11 patients were treated with retroperitoneal approach (RRP) and 9 with transperitoneal approach (TRP). For each patient intra and perioperative data were recorded: operative time (OT), blood loss (BL), length of hospital stay (LOS), stone clearance, post-operative complications and time to remove the drain. The presence of stone fragments < 4 mm was considered as stone free rate. RESULTS: The principal stone burden was greater in the TRP group than in the RRP group (48 ± 10 mm vs 32 ± 14 mm, p = 0.12). Preoperative hydronephrosis was present in 7 (64%) patients in RRP group and a mild hydronephrosis in 3 of TRP group (p = 0.04). The average operative time was higher in the RRP group than in the TRP group (203 ± 45 min vs 137 ± 31 min, p = 0.002). The average blood loss was 305 ± 175 ml in the RRP group versus 94 ± 104 ml in the TRP group (p = 0.005). The stone free rate was similar between the two groups, 36% (4 patients) in the RRP group and 44% (4 patients) in the TRP (p = 0.966). CONCLUSIONS: RP appears to be a safe and effective minimally invasive treatment for some patients with renal staghorn calculi or urinary tract malformations. The TRP may give lower operative time and better results in terms of blood loss and length of hospital stay.


Assuntos
Cálculos Renais/cirurgia , Pelve Renal/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Idoso , Perda Sanguínea Cirúrgica , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Espaço Retroperitoneal , Estudos Retrospectivos , Resultado do Tratamento
17.
Arch Ital Urol Androl ; 91(2)2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31266279

RESUMO

OBJECTIVE: To determine if there is a difference between postoperative urinary infection rates after retrograde intra-renal surgery (RIRS) when ureteral access sheath (UAS) was used or not used. MATERIALS AND METHODS: We retrospectively analyzed the medical records of all patients who underwent RIRS at our institution between January 2016 and October 2018. RESULTS: 129 patients were included in the study. The mean age of the patients was 48.8 ± 12.1 years; 94 patients were male and 35 were female. The mean stone size (largest diameter), stone attenuation and stone volume were 15.3 ± 5.8 mm, 1038 ± 368 HU and 1098 ± 1031 mm3, respectively. Out of 129 patients, 81 were treated by using UAS (Group 1) and 48 were treated without use of UAS (Group 2). There was no statistically significant difference between the two groups in terms of post-operative infection (p = 0.608). However, the operative time of patients with post-operative infection was statistically higher than the other patients; 88.35 ± 22.5 min versus 59.37 ± 22.1 min (p = 0.017). In multivariate regression analysis, operation time (p = 0.02, r = 1.07) was found to be the sole predictor of post-operative infection. CONCLUSIONS: Using UAS during RIRS might reduce the intrarenal pressure and also has several advantages. However not prolonging the operation time too much could be of higher importance than UAS use in terms of preventing post-operative infection after RIRS.


Assuntos
Cálculos Renais/cirurgia , Complicações Pós-Operatórias/epidemiologia , Infecções Urinárias/epidemiologia , Procedimentos Cirúrgicos Urológicos/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Ureter , Procedimentos Cirúrgicos Urológicos/instrumentação
18.
BMC Urol ; 19(1): 58, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272430

RESUMO

BACKGROUND: The use of ureteral access sheath (UAS) during ureteroscopy is controversial. We aimed to explore practice patterns of UAS during ureteroscopy for nephrolithiasis among endourologists worldwide. METHODS: A 15-question survey was designed using the SurveyMonkey® platform. The questions covered the background and professional experience of the potential respondents, indications for UAS insertion, UAS caliber and possible complications associated with its use. The questions were anonymously tabulated in order to determine practice patterns of UAS during ureteroscopy for nephrolithiasis among endourologists. The survey was then distributed via e-mail to all the Endourological Society members. RESULTS: 216 members responded. 99.53% of the respondents practice as endourologists, 63.4% are fellowship trained and 74.4% are at least 6 years post-fellow. 73.2% practice in an academic facility. 77.3% perform at least 100 ureteroscopies annually. 46 and 76% routinely use UAS for the treatment of ureteral and kidney stones, respectively. In both cases, the 12/14 access sheath is the most common. 42% use UAS in primary ureteroscopy. 90.3% believe that a double J stent insertion is not mandatory prior to UAS insertion. 79.1% think the use of UAS does not increase postoperative complications rate, and if the latter does encounter, then most likely it is either a ureteral stricture (93.2%) or pain (48%). CONCLUSIONS: UAS is commonly used by highly skilled endourologists during ureteroscopy. 12/14 UAS is mostly used. Ureteral stricture and post-operative pain are proposed as possible complications following UAS introduction, however pre-stenting is not mandatory as overall low complication rate is expected.


Assuntos
Nefrolitíase/cirurgia , Inquéritos e Questionários , Ureter/cirurgia , Ureteroscopia/métodos , Urologistas , Humanos , Cálculos Renais/diagnóstico , Cálculos Renais/cirurgia , Nefrolitíase/diagnóstico , Ureter/patologia , Cálculos Ureterais/diagnóstico , Cálculos Ureterais/cirurgia , Ureteroscopia/normas , Urologistas/normas
19.
Australas Phys Eng Sci Med ; 42(3): 771-779, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31332724

RESUMO

A decision support system (DSS) was developed to predict postoperative outcome of a kidney stone treatment procedure, particularly percutaneous nephrolithotomy (PCNL). The system can serve as a promising tool to provide counseling before an operation. The overall procedure includes data collection and prediction model development. Pre/postoperative variables of 254 patients were collected. For feature vector, we used 26 variables from three categories including patient history variables, kidney stone parameters, and laboratory data. The prediction model was developed using machine learning techniques, which includes dimensionality reduction and supervised classification. A novel method based on the combination of sequential forward selection and Fisher's discriminant analysis was developed to reduce the dimensionality of the feature space and to improve the performance of the system. Multiple classifier scheme was used for prediction. The derived DSS was evaluated by running leave-one-patient-out cross-validation approach on the dataset. The system provided favorable accuracy (94.8%) in predicting the outcome of a treatment procedure. The system also correctly estimated 85.2% of the cases that required stent placement after the removal of a stone. In predicting whether the patient might require a blood transfusion during the surgery or not, the system predicted 95.0% of the cases correctly. The results are promising and show that the developed DSS could be used in assisting urologists to provide counseling, predict a surgical outcome, and ultimately choose an appropriate surgical treatment for removing kidney stones.


Assuntos
Inteligência Artificial , Sistemas de Apoio a Decisões Clínicas , Cálculos Renais/patologia , Cálculos Renais/terapia , Algoritmos , Transfusão de Sangue , Feminino , Humanos , Cálculos Renais/cirurgia , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea , Stents , Resultado do Tratamento
20.
BMC Urol ; 19(1): 57, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31262284

RESUMO

BACKGROUND: Clinical studies assessing the feasibility and accuracy of three stone scoring systems's (SSSs: Guy's stone score, CROES nomogram and S.T.O.N.E nephrolithometry scoring system) have reported contradictory outcomes. This systematic evaluation was performed to obtain comprehensive evidence with regard to the feasibility and accuracy of three SSSs. METHODS: A systematic search of Embase, Pubmed, Medline, and the Cochrane Library was conducted to identify studies that compared three SSSs up to Mar 2018. Patients were categorized according to stone free (SF) and no-stone free (NSF), Outcomes of interest included perioperative variables, stone-free rate (SFR), and complications. RESULTS: Ten studies estimating three SSSs were included for meta-analysis. The results showed that SF patients had a significantly lower proportion of male (OR = 1.48, P = 0.0007), lower stone burden (WMD = -504.28, P < 0.0001), fewer No of involved calyces (OR = -1.23, P = 0.0007) and lower proportion of staghorn stone (OR = 0.33, P < 0.0001). Moreover, SF patients had significantly lower score of Guy score (WMD = -0.64, P < 0.0001), but, S.T.O.N.E. score (WMD = -1.23, P < 0.0001) and a higher score of CROES nomogram (WMD = 29.48, P = 0.003). However, the comparison of area under curves (AUC) of predicting SFR indicated that there was no remarkable difference between three SSSs. Nonetheless, Guy score was the only stone scoring system that predicted complications after PCNL (WMD = -0.29, 95% CI: - 0.57 to - 0.02, P = 0.03). CONCLUSIONS: Our meta-analysis indicated that the three SSSs were equally, feasible and accurate for predicting SFR after PCNL. However, Guy score was the only stone scoring system that predicted complications after PCNL.


Assuntos
Cálculos Renais/diagnóstico , Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Índice de Gravidade de Doença , Humanos , Nefrolitotomia Percutânea/tendências , Valor Preditivo dos Testes , Estudos Retrospectivos
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