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2.
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
3.
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
4.
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
5.
Med Oncol ; 37(4): 26, 2020 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-32166542

RESUMO

RENAL score has been validated on predicting adverse events and relapses in percutaneous treatments of renal lesions. To better fit interventional issues a modified score (mRENAL) has been introduced, but the only difference from the RENAL score is on the dimensional parameter. However, it remains of surgical derivation while a specific interventional score is missing. This study aims to obtain a specific score (ABLATE) to better quantify the risk of complications and relapses in percutaneous kidney ablation procedures compared to the existing surgical scores. Taking inspiration from previous papers, a score was built to quantify the real difficulties faced in percutaneous treatment of renal lesions. The ABLATE score was used on 71 cryoablations to evaluate its predictivity of complications and relapses. Logistic regression was used to predict complication incidence; Cox-regression was used for relapses; ROC analysis was used to evaluate the accuracy of the different scores. Between January 2014 and November 2019, 71 lesions in 68 patients were treated. Overall, malignant histology was found in 62 lesions (87.3%). Mean and median RENAL, mRENAL, and ABLATE scores were 7.04 and 7, 7.19 and 7, and 5.11 and 4, respectively. Out of 71 treatments, we experienced 3 bleeding with anemia (4.2%), only 2 of which needed further treatment (2.82%). The mean and median RENAL, mRENAL, and ABLATE scores in those with complications were 7.66 and 7.01 (p = 0.69), 8.0 and 7.1 (p = 0.54), and 6.6 and 5.0 (p = 0.38), respectively. Out of 62 malignant lesions, we experienced 2 persistent and 6 recurrent lesions (3.2% and 8.4%, respectively). At Cox-regression analyses, mABLATE score outperformed both RENAL and mRENAL scores in predicting recurrences (HR 1.48; p < 0.001 vs. 1.41; p = 0.1 vs. 1.38: p = 0.07, respectively). The ABLATE score showed to be a better predictor of relapses than RENAL and mRENAL. The small number of complications conditioned a lack of statistic power on complications for all the scores. At the moment to quantify the risks in percutaneous kidney ablation procedures, surgical scores are used. A specific score better performs this task.


Assuntos
Nefropatias/patologia , Nefropatias/cirurgia , Nefrostomia Percutânea/métodos , Técnicas de Ablação/efeitos adversos , Técnicas de Ablação/métodos , Idoso , Feminino , Humanos , Masculino , Nefrostomia Percutânea/efeitos adversos , Complicações Pós-Operatórias , Valor Preditivo dos Testes , Recidiva , Resultado do Tratamento
6.
BJU Int ; 125(6): 898-904, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32077229

RESUMO

OBJECTIVE: To compare the safety and effectiveness of using a conventional nephrostomy sheath (NS) vs using a new NS with suction and evacuation functions in minimally invasive percutaneous nephrolithotomy (MPCNL) for the treatment of staghorn stones. PATIENTS AND METHODS: A prospective and randomised study of 60 patients with staghorn stones randomly assigned into two groups of 30 patients. One group underwent MPCNL using conventional NS, whereas the other group underwent MPCNL with suction-evacuation NS (SENS). Patient demographics, stone characteristics, intraoperative data, perioperative data, and surgical results were collected and analysed. RESULTS: The patient demographics and stone characteristics were similar amongst the two groups. The SENS group had a significantly lower peak and a significantly lower average renal pelvic pressure (RPP) throughout the procedure. The SENS group was more efficient for stone removal and had a much shorter stone treatment time, a lesser use of the stone extractor, and ultimately a higher stone-free rate (SFR). The effects of a lower RPP and shorter stone treatment time translated into less severe postoperative complications as measured per modified Clavien grade. CONCLUSION: Using SENS in MPCNL for the treatment of staghorn stones has the advantages of lower RPP, increased effectiveness in stone retrieval, decreased surgery related complications, and an improved SFR.


Assuntos
Nefrostomia Percutânea , Cálculos Coraliformes/cirurgia , Adulto , Desenho de Equipamento , Feminino , Humanos , Pelve Renal/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrostomia Percutânea/efeitos adversos , Nefrostomia Percutânea/instrumentação , Nefrostomia Percutânea/métodos , Complicações Pós-Operatórias , Estudos Prospectivos , Sucção/instrumentação
7.
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
8.
Urol J ; 17(1): 14-18, 2020 01 26.
Artigo em Inglês | MEDLINE | ID: mdl-30882168

RESUMO

OBJECTIVE: To explore the feasibility and safety of ambulatory mPCNL (mini percutaneous nephrolithotomy) on upper urinary tract calculi. METHODS: Clinical data of 18 patients received ambulatory mPCNL during Aug. 2017 to Jan. 2018 and 23 patients treated with routine inpatient mPCNL of the corresponding period were collected. All the patients included received 16Fr channel PCNL under the guidance of Doppler ultrasound. A 6Fr double J stent was placed in the ureter for internal drainage, and either an indwelling 14Fr open nephrostomy tube was placed or the puncture channel was filled with absorbable hemostatic materials alone, depends on the bleeding condition of the puncture channel and the intraoperative conditions. Preoperative parameters and surgery time, complications, total hospitalization costs and hospital stay time between the two groups were compared. RESULTS: Preoperative parameters regarding age (P=0.057), sex distribution (P=0.380), ASA score (P=0.388), Calculi CT value (P=0.697), and the S.T.O.N.E. score (P=0.122) were comparable between the two groups. Maximum diameter of calculi (cm) of the conventional hospitalization group, however, was larger than the ambulatory surgery group (P=0.041). There were no significant differences in the mean surgery time (P=0.146), postoperative hemoglobin drop (P=0.865), Calculi-free rate on the next day after surgery (P=0.083) and postoperative fever rate (P=0.200) between the two groups. With regard to tubeless rate (P<0.001), total hospitalization costs (P=0.003) and hospital stay time (P<0.001), there were significant advantage favored ambulatory mPCNL. CONCLUSIONS: For patients with simple upper urinary tract calculi and relatively good performance status, ambulatory mPCNL is feasible as it's equally safe and efficient as compared with routine inpatient mPCNL. Moreover, ambulatory mPCNL decreases hospitalization costs and hospital stay time. Nevertheless, perioperative management should be carefully conducted, and well-designed studies are warranted.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Nefrostomia Percutânea , Cálculos Urinários/cirurgia , Adulto , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Procedimentos Cirúrgicos Ambulatórios/economia , Feminino , Febre/etiologia , Hemoglobinas/metabolismo , Humanos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Nefrostomia Percutânea/efeitos adversos , Nefrostomia Percutânea/economia , Duração da Cirurgia , Estudos Prospectivos
9.
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
10.
Rev Lat Am Enfermagem ; 27: e3191, 2019.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-31596421

RESUMO

OBJECTIVE: to evaluate the impact on the quality of life as well as anxiety and pain in patients with nephrostomy tubes. METHOD: this is a longitudinal descriptive study performed on a sample of n=150 patients. To evaluate the quality of life, the EuroQol-5D questionnaire was used; anxiety was quantified by the Beck Anxiety Inventory; to study pain, a visual analogue scale was employed. RESULTS: statistically significant differences were found in the quality of life, with its worsening (r = 0.51; p <0.01) when evaluated at the first tube replacement. Patients presented mild to moderate anxiety before the procedure, which was reduced at the first tube replacement, although this difference was not significant (r = 0.028, p = 0.393). Finally, the degree of pain was also significantly reduced (r = 0.13, p<0.01) after six weeks. As for gender, women presented the worst values ​​in the three variables studied (worse quality of life and greater anxiety and pain). CONCLUSIONS: nephrostomy tubes have a negative impact on the patient's quality of life. During the time they live with these tubes, patients have mild to moderate pain and anxiety.


Assuntos
Transtornos de Ansiedade/psicologia , Nefrostomia Percutânea/efeitos adversos , Dor/etiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Nefrostomia Percutânea/enfermagem , Nefrostomia Percutânea/psicologia , Escalas de Graduação Psiquiátrica , Qualidade de Vida , Inquéritos e Questionários
11.
Eur J Obstet Gynecol Reprod Biol ; 241: 99-103, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31484100

RESUMO

OBJECTIVE: This study aimed to evaluate the efficacy of ureteral stent placement for the treatment of hydronephrosis secondary to cervical cancer and analyze factors that may predict failure of ureteral stent placement and the differences between ureteral stent placement and percutaneous nephrostomy. STUDY DESIGN: Clinical data of patients with cervical cancer complicated with hydronephrosis admitted to our hospital from July 2008 to August 2018 were retrospectively analyzed. To evaluate the efficacy of ureteral stent placement and percutaneous nephrostomy in the management of hydronephrosis secondary to cervical cancer. RESULTS: A total of 89 patients were analyzed. A ureteral stent was successfully placed in 60 patients. Indwelling stent failed in 29 patients, and then percutaneous nephrostomy was performed. Both surgical procedures were safe and effective. There was a significant correlation between the success rate of ureteral stent placement and the degree of hydronephrosis and the length of the ureteral obstruction. There was no significant difference in the incidence of complications following ureteral stent placement and percutaneous nephrostomy, while there were significant differences between the two treatment modalities in terms of surgical time, hospitalization time, and surgical cost. CONCLUSION: Ureteral stent placement is the preferred method for the treatment of hydronephrosis secondary to cervical cancer. However, in patients with more severe hydronephrosis and ureteral obstruction >3 cm in length, percutaneous nephrostomy may be more appropriate.


Assuntos
Hidronefrose/cirurgia , Nefrostomia Percutânea/estatística & dados numéricos , Stents/estatística & dados numéricos , Neoplasias do Colo do Útero/complicações , Adulto , Idoso , Cistoscopia/instrumentação , Cistoscopia/estatística & dados numéricos , Feminino , Humanos , Hidronefrose/etiologia , Pessoa de Meia-Idade , Nefrostomia Percutânea/efeitos adversos , Estudos Retrospectivos , Stents/efeitos adversos , Ureter
12.
J Endourol ; 33(10): 823-828, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31397180

RESUMO

Objectives: To describe our surgical technique of robotic ureteroileal reimplantation (RUIR) for ureteroileal anastomosis strictures with the use of near-infrared fluorescence imaging (NIFI) after transnephrostomic antegrade injection of indocyanine green in patients previously treated with robot-assisted radical cystectomy and intracorporeal orthotopic neobladder. Materials and Methods: From March 2015 to December 2017, 10 consecutive patients underwent RUIR in our tertiary referral center. All patients previously underwent percutaneous nephrostomy and at least one antegrade stenting and stricture dilatation attempt. Clinical data were prospectively collected into our institutional dataset. Both perioperative and functional outcomes were assessed. Results: Median time from robotic cystectomy to ureteroileal anastomosis strictures diagnosis was 5 months (interquartile range [IQR] 2-6). Median stricture length was 1.5 cm (IQR 1-2). Median operative time was 140 minutes (IQR 81-155), and median length of stay was 5 days (IQR 3-9). Two patients experienced Clavien grade 2 complications (urinary tract infection requiring antibiotics and blood transfusion, respectively). One patient underwent ileum resection and anastomosis due to bowel perforation (Clavien IIIb). At a median follow-up of 19 months (IQR 14-39), one patient developed a stricture recurrence. No patient developed worsening of renal function (newly onset chronic kidney disease stage 3b-4). Conclusions: Robotic reimplantation for ureteroileal anastomosis strictures is a safe and highly effective procedure, with a high success rate and excellent perioperative and functional outcomes. NIFI provides an easy guide to identify and progressively dissect the ureter.


Assuntos
Constrição Patológica/cirurgia , Cistectomia/métodos , Complicações Pós-Operatórias/cirurgia , Reimplante/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Ureter/cirurgia , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Feminino , Humanos , Íleo/cirurgia , Verde de Indocianina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Nefrostomia Percutânea/efeitos adversos , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia
13.
Urol J ; 17(5): 456-461, 2019 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-31422576

RESUMO

PURPOSE: To review the safety and effectiveness of tubeless percutaneous nephrolithotomy (PCNL) with an externalized ureteral catheter (EUC) compared with standard PCNL with nephrostomy tube and tubeless PCNL with double-J (DJ) stent following uncomplicated PCNL and the absence of residual stones. MATERIALS AND METHODS: Patients with kidney stones who underwent uncomplicated PCNL between January 2000 to December 2017 and had no residual stones were retrospectively evaluated. The 766 patients were divided into standard PCNL with nephrostomy tube (group 1; 350 patients), tubeless PCNL with DJ stent (group 2; 189 patients), and tubeless PCNL with EUC (group 3; 227 patients). Demographic characteristics, stone-related factors, perioperative and postoperative parameters were analyzed. RESULTS: Demographic and stone-related characteristics were comparable. The differences in the mean operative time and complication rates were not significant. Postoperative hospitalization period was shorter in group 3 (3.19 ± 2.2 days) compared with group 1 (4.12 ± 2.4 days; p < .001) but not to that of group 2 (3.44 ± 2.8 days; p = .680). Postoperative pain score was lower in group 3 (3.24 ± 1.1) compared with both group 1 (6.36 ± 1.7; p < .001) and group 2 (4.85 ± 1.1; p < .001). Urine leakage complication was lower in group 3 (0.4%) compared with group 1 (2.9%, p = .038) but not to that of group 2 (0.5%; p = .897). CONCLUSIONS: Tubeless PCNL is effective and safe for uncomplicated PCNL in the absence of residual stones. Tubeless PCNL with EUC is associated with decreased pain, hospitalization time, and urine leakage compared with standard PCNL. However, it is only associated with decreased pain when compared with tubeless PCNL with DJ stent.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Nefrostomia Percutânea , Dor Pós-Operatória/prevenção & controle , Stents , Cateteres Urinários/classificação , Feminino , Humanos , Pelve Renal/diagnóstico por imagem , Pelve Renal/cirurgia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Nefrostomia Percutânea/efeitos adversos , Nefrostomia Percutânea/instrumentação , Nefrostomia Percutânea/métodos , Duração da Cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Estudos Retrospectivos , Ureter/cirurgia , Derivação Urinária/instrumentação , Derivação Urinária/métodos
14.
BMC Urol ; 19(1): 50, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174519

RESUMO

BACKGROUND: Physicians doubt percutaneous nephrostomy (PCN) insertion on cancer related hydronephrosis patients causes tumor seeding and worse cancer control. In this article, we attempted to determine if preoperative PCN alters cancer control in upper tract urothelial cancer (UTUC) patients. METHODS: Retrospective analysis of UTUC patients in a single center from 2005 to 2015. Exclusion criteria included lymph node metastasis, and patients underwent perioperative adjuvant chemotherapy or radiotherapy. There were 664 patients in this analysis, with clinico-pathological data being collected retrospectively for Cox-regression statistical analysis. Outcomes were measured by local recurrence, distant metastasis and cancer-specific death with Kaplan-Meier curves. RESULTS: There were respectively 25 and 639 UTUC cancers in the preoperative PCN and non-PCN insertion groups with mean follow-up duration of 37.9 and 48.6 months, respectively. The preoperative PCN group consisted of 17 patients (68%) with tumor located in the ureter, while the PCN-negative group included 236 patients (36%) with tumor located in the ureter being statistically significant. These two groups were comparable in gender, age, follow-up duration, tumor stage, and pathological features of the UTUC. As for the cancer control in the PCN group, 4(16%), 1(4%) and 1(4%) had local recurrence, distant metastasis and cancer-specific death respectively; in the non-PCN group, 101(15.8%), 96(15%) and 72(11.2%) exhibited local recurrence, distant metastasis and cancer-specific death respectively. Statistical analysis showed no difference in oncologic outcomes between these two groups.(p = 0.804, 0.201 and 0.254). CONCLUSIONS: Preoperative percutaneous nephrostomy on upper-tract urothelial cancer poses little risk on tumor seeding and could be considered as part of treatment strategy if renal function preservation is needed.


Assuntos
Carcinoma de Células de Transição/cirurgia , Neoplasias Renais/cirurgia , Nefrostomia Percutânea/efeitos adversos , Neoplasias Ureterais/cirurgia , Idoso , Progressão da Doença , Feminino , Humanos , Masculino , Inoculação de Neoplasia , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios , Estudos Retrospectivos
15.
J Endourol ; 33(10): 777-786, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31250680

RESUMO

Purpose: To review the literature on optimal methods of drainage for obstructive urolithiasis in adult patients, comparing percutaneous nephrostomy (PCN) with retrograde ureteral catheterization (Double J [JJ]) regarding success of procedure, efficacy, complications, quality of life (QoL), and costs. Methods: Web of Science and the Medline, Embase, Emcare, and Cochrane controlled trial databases were searched for all relevant publications until November 2018. A review protocol was created, using the PRISMA statement. Two reviewers independently screened the titles and abstracts in Endnote X8, using criteria as stated in the research protocol. A total of 1108 abstracts were screened of which 9 were included in the qualitative synthesis. Level of evidence of the studied articles varies between 1b and 2c. Results: Both JJ and PCN have high success rates (80%-100% and 99%-100%, respectively). No major complications were reported in both groups. Procedural and fluoroscopy times are significantly shorter for JJ than for PCN (31-33 minutes vs 35-49 minutes and 5 minutes vs 7 minutes, respectively). Time to clinical improvement did not differ. In the JJ group, analgesics were used more frequently than in the PCN group. Data regarding procedural costs were contradictory, but overall the PCN group was associated with higher costs. In pregnant women, PCN placement appears to be significantly more effective than placement of JJ. A significant decrease between pre- and postintervention QoL was found with patients receiving a JJ. Back pain was reported more frequently in the PCN group, urinary symptoms were more common in the patients with a JJ. Conclusions: Both PCN and JJ have comparable success rates for patients with obstructive urolithiasis and procedure-related complications are rare. Overall, higher rates of sepsis, longer hospital stay, and higher costs were found in the PCN group, but that could be explained by patient selection. Patients with JJ experienced a lower QoL and experience more lower urinary tract symptoms.


Assuntos
Nefrostomia Percutânea/métodos , Obstrução Ureteral/cirurgia , Cateterismo Urinário/métodos , Urolitíase/cirurgia , Drenagem/métodos , Humanos , Nefrostomia Percutânea/efeitos adversos , Qualidade de Vida , Obstrução Ureteral/etiologia , Cateterismo Urinário/efeitos adversos , Urolitíase/complicações
16.
J Coll Physicians Surg Pak ; 29(6): 558-562, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31133157

RESUMO

OBJECTIVE: To investigate the risk factors that may cause urinary tract infection (UTI) in patients applied with retrograde intrarenal surgery (RIRS). STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Departments of Urology, Ankara Training and Research Hospital, Turkey, from September 2014 to April 2017. METHODOLOGY: A retrospective examination was made of patients who underwent RIRS. The patients were separated into 2 groups as those with no UTI in the postoperative period (Group 1) and those with UTI (Group 2). The groups were compared in respect of age, stone size, operating time, presence of residual stone, and body mass index. Continuous independent variables were compared using the Student's t-test and in the comparison of categorical variables, the Chisquare test was used. A value of p<0.05 was accepted as statistically significant. RESULTS: Group 1 comprised 169 patients with no UTI and Group 2, 20 patients with UTI. The mean operating time was 55.82 ±14.73 minutes in Group 1 and 75.5 ±23.9 minutes in Group 2 (p=0.002). In multivariate analysis, operating time was determined as an independent prognostic risk factor increasing the risk of infection (p=0.001). The cut-off value determined with ROC analysis was 61 minutes. When operating time exceeded 61 minutes, the infection risk was increased 11.1-fold (sensitivity 75%, specificity 76%, AUC 0.76). CONCLUSION: Operating time in patients applied with RIRS was determined to be an independent prognostic risk factor for UTI risk in the postoperative period. In patients where surgery lasts more than 1 hour, particular attention should be paid in respect of infection risk.


Assuntos
Cálculos Renais/cirurgia , Rim/cirurgia , Nefrostomia Percutânea/efeitos adversos , Complicações Pós-Operatórias/etiologia , Sepse/etiologia , Cálculos Ureterais/cirurgia , Infecções Urinárias/etiologia , Adulto , Idoso , Feminino , Febre/etiologia , Humanos , Incidência , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Nefrostomia Percutânea/métodos , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco , Sepse/epidemiologia , Resultado do Tratamento
17.
BMJ Case Rep ; 12(5)2019 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-31129641

RESUMO

Percutaneous nephrostomy (PCN) catheter placement is a commonly performed procedure in the urological practice for various indications like percutaneous nephrolithotomy, pyonephrosis, infected hydronephrosis and after failed attempt of ureteric stenting. The nephrostomy catheter is usually associated with low complication and morbidity rate, but prolonged indwelling nephrostomy tube may be hazardous in some cases. We hereby report a case of squamous cell carcinoma of skin around the PCN, which was attributed to chronic inflammation and persistent irritation from a long-term neglected indwelling nephrostomy catheter for last 3 years. The patient was managed with wide local excision of skin carcinoma and ureterocalicostomy for pelviureteric junction stricture. The authors report the first documented case with aforementioned presentation.


Assuntos
Carcinoma de Células Escamosas/etiologia , Cateteres de Demora/efeitos adversos , Neoplasias Cutâneas/etiologia , Adulto , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Feminino , Humanos , Imagem por Ressonância Magnética , Nefrostomia Percutânea/efeitos adversos , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/patologia
18.
Int J Surg ; 66: 62-71, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31034987

RESUMO

OBJECTIVE: To compare the safety and efficacy of percutaneous nephrolithotripsy (PCNL) in supine versus prone position for patients with renal or upper ureteral calculi. METHODS: A systematic search of Pubmed, Embase and Cochrane Central Register of Controlled Trials was performed to identify all eligible studies. All included randomized controlled trials (RCTs) were evaluated based on the inclusion and exclusion criteria. After quality assessment and date extraction, a meta-analysis was performed using RevMan 5.3 software. RESULTS: A total of 15 RCTs with 1474 patients were included in our meta-analysis. Pooled data showed that PCNL in supine position could significantly reduce the operative time [weighted mean difference (WMD) -12.02, 95% confidence interval (CI) -20.49 to -3.54, p = 0.005] and rate of fever [risk ratio (RR) 0.67, 95% CI 0.46 to 0.97, p = 0.03] compared to prone position. In addition, no significant differences could be found between groups in stone-free rate (p = 0.31), hospital stay (p = 0.59) and rate of overall complications (p = 0.11), mainly including urinary leakage (p = 0.83), pleural effusion (p = 0.74) and blood transfusion (p = 0.58). CONCLUSIONS: The current study found comparable stone-free rate and significant lower rate of postoperative fever in supine PCNL compared with prone PCNL. PCNL in supine position could be a safe and efficient choice for patients with renal or upper ureteral calculi.


Assuntos
Cálculos Renais/cirurgia , Nefrostomia Percutânea/métodos , Posicionamento do Paciente/métodos , Cálculos Ureterais/cirurgia , Adulto , Febre/etiologia , Humanos , Tempo de Internação/estatística & dados numéricos , Nefrostomia Percutânea/efeitos adversos , Razão de Chances , Duração da Cirurgia , Complicações Pós-Operatórias , Decúbito Ventral , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Decúbito Dorsal , Resultado do Tratamento
19.
J Coll Physicians Surg Pak ; 29(4): 384-386, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30925968

RESUMO

Retrograde intrarenal surgery (RIRS) is an efficient method for kidney stones with low complication rates. Reported here is an unusual complication of this surgery; a retroperitoneal hematoma 8x7.5x5 cm in dimension in a 40-year female, which was completely resolved by conservative treatment. This is the first reported case of retroperitoneal hematoma following RIRS in the literature. Although this technique is safe, feasible and minimally invasive for kidney stones, urologists should be vigilant for such a complication.


Assuntos
Hematoma/etiologia , Cálculos Renais/cirurgia , Nefrostomia Percutânea/efeitos adversos , Adulto , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Feminino , Febre/tratamento farmacológico , Febre/etiologia , Hematoma/terapia , Humanos , Nefrostomia Percutânea/métodos , Doenças Peritoneais , Complicações Pós-Operatórias/terapia , Resultado do Tratamento , Ureteroscopia/métodos
20.
Diagn Interv Radiol ; 25(2): 127-133, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30860076

RESUMO

PURPOSE: We aimed to present our clinical experience with percutaneous antegrade ureteral stent placement in a single center. METHODS: Electronic records of patients who underwent percutaneous image-guided ureteral stent placement between September 2005 and April 2017 were reviewed. A total of 461 patients (322 males, 139 females; age range, 19-94 years; mean age, 61.4±15 years) were included in the study. Patients were classified into two main groups: those with neoplastic disease and those with non-neoplastic disease. Failure was defined as persistence of high level of serum creatinine or an inability to place stents percutaneously. Postprocedural complications were grouped as percutaneous nephrostomy and stent placement related complications. RESULTS: A total of 727 procedures in 461 patients were included in the study: 654 procedures (90%) in 407 patients (88.3%) were in the neoplastic group and 73 procedures (10%) in 54 patients (11.7%) were in the non-neoplastic group. Our technical success rates were 97.7% and 100% and complication rates were 3.1% and 4.1% in neoplastic and non-neoplastic groups, respectively. Seven stents retrievals and 112 balloon dilatations were performed successfully. CONCLUSION: Percutaneous antegrade ureteral stent placement is a safe and effective method for management of ureteral injuries and obstructions due to both malignant and benign causes when the retrograde approach has failed.


Assuntos
Nefrostomia Percutânea/instrumentação , Ureter/lesões , Ureter/cirurgia , Obstrução Ureteral/cirurgia , Idoso , Creatinina/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefrostomia Percutânea/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Stents/efeitos adversos , Falha de Tratamento , Resultado do Tratamento , Ureter/diagnóstico por imagem , Ureter/patologia , Obstrução Ureteral/diagnóstico por imagem
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