Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.055
Filtrar
2.
BMJ Case Rep ; 14(1)2021 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-33468632

RESUMO

A 53-year-old man presented with lower urinary tract symptoms and recurrent urinary tract infections since last 3 years without being investigated or treated properly. Examination revealed a hard mobile lump in the pelvis, and blood investigations showed raised serum creatinine of 2.9 mg/dL. Subsequent urgent ultrasound scan showed a large urinary bladder stone with bilateral hydroureteronephrosis, and X-ray kidney, ureter and bladder demonstrated a 9 cm×6 cm elliptical radio-opaque shadow in the pelvis. He underwent emergency admission followed by open cystolithotomy on the next day. He was discharged after 48 hours with a urethral catheter. After 2 weeks, his renal function recovered completely; repeat ultrasound scan revealed complete resolution of hydronephrosis. Urethral catheter was removed following a normal cystogram. Uroflowmetry after 6 weeks revealed underlying bladder outlet obstruction, and he was started on alpha blocker which improved his urinary flow.


Assuntos
Hidronefrose/etiologia , Obstrução Ureteral/etiologia , Cálculos da Bexiga Urinária/complicações , Cálculos da Bexiga Urinária/diagnóstico , Humanos , Hidronefrose/diagnóstico por imagem , Hidronefrose/cirurgia , Masculino , Pessoa de Meia-Idade , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/cirurgia , Cálculos da Bexiga Urinária/cirurgia
3.
Medicine (Baltimore) ; 99(45): e23072, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157969

RESUMO

RATIONALE: Hydronephrosis, mostly caused by ureteropelvic junction obstruction, rarely occurs in infants. However, imperforate hymen atresia in female infants may cause hydronephrosis, even though it is rare. PATIENT CONCERNS: A 3-month-old female infant was admitted to our hospital for frequent crying. There was no significant past medical history. DIAGNOSES: Following ultrasound imaging, the patient was diagnosed with hydronephrosis possibly caused by imperforate hymen. INTERVENTIONS: The infant underwent hymenotomy with a cruciate incision to prevent future complications such as acute renal injury. OUTCOMES: Hydronephrosis resolved after the operation. The outcome was very good, with no complications in the postoperative period. CONCLUSIONS: Early ultrasound diagnosis plays a significant role in the management and treatment of infant patients. Ultrasound is the mandatory imaging technology for determining the cause of hydronephrosis.


Assuntos
Hidronefrose/etiologia , Hímen/anormalidades , Anormalidades Congênitas , Feminino , Humanos , Hidronefrose/cirurgia , Hímen/cirurgia , Lactente
4.
Cir. pediátr ; 33(3): 124-130, jul. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193554

RESUMO

OBJETIVO: Actualmente, los algoritmos para estudiar hidronefrosis en niños incluyen realizar cistografía miccional (CUMS) y renograma diurético (RD) a todos. Ambos son invasivos, molestos y con riesgo de radiación. Contrariamente, las pruebas básicas de función renal (PFRb) no están incluidas. Este estudio se realizó para saber si las PFRb pueden ayudarnos a evitar alguna CUMS y/o RD. MÉTODOS: Análisis retrospectivo de todas las historias de niños con hidronefrosis (pelvis renal ≥ 20 mm) atendidos durante un año (n = 38), [estenosis pieloureteral (EPU) n = 12; reflujo vesicoureteral (RVU) de alto grado n = 8; hidronefrosis no obstructiva (HNO) n = 18]. Analizamos las tres PFRb protocolizadas [osmolalidad urinaria máxima tras DDAVP (UOsm), albúmina/creatinina (Alb/Cr) y NAG/creatinina (NAG/Cr)], junto con CUMS y RD. RESULTADOS: UOsm estaba disminuida en 100% RVU, 75% EPU, 16,7% HNO. Alb/Cr estaba aumentado en 62,5% RVU, 8,3% EPU, 11,1% HNO. NAG/Cr estaba aumentado en 42,8% RVU, 25% EPU, 6,7% HNO. En relación a la necesidad de cirugía, UOsm estaba disminuida en la mayoría de pacientes intervenidos (100% con RVU y 74% con EPU), mientras solo en el 11% de pacientes sin cirugía (HNO). CONCLUSIÓN: Estos resultados sugieren que las PFRb pueden ser útiles para retrasar o evitar CUMS en algunos niños con hidronefrosis. La UOsm es la PFRb más sensible. Ningún niño con RVU (de alto grado) mostró una UOsm normal. Se podrían haber evitado CUMS en el 43% de nuestros pacientes, con UOsm normal, sin haber perdido ningún diagnóstico de VUR (de alto grado)


OBJECTIVE: Nowadays, the algorithms for the study of hydronephrosis in children include voiding cystourethrogram (VCUG) and diuretic renogram (DR) in all patients. Both are invasive, distressing, and associated with radiation risk. However, basic renal function tests (bRFTs) are not included. This study was designed to determine whether bRFTs may help avoid VCUG and/or DR in some children. METHODS: Retrospective review of hydronephrosis (≥ 20 mm renal pelvis) patient records over one year (n = 38) (pyeloureteral stenosis (PUS) n = 12; high-grade vesicoureteral reflux (VUR) n = 8; non-obstructive hydronephrosis (NOH) n = 18. Data from the three protocolized bRFTs (maximum urine osmolality after DDAVP (UOsm), albumin/creatinine ratio (Alb/Cr), and NAG/creatinine ratio (NAG/Cr), together with VCUG and DR, were analyzed. RESULTS: 38 hydronephrosis patients (pyeloureteral stenosis (PUS) n = 12; high grade vesicoureteral reflux (VUR) n = 8; non-obstructive hydronephrosis (NOH) n = 18. UOsm was decreased in 100% of VUR patients, 75% of PUS patients, and 16.7% of NOH patients. Alb/Cr ratio was increased in 62.5% of VUR patients, 8.3% of PUS patients, and 11.1% of NOH patients. NAG/Cr ratio was increased in 42.8% of VUR patients, 25% of PUS patients, and 6.7% of NOH patients. UOsm was decreased in most patients who required surgery (100% of VUR patients and 74% of PUS patients), but only in 11.1% of patients who did not (NOH group). CONCLUSIONS: These results suggest that bRFTs may be useful in delaying or avoiding VCUG in some hydronephrosis cases. UOsm is the most sensitive test. No child with (high grade) VUR had a normal UOsm. VCUG could have been avoided in 43% of our patients –with a normal UOsm-without missing any high grade VUR


Assuntos
Humanos , Masculino , Feminino , Lactente , Hidronefrose/diagnóstico por imagem , Hidronefrose/cirurgia , Algoritmos , Cistografia , Renografia por Radioisótopo , Estudos Retrospectivos , Pelve Renal/diagnóstico por imagem , Pelve Renal/patologia , Albuminúria/diagnóstico , Refluxo Vesicoureteral/diagnóstico , Razão de Chances , Técnicas de Laboratório Clínico
5.
J Urol ; 204(5): 1048-1053, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32420797

RESUMO

PURPOSE: We aimed to compare the Society for Fetal Urology and anteroposterior pelvic diameter classification systems in predicting the time to resolution of isolated hydronephrosis. MATERIALS AND METHODS: We retrospectively reviewed isolated hydronephrosis cases prenatally detected and postnatally diagnosed between 1994 and 2018. Other urinary tract anomalies and vesicoureteral reflux were excluded. Baseline grades for both systems were collected. Anteroposterior pelvic diameter was classified as grade 1 to 4 over a scale of 5 mm. Resolution was defined by an anteroposterior pelvic diameter of less than 5 mm with Society for Fetal Urology grade I hydronephrosis. Time to resolution was analyzed using Kaplan-Meier curves. RESULTS: The study population consisted of 831 patients (1,028 renal units). Median followup was 26 months (range 6 to 260), and 559 units (54.3%) reached resolution during a median followup of 9 months (1 to 133). Resolution rates at 48 months were 81.7%, 65.6%, 37.6% and 5.2% for Society for Fetal Urology grades I through IV disease and 80.0%, 41.2%, 13.1% and 2.5% for anteroposterior pelvic diameter grades 1 through 4, respectively. Discrepancies between these grades were present in 481 units (46.8%). Society for Fetal Urology grades II to IV categorized as anteroposterior pelvic diameter grade 1 showed a superior cumulative rate of resolution (84.7%) vs anteroposterior pelvic diameter grades 2 to 4 categorized as Society for Fetal Urology grade I (53.2%, log-rank test p <0.001). CONCLUSIONS: Hydronephrosis cases with anteroposterior pelvic diameter grades 2 to 4 but categorized as Society for Fetal Urology grade I have an inferior cumulative rate of resolution than vice versa. Society for Fetal Urology grades have little influence on resolution when anteroposterior pelvic diameter is less than 10 mm. Therefore, anteroposterior pelvic diameter is more useful in predicting the time to resolution.


Assuntos
Feto/anormalidades , Hidronefrose/diagnóstico , Pelve Renal/diagnóstico por imagem , Índice de Gravidade de Doença , Adolescente , Criança , Pré-Escolar , Feminino , Feto/diagnóstico por imagem , Seguimentos , Humanos , Hidronefrose/congênito , Hidronefrose/cirurgia , Lactente , Recém-Nascido , Pelve Renal/anormalidades , Pelve Renal/cirurgia , Masculino , Gravidez , Prognóstico , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Remissão Espontânea , Estudos Retrospectivos , Fatores de Tempo , Ultrassonografia Pré-Natal , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Adulto Jovem
6.
Urologiia ; (1): 86-90, 2020 Mar.
Artigo em Russo | MEDLINE | ID: mdl-32191008

RESUMO

The aim was to evaluate the surgical learning curve and advantages of top-dow two-knot laparoscopic pyeloplasty in children with uretero-pelvic junction obstruction (UPJO). MATERIALS AND METHODS: A retrospective analysis of medical records regarding 98 patients from Speranskij Childrens Municipal Hospital No9, Moscow and Regional Clinical Hospital No7, Volgograd, aged from 3 to 24 months with unilateral hydronephrosis of varying degrees, according to the SFU classification (Society of Fetal Urology) in the Onen modification was carried out. LP in all children was performed in accordance with the Heins-Andersen technique, with minimal resection of the pelvis. In order to compare different techniques for the formation of pyeloureteral anastomosis, patients are divided into two groups: on the first group (n=59) TDTKT was performed, and on the second (n=39) - the standart knotting technique (SKT) was performed. The patients were operated by two surgeons from different clinics. Average time of operation, learning curves, frequency of post-operative complications and post-operative assessments were included as criteria for the comparison of the two groups. RESULTS: Using TDTKT allowed a reduction in mean time of surgery of 30%. Positive results were obtained in both groups of patients by reducing the degree of hydronephrotic transformation of the kidney during their follow-up year. CONCLUSION: Using TDTKT not only permits an experienced surgeon to reduce his duration of operation to 67.86 minutes, it also positively affects the surgical learning curve for less experienced surgeons. In this regard, this technique can be recommended to surgeons who do not have much experience in conducting laparoscopic pyeloplasty.


Assuntos
Hidronefrose/cirurgia , Laparoscopia , Obstrução Ureteral/cirurgia , Criança , Pré-Escolar , Humanos , Lactente , Pelve Renal , Curva de Aprendizado , Moscou , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos
7.
Int Braz J Urol ; 46(2): 253-259, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32022515

RESUMO

Objetive: Pelvicureteric junction (PUJ) obstruction is the main cause of hydronephrosis in childhood. Open pyeloplasty has been the gold standard treatment of this condition with success rate above 90%. The role of laparoscopic pyeloplasty (LP) in children is less well defined and has slowly emerged as an alternative procedure. We report outcomes of our initial experience with LP in 38 children from 2 months of age. MATERIALS AND METHODS: From June 2015 to December 2017 38 children aged 2-60 months (mean age 1.7 years) underwent LP for correction of PUJ obstruction. The mean pre operative anteroposterior diameter of the renal pelvis (APD) was 43,5mm and all patients had hydronephrosis (APD 21.4-76 mm) and obstructed curve on diuretic renogram. Anderson-Hynes pyeloplasty was the performed technique. Results are reported. RESULTS: Mean operative time was 107 minutes (70-180) with no conversion to open procedure. Pain control was needed mainly in the fi rst 12hs. Mean hospitalization was 2 days (1-5). There were complications in 5 children not affecting the fi nal outcome. Two patients had a re-obstruction requiring a second procedure with good result. The mean follow up was 18 months (13-36). The mean reduction on the postoperative APD was 41% - p<0,001 (end APD 5 to 41mm). Overall success rate was 94,7%. All children had good cosmetic results. CONCLUSIONS: This is a small series limited by short follow up, however its data suggest that LP has good functional and cosmetic results, not compromising the success of the open procedure, regardless patient age.


Assuntos
Hidronefrose/cirurgia , Pelve Renal/cirurgia , Laparoscopia/métodos , Obstrução Ureteral/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Pré-Escolar , Feminino , Seguimentos , Humanos , Hidronefrose/etiologia , Lactente , Pelve Renal/patologia , Masculino , Resultado do Tratamento , Obstrução Ureteral/complicações
8.
J Laparoendosc Adv Surg Tech A ; 30(5): 520-524, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32027216

RESUMO

Purpose: To investigate the feasibility of retroperitoneal laparoscopic ipsilateral nephrectomy of a benign nonfunctional kidney after percutaneous nephrostomy, and to compare this method with open surgery. Materials and Methods: Data from 70 patients who underwent simple nephrectomy from January 2014 to October 2018 at three large centers were retrospectively analyzed. All patients underwent percutaneous nephrostomy because of renal or ureteral calculi with severe hydronephrosis or pyonephrosis. Simple nephrectomy was performed via retroperitoneal laparoscopic surgery (retroperitoneal laparoscopic group; n = 33) or open surgery (open group; n = 37). The retroperitoneal laparoscopic and open groups were compared regarding preoperative variables (age, sex, location of surgery, hypertension, diabetes, BMI, preoperative serum creatinine level, American Society of Anesthesiologists (ASA) grade, fistula duration, fistula size, number of fistulae, and urinary tract infection), and perioperative variables (operation time, intraoperative blood loss, postoperative drainage volume, catheter indwelling time, gastrointestinal function recovery time, duration of bedrest, duration of postoperative hospitalization, postoperative hemoglobin decline, perioperative transfusion, and postoperative complications). Results: The retroperitoneal laparoscopic group included more patients with hydronephrosis, while the open group included more patients with pyonephrosis. There were no significant differences between the two groups in age (P = .813), sex (P = .729), location of surgery (P = .345), hypertension (P = .271), diabetes (P = .394), BMI (P = .798), preoperative serum creatinine level (P = .826), ASA grade (P = .820), fistula duration (P = .108), fistula size (P = .958), number of fistulae (P = .925), urinary tract infection (P = .111), or operative time (P = .851). The retroperitoneal laparoscopic group had significantly lesser intraoperative blood loss (P = .007), postoperative drainage volume (P = .008), shorter catheter indwelling time (P = .002), gastrointestinal function recovery time (P < .001), duration of bedrest (P < .001), and duration of postoperative hospitalization (P < .001), and lesser postoperative hemoglobin decline (P = .035) compared with the open group. Conclusions: Retroperitoneal laparoscopic ipsilateral nephrectomy is feasible for a benign nonfunctional kidney after percutaneous nephrostomy. The surgical method should be selected based on the surgeon's experience and the specific situation of the patient.


Assuntos
Nefrectomia/métodos , Espaço Retroperitoneal/cirurgia , Adulto , Repouso em Cama , Perda Sanguínea Cirúrgica , Estudos de Viabilidade , Feminino , Trato Gastrointestinal/fisiopatologia , Humanos , Hidronefrose/etiologia , Hidronefrose/cirurgia , Cálculos Renais/complicações , Cálculos Renais/cirurgia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Nefrostomia Percutânea , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Pionefrose/etiologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Cálculos Ureterais/complicações , Cálculos Ureterais/cirurgia
9.
Br J Hosp Med (Lond) ; 81(1): 1-8, 2020 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-32003628

RESUMO

Hydronephrosis is diagnosed more often with the increased availability of computed tomography and ultrasound scanning. Hydronephrosis is an important consideration in patients with abdominal or pelvic pathology as progressive dilation of the upper urinary tract can lead to acute kidney injury and, if not corrected, permanent nephron loss. This article explores how to approach an adult patient with hydronephrosis, encompassing aetiology, clinical presentation, diagnosis and management.


Assuntos
Hidronefrose , Adulto , Humanos , Hidronefrose/diagnóstico , Hidronefrose/etiologia , Hidronefrose/fisiopatologia , Hidronefrose/cirurgia , Tomografia Computadorizada por Raios X , Ultrassonografia
10.
BMJ Case Rep ; 13(1)2020 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-31980472

RESUMO

Isolated renal involvement by myxoid adipocytic tumour is a very rare presentation. We are reporting a horseshoe kidney with ureteropelvic junction obstruction (UPJO) with myxolipoma, which was revealed after routine histopathological evaluation postbilateral open pyeloplasty. We evaluated the patient thoroughly and after detailed discussions with the patient and parents, took the decision to manage the patient on active surveillance with interval imaging and renal dynamic scans. Managing a myxolipoma associated with UPJO is a novel experience as a surgeon, by virtue of its extreme rarity. Isolated myxolipoma of renal pelvis in association with UPJO and horseshoe kidney has never been reported earlier to the best of our knowledge. The patient has not progressed at follow-up of 30 months with occasional mild abdominal discomfort. We intend to closely monitor the patient in similar fashion. Any significant progression of disease or renal failure shall entail nephrectomy with excision of mass and subsequent renal replacement therapy.


Assuntos
Rim Fundido/complicações , Hidronefrose/cirurgia , Pelve Renal/patologia , Lipoma/complicações , Obstrução Ureteral/cirurgia , Adolescente , Feminino , Humanos , Procedimentos Cirúrgicos Reconstrutivos , Tomografia Computadorizada por Raios X , Procedimentos Cirúrgicos Urológicos
13.
Clin Adv Hematol Oncol ; 17(12): 697-707, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31851158

RESUMO

Bladder-sparing therapies for the treatment of nonmetastatic muscle-invasive bladder cancers are included in both American and European guidelines. Numerous treatment approaches have been described, including partial cystectomy, radiation monotherapy, and radical transurethral resection. However, the most oncologically favorable and well-studied regimen employs a multimodal approach that consists of maximal transurethral resection of the bladder tumor followed by concurrent radiosensitizing chemotherapy and radiotherapy. This sequence, referred to as trimodal therapy (TMT), has been evaluated with robust retrospective comparative studies and prospective series, although a randomized trial comparing TMT with radical cystectomy has not been performed. Despite promising reports of 5-year overall survival rates of 50% to 70% in well-selected patients, relatively few patients qualify as ideal candidates for TMT. Specifically, contemporary series exclude patients who have clinical stage T3 disease, multifocal tumors, coexisting carcinoma in situ, or hydronephrosis. Herein, we review all forms of bladder-preserving therapies with an emphasis on TMT, highlighting the rationale of each component, survival outcomes, and future directions.


Assuntos
Carcinoma in Situ/cirurgia , Cistectomia , Hidronefrose/cirurgia , Neoplasias da Bexiga Urinária/cirurgia , Bexiga Urinária/cirurgia , Carcinoma in Situ/metabolismo , Carcinoma in Situ/patologia , Feminino , Humanos , Hidronefrose/metabolismo , Hidronefrose/patologia , Masculino , Invasividade Neoplásica , Estudos Prospectivos , Estudos Retrospectivos , Bexiga Urinária/metabolismo , Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/metabolismo , Neoplasias da Bexiga Urinária/patologia
14.
Medicine (Baltimore) ; 98(44): e17780, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689845

RESUMO

RATIONALE: Foreign bodies related ureteral obstruction and hydronephrosis is rare and usually cause numerous problems for clinical physicians. PATIENT CONCERNS: We report a 36-year-old female who was referred to our hospital due to a 4-year history of dull pain on the left back. DIAGNOSIS: X-ray and abdominal CT revealed a foreign body around the upper part of the left ureter with ureteral obstruction and hydronephrosis. INTERVENTIONS: Laparoscopy was performed and a 3-cm sewing needle was removed successfully. OUTCOMES: After 6 months' follow-up, the patient's ureteral obstruction and hydronephrosis were significantly reduced, and the double-J ureteral stent was removed. LESSONS: This case indicated that ureteral obstruction and hydronephrosis caused by foreign bodies needed to be early diagnosed and located. Invasive therapies rather than conservative treatments are preferred to remove the FBs and relieve obstruction.


Assuntos
Corpos Estranhos/complicações , Hidronefrose/etiologia , Laparoscopia/métodos , Ureter/lesões , Obstrução Ureteral/etiologia , Adulto , Feminino , Corpos Estranhos/cirurgia , Humanos , Hidronefrose/cirurgia , Laparoscopia/instrumentação , Stents , Ureter/cirurgia , Obstrução Ureteral/cirurgia
15.
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med ; 27(Special Issue): 667-670, 2019 Aug.
Artigo em Russo | MEDLINE | ID: mdl-31747159

RESUMO

The article presents modern technologies of medical rehabilitation of children operated for hydronephrosis. The importance of medical rehabilitation of children with hydronephrosis is associated with high incidence, possibility of developing chronic kidney disease, and early disability of these patients. After surgery on the ureter it is important to use medical rehabilitation technologies aimed at preventing urodynamics disorders of upper and lower urinary tract, and at stimulation of regenerative processes. In recent years, particular attention has been paid to high-intensity pulsed electromagnetic field therapy, which has a more significant and long-term stimulating effect compared to various types of electrical stimulation. Clinical studies were conducted in 80 children operated for hydronephrosis, aged 3 to 15. The main group consisted of 40 children who received high-intensity pulsed magnetic therapy, and 40 children were included in the control group (without physiotherapy). Basic treatment included uroseptics and exercise therapy. Effectiveness of the method was assessed using clinical, laboratory and ultrasound data, and Doppler ultrasound of the renal blood flow. The results of the study demonstrated the rationale of including high-intensity pulsed electromagnetic field therapy in medical rehabilitation of children operated for hydronephrosis. The positive effect of high-intensity pulsed electromagnetic therapy on the urodynamics of the urinary tract (reduction in the size of renal pelvis and calyx) and renal blood flow (restoration of blood flow to the renal cortex) were revealed. This method helped to reduce inflammation in the renal parenchyma (reduction of proteinuria, leukocyturia) in children operated on for hydronephrosis. A significantly higher effectiveness of medical rehabilitation with the use of high-intensity pulsed magnetic therapy was proved (87.5%).


Assuntos
Hidronefrose , Adolescente , Criança , Pré-Escolar , Humanos , Hidronefrose/cirurgia , Rim/fisiopatologia , Rim/cirurgia
16.
J Biol Regul Homeost Agents ; 33(5 Suppl. 1): 105-110, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31630723

RESUMO

Pelviureteric junction obstruction (PUJO) due to intrinsic or extrinsic causes is a common problem in childhood. Extrinsic compression by a lower pole-crossing blood vessel can present symptomatically in older children. In these cases, laparoscopies Vascular Hitch can represent a valid alternative to pyeloplasty dismembered. We analyzed the data of 4 children affected by extrinsic PUJO treated at our institution with the laparoscopic Vascular Hitch procedure modified by Chapman. Surgical indications included presence of clinical symptoms, worsening of intermittent hydronephrosis, signs of obstruction on the MAG-3 scan, clear or suspected images of polar crossing vessels on CT scan or Uro-MRI. All procedures were completed laparoscopically. No complications occurred. Mean follow-up was 13 months with resolution of symptoms and PUJ obstruction and significant improvement of hydronephrosis in all cases. When blood vessels crossing lower pole represent the pure mechanical cause of UPJ obstruction the laparoscopic Vascular Hitch procedure represents an excellent alternative to dismembered pyeloplasty. It is less technically demanding then pyeloplasty and is associated with a lower complication rate. The main challenge is to intraoperatively ascertain the absence of associated intrinsic stenosis.


Assuntos
Hidronefrose/congênito , Laparoscopia , Rim Displásico Multicístico/cirurgia , Obstrução Ureteral/cirurgia , Procedimentos Cirúrgicos Urológicos , Idoso , Criança , Humanos , Hidronefrose/cirurgia , Pelve Renal
17.
Transplant Proc ; 51(9): 3084-3086, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31627914

RESUMO

A 72-year-old man with a past medical history notable for deceased renal transplant presented to the interventional radiology department for routine right lower quadrant renal transplant nephroureteral catheter exchange. The nephroureteral catheter was placed in 2016 because of the presence of a hematoma causing partial page kidney and hydronephrosis. An antegrade nephrostogram was notable for opacification of the small bowel instead of the renal collecting system. The patient then subsequently developed urinary retention and intractable abdominal pain. Because of the combination of events, it was deemed necessary for laparotomy and surgical repair of the small bowel. Intraoperative findings were notable for small bowel adhesion to the abdominal wall but otherwise no evidence of acute inflammatory changes. In this case report, we describe the first case of an idiopathically dislodged nephrostomy catheter to the small bowel from a transplanted kidney and its successful management.


Assuntos
Migração de Corpo Estranho , Intestino Delgado/patologia , Transplante de Rim/efeitos adversos , Nefrostomia Percutânea/efeitos adversos , Cateteres Urinários/efeitos adversos , Idoso , Migração de Corpo Estranho/patologia , Migração de Corpo Estranho/cirurgia , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Hidronefrose/etiologia , Hidronefrose/cirurgia , Masculino , Nefrostomia Percutânea/instrumentação
18.
Int Braz J Urol ; 45(5): 965-973, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31626519

RESUMO

OBJECTIVE: We aimed to evaluate the results of laparoscopic pyeloplasty with concomitant pyelolithotomy and compare results with a cohort of patients undergoing laparoscopic pyeloplasty without pyelolithotomy. MATERIALS AND METHODS: We retrospectively reviewed records of 43 patients undergoing transperitoneal laparoscopic Anderson-Hynes dismembered pyeloplasty between December 2012 and July 2018 at our department. Eighteen patients (42%) underwent laparoscopic pyeloplasty with concomitant pyelolithotomy. The results of patients with renal stones were compared with 25 matched patients undergoing laparoscopic pyeloplasty without concomitant renal stones. Demographic data, operative and stone parameters were compared between the groups. RESULTS: The groups were similar regarding to demographic characteristics. All operations were completed laparoscopically with no conversions to open surgery. In 3 cases without renal stones and 15 cases with renal stones, transposition of the ureter due to crossing vessels was performed. The mean stone size was 13±5.24 mm, and the median number of stones was 1 (1-18). The success of laparoscopic pyeloplasty with and without pyelolithotomy was 93.3% and 92.9%, respectively, as confirmed by negative diuretic renogram at postoperative 3rd months. Overall stone-free rate after laparoscopic pyelolithotomy was 93.3%. Mean operative time was 222.6765.71 minutes vs. 219.11±75.63 minutes for the pyeloplasty with concomitant pyelolithotomy vs. pyeloplasty, respectively (p=0.88). CONCLUSIONS: Laparoscopic pyeloplasty with concomitant pyelolithotomy is a safe and effective intervention with associated good cosmetic results and high stone-free rates without significant increase in operative time or complications.


Assuntos
Pelve Renal/cirurgia , Laparoscopia/métodos , Nefrolitíase/cirurgia , Nefrotomia/métodos , Obstrução Ureteral/cirurgia , Adolescente , Adulto , Criança , Feminino , Humanos , Hidronefrose/cirurgia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Nefrolitíase/patologia , Duração da Cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Estatísticas não Paramétricas , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos/métodos , Adulto Jovem
20.
PLoS One ; 14(9): e0222223, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31513614

RESUMO

BACKGROUND: Hydronephrosis is a common finding in patients with bladder cancer. The aim of the study was to appraise the prognostic value of preoperative hydronephrosis in bladder cancer patients undergoing radical cystectomy. METHODS: We conducted a literature search using PubMed and Embase databases in Aug 2018. Summary hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using fixed-effect or random-effects models. The primary endpoint was overall survival (OS). Secondary endpoints were cancer-specific survival (CSS) and recurrence-free survival (RFS). RESULTS: Overall, 13 studies published between 2008 and 2018 including 4,820 patients were selected for the meta-analysis. The age of bladder cancer patients ranged from 27 to 90.4 years, and the overall proportion of males was 72.5%. Preoperative hydronephrosis was reported in 27.4% of patients. The pooled HR was statistically significant for OS (HR, 1.36; 95% CI [1.20-1.55]) and CSS (HR, 1.64; 95% CI [1.33-2.02]), with no heterogeneity among the enrolled studies. Patients with bilateral hydronephrosis showed a poorer CSS compared to those with no hydronephrosis (HR 5.43, 95% CI [3.14-9.40]). However, there was no difference in CSS between no hydronephrosis and unilateral hydronephrosis groups (HR 1.35, 95% CI [0.84-2.14]). Despite a tendency towards poorer RFS (HR, 1.27; 95% CI [0.96-1.96]), the results demonstrated no significant association between presence of preoperative hydronephrosis and RFS after radical cystectomy. CONCLUSION: This meta-analysis indicates that preoperative hydronephrosis is significantly associated with poorer OS and CSS after radical cystectomy for patients with bladder cancer. Preoperative hydronephrosis has a stronger effect on CSS in patients with bilateral hydronephrosis. The presence of preoperative hydronephrosis not only predicts prognosis, but may also help to identify patients who benefit the most from neoadjuvant chemotherapy.


Assuntos
Hidronefrose/fisiopatologia , Neoplasias da Bexiga Urinária/complicações , Neoplasias da Bexiga Urinária/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cistectomia/métodos , Cistectomia/mortalidade , Feminino , Humanos , Hidronefrose/cirurgia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Bexiga Urinária/patologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA