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1.
BMJ Case Rep ; 14(1)2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33514620

RESUMO

Complications after renal allograft transplantation are not so uncommon. Most complications are related to graft rejection, immune-suppressive drug toxicity and the operative procedure. Stents are placed after a transplant to prevent urine leak at the site of ureteric reimplantation, to facilitate an early healing in immune-suppressed individuals and to prevent obstruction at the site of ureteral anastomosis. We report a case of a renal allograft recipient with a forgotten ureteral double J stent. where the stent remained in situ for more than 4 years and further complicated by encrustation and stone formation at both the bladder and renal pelvic ends. The stone over the bladder coil was removed by holmium laser cystolithotripsy while the encrusted renal pelvic coil was removed by percutaneous approach. This case is presented for its rarity and also to emphasise on the need for maintenance of a stent register in order to ensure avoidance of such preventable complications.


Assuntos
Remoção de Dispositivo/métodos , Transplante de Rim/efeitos adversos , Nefrolitotomia Percutânea/métodos , Stents/efeitos adversos , Adulto , Aloenxertos , Humanos , Transplante de Rim/métodos , Lasers de Estado Sólido , Masculino , Transplantados , Resultado do Tratamento , Cálculos da Bexiga Urinária/diagnóstico por imagem , Cálculos da Bexiga Urinária/etiologia , Cálculos da Bexiga Urinária/cirurgia , Cálculos Urinários/diagnóstico por imagem , Cálculos Urinários/etiologia , Cálculos Urinários/cirurgia
2.
Medicine (Baltimore) ; 99(40): e22477, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019439

RESUMO

INTRODUCTION: Percutaneous nephrolithotomy is a procedure used for management of refractory renal calculi. Oral and parenteral opioids, along with local anesthetic infiltration, neuraxial anesthesia, and paravertebral blocks are the most common methods of managing intra-operative and post-operative pain for these patients. The erector spinae plane block with catheter (ESPC) is a newer interfascial regional anesthetic technique that can be used to manage peri-operative pain in these patients. CLINICAL FINDINGS: Three patients complained of significant flank pain were scheduled for percutaneous nephrolithotomy under general anesthesia in the prone position. DIAGNOSES: Patients were diagnosed with large renal calculi. THERAPEUTIC INTERVENTIONS: Patients received ESPC in the pre-operative holding area at the level of the T7 transverse process. The ESPCS were bolused with a solution of 30 mL 0.25% bupivacaine with 4 mg dexamethasone prior to surgery. Patients also received oral tramadol 50 mg and acetaminophen 1 g as part of the multimodal pain protocol prior to surgery. After the procedure, the patients were bolused with 0.25% bupivacaine or started on an infusion of 0.25% bupivacaine to manage their pain. OUTCOMES: No opioid or other pain medications, other than the local anesthetic solution given in the ESPCs, were used during the intra-operative or post-operative period for management of pain in these patients. Visual analogue scale (VAS) scores were below 4 for all patients in the post-operative period, and patients did not report any issues with post-operative nausea or vomiting. CONCLUSION: These patients were compared to 3 prior patients who had undergone percutaneous nephrolithotomy without ESPC. The 3 patients without ESPC placement reported increased VAS scores, had increased opioid/pain medication consumption intraoperatively and postoperatively, and had increased incidence of perioperative nausea when compared to our ESPC patients. Our report shows that ESPC, in combination with a multimodal pain protocol, can be a good option for management of patients undergoing percutaneous nephrolithotomy.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Idoso , Anestésicos Locais/uso terapêutico , Bupivacaína/uso terapêutico , Dexametasona/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Músculos Paraespinais
3.
Arch. esp. urol. (Ed. impr.) ; 73(8): 753-766, oct. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-197473

RESUMO

Holmium laser has been established as the gold-standard for the ureteroscopic management of urinary stone disease. However the role of laser in percutaneous nephrolithotomy (PCNL) varies, as multiple energy sources and lithotripters are available. Currently, lasers are becoming more relevant with the development of several miniaturized PCNL techniques. The purpose of this article is to review the role of laser in percutaneous renal surgery, and whether or not it is the best option for this approach. Discussion points include: the history and background of lasers in urologic surgery, PCNL and its outcomes in the literature, the positives and negatives of lasers versus other lithotripters in several different PCNL techniques, emerging laser technology such as thulium fiber laser, the use of lasers in establishing percutaneous renal access, and laser's role in non-stone percutaneous renal surgery


El láser holmium está establecido como gold-standard en el manejo de la litiasis con ureteroscopio. El papel del láser en la nefrolitotomía percutánea varía ya que existen varios tipos de láser. El objetivo de este artículo es revisar el papel del láser en la cirugía percutánea renal para determinar si es una buena opción terapéutica. Discutiremos la historia del láser en urología, nefrolitotomía percutánea y sus resultados en la literatura, los pros y contras de los láseres vs otros litotriptores como el tulio, el uso del láser para establecer el acceso percutáneo; el papel del láser en la cirugía percutánea no-litiásica


Assuntos
Humanos , Nefrolitotomia Percutânea/métodos , Lasers de Estado Sólido/uso terapêutico , Cálculos Renais/cirurgia , Litotripsia a Laser/métodos , Nefrolitotomia Percutânea/instrumentação , Rim/cirurgia , Litotripsia a Laser/instrumentação
4.
Arch. esp. urol. (Ed. impr.) ; 73(7): 643-650, sept. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-195962

RESUMO

OBJECTIVE: To compare miniaturized percutaneous nephrolithotomy (mini-PNL) and retrograde intrarenal surgery (RIRS) in children with 10-20 mm renal stones. MATERIALS AND METHODS: Between 2015 and 2019, 63 pediatric patients aged under 16 years who underwent mini-PNL and RIRS for the treatment of kidney stones sized 10-20 mm were analyzed retrospectively. The mini-PNL group (n=30) was defined as group 1 and the RIRS group (n=33) was defined as group 2. Peri-operative data including stone-free rate, operative time, fluoroscopy time, hospitalization time, number of anesthesia sessions, complication rates, and cost-effectiveness were analyzed. RESULTS: The mean age was 8.09±5.49 years in group 1 and 5.75±4.56 years in group 2. The stonefree rate was not different at the first (80.0% vs. 57.6%) and third month (93.3% vs. 90.9%) follow-up in group 1 and group 2. The mean hospitalization, operative, and fluoroscopy times were statistically significantly longer in group 1. The mean number of anesthesia sessions for patients was 1.20±0.40 in group 1 and 2.15±0.44 in group 2 (p = 0.00). Minor complication rates were not different and no major complications were observed in either group. The cost per patient was calculated as 365.97 Euros in group 1 and 698.64 Euros in group 2 (p = 0.001). CONCLUSIONS: This study suggested that RIRS was an effective alternative treatment method for 10-20 mm kidney stones in children, with comparable stone-free and complication rates. RIRS has a shorter operative time, fluoroscopy time, hospital stay than mini-PNL, with a similar stone-free rate for 10-20 mm kidney stones in children. However, mini-PNL is cheaper and allowed a lower need for anesthesia sessions


OBJETIVO: Comparar nefrolitotomia percutánea mini y ureteroscopia flexible retrógrada intrarenal para litiasis de 10-20 mm en niños. MATERIAL Y METODOS: Entre 2015 y 2019, analizamos retrospectivamente 63 pacientes pediátricos menores de 16 años recibieronmini-nefrolitotomia percutanea y URs flexible para el tratamiento de litiasis renales de entre 10-20 mm. Grupo 1 (n=30) mini nefrolitotomía percutánea, grupo 2 (n= 33) URs flexible. Datos perioperatorios incluyendo la tasa libre de litiasis, tiempo quirúrgico, tiempo hospitalización, número de anestesias requeridas, tasa de complicaciones y coste-efectividad fueron analizados. RESULTADOS: La edad media fue de 8,09±5,49 años en el grupo 1 y 5,75±4,56 en el grupo 2. La tasa libre de litiasis no fue diferente en el primer mes (80,0% vs. 57,6%) y 3er mes (93,3% vs. 90,9%) entre el grupo 1 y grupo 2. La mediana de tiempo hospitalización, tiempo quirúrgico y tiempo exposición a fluoroscopia fueron mas largos en el grupo 1. La media de anestesias fue de 1,20±0,40 en el grupo 1 y 2,15±0,44 en el grupo 2 (p = 0,00). La tasa de complicaciones menores no fue diferente y la de mayores tampoco. El coste por paciente se estableció en 365 euros en el grupo 1 y 698 euros en el grupo 2. CONCLUSIONES: Este estudio sugiere que la ureteroscopia flexible es un tratamiento efectivo como alternativa en niños con litiasis de 10-20 mm con unas tasa libres de litiasis y complicaciones parecidas. La URs flexible comporta un menor tiempo operatorio, fluoroscopia, estancia hospitalaria que la mini percutánea con tasa libre de litaisis similares. Por contra, la mini-percutanea es mas barata y comporta menos sesiones anestésicas


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Nefrolitotomia Percutânea/métodos , Ureteroscopia/métodos , Nefrolitíase/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Duração da Cirurgia , Seguimentos , Complicações Intraoperatórias
5.
Medicine (Baltimore) ; 99(34): e21847, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846834

RESUMO

RATIONALE: Lesch-Nyhan syndrome (LNS) is an X-linked recessive disorder presenting with uric acid overproduction, neurocognitive disability, and behavioral disturbances. Inhalational anesthesia has been frequently used in LNS patients undergoing surgery. Characteristic compulsive self-injurious behavior and high risk of emesis may hinder inhalational induction. Propofol may be beneficial for these patients because of its easy and rapid titration for anesthetic depth during induction, early recovery from anesthesia, and antiemetic effect as well as uricosuric effect. PATIENT CONCERNS: A 16-year-old male adolescent was scheduled for percutaneous nephrolithotomy. He exhibited poorly controlled muscle, self-injurious behaviors and intellectual disability. DIAGNOSIS: The patient presented with neurodevelopmental delay in the first year of life, and was diagnosed with LNS, with a substitution of phenylalanine to leucine in hypoxanthine-guanine phosphoribosyltransferase (HPRT) 1 gene on the X-chromosome at 3 years of age. INTERVENTIONS: Total intravenous anesthesia was used for induction and maintenance of anesthesia with propofol and remifentanil using target-controlled infusion. OUTCOMES: Time to recovery of consciousness was prolonged after uneventful surgery. Serum uric acid levels gradually increased during postoperative period. LESSONS: Propofol anesthesia using target-controlled infusion does not provide significant clinical advantages in rapid emergence from anesthesia and management of hyperuricemia in LNS patients undergoing urological surgery.


Assuntos
Anestesia Geral/efeitos adversos , Hipoxantina Fosforribosiltransferase/genética , Síndrome de Lesch-Nyhan/psicologia , Propofol/administração & dosagem , Administração Intravenosa , Adolescente , Período de Recuperação da Anestesia , Anestesia Geral/métodos , Humanos , Hiperuricemia/tratamento farmacológico , Hiperuricemia/etiologia , Deficiência Intelectual/etiologia , Cálculos Renais/cirurgia , Síndrome de Lesch-Nyhan/sangue , Síndrome de Lesch-Nyhan/diagnóstico , Síndrome de Lesch-Nyhan/genética , Masculino , Nefrolitotomia Percutânea/métodos , Transtornos do Neurodesenvolvimento/etiologia , Comportamento Autodestrutivo/etiologia , Resultado do Tratamento , Ácido Úrico/sangue , Vômito/induzido quimicamente
6.
Curr Urol Rep ; 21(6): 23, 2020 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-32378073

RESUMO

PURPOSE OF THE REVIEW: We investigate articles in the literature published in the last 5 years (2014-2019) regarding ultrasound education in the specialty of urology. RECENT FINDINGS: Ultrasound has been touted as the modern day stethoscope. Medical educational governing bodies have encouraged the incorporation of ultrasound in medical school education. However, in this review, we find that there are gaps in educational opportunities and standardization in residency and continuing education for urology practitioners. We have identified several new tools for procedure-specific training published in the last 5 years including MRI fusion prostate biopsy and percutaneous nephrolithotomy. New technology is being fused with traditional ultrasound training to provide procedure-specific ultrasound knowledge. There is a need to incorporate new technology and standards into resident and continuing medical education.


Assuntos
Internato e Residência/métodos , Nefrolitotomia Percutânea/métodos , Ultrassonografia , Urologia/educação , Cateterismo/métodos , Currículo , Educação Médica Continuada/métodos , Humanos , Hidronefrose/diagnóstico por imagem , Biópsia Guiada por Imagem , Imagem por Ressonância Magnética , Masculino , Imagem Multimodal , Próstata/patologia , Treinamento por Simulação , Ultrassonografia de Intervenção , Realidade Virtual
7.
Curr Urol Rep ; 21(7): 27, 2020 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-32444987

RESUMO

PURPOSE OF REVIEW: Urologists are at significant risk due to radiation exposure (RE) from endourological procedures for stone disease. Many techniques described have shown a reduction of RE. The purpose of this article is to review available protocols to decrease RE during such procedures and provide tips and tricks for their implementation. RECENT FINDINGS: Several low-radiation and radiation-free protocols for percutaneous nephrolithotomy and flexible ureteroscopy have been described as an attempt to reduce RE during surgery. Beginning with specific checklists to ensure adequate C-arm usage, fluoroless procedures are based on endoscopic assessment, tactile guidance, and use of ultrasound to avoid fluoroscopy. A specific preoperative checklist and low radiation or complete fluoroless radiation endourological procedures have shown to be effective, feasible, and safe. It is recommended for urologists to be aware of the risks of RE and apply the "ALARA" (As Low As Reasonably Achievable) protocols.


Assuntos
Nefrolitotomia Percutânea/métodos , Exposição Ocupacional/prevenção & controle , Exposição à Radiação/prevenção & controle , Ureteroscopia/métodos , Cálculos Urinários/diagnóstico por imagem , Lista de Checagem , Fluoroscopia , Humanos , Ultrassonografia , Cálculos Urinários/cirurgia
8.
Arch. esp. urol. (Ed. impr.) ; 73(4): 307-315, mayo 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-192991

RESUMO

OBJETIVO: Comparar la eficiencia, seguridad y coste de la ureteroscopia flexible polo inferior y la nefrolitotomia percutanea para el tratamiento de litiasis del polo inferior de 1 a 2 cm de diámetro. MÉTODOS: Esto fue un estudio prospectivo randomizado. En total, 175 pacientes fueron randomizados en 5 grupos (35 en cada grupo): Grupo A se manejó con uretereroscopia flexible retrograda polo inferior (UFRI), Grupo B con micronefrolitotomia percutánea (NLP); grupo C con ultra-mini NLP; Grupo D con mini NLP y el grupo E con estándar NLP. Tiempo quirúrgico y de fluoroscopio, estancia hospitalaria, tasa libre de litiasis (TLL), complicaciones, ureterolitotripsias secundarias y coste fueron comparados entre grupos. RESULTADOS: Un total de 168 pacientes fueron incluidos en el análisis final. La TLL fue de 76%, 77%, 90,1%, 94,1% y 94%. La estancia media hospitalaria fue de 1, 1,5, 2,2, y 3 días para UFRI, micoNLP, ultra-mini NLP, mini NLP y estándar NLP (p < 0,001) .El coste total medio de los procedimientos fue de 1250 USD, 962 USD, 695 USD, 632 USD y 619 USD respectivamente. El tiempo medio de retorno a las actividades diarias fue de 3,9, 4,5, 6,5, 9,3 y 13,5 días para UFRI, micro NLP, ultra-mini NLP, mini NLP,estándar NLP, respectivamente (p < 0,001). CONCLUSIONES: TLL para el tratamiento de litiasis de polo inferior fue mayor para ultra-mini NLP, mini NLP y estándar NLP que para micro NLP y UFRI. Ademas, los pacientes deben ser informados sobre los resultadoscon los otros procedimientos; con aumento de la agresividad del tratamiento, el coste del procedimiento disminuye, pero la estancia hospitalaria y el retorno a las actividades diarias se incrementa


OBJECTIVE: To compare efficiency, safety and full cost of lower retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) types for the treatment of lower calyceal stones between 1 and 2 cm in size. METHODS: This was a prospective, randomized study. In all, 175 patients were randomly divided into five groups of 35 patients each: Group A was managed by RIRS, Group B by micro PNL, Group C by ultra-mini PNL, Group D by mini PNL, and Group E by standard PNL. Operating and fluoroscopy time, length of hospital stay, stone-free rates (SFR), complications, secondary ureterolithotripsy and cost were compared between groups. RESULTS: A total of 168 patients were included in the final analysis. The SFR was 76%, 77%, 90.1%, 94.1% and 94%; median length of hospital stay 1, 1.5, 2, 2, and 3 days was for RIRS, micro, ultra-mini, mini, and standard PNL, respectively (p < 0.001). The mean total costs of the procedures per case were $1,250, $962, $695, $632, and $619, and the mean return to daily activities time was 3.9, 4.5, 6.5, 9.3, and 13.5 days for RIRS, micro, ultra-mini, mini, and standard PNL, respectively (p < 0.001). CONCLUSIONS: SFR of treatment of lower calyceal stone was higher in ultra-mini, mini and standard PNL than micro PNL and RIRS. Moreover, patients should be informed about the results of all different procedures; with increasing of the invasiveness of treatment, cost of the procedure decrease; but the hospital stay and return to daily activity interval increase


Assuntos
Humanos , Masculino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Análise Custo-Eficiência , Histeroscópios/normas , Nefrolitotomia Percutânea/métodos , Litíase/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Resultado do Tratamento , Estudos Prospectivos , Fluoroscopia , Tempo de Internação , Procedimentos Cirúrgicos Urológicos , Cálices Renais/cirurgia , Ureteroscopia
9.
BJU Int ; 126(1): 168-176, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32279423

RESUMO

OBJECTIVES: To comparatively evaluate the clinical outcomes of super-mini percutaneous nephrolithotomy (SMP) and mini-percutaneous nephrolithotomy (Miniperc) for treating urinary tract calculi of >2 cm. PATIENTS AND METHODS: An international multicentre, retrospective cohort study was conducted at 20 tertiary care hospitals across five countries (China, the Philippines, Qatar, UK, and Kuwait) between April 2016 and May 2019. SMP and Miniperc were performed in 3525 patients with renal calculi with diameters of >2 cm. The primary endpoint was the stone-free rate (SFR). The secondary outcomes included: blood loss, operating time, postoperative pain scores, auxiliary procedures, complications, tubeless rate, and hospital stay. Propensity score matching analysis was used to balance the selection bias between the two groups. RESULTS: In all, 2012 and 1513 patients underwent SMP and Miniperc, respectively. After matching, 1380 patients from each group were included for further analysis. Overall, there was no significant difference in the mean operating time or SFR between the two groups. However, the hospital stay and postoperative pain score were significantly in favour of SMP (both P < 0.001). The tubeless rate was significantly higher in the SMP group (72.6% vs 57.8%, P < 0.001). Postoperative fever was much more common in the Miniperc group (12.0% vs 8.4%, P = 0.002). When the patients were further classified into three subgroups based on stones diameters (2-3, 3-4, and >4 cm). The advantages of SMP were most obvious in the 2-3 cm stone group and diminished as the size of the stone increased, with longer operating time in the latter two subgroups. Compared with Miniperc, the SFR of SMP was comparable for 3-4 cm stones, but lower for >4 cm stones. There was no statistical difference in blood transfusions and renal embolisations between the two groups. CONCLUSIONS: Our data showed that SMP is an ideal treatment option for stones of <4 cm and is more efficacious for stones of 2-3 cm, with lesser postoperative fever, blood loss, and pain compared to Miniperc. SMP was less effective for stones of >4 cm, with a prolonged operating time.


Assuntos
Cálculos Renais/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Nefrolitotomia Percutânea/métodos , Pontuação de Propensão , Feminino , Seguimentos , Humanos , Cálculos Renais/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia
10.
J Robot Surg ; 14(6): 855-859, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32141015

RESUMO

The gold standard for urologic management of large stone disease traditionally has been percutaneous nephrolithotomy (PCNL). An alternative to PCNL is robotic pyelolithotomy (RP), which continues to gain traction. This study is a retrospective review of ten cases performed over a 2 year period presenting operative outcomes for large stone disease treated with RP. The mean and standard deviation were calculated for age, body mass index, stone volume, stone diameter, pre-operative creatinine, operative time, robot-docked time, length of stay, post-operative creatinine, and estimated blood loss. In addition, results were collected for post-operative complications and secondary procedure requirements. Complete stone clearance was successful in 9 of 10 cases. The average renal function remained stable from a pre-operative creatinine of 0.917 mg/dL to a post-operative creatinine level of 0.943 mg/dL. This case series demonstrates that robotic assisted surgery has practical application when managing large stone disease.


Assuntos
Cálculos Renais/cirurgia , Pelve Renal/cirurgia , Litotripsia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Perda Sanguínea Cirúrgica , Creatinina/sangue , Feminino , Humanos , Masculino , Nefrolitotomia Percutânea/métodos , Duração da Cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos , Cálculos Coraliformes/cirurgia , Resultado do Tratamento
11.
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
12.
Arch Ital Urol Androl ; 91(4): 256-260, 2020 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-31937089

RESUMO

PURPOSE: To assess disease-specific and health-related QoL, anxiety and depression as well as satisfaction regarding retrograde intrarenal surgery (RIRS) and miniaturized percutaneous nephrolithotomy (mPCNL) intervention for kidney stones up to 2.5 cm. Secondarily, pain as well as perioperative and postoperative patient outcomes were evaluated. METHODS: 60 consecutive patients with kidney stones of dimensions not exceeding 2.5 cm were enrolled in the study of which 30 underwent RIRS and 30 mPCNL. Perioperative characteristics (age, gender, body mass index (BMI), stone side and size, previous interventions for kidney stones and duration of hospitalization) and surgical outcomes (hemoglobin drop, stone-free rate, visual analogue scale (VAS), stenting time, size of ureteral access sheath (UAS) deployment, and postoperative complications) of patients were collected. Quality of life and psychological outcomes were evaluated using validated questionnaires. RESULTS: No significant differences were found between the two groups in terms of age, gender, BMI, stone side and size (p > 0.05). Significant differences between the mPCNL and the RIRS groups were found regarding stenting time (p = 0.032) and duration of hospital stay (p < 0.001). The stone-free rates of mPCNL vs RIRS were not significantly different between the two groups (73.3% vs 66.7%, p > 0.05). Peri- and postoperative complications were not statistically different between the two groups (p > 0.05). RIRS group reported higher anxiety and depression scores compared with the mPCNL group (3 [range 0-15] vs 15 [range 6-24], p < 0.01). We found significant differences between the two groups in social (p < 0.05) and vitality (p < 0.01) scores. VAS pain score was significantly lower in the mPCNL group than in the RIRS one (p < 0.05). CONCLUSIONS: These results open new scenarios in the treatment of kidney stones up to 2.5 cm when RIRS and mPCNL have interchangeable indications. Since in our experience complications and success rate are similar, the surgical choice of switching from RIRS to mPCNL in real-time and viceversa may be proposed to the patient in the preoperative counseling.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Satisfação do Paciente , Qualidade de Vida , Adulto , Ansiedade/epidemiologia , Depressão/epidemiologia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Inquéritos e Questionários , Resultado do Tratamento
13.
Curr Opin Urol ; 30(2): 120-129, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31990816

RESUMO

PURPOSE OF REVIEW: The aim of the article is to evaluate the actual role of extracorporeal shock-wave lithotripsy (ESWL) in the management of urolithiasis based on the new developments of flexible ureterorenoscopy (FURS) and percutaneous nephrolithotomy (PCNL). RECENT FINDINGS: In Western Europe, there is a significant change of techniques used for treatment of renal stones with an increase of FURS and a decrease of ESWL. The reasons for this include the change of indications, technical improvement of the endourologic armamentarium, including robotic assistance. Mostly relevant is the introduction of digital reusable and single-use flexible ureterorenoscopes, whereas micro-PCNL has been abandoned. Some companies have stopped production of lithotripters and novel ideas to improve the efficacy of shock waves have not been implemented in the actual systems. Promising shock-wave technologies include the use of burst-shock-wave lithotripsy (SWL) or high-frequent ESWL. The main advantage would be the very fast pulverization of the stone as shown in in-vitro models. SUMMARY: The role of ESWL in the management of urolithiasis is decreasing, whereas FURS is constantly progressing. Quality and safety of intracorporeal shock-wave lithotripsy using holmium:YAG-laser under endoscopic control clearly outweighs the advantages of noninvasive ESWL. To regain ground, new technologies like burst-SWL or high-frequent ESWL have to be implemented in new systems.


Assuntos
Endoscopia , Cálculos Renais/cirurgia , Litotripsia , Procedimentos Cirúrgicos Robóticos , Endoscopia/métodos , Endoscopia/tendências , Humanos , Terapia a Laser , Lasers de Estado Sólido/uso terapêutico , Litotripsia/métodos , Litotripsia/tendências , Nefrolitotomia Percutânea/métodos , Nefrolitotomia Percutânea/tendências , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/tendências , Resultado do Tratamento , Ureteroscopia/instrumentação , Ureteroscopia/métodos , Ureteroscopia/tendências , Urolitíase/cirurgia
14.
Curr Opin Urol ; 30(2): 107-112, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31895077

RESUMO

PURPOSE OF REVIEW: Miniaturization was the major trend in percutaneous nephrolithotomy in the past 15 years, aiming to lower tract-size-related complication rates while maintaining good stone-free-rates (SFR). Although there is some evidence that 18 Fr Mini-percutaneous lithotomy (PCNL) has comparable efficacy to conventional PCNL and a lower risk of bleeding, it is less clear whether further miniaturization led to an even better safety profile while maintaining good SFR. The present review evaluates the latest results on efficacy, safety, and feasibility of miniaturized techniques 14 Fr or less in PCNL. RECENT FINDINGS: Recent literature of the last 2 years reported outcomes of different systems from 4.85 to 14 Fr. Most of these studies demonstrated good efficacy when comparing with RIRS or conventional PCNL. Limitations were a decrease in SFR for stone sizes more than 2 cm, a longer operative time and the likelihood of pathologic intrarenal pressure (IRP) with a higher risk of postoperative fever or sepsis. SUMMARY: Miniaturization of PCNL is an innovative approach in order to lower complication rates and hospitalization time for therapy of renal stones. Limitations like longer OR time or higher IRP may limit the benefit of super miniaturized systems. Currently, the 18 Fr Mini-PCNL seems to be the most reliable solution for stones up to 25 mm, whereas RIRS remains the first choice in renal stones less than 10 mm.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/instrumentação , Nefrolitotomia Percutânea/métodos , Endoscopia/métodos , Estudos de Viabilidade , Humanos , Miniaturização , Duração da Cirurgia , Resultado do Tratamento
15.
J Robot Surg ; 14(3): 401-407, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31317314

RESUMO

Standard of care for large or complex renal stones is percutaneous nephrolithotomy. Robotic pyelolithotomy, however, may be a feasible alternative, but limited data exist on its outcomes and complications. Our study objective was to describe the outcomes and peri-operative complications of robotic pyelolithotomy for complex renal calculi. We performed a retrospective analysis of robotic pyelolithotomy at our tertiary academic institution from 2015 to 2018. Demographics, stone clearance rates, complications, estimated blood loss, operative time, and length of stay were reported. 15 patients were included with a median age of 59 years (SD 15.3, 27-80) and BMI 25 kg/m2 (SD 4.6, 20.9-35.7). Median follow-up was 4 months. Median stone size was 3 cm (SD 1.2 cm, 2-5 cm). Concomitant pyeloplasty was performed in 2 patients, complete stone clearance in 11 (73%) cases and 4 out of 5 (80%) with a solitary stone. Median operative time was 191.5 min (SD 64.8 min, 110-303 min), with no open conversion. Median EBL was 70 ml (SD 65 ml, 20-250 ml) and median length of stay was 1 day (SD 1 day, 1-5 days). Median change in creatinine and eGFR were - 0.02 mg/dl and + 3 ml/min/1.73 m2. There were no cases of sepsis or post-operative fever and only one case of transfusion. Robotic pyelolithotomy appears safe and effective. Ultimately, less bleeding, lower septicemia, renal parenchymal preservation, and favorable stone-free rates in a single procedure make this as an attractive option in the management of select patients with large renal stone disease.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica , Feminino , Seguimentos , Humanos , Pelve Renal/cirurgia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
16.
Minim Invasive Ther Allied Technol ; 29(2): 61-69, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30849258

RESUMO

To compare the safety and efficacy of total tubeless percutaneous nephrolithotomy (PCNL) with standard PCNL for the treatment of upper urinary calculi. PubMed, EMBASE, Cochrane Library and ScienceDirect were searched for collecting related literature on the two procedures. All compared studies, including randomized controlled trials (RCT), cohort studies (CS) and case-control studies (CCS), were included. Totally, 14 studies were included. Pooled data demonstrated that patients who underwent total tubeless PCNL were associated with significantly shorter operation time [weighted mean difference (WMD): -3.41, P = 0.004], shorter hospital stay (WMD: -1.54, P < 0.00001). It seemed that significantly less postoperative analgesic requirement could be found in the total tubeless PCNL group according to subgroup analysis. However, no significant differences could be found between the two groups in stone-free rate [risk ratio (RR): 1.03, P = 0.26], hemoglobin drop (WMD: -0.03, P = 0.85), and rates of postoperative fever (RR: 0.53, P = 0.11) and transfusion (RR: 0.79, P = 0.41). Sensitivity analysis after excluding CCS revealed results similar to previous findings. Total tubeless PCNL would be superior to standard PCNL in reducing operation time, hospital stay and postoperative analgesic requirement without significantly more adverse events.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Analgésicos/administração & dosagem , Transfusão de Sangue , Humanos , Tempo de Internação , Duração da Cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
17.
Asian J Surg ; 43(1): 60-68, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30782495

RESUMO

This systematic review was designed to evaluate the efficacy of tubeless percutaneous nephrolithotomy (PCNL) versus standard percutaneous nephrolithotomy (PCNL) for kidney stones. Computerized search was performed for randomized clinical trials (RCTs) from PubMed, EMBASE, CENTRAL and Cochrane Database of Systematic Reviews databases. The included studies were randomized trials investigating tubeless PCNL versus standard PCNL in patients with kidney stones. Outcomes measured included postoperative pain, postoperative analgesia, hospital stay, drop in hemoglobin, stone free, urine leakage, blood transfusion, or pyrexia per randomized patients. In all, 15 RCTs involving 947 subjects were included. With regard to postoperative pain, analgesia, hospital stay and urine leakage, it was significantly reduced in tubeless PCNL group. In respect of drop in hemoglobin, stone free, blood transfusion and pyrexia, tubeless PCNL group appeared to be equivalent with standard PCNL group. Tubeless PCNL technology is associated with shorter hospitalization time, lower incidence of postoperative pain and less analgesia requirement after nephrolithotony. Tubeless PCNL can be used as a substitute for traditional standard PCNL of the first-line treatment. Nevertheless, further research in this field is urgently needed to confirm it.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Resultado do Tratamento
18.
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
19.
Urology ; 136: 266-271, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31734350

RESUMO

OBJECTIVE: To determine feasibility of an electromagnetic (EM) guidance system (Auris Health, Redwood City, CA) in obtaining percutaneous renal access among urologists and trainees of different experience levels. EM-guidance is appealing for access as it allows real time, 3-dimensional targeting without radiation. Few studies have explored this for percutaneous nephrolithotomy (PCNL) and none have assessed its potential to decrease the learning curve in obtaining access using traditional techniques. METHODS: Institutional Animal Care and Use Committee approval was obtained to compare EM-guided percutaneous access to fluoroscopic guided access in a porcine model. Voluntary participants included urology trainees and faculty. They were categorized as beginner (no prior primary percutaneous nephrolithotomyexperience), intermediate (10-100 prior) and advanced (>100). Each participant attempted an EM and fluoroscopic guided puncture. Primary outcome was successful puncture. Secondary outcomes included access time, fluoroscopy time, and number of attempts. Participants were limited to 3 attempts and 10 minutes total to obtain access using each technique. RESULTS: Fourteen participants (6 beginners, 4 intermediates, and 4 experts) attempted 28 punctures. Overall success using EM-guidance was 93% compared to 71% using fluoroscopy (P = .33). EM punctures had shorter access times (85 vs 255 seconds, P <.01) required fewer attempts (1 vs 2, P = .04) and had decreased associated fluoroscopy times (1 vs 96 seconds, P <.01) excluding the initial retrograde pyelogram and guidance of the ureteroscope to the desired calyx. Beginners showed comparable success rates and outcomes relative to experts despite higher access times. CONCLUSION: EM-guidance is a promising new technique to decrease the learning curve of percutaneous access with high success rates and minimal radiation.


Assuntos
Competência Clínica , Campos Eletromagnéticos , Nefrolitotomia Percutânea/métodos , Urologia , Animais , Estudos de Viabilidade , Projetos Piloto , Suínos
20.
BJU Int ; 125(2): 276-283, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31721407

RESUMO

OBJECTIVES: To evaluate prospectively whether a tubeless (JJ stent-only) percutaneous nephrolithotomy (PCNL) might reduce the risk of hydrothorax, compared to an approach where a nephrostomy tube is left. MATERIALS AND METHODS: We conducted a two-arm open-label prospective randomized study (NCT02036398) comparing tubeless supra-costal PCNL (with a JJ stent only) to standard PCNL (with nephrostomy tube and JJ stent) using intention-to-treat (ITT) and per-protocol (PP) analyses. All patients underwent a standard single-stage prone supra-costal procedure with single-tract access. Complication data were collected according to the Clavien-Dindo grading system. The primary endpoint was the rate of hydrothorax, and secondary endpoints included stone-free rate (SFR) and complication rate. Multivariable logistic regression analysis identified factors associated with hydrothorax formation. RESULTS: Out of 101 patients approached, 75 were finally analysed. No differences were observed between the two arms with regard to baseline demographic and stone characteristics. The mean largest stone size ranged between 23 and 24.2 mm. No significant difference was seen in the mean operating time and length of hospital stay. The incidence of hydrothorax was significantly higher in the nephrostomy group in comparison to the tubeless group (37.8% vs 15.8%, P = 0.031, and 38.4% vs 13.8%, P = 0.016, in the ITT and PP analyses, respectively). The SFR and complication rate were similar in both groups using the ITT and PP analyses. Multivariable logistic regression analysis showed that nephrostomy tube placement was the only covariate associated in a statistically significant manner to hydrothorax (odds ratio 3.628, 95% confidence interval 1.073-12.265; P = 0.038). CONCLUSION: The rate of hydrothorax in supra-costal PCNL is associated with the type of postoperative drainage left. When possible, a tubeless approach should be applied as it may confer a lower risk of hydrothorax.


Assuntos
Hidrotórax/epidemiologia , Cálculos Renais/cirurgia , Nefrolitotomia Percutânea , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Feminino , Humanos , Hidrotórax/prevenção & controle , Cálculos Renais/epidemiologia , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/métodos , Duração da Cirurgia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Resultado do Tratamento
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