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1.
Medicine (Baltimore) ; 100(12): e25187, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761700

RESUMO

INTRODUCTION: Duplicate kidneys are the most common congenital abnormality of the urinary system. The location of duplicate kidneys varies. We report a case of an adolescent with upper and lower kidneys that are arranged vertically and approximately T-shaped. PATIENT CONCERNS: A 16-year-old male teenager was examined for pain in the left side of the waist. The Computed Tomography scan revealed that the left kidney was incompletely duplicated and fused; the left upper urinary tract was incompletely obstructed. DIAGNOSIS: The abdominal tomography confirmed the diagnosis of incomplete duplicate kidney. INTERVENTIONS: The patient underwent laparoscopic surgery. The failure to ligate the renal pedicle resulted in increased bleeding during the operation and an open ureteral stump. OUTCOMES: No urine leakage occurred after the operation. Doppler ultrasound of the urinary system showed no hydronephrosis, and the patient was asymptomatic. CONCLUSION: Through this case report, we found that the duplicate kidneys could be arranged in a T-shape under laparoscopy. Although only the supply of the duplicate renal arteries can be ligated during surgical resection, the renal pedicle must also be ligated during the operation if there is a lot of bleeding.


Assuntos
Rim/anormalidades , Rim/cirurgia , Laparoscopia/métodos , Nefrectomia/métodos , Adolescente , Perda Sanguínea Cirúrgica , Humanos , Rim/irrigação sanguínea , Rim/diagnóstico por imagem , Pelve Renal/anormalidades , Pelve Renal/cirurgia , Laparoscopia/efeitos adversos , Dor Lombar/etiologia , Masculino , Nefrectomia/efeitos adversos , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler em Cores , Ureter/anormalidades , Ureter/cirurgia
2.
Ann R Coll Surg Engl ; 103(4): e136-e139, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33666521

RESUMO

Upper-tract urothelial cancer comprises only 3% of all urothelial cancers. Risk factors include tobacco smoking, recurrent urinary infection, urolithiasis and analgesic abuse. Urolithiasis-induced chronic inflammation leads to urothelial proliferation and eventual malignant transformation. The most common association is reported with squamous cell cancer. A 54-year man under evaluation for right flank pain was diagnosed with a large distal ureteric stone and urothelial cancer of the entire right ureter and renal pelvis. The patient underwent right nephroureterectomy and stone retrieval, with urinary bladder cuff excision and pelvic lymph node dissection. On follow-up, the patient succumbed to disease recurrence with widespread metastasis. Urothelial cancer associated with stone disease is atypical. Long-standing inflammation causing metaplastic and dysplastic changes is a possible hypothesis. Careful assessment of the malignancy should be looked for in patients with long-standing obstruction due to stone disease.


Assuntos
Carcinoma de Células de Transição/diagnóstico , Neoplasias Renais/diagnóstico , Pelve Renal/patologia , Cálculos Ureterais/diagnóstico , Neoplasias Ureterais/diagnóstico , Carcinoma de Células de Transição/complicações , Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/cirurgia , Evolução Fatal , Humanos , Neoplasias Renais/complicações , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Pelve Renal/cirurgia , Masculino , Pessoa de Meia-Idade , Nefroureterectomia , Carga Tumoral , Cálculos Ureterais/complicações , Cálculos Ureterais/cirurgia , Neoplasias Ureterais/complicações , Neoplasias Ureterais/patologia , Neoplasias Ureterais/cirurgia
3.
Curr Urol Rep ; 22(4): 22, 2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33554322

RESUMO

PURPOSE: To provide a comprehensive review on the new da Vinci SP (single port) robotic surgical system. The published literature to date within urology and a description of the new system will be discussed. FINDINGS: There are currently no high-quality published studies with the SP robotic system. All studies are case series, many with 10 or fewer patients. However, all studies have found the SP system to be safe and feasible in performing most urological procedures. Renal and pelvic surgery using the SP robotic system is safe and feasible in the hands of expert robotic surgeons. Long-term, high-quality data is lacking. While the current high price and the learning curve will limit the SP systems' use in many health care systems, new updates and the release of robotic surgical systems from other developers may help drive down costs and encourage uptake.


Assuntos
Procedimentos Cirúrgicos Robóticos/instrumentação , Doenças Urológicas/cirurgia , Procedimentos Cirúrgicos Urológicos/instrumentação , Cistectomia/instrumentação , Cistectomia/métodos , Endoscopia , Humanos , Imageamento Tridimensional , Pelve Renal/cirurgia , Curva de Aprendizado , Nefrectomia/instrumentação , Nefrectomia/métodos , Prostatectomia/instrumentação , Prostatectomia/métodos , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Robóticos/economia , Procedimentos Cirúrgicos Robóticos/educação , Procedimentos Cirúrgicos Robóticos/tendências , Ureter/cirurgia , Bexiga Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/economia , Procedimentos Cirúrgicos Urológicos/educação , Procedimentos Cirúrgicos Urológicos/tendências
4.
Urol Clin North Am ; 48(1): 113-125, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218586

RESUMO

Almost 30 years have passed since the inception of minimally invasive surgery in urology and specifically in pediatric urology. Laparoscopy has now become an essential tool in the pediatric urologic armamentarium. The application of robot-assisted surgery in pediatrics has allowed for widespread utilization for common reconstructive procedures such as pyeloplasty and ureteral reimplantation. Understanding the implementation, technical considerations, and outcomes are critical for continued success and adoption. This has allowed for increased use in more complex urologic procedures such as redo pyeloplasty, dismembered ureteral reimplantation, catheterizable channel creation, and bladder augmentation.


Assuntos
Pelve Renal/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Ureter/cirurgia , Doenças Urológicas/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Anestesia , Criança , Previsões , Humanos , Curva de Aprendizado , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/tendências , Reimplante , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/tendências , Obstrução Ureteral/cirurgia , Doenças Urológicas/congênito , Procedimentos Cirúrgicos Urológicos/tendências , Refluxo Vesicoureteral/cirurgia
5.
Acta Cir Bras ; 35(11): e351108, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33331458

RESUMO

PURPOSE: To develop a model for simulated training of ureteropyelic anastomosis in laparoscopicpyeloplasty. METHODS: Longitudinal and experimental study, with 16 participants. A synthetic instrument was produced to simulate the renal pelvis and the proximal portion of the ureter positioned on a platform within laparoscopic simulators, thereby resulting in the realistic simulation of the ureteropelvic anastomosis. A step-by-step guide was also developed for the accomplishment of the ureteropelvic anastomosis training model. RESULTS: In the evaluation of all participants' suture training, a decrease was found in the time needed to perform the anastomosis, with a median of 17.83 min in the 1st step and 14.21 min in the last one (p = 0.01). Regarding the knots, in the 1st step, 5% of them were considered firm, with an evolution to 30% in the last step (p = 0.011). CONCLUSION: We noticed improvement in the ability to perform the ureteropelvic anastomosis by participants with no experience with it. Therefore, even unexperienced participants can improve their skills with this training. Moreover, we observed the effectiveness of the model use, confirmed by the participants' opinion and its validation by expert surgeons.


Assuntos
Laparoscopia , Procedimentos Cirúrgicos Reconstrutivos , Ureter , Obstrução Ureteral , Anastomose Cirúrgica , Humanos , Pelve Renal/cirurgia , Ureter/cirurgia , Obstrução Ureteral/cirurgia
6.
Arch Esp Urol ; 73(9): 856-859, 2020 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-33144541

RESUMO

OBJECTIVE: Horseshoe kidney is the most common renal fusion anomaly. Its peculiar anatomical characteristics increase the risk of lithiasis formation and always entails a surgical challenge for its treatment. MATERIAL AND METHODS: We present the cases of men with horseshoe kidneys diagnosed by CT one case of alarge pyelic lithiasis with others of a smaller size in the calyces, and the other of a big solitary lithiasis in renal pelvis. RESULTS: We performed a laparoscopic pyelolitectomy to remove the pyelic lithiasis and we used a flexible cystoscope through a trocar to extract the calyceal stones. The postoperative period was uneventful without evidence of urinary leakage or residual lithiasis. CONCLUSIONS: The laparoscopic approach to lithiasisis a suitable alternative in especially complex cases such as horseshoe kidney. The use of a flexible cystoscope allows to navigate through the renal cavities and extract the lithiasis which cannot be accessed through laparoscopic instruments, improving the efficiency of this approach.


Assuntos
Rim Fundido , Cálculos Renais , Laparoscopia , Rim Fundido/complicações , Rim Fundido/cirurgia , Humanos , Rim/cirurgia , Cálculos Renais/cirurgia , Cálices Renais , Pelve Renal/cirurgia , Masculino
7.
Hinyokika Kiyo ; 66(9): 303-306, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-32988167

RESUMO

A 56-year-old woman presented with left flank pain. Computed tomography revealed hydronephrosis and a 35 mm mass in the left renal pelvis. Ureteroscopy revealed a white elevated lesion in the left renal pelvis. Tissue biopsy was performed and the histological findings showed no evidence of malignancy. Urine cytology was class III. Based on these results, we could not completely rule out malignancy. Left retroperitoneoscopic nephroureterectomy was performed and a pedunculated white mass was found in the renal pelvis. The pathological diagnosis was a fibroepithelial polyp of the renal pelvis. Fibroepithelial polyps in the urinary tract are relatively rare, and those in the renal pelvis even more so. When the preoperative diagnosis shows no malignant findings, fibroepithelial polyps should be considered as a differential diagnosis.


Assuntos
Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/diagnóstico , Neoplasias Renais/cirurgia , Pólipos/diagnóstico por imagem , Pólipos/diagnóstico , Pólipos/cirurgia , Neoplasias Cutâneas , Feminino , Humanos , Pelve Renal/diagnóstico por imagem , Pelve Renal/cirurgia , Pessoa de Meia-Idade , Ureteroscopia
8.
Arch Esp Urol ; 73(4): 251-256, 2020 May.
Artigo em Espanhol | MEDLINE | ID: mdl-32379059

RESUMO

OBJECTIVE: Polar vessels are related with pyelo-ureteral stenosis (PUE) in 5-10% of the patients. In the 24% of these cases an intrinsic cause of stenosis can also be found. An increased incidence of polar vessels is found in laparoscopic surgery, compare to open procedures. Our study analyses this difference in our hospital, studying its influence in the aetiology of the disease.MATERIAL AND METHODS: Descriptive and retrospective study of patients operated in our hospital of pyeloplasty, because of PUE between 2009 and 2017. Patients have been divided in two groups: operated by laparoscopy (PL), or operated by conventional surgery (PA). All cases in which polar vessels were seen in TC where excluded. Each group included 47 patients. RESULTS: We found no statistical differences in the age of surgery of the two groups (36,1±41,3 months PL/31,8±37,2 months PA; p=0.527). Overall, 18 polar vessels were found, 15 in PL and 3 in PA. 6 patients of the PA group presented recurrence of the obstruction, and in 2 of them, polar vessels were found in the second surgery. All the 18th cases presented anomalies in the histological study related with inflammation or fibrosis. CONCLUSIONS: The laparoscopic approach allows a better vision of crossing vessels in the cases of extrinsic PUE. Dismembered pyeloplasty might be the best treatment, as an intrinsic cause of obstruction cannot be ruled out according to the observed histological alterations.


Assuntos
Laparoscopia , Ureter/cirurgia , Obstrução Ureteral/cirurgia , Constrição Patológica , Humanos , Pelve Renal/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos
9.
J Urol ; 204(5): 1048-1053, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32420797

RESUMO

PURPOSE: We aimed to compare the Society for Fetal Urology and anteroposterior pelvic diameter classification systems in predicting the time to resolution of isolated hydronephrosis. MATERIALS AND METHODS: We retrospectively reviewed isolated hydronephrosis cases prenatally detected and postnatally diagnosed between 1994 and 2018. Other urinary tract anomalies and vesicoureteral reflux were excluded. Baseline grades for both systems were collected. Anteroposterior pelvic diameter was classified as grade 1 to 4 over a scale of 5 mm. Resolution was defined by an anteroposterior pelvic diameter of less than 5 mm with Society for Fetal Urology grade I hydronephrosis. Time to resolution was analyzed using Kaplan-Meier curves. RESULTS: The study population consisted of 831 patients (1,028 renal units). Median followup was 26 months (range 6 to 260), and 559 units (54.3%) reached resolution during a median followup of 9 months (1 to 133). Resolution rates at 48 months were 81.7%, 65.6%, 37.6% and 5.2% for Society for Fetal Urology grades I through IV disease and 80.0%, 41.2%, 13.1% and 2.5% for anteroposterior pelvic diameter grades 1 through 4, respectively. Discrepancies between these grades were present in 481 units (46.8%). Society for Fetal Urology grades II to IV categorized as anteroposterior pelvic diameter grade 1 showed a superior cumulative rate of resolution (84.7%) vs anteroposterior pelvic diameter grades 2 to 4 categorized as Society for Fetal Urology grade I (53.2%, log-rank test p <0.001). CONCLUSIONS: Hydronephrosis cases with anteroposterior pelvic diameter grades 2 to 4 but categorized as Society for Fetal Urology grade I have an inferior cumulative rate of resolution than vice versa. Society for Fetal Urology grades have little influence on resolution when anteroposterior pelvic diameter is less than 10 mm. Therefore, anteroposterior pelvic diameter is more useful in predicting the time to resolution.


Assuntos
Feto/anormalidades , Hidronefrose/diagnóstico , Pelve Renal/diagnóstico por imagem , Índice de Gravidade de Doença , Adolescente , Criança , Pré-Escolar , Feminino , Feto/diagnóstico por imagem , Seguimentos , Humanos , Hidronefrose/congênito , Hidronefrose/cirurgia , Lactente , Recém-Nascido , Pelve Renal/anormalidades , Pelve Renal/cirurgia , Masculino , Gravidez , Prognóstico , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Remissão Espontânea , Estudos Retrospectivos , Fatores de Tempo , Ultrassonografia Pré-Natal , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Adulto Jovem
11.
J Radiol Case Rep ; 14(1): 12-20, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32184930

RESUMO

Isolated rupture of the renal pelvis secondary to blunt trauma is rare, though there is increased incidence in the setting of a pre-existing renal abnormality that predisposes the kidney to injury. We report a case of post-traumatic hemorrhage into the renal collecting system leading to delayed rupture of the renal pelvis in the setting of suspected chronic ureteropelvic junction obstruction. This case illustrates the difficulty in diagnosis of acute hemorrhage into the renal collecting system. Special attention should be given to a kidney with a pre-existing abnormality in the setting of trauma to prevent complications. A literature review of hemorrhage into the collecting system along with appropriate imaging and management are discussed.


Assuntos
Hemorragia/etiologia , Pelve Renal/lesões , Ruptura/etiologia , Obstrução Ureteral/complicações , Ferimentos não Penetrantes/complicações , Adulto , Doença Crônica , Diagnóstico Diferencial , Evolução Fatal , Hemorragia/diagnóstico por imagem , Hemorragia/cirurgia , Humanos , Pelve Renal/diagnóstico por imagem , Pelve Renal/cirurgia , Masculino , Ruptura/diagnóstico por imagem , Ruptura/cirurgia , Tempo , Tomografia Computadorizada por Raios X/métodos , Obstrução Ureteral/diagnóstico por imagem , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/cirurgia
13.
J Robot Surg ; 14(6): 855-859, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32141015

RESUMO

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


Assuntos
Cálculos Renais/cirurgia , Pelve Renal/cirurgia , Litotripsia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Perda Sanguínea Cirúrgica , Creatinina/sangue , Feminino , Humanos , Masculino , Nefrolitotomia Percutânea/métodos , Duração da Cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos , Cálculos Coraliformes/cirurgia , Resultado do Tratamento
14.
BJU Int ; 125(6): 898-904, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32077229

RESUMO

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


Assuntos
Nefrostomia Percutânea , Cálculos Coraliformes/cirurgia , Adulto , Desenho de Equipamento , Feminino , Humanos , Pelve Renal/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrostomia Percutânea/efeitos adversos , Nefrostomia Percutânea/instrumentação , Nefrostomia Percutânea/métodos , Complicações Pós-Operatórias , Estudos Prospectivos , Sucção/instrumentação
15.
Int Braz J Urol ; 46(2): 253-259, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32022515

RESUMO

Objetive: Pelvicureteric junction (PUJ) obstruction is the main cause of hydronephrosis in childhood. Open pyeloplasty has been the gold standard treatment of this condition with success rate above 90%. The role of laparoscopic pyeloplasty (LP) in children is less well defined and has slowly emerged as an alternative procedure. We report outcomes of our initial experience with LP in 38 children from 2 months of age. MATERIALS AND METHODS: From June 2015 to December 2017 38 children aged 2-60 months (mean age 1.7 years) underwent LP for correction of PUJ obstruction. The mean pre operative anteroposterior diameter of the renal pelvis (APD) was 43,5mm and all patients had hydronephrosis (APD 21.4-76 mm) and obstructed curve on diuretic renogram. Anderson-Hynes pyeloplasty was the performed technique. Results are reported. RESULTS: Mean operative time was 107 minutes (70-180) with no conversion to open procedure. Pain control was needed mainly in the fi rst 12hs. Mean hospitalization was 2 days (1-5). There were complications in 5 children not affecting the fi nal outcome. Two patients had a re-obstruction requiring a second procedure with good result. The mean follow up was 18 months (13-36). The mean reduction on the postoperative APD was 41% - p<0,001 (end APD 5 to 41mm). Overall success rate was 94,7%. All children had good cosmetic results. CONCLUSIONS: This is a small series limited by short follow up, however its data suggest that LP has good functional and cosmetic results, not compromising the success of the open procedure, regardless patient age.


Assuntos
Hidronefrose/cirurgia , Pelve Renal/cirurgia , Laparoscopia/métodos , Obstrução Ureteral/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Pré-Escolar , Feminino , Seguimentos , Humanos , Hidronefrose/etiologia , Lactente , Pelve Renal/patologia , Masculino , Resultado do Tratamento , Obstrução Ureteral/complicações
17.
J Robot Surg ; 14(2): 325-329, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31222624

RESUMO

Ureteropelvic junction obstruction (UPJO) is a frequently found congenital abnormality of the upper urinary tract treated with pyeloplasty. We hereby report a study to compare open pyeloplasty (OP), laparoscopic pyeloplasty (LP) and robotic assisted pyeloplasty (RAP) for UPJO in terms of functional and perioperative outcomes. 102 patients who underwent Anderson-Hynes dismembered pyeloplasty for UPJO were divided into three groups based on type of surgical techniques utilized as follows: OP (Group A; n = 34), LP (Group B; n = 34), and RAP (Group C; n = 34). Preoperative, intraoperative and postoperative data were recorded. The mean operative time was significantly more in the Group B (187.76 min) than the Group A (132.06 ± 30.1 min) and Group C (136.76 ± 25.1 min) (p < .001). Mean blood loss was more in OP group 86.47 ± 29. 35 ml versus 42.94 ± 20. 77 ml in RAP and 45.59 ± 20. 3 ml in the LP group (p < .001). The LP was found to be much tiring. Mean surgeon fatigue index (SFI) calculated was 7 ± 1.1 in the LP group compared to 4.12 ± 1.1 in RAP group and the difference was statistically significant (p< .001). Average VAS score in the first 2 days postoperatively was 6.66±1.58 in the OP group compared to 4.29 ± 1.16 in RAP group and 4.29 ± 1.31 in the LP group (p < 0.001). Pyeloplasty has a similar success rate and efficacy irrespective of the technique utilized. RAP improves the surgeons QOL (quality of life) and the fatigue scores, which is useful for surgeon longevity. RAP has become widely favorite and can be considered the approach of choice in the management of UPJO wherever infrastructure and finances allow.


Assuntos
Pelve Renal/cirurgia , Laparoscopia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Ureter/cirurgia , Obstrução Ureteral/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Adulto , Feminino , Humanos , Masculino , Duração da Cirurgia , Qualidade de Vida , Resultado do Tratamento , Obstrução Ureteral/etiologia , Sistema Urinário/anormalidades
18.
J Robot Surg ; 14(3): 401-407, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31317314

RESUMO

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


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica , Feminino , Seguimentos , Humanos , Pelve Renal/cirurgia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
19.
J Robot Surg ; 14(2): 241-248, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31280462

RESUMO

Robot-assisted laparoscopic pyeloplasty (RLP) has excellent surgical safety and efficacy in primary pyeloplasty. In recent, the application of robotics has explored to more complex surgical conditions such as failed pyeloplasty. This meta-analysis aimed to evaluate the surgical and clinical outcomes of secondary RLP compared with primary RLP. Following PRISMA guidelines, we carried out an extensive literature search in the PubMed, Web of Science, Cochrane Library, Scopus, and Google Scholar to extract the published articles comparing primary vs. secondary RLP up to April 2019. Interested surgical and clinical outcomes were extracted from each study and then used RevMan 5.3 Software for meta-analysis comparison. Furthermore, the quality of each study was assessed using the Modified Newcastle-Ottawa Scale for cohort studies. Our search has yielded seven studies that met our inclusion criteria. These studies contained 613 vs. 107 patients in primary vs. secondary RLP, respectively. Using random effect model, the analysis showed no statistical difference between the groups in the presence of a crossing vessel, complications, length of hospital stays (LOS), and follow-up period. However, the operative time, estimated blood loss (EBL), and recurrence rate were significantly higher in the secondary RLP compared with primary RLP (p = 0.004), (p = 0.01), and (p = 0.04), respectively. Our results indicate that secondary RLP is associated with significantly increased operative time and EBL and higher recurrence rates compared with primary RLP. We believe that our findings might help surgeon's decision making in patient selection and consultation during redo pyeloplasty surgical planning.


Assuntos
Pelve Renal/cirurgia , Laparoscopia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Ureter/cirurgia , Obstrução Ureteral/cirurgia , Tomada de Decisões , Humanos , Duração da Cirurgia , Reoperação , Segurança
20.
BMC Urol ; 19(1): 112, 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31711468

RESUMO

BACKGROUND: Multiple surgical treatment options are available for the treatment of ureteropelvic junction obstruction (UPJO). The aim of this study is to compare the most frequently used technics in a comprehensive network approach. METHODS: A systematic literature search of the EMBASE, MEDLINE and COCHRANE libraries was conducted in January 2018. Publications were included that evaluated at least two of the following surgical techniques: open pyeloplasty (OP), endopyelotomy (EP), laparoscopic (LP) and robot assisted pyeloplasty (RP). Main outcomes were operative success, complications, urinary leakage, re-operation, transfusion rate, operating time, and length of stay. Network meta-analyses with random effects models simultaneously assessed effectiveness of all surgical techniques. RESULTS: A total of 26 studies including 3143 patients were analyzed. Compared with RP, EP and LP showed lower operative success rates (EP: OR = 0.09, 95%CI:0.05-0.19; p < 0.001; LP: OR = 0.51, 95%CI:0.31-0.84; p = 0.008). Compared with OP, LP and RP had lower risk for complications (LP: OR = 0.62; 95%CI:0.41-0.95; p = 0.027; RP: OR = 0.41; 95%CI:0.22-0.79; p = 0.007). Compared with RP, no significant differences were detected for urinary leakage or re-operation, transfusion rates. Compared with EP, RP yielded longer operating time (mean = 102.87 min, 95%CI:41.79 min-163.95 min, p = < 0.001). Further significant differences in operating times were detected when comparing LP to EP (mean = 115.13 min, 95%CI:65.63 min-164.63 min, p = < 0.001) and OP to EP (mean = 91.96 min, 95%CI:32.33 min-151.58 min, p = 0.003). CONCLUSIONS: Multiple surgical techniques are available for treatment of UPJO. RP has the highest rates of operative success and as well as LP lower complication rates than OP. Although surgical outcomes are worse for EP, its operating time is shorter than OP, RP, and LP. Surgeons should consider these findings when selecting the optimal treatment method for individual patients.


Assuntos
Pelve Renal/cirurgia , Obstrução Ureteral/cirurgia , Humanos , Metanálise em Rede , Procedimentos Cirúrgicos Urológicos/métodos
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