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1.
Rev Assoc Med Bras (1992) ; 66(12): 1696-1701, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33331579

RESUMO

INTRODUCTION: Patients with bilateral kidney stones and burdened by large stones are challenging cases for endourologists. Simultaneous bilateral percutaneous nephrolithotomy (sbPCNL) is an option; however, it may be accompanied by important morbidity. An alternative is a staged PCNL, operating one side each time. Herein, we compare the impact of sbPCNL and staged PCNL on complication rates and renal function. METHODS: Patients who underwent sbPCNL or staged bilateral PCNL with a frame time of 6 months were searched in our prospectively collected kidney stone database. Groups were compared for age, gender, body mass index (BMI), comorbidities (classification by the American Society of Anesthesiology - ASA), stone size, Guy's score, stone-free status, renal function, blood loss, blood transfusion rate, complication rate, and length of hospital stay. RESULTS: Twenty-six patients and 52 kidney units were enrolled. The mean operative time was 134.7 min. Only 11.3% of cases had complications, all of them minor (Clavien ≤ 2). Overall, the stone-free rate was 61.50%. Comparing the groups, there was a significantly longer operative time in the sbPCNL group (172.5 vs. 126.3 min; p=0.016), as well as a higher transfusion rate (12.5% vs. 5.6%; p=0.036). There was no statistically significant difference in creatinine levels between the groups. Regarding the stone-free rate, there was a significantly higher proportion of patients in the staged PCNL group (64.9% vs. 43.8%; p=0.012). CONCLUSION: sbPCNL is a safe procedure; however, when compared to staged procedures it has a higher transfusion and lower stone-free rate.


Assuntos
Cálculos Renais , Nefrolitotomia Percutânea , Nefrostomia Percutânea , Humanos , Cálculos Renais/cirurgia , Tempo de Internação , Nefrolitotomia Percutânea/efeitos adversos , Nefrostomia Percutânea/efeitos adversos , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento
2.
Urologiia ; (5): 139-148, 2020 Nov.
Artigo em Russo | MEDLINE | ID: mdl-33185362

RESUMO

Percutaneous nephrolithotomy (PCNL) is the gold standard treatment of large and staghorn kidney stones. Despite technological progress and improvement of PCNL technique, this procedure is associated with complications and in some cases remain a challenge for endourologists. According to the time, complications can be divided into intra- and postoperative. Intraoperative complications include bleeding, injury of the renal collecting system, visceral organs, pulmonary complications, thromboembolic disorders, extrarenal migration of the stone fragments and incorrect nephrostomy tube placement. Postoperative complications include infection and sepsis, bleeding, persistent urinary fistula, infundibular stenosis and death of the patient. The different recommendations that might be useful for the timely diagnosis of various complications in patients undergoing PCNL are provided in the review. Additionally, information on treatment algorithms is included.


Assuntos
Cálculos Renais , Nefrolitotomia Percutânea , Nefrostomia Percutânea , Cálculos Coraliformes , Humanos , Cálculos Renais/diagnóstico , Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/efeitos adversos , Nefrostomia Percutânea/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Resultado do Tratamento
3.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(4): 667-671, 2020 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-32773798

RESUMO

OBJECTIVE: To evaluate the effectiveness of super-selective renal artery embolization in treatment of post-percutaneous nephrolithotomy bleeding, and to analyse the causes of failure embolization. METHODS: In the study, 65 post-percutaneous nephrolithotomy patients with severe renal bleeding and hemodynamic instability were treated by super-selective renal artery embolization. First of all, we performed selective renal arteriography. After clarifying the location of the bleeding, superselective intubation of the injured vessel with a microcatheter was carried out. Then the injured vessel was embolized with Tornado micro-coil. When complete embolization was not achieved with micro-coil, a small amount of gelatin sponge particles were added. If there was no positive finding of the beginning selective renal arteriography, the following measures could be taken to prevent missing lesions: (1) Abdominal aorta angiography was performed to determine whether there were anatomical variations, such as accessory renal arteries or multiple renal arteries; (2) Ultra-selective intubation angiography next to the nephrostomy tube path was performed; (3) Renal arteriography was repeated; (4) Renal arteriography after removing the nephrostomy tube while retaining the puncture channel. We evaluated the different angiographic findings and analysed the causes of embolization failure. RESULTS: Bleeding was successfully controled in 60 patients (62 kidneys) whose renal arteriography was postive. Positive findings included: pseudoaneurysm formation, patchy contrast extravasation, pseudoaneurysm combined with arteriovenous fistula, contrast agent entering the collection system, extravascular perinephric leakage of contrast. After first embolization, bleeding was controled in 53 patients (55 kidneys). The success rate after the first and second embolization was 88.7% and 96.7% respectively. The second session was required because of failure to demonstrate bleeding arteries during the first session (4 patients, 57.1%) and recurrent hemorrhage of the embolized injured arteries (2 patients, 28.6%). In 5 patients with no positive findings, after conservative treatment, hematuria disappeared. All the patients were followed up for 3, 6, and 12 months after embolization, and no hematuria occurred again, and no sustained and serious renal insufficiency. CONCLUSION: Super-selective renal artery embolization is an effective treatment for post percutaneous nephrolithotomy bleeding. The main cause of failure is omitting of injured arteries during renal arteriography. Renal artery branch injury has various manifestations. Attention should paid to the anatomical variation of the renal artery, and patient and meticulous superselective intubation angiography is the key to avoiding missing the lesion and improving the success rate of embolization.


Assuntos
Embolização Terapêutica , Hemorragia/etiologia , Nefrolitotomia Percutânea , Nefrostomia Percutânea , Humanos , Nefrolitotomia Percutânea/efeitos adversos , Artéria Renal , Estudos Retrospectivos
4.
Medicina (B Aires) ; 80(3): 241-247, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32442938

RESUMO

The second part of the Inter-Society Argentine Consensus on Urinary Tract Infection (UTI) includes the analysis of special situations. In patients with urinary catheter, urine culture should be requested only in the presence of UTI symptomatology, before instrumentation of the urinary tract, or as a post-transplant control. The antibiotics recommended for empirical treatment in patients without risk factors are third-generation cephalosporins or aminoglycosides. UTIs associated with stones are always considered complicated. In case of obstruction with urosepsis, an emergency drainage should be performed via a percutaneous nefrostomy or ureteral stenting. In patients with stents or ureteral prostheses, such as double J catheters, empirical treatment should be based on epidemiology, prior antibiotics, and clinical status. Before the extracorporeal lithotripsy procedure, bacteriuria should be investigated and antibiotic prophylaxis should be administered in case of positive result, according to the antibiogram. First generation cephalosporins or aminoglycosides are valid alternatives. The use of antibiotic prophylaxis with first-generation cephalosporins or aminoglycosides before percutaneous nephrolithotomy is recommended. Transrectal prostatic biopsy can be associated with infectious complications, such as UTI or acute prostatitis, mainly due to Escherichia coli or other enterobacteria. In patients without risk factors for multiresistant bacteria and negative urine culture, prophylaxis with intravenous amikacin or ceftriaxone is recommended. In patients with positive urine culture, prophylaxis will be performed according to the antibiogram, from 24 hours before to 24 hours post-procedure. For the targeted treatment of post-transrectal biopsy prostatitis, carbapenems for 3-4 weeks are the treatment of choice.


Assuntos
Anti-Infecciosos Urinários/uso terapêutico , Consenso , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/etiologia , Argentina , Feminino , Humanos , Litotripsia/efeitos adversos , Masculino , Nefrolitíase/complicações , Nefrolitotomia Percutânea/efeitos adversos , Prostatite/tratamento farmacológico , Prostatite/etiologia , Fatores de Risco , Stents/efeitos adversos , Cateteres Urinários/efeitos adversos
5.
Curr Urol Rep ; 21(5): 21, 2020 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-32318942

RESUMO

PURPOSE OF REVIEW: To present the latest evidence related to the impact of ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) on the renal function. RECENT FINDINGS: Our review suggests that the overall renal function is not detrimentally affected by endourological interventions (URS, PCNL). This is however influenced by the preoperative renal function, presence of comorbidities such as diabetes and hypertension. For PCNL procedures, tract multiplicity, preoperative UTI, and postoperative bleeding also contribute to a decline in renal function. This review suggests that endourological interventions do not adversely affect renal function and tend to improve it in patients who do not have a poor renal function prior to the procedure. Several factors including poor preoperative renal function, diabetes, hypertension, and multiple percutaneous tracts appear to predispose patients to declining renal function after procedure, and these patients should be counseled for and followed up appropriately.


Assuntos
Nefrolitotomia Percutânea/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Insuficiência Renal/epidemiologia , Ureteroscopia/efeitos adversos , Humanos , Hipertensão/complicações , Nefrostomia Percutânea/efeitos adversos
6.
Medicine (Baltimore) ; 99(10): e19403, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150088

RESUMO

BACKGROUND: Shock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), and minimally invasive PCNL are currently therapeutic options for lower-pole renal stones (LPS). However, the optimal treatment for LPS remains unclear. A comprehensive evaluation of the efficacy and safety of each intervention is needed to inform clinical decision-making. This study aimed at assessing the efficacy and safety of different interventions for LPS. METHODS: PubMed, Embase, ScienceDirect, ClinicalKey, Cochrane Library, ProQuest, Web of Science, and ClinicalTrials.gov were searched from inception to December 6th 2018. Only randomized controlled trials (RCTs) including the patients treated for LPS were included. The frequentist models of network meta-analysis were used to compare the effect sizes. The primary outcome was stone free rate, and the secondary outcomes were overall complication rate, major complication rate, retreatment rate, and auxiliary procedure rate. RESULTS: This study included 13 RCTs comprising 1832 participants undergoing 6 different interventions, including RIRS, PCNL, Mini-PCNL, Micro-PCNL, SWL, and conservative observation. PCNL had the best stone free rate (odds ratio [OR] = 3.45, 95% confidence interval [CI] = 1.30-9.12), followed by Mini-PCNL (OR = 2.90, 95% CI = 1.13-7.46). Meta-regression did not find any association of the treatment effect with age, sex, and stone size. Although PCNL tended to exhibit a higher complication rate, the difference of complication rate among various interventions did not achieve a statistical significance. SWL was the less effective and associated with higher retreatment rate compared with PCNL, Mini-PNCL, and RIRS. CONCLUSIONS: PCNL was associated with the best stone free rate for LPS regardless of age, sex, and stone size. Each treatment achieved a similar complication rate compared with the others. Future large-scale RCTs are warranted to identify the most beneficial management for renal stones at a more complicated location.


Assuntos
Cálculos Renais/cirurgia , Rim/cirurgia , Litotripsia , Nefrolitotomia Percutânea , Humanos , Litotripsia/efeitos adversos , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/métodos , Metanálise em Rede , Complicações Pós-Operatórias , Reoperação
9.
J Pak Med Assoc ; 70(Suppl 1)(2): S83-S88, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31981342

RESUMO

Technological progress has changed the landscape of surgical practice. Minimally invasive surgery (MIS) and percutaneous interventions (PC) are constantly replacing open procedures. This reduces hospital stay and allows quicker recovery. The application of MIS should follow the good medical practice dictum by Hippocrates i.e. "First do no harm". To remain abreast with new procedures, the medical personnel are required to update and enhance their knowledge and skill. To ensure safety, the innovations are rigorously tested and tried. The learning curve of MIS is shortened by simulator training and proctorship. Credentialing processes are in place to enhance safe delivery of care. Despite of all these measures MIS and PCI are associated with adverse effects. The purpose of this article is to overview the iatrogenic trauma associated with MIS and PCI in major surgical subspecialties.


Assuntos
Doença Iatrogênica , Complicações Intraoperatórias/etiologia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Ferimentos e Lesões/etiologia , Fístula Arteriovenosa/etiologia , Valvuloplastia com Balão/efeitos adversos , Cateterismo Cardíaco/efeitos adversos , Anuloplastia da Valva Cardíaca/efeitos adversos , Ablação por Cateter/efeitos adversos , Cateterismo Venoso Central/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Nefrolitotomia Percutânea/efeitos adversos , Nefrostomia Percutânea/efeitos adversos , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Ortopédicos/efeitos adversos , Intervenção Coronária Percutânea/efeitos adversos , Pneumoperitônio Artificial/efeitos adversos , Pneumotórax/etiologia , Embolia Pulmonar/etiologia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Lesões do Sistema Vascular/etiologia
10.
Urol J ; 17(1): 8-13, 2020 01 26.
Artigo em Inglês | MEDLINE | ID: mdl-30882169

RESUMO

PURPOSE: There is conflict of evidence regarding whether absence of hydronephrosis is a risk factor for bleeding in percutaneous nephrolithotomy (PNL). Moreover, among the stone complexity scoring system used for PNL (Guy's stone score, the S.T.O.N.E. nephrometry and the CROES nomogram), only the S.T.O.N.E. nephrometry score incorporates hydronephrosis as a risk factor. Therefore, this study aimed to compare perioperative outcomes according to the presence or absence of hydronephrosis in percutaneous nephrolithotomy (PCNL) patients and to investigate whether absence of hydronephrosis is a risk factor for blood transfusion rate. MATERIALS AND METHODS: 281 patients who had undergone PCNL between December 2009 and April 2017 were divided according to the absence or presence of hydronephrosis (group I and group II, respectively). Perioperative outcomes were compared between the two groups. A multivariable regression analysis was performed to investigate whether hydronephrosis was a risk factor for blood transfusion rate. RESULTS: Patients without hydronephrosis showed significantly longer operation time and admission period, lower stone-free rate and higher blood transfusion rate compared to patients with hydronephrosis (p < 0.05, p = 0.002, p = 0.011, and p < 0.05, respectively). Multivariate logistic regression analysis showed that hydronephrosis was a significant risk factor for blood transfusion (OR, 95% CI and p value was 0.353, 0.163-0.761 and 0.008, respectively). CONCLUSION: Based on the results of the current study, we found that absence of hydronephrosis was a significant risk factor for blood transfusion in conventional PCNL.


Assuntos
Hemorragia/etiologia , Hidronefrose/etiologia , Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/efeitos adversos , Adulto , Idoso , Transfusão de Sangue , Feminino , Hemorragia/terapia , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Fatores de Risco
11.
Balkan Med J ; 37(2): 108-111, 2020 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-31698887

RESUMO

The percutaneous nephrolithotomy method is the most used treatment option for urinary stone disease. Bleeding is the most feared complication of this method. Transcatheter coil or medical glue embolization is currently the used treatment option for this bleeding complication. The aim of this report to show the novel subcutaneous fat tissue embolization technique for percutaneous nephrolithotomy related bleeding complications. In these two cases, we treated the percutaneous nephrolithotomy related bleeding complication with subcutaneous fat tissue. Subcutaneous fat tissue was taken with subcutaneous fascia from the femoral site by 1 cm incision. This tissue to be used for embolization was passed on the 0.014 guidewire from the back end of this guidewire (like shish kebab). The fat tissue passed on the 0.014 wire was sent to the bleeding site through the guiding catheter and guideliner, over the 0.014 guidewire with the monorail balloon (as a pusher) placed behind this fat tissue. The subcutaneous fat tissue with subcutaneous fascia embolization was completely stopped the bleeding and fistula. We have successfully used a novel embolization technique for fat tissue embolization to the bleeding site (Ari technique). Subcutaneous fat tissue embolization with the novel embolization technique for percutaneous nephrolithotomy related bleeding is a safe and reliable treatment option.


Assuntos
Autoenxertos/normas , Embolização Terapêutica/métodos , Hemorragia/terapia , Rim/lesões , Nefrolitotomia Percutânea/efeitos adversos , Tecido Adiposo , Idoso , Embolização Terapêutica/estatística & dados numéricos , Feminino , Hemorragia/fisiopatologia , Humanos , Rim/anormalidades , Rim/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/métodos
12.
Urology ; 137: 152-156, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31883881

RESUMO

OBJECTIVE: To evaluate the efficacy and safety of supracostal percutaneous nephrolithotomy (PCNL) through the 11th intercostal space and compare it with subcostal PCNL in children with renal calculi. MATERIALS AND METHODS: Children with renal calculi who underwent PCNL between January 2010 and December 2017 were divided into 2 groups: supracostal PCNL (group 1) and subcostal PCNL (group 2). Stone location, stone burden, location of the access points, operative time, postoperative visual pain score, success rate, hospital stay, and complications according to the modified Clavien classification were compared. Comparison of medians was done using Mann Whitney U test and the means were compared using t test. RESULTS: Group 1 had 50 patients while group 2 had 60 patients. The stone-free rate was 84.0% and 85.0% in groups 1 and 2, respectively after 1 session of PCNL (P = .885). After auxiliary procedures, it increased to 96.0% and 96.6%, respectively (P = .852). The mean fall in hematocrit was 0.9% in group 1 and 1.5% in group 2 (P = .11) whereas the median pain score was 4 in group 1 and 3 in group 2 (P = .37). In all, 54 complications were recorded the commonest among which were grade I (81.5%). Twenty-nine complications were observed in group 1 while 25 complications were observed in group 2 (P = .088). One patient developed nephropleural fistula while another patient developed hydropneumothorax. Both belonged to group 1. CONCLUSION: Supracostal access for PCNL is an effective and safe alternative to subcostal access for children with renal calculi in terms of stone-free rate and complications.


Assuntos
Hidropneumotórax , Cálculos Renais , Nefrolitotomia Percutânea , Complicações Pós-Operatórias/diagnóstico , Fístula Urinária , Criança , Feminino , Humanos , Hidropneumotórax/diagnóstico , Hidropneumotórax/etiologia , Índia/epidemiologia , Cálculos Renais/diagnóstico , Cálculos Renais/epidemiologia , Cálculos Renais/cirurgia , Tempo de Internação/estatística & dados numéricos , Masculino , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/métodos , Duração da Cirurgia , Resultado do Tratamento , Fístula Urinária/diagnóstico , Fístula Urinária/etiologia
13.
World J Urol ; 38(1): 219-229, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30972490

RESUMO

PURPOSE: To describe the clinical characteristics of struvite stones and determine the preoperative predictors of sepsis in struvite patients undergoing percutaneous nephrolithotomy (PCNL). METHODS: A retrospective study of patients who underwent PCNL between April 2011 and March 2018 was performed. The data of the struvite stones and non-struvite stones groups were compared following propensity score matching. Subsequently, the struvite stones group was sub-divided for further analysis according to the Sepsis-3 definition: non-sepsis and sepsis groups. RESULTS: After matching based on age, gender, BMI, and number of access tracts, the comparative analysis showed that staghorn calculi and higher Guy's stone score were more frequently observed in non-struvite stone patients (n = 97), while a history of urolithiasis surgery (56.70%), preoperative broad-spectrum antibiotic therapy (53.61%), positive preoperative urine culture (55.67%), and sepsis (35.05%) after surgery were more common in patients (n = 97) with struvite stones (all P values < 0.05). Eighteen (18.56%) patients presented with multidrug-resistant (MDR) bacteriuria. Multivariate analysis demonstrated that the preoperative presence of MDR bacteriuria (OR = 3.203; P = 0.043) and increased serum creatinine (OR = 3.963; P = 0.010) were independent risk predictors of sepsis. The two factors were used to construct a nomogram to predict the probability of sepsis. The nomogram was well calibrated and had moderate discriminative ability (concordance index: 0.711). CONCLUSION: Our study revealed that patients with struvite stones were associated with a significantly high risk of calculi recurrence and sepsis after surgery. The presence of MDR bacteriuria preoperatively was a reliable factor to predict sepsis.


Assuntos
Nefrolitotomia Percutânea/efeitos adversos , Medição de Risco/métodos , Sepse/epidemiologia , Cálculos Coraliformes/cirurgia , Infecção da Ferida Cirúrgica/epidemiologia , Antibacterianos/uso terapêutico , China/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Sepse/etiologia , Sepse/prevenção & controle , Cálculos Coraliformes/diagnóstico , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle
14.
Int J Surg ; 72: 85-90, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31689555

RESUMO

BACKGROUND: Staghorn calculi remain a treatment challenge for urologists. The aim of the study was to compare the treatment outcomes of suctioning minimally invasive percutaneous nephrolithotomy (MPCNL) and traditional MPCNL for renal staghorn stones. MATERIALS AND METHODS: Between April 2018 and June 2019, we included patients suffering from renal staghorn stones who were treated with modified MPCNL with a suctioning system. The outcomes of these patients were compared with those of a cohort of patients undergoing traditional MPCNL (between January 2017 and March 2018) using a 1:1 scenario matched-pair analysis. Cases were matched sequentially according to stone burden, stone branches, and stone hardness as well as age and sex. RESULTS: A total of 512 patients were included in this study (256 patients in each group). The baseline characteristics were equally distributed between the two groups. The suctioning MPCNL group achieved a significantly higher stone-free rate (SFR) (78.5% vs 69.1%; P = 0.016) after a single procedure and had a significantly shorter operative time (106.2 ±â€¯18.4 vs. 132.1 ±â€¯22.2 min; P < 0.001) than the traditional MPCNL group. The traditional MPCNL group experienced a significantly higher rate of overall complications than the suctioning MPCNL group (27.3% vs. 16.8%; P = 0.004). Regarding individual complications, a significantly higher rate of fever (13.7% vs. 7.4%; P = 0.021) and urosepsis requiring only additional antibiotics (8.2% vs. 3.5%; P = 0.024) was observed in the traditional MPCNL group than in the suctioning MPCNL group; there was a trend that the suctioning MPCNL group conferred a decreased risk of urosepsis shock (1.2% vs. 2.3%), but this trend failed to achieve statistical significance (P = 0.313). There was no significant difference between the two groups regarding the incidence of severe hemorrhage, the mean number of tracts used during a single procedure and the postoperative hospital stay. CONCLUSIONS: The use of suctioning MPCNL for staghorn calculi had advantages over the use of traditional MPCNL in terms of a higher SFR after a single procedure and fewer postoperative infectious complications. Further well-designed studies are needed to confirm the results.


Assuntos
Nefrolitotomia Percutânea/métodos , Cálculos Coraliformes/cirurgia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/instrumentação , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Choque Séptico/etiologia , Sucção/instrumentação , Sucção/métodos , Resultado do Tratamento , Infecções Urinárias/etiologia
15.
Ned Tijdschr Geneeskd ; 1632019 10 31.
Artigo em Holandês | MEDLINE | ID: mdl-31750639

RESUMO

BACKGROUND: The pleural effusion found in urinothorax is traditionally classified as transudate. In some cases, however, the Light-criteria can show an exudate. CASE DESCRIPTION: We describe the case of a 30-year-old man who attended the emergency department with shortness of breath and severe, diffuse, chest pain; this occurred two days after he had undergone a left-sided percutaneous nephrolithotomy by a urologist. A chest X-ray showed pleural effusion in the left basal region. Based on the Light-criteria, this effusion was an exudate. We made the diagnosis of urinothorax following percutaneous nephrolithotomy. CONCLUSION: When urinothorax is suspected, biochemical analysis can reveal either a transudate or an exudate. The pleural fluid/serum creatinine ratio can be a valuable addition to the Light-criteria in this setting. The Light-criteria should always be interpreted in a clinical context.


Assuntos
Exsudatos e Transudatos , Nefrolitotomia Percutânea/efeitos adversos , Derrame Pleural/etiologia , Urina , Adulto , Biomarcadores/metabolismo , Dor no Peito/etiologia , Creatinina/metabolismo , Humanos , Masculino , Derrame Pleural/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Radiografia , Urinoma/etiologia
16.
Medicine (Baltimore) ; 98(48): e17967, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770205

RESUMO

INTRODUCTION: The analgesic efficacy of paravertebral block for percutaneous nephrolithotomy remains controversial. We conduct a systematic review and meta-analysis to explore the analgesic efficacy of paravertebral block for patients with percutaneous nephrolithotomy. METHODS: We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases, and randomized controlled trials (RCTs) assessing analgesic efficacy of paravertebral block for percutaneous nephrolithotomy are included in this meta-analysis. RESULTS: Five RCTs are included in the meta-analysis. Overall, compared with control group after percutaneous nephrolithotomy, paravertebral block is associated with the decrease in analgesic consumption (standard mean difference (Std. MD) = -1.55; 95% confidence interval (CI) = -2.18 to -0.92; P < .00001) and additional analgesics (risk ratio (RR) = 0.17; 95% CI = 0.07 to 0.44; P = .0003), prolonged time to first analgesic requirement (Std. MD = 1.51; 95% CI = 0.26 to 2.76; P = .02). There is no statistical difference of adverse events including nausea or vomiting (RR = 0.51; 95% CI = 0.11 to 2.35; P = .38), or itching (RR = 0.69; 95% CI = 0.26 to 1.81; P = .45) between 2 groups. CONCLUSIONS: Paravertebral block is effective for pain control after percutaneous nephrolithotomy.


Assuntos
Analgésicos/uso terapêutico , Nefrolitotomia Percutânea/efeitos adversos , Bloqueio Nervoso/estatística & dados numéricos , Manejo da Dor/estatística & dados numéricos , Dor Pós-Operatória/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Dor Pós-Operatória/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
17.
J Nepal Health Res Counc ; 17(3): 320-324, 2019 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-31735925

RESUMO

BACKGROUND: Percutaneous nephrolithotomy has become the standard procedure for large renal stones but still remains highly challenging due to complications such as bleeding and sepsis, even though it has high stone free rate (SFR). We report the early outcomes of more than 1000 percutaneous nephrolithotomys done in our center. METHODS: A retrospective study of all patients undergoing percutaneous nephrolithotomy from January 2010 to December 2017 in single institution was conducted. All cases were stratified into three groups based on tract size; standard percutaneous nephrolithotomy with tract size ? 22 F, mini percutaneous nephrolithotomy with tract size 15 - 20 F and ultramini percutaneous nephrolithotomy with tract size ? 14 F. Age, gender, stone complexity using Guy's stone score, stone size, operative time, hemoglobin drop, hospital stay, early major and minor complications were reviewed. RESULTS: A total of 1074 patients had undergone percutaneous nephrolithotomy among which, 578 patients were standard percutaneous nephrolithotomy, 433 mini percutaneous nephrolithotomy and 63 had undergone ultramini percutaneous nephrolithotomy. There was even distribution of patients with Guy's stone score 1 and 2 in all three groups. However, majority of patients with Guy's stone score 3 underwent standard percutaneous nephrolithotomy or mini percutaneous nephrolithotomy and no patients with Guy's stone score 4 underwent ultramini percutaneous nephrolithotomy. Age group, gender and operative time were comparable between the groups; however, significant difference was noted in terms of less hemoglobin drop and shorter hospital stay (p-value < 0.05) in the miniaturized percutaneous nephrolithotomy group. Complications were found to be fewer in mini percutaneous nephrolithotomy and ultramini percutaneous nephrolithotomy group in comparison to standard percutaneous nephrolithotomy. CONCLUSIONS: Miniaturization of tract size significantly decreases post-operative complication rates, blood loss and hospital stay while maintaining high stone free rates in well selected patients undergoing Percutaneous nephrolithotomy.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea , Adulto , Feminino , Humanos , Cálculos Renais/patologia , Tempo de Internação/estatística & dados numéricos , Masculino , Nepal , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/métodos , Duração da Cirurgia , Estudos Retrospectivos , Resultado do Tratamento
18.
Arch Ital Urol Androl ; 91(3)2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31577102

RESUMO

OBJECTIVES: Introduction of the "access sheet" is one of the most important steps steps of the percutaneous nephrolithotomy (PNL) intervention. In creating the access tract, various dilatators (balloon, metal) are used and different need-based dilatation tools were developed. In this study, we aimed to compare the mechanical Amplatz dilatation (AD), balloon dilatation (BD) and one-shot dilatation (OSD) methods in a retrospective manner. METHODS: A total of 182 patients (127 males and 55 females), who underwent PNL surgery in Urology Department of Fatih Sultan Mehmet Research and Training Hospital between January 2016 and September 2018, were included in this study. RESULTS: The average age was 47.34 ± 12.68 years (age range 15-80) and average BMI was 27.15 ± 5.01 kg/m2 (range between 17.12 and 40.75 kg/m2). There was a prominent difference in terms of operation duration (p = 0.032). Meaningful difference was found among the groups in terms of dilation fluoroscopy time (p = 0.001), with a notable shorter time in OSD group than the others (p < 0.05). Beside this, there was no difference between the AD and BD groups in terms of fluoroscopy times (p > 0.05). Also, there was no difference among the groups by Clavien complication rate (p > 0.05). There was a prominent difference among the groups in terms of hemoglobin decrement (p = 0.012; p < 0.05). The hemoglobin decrease in OSD group was significantly lower than in AD and BD groups (p < 0.05; p < 0.01). On the contrary, there was no meaningful difference between AD and BD groups with this regard (p > 0.05). CONCLUSIONS: As a result, we have concluded that the use of OSD modality in PNL interventions could be superior to other methods with respect to its feasibility, cost-effectiveness, shorter radiation exposure / fluoroscopy time and it could be a preferable way of treatment especially in developing countries.


Assuntos
Dilatação/métodos , Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dilatação/efeitos adversos , Dilatação/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Estudos Retrospectivos , Adulto Jovem
19.
Int J Urol ; 26(12): 1144-1147, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31571295

RESUMO

AIM: To assess the efficacy and safety of trans-tract electrocoagulation at the end of endoscopic combined intrarenal surgery for renal or ureteral stones. METHODS: The present study included patients who underwent endoscopic combined intrarenal surgery from May 2010 to March 2018. After June 2013, the trans-tract electrocoagulation procedure, to coagulate bleeding from the access tract using a resectscope was carried out at the end of the operation. We compared the patients' background and surgical outcomes between patients with and without trans-tract electrocoagulation. RESULTS: Between the trans-tract electrocoagulation (n = 225) and non-trans-tract electrocoagulation (n = 72) groups, the stone number was significantly smaller (1:2:3 or more, 126:72:27 vs 59:10:3, P = 0.001) and the initial stone-free rates were significantly higher (80% vs 72%, P = 0.006) in the trans-tract electrocoagulation group than in the non-trans-tract electrocoagulation group. Patients experienced a higher nephrostomy tube-free rate (67% vs 26%, P < 0.0001), shorter postoperative catheterization time (2.8 ± 3.8 vs 5.4 ± 5.0 days, P = 0.002) and shorter hospital stay (6.5 ± 3.6 vs 8.8 ± 5.0 days, P = 0.0001) in the trans-tract electrocoagulation group than in the non-trans-tract electrocoagulation group. CONCLUSIONS: Trans-tract electrocoagulation in endoscopic combined intrarenal surgery is a safe and efficient procedure that decreases the need for nephrostomy tube placement after surgery.


Assuntos
Eletrocoagulação/métodos , Endoscopia/métodos , Hemostasia Cirúrgica/métodos , Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Nefrostomia Percutânea/estatística & dados numéricos , Cálculos Ureterais/cirurgia , Idoso , Perda Sanguínea Cirúrgica/prevenção & controle , Cateteres/estatística & dados numéricos , Eletrocoagulação/efeitos adversos , Eletrocoagulação/instrumentação , Endoscopia/efeitos adversos , Endoscopia/instrumentação , Feminino , Hemostasia Cirúrgica/efeitos adversos , Hemostasia Cirúrgica/instrumentação , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/instrumentação , Nefrostomia Percutânea/instrumentação , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Período Pós-Operatório , Estudos Retrospectivos
20.
Int J Surg ; 71: 1-11, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31521837

RESUMO

OBJECTIVE: The purpose of this study was to retrospectively assess the efficacy and safety of minimally invasive nephrolithotomy (MPCNL) versus retrograde intrarenal surgery (RIRS) in the management of upper urinary stones. METHODS: A comprehensive literature review of articles that investigated the efficacy and safety of MPCNL and RIRS was conducted by systematically searching PubMed, EMBASE, and Cochrane Library in March 2019. Two reviewers searched the literature, independently extracted the data and evaluated the quality of the data according to the inclusion and exclusion criteria. A meta-analysis was performed by using Review Manager 5.3 software. RESULTS: Eight randomized controlled trials (RCTs) involving 725 patients with upper urinary stones were analysed based on the inclusion criteria. While MPCNL has a better clinical efficacy than RIRS with respect to the stone-free rate (SFR) [RR = 1.11, 95% CI (1.05-1.17), p = 0.0005], MPCNL has a higher incidence of haematoma [RR = 3.09, 95% CI (1.44-6.66), p = 0.004] and longer hospitalization time [MD = 0.89 day, 95% CI (0.07-1.72), p = 0.04]. In addition, no significant difference in operative time [MD = 2.46 min, 95% CI (-17.99 to 22.92), p = 0.81] and postoperative pain score [MD = 0.74, 95% CI (-0.45 to 1.94), p = 0.22] were observed between the two methods. Overall, the evidence was insufficient to suggest a statistically significant difference in the adverse event profile for MPCNL compared with RIRS. CONCLUSIONS: Our data suggest that MPCNL is an effective method for treating upper urinary stones, especially lower calyceal stones that are 1-2 cm in size. Compared to RIRS, MPCNL is associated with a longer hospital stay time and a higher incidence of haematoma. In addition, both methods have proven to be safe. Nevertheless, the findings should be further confirmed through well-designed prospective RCTs with a larger patient series.


Assuntos
Rim/cirurgia , Nefrolitotomia Percutânea/métodos , Complicações Pós-Operatórias/etiologia , Cálculos Urinários/cirurgia , Feminino , Humanos , Tempo de Internação , Masculino , Nefrolitotomia Percutânea/efeitos adversos , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Resultado do Tratamento
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