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1.
Urologe A ; 59(3): 261-265, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-32030434

RESUMO

A primary, congenital megaureter means a dilatation of the ureter with a ureteric diameter ≥7 mm due to a structural or functional obstruction of the ureterovesical junction and represents the second most likely cause of neonatal hydronephrosis. Conservative management is the primary treatment option for many patients due to a high spontaneous remission rate of up to 85%. Concerning diagnostic management, meticulous and repeat postnatal evaluation by ultrasound is mandatory to identify patients who are at risk of renal deterioration. Routine voiding cystourethrography or contrast-enhanced voiding urosonography is currently recommended for all patients to detect vesicoureterorenal reflux and other concomitant pathologies. The relevance of the additional information provided by this examination must be critically questioned considering the lack of clinical consequences. Moreover, the question arises as to whether these examinations should be prolonged until clinical symptoms occur. Nevertheless, a subvesical obstruction should still be ruled out for male patients with a bilateral megaureter. The same critical discussion is necessary for the routine use of diuretic renography in patients with primary megaureter. In principal, this examination is used to determine the global as well as the split renal function and in addition is considered to offer an evaluation of the extent of obstruction. Similarly, the question arises of whether this examination should be mandatory for every child with a primary megaureter or whether the decision should be based on the extent of the upper urinary tract dilatation. The trend of diagnostic management should go towards individualized and risk-adapted diagnostic measures.


Assuntos
Hidronefrose/diagnóstico por imagem , Ureter/anormalidades , Doenças Ureterais/diagnóstico por imagem , Obstrução Ureteral/congênito , Criança , Humanos , Hidronefrose/terapia , Masculino , Cintilografia , Ultrassonografia Pré-Natal , Ureter/diagnóstico por imagem , Doenças Ureterais/terapia , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/terapia , Micção , Urografia/métodos
2.
Curr Urol Rep ; 21(1): 3, 2020 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-31960193

RESUMO

PURPOSE OF REVIEW: In the setting of kidney transplantation, the ureter is a common source for complications. As a result, prevention of ureteral complications and their management is of crucial importance. In this context, the purpose of this review is to summarize recent literature on the ureter in the kidney transplant setting with a special focus on new findings. We conducted a PubMed and Medline search over the last 10 years to identify all new publications related to ureteroneoimplantations, stents and management of complications in the kidney transplant setting. RECENT FINDINGS: Performance of the "Lich-Gregoir" technique for ureteroneocystostomy seems to be favourable in regard to postoperative complications when compared with other methods described in the literature. Moreover, major urologic complications can be further reduced by ureteral stenting. A new approach for management of ureteral strictures in renal transplants is presented. We discussed the usage of a ureteral stent covered with a biostable polymer aiming to prevent tissue ingrowth into the lumen as a new option for management of ureteral stricture in the kidney transplant setting.


Assuntos
Transplante de Rim/métodos , Ureter/cirurgia , Obstrução Ureteral/terapia , Derivação Urinária/efeitos adversos , Derivação Urinária/métodos , Anastomose Cirúrgica/efeitos adversos , Constrição Patológica , Humanos , Stents , Obstrução Ureteral/etiologia
3.
Support Care Cancer ; 28(2): 725-730, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31129761

RESUMO

PURPOSE: Hydronephrosis due to ureteric obstruction (UO) is stage-defining at cervical cancer presentation but may occur after primary staging. We aimed to determine the incidence and review the presentation and management of UO in women with cervical cancer attending our center. Particular attention was paid to the evolving role of interventional radiology (IR) in management. METHODS: Women with a new diagnosis of cervical cancer between January 2012 and December 2016 formed the cohort that was retrospectively reviewed from the oncology database and patient records. RESULTS: There were 310 women diagnosed with cervical cancer; 240 were stages I/II and 70 were stages III/IV. Primary treatments were chemoradiotherapy (n = 168; 54.2%), surgery (n = 121; 39.0%), and palliative care alone (n = 21; 6.8%). UO occurred in 74 (23.9%); present at primary staging in 53 (71.6%) and arising after staging in 21 (28.4%). Primary interventions for hydronephrosis were IR (n = 50; 67.6%), cystoscopic stenting (n = 19; 25.7%), bowel urinary conduit construction (n = 2; 2.7%), and none (n = 3; 4.1%). For those who attended IR, the mean number of IR procedures was 2.2, range 1-7. Maximum serum creatinine was 303 µmol/L for women with UO at primary staging compared with 252 µmol/L for UO after staging (P = 0.267). Thirty-eight women experienced substantial morbidity related to UO. Stage-adjusted mortality risk was 2.3 times higher for UO cases compared with those without UO. CONCLUSIONS: UO is associated with substantial morbidity and survival disadvantage in cervical cancer and may present after primary cancer staging. We recommend renal biochemistry during routine follow-up. A majority of cervical cancer-associated UO cases are managed with IR in our center.


Assuntos
Obstrução Ureteral , Neoplasias do Colo do Útero/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimiorradioterapia , Estudos de Coortes , Creatinina/sangue , Feminino , Humanos , Hidronefrose/patologia , Incidência , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Obstrução Ureteral/diagnóstico , Obstrução Ureteral/patologia , Obstrução Ureteral/terapia , Neoplasias do Colo do Útero/terapia , Adulto Jovem
4.
BMC Urol ; 19(1): 137, 2019 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-31881875

RESUMO

BACKGROUND: To study the outcomes and experiences of using metallic stents in treating patients with malignant ureteral obstruction (MUO), we examined the effects of metallic ureteral stenting using the Cook Resonance® stent in the treatment of MUO. METHODS: All patients who had a Resonance metallic stent inserted between April 2015 and March 2018 at one of multiple facilities were prospectively observed with a 1-year follow-up. The primary outcome was the patency rate of the metallic ureteral stent. The secondary outcomes included the complications (e.g., infection and fever). RESULTS: Although stent insertion was attempted in 50 patients, the stent could not be inserted as a ureteral stent in three patients due to severe ureteral stricture, and one ureteral cancer patient was excluded from the analysis. The remaining 46 patients' median age was 67 years (range 28-85 years) (16 males, 30 females). Twenty-four patients died during the study; their median survival time was 226 days. The median follow-up period for the censored patients was 355 days (range 16-372 days), and just seven patients were still alive without Resonance failure > 1 year later. The women's IPSS scores tended to be lower than those of the men. Regarding the OABSS score, although the women's total score tended to be low, the difference between the men's and women's scores was nonsignificant. The bacteria detected from urine culture after stent insertion were more gram-positive than gram-negative. CONCLUSION: Metallic ureteric stenting using the Resonance stent is safe and effective for treating MUO. Subjective symptoms were relatively less in the female patients.


Assuntos
Stents , Obstrução Ureteral/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Bacterianas/urina , Creatinina/sangue , Feminino , Seguimentos , Neoplasias Gastrointestinais/complicações , Neoplasias dos Genitais Femininos/complicações , Humanos , Imagem por Ressonância Magnética , Masculino , Metais , Pessoa de Meia-Idade , Estudos Prospectivos , Desenho de Prótese , Falha de Prótese , Implantação de Prótese/métodos , Fatores Sexuais , Stents/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Obstrução Ureteral/etiologia , Obstrução Ureteral/mortalidade
5.
J Laparoendosc Adv Surg Tech A ; 29(12): 1565-1570, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31660792

RESUMO

Aim: Percutaneous nephrostomy (PN), the indispensable interventional procedure in situations such as obstructive uropathy and pyonephrosis, requires serious experience. As a result, many urologists and radiologists avoid this procedure. However, this can leave both doctor and patient in a difficult situation when it is necessary. In this study, we aimed at presenting a nephrostomy insertion technique by using a transrectal ultrasonography probe that we use in our clinic and we believe that this has made the PN procedure easier, along with our results. Patients and Methods: Data from patients with PN inserted by using this method at our clinic from January 2013 to December 2018 were retrospectively scanned. The nephrostomy indications, complications, and success rates for patients were assessed. All procedures were performed under local anesthesia without the help of a radiologist. Results: A total of 84 patients, 55 male and 29 female, had 146 nephrostomy catheters inserted. Nephrostomy was performed in 52 patients due to obstruction linked to malignancy and in 32 patients due to reasons other than malignancy. The procedure was successfully concluded in all patients independent of degree of hydronephrosis. Conclusion: With our technique, PN was found to be performed easily with low complication rates.


Assuntos
Nefrostomia Percutânea/métodos , Ultrassonografia/métodos , Obstrução Ureteral/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Obstrução Ureteral/etiologia
6.
Clin Exp Nephrol ; 23(12): 1345-1356, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31482255

RESUMO

BACKGROUND: Previous studies showed that microRNA-29b (miR-29b) inhibits renal fibrosis. Therefore, miR-29b replacement therapy represents a promising approach for treating renal fibrosis. However, an efficient method of kidney-targeted miRNA delivery has yet to be established. Recombinant adeno-associated virus (rAAV) vectors have great potential for clinical application. For kidney-targeted gene delivery, the most suitable AAV serotype has yet to be established. Here, we identified the most suitable AAV serotype for kidney-targeted gene delivery and determined that AAV-mediated miR-29b delivery can suppress renal fibrosis in vivo. METHOD: To determine which AAV serotype is suitable for kidney cells, GFP-positive cells were identified by flow cytometry after the infection of rAAV serotype 1-9 vectors containing the EGFP gene. Next, we injected rAAV vectors into the renal pelvis to determine transduction efficiency in vivo. GFP expression was measured seven days after injecting rAAV serotype 1-9 vectors carrying the EGFP gene. Finally, we investigated whether rAAV6-mediated miR-29b delivery can suppress renal fibrosis in UUO mouse model. RESULTS: We found that rAAV6 vector is the most suitable for targeting kidney cells regardless of animal species in vitro and rAAV6 is the most suitable vector for kidney-targeted in vivo gene delivery in mice. Intra-renal pelvic injection of rAAV vectors can transduce genes into kidney TECs. Furthermore, rAAV6-mediated miR-29b delivery attenuated renal fibrosis in UUO model by suppressing Snail1 expression. CONCLUSION: Our study has revealed that rAAV6 is the most suitable serotype for kidney-targeted gene delivery and rAAV6-mediated miR-29b delivery into kidney TECs can suppress established renal fibrosis.


Assuntos
Técnicas de Transferência de Genes , Terapia Genética/métodos , Vetores Genéticos , Nefropatias/prevenção & controle , Túbulos Renais Proximais/metabolismo , MicroRNAs/genética , Parvovirinae/genética , Obstrução Ureteral/terapia , Animais , Linhagem Celular , Modelos Animais de Doenças , Fibrose , Humanos , Nefropatias/diagnóstico , Nefropatias/metabolismo , Nefropatias/patologia , Túbulos Renais Proximais/efeitos dos fármacos , Túbulos Renais Proximais/patologia , Masculino , Camundongos Endogâmicos C57BL , MicroRNAs/metabolismo , Parvovirinae/metabolismo , Ratos , Fator de Crescimento Transformador beta1/toxicidade , Obstrução Ureteral/genética , Obstrução Ureteral/metabolismo , Obstrução Ureteral/patologia
7.
Vet Clin North Am Exot Anim Pract ; 22(3): 521-538, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31395329

RESUMO

Medical devices are defined as implantable if they are intended to remain in the body after the procedure. In veterinary medicine, use of such devices is marginal but may find some indications. Use in exotic pet medicine is even more challenging due to size restriction and the limited data available. This review focuses on the esophageal and tracheal stent in the case of stricture, ureteral stent and subcutaneous ureteral bypass in the case of ureteral obstruction, permanent urinary diversion in the case of bladder atony, and pacemaker in the case of severe arrythmias. Comparative aspects are developed.


Assuntos
Obstrução das Vias Respiratórias/veterinária , Animais Exóticos , Materiais Biocompatíveis/classificação , Estenose Esofágica/veterinária , Marca-Passo Artificial/veterinária , Obstrução Ureteral/veterinária , Obstrução das Vias Respiratórias/terapia , Animais , Gatos , Cistotomia/instrumentação , Cistotomia/veterinária , Cães , Estenose Esofágica/terapia , Feminino , Furões , Humanos , Masculino , Coelhos , Stents , Obstrução Ureteral/terapia , Derivação Urinária
8.
J Vet Intern Med ; 33(5): 2124-2132, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31386229

RESUMO

BACKGROUND: Subcutaneous ureteral bypass (SUB) device placement is an increasingly popular treatment option for decompression of ureteral obstruction in cats. Mineralization occlusion of the device occurs in a minority of cases but is the most common complication. OBJECTIVE: To evaluate a 2% tetrasodium ethylenediaminetetraacetic acid (tEDTA) solution for treatment of mineralization occlusion in cats with SUBs. ANIMALS: Six client-owned cats (8 obstructed devices). METHODS: Case series. Each cat was found to have device occlusion based on a combination of ultrasound examination, SUB irrigation, and failure to identify another cause of device obstruction. Each SUB was drained, irrigated using sterile saline, and infused with 1-2 mL of 2% tEDTA solution. Success was defined as normalization of flow during subsequent ultrasound visualization while irrigating. The volume and frequency of tEDTA instillations, time to achieve device patency, follow-up biochemical and ultrasound findings, and future reobstruction events were recorded. RESULTS: Resolution of mineralization was documented in all 8 SUBs. Reobstruction events occurred in 2 cats, all of which resolved after additional tEDTA infusions, but 1 cat ultimately required device exchange at 356 days from the first tEDTA infusion. In 1 cat, a single infusion was prematurely discontinued because of persistent pelvic dilatation after 1.25 mL of tEDTA had been instilled. No complications were observed. CONCLUSIONS AND CLINICAL IMPORTANCE: Tetrasodium EDTA infusions can be safely considered as a treatment option for mineralized SUB devices in cats. This solution was easily infused, well tolerated, and avoided the need for SUB device exchange in the majority of cats in which it was used.


Assuntos
Doenças do Gato/terapia , Ácido Edético/administração & dosagem , Stents/veterinária , Procedimentos Cirúrgicos Urológicos/veterinária , Animais , Quelantes de Cálcio/administração & dosagem , Doenças do Gato/diagnóstico por imagem , Gatos , Feminino , Masculino , Ultrassonografia/veterinária , Obstrução Ureteral/terapia , Obstrução Ureteral/veterinária , Procedimentos Cirúrgicos Urológicos/instrumentação
9.
PLoS One ; 14(4): e0215232, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30978213

RESUMO

BACKGROUND: The costimulatory CD40-CD40L pathway plays a role in kidney inflammation. We have previously reported that renal CD40 upregulation precedes cellular interstitial infiltrate and fibrosis in the unilateral ureteral obstruction (UUO) model. Here we sought to evaluate whether the administration of siRNA-CD40 has a therapeutic effect in a reversible unilateral ureteral obstruction (D-UUO) mice model. METHODS: Eight week-old C57BL6J male mice were divided into four groups: Vehicle (Phosphate-buffered saline) (n = 8); siRNA SC (non-specific siRNA) (n = 6); siRNA-CD40 (n = 8) and WT (wild type) (n = 6) mice. UUO was performed with a microvascular clamp. At day 3 after surgery, the ureteral clamp was removed and nephrectomy of the contralateral kidney was performed. Immediately, PBS, siRNA SC (50µg) or siRNA-CD40 (50µg) was administrated via the tail vein. Mice were killed 48h hours after the siRNA or saline administration. Wild type (WT) mice were used as controls. Blood samples were collected for measuring creatinine and blood urea nitrogen (BUN). Histology and kidney mRNA expression were performed. RESULTS: The administration of siRNA-CD40 reduced significantly the severity of acute renal failure associated with UUO. Pathologic analysis showed reduction of tubular dilation, interstitial fibrosis, F4/80 macrophage and CD3 (T cell) infiltration in animals treated with siRNA-CD40. Furthermore, kidney mRNA gene expression analysis showed significantly lower levels of macrophage markers (F4/80 and Mannose receptor), fibrosis matrix proteins (Fibronectin, MMP-9, Collagen IV and α-SMA), pro-inflammatory cytokines (iNOS and MCP-1) and the pro-fibrotic molecule TGF-ß1 in siRNA-CD40. CONCLUSIONS: The administration of siRNA-CD40 therapy reduces the severity of the acute kidney injury induced by obstructive uropathy and promotes kidney repair. This strategy seems suitable to be tested in humans.


Assuntos
Lesão Renal Aguda/etiologia , Lesão Renal Aguda/prevenção & controle , Antígenos CD40/antagonistas & inibidores , Antígenos CD40/genética , Obstrução Ureteral/complicações , Obstrução Ureteral/terapia , Lesão Renal Aguda/patologia , Animais , Modelos Animais de Doenças , Fibrose , Expressão Gênica , Inativação Gênica , Humanos , Mediadores da Inflamação/antagonistas & inibidores , Rim/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , RNA Interferente Pequeno/genética
10.
Stem Cell Res Ther ; 10(1): 104, 2019 03 21.
Artigo em Inglês | MEDLINE | ID: mdl-30898157

RESUMO

BACKGROUND: Putative endothelial progenitor cells (pEPCs) have been confirmed to participate in alleviation of renal fibrosis in several ischaemic diseases. However, their mechanistic effect on renal fibrosis, which is characterized by vascular regression and further rarefaction-related pathology, remains unknown. METHODS: To explore the effect and molecular mechanisms by which pEPCs act on unilateral ureteral obstruction (UUO)-induced renal fibrosis, we isolated pEPCs from murine bone marrow. In vivo, pEPCs (2 × 105 cells/day) and pEPC-MVs (microvesicles) were injected into UUO mice via the tail vein. In vitro, pEPCs were co-cultured with renal-derived pericytes. Pericyte-myofibroblast transition was evaluated using the myofibroblast marker α-smooth muscle actin (α-SMA) and pericyte marker platelet-derived growth factor receptor ß (PDGFR-ß). RESULTS: Exogenous supply of bone marrow-derived pEPCs attenuated renal fibrosis by decreasing pericyte-myofibroblast transition without significant vascular repair in the UUO model. Our results indicated that pEPCs regulated pericytes and their transition into myofibroblasts via pEPC-MVs. Co-culture of pericytes with pEPCs in vitro suggested that pEPCs inhibit transforming growth factor-ß (TGF-ß)-induced pericyte-myofibroblast transition via a paracrine pathway. CONCLUSION: pEPCs effectively attenuated UUO-induced renal fibrosis by inhibiting pericyte-myofibroblast transition via a paracrine pathway, without promoting vascular repair.


Assuntos
Células da Medula Óssea , Células Progenitoras Endoteliais , Miofibroblastos , Comunicação Parácrina , Pericitos , Obstrução Ureteral , Animais , Células da Medula Óssea/metabolismo , Células da Medula Óssea/patologia , Células Progenitoras Endoteliais/metabolismo , Células Progenitoras Endoteliais/patologia , Células Progenitoras Endoteliais/transplante , Fibrose , Nefropatias/etiologia , Nefropatias/metabolismo , Nefropatias/patologia , Nefropatias/terapia , Masculino , Camundongos , Camundongos Transgênicos , Miofibroblastos/metabolismo , Miofibroblastos/patologia , Pericitos/metabolismo , Pericitos/patologia , Obstrução Ureteral/complicações , Obstrução Ureteral/metabolismo , Obstrução Ureteral/patologia , Obstrução Ureteral/terapia
11.
J Am Soc Nephrol ; 30(2): 261-276, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30635373

RESUMO

BACKGROUND: Although hepatocyte growth factor (HGF) has antifibrotic effects and is involved in angiogenesis and vasodilation, systemic administration of HGF to prevent kidney fibrosis is not a feasible strategy for suppressing interstitial fibrosis in patients with CKD. METHODS: We investigated a novel therapy involving HGF transgenic cell sheets grown in culture from human mesothelial cells and administered to rats with unilateral ureteral obstruction (UUO). We compared progression of fibrosis in rats with UUO that received one of five interventions: HGF-transgenic mesothelial cell sheets transplanted to the kidney surface, HGF-transgenic mesothelial cell sheets transplanted to thigh, mesotherial cell sheets transplanted to kidney, no sheets, or HGF injections. RESULTS: HGF transgenic cell sheets transplanted to the kidney strongly suppressed the induction of myofibroblasts and collagen in the kidney for 28 days; other interventions did not. Additionally, the HGF-secreting cell sheets ameliorated loss of peritubular capillaries and maintained renal blood flow. CONCLUSIONS: These findings suggest that cell sheet therapy is a novel and promising strategy for inhibiting progressive fibrosis in CKD.


Assuntos
Fator de Crescimento de Hepatócito/farmacologia , Insuficiência Renal Crônica/patologia , Insuficiência Renal Crônica/terapia , Obstrução Ureteral/terapia , Animais , Transplante de Células/métodos , Células Cultivadas , Modelos Animais de Doenças , Progressão da Doença , Fibrose/patologia , Fibrose/prevenção & controle , Fator de Crescimento de Hepatócito/metabolismo , Humanos , Masculino , Mioblastos/transplante , Distribuição Aleatória , Ratos , Insuficiência Renal Crônica/metabolismo , Sensibilidade e Especificidade , Transfecção , Resultado do Tratamento , Obstrução Ureteral/patologia
12.
CEN Case Rep ; 8(1): 38-41, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30141138

RESUMO

Urinary tract infections after JJ stent insertion are among the most common complications, and the associated microorganisms carry more antibiotic resistance determinants than those found in urine prior to stent insertion. In line with the trends in healthcare epidemiology which implicate multi-resistant microorganisms in a plethora of healthcare-associated infections, prosthetic stent material also represents an ideal milieu for biofilm formation and subsequent infection development with resistant bacterial agents. Here we describe a case of a 73-year-old Caucasian woman presenting with urinary tract infection after JJ ureteric stent insertion due to ureteric obstruction and hydronephrosis of her left kidney. Extensive microbiological work-up and comprehensive molecular analysis identified the putative microorganism as carbapenem-resistant Enterobacter aerogenes carrying New Delhi metallo-beta-lactamase 1 (NDM-1). This is a first literature report implicating such extensively resistant strain of this species in early indwelling ureteric stent complications, and also the first report of NDM-1 in Enterobacter aerogenes in Croatia and Europe.


Assuntos
Enterobacter aerogenes/isolamento & purificação , Infecções por Enterobacteriaceae/microbiologia , Stents/microbiologia , Infecções Urinárias/microbiologia , beta-Lactamases/biossíntese , Idoso , Carbapenêmicos/farmacologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/etiologia , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla , Enterobacter aerogenes/efeitos dos fármacos , Enterobacter aerogenes/metabolismo , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/etiologia , Feminino , Humanos , Testes de Sensibilidade Microbiana/métodos , Obstrução Ureteral/terapia , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/etiologia
13.
Urolithiasis ; 47(4): 395-400, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30349974

RESUMO

Patients presenting acutely with obstructing stones often have a ureteral stent placed as a temporizing solution. Ureteroscopy is then commonly performed in a staged fashion, but occasionally the stone is found to have passed. We aimed to identify the frequency and predictors of ureteral stone passage with a stent in place. Records were reviewed to identify patients who had a stent placed for a single ureteral stone. Subsequent ureteroscopy or CT scan was used to ascertain stone passage. Effect of age, gender, BMI, stone diameter, alpha blocker use, urinary tract infection, hydronephrosis, and stent duration on stone passage was assessed. Inclusion and exclusion criteria were met in 209 patients. Mean maximum stone diameter was 6.5 ± 2.5 mm. Passage rates for stones < 3 mm, 3-4.9 mm, 5-6.9 mm, and ≥ 7 mm were 50%, 13%, 10%, and 0%, respectively. The overall rate of passage was 8%. Stone passage was associated with smaller maximum stone diameter, more distal stone location, and longer duration of stent before ureteroscopy/CT on univariate analysis (p < 0.01). Stone diameter and stent duration remained significantly associated on multivariable analysis (p = 0.001 and p = 0.05, respectively). Our findings suggest ureteral stone passage with a concurrent ureteral stent is not a rare event as it occurred in 14% of stones less then 7 mm in maximum diameter. Stone size and duration of stent before ureteroscopy or CT were found to be independent predictors of passage. Select patients with small ureteral stones who have been stented should be considered for a trial of urine straining or repeat imaging before subsequent ureteroscopy.


Assuntos
Cateteres de Demora , Stents , Cálculos Ureterais/terapia , Obstrução Ureteral/terapia , Cateteres Urinários , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Ureter/diagnóstico por imagem , Ureter/cirurgia , Cálculos Ureterais/complicações , Cálculos Ureterais/diagnóstico por imagem , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/etiologia , Ureteroscopia , Adulto Jovem
14.
J Pediatr Surg ; 54(8): 1650-1653, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30340877

RESUMO

OBJECTIVE: To assess the role of urinary carbohydrate antigen 19-9 (CA19-9) measurement in determining optimal management of ureteropelvic junction obstruction (UPJO) and predicting failure of conservative management. PATIENTS AND METHODS: Children with UPJO diagnosed between December 2012 and April 2015 were included. Depending on clinical and para-clinical findings, patients were divided into three groups: Group 1 consisted of patients who were considered for non-operative management with improvement of the condition during the course of follow-up. Group 2 were suitable for observation; however due to deterioration of condition pyeloplasty was indicated after a period of observation. Group 3 patients required immediate pyeloplasty. Urinary CA19-9 was measured in all patients at baseline and compared between the study groups. RESULTS: A total of 112 children (115 affected kidneys) with UPJO and mean age of 18.6 ±â€¯3.3 months were assessed. Group 1, 2, and 3 consisted of 54(48.2%), 24(21.4%), and 34(30.4%) patients, respectively. Mean baseline urinary CA19-9 was 37.83 ±â€¯5.20, 145.45 ±â€¯18.38 and 244.62 ±â€¯41.42 in groups 1, 2 and 3, respectively. Multivariate analysis showed that both CA19-9 and APD are independent predictors of need for surgery in patients on observation. ROC curve analysis revealed that urinary CA19-9 level at cut off value of 52.6 U/mL had sensitivity of 92.0% and specificity of 70.9% in predicting failure of non-operative management. CONCLUSION: Higher urinary CA19-9 level is associated with failure of non-operative management in patients with UPJO. Such patients may require close follow-up and assessments to prevent irreversible damage to the kidney. TYPE OF STUDY: Study of Diagnostic Test. LEVEL OF EVIDENCE: Level II.


Assuntos
Antígeno CA-19-9/urina , Pelve Renal/patologia , Obstrução Ureteral/terapia , Obstrução Ureteral/urina , Tratamento Conservador , Feminino , Humanos , Hidronefrose/etiologia , Lactente , Pelve Renal/cirurgia , Masculino , Valor Preditivo dos Testes , Curva ROC , Falha de Tratamento , Ureter/cirurgia , Obstrução Ureteral/complicações , Conduta Expectante
15.
Eur Radiol ; 29(2): 628-635, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29974220

RESUMO

OBJECTIVES: The aim of this study was to compare single and tandem ureteral stenting in the management of malignant ureteral obstruction (MUO). METHODS: Our hospital's institutional review board approved this prospective study. Between November 2014 and June 2017, single ureteral stenting was performed in 56 patients (94 renal units) and tandem ureteral stenting in 48 patients (63 renal units) for MUO. A comparative analysis of the technical success rate, patient survival, stent patency, and complications was performed. RESULTS: Similar demographic data were observed in patients receiving either single or tandem ureteral stenting. The technical success rate was 93.6% (88/94) for single ureteral stenting and 95.2% (60/63) for tandem ureteral stenting. There was no difference in overall survival between patients receiving single or tandem ureteral stenting (p = 0.41), but the duration of stent patency in tandem ureteral stenting was significantly longer (p = 0.022). The mean patency time was 176.7 ± 21.3 days for single ureteral stenting, and 214.7 ± 21.0 days for tandem ureteral stenting. The complications of ureteral stenting were urinary tract infection (n = 18), lower urinary tract symptoms (n = 5), haematuria (n = 3), and stent migration (n = 1). CONCLUSIONS: Tandem ureteral stenting is a safe and feasible treatment for MUO, and had better efficacy compared to single ureteral stenting. KEY POINTS: • Ureteral stenting is an established treatment for the management of malignant ureteral obstruction (MUO) • Prospective single-centre study showed that tandem ureteral stenting is a safe and feasible treatment for MUO • Tandem ureteral stenting provides longer stent patency compared to single ureteral stenting in patient with MUO.


Assuntos
Stents , Obstrução Ureteral/terapia , Adulto , Idoso , Feminino , Hematúria/etiologia , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Cuidados Paliativos/métodos , Estudos Prospectivos , Stents/efeitos adversos , Ultrassonografia de Intervenção/métodos , Ureter , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/etiologia , Infecções Urinárias/etiologia
16.
Curr Opin Urol ; 29(2): 124-128, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30531433

RESUMO

PURPOSE OF REVIEW: We present a review of recent literature to summarize the most recent evidence on the use of ureteral stents, including the use of different materials and treatment of stent-related symptoms. RECENT FINDINGS: Metal stents are able to resist lumen occlusion from extrinsic compression allowing longer indwelling time and making them an option for long-term use. Biodegradable stents have the advantage not to require secondary procedures; however, they have not proven their safety in the clinical setting yet. Coated and drug-eluting stents seem to be promising concepts to prevent stent-related symptoms, but still have to be considered as experimental approaches. The most commonly used stent type is the standard double J stent, named for its J-shaped curled ends and manufactured from polyurethane, silicone or various polymers. SUMMARY: After more than 5 decades of using stents there are promising advancements in their designs and materials aiming to maintain their patency and control stent-related symptoms. Long-term metallic stents and coated stents are good options that should be considered in selected patients. Biodegradable stents are promising developments but not sophisticated yet. Pain medication, alpha-blocker and antimuscarinic medications are still frequently used and necessary. Treatment combinations can result in better outcomes than monotherapy.


Assuntos
Stents , Ureter , Obstrução Ureteral , Antagonistas Adrenérgicos alfa/uso terapêutico , Humanos , Antagonistas Muscarínicos/uso terapêutico , Polímeros , Obstrução Ureteral/terapia
17.
Can J Urol ; 25(6): 9596-9600, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30553285

RESUMO

INTRODUCTION: Stent placement is a common procedure for addressing obstructive uropathy. However, lack of operating room (OR) availability can substantially delay this procedure. In this study, we sought to assess the feasibility, safety, and efficacy of this procedure in a clinical setting using nitrous oxide (N2O) and local anesthesia. MATERIALS AND METHODS: Patients included in this study included those who were determined to need management of urinary obstruction with a JJ ("double J") stent and had their procedure performed in the clinic procedure suite with N2O anesthesia. RESULTS: We present a case series of 565 patients undergoing ureteral stent placements in a clinic operative suite with N2O. In this cohort, complications occurred after 4.1% of procedures and unplanned admissions to the hospital occurred after 2.5% of procedures. Stent placements failed in 1.0% of procedures. Failures occurred due to pain in 2/565 patients. No anesthetic complications were encountered. CONCLUSION: We report the feasibility and clinical outcomes of ureteral stent placements for ureteral obstruction in a clinic setting with the use of local anesthetic or N2O anesthesia, with excellent results. A majority of patients tolerated the procedure well and only 2 of 565 had their procedures stopped due to discomfort. To our knowledge, this is the first report of the use of N2O anesthetic for conscious sedation for the placement of ureteral stents.


Assuntos
Stents , Obstrução Ureteral/terapia , Adulto , Idoso , Assistência Ambulatorial/estatística & dados numéricos , Anestésicos Inalatórios , Anestésicos Locais , Estudos de Viabilidade , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Óxido Nitroso , Ambulatório Hospitalar , Dor/etiologia , Estudos Retrospectivos , Stents/efeitos adversos , Resultado do Tratamento
18.
Scand J Urol ; 52(4): 291-295, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30334631

RESUMO

OBJECTIVE: To introduce a new position for ureteroscopic holmium laser lithotripsy for patients with upper ureteral calculi. MATERIALS AND METHODS: Between June 2014 and May 2017, 192 patients were enrolled in this study. Patients were randomly assigned to one of two groups: group A, ureteroscopic lithotripsy (URSL) in the Trendelenburg position; or group B, URSL in the standard position. Baseline information, including gender, age, body mass index (BMI), stone side, stone size and hydronephrosis grade, was collected and determined preoperatively. Stone-free rate (SFR) was evaluated 3 weeks after surgery and was defined by the absence of residual stones or the presence of residual stones <2 mm in diameter. Operation time, hospital stay, stone migration, operative complications and SFR were assessed and compared between the two groups. RESULTS: There were no statistically significant differences in gender, age, BMI, stone side, stone size, serum creatinine or hydronephrosis grade between the two groups (all p > 0.05). There were no significant differences in the postoperative hospital stay or postoperative complications between the two groups (all p > 0.05), but the differences in operative time, stone migration and SFR between the two groups were statistically significant (p < 0.05). CONCLUSION: This study introduced a new position for ureteroscopic holmium laser lithotripsy for patients with upper ureteral calculi. The Trendelenburg position can improve the SFR and may provide an optional surgical method for treating upper ureteral calculi.


Assuntos
Decúbito Inclinado com Rebaixamento da Cabeça , Hidronefrose/terapia , Litotripsia a Laser/métodos , Cálculos Ureterais/terapia , Obstrução Ureteral/terapia , Ureteroscopia/métodos , Adulto , Feminino , Humanos , Hidronefrose/etiologia , Lasers de Estado Sólido , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento , Cálculos Ureterais/complicações , Obstrução Ureteral/etiologia
19.
J Endourol ; 32(12): 1148-1153, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30221548

RESUMO

PURPOSE: To investigate the principles that govern ureteral stent failure by digitally and mechanically characterizing their luminal reduction in response to various extrinsic compression forces. To explore the relationship between ureteral stent "material area," "luminal area," and "cross-sectional area (CSA)" for resisting extrinsic compression forces. MATERIALS AND METHODS: We mechanically investigated 4.8F (n = 9), 6F (n = 9), and 7F (n = 9) ureteral stents to determine parameters that contribute to resisting radial compression forces. Digitalized images of luminal reduction values under incrementally increased reductions of stent outer diameters were obtained (0%, 25%, 50%, and 60% of original outer diameter). Forces (Newton [N]) and percentage luminal reduction that resulted in complete ureteral stent obstruction were determined. RESULTS: Uniaxial incremental compression in the radial direction demonstrated complete luminal reduction (95%-100%) when 58% to 62% of the outer stent diameter was compressed. The 6F ureteral stents demonstrated the greatest resistance to extrinsic compression and the greatest "material area" relative to "CSA" (mm2). The force (N) required for 50% compression of outer stent diameter was 10.44, 28.13, and 25.39 N for 4.8F, 6F, and 7F ureteral stents, respectively. The "material area"/"CSA" at 50% compression of the outer stent diameter was 76%, 86%, and 78% for 4.8F, 6F, and 7F ureteral stents, respectively. CONCLUSIONS: Maintenance of intraluminal stent diameter in the presence of extrinsic compressive forces is primarily dependent on the stent's ratio of "material area" to "CSA." Urologists should be aware of these findings to decrease the risk of ureteral stent failure when treating extrinsic ureteral obstruction.


Assuntos
Stents , Ureter/cirurgia , Obstrução Ureteral/terapia , Força Compressiva , Drenagem , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pressão , Risco , Estresse Mecânico , Urologia/normas
20.
Eur J Pediatr ; 177(12): 1761-1765, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30209594

RESUMO

The aim of the study was to retrospectively review the outcome of neonatal ureteropelvic junction obstruction with a good renal function and a poor drainage at a first diuretic renal scan, in cases where surgery was recommended on the basis of a loss of renal function, worsening of hydronephrosis or occurrence of clinical symptoms. Hydronephrosis was graded from 1 to 4 or as ureteral tract dilatation (UTD) P1 to UTD P3. During follow-up, 15 out of 38 patients (34.2%) required surgery while 25 out of 38 (65.8%) could have been managed conservatively. In patients with grade 2, 3, and 4 hydronephrosis, the ureteropelvic junction obstruction resolved or improved spontaneously in 100%, 63%, and 33% of cases (in 100% of UTD P1, 67% of UTD P2, and 50% of UTD P3), respectively. The median of follow-up was 14 years. Chi-square test showed a significant relationship between initial grade of hydronephrosis or UTD and the possibility of an efficient conservative management (p = 0.0088 and p = 0.0460).Conclusion: Conservative management can be safely achieved in ureteropelvic junction obstruction with poor drainage. Scheduled controls are needed for early discovery of functional renal deterioration. High-grade hydronephrosis is unlikely to resolve spontaneously and is often accompanied by a loss of renal function during the first years of life. What is Known: • There is controversy about which management should be adopted in infants with unilateral ureteropelvic junction obstruction with poor drainage but good differential renal function. What is New: • Long-term follow-up suggests that conservative management can be safely achieved also in unilateral ureteropelvic junction obstruction with poor drainage in more than 60% of cases, even if high-grade hydronephrosis is unlikely to resolve spontaneously and it is often accompanied by a loss of renal function during the first years of life. In our experience, surgical intervention was required in more than 50% of cases before 1 year of life and in all cases before 3 years of life.


Assuntos
Tratamento Conservador/métodos , Hidronefrose/etiologia , Rim/fisiopatologia , Obstrução Ureteral/terapia , Pré-Escolar , Drenagem , Feminino , Seguimentos , Humanos , Hidronefrose/terapia , Lactente , Recém-Nascido , Masculino , Prognóstico , Estudos Retrospectivos , Obstrução Ureteral/complicações
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