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1.
Urology ; 135: 57-65, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31618656

RESUMO

OBJECTIVE: To evaluate differences in the incidence of benign ureteroenteric stricture, we compared stricture rates of robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC) using Surveillance, Epidemiology, and End Results-Medicare data. METHODS: We identified 332 RARC and 1449 ORC performed between 2009 and 2014 to determine stricture rates at 6, 12, and 24 months following surgery. We defined ureteroenteric stricture as the need for procedural intervention. Additionally, we compared the incidence of stricture diagnosis. Multivariable proportional hazards regression was performed to determine factors associated with stricture development. RESULTS: The incidence of ureteroenteric stricture at 6 and 12 months was higher for RARC vs ORC at 12.1% vs 7.0% (P < .01) and 15.0% vs 9.5% (P = .01), respectively. RARC vs ORC stricture incidence at 2 years did not differ significantly at 14.6% vs 11.4% (P = .29). Similarly, the stricture diagnosis rates were significantly lower following ORC at 6, 12, and 24 months (P < .05). In adjusted analysis, RARC (HR 1.64, 95%CI 1.23-2.19) and preoperative hydronephrosis (HR 1.51, 95% CI 1.17-1.94) were associated with the development of stricture. Higher hospital volume was associated with a lower risk of stricture (HR 0.40, 95%CI 0.26-0.63). CONCLUSION: RARC is associated with a higher rate of ureteroenteric stricture diagnosis and intervention on a population-based level that is mitigated by higher hospital volume. A significant study limitation is inability to differentiate extracorporeal vs intracorporeal diversion. However, a stricture complication compounds the financial burden of care and efforts must be pursued to improve this surgical outcome.


Assuntos
Cistectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Obstrução Ureteral/epidemiologia , Derivação Urinária/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Carcinoma de Células de Transição/cirurgia , Constrição Patológica/epidemiologia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Cistectomia/métodos , Feminino , Humanos , Incidência , Intestinos/cirurgia , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do Tratamento , Ureter/cirurgia , Obstrução Ureteral/etiologia , Obstrução Ureteral/cirurgia , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos
3.
Arch Esp Urol ; 72(9): 884-890, 2019 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-31697248

RESUMO

OBJECTIVE: The effects of pyeloplasty on renal function are not fully well defined. Our objective is to determine if renal function and renal dilation change after pyeloplasty and the risk factors that may influence in both parameters. METHODS: Retrospective study of patients who underwent pyeloplasty. The parameters analyzed included: age, differential renal function, renal dilation, infection and complications. We compared ultrasound findings with measurement of the anterior-posterior diameter of the renal pelvis (mm) and the time/activity upload curve of the 99mTc- Mercaptoacetyltriglycine renography before and after surgery. Patients were divided in groups by renal function: bad (<20%), diminished (20-40%), normal (40-55%) and supranormal (>55%). RESULTS: A total of 129 patients were included in the study. The normal renal function group was the one undergoing surgery most frequently. Comparison of function before and after surgery showed a statistically significant improvement when preoperative function was bad (<20%) (mean 9.2+/-8.9) or supranormal (>55%) (mean -8.7+/-8.5). In the subgroup of patients under 12 months, it was notable there were significant results only when renal function was diminished (20-40%) (mean 5.6+/-2.2). Renal dilation presented significant changes after surgery in all groups (mean 5.6+/-2.2) (p<0.0001), except in cases presenting complications. CONCLUSIONS: Previous renal function has prognostic value on pieloplasty results. Supranormal renal function should be considered pathologic, but recoverable and it may improve after pieloplasty. In the absence of intra or postoperative complications, pyelocalycial dilation diminished after pieloplasty.


Assuntos
Hidronefrose , Obstrução Ureteral , Criança , Dilatação , Humanos , Pelve Renal , Renografia por Radioisótopo , Estudos Retrospectivos , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/cirurgia
4.
Medicine (Baltimore) ; 98(44): e17780, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689845

RESUMO

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


Assuntos
Corpos Estranhos/complicações , Hidronefrose/etiologia , Laparoscopia/métodos , Ureter/lesões , Obstrução Ureteral/etiologia , Adulto , Feminino , Corpos Estranhos/cirurgia , Humanos , Hidronefrose/cirurgia , Laparoscopia/instrumentação , Stents , Ureter/cirurgia , Obstrução Ureteral/cirurgia
5.
Int Braz J Urol ; 45(5): 965-973, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31626519

RESUMO

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


Assuntos
Pelve Renal/cirurgia , Laparoscopia/métodos , Nefrolitíase/cirurgia , Nefrotomia/métodos , Obstrução Ureteral/cirurgia , Adolescente , Adulto , Criança , Feminino , Humanos , Hidronefrose/cirurgia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Nefrolitíase/patologia , Duração da Cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Estatísticas não Paramétricas , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos/métodos , Adulto Jovem
6.
J Biol Regul Homeost Agents ; 33(5 Suppl. 1): 105-110, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31630723

RESUMO

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


Assuntos
Hidronefrose/congênito , Laparoscopia , Rim Displásico Multicístico/cirurgia , Obstrução Ureteral/cirurgia , Procedimentos Cirúrgicos Urológicos , Idoso , Criança , Humanos , Hidronefrose/cirurgia , Pelve Renal
7.
Medicine (Baltimore) ; 98(40): e17308, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577723

RESUMO

Retroperitoneal laparoscopic pyeloplasty (RLP) is 1 method for treating ureteropelvic junction obstruction (UPJO) in children, but reports are more common in children than in infants younger than 2 years old. The purpose of this study was to evaluate the clinical value of RLP for infants with UPJO.From January 2015 to December 2017, a retrospective analysis of 22 infants aged 2 to 24 (11.95 ±â€Š6.00) months with UPJO who were treated with RLP in our hospital was performed. During the same period, 14 infants who underwent conventional transperitoneal laparoscopic pyeloplasty (TLP) were compared with those who underwent RLP. Postoperative recovery and complications, including bleeding, infection, urinary leakage and anastomotic stenosis, postoperative resumption of oral feeding, postoperative hospitalization time and surgical success rate were evaluated. Drainage and function were assessed with isotope scan at 6 months and later during the yearly follow-up and by intravenous urography (IVU) and mercaptoacetyltriglycine (MAG3) renography.Both groups underwent successful surgery. The operative time in the RLP group was 88 to 205 (120.59 ±â€Š24.59) min, and there was no significant difference compared with the TLP group (P = .767). The estimated intraoperative blood loss was 2 to 10 (3.75 ±â€Š1.59) ml, which was not significantly different between the 2 groups (P = .386). In the RLP group, the mean postoperative resumption of oral feeding was faster than that in the TLP group (3.55 ±â€Š0.74 vs 5.50 ±â€Š0.85 hour, P < .001), and the postoperative hospitalization time was shorter in the TLP group than in the RLP group (6.59 ±â€Š0.50 vs 7.07 ±â€Š0.47 day, P = .007 < .05). Follow-up lasted from 6 months to 3 years, and there was a significant reduction in postoperative hydronephrosis in both groups (P < .05, respectively).RLP is a safe procedure for infants. This procedure is associated with relatively little trauma, a quick recovery and good cosmetic effects. RLP also has the advantages of relatively little interference with the abdominal cavity and sufficient operating space; thus, this technique is worth promoting.


Assuntos
Pelve Renal/cirurgia , Laparoscopia/métodos , Espaço Retroperitoneal/cirurgia , Obstrução Ureteral/cirurgia , Perda Sanguínea Cirúrgica , Pré-Escolar , Feminino , Humanos , Hidronefrose/etiologia , Lactente , Tempo de Internação , Masculino , Nefrotomia , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Obstrução Ureteral/complicações
8.
BMC Surg ; 19(1): 150, 2019 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-31646995

RESUMO

BACKGROUND: Pyelo-ureteral junction syndrome (PUJS) is a frequent congenital malformation. We report the surgical management of PUJS by pyeloplasty according to Anderson-Hyne-Kuss's procedure at the Zinder National Hospital.. METHODS: This was a retrospective study from January 2013 to December 2016 (4 years), including patients who have undergone surgery for PUJS. RESULTS: Twelve (12) cases of PUJS had a surgery among which 66.7% were men with an average age of 32.5 ± 7.6 years. The clinical symptomatology was lumbar pain or renal colic in 92.3% of cases. This pain had evolved for more than 2 years for 58.3% of the cases. Ultrasound coupled with intravenous urography or CT-scan was performed to confirm the diagnosis of PUJS in 58.3 and 41.7% of cases. The average serum creatinine level at admission was 181.25 ± 67.3 µmol/L [Lab reference range: 53-97 µmol/L]. The Anderson-Hynes non dismembered pyeloplasty is used for all the patients. The release of a crossing lower pole vessel was performed in 25%, pyelolithotomy in 16.7%. The average surgery time was 118.3 ± 20.7 min. The average hospital length of stay was 10.8 ± 3 days. Immediate postoperative complications were recorded in 33.3% (n = 4). Postoperative outcomes were considered good by disappearance of clinical, biological and radiological signs. CONCLUSION: The Anderson-Hynes non dismembered pyeloplasty gives good results and provides a successful alternative in an environment where laparoscopy and robotic surgery are not developed.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Obstrução Ureteral/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Adulto , Feminino , Humanos , Rim/cirurgia , Masculino , Pessoa de Meia-Idade , Níger , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Síndrome , Tomografia Computadorizada por Raios X , Adulto Jovem
9.
Urology ; 134: 243-245, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31542465

RESUMO

OBJECTIVE: To describe a novel, minimally invasive surgical technique, robotic-assisted laparoscopic dismembered extravesical cross-trigonal ureteral reimplantation for primary obstructive megaureter and to report a case series of 13 patients. METHODS: Thirteen patients between the ages of 10 and 96 months who were diagnosed with primary obstructive megaureter underwent robotic-assisted laparoscopic dismembered extravesical cross-trigonal ureteral reimplantation between April 2017 and May 2019. The principle of this technique is performing an extravesical cross-trigonal ureteral reimplantation with intracorporeal tailoring of the ureter. This provides the advantage of achieving a long tunnel mimicking the Cohen cross-trigonal ureteral reimplantation, without performing the open surgical technique and offers the potential benefits of minimally invasive surgery. Surgical technique is described, demographic data and intra- and/or postoperative parameters are reported. RESULTS: Median age was 26 months (IQR 16-60). Median weight was 15 kg (IQR 10.1-31). Median console time was 113 minutes (IQR 90.5-140). Median postoperative stay was 2.5 days (IQR 1.3-3). Median ureteral diameter decreased from 17 mm (IQR 12.5-18.5) to 3 mm (IQR 0-6.5, P = .001). Median renal pelvis diameter decreased from 28 mm (IQR 20.5-37.8) to 4 mm (IQR 1.5-5, P = .005). Median renal function before surgery was 46% (IQR 24.5-48.5) and following surgery was 42% (IQR 36-42, P = .700). Median T1/2 decreased from 28 minutes (IQR 19.3-30) to 4.5 minutes (IQR 3-5, P = .009). Postoperative complications graded by the Clavien-Dindo classification were apparent in 3 patients (21%). One had grade I complication (fever, resolved spontaneously) and 2 had a Grade II complication (urinary tract infection). CONCLUSION: Robot-assisted cross-trigonal ureteral reimplantation with intracorporeal tailoring is safe, feasible, and reproducible in short-term follow-up.


Assuntos
Laparoscopia , Procedimentos Cirúrgicos Robóticos , Ureter/anormalidades , Ureter/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Pré-Escolar , Humanos , Lactente , Duração da Cirurgia , Complicações Pós-Operatórias , Obstrução Ureteral/etiologia , Obstrução Ureteral/cirurgia
10.
Urology ; 134: 72-78, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31487513

RESUMO

OBJECTIVE: To assess the symptoms associated with long-term Double-J ureteral stenting including the influence of biofilms on ureteral stents. METHODS: Patients with long-term (>8 weeks) uni- or bilateral ureteral stents completed the Ureteral Stent Symptoms Questionnaire (USSQ) at the day of stent exchange. Repeated assessment of patients was possible to allow for analysis of intraindividual changes. Assessment of biofilm mass on the stents was performed according to a validated method, its correlation with the USSQ total score was defined as primary outcome. Secondary outcomes included further analyses of stent-associated symptoms and their temporal course. RESULTS: A total of 87 stent indwelling periods in 35 patients were investigated. Median USSQ total score did not differ significantly between unilateral and bilateral stenting (42 vs 39 points; P = .17). An increasing total stent treatment time up to study inclusion did not correlate with the USSQ total score, but was significantly correlated with less urinary symptoms and a better quality of life. USSQ total score and subscores within individual patients did not significantly increase or decrease over the sequence of stent indwelling periods. Higher total biofilm masses were not associated with higher USSQ total scores or subscores. CONCLUSION: Long-term Double-J stenting provides a valuable treatment option, if stent-associated symptoms are low during the initial indwelling period. Thus, symptoms remain stable over the long-term course and the majority of patients are satisfied with the treatment. Furthermore, biofilm formation on ureteral stents does not seem to be the relevant driver of symptoms.


Assuntos
Bactérias , Biofilmes , Efeitos Adversos de Longa Duração , Implantação de Prótese , Infecções Relacionadas à Prótese , Qualidade de Vida , Stents , Obstrução Ureteral/cirurgia , Idoso , Bactérias/classificação , Bactérias/isolamento & purificação , Correlação de Dados , Remoção de Dispositivo/métodos , Remoção de Dispositivo/estatística & dados numéricos , Feminino , Humanos , Efeitos Adversos de Longa Duração/diagnóstico , Efeitos Adversos de Longa Duração/microbiologia , Efeitos Adversos de Longa Duração/psicologia , Masculino , Desenho de Prótese , Implantação de Prótese/efeitos adversos , Implantação de Prótese/instrumentação , Implantação de Prótese/métodos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/psicologia , Stents/efeitos adversos , Stents/microbiologia , Inquéritos e Questionários , Suíça , Avaliação de Sintomas/métodos
11.
Top Companion Anim Med ; 36: 22-24, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31472725

RESUMO

A 4-month-old, intact male, domestic longhair cat was admitted with a 2-month history of abdominal distention. Physical examination revealed a mild inspiratory distress and a large palpable intraabdominal mass, in an otherwise bright and alert cat. Abdominal ultrasonography revealed a large hypoechoic cystic structure compatible with hydronephrosis or a renal cyst. On exploratory celiotomy, hydronephrosis of the right kidney was documented and ureteronephrectomy was performed. Histopathology of the excised tissues revealed severe stenosis in the proximal ureteral lumen without evidence of obstructive material, a normal ureteral epithelium and severe atrophy of the renal cortex and medulla, supporting the diagnosis of congenital unilateral ureteral stenosis. The cat recovered uneventfully and 8 months later was in excellent clinical condition. Congenital ureteral stenosis with secondary hydronephrosis may occur rarely in cats and should be included in the differential diagnosis of progressive abdominal distention in young cats.


Assuntos
Doenças do Gato/congênito , Hidronefrose/veterinária , Obstrução Ureteral/veterinária , Animais , Doenças do Gato/diagnóstico , Doenças do Gato/cirurgia , Gatos , Hidronefrose/congênito , Hidronefrose/diagnóstico , Masculino , Resultado do Tratamento , Ultrassonografia/veterinária , Obstrução Ureteral/congênito , Obstrução Ureteral/diagnóstico , Obstrução Ureteral/cirurgia
12.
Urology ; 133: e7-e8, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31377257

RESUMO

Fraley's syndrome is a rare cause of obstruction of the collecting system. It results from an extrinsic vascular compression of a calyceal infundibulum by a branch of the renal artery. Clinicians should be aware of this syndrome when facing an isolated dilatation of a calyx, classically an upper pole calyx dilatation, with a defect in the superior infundibulum on CT urography. Here, we pictorially present the conservative surgical treatment of a Fraley's syndrome. After identification of the artery responsible for the obstruction, the infundibulum was opened, uncrossed from the vessel, and closed by an end-to-end anastomosis.


Assuntos
Cálices Renais , Nefropatias/etiologia , Túbulos Renais Coletores , Artéria Renal , Obstrução Ureteral/etiologia , Obstrução Ureteral/cirurgia , Adolescente , Feminino , Humanos , Síndrome
13.
J Laparoendosc Adv Surg Tech A ; 29(9): 1111-1115, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31314664

RESUMO

Background: To describe and analyze our experience of robotic-assisted laparoscopic ureteroureterostomy (RALU) and conventional LU for the repair of ureteral stenosis and compare the differences of safety and efficacy between RALU and LU. Materials and Methods: Patients who underwent RALU or LU for ureteral stenosis were retrospectively analyzed. Baseline characteristics, details of stenosis, surgery and some laboratory tests, and follow-up data were collected and analyzed. Results: Among 126 patients presented with ureteral stenosis, 65 patients underwent RALU and 61 patients underwent LU. All operations were completed successfully without conversion to open surgery. Both groups were comparable in baseline characteristics and details of stenosis. The mean operative time, suturing time, and hospitalization time of patients in RALU group were significantly less than those in LU group. The mean operative time of the RALU group was 126.34 minutes, whereas the mean operative time of the LU group was 176.57 minutes (P < .001). The average suturing time of RALU and LU was 26.88 and 70.43 minutes, respectively (P < .001). The mean hospitalization time of RALU and LU was 4.01 and 5.02, respectively (P < .001). RALU presented a lower degree of leukocytes rise than LU (P < .001). The mean follow-up time was 29.52 months. Conclusions: RALU and LU both are safe and feasible for ureteral stenosis with a low incidence of complications. Compared with LU, RALU may be a better choice with shorter operative time, suturing time, postoperative hospitalization time, and slighter inflammation. Further clinical studies of high quality are needed to confirm the priority of RALU.


Assuntos
Laparoscopia/métodos , Robótica/métodos , Ureter/cirurgia , Obstrução Ureteral/cirurgia , Ureterostomia/métodos , Adulto , Idoso , Anastomose Cirúrgica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Período Pós-Operatório , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Obstrução Ureteral/diagnóstico , Adulto Jovem
14.
Int J Surg ; 68: 126-133, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31279854

RESUMO

OBJECTIVE: To assess the efficacy and safety of double J (DJ) stented, external stented and stent-less procedures in pediatric pyeloplasty by adopting a network meta-analysis (NMA). MATERIAL AND METHODS: Electronic databases including PubMed, Cochrane Library, Web of science and Embase database were retrieved. The trials that compared double J (DJ) stented, external stented or stent-less procedures in pediatric pyeloplasty were identified. A network meta-analysis was conducted with the software of STATA 14.0. Probability-based ranking results were performed to identify the best treatment, and publication bias was analyzed by funnel plots. RESULTS: 15 studies with 1731 participants were enrolled in the analysis, including 4 randomized controlled trials (RCT) and 11 retrospective studies. The NMA results revealed that no significant differences were detected in the outcomes of operative time, operative success, hospital stay, improvement of renal functions, overall complications and redo pyeloplasty. DJ stented and external stented procedures were associated with more postoperative pain than that of stent-less procedures [DJ stented: OR = 4.47, 95%CI(1.05,19.08); external stented: OR = 5.83, 95%CI(0.09,1.43)]. DJ stented procedure had a lower rate of urine leakage than those of external stented procedure [OR = 0.18, 95%CI (0.04, 0.76)] and stent-less procedure [OR = 0.07, 95%CI=(0.01, 0.34)]. No significant difference was observed in other types of complications such as urinary tract infection (UTI), stent migration, recurrent ureteropelvic junction obstruction (UPJO) and fever. The probabilities of ranking results indicated that the DJ stented procedure was the best treatment in the outcomes of hospital stay, operative success, improvement of renal functions, and the complication of urine leakage. Stent-less procedure showed its advantages in the outcomes of operative time, flank pain and UTI. External stented procedure had the lowest rate of overall complications and redo pyeloplasty. CONCLUSIONS: There were no obvious differences in operative time, operative success, hospital stay, improvement of renal functions, overall complications between external stented, DJ stented and stent-less procedures for pediatric pyeloplasty. When considering the ranking results, the DJ stented procedure seemed to be more beneficial for pediatric pyeloplasty than the other methods. However, with the limitation of our study, additional high-quality studies are needed for further evaluation.


Assuntos
Pelve Renal/cirurgia , Meta-Análise em Rede , Procedimentos Cirúrgicos Reconstrutivos/métodos , Stents , Obstrução Ureteral/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Criança , Humanos , Tempo de Internação , Estudos Retrospectivos
16.
Clinics (Sao Paulo) ; 74: e777, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31271586

RESUMO

OBJECTIVE: To analyze our experience and learning curve for robotic pyeloplasty during this robotic procedure. METHODS: Ninety-nine patients underwent 100 consecutive procedures. Cases were divided into 4 groups of 25 consecutive procedures to analyze the learning curve. RESULTS: The median anastomosis times were 50.0, 36.8, 34.2 and 29.0 minutes (p=0.137) in the sequential groups, respectively. The median operative times were 144.6, 119.2, 114.5 and 94.6 minutes, with a significant difference between groups 1 and 2 (p=0.015), 1 and 3 (p=0.002), 1 and 4 (p<0.001) and 2 and 4 (p=0.022). The mean hospital stay was 7.08, 4.76, 4.88 and 4.20 days, with a difference between groups 1 and 2 (p<0.001), 1 and 3 (p<0.001) and 1 and 4 (p<0.001). Clinical and radiological improvements were observed in 98.9% of patients. One patient presented with recurrent obstruction. CONCLUSIONS: Our results demonstrate a high success rate with low complication rates. A significant decrease in hospital stay and surgical time was evident after 25 cases.


Assuntos
Pelve Renal/cirurgia , Laparoscopia/educação , Curva de Aprendizado , Procedimentos Cirúrgicos Robóticos/educação , Cirurgiões/educação , Obstrução Ureteral/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Feminino , Humanos , Laparoscopia/métodos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Robóticos/métodos , Estatísticas não Paramétricas , Resultado do Tratamento , Adulto Jovem
17.
J Laparoendosc Adv Surg Tech A ; 29(9): 1180-1184, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31355700

RESUMO

Purpose: To compare the surgical outcomes of children submitted to robot-assisted reconstruction with or without drainage placement performed by a single surgeon in a tertiary referral center. Materials and Methods: Patients submitted to robot-assisted reconstruction, including pyeloplasty for ureteral pelvic junction obstruction, end-to-end anastomosis for retrocaval ureter, and reimplantation for vesical ureter reflux (VUR) from January 2016 to November 2018, were included. Patients with ureteral pelvic junction obstruction or retrocaval ureter were selected for surgery according to the presence of symptoms and/or evidence of obstruction on diagnostic imaging. The criteria for reimplantation included breakthrough urinary tract infections, progressive renal scarring, and persistent VUR despite watchful waiting. Results: Overall, 31 children composed the no drain placement (DP) group and 29 the DP group. Preoperative feature of the two groups were comparable. Overall, only 1 (3.3%) postoperative complication occurred in no DP group and 2 (6.9%) in the placement group (P = .512). Length of stay was 3 (interquartile range [IQR]: 3-4) and 4 (IQR: 4-4) days, respectively (P = .651). At last follow-up, overall success rate was 100% in the no DP group and 96.6% in the DP group (P = .297). Conclusions: Robot-assisted reconstruction represents a safe minimally invasive approach with optimal surgical outcomes for the treatment of upper urinary tract. Expert robotic surgeons could avoid drainage placement after surgery as this does not undermine perioperative outcomes and postoperative success rate. Our study, first in literature, proves the interest in assessing the safety of no drainage placement also in the pediatric field.


Assuntos
Drenagem/métodos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Centros de Atenção Terciária , Ureter/cirurgia , Obstrução Ureteral/cirurgia , Refluxo Vesicoureteral/cirurgia , Anastomose Cirúrgica/métodos , Pré-Escolar , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Reimplante/métodos , Estudos Retrospectivos , Resultado do Tratamento , Refluxo Vesicoureteral/etiologia
19.
Urology ; 131: 234-239, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31181272

RESUMO

OBJECTIVES: To assess long-term clinical and functional outcomes postpyeloplasty in unilateral UPJO in poorly functioning kidneys in exclusive adult population. MATERIALS AND METHODS: We reviewed the database of all cases admitted with unilateral UPJO treated with pyeloplasty and preoperative split renal function (SRF) was <30% (by diuretic MAG-3 renography). We further subdivided patients into 2 groups; group (A) SRF ≤20% and group (B) SRF >20% and <30%. Renal function difference was evaluated by the changes in SRF at last follow-up, where 5% change was considered significant. Functional success was defined as absence of obstructive pattern on diuretic renogram with no decline in renal function. Clinical success is defined as no need of secondary intervention (redo pyeloplasty, nephrectomy, stenting, or endopyelotomy). RESULTS: Among 211 patients. The mean SRF was 20.5 ± 6.6%. After a median follow-up of 67.1 ± 11.8 months, SRF increased significantly to 23.5 ± 7.5 (P<.0001). In group (A) 92 patients, SRF increased from 14.3 ± 4.9 to 18.7 ± 7.1 (P <.0001). Functional success was achieved in 88 (95.6%) patients. Whereas, in group (B), SRF increased from 24.9 ± 3.3 to 27.2 ± 6.3 (P <.0001) at last follow-up. Functional success was achieved in 121 (95%) patients. Static SRF in serial follow-up renography had been observed after 12 months of follow-up. CONCLUSION: Pyeloplasty provides high rates of functional success in poorly functioning kidneys. After 12 months follow-up, SRF seems to be static without deterioration.


Assuntos
Pelve Renal/cirurgia , Rim/fisiopatologia , Obstrução Ureteral/fisiopatologia , Obstrução Ureteral/cirurgia , Adolescente , Adulto , Feminino , Humanos , Testes de Função Renal , Masculino , Indução de Remissão , Estudos Retrospectivos , Fatores de Tempo , Procedimentos Cirúrgicos Urológicos/métodos , Adulto Jovem
20.
Ren Fail ; 41(1): 497-506, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31215300

RESUMO

Objectives: To improve the mouse model of relief for unilateral ureteral obstruction (RUUO) and explore the pathological process of renal fibrosis after the obstruction was relieved. Methods: C57BL/6 mice in model group were randomly divided into RUUO group, improved RUUO group, and UUO group. After leaving Unilateral Ureteral Obstruction (UUO) for 3 days, the obstruction was released by reimplantation way in RUUO group and in reimplantation + catheter way in improved RUUO group. C57BL/6 mice in observation group were randomly divided into 1d RUUO group, 3d RUUO group, 7d RUUO group, and 14d RUUO group. Three days after UUO, the obstruction was released by reimplantation + catheter in four groups. We detected the renal volume, H&E, Masson staining, and immunohistochemistry of kidney pathology on the seventh day after RUUO in model group and on the 1st, 3rd, 7th, and 14th day after RUUO in observation group. Results: Comparing with mice in RUUO group, mice in improved RUUO group had lower renal volume, tubular damage score, and collagen area percentage. After the obstruction was relieved, the renal volume decreased gradually within 2 weeks. The tubular damage score in 7d RUUO group was lower than that in 1d RUUO and 3d RUUO group. However, the tubular damage score in 14d RUUO group was higher than that in 7d RUUO group. The tendency of collagen area percentage and α-SMA IOD value were consistent with the tubular damage score. Conclusions: Using the method of reimplantation + catheter, a reliable mice model of RUUO can be got. After RUUO, the de-obstructed kidneys are still in damage and fibrosis state.


Assuntos
Modelos Animais de Doenças , Rim/patologia , Obstrução Ureteral/complicações , Cateterismo Urinário/métodos , Animais , Fibrose , Humanos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Ureter/cirurgia , Obstrução Ureteral/etiologia , Obstrução Ureteral/cirurgia , Cateterismo Urinário/instrumentação , Cateteres Urinários
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