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1.
Magn Reson Med ; 89(1): 343-355, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36089805

RESUMO

PURPOSE: To assess the potential of DCE MR CEST urography for assessing renal function in mice with unilateral ureter obstruction (UUO) by simultaneous pH and renal uptake/clearance measurements following injection of iopamidol. METHODS: The right ureter of nine mice was obstructed via suture ligation. The animals were imaged at day 1, 2, and 3 post-obstruction on an 11.7T MRI scanner. Ninety-six sets of saturated CEST images at 4.3 and 5.5 ppm were collected. Renal pH values were obtained by calculating the signal ratio for these two frequencies and using a pH calibration curve. Renal time activity curves were measured as a percentage change in the post-injection CEST signal at 4.3 ppm relative to the average pre-injection signal. RESULTS: For the healthy mice, the time activity curves of both kidneys were nearly identical and displayed rapid excretion of contrast. For the UUO mice, the dynamic CEST curves for the obstructed kidneys displayed prolonged time to peak (TTP) values and delayed contrast excretion compared with the contralateral (CL) kidneys. Renal pH maps of the healthy animals showed similar acidic values for both kidneys (pH 6.65 ± 0.04 vs 6.67 ± 0.02), whereas in the obstructed kidneys there was a significant increase in pH values compared with the CL kidneys (pH 6.67 ± 0.08 vs 6.79 ± 0.11 in CL and UUO kidneys, respectively). CONCLUSION: Our findings indicate that DCE-MR-CEST urography can detect changes in renal uptake/excretion and pH homeostasis and distinguish between obstructed and unobstructed kidney as early as 1 day after UUO.


Assuntos
Ureter , Obstrução Ureteral , Animais , Camundongos , Obstrução Ureteral/diagnóstico por imagem , Rim/diagnóstico por imagem , Rim/fisiologia , Imageamento por Ressonância Magnética/métodos , Concentração de Íons de Hidrogênio , Urografia
2.
Urol Clin North Am ; 50(1): 19-29, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36424080

RESUMO

A variety of biomarkers have been studied in the setting of conditions and scenarios related to kidney stone disease. These biomarkers are commonly serum markers, novel urinary proteins, and inflammatory whose use is aimed at providing clinicians with additional information of underlying processes and improving detection and stratification of patients with kidney stones, acute ureteral obstruction, stone passage, and related infectious complications. Their adoption has been limited, and further evidence is required to determine their role in the care of patients with stone disease.


Assuntos
Cálculos Renais , Ureter , Cálculos Ureterais , Urolitíase , Humanos , Urolitíase/diagnóstico , Cálculos Renais/diagnóstico , Biomarcadores
3.
Hinyokika Kiyo ; 68(11): 345-348, 2022 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-36458397

RESUMO

A 73-year-old woman was referred to our hospital for treatment of a 12 mm stone in the right ureteropelvic junction and pyonephrosis. A double-J ureteral stent was indwelled for right hydronephrosis and emphysematous pyelonephritis. After antibiotic treatment, flexible transurethral lithotripsy (f-TUL) was performed and all the stones were disintegrated and extracted without any complications. On the day after f-TUL, severe back pain occurred, and computed tomography revealed subcapsular hematoma and renal pseudoaneurysm. Angiography and selective embolization of the bleeding artery were performed to control the bleeding.


Assuntos
Falso Aneurisma , Hidronefrose , Litotripsia , Ureter , Feminino , Humanos , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Litotripsia/efeitos adversos , Rim
4.
Hinyokika Kiyo ; 68(11): 349-353, 2022 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-36458398

RESUMO

Emphysematous pyelonephritis (EPN) is a severe necrotic urinary tract infection accompanied by retention of gas in the kidney and areas around it. Formerly, emergency nephrectomy was the primary treatment, but the trend is shifting to treatment with maximum conservation of the kidney. In this report, two cases of EPN successfully treated by transurethral drainage are presented. The first case was in a 63-year-old woman with a history of poorly controlled diabetes. She arrived at the hospital by ambulance with primary symptoms of vomiting and trembling of the hands, and computed tomography (CT) revealed gas in the right renal calix. The second case was in a 61-year-old woman who arrived by ambulance with difficulty of body movement as the primary symptom, and CT revealed a calculus in the right ureter accompanied by right hydronephrosis and retention of gas in the right renal pelvis and right upper ureter. Both patients were diagnosed with EPN and treated by transurethral drainage rather than percutaneous drainage or nephrectomy because of their poor general condition. The treatment was successful. Along with percutaneous drainage, transurethral drainage is considered to be an option of surgical treatment for EPN.


Assuntos
Pielonefrite , Ureter , Feminino , Humanos , Pessoa de Meia-Idade , Pielonefrite/complicações , Pielonefrite/terapia , Rim , Nefrectomia , Cateterismo
5.
Urolithiasis ; 51(1): 6, 2022 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-36459265

RESUMO

To compare the role of primary and deferred ureteroscopy (URS) in the management of obstructive anuria secondary to ureteric urolithiasis in pediatric patients. This prospective randomized study included 120 children aged ≤ 12 years who presented with obstructive anuria secondary to ureteric urolithiasis between March 2019 and January 2021. The children were subdivided into group A, which included children who had undergone primary URS without pre-stenting, and group B, which included children who had undergone URS after ureteric stenting. All children were clinically compensated and sepsis-free. Patients with underlying urological structural abnormalities were excluded. The operative time, improvement of renal functions, stone-free rate, and complications were compared between the two groups. At the 1-month follow-up, urine analysis; kidney, ureter, and bladder radiography; and ultrasonography were performed. The patient characteristics of both groups did not show any significant difference. Primary URS had failed in ten children (16.6%) in group A. Moreover, failure of stenting was noted in six patients (11%) in group B. The mean operative time for group B was significantly lower than that for group A (p ≤ 0.001). The stone-free rate was significantly higher in group B (p ≤ 0.001). The rate of overall complications was higher in group A. Deferred URS is preferable over primary URS in the management of obstructive anuria secondary to ureteric urolithiasis". In children because of the lower need for ureteric dilatation, higher stone- free rate, shorter procedure time, and lower complication rate.


Assuntos
Anuria , Ureter , Urolitíase , Humanos , Criança , Ureteroscopia/efeitos adversos , Ureter/cirurgia , Estudos Prospectivos , Urolitíase/complicações , Urolitíase/cirurgia
6.
Medicine (Baltimore) ; 101(44): e31580, 2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36343058

RESUMO

RATIONALE: Ureteral triplication (UT) is a very rare disorder, with a challenging diagnosis and varied therapeutic methods. In the past, the treatment usually involved heminephrureterectomy of the stunted moiety. Here, we reported a case of complete UT that was treated by laparoscopic triple-ureteral ureteroureterostomy (UU). PATIENT CONCERNS: A 2-year-old girl presented with frequent urine incontinence. Intravenous pyelography and voiding cystourethrography revealed a 3-segment left kidney with pelvi-ureteric dilation of the upper and middle moieties and grade IV to V vesicoureteral reflux. Laparoscopic triple-UU was successfully performed in the child, after which vesicoureteral reflux and urinary incontinence disappeared completely, hydronephrosis was improved, and hemirenal resection was avoided. DIAGNOSIS: Based on the imageological examination results, the final diagnosis of the 2-year-old girl was as follows: left 3 renal pelvis with complete ureteral duplication, combined with upper and middle hydronephrosis, and upper and middle vesicoureteral reflux grade IV to V. INTERVENTION: Laparoscopic triple-ureteral ureteroureterostomy was performed under general anesthesia. OUTCOMES: The patient recovered smoothly without complications after surgery. At 6 months follow-up, ultrasonography of the urinary system showed that hydronephrosis of the dilated kidney segment was attenuated. LESSONS: Laparoscopic triple-ureteral UU was successful in our patient. For children with duplex kidney and multiple ureteral duplications, minimally invasive urinary tract reconstruction can be a suitable intervention.


Assuntos
Gastroenteropatias , Hidronefrose , Laparoscopia , Ureter , Obstrução Ureteral , Incontinência Urinária , Refluxo Vesicoureteral , Criança , Feminino , Humanos , Pré-Escolar , Refluxo Vesicoureteral/cirurgia , Refluxo Vesicoureteral/etiologia , Estudos Retrospectivos , Ureter/cirurgia , Obstrução Ureteral/etiologia , Pelve Renal , Hidronefrose/cirurgia , Laparoscopia/métodos , Incontinência Urinária/cirurgia , Gastroenteropatias/complicações
7.
J Egypt Natl Canc Inst ; 34(1): 49, 2022 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-36437423

RESUMO

BACKGROUND: Ipsilateral synchronous renal and ureteric tumor is uncommon. Nephron sparing surgery is the standard for small renal masses. Ureteric tumors can be selectively managed with nephron sparing surgery, especially in renal dysfunction. This case report details the management of double malignancy by nephron sparing surgery with robot-assisted approach. CASE REPORT: A 63-year-old gentleman with diabetes presented with history of intermittent gross hematuria for 2 weeks. He was clinically normal. On evaluation, he had grade 4 renal dysfunction (Se. creatinine 4.5 mg%) with mild proteinuria. Magnetic resonance imaging revealed right renal upper polar Bosniak III lesion and right hydroureteronephrosis due to 2 cm ureteric tumor near the vessel crossing. Renogram showed overall GFR of 22 ml/min with 31% (6 ml/min) contribution from the right side. He underwent robot-assisted right partial nephrectomy with distal ureterectomy and Boari flap ureteric reimplantation. Histopathology revealed margins free T2 clear cell carcinoma (kidney) and high-grade T3 transitional cell carcinoma (ureter). His nadir creatinine at 1 year follow-up was 3.3 mg% and no recurrence on MRI, cystoscopy, and ureteroscopy at 1 year. CONCLUSION: Minimally invasive nephron sparing surgery is feasible and reasonable option with satisfactory oncological control even in ipsilateral synchronous renal and ureteric tumors in selected patients with renal dysfunction.


Assuntos
Neoplasias Renais , Robótica , Ureter , Masculino , Humanos , Pessoa de Meia-Idade , Ureter/cirurgia , Ureter/patologia , Creatinina , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Neoplasias Renais/patologia , Nefrectomia/métodos , Rim/diagnóstico por imagem , Rim/cirurgia , Rim/patologia
8.
Am J Case Rep ; 23: e937961, 2022 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-36403085

RESUMO

BACKGROUND Encrustation of the ureteral stent is a common complication that occurs after a prolonged indwelling duration. Other identified risk factors in the literature include urinary sepsis, chemotherapy, chronic renal failure, metabolic or congenital abnormalities, and nephrolithiasis. This report presents the case of a 39-year-old man with nephrolithiasis and fragmentation of a calcified right ureteric stent that required ureteroscopy and laser lithotripsy. CASE REPORT A 39-year-old man was initially admitted for ureteroscopy and laser lithotripsy after the diagnosis of bilateral urolithiasis. Ureteral stents were placed. One postoperative month later, the patient returned for follow-up and stent withdrawal. Follow-up computed tomography revealed a normal left kidney, intact bilateral ureteral stents, and residual right renal stones. However, an attempt to completely withdraw the stent failed and the patient had to undergo a secondary right ureteroscopy with laser lithotripsy. The fragmented proximal section of a calcified right ureteral stent with occluded lumen was found intraoperatively and sent for product analyses. After successful reintervention, the patient had a new right ureteral stent placed, which was successfully withdrawn during his next follow-up. CONCLUSIONS Ureteral stent encrustation may occur earlier than anticipated, possibly due to underlying patient risk factors. Complications, such as fragmentation of the ureteral stent, may occur during withdrawal. Physicians should be aware of any predictors for early ureteral stent encrustation to prevent unnecessary reintervention.


Assuntos
Cálculos Renais , Litotripsia a Laser , Ureter , Masculino , Humanos , Adulto , Ureteroscopia/métodos , Stents/efeitos adversos , Cálculos Renais/cirurgia
9.
J Int Med Res ; 50(11): 3000605221123671, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36412222

RESUMO

Ganglioneuroma is a rare tumor originating from neural crest tissue of the sympathetic nervous system. We report on an approximately 55-year-old woman who was admitted to hospital with abdominal pain. Surgery revealed a tumor in her right ureter, which was pathologically confirmed as a ganglioneuroma. The patient underwent transabdominal total hysterectomy, bilateral adnexal resection, release of pelvic and intestinal adhesions, right ureteroscopy, right ureter retrograde intubation, right ureteral lesion excision, and ureteral anastomosis. A literature review indicated that most ganglioneuromas are benign tumors. Clinicians may consider total or subtotal tumor resection, depending on the tumor location and patient's condition. The patient's clinical condition may improve after surgery combined with periodic long-term follow-up.


Assuntos
Ganglioneuroma , Ureter , Humanos , Feminino , Pessoa de Meia-Idade , Ganglioneuroma/diagnóstico por imagem , Ganglioneuroma/cirurgia , Ureter/diagnóstico por imagem , Ureter/cirurgia , Ureter/patologia
10.
Acta Vet Scand ; 64(1): 29, 2022 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-36397093

RESUMO

BACKGROUND: An ectopic ureter is a congenital malformation characterized by caudal displacement of one or both ureteral orifices and is the most common cause of urinary incontinence in young dogs. Complete resolution of incontinence after surgery has been reported in 25-82% of dogs. The aim of this study was to identify preoperative prognostic factors for continence after surgical treatment of dogs with an ectopic ureter. Dogs were included if surgical correction of an ectopic ureter was performed and at least 1 year follow-up was available. RESULTS: Fifty-one dogs met the inclusion criteria. The ectopic ureters were either intramural (91%) or extramural (9%). The ectopic ureters were bilateral in 49% of cases. Overall median follow-up time after surgery was 6.5 years (range 1-13 years). Surgical correction alone resolved urinary incontinence in 47% of cases. Low grade pre-operative incontinence, male sex and pre-operative presence of ureteral or renal pyelum dilation were significantly associated with urinary continence after surgery. CONCLUSIONS: Dogs with severe preoperative incontinence were less likely to become completely continent after surgery, whereas male sex and preoperative dilation of the ureter or renal pyelum were positive prognostic indicators for continence. These results may assist in predicting outcome after surgical correction of ectopic ureters and suggest assessment of pre-operative urethral pressure profiling in future studies.


Assuntos
Doenças do Cão , Ureter , Incontinência Urinária , Cães , Masculino , Animais , Ureter/cirurgia , Ureter/anormalidades , Seguimentos , Prognóstico , Doenças do Cão/cirurgia , Doenças do Cão/etiologia , Incontinência Urinária/etiologia , Incontinência Urinária/cirurgia , Incontinência Urinária/veterinária
11.
Acute Med ; 21(3): 146, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36427213

RESUMO

Misplacement of a urinary catheter in the ureter is a rare phenomenon. The described cases occurred in patients with neurogenic bladder. We describe an unusual case of 58 years old female where the Foley catheter was unintentionally placed in the left ureter. The patient developed sepsis due to complete obstruction of the left ureter treated with antibiotic therapy after repositioning the catheter.


Assuntos
Sepse , Ureter , Humanos , Feminino , Pessoa de Meia-Idade , Cateteres Urinários/efeitos adversos , Cateterismo Urinário/efeitos adversos , Sepse/diagnóstico , Sepse/etiologia , Antibacterianos/uso terapêutico
12.
BMC Surg ; 22(1): 380, 2022 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-36335342

RESUMO

BACKGROUND: Seventy percent of ureteric injuries result from iatrogenic causes with about 75% of these diagnosed in the postoperative period. It may have fatal complications such as sepsis and or renal functional damage increasing morbidity and treatment cost. OBJECTIVE: The study aimed to identify the risk factors for iatrogenic ureteric injuries from open surgical procedures and the intervention outcome in a resource-poor setting. PATIENTS AND METHODS: This was a multi-centre study. The clinical records of patients with iatrogenic ureteric injuries seen between 2015-2021 who were managed at the urology units of the Margaret Marquart Catholic Hospital, and the Ho Teaching Hospital, in the Volta region of Ghana, were retrieved. The data extracted included patients' demographic factors, the clinical presentation, the primary surgery details, the time from surgery to presentation, the intervention offered, and the outcomes. The data were analysed using the Statistical Package for Social Scientists (SPSS) version 24.0. RESULTS: Twelve patients aged between 24-54 years with a total of 19 ureteric injuries were managed. The injuries resulted from a hysterectomy in 10 cases (83.3%), and one each from emergency caesarean section and inguinal hernia repair with traction and transection injuries respectively (16.7%). Seven out of 12 cases were diagnosed 48 h after surgery. Bilateral injuries occurred in 7 cases (14/19 injuries). Intraoperative recognition was common in unilateral injuries and surgeries performed by specialist surgeons. Ureteroneocystostomy (14/19), uretero-ureterostomy (1/19), and open suture release were the management procedures performed as in the intervention. CONCLUSION: Open hysterectomy (83.7%) was the most common procedure leading to iatrogenic ureteric injuries in this study. Intra-operative recognition occurred when trained specialist surgeons performed the surgery. Late presentation with more severe morbidity was found amongst non-specialist surgeons. Thus, improvement in training to allow intra-operative diagnosis should be encouraged in general practitioners to reduce morbidity and improve outcomes.


Assuntos
Traumatismos Abdominais , Ureter , Humanos , Gravidez , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Estudos Retrospectivos , Cesárea , Ureter/cirurgia , Histerectomia , Traumatismos Abdominais/cirurgia , Doença Iatrogênica , Estudos Multicêntricos como Assunto
13.
Transpl Int ; 35: 10754, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36406779

RESUMO

Urinary tract infection (UTI) occurs in 25% of recipients of living-donor kidney transplantation (LDKT). Female sex, age, and anatomical abnormalities have been reported as recipient-related risk factors for UTI after LDKT; few studies have reported donor-related factors. We retrospectively examined UTI occurrence within 5 years of transplantation in recipients (n = 211) who underwent LDKT at our hospital between April 2011 and April 2021. All nephrectomies were performed using a retroperitoneal pure laparoscopic approach. The ureter was dissected at the lower level of the common iliac artery and trimmed to the shortest length, enough to reach the bladder using extra vesicular ureterocystoneostomy with a 3 cm submucosal tunnel. Twenty-nine recipients (13.7%) developed UTI within 5 years, and the median time to onset was 40.0 days. After adjusting for the well-known factors, including recipient sex, graft ureter length was an independent factor for UTI occurrence (HR 1.25, 95% CI 1.02∼1.53, p = 0.028) in the multivariate Cox regression analysis. The long ureter is usually trimmed, and the widest part is used for anastomosis, which may increase the possibility of reflux from the bladder to the ureter in the standard technique. The ureter length may be associated with the incidence of UTI after LDKT.


Assuntos
Transplante de Rim , Ureter , Infecções Urinárias , Humanos , Feminino , Ureter/cirurgia , Doadores Vivos , Transplante de Rim/efeitos adversos , Transplante de Rim/métodos , Estudos Retrospectivos , Infecções Urinárias/etiologia , Infecções Urinárias/epidemiologia
14.
PLoS One ; 17(11): e0274868, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36445893

RESUMO

OBJECTIVE: To describe the technique of laparoscopic radical prostatectomy in canine cadavers. STUDY DESIGN: Cadaveric study. ANIMALS: 8 canine cadavers. METHODS: Specimens were randomly divided into a 2D or 3D group. The vesicourethral anastomosis (VUA) was performed with 5 mm laparoscopic needle holders. A unidirectional barbed suture was used to complete the VUA with two simple continuous suture patterns. The number of stitches placed, the patency of the anastomosis, and the distance between the VUA and the ureters were recorded. RESULTS: Four dogs were entered into each group. The prostatectomy was completed in each dog following the same technique. VUA were completed with nine stitches (range: 8-10 stitches) for the 2D group and ten stitches (range: 9-11 stitches) for the 3D group (p<0.176). All the stitches were placed full thickness. The VUA was patent in each case. The left ureter was 1.05 cm (range: 0.5 to 1.1cm) from the VUA in the 2D group and 1.8 cm (range: 1.3-1.8 cm) for the 3D group (p< 0.025). The right ureter was 1.5 cm (range: 1 to 2 cm) from the VUA in the 2D group and 1.75 cm (range: 1.3-2 cm) for the 3D group (p< 0.55). CONCLUSION: Laparoscopic radical prostatectomy can be performed with a 2D or a 3D camera in canine cadavers. The 3D camera results in more accurate placement of the sutures since they were placed further away from the left ureter. CLINICAL SIGNIFICANCE: Radical prostatectomy with laparoscopy should be considered for dogs.


Assuntos
Laparoscopia , Ureter , Masculino , Cães , Animais , Prostatectomia , Suturas , Cadáver
15.
BMC Womens Health ; 22(1): 458, 2022 11 18.
Artigo em Inglês | MEDLINE | ID: mdl-36401287

RESUMO

BACKGROUND: Cervical cancer is often associated with malignant ureteral obstruction and consequent hydronephrosis. Hydronephrosis caused in this way can be resolved by placing ureteral stents or performing a percutaneous nephrostomy. Complications that may occur during the retrograde ureteral stent placement are usually mild, but serious complications such as stent migration into the cardiovascular system are also possible. Here we present an unusual case where a ureteral stent entered the abdominal aorta during the cystoscopic ureteral stenting, which was resolved by a cystoscopic stent removal kept in check by endovascular catheters. CASE PRESENTATIONS: The 48-year-old female patient was treated in the regional secondary healthcare facility due to bilateral hydronephrosis caused by cervical cancer. The patient had bilateral percutaneous nephrostomies and ureteral stents. Due to the calcification of the left ureteral stent, an urethrorenoscopy with lithotripsy of the calculus in the left ureter was performed in the regional secondary healthcare facility, and the ureteral stent was cystoscopically replaced. The control radiography of the urinary tract showed a misplacement of the left ureteral stent, and a computed tomography showed that the stent was located in the abdominal aorta. The patient was referred to the University Clinical Center of Serbia, where a ureteral stent was cystoscopically removed from the abdominal aorta under the control of endovascular catheters. The patient was in good general condition at all times, with no signs of bleeding, and she was discharged from the hospital on the fourth postoperative day. CONCLUSIONS: The migration of a ureteral stent into the abdominal aorta and the cardiovascular system in general is a rare type of ureteral stenting complication whose treatment requires a multidisciplinary approach. In order to prevent such complications, it is necessary to strictly adhere to the indications for the ureteral stent placement in the case of malignant ureteral obstruction. Also, this procedure should be performed according to the current guidelines and controlled by an X-ray or ultrasound.


Assuntos
Hidronefrose , Ureter , Obstrução Ureteral , Neoplasias do Colo do Útero , Feminino , Humanos , Pessoa de Meia-Idade , Obstrução Ureteral/complicações , Obstrução Ureteral/cirurgia , Aorta Abdominal/diagnóstico por imagem , Neoplasias do Colo do Útero/complicações , Hidronefrose/complicações , Hidronefrose/cirurgia , Stents/efeitos adversos
16.
Medicine (Baltimore) ; 101(45): e31194, 2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36397363

RESUMO

BACKGROUND: Percutaneous nephrostomy (PCN) and Double J stenting (DJS) are the 2 main treatment options of ureteral obstruction. We evaluate which of these 2 methods is superior concerning the course of procedure, postoperative complication and quality of life. METHODS: A detailed review of electronic databases including PubMed, Embase, Cochrane Library, China Biology Medicine disc, China National Knowledge Infrastructure up to February 21st, 2021 was searched. Continuous data were evaluated using mean difference (MD) with 95% confidence interval (CI), while nominal data were analyzed by risk ratio (RR) with 95% CI. Meanwhile, we performed the subgroup analysis based on study design, disease type, sample size, sepsis, DJ diameter, nephrostomy diameter, anesthesia type and guidance under X-ray or ultrasound. RESULTS: There were 18 previous studies included in current study. As a result, we found that there were significant differences in fluoroscopy time (MD = 0.31; 95% CI, 0.14-0.48, P < .001) and hospital stay (MD = 1.23; 95% CI, 0.60-1.85, P < .001). However, no statistic difference was detected in operative time (MD = 5.40; 95% CI, -1.78 to 12.58, P = .140) between the paired groups. Although DJS showed a higher rate of postoperative complications (25.19% vs 17.61%), there was no significant difference in the incidence of complications following DJS and PCN (RR = 0.92; 95% CI, 0.60-1.43; P = .720). Based on the EuroQol analysis, the 2 main treatment options had different impacts on quality of life. The pooled results showed that PCN patients reported more difficulties in self-care compared to DJS patients (RR = 3.07; 95% CI, 1.32-7.14; P = .009). CONCLUSIONS: DJS is a safe and better method of temporary urinary diversion than PCN for management of ureteral obstruction with shorter fluoroscopy time and hospital stay. As for quality of life, patients receiving PCN had a distinct difficulty in self-care compared to those receiving DJS. However, these 2 treatment options often depends on the individual situation.


Assuntos
Nefrostomia Percutânea , Ureter , Obstrução Ureteral , Humanos , Nefrostomia Percutânea/efeitos adversos , Nefrostomia Percutânea/métodos , Complicações Pós-Operatórias/epidemiologia , Carbonitrila de Pregnenolona , Qualidade de Vida , Ureter/cirurgia , Obstrução Ureteral/cirurgia , Obstrução Ureteral/etiologia
17.
Int J Clin Pract ; 2022: 3343244, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36415697

RESUMO

Purpose: Ureteral access sheaths (UAS) are widely used in retrograde intrarenal surgery (RIRS), and this study aimed to develop a model for predicting the success of UAS placement based on computed tomography. Methods: We analyzed the clinical data of 847 patients who received ureteroscopy. Data on patient and stone characteristics and several computed tomography (CT)-based measurements were collected. A nomogram predicting the success of UAS placement was developed and validated using R software. Results: Two hundred and forty-seven patients were identified. Twenty-five patients (10.1%) failed to pass through the UAS. A model with three factors including the short diameter of ureteral calculi, the short diameter of hydronephrosis, and the diameter of the narrowest part of the renal parenchyma was to be strongly practical and had a high area under the curve on internal validation (80.3%). Using a threshold cutoff of 92%, the sensitivity and specificity for predicting UAS placement were 0.35 and 0.92, respectively. Conclusion: Our study provides a nomogram for predicting the success of UAS placement, and this model could help discriminate patients who are likely to suffer from failed UAS insertion; preoperative ureteral stenting is recommended according to the prediction.


Assuntos
Cálculos Renais , Ureter , Cálculos Ureterais , Humanos , Cálculos Renais/cirurgia , Ureter/diagnóstico por imagem , Ureter/cirurgia , Ureteroscopia/métodos , Cálculos Ureterais/diagnóstico por imagem , Cálculos Ureterais/cirurgia , Tomografia Computadorizada por Raios X
18.
Actas urol. esp ; 46(8): 504-512, oct. 2022. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-211490

RESUMO

Introducción: Los verdaderos beneficios de la colocación perioperatoria de un catéter doble J (CDJ) están siendo ampliamente estudiados debido a sus conocidos efectos secundarios. Sin embargo, todavía no se ha llegado a un consenso en la literatura sobre el diseño óptimo del catéter. Por este motivo, este estudio prospectivo, aleatorizado y simple ciego, tuvo como objetivo comparar la sintomatología asociada a 2 diseños de catéter: el de superficie lisa y el de diseño acanalado.Materiales y métodosEl estudio recogió prospectivamente los datos de 42 pacientes que se sometieron a la colocación de un CDJ entre julio de 2019 y agosto de 2020. Los pacientes se dividieron aleatoriamente en 2 grupos según el diseño del catéter utilizado: en el primer grupo se utilizó el catéter de superficie lisa (control) y en el segundo, el catéter de diseño acanalado (intervención). Después de la cirugía, todos los pacientes completaron el Cuestionario de Síntomas del Catéter Ureteral validado en portugués en 3 momentos del postoperatorio (días 7 y 30 después del procedimiento quirúrgico, y día 30 después de la retirada del catéter).Resultados: No se encontraron diferencias significativas en cuanto al sexo, la edad, la mediana de índice de masa corporal, la lateralidad, el tipo de procedimiento quirúrgico (ureteroscopia flexible, semirrígida o mixta). Los CDJ de superficie lisa se asociaron a una mayor incidencia de dolor en el flanco (52,38 vs. 10%; p=0,006) y de dolor suprapúbico (57,14 vs. 30%; p=0,04) el día 7 después del procedimiento. La regresión lineal mixta mostró, de forma significativa, menos dolor en el flanco (p<0,001) y suprapúbico (p<0,01), y un rendimiento sexual significativamente mejor en el grupo de intervención (p=0,03).ConclusionesLos CDJ con diseño acanalado se asocian a una menor incidencia de dolor en el flanco y suprapúbico, y tienen un impacto menor en el rendimiento sexual de los pacientes. (AU)


Introduction: The true benefits of perioperative JJ stent placement are being widely studied due to its known side effects. However, no consensus has been reached in the literature regarding the best type of stent. This prospective, randomized, single-blinded study therefore aimed to compare the symptomatology associated with two JJ stent designs: smooth-walled and grooved.Materials and methodsThe study prospectively recruited 42 patients who underwent JJ stent placement between July 2019 and August 2020. The patients were randomly divided into two groups according to the JJ stent design used: the smooth-walled stent (control) and grooved stent (intervention) groups. After surgery, all patients completed the Portuguese-validated Ureteral Stent Symptom Questionnaire at three timepoints (days 7 and 30 post-surgical procedure, and day 30 post-stent removal).Results: No significant differences in gender, age, median body mass index, laterality, type of surgical procedure (flexible, semi-rigid or mixed ureteroscopy) were found. Smooth-walled JJ stents were associated with a higher incidence of flank pain (52.38% vs. 10%, P=.006) and suprapubic pain (57.14% vs. 30%, P=.04) on the 7th. post-procedure day. Linear mixed regression showed significantly lower flank (P<.001) and suprapubic pain (P<.01), and significantly better sexual performance in the intervention group (P=.03).ConclusionsUreteral stent with a grooved format are associated with a lower incidence of flank and suprapubic pain and had less impact on the sexual performance of patients. (AU)


Assuntos
Humanos , Dor , Stents/efeitos adversos , Ureter/cirurgia , Ureteroscopia/métodos , Método Simples-Cego , Estudos Prospectivos
20.
Can J Urol ; 29(5): 11323-11325, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36245204

RESUMO

Non-urothelial malignant ureteral obstruction (MUO) causes hydronephrosis, renal damage and infectious sequelae. The overall condition, symptoms, and plans for systemic therapy inform urologic intervention. In well-selected cases, there is a role for definitive reconstruction. We describe a robotic-assisted distal ureterectomy and reimplant for definitive repair of obstructive metastatic melanoma.


Assuntos
Melanoma , Procedimentos Cirúrgicos Robóticos , Ureter , Neoplasias Ureterais , Humanos , Melanoma/complicações , Melanoma/cirurgia , Ureter/cirurgia , Neoplasias Ureterais/complicações , Neoplasias Ureterais/patologia , Neoplasias Ureterais/cirurgia , Procedimentos Cirúrgicos Urológicos
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