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1.
Molecules ; 26(12)2021 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-34205289

RESUMO

The inadvertent severing of a ureter during surgery occurs in as many as 4.5% of colorectal surgeries. To help prevent this issue, several near-infrared (NIR) dyes have been developed to assist surgeons with identifying ureter location. However, the majority of these dyes exhibit at least some issue that precludes their widespread usage such as high levels of uptake in other tissues, overlapping emission wavelengths with other NIR dyes used for other fluorescence-guided surgeries, and/or rapid excretion times through the ureters. To overcome these limitations, we have synthesized and characterized the spectral properties and biodistribution of a new series of PEGylated UreterGlow derivatives. The most promising dye, UreterGlow-11 was shown to almost exclusively excrete through the kidneys/ureters with detectable fluorescence observed for at least 12 h. Additionally, while the excitation wavelength is similar to that of other NIR dyes used for cancer resections, the emission is shifted by ~30 nm allowing for discrimination between the different fluorescence-guided surgery probes. In conclusion, these new UreterGlow dyes show promising optical and biodistribution characteristics and are good candidates for translation into the clinic.


Assuntos
Abdome/cirurgia , Imagem Óptica/métodos , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Ureter/cirurgia , Animais , Fluorescência , Corantes Fluorescentes/metabolismo , Humanos , Rim/cirurgia , Camundongos , Distribuição Tecidual/fisiologia , Ureter/metabolismo
2.
BMJ Case Rep ; 14(6)2021 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-34155008

RESUMO

A 30-year-old woman presented with right-sided abdominal pain associated with fever. Her ultrasound showed right renal calculus with no hydronephrosis along with collection in peritoneal cavity and pouch of Douglas. CT showed ruptured right kidney with multiple renal and ureteric calculi as well as displaced renal calculi in perinephric space and pararenal space. Exploratory laparotomy and right nephroureterectomy were done. Nephrolithiasis with secondary infection makes the kidney fragile due to pathological changes, which may cause rupture of the renal calyces with trivial trauma or may be spontaneous. Distal obstruction by the stone and increased back pressure in the calyces may have added to the spontaneous rupture of the calyx and subsequently renal parenchyma. Management includes early exploration with nephrectomy and it is often life saving.


Assuntos
Hidronefrose , Cálculos Renais , Peritonite , Cálculos Ureterais , Cálculos Urinários , Adulto , Feminino , Humanos , Hidronefrose/diagnóstico por imagem , Hidronefrose/etiologia , Hidronefrose/cirurgia , Rim/diagnóstico por imagem , Rim/cirurgia , Peritonite/etiologia , Peritonite/cirurgia , Cálculos Ureterais/complicações , Cálculos Ureterais/diagnóstico por imagem , Cálculos Ureterais/cirurgia
3.
J Pak Med Assoc ; 71(6): 1666-1670, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34111093

RESUMO

The aim of this study was to evaluate the factors affecting intraoperative and postoperative complications in retrograde intrarenal surgery. In this retrospective cohort study, 706 retrograde intrarenal surgery procedures administered to 617 patients were reviewed. Intraoperative and postoperative complications were classified according to the modified Satava and modified Clavien classification systems. The stone-free rate was 407 (57.6%) and the success rate was 528 (74.8%). Intraoperative complications were observed in 215 (30.5%) patients. The most common intraoperative complication was mild bleeding 60(8.5%), while the only independent risk factor associated with intraoperative complications was the presence of residual stones. Postoperative complications were observed in 190 (26.9%) patients. The most common postoperative complication was fever requiring antipyretic drugs 60(8.6%), while independent risk factors associated with postoperative complications were the presence of residual stones and solitary kidney.


Assuntos
Cálculos Renais , Humanos , Rim/cirurgia , Cálculos Renais/cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
4.
Arch Esp Urol ; 74(5): 511-518, 2021 Jun.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34080571

RESUMO

OBJECTIVES: Even after a successful retrograde intrarenal surgery (RIRS), clinically insignificant residual fragments (CIRF) could not pass from the kidney. We aimed to find out the differences on the fate of CIRF according to being in the lower pole or other renal localizations. METHODS: 81 patients whose stones were fragmented completely by RIRS were subdivided into two groups as group 1 (lower pole with 41 patients) and group 2 (upper pole, midpole, and renal pelvis with 40 patients). Basal characteristics, urine culture, and renal stone screening were evaluated before and 1-year later from the surgery. RESULTS: While the number of stone-free patients was less and patients with CIRF ≤4 mm was higher in the lower pole stone group 1-year later from the surgery, there was no statistical difference between the two groups (p=0.158, p=0.136). The number of patients whose CIRFs regrew was 46.3% in group 1 and, 52.5% in group 2. A positive correlation was detected between preoperative stone size and first-year maximal residual fragment size in group 1. Linear regression analysis suggested that preoperative stone size is a predictor of the postoperative first-year residual fragment size in group 1. CONCLUSIONS: We observed that almost the half of the CIRFs in all renal localizations regrew and became symptomatic. There is an effect of the stone size on the residual fragment size while performing RIRS for particularly the lower pole renal stones. Patients with CIRF are needed to be followed-up more closely regardless of the renal localization in order to assess the requirement of retreatment.


Assuntos
Cálculos Renais , Seguimentos , Humanos , Rim/diagnóstico por imagem , Rim/cirurgia , Cálculos Renais/cirurgia , Estudos Prospectivos , Resultado do Tratamento
5.
Acta Cir Bras ; 36(5): e360503, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34161432

RESUMO

PURPOSE: As a classical xenotransplantation model, porcine kidneys have been transplanted into the lower abdomen of non-human primates. However, we have improved upon this model by using size-matched grafting in the orthotopic position. The beneficial aspects and surgical details of our method are reported herein. METHODS: Donors were two newborn pigs (weighting 5 to 6 kg) and recipients were two cynomolgus monkeys (weighting, approximately, 7 kg). After bilateral nephrectomy, kidneys were cold-transported in Euro-Collins solution. The porcine kidney was transplanted to the site of a left nephrectomy and fixed to the peritoneum. RESULTS: Kidneys transplanted to the lower abdomen by the conventional method were more susceptible to torsion of the renal vein (two cases). In contrast, early-stage blood flow insufficiency did not occur in orthotopic transplants of theleft kidney. CONCLUSIONS: Size-matched porcine-primate renal grafting using our method of transplanting tothe natural position of the kidneys contributes to stable post-transplant blood flow to the kidney.


Assuntos
Transplante de Rim , Transplantes , Animais , Sobrevivência de Enxerto , Rim/cirurgia , Macaca fascicularis , Nefrectomia , Suínos
6.
Beijing Da Xue Xue Bao Yi Xue Ban ; 53(3): 613-622, 2021 Jun 18.
Artigo em Chinês | MEDLINE | ID: mdl-34145871

RESUMO

OBJECTIVE: To construct a preoperative evaluation system for partial nephrectomy using CT three-dimensional visualization technology and to explore its practical value. METHODS: The clinical data of the patients who underwent partial nephrectomy for renal tumors in Department of Urology, Peking University First Hospital were collected retrospectively. At the same time, the homogenized standard data of patients who underwent partial nephrectomy for renal tumors were collected in 16 clinical centers in China. The CT three-dimensional visualization system was applied (IPS system, Yorktal) to evaluate tumor anatomy, blood supply, perirenal fat and other information. The parameters were summarized to build a three-dimensional nephrometry system, on the basis of which virtual surgery design and intraoperative navigation were completed. RESULTS: A three-dimensional visualization image was established based on the enhanced CT urography. The nephrometry system included the longest diameter and volume of the tumor, proportion volume of tumor invading the parenchyma, maximum depth of the tumor invading the parenchyma, contact surface area, flatness of the tumor surface, renal segment where the tumor was located, vascular variation, and perirenal fat. The average two-dimensional diameter of the tumor was (2.78±1.43) cm, the average three-dimensional maximum diameter was (3.09±1.35) cm, and the average postoperative pathological size was (3.01±1.38) cm. The maximum tumor diameter in the three-dimensional image was significantly related to the prolonged renal artery clamping time and intra-operative blood loss (r=0.502, P=0.020; r=0.403, P=0.046). The three-dimensional and pathological tumor volume were (25.7±48.4) cm3 and (33.0±36.4) cm3, respectively (P=0.229). The tumor volume was significantly related to the intraoperative blood loss (r=0.660, P < 0.001). The proportion volume of the tumor invading into renal parenchyma was significantly related to the prolongation of renal artery clamping and the occurrence of postoperative complications (r=0.410, P=0.041; r=0.587, P=0.005). The tumor contact surface area and the presence of vascular variation did not show correlation with the perioperative data and postoperative complications. While the preoperative evaluation was completed, the reconstructed three-dimensional image could be zoomed, rotated, combined display, color adjustment, transparency, and simulated cutting on the Touch Viewer system. The process generally consisted of showing or hiding the tissue, adjusting the transparency of the interested area, rotating and zooming the image to match the position of the surgical patient. Together, these functions met the requirements of preoperative virtual surgery plan and intraoperative auxiliary navigation. CONCLUSION: Three-dimensional images can provide a more intuitive anatomical structure. The CT three-dimensional visua-lization system clearly displays tumor anatomical parameters, blood supply and perirenal fat. The three-dimensional nephrometry system for renal tumors can help predict the difficulty of partial nephrectomy and perioperative complications. Importing the reconstructed three-dimensional visualization image into the specified program or robot operating system can complete virtual surgery and intraoperative navigation, helping the surgeon to better grasp the surgical process. The indexes included in the nephrometry system and the score weights of each index need to be confirmed and perfected by multi-center study with large samples.


Assuntos
Neoplasias Renais , Laparoscopia , China , Humanos , Rim/diagnóstico por imagem , Rim/cirurgia , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Nefrectomia , Estudos Retrospectivos
7.
Angiol Sosud Khir ; 27(2): 32-40, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34166342

RESUMO

The article is a review of contemporary randomized studies on radiofrequency denervation of renal arteries, followed by critical assessment of their advantages and disadvantages for possible optimization of endovascular treatment of resistant arterial hypertension.


Assuntos
Ablação por Cateter , Hipertensão , Anti-Hipertensivos , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Rim/cirurgia , Artéria Renal/diagnóstico por imagem , Artéria Renal/cirurgia , Simpatectomia , Resultado do Tratamento
8.
Int J Comput Assist Radiol Surg ; 16(7): 1141-1149, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33991305

RESUMO

PURPOSE: Robotic-assisted partial nephrectomy (RAPN) is a tissue-preserving approach to treating renal cancer, where ultrasound (US) imaging is used for intra-operative identification of tumour margins and localisation of blood vessels. With the da Vinci Surgical System (Sunnyvale, CA), the US probe is inserted through an auxiliary access port, grasped by the robotic tool and moved over the surface of the kidney. Images from US probe are displayed separately to the surgical site video within the surgical console leaving the surgeon to interpret and co-registers information which is challenging and complicates the procedural workflow. METHODS: We introduce a novel software architecture to support a hardware soft robotic rail designed to automate intra-operative US acquisition. As a preliminary step towards complete task automation, we automatically grasp the rail and position it on the tissue surface so that the surgeon is then able to manipulate manually the US probe along it. RESULTS: A preliminary clinical study, involving five surgeons, was carried out to evaluate the potential performance of the system. Results indicate that the proposed semi-autonomous approach reduced the time needed to complete a US scan compared to manual tele-operation. CONCLUSION: Procedural automation can be an important workflow enhancement functionality in future robotic surgery systems. We have shown a preliminary study on semi-autonomous US imaging, and this could support more efficient data acquisition.


Assuntos
Neoplasias Renais/cirurgia , Rim/cirurgia , Laparoscopia/métodos , Nefrectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Ultrassonografia/instrumentação , Desenho de Equipamento , Humanos , Rim/diagnóstico por imagem , Neoplasias Renais/diagnóstico
9.
Pediatr Surg Int ; 37(8): 1135-1139, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33942133

RESUMO

AIM: Laparoscopic pyeloplasty (LP) is less popular and considered less successful in infants compared to older children. There are few reports analyzing the functional results of LP in relation to age of surgery. The aim of this paper is to compare the functional results of LP in infants (group 1) with children over 1 year of age (group 2). MATERIAL AND METHODS: The data of all children undergoing LP between August 2016 and July 2019 were retrospectively analyzed for patient details and follow-up. Only children (n = 135) with at least 1-year follow-up and completed post-operative ultrasound and diuretic renogram were included. All children underwent pre-operative and post-operative ultrasound and diuretic renogram; pre-operative, operative and post-operative parameters were compared between both groups. Statistical analysis was done using software; Mann-Whitney U test, Student t test, and Fisher's exact test were applied. RESULTS: There were 71 infants (group 1) and 64 children > 1 year (group 2). Pre-operatively, all kidneys had SFU grade 3 or 4 HDN and 131/135 kidneys had a renal pelvic APD > 20 mm; all kidneys had unequivocal obstruction on DR. At surgery, the preferred drainage method was intra-operative antegrade placement of a JJ stent in 68 (96%) group 1 and 63 (98%) group 2 children. The remaining 4 cases (3 group 1, 1 group 2) had a nephrostomy with trans-anastomotic external stent placement, because the JJ stent could not be negotiated into the bladder. The demographic data and comparison of pre- and post-operative parameters between both groups are summarized in Tables 1 and 2, respectively. Group 1 had significantly more children with antenatal diagnosis of HDN (87% vs 56%, p = 0.0005). The 36 children with antenatal diagnosis in group 2 were initially followed expectantly; the indication for pyeloplasty was deterioration of SRF on serial DR, urinary infection, and pain, in 13, 14, and 9 children, respectively. The operating time was significantly longer in group 2 (p = 0.0001). There was no difference in the success of LP or complication rate in both groups. Group 2 had significantly more children with extrinsic obstruction (1.4% vs 17%, p = 0.001). All children underwent post-operative US and DR; a significant reduction in hydronephrosis (APD) on follow-up was noted in both groups (p = 0.0001). The mean pre-operative SRF in both groups was comparable (p = 0.088). The mean SRF in both groups improved significantly after LP; however, the mean post-operative SRF was significantly higher in group 1 when compared to group 2 (p = 0.0001). Furthermore, group 1 had significantly more kidneys demonstrating > 10% increase in SRF after LP (53% vs 26%, p = 0.0003). CONCLUSIONS: The safety profile and success of LP in infants was comparable to older children. Infant LP took shorter time to perform, while older children had increased incidence of extrinsic obstruction. Infant kidneys demonstrated better functional improvement than older children after LP. These findings should encourage more surgeons to utilize LP for pyeloplasty even in infants.


Assuntos
Rim/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/reabilitação , Ureter/cirurgia , Procedimentos Cirúrgicos Urológicos/reabilitação , Criança , Feminino , Humanos , Lactente , Laparoscopia/métodos , Laparoscopia/reabilitação , Masculino , Período Pós-Operatório , Gravidez , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Procedimentos Cirúrgicos Urológicos/métodos
10.
BMJ Open ; 11(3): e045518, 2021 03 08.
Artigo em Inglês | MEDLINE | ID: mdl-34006035

RESUMO

INTRODUCTION: Kidney donors have been reported to have accelerated progression of aortic stiffness and decreased glomerular filtration compared with healthy non-donors. This is a concern because increased aortic stiffness is an independent predictor of overall cardiovascular disease and all-cause mortality in the general population. To confirm if arterial stiffness increases after donation, we will systematically review all studies that evaluated indices of arterial stiffness in healthy individuals who underwent unilateral nephrectomy for kidney donation compared with age-matched healthy non-nephrectomised controls. METHODS/ANALYSIS: We will comprehensively search for studies published between 1 January 1960 and 15 March 2021 in MEDLINE, EMBASE, Cochrane Central, OVID and EBM reviews. All prospective (cohort, case-control, case series and before-and-after studies) and retrospective non-randomised studies reporting indices of arterial stiffness in nephrectomised and non-nephrectomised healthy participants will be included. Primary outcome will be the difference in the functional metrics of arterial stiffness between donors and non-donors. Secondary outcomes will be the differences in systolic/diastolic blood pressures, serum creatinine, glomerular filtration, carotid artery intima-media thickness and vascular calcification. Study screening, selection and data extraction will be performed by two independent reviewers. Risk of bias will be independently assessed with the ROBINS-I tool and confidence in evidence by the Grading of Recommendations Assessment, Development and Evaluation recommendations. Qualitative and quantitative data syntheses as well as clinical and statistical heterogeneity (Forest plots, I2 and Cochran's Q statistics) will be evaluated. If clinical and statistical heterogeneity are acceptable, inverse variance-weighted effects will be analysed by random effect models. ETHICS AND DISSEMINATION: No ethical approval is necessary. Our results will be disseminated through peer-review publication and presentations to guide stakeholders on the evaluation and follow-up care of kidney donors. PROSPERO REGISTRATION NUMBER: CRD42020185551.


Assuntos
Rigidez Vascular , Espessura Intima-Media Carotídea , Humanos , Rim/cirurgia , Estudos Prospectivos , Estudos Retrospectivos
11.
Am J Case Rep ; 22: e931124, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34016943

RESUMO

BACKGROUND En bloc pediatric kidneys (EBPK) are one potential solution to increase the number of organs available in the donor community, thus promoting transplantation of these allografts into adult recipients. However, EBPK transplantation has been traditionally considered suboptimal due to concerns for perioperative complications, mainly vascular thrombosis. We report an en bloc kidney transplantation using vascular grafts from another deceased donor to extend the EBPK aorta and vena cava and create a tension-free anastomosis with recipient external iliac vessels. CASE REPORT A pair of 2-month-old female en bloc kidneys weighting 6 kg were transplanted to a 30-year-old adult male. Prolonged cold ischemic time (CIT) was related to high refusal rate and long travel from Nevada to Miami. Prior to transplantation, the EBPK were connected to the LifePort Renal Preservation Machine® and deemed transplantable only after showing a significant improvement in perfusion parameters. Back-table reconstruction was conducted through an end-to-end anastomosis between an adult deceased donor common iliac artery and vein grafts to the inferior vena cava and aortic distal ends, respectively. The patient displayed immediate graft function (IGF) without any postoperative complications, showing a creatinine of 1.5 mg/dl at 4-month follow-up. CONCLUSIONS Use of renal preservation machine (RPM) and refined back-table reconstruction of these allografts are important tools to improve the significant discard rate and improve outcomes of EBPK.


Assuntos
Transplante de Rim , Adulto , Anastomose Cirúrgica , Criança , Feminino , Sobrevivência de Enxerto , Humanos , Lactente , Rim/cirurgia , Masculino , Complicações Pós-Operatórias , Doadores de Tecidos
12.
J Int Med Res ; 49(5): 3000605211016381, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34024190

RESUMO

Renal arteriovenous malformations (AVMs) are infrequent vascular morphological anomalies. About 20% of AVMs are congenital renal AVMs (CRAVMs). A 53-year-old female patient presented with a 5-day history of gross hematuria and right flank pain. The patient underwent the selective renal arteriography and embolization under local anesthesia. Renal computed tomography angiography (CTA) and digital subtraction angiography (DSA) results showed bleeding of the right renal arteriovenous malformation, both nidus and aneurysm, which indicated that the patient had both cirsoid and cavernosal types of CRAVM. Endovascular management was chosen to treat the patient. The patient was cured and discharged, then followed-up for 3 months. These results show that early identification using radiologic tests is important for diagnosis and treatment of CRAVM.


Assuntos
Malformações Arteriovenosas , Embolização Terapêutica , Malformações Arteriovenosas Intracranianas , Nefropatias , Angiografia Digital , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/cirurgia , Feminino , Humanos , Rim/diagnóstico por imagem , Rim/cirurgia , Pessoa de Meia-Idade
13.
Medicine (Baltimore) ; 100(21): e25965, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34032707

RESUMO

RATIONALE: Ureteral obstruction of the graft kidney is a common complication of kidney transplantation. However, ureteral obstruction caused by inguinal hernia has rarely been reported. We present a rare case of ureteral obstruction with allograft dysfunction caused by an inguinal hernia. PATIENT CONCERNS: A 76-year-old man, who was a renal transplant recipient, presented with bilateral pitting oedema, reduced urine output, and right inguinal hernia. DIAGNOSES: Abdominal computed tomography revealed severe hydroureteronephrosis of the kidney allograft. A right inguinal hernia with ureteral incarceration was observed. INTERVENTIONS: The patient underwent graft percutaneous nephrostomy, followed by antegrade insertion of a double-J tube (DJ). Gradual improvement was observed in his renal function. Right inguinal herniorrhaphy was performed 5 days later. OUTCOMES: The renal function returned to normal after percutaneous nephrostomy and insertion of the DJ. A right inguinal direct-type hernia with ureter adhesion to the hernial sac was observed during the surgery. The posterior wall defect was repaired by the McVay technique. The DJ was removed after 1 month. The patient's renal function remained stable at 6-month follow-up. LESSONS: The orientation of the graft kidney has a significant influence on the location of the ureter. Upward orientation of the hilum will result in superficial location of the ureter, rendering it close to the hernial sac and susceptible to incarceration. The transplant surgeon should be aware of such a presentation of graft dysfunction with inguinal hernia to prevent a delay in the diagnosis and graft loss.


Assuntos
Hérnia Inguinal/diagnóstico , Hidronefrose/etiologia , Transplante de Rim/efeitos adversos , Obstrução Ureteral/etiologia , Idoso , Aloenxertos/diagnóstico por imagem , Aloenxertos/patologia , Aloenxertos/cirurgia , Hérnia Inguinal/complicações , Hérnia Inguinal/cirurgia , Herniorrafia , Humanos , Hidronefrose/diagnóstico , Hidronefrose/patologia , Hidronefrose/cirurgia , Rim/diagnóstico por imagem , Rim/patologia , Rim/cirurgia , Masculino , Nefrostomia Percutânea/instrumentação , Nefrostomia Percutânea/métodos , Stents , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ureter/diagnóstico por imagem , Ureter/patologia , Obstrução Ureteral/diagnóstico , Obstrução Ureteral/cirurgia , Urografia
14.
BMJ Case Rep ; 14(5)2021 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-34011651

RESUMO

A 9-month-old girl presented with progressive abdominal distension. Imaging revealed a huge cystic mass in the left retroperitoneum with solid components. The right kidney was absent and hydrometrocolpos was found. Tumour drainage and complete surgical excision were performed. A bulge in the right side of the uterus, suggestive of a uterine anomaly, was seen on laparoscopic observation. Pathology was consistent with teratoma with a small portion of immature neural tissue. The patient was discharged in good condition and was advised regular follow-up.


Assuntos
Nefropatias , Teratoma , Anormalidades Urogenitais , Feminino , Humanos , Lactente , Rim/diagnóstico por imagem , Rim/cirurgia , Teratoma/complicações , Teratoma/diagnóstico por imagem , Teratoma/cirurgia , Útero , Vagina
15.
BMJ Case Rep ; 14(5)2021 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-34011660

RESUMO

Herlyn-Werner-Wunderlich syndrome, a rare Mullerian duct anomaly, includes a triad of uterine didelphys, obstructed haemivagina and ipsilateral renal agenesis. A 58-year-old woman with Herlyn-Werner-Wunderlich syndrome, reported of recurrent genital bleeding for 9 years, was finally diagnosed with endometrial cancer. She had a history of vaginal septum resection and nephrectomy of atrophic right kidney. MRI demonstrated uterine didelphys, a tumour filling the left uterus and a cyst on the right lateral side of the uterus. Robot-assisted hysterectomy, including bilateral salpingo-oophorectomy and pelvic lymphadenectomy, was performed. As the cyst communicated with the right cervix, but not with the urinary tract, a Gartner duct cyst was diagnosed. Uncertain diagnosis and delay of treatment in endometrial cancer may occur in patients with Herlyn-Werner-Wunderlich syndrome. We should preoperatively fully evaluate the anatomy of the uterus and surrounding tissues and plan surgical procedures, especially in patients with urogenital malformations.


Assuntos
Neoplasias do Endométrio , Laparoscopia , Robótica , Anormalidades Urogenitais , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Histerectomia , Rim/diagnóstico por imagem , Rim/cirurgia , Pessoa de Meia-Idade , Anormalidades Urogenitais/complicações , Anormalidades Urogenitais/cirurgia , Útero/diagnóstico por imagem , Útero/cirurgia , Vagina/cirurgia
16.
Curr Urol Rep ; 22(7): 35, 2021 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-34031768

RESUMO

PURPOSE OF REVIEW: We aim to summarize the current state of art about 3D applications in urology focusing on kidney surgeries. In addition we aim to provide a snapshot about future perspective of intraoperative applications of augmented reality (AR). RECENT FINDINGS: A variety of applications in different fields have been proposed. Many applications concern current realities and 3D reconstruction, while some others are about future perspective. The majority of recent studies have focused their attention on preoperative surgical planning, patient education, surgical training, and AR. The disposability of 3D models in healthcare scenarios might improve surgical outcomes, learning curves of novice surgeons and residents, as well as patients' understanding and compliance, allowing a more shared surgical decision-making.


Assuntos
Realidade Aumentada , Imageamento Tridimensional , Rim/diagnóstico por imagem , Rim/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Humanos , Educação de Pacientes como Assunto
17.
BMJ Case Rep ; 14(5)2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-33990296

RESUMO

We report the case of a 50-year-old Tibetan man who presented to an outpatient urology clinic after abdominal ultrasound for poorly defined abdominal pain demonstrated horseshoe kidney (HK) with a right moiety ~3.7 cm mass further characterised using contrast-enhanced CT scan (CECT). This dedicated imaging confirmed HK with a heterogeneously enhancing right upper pole 3.1 cm×3.7 cm×2.7 cm mass. Due to suspicion for aberrant vasculature on CECT, renovascular angiography was performed, which revealed recruitment of a right paravertebral vessel alongside two right renal moiety arteries and multiple right renal moiety veins. Based on vascular complexity and the surgical exposure required for arterial clamping, open transperitoneal right partial nephrectomy was preferred to minimally invasive techniques. Postoperative course was complicated by ileus, which resolved with standard management. Pathologic analysis revealed complete resection of a 5.0 cm Fuhrman grade II clear cell renal cell carcinoma.


Assuntos
Carcinoma de Células Renais , Rim Fundido , Neoplasias Renais , Laparoscopia , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/cirurgia , Rim Fundido/complicações , Rim Fundido/diagnóstico por imagem , Rim Fundido/cirurgia , Humanos , Rim/diagnóstico por imagem , Rim/cirurgia , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrectomia
18.
Int J Hyperthermia ; 38(1): 593-603, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33853496

RESUMO

PURPOSE: To examine the ablation zone, muscle contractions, and temperature increases in both rabbit liver and kidney models in vivo for a custom-made high-frequency irreversible electroporation (H-FIRE) generator. MATERIALS AND METHODS: A total of 18 New Zealand white rabbits were used to investigate five H-FIRE protocols (n = 3 for each protocol) and an IRE protocol (n = 3) for the performance of the designed H-FIRE device in both liver and kidney tissues. The ablation zone was determined by using histological analysis 72 h after treatment. The extent of muscle contractions and temperature change during the application of pulse energy were measured by a commercial accelerometer attached to animals and fiber optic temperature probe inserted into organs with IRE electrodes, respectively. RESULTS: All H-FIRE protocols were able to generate visible ablation zones without muscle contractions, for both liver and kidney tissues. The area of ablation zone generated in H-FIRE pulse protocols (e.g., 0.3-1 µs, 2000 V, and 90-195 bursts) appears similar to that of IRE protocol (100 µs, 1000 V, and 90 pulses) in both liver and kidney tissues. No significant temperature increase was noticed except for the protocol with the highest pulse energy (e.g., 1 µs, 2000 V, and 180 bursts). CONCLUSION: Our work serves to complement the current H-FIRE pulse waveforms, which can be optimized to significantly improve the quality of ablation zone in terms of precision for liver and kidney tumors in clinical setting.


Assuntos
Eletroporação , Fígado , Animais , Eletrodos , Rim/cirurgia , Fígado/cirurgia , Coelhos , Temperatura
19.
Eur J Obstet Gynecol Reprod Biol ; 261: 12-16, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33873082

RESUMO

OBJECTIVE: To describe and summarize the early diagnosis, treatment and outcomes of obstructed hemivagina and ipsilateral renal anomaly (OHVIRA). METHODS: Data from patients with OHVIRA treated at the study centre over the last decade were analysed retrospectively, including demographic characteristics, symptoms, diagnosis, treatment and outcomes. Relevant published literature was also reviewed in this study. RESULTS: In total, 11 cases were diagnosed with OHVIRA over the study period, ranging in age from 3 to 14 years (median 11 years). Four cases were asymptomatic, four had abdominal pain and three had urinary symptoms. All 11 cases underwent vaginoplasty. Ureteral bladder re-implantation (n = 1), dysplastic nephrectomy (n = 1), separation of labia minora adhesions (n = 1), perineoplasty (n = 1) and urethroplasty (n = 1) were performed. Cases were followed up for 2 months to 8 years (median 5 years) with good follow-up outcomes. CONCLUSIONS: Based on the cases in this study and the relevant literature, ultrasound appears to be an effective method for the diagnosis of OHVIRA. Experienced ultrasonographers are able to achieve a high corrected diagnosis rate. The differential diagnosis of OHVIRA should be considered by paediatric surgeons, urologists, emergency physicians and gynaecologists when they identify patients with didelphys uterus or renal agenesis. Early surgery can reduce the risk of potential genital tract infection and gynaecological complications.


Assuntos
Anormalidades Múltiplas , Vagina , Adolescente , Criança , Pré-Escolar , Diagnóstico Precoce , Feminino , Humanos , Rim/diagnóstico por imagem , Rim/cirurgia , Estudos Retrospectivos , Síndrome , Resultado do Tratamento , Útero/diagnóstico por imagem , Útero/cirurgia , Vagina/cirurgia
20.
BMJ Case Rep ; 14(4)2021 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-33832930

RESUMO

We report a rare case of non-fused renal ectopia with pelviureteric junction obstruction and multiple pelvic and renal calculi thereby discussing vascular anatomy of the non-fused ectopic kidney along with robot assisted surgical management of this rare clinical entity which amounts for good preoperative workup for best surgical and clinical outcome.


Assuntos
Cálculos Renais , Rim Displásico Multicístico , Procedimentos Cirúrgicos Robóticos , Humanos , Hidronefrose/congênito , Rim/diagnóstico por imagem , Rim/cirurgia , Cálculos Renais/complicações , Cálculos Renais/diagnóstico por imagem , Cálculos Renais/cirurgia , Obstrução Ureteral
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