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2.
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
3.
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
4.
Urology ; 133: 240, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31465792

RESUMO

OBJECTIVE: To present a rare case of "huge" hydronephrosis causing distortion of large vessels and formation of a thrombus in the inferior vena cava. Multidisciplinary treatment was applied with particular focus on pyeloplasty utilizing a robot-assisted laparoscopic approach. METHODS: A 20-month-old male presented to the emergency room severely ill with abdominal pain, nausea, vomiting, and fever and was subsequently transferred to the intensive care unit, in septic shock. An abdominal ultrasound revealed a large multilobular cystic structure in the right hemiabdomen, which was initially interpreted as an infected mesenteric cyst. CT scan revealed a huge hydronephrotic kidney crossing the midline, causing a mass effect that compressed and distorted the vena cava laterally, in addition to a thrombus between the hepatic vein and right renal vein. Intravenous Ceftriaxone and Amikacin, as well as anticoagulation therapy with low molecular weight heparin (Enoxaparin) were initiated. A nephrostomy tube was inserted that drained 900 mL of purulent urine. A full hematology investigation including protein C, S, and antithrombin III was carried out, excluding factor V Leiden and prothrombin mutation. All values were in the normal range. Dimercaptosuccinic Acid (DMSA) scan showed 30% function on the affected kidney and Voiding Cystourethrogram (VCUG) excluded any bladder pathology or reflux. Subcutaneous Enoxaparin was continued for 3 months, maintaining antifactor Xa in the therapeutic range (0.7-1 IU/mL). Ultrasound Doppler of the vena cava showed full resolution of the thrombus. Robot-assisted laparoscopic pyeloplasty was performed and significant reduction of the renal pelvis was carried out, taking care to preserve the calyces. Postoperative ultrasound 4 months after surgery showed a complete resolution of the hydronephrosis. CONCLUSION: Giant hydronephrosis is a rare finding. Distortion of adjacent veins and formation of thrombosis should be kept in mind, as they are life threatening. A multidisciplinary collaboration is mandatory to ensure optimal treatment.


Assuntos
Hidronefrose/complicações , Hidronefrose/cirurgia , Pelve Renal/cirurgia , Laparoscopia/métodos , Procedimentos Cirúrgicos Robóticos , Trombose/etiologia , Trombose/cirurgia , Veia Cava Inferior , Humanos , Hidronefrose/patologia , Lactente , Masculino
5.
Int Braz J Urol ; 45(5): 956-964, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31408287

RESUMO

PURPOSE: We aimed to compare the outcomes of supine and prone miniaturized percutaneous nephrolithotomy (m-PNL) in the treatment of lower pole, middle pole and renal pelvic stones. MATERIALS AND METHODS: 54 patients who performed supine m-PNL between January 2017 and March 2018 and 498 patients who performed prone m-PNL between April 2015 and January 2018 were included in the study. Of the 498 patients, 108 matching 1: 2 in terms of age, gender, body mass index, American Association of Anesthesiology score, stone size, stone localization and hydronephrosis according to the supine m-PNL group were selected as prone m-PNL group. The patients with solitary kidney, upper pole stone, urinary system anomaly or skeletal malformation and pediatric patients (<18 years old) were excluded from the study. The success was defined as 'complete stone clearance' and was determined according to the 1st month computed tomography. RESULTS: The operation time and fluoroscopy time in supine m-PNL was significantly shorter than prone m-PNL group (58.1±45.9 vs. 80.1±40.0 min and 3.0±1.7 min vs. 4.9±4.5 min, p=0.025 and p=0.01, respectively). When post-operative complications were compared according to the modified Clavien-Dindo classification, overall and subgroup complication rates were comparable between groups. There was no significant difference between the groups in terms of the success rates (supine m-PNL; 72.2%, prone m-PNL; 71.3%, p=0.902). CONCLUSIONS: Supine m-PNL procedure is more advantageous in terms of operation time and fluoroscopy time in the treatment of lower pole, middle pole and renal pelvic stones.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Posicionamento do Paciente/métodos , Decúbito Ventral , Decúbito Dorsal , Adulto , Feminino , Fluoroscopia/métodos , Humanos , Cálculos Renais/patologia , Pelve Renal/cirurgia , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Duração da Cirurgia , Reprodutibilidade dos Testes , Estatísticas não Paramétricas , Resultado do Tratamento
6.
Arch Ital Urol Androl ; 91(2)2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31266278

RESUMO

OBJECTIVE: To compare the retroperitoneal with the transperitoneal approach in a series of patients underwent to robotic-assisted pyelolithotomy (RP). MATERIALS AND METHODS: From January 2015 to December 2018 we evaluated 20 patients subjected to robotic pyelolithotomy; 11 patients were treated with retroperitoneal approach (RRP) and 9 with transperitoneal approach (TRP). For each patient intra and perioperative data were recorded: operative time (OT), blood loss (BL), length of hospital stay (LOS), stone clearance, post-operative complications and time to remove the drain. The presence of stone fragments < 4 mm was considered as stone free rate. RESULTS: The principal stone burden was greater in the TRP group than in the RRP group (48 ± 10 mm vs 32 ± 14 mm, p = 0.12). Preoperative hydronephrosis was present in 7 (64%) patients in RRP group and a mild hydronephrosis in 3 of TRP group (p = 0.04). The average operative time was higher in the RRP group than in the TRP group (203 ± 45 min vs 137 ± 31 min, p = 0.002). The average blood loss was 305 ± 175 ml in the RRP group versus 94 ± 104 ml in the TRP group (p = 0.005). The stone free rate was similar between the two groups, 36% (4 patients) in the RRP group and 44% (4 patients) in the TRP (p = 0.966). CONCLUSIONS: RP appears to be a safe and effective minimally invasive treatment for some patients with renal staghorn calculi or urinary tract malformations. The TRP may give lower operative time and better results in terms of blood loss and length of hospital stay.


Assuntos
Cálculos Renais/cirurgia , Pelve Renal/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Idoso , Perda Sanguínea Cirúrgica , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Espaço Retroperitoneal , Estudos Retrospectivos , Resultado do Tratamento
7.
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
8.
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
9.
J Laparoendosc Adv Surg Tech A ; 29(7): 970-975, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31211649

RESUMO

Purpose: The aim of this study is to compare minilaparoscopic (MLS) and open pyeloplasty (OP) in children <1 year in terms of intra- and perioperative outcomes and esthetic results. Materials and Methods: Patients <1 year of age, with prenatal hydronephrosis, who underwent Anderson-Hynes pyeloplasty for monolateral ureteropelvic junction obstruction (UPJO) at our center from January 2016 to August 2017 were enrolled in the study. Outcomes evaluated were as follows: operative time, length of hospital stay, and postoperative pain anterior-posterior pelvic diameter (APD) reduction. The Vancouver Scar Scale (VSS) was utilized to evaluate esthetic results. Mean follow-up was 26.5 months. Results: Eighteen patients (11M, 7F) of mean age 8.1 months (range 4-12) and mean weight 8.5 kg (range 7-10) underwent Anderson-Hynes pyeloplasty in the study period. Nine of eighteen underwent OP, and 9/18 underwent MLS. Mean operative time was 167 minutes for MLS versus 153 minutes for OP (P = .14). Mean hospital stay was 3.9 days for MLS versus 5.3 days for OP (P = .11). Mean APD reduction was 13.6 mm for MLS and 16.5 mm for OP procedures (P = .63). Mean VSS score was 1.3 for VLS versus 3.4 for OP (P = .04). Conclusions: MLS pyeloplasty is feasible and safe, and reported equivalent results as open procedure for management of UPJO also in toddlers and infants. We found that the only significant difference between the two approaches in children <1 year was represented by the esthetic outcome in the short follow-up period.


Assuntos
Pelve Renal/cirurgia , Laparoscopia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Ureter/cirurgia , Obstrução Ureteral/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Feminino , Humanos , Hidronefrose/etiologia , Lactente , Laparoscopia/efeitos adversos , Tempo de Internação , Masculino , Duração da Cirurgia , Dor Pós-Operatória/etiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Resultado do Tratamento , Obstrução Ureteral/complicações , Procedimentos Cirúrgicos Urológicos/efeitos adversos
10.
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
11.
Urologiia ; (2): 26-30, 2019 Jun.
Artigo em Russo | MEDLINE | ID: mdl-31162897

RESUMO

INTRODUCTION: Percutaneous nephrolithotripsy (PNL) is considered as the main treatment method of patients with large and staghorn kidney stones. In some cases, laparoscopic pyelolithotomy (LP) may be an alternative option to PNL. The aim of our work was to compare the results of these surgical methods for treatment of large pelvis stones. MATERIALS AND METHODS: The results of surgical treatment of 60 patients with large pelvis stones were reviewed. In 40 patients (66.7%) PNL were performed, while in 20 cases (33.3%) LP were done. In the PNL group, the average stone size was 2.7 (2.5-3.8) cm and in the LP group it was 3.0 (2.6-4.2) cm. Four patients in the LP group had kidney malrotation, one patient had pelvic dystopia, and in another case a horseshoe kidney was diagnosed. The operative time and stone-free rate, intra- and postoperative complications, the amount of blood loss and the length of hospitalization were compared. RESULTS: There was no conversion in both groups. There were no significant differences in the mean length of hospitalization (4.5+/-1.5 vs 4.4+/-1.4 days) and analgesic use (2.2+/-0.9 vs 2.4+/-1.0 days) and stone-free rate (100 vs 90%) between groups. The mean operative time was significantly higher at the PL (110.0+/-25.0 vs 65.4+/-24.5 min; p less or equal 0.05), but the amount of blood loss was significantly lower (70+/-28 versus 160.0+/-55 ml; p less or equal 0.05) compared to the PNL group. CONCLUSIONS: PNL remains the main treatment method for patients with large kidney stones. However, abnormal kidneys, concomitant ureteropelvic junction obstruction or endoscopic treatment failure can be indications to LP.


Assuntos
Cálculos Renais/cirurgia , Pelve Renal/cirurgia , Nefrolitotomia Percutânea , Nefrotomia , Humanos , Laparoscopia/métodos , Nefrotomia/métodos , Cálculos Coraliformes/cirurgia , Resultado do Tratamento
12.
Int Braz J Urol ; 45(5): 1075, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31136106

RESUMO

INTRODUCTION AND OBJECTIVES: Chyluria, or the passage of chyle into the urine from anomalous lymphatic connections, results in a characteristic milky urine. In severe cases, it can cause signifi cant morbidity from nutritional losses and immune suppression. Although predominantly associated with Wuchereria bancrofti infections, non-parasitic cases have also been described. Traditionally, surgical treatment has involved renal lymphatic disconnection using open or minimally invasive methods, occasionally aided by pre-operative imaging techniques like lymphangiography, or by identifi cation of structures with laparoscopic magnifi cation.


Assuntos
Quilo , Corantes/uso terapêutico , Verde de Indocianina/uso terapêutico , Pelve Renal/cirurgia , Laparoscopia/métodos , Anormalidades Linfáticas/cirurgia , Idoso , Feminino , Humanos , Reprodutibilidade dos Testes , Resultado do Tratamento , Urina
13.
Adv Clin Exp Med ; 28(11): 1507-1511, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30929320

RESUMO

BACKGROUND: A bundle of crossing vessels (CV) supplying the lower pole of the kidney and causing mechanical obstruction of the ureteropelvic junction (UPJ) has been the subject of many discussions. During pyeloplasty, it is possible to overlook the CV. This may result in recurrent dilatation of the kidney and the need for re-surgery. OBJECTIVES: To compare the detection rate of CV in UPJ obstruction (UPJO) depending on the operational access applied (transperitoneal laparoscopy (LAP) vs open lumbotomy (OPEN)). Assessment of features that could indicate the presence of CV. MATERIAL AND METHODS: Two hundred and forty-six pediatric pyeloplasties were performed between January 2006 and July 2017 in the Department of Pediatric Surgery and Urology at the Wroclaw Medical University, Poland - 111 out of them by LAP and 135 by OPEN, on 98 girls and 148 boys. A retrospective analysis of the patient records for the detection of CV and characteristics of the CV before surgery was performed. RESULTS: Intraoperative CV causing obstruction of the UPJ in the LAP group were recognized in 34.2% (n = 38) of the patients, and within the OPEN group in 12.5% (n = 17) (p < 0.0001); 90% (n = 27) of patients with the diagnosed CV did not show congenital hydronephrosis. In 68% (n = 21) of the patients there were cases of recurrent renal colic. The presence of CV was suspected in 7.2% of kidney ultrasounds and in 12.5% in computed tomography (CT) urograms. CONCLUSIONS: The detection rate of CV in UPJO is statistically higher in LAP access than in open retroperitoneal lumbotomy. The distinguishing features of patients with CV are the lack of prenatal diagnosis for hydronephrosis and the presence of pain in the lumbar region.


Assuntos
Hidronefrose/cirurgia , Pelve Renal/cirurgia , Laparoscopia , Ureter/irrigação sanguínea , Obstrução Ureteral/cirurgia , Criança , Feminino , Humanos , Hidronefrose/diagnóstico por imagem , Pelve Renal/irrigação sanguínea , Pelve Renal/patologia , Laparoscopia/métodos , Masculino , Polônia , Estudos Retrospectivos , Ureter/cirurgia , Obstrução Ureteral/diagnóstico , Obstrução Ureteral/diagnóstico por imagem , Procedimentos Cirúrgicos Urológicos/métodos
14.
Urology ; 129: 235, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30959118

RESUMO

OBJECTIVE: To show how to perform a robot-assisted partial nephrectomy and bilateral pyelolithotomy in ectopic pelvic kidneys. This is a congenital abnormality of position and rotation1 frequently associated with urolithiasis.2 Renal cell carcinoma is a very rare event in pelvic kidneys.3,4 These 2 findings in the same patient could be a surgical challenge and whenever possible a "one stage" treatment is preferred. MATERIALS AND METHODS: A 44-year-old male with bilateral pelvic kidneys admitted because of left back pain. Abdominal CT scan showed a 17 mm stone in the left renal pelvis, a 12 mm stones in the right pelvis and a 34 × 27 mm right lower pole renal mass. A robotic surgery was indicated. Patient was placed in Trendelenburg position with ports configuration as for transperitoneal radical prostatectomy. The right kidney was firstly approached: after isolation of the ureter and suspension of the renal artery, a clampless partial nephrectomy was performed; then through a longitudinal pyelotomy the stone was extracted. To minimize the opening of the posterior peritoneum covering the left kidney, the site of the stone was identified by intraoperative ultrasound; then, through a longitudinal pyelotomy the stone was extracted. Given the watertight sutures and the lack of ureteral obstructions no pigtails ureteral catheters were inserted. A Jackson-Pratt drainage was placed through the inferior port. RESULTS: Consolle time was 190 minutes. Estimated Blood Loss (EBL) was 50 ml. No complications were reported. The drain was removed on the second postoperative day, assessed that creatinine dosage was equal to serum. The length of stay was 4 days. Histopathology showed a pT1a G2 clear cell renal cell carcinoma with negative surgical margins, while stones analysis was calcium oxalate. CONCLUSION: With the availability of robotic technology, the indications for minimally invasive surgery may be safely expanded to include concomitant morbidities in uncommon presentations.


Assuntos
Pelve Renal/cirurgia , Laparoscopia/métodos , Nefrectomia/métodos , Nefrotomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Humanos , Pelve Renal/anormalidades , Pelve Renal/diagnóstico por imagem , Masculino , Posicionamento do Paciente , Tomografia Computadorizada por Raios X , Ultrassonografia
15.
Future Oncol ; 15(17): 2009-2018, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30931608

RESUMO

Aim: To study the expression of EIF5A2 in urinary tract urothelial carcinoma and its clinicopathological features and prognosis. Methods: EIF5A2 expression was detected via immunohistochemistry in 101 patients. Results: Kaplan-Meier analysis showed that the EIF5A2 low expression group had significantly longer overall survival (OS; p < 0.001) and progression-free survival (PFS; p < 0.001) than the EIF5A2 high expression group. The high expression of EIF5A2 significantly predict poor OS and PFS in the subset patients (p < 0.05). EIF5A2 was an independent prognostic factor for OS and PFS (p = 0.003 and p = 0.001). The established nomogram model and its calibration curve predicted the probability of survival accurately. Conclusion: EIF5A2 is a potential molecular marker of poor prognosis in urinary tract urothelial carcinoma.


Assuntos
Carcinoma de Células de Transição/patologia , Neoplasias Renais/patologia , Fatores de Iniciação de Peptídeos/metabolismo , Proteínas de Ligação a RNA/metabolismo , Neoplasias Ureterais/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais , Carcinoma de Células de Transição/mortalidade , Carcinoma de Células de Transição/cirurgia , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Neoplasias Renais/mortalidade , Neoplasias Renais/cirurgia , Pelve Renal/patologia , Pelve Renal/cirurgia , Masculino , Pessoa de Meia-Idade , Nefroureterectomia , Prognóstico , Intervalo Livre de Progressão , Ureter/patologia , Ureter/cirurgia , Neoplasias Ureterais/mortalidade , Neoplasias Ureterais/cirurgia
16.
Adv Clin Exp Med ; 28(6): 777-782, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30968612

RESUMO

BACKGROUND: Crossing vessels (CVs) are common in older children and adults with hydronephrosis but no gold standard exists on how to treat this condition. The final decision is made intraoperatively by the surgeon. OBJECTIVES: To assess the outcome of the laparoscopic dismembered pyeloplasty with translocation of the CVs in children and adults. MATERIAL AND METHODS: Prospectively collected data from 3 departments was reviewed. Inclusion criteria were: 1) a transperitoneal laparoscopic approach; 2) dismembered pyeloplasty; and 3) the same operating pediatric urologist (RC) or urologist (TS). In the case of CVs, pyeloplasty with vessel transposition (children) or with cephalad translocation (adults) was performed. Forty-eight children and 41 adults met these criteria. Patients were divided into 4 groups: children with (group 1A) and without (group 1B) CVs, and adults with (group 2A) and without (group 2B) CVs. Any surgical reintervention at the uretero-pelvic junction (UPJ) was deemed a failure. RESULTS: The overall reintervention rate was 3/48 (6.25%) in children and 2/41 (4.9%) in adults (p > 0.05), and involved the following: 4 endopyelotomies and 1 redo pyeloplasty. Crossing vessels were identified in 28/48 (58%) children and 12/41 (29%) adults. The mean operation time was 152 min in group 1A and 161 min in group 2A (p > 0.5). Reintervention was needed in 2/28 patients in group 1A and in 1/12 patients in group 2A (p > 0.05). There was no difference in the failure rate between group 1A and group 1B, nor between group 2A and group 2B (p > 0.05). CONCLUSIONS: Crossing vessels should be meticulously looked for during pyeloplasty in older children and adults. Dismembered laparoscopic pyeloplasty (LP) with dorsal transposition or cephalad translocation are comparable methods in terms of success rate for the treatment of UPJ obstruction in these patients.


Assuntos
Hidronefrose/congênito , Pelve Renal/cirurgia , Laparoscopia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Obstrução Ureteral/cirurgia , Malformações Vasculares/cirurgia , Adulto , Idoso , Criança , Humanos , Hidronefrose/diagnóstico por imagem , Hidronefrose/cirurgia , Pelve Renal/patologia , Duração da Cirurgia , Resultado do Tratamento , Obstrução Ureteral/diagnóstico por imagem , Procedimentos Cirúrgicos Urológicos/métodos , Malformações Vasculares/diagnóstico por imagem , Procedimentos Cirúrgicos Vasculares/métodos
17.
J Cancer Res Ther ; 15(Supplement): S170-S172, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30900642

RESUMO

Renal pelvis squamous cell carcinoma (RSCC) is a rare tumor. It starts with nonspecific symptoms and it is usually at an advanced stage with a poor prognosis at the time of diagnosis. SCC-associated hypercalcemia is a well-known paraneoplastic syndrome; however RSCC-associated hypercalcemia is a rare condition. Our patient is a 57-year-old-male patient with no bone metastases. Based on the literature screening on PubMed Database for paraneoplastic malignant hypercalcemia-associated RSCC, we found a few cases.


Assuntos
Carcinoma de Células Escamosas/complicações , Hipercalcemia/etiologia , Neoplasias Renais/complicações , Pelve Renal/patologia , Síndromes Paraneoplásicas/etiologia , Cálcio/sangue , Carcinoma de Células Escamosas/sangue , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Humanos , Hipercalcemia/sangue , Neoplasias Renais/sangue , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Pelve Renal/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrectomia , Síndromes Paraneoplásicas/sangue , Resultado do Tratamento
18.
Urology ; 127: 133, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30794908

RESUMO

OBJECTIVE: To describe the steps and technique of a robotic pyelolithotomy for complete removal of a left staghorn stone after a previous open pyelolithotomy. METHODS: The patient is placed in a left modified flank position with 4 laparoscopic ports placed: 12mm port for camera paramedian to the left of the midline, 8mm robotic port left lower quadrant at the level of the umbilicus, 8mm robotic port midclavicular line 2 finger breaths below the costal margin, 12mm Airseal assistant port paramedian infraumbilical. The white line of Toldt was incised and the colon was mobilized medially. Anterior Gerota's fascia was opened and tacked to the lateral abdominal wall exposing renal pelvis and parenchyma. An intraoperative ultrasound confirmed the underlying stone. A V-shaped Gil-Vernet pyelolithotomy incision was made and Prograsp forceps were used to manipulate the stone out of the renal pelvis. The collecting system was inspected and irrigated using the robotic lens. The pyelotomy was closed with 4-0 Monocryl suture on a TF needle in 2 lengths of suture, superiorly and inferiorly. Gerota's fascia was closed over the renal pelvis and the kidney was re-retroperitonealized by tacking the colon to the white line of Toldt. The specimen was retrieved through a mini-Pfannenstiel incision via a specimen bag. The patient was discharged on postoperative day 1 and seen in clinic 5 weeks later for stent removal. CONCLUSIONS: Robotic pyelolithotomy is a minimally invasive alternative that can be offered to patients with complete staghorn stones even after major open stone surgery. However case selection for this approach relies on the stone burden primarily in a dilated renal pelvis with limited calyceal projections. It is imperative to review preoperative imaging to understand the calyceal anatomy and the rotation required to free the stone from the collecting system.


Assuntos
Cálculos/cirurgia , Cálculos Renais/cirurgia , Litotripsia/métodos , Nefrotomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Cálculos Coraliformes/cirurgia , Cálculos/diagnóstico por imagem , Seguimentos , Humanos , Cálculos Renais/diagnóstico por imagem , Pelve Renal/cirurgia , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Monitorização Intraoperatória/métodos , Duração da Cirurgia , Posicionamento do Paciente , Reoperação/métodos , Medição de Risco , Cálculos Coraliformes/diagnóstico por imagem , Resultado do Tratamento
19.
PLoS One ; 14(1): e0206810, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30703102

RESUMO

OBJECTIVES: To compare the efficacy and safety of percutaneous nephrolithotomy (PCNL) and open surgery (OS) for surgical treatment of patients with staghorn stones based on published literatures. MATERIALS AND METHODS: A comprehensive literature search of Pubmed, Embase, CNKI and Cochrane Library was conducted to identify studies comparing outcomes of PCNL and OS for treating patients with staghorn stones up to Jan 2018. RESULTS: There was no significant difference in final-SFR between PCNL and OS (odds ratio[OR]: 1.17; 95% confidence interval [CI]: 0.64, 2.15; p = 0.61), while PCNL provided a significantly lower immediate-SFR compared with OS (OR: 0.29; 95% CI: 0.16, 0.51; P < 0.0001). PCNL provided significantly lower overall complication rate, shorter operative times, hospitalization times, less blood loss and blood transfusion compared with OS (OR: 0.59; 95% CI: 0.41, 0.84; P = 0.004), (weighted mean difference [WMD]: -59.01mins; 95% CI: -81.09, -36.93; p < 0.00001), (WMD: -5.77days; 95% CI: -7.80, -3.74; p < 0.00001), (WMD: -138.29ml; 95% CI: -244.98, -31.6; p = 0.01) and (OR: 0.44; 95% CI: 0.29, 0.68; P = 0.00002), respectively. No significant differences were found in minor complications (Clavien I-II) (OR: 0.72; 95% CI: 0.47, 1.09; p = 0.12) and major complications (Clavien III-V) (OR: 0.5; 95% CI: 0.23, 1.08; P = 0.08). In subgroup analysis, there were no significant differences for overall complications and operative times between mini-PCNL and OS. In sensitivity analysis, there was no significant difference for overall complications between PCNL and OS. CONCLUSION: Our analysis suggested that standard PCNL turns out to be a safe and feasible alternative for patients with staghorn stones compared to OS or mini-PCNL. Because of the inherent limitations of the included studies, further large sample, prospective, multi-centric and randomized control trials should be undertaken to confirm our findings.


Assuntos
Cálculos Renais/cirurgia , Pelve Renal/cirurgia , Nefrolitotomia Percutânea/métodos , Complicações Pós-Operatórias/epidemiologia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Transfusão de Sangue/estatística & dados numéricos , Estudos de Viabilidade , Humanos , Tempo de Internação/estatística & dados numéricos , Nefrolitotomia Percutânea/efeitos adversos , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
20.
Minerva Urol Nefrol ; 71(2): 168-173, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30767492

RESUMO

BACKGROUND: The aim of the study was to describe the surgical outcomes of a series of consecutive patients treated with robot-assisted pyeloplasty (RAP) for ureteropelvic junction obstruction in a single tertiary referral center. METHODS: We prospectively collected and retrospectively analyzed data of 292 patients submitted to RAP performed from September 2011 to December 2016 by four experienced surgeons. The stenotic ureteropelvic junction was resected according to the Anderson-Hynes technique. Complications' severity was recorded and graded according to the modified Clavien classification system. RESULTS: The mean age was 40.6 years (SD15.5). Median Charlson Comorbidity Index was 0 (IQR 0-1). All interventions were performed with a transperitoneal access and a ureteral stent was always positioned. The mean operative time was 112.8 minutes (SD 48.7). Overall postoperative complications were 29 (9.9%): 24 (8.2%) surgical complications (7.2% Clavien 1, 0.7% Clavien 2 and 0.3% Clavien 3) and 5 (1.7%) medical complications (1% Clavien 1, 0.7% Clavien 2). The mean length of stay (LOS) was 4 days (SD 2.0). Median follow-up was 21 months (range 14-62). Six (2%) patients presented a recurrent obstruction with persistent hydronephrosis with or without symptoms or they had persistent symptoms. They were all submitted to retrograde holmium laser endopyelotomy. One (0.3%) of them required redo RAP for persistence of symptoms 8 months after the endoscopic treatment. CONCLUSIONS: In our experience, RAP with Anderson-Hynes technique performed in a tertiary referral center by expert surgeons represent a safe and feasible procedure with an overall low rate of postoperative complications.


Assuntos
Procedimentos Cirúrgicos Robóticos/métodos , Obstrução Ureteral/cirurgia , Adulto , Idoso , Feminino , Humanos , Pelve Renal/cirurgia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Centros de Atenção Terciária , Resultado do Tratamento , Ureter/cirurgia , Adulto Jovem
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