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1.
Arch Esp Urol ; 74(3): 335-342, 2021 Apr.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33818430

RESUMO

OBJECTIVE: In this study, we aimed to determine the factors predicting the duration and successof semirigid ureteroscopy performed for the treatment of ureteral stones in different localizations. MATERIALS AND METHODS: Medical records of the patients whom under went semirigid ureteroscopy for urolithiasis in our centre between January 2015 and December 2019 were retrospectively reviewed. The study group composed of 170 patients and divided into three subgroups; of which 54 in proximal ureter (31.8%), 51 in the mid (30 %) and 65 (38.2%) in the distal ureter. Predictive factors of semirigid ureteroscopy duration and success were determined by performance of correlation analysis and multivariate analysis. RESULTS: Overall stone-free rate was calculated as 78.8%. Success rates for proximal, mid and distal ureteral stones were 72.2% (39/54 patients), 74.5% (38/51 patients) and 87.7% (57/65 patients), respectively. Complications were present in 19 patients (11.2%). Multivariate analysis indicated that stone diameter and stone burden independently affected the stone-free rate. Statistically significant negative correlation was determined between success of the procedure and stone diameter, stone burden, impaction and more proximal stone localization. While there was a statistically significant positive correlation between duration of procedure and stone burden, diameter, impaction, historyof ipsilateral ureteroscopy and more proximal stone localization, there was negative correlation between duration of procedure and stone-free status. CONCLUSION: We conclude that stone diameter, stone burden, impaction and more proximal stone localization are common factors affecting both duration and success of semirigid ureteroscopy. In addition, stone size and stone burden were determined as independent markers of stone-free status.


Assuntos
Litotripsia , Ureter , Cálculos Ureterais , Urolitíase , Humanos , Estudos Retrospectivos , Resultado do Tratamento , Cálculos Ureterais/cirurgia , Ureteroscopia
2.
Arch Esp Urol ; 74(3): 343-349, 2021 Apr.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33818431

RESUMO

OBJECTIVES: With the spread of more powerful lasers and the advent of new technologies, endoscopic interventions for urolithiasis are continuously evolving. The aim of this study is to present our experience and technique regarding Low Energy (LE)/High Frequency (HF) lithotripsy by using a 120-W Holmium laser (Lumenis®). METHODS: We retrospectively analysed our prospectively maintained Retrograde Intra Renal Surgery (RIRS) database. Lithotripsy was performed using LE/HF settings with a Long Pulse Width (LPW) and consisted of the following steps: 1) contact Laser lithotripsy (LE/HF/LPW dusting - 0,5 J/50 Hz or 02 J/70 Hz); 2) extraction ofmain fragments; 3) non-contact Laser lithotripsy (LE/HF/Short Pulse Width Pop Dusting - 0,5 J /80Hz). Pre-operativeand peri-operative outcomes were collected. Post-operative complications were recorded according to Clavien-Dindo Grading System. Finally, all patients under went a CT scan at three months after RIRS to assess the success of procedure, defined as stone-free or presence of ≤4 mm fragments (Clinical Insignificant Residual Fragments - CIRF). RESULTS: Overall, 104 LE/HF/LPW RIRS from December 2017 to January 2019 were performed. Mean operative time was 59 (SD ±23) minutes, median post-operative stay was two days (IQR 2-3). The post-operative complication rate was 4,8%: one patient had nausea and vomiting (Clavien-Dindo I) and four patients developed urosepsis (Clavien-Dindo II). The success rate was 88,5% (71,2% stone-free and 17,3% CIRF). CONCLUSIONS: LE/HF/LPW RIRS seems to be safe and effective in terms of positive success rate, safety and standard operative time. However, randomized clinical trials are needed to compare this technique to standard RIRS.


Assuntos
Cálculos Renais , Lasers de Estado Sólido , Litotripsia a Laser , Humanos , Cálculos Renais/cirurgia , Lasers de Estado Sólido/uso terapêutico , Estudos Retrospectivos , Resultado do Tratamento , Ureteroscopia
3.
Arch Esp Urol ; 74(3): 359-362, 2021 Apr.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33818434

RESUMO

OBJECTIVES: We present a unique case with a ureteral fibroepithelial tumor originating from the ureter, which could be confused with a bladder tumor on ultrasound examination due to its movement in and out of the bladder. METHODS: In cystoscopy, a papillary tumor lesion emerging from the right ureteral orifice was seen. After scanning the other quadrants, however, the tumor was not observed at the right ureteral orifice. It was then protruded back into the bladder. The tumor was seen several times to protrude into the bladder and return to the ureter, possibly due to ureteral peristalsis. Then, a semi-rigid ureteroscope was introduced through the right ureteric orifice, and the tumor was excised in one piece using Holmium laser fiber with 365µm of diameter. The size of the removed tumor was approximately 8 cm long. A double-j stent of 4.8 Fr was placed in the ureter. RESULTS: The patient was discharged on the first day without complications. The fibroepithelial polyps of the ureter, which consist of the stroma of mesoderm origin, covered with histologically normal or hyperplastic urothelial epithelial cells, are extremely rare tumors. It is important to distinguish these polyps from urothelial cancers, since these two entities are different in treatment and prognosis, although similar in symptoms and imaging procedures. CONCLUSIONS: Minimally invasive treatment techniques can be safely applied in the treatment of such exceedingly rare tumors.


Assuntos
Pólipos , Ureter , Neoplasias Ureterais , Humanos , Pólipos/diagnóstico por imagem , Pólipos/patologia , Pólipos/cirurgia , Ureter/patologia , Neoplasias Ureterais/diagnóstico por imagem , Neoplasias Ureterais/patologia , Neoplasias Ureterais/cirurgia , Ureteroscopia , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/patologia , Bexiga Urinária/cirurgia
4.
Urologiia ; (1): 66-69, 2021 Mar.
Artigo em Russo | MEDLINE | ID: mdl-33818938

RESUMO

OBJECTIVE: To compare the perioperative complications of patients who underwent flexible ureteroscopy (fURS) for the treatment of urolithiasis according to the type of ureteroscope used, single-use (suURS) or reusable (rURS) flexible ureteroscope. PATIENTS AND METHODS: A retrospective and single-center study was conducted between January 2017 and May 2019, including all fURS performed for nephrolithiasis management. During the study period, 5rURS and 1suURS (UscopePU3022) were available. The primary endpoint was the occurrence of 30-days postoperative complications, especially infectious complications, classified according to Clavien-Dindo grading system. RESULTS: Overall, 322 consecutive fURS were included corresponding to 186 rURS (57.8%) and 136 suURS (42.2%). Respectively in rURS and suURS groups, the median (IQR) age was 57 (45-65) vs 57 (44-66) years (p=0.75), 83 (44.6%) vs 63 (46.3%) female were included (p=0.82), and median (IQR) Charlson score was 2 (1-3) vs 2 (0-3) (p=0.15). Fifty-one patients (15.8%) developed postoperative complications, 28 patients (15%) in rURS group and 23 patients (17.6%) in suURS group (p=0.64). Most of them (n=47, 92.1% of overall complications) were minor (Clavien I-II). Occurrence of urinary tract infection in suURS group (n=13; 9.5%) was equally comparable with rURS group (n=10; 5.4%), p=0.15. CONCLUSIONS: Our data suggests that suURS represents a safe alternative to rURS. Compared to reusable devices, UscopePU3022 use was associated with a similar complication rates, however, did not decrease the occurrence of infectious events.


Assuntos
Cálculos Renais , Urolitíase , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Ureteroscópios , Ureteroscopia/efeitos adversos , Urolitíase/cirurgia
5.
Arch. esp. urol. (Ed. impr.) ; 74(1): 80-93, ene.-feb. 2021. tab
Artigo em Espanhol | IBECS | ID: ibc-199439

RESUMO

INTRODUCCIÓN: El Tratamiento Médico Expulsivo (TME) para litiasis ureterales ha sido puesto en cuestión durante los últimos años. OBJETIVOS: El objetivo principal de nuestro trabajo es definir las indicaciones del TME, los fármacos empleados y su efectividad y proponer un esquema de seguimiento. Los objetivos secundarios son analizar la efectividad del TME en algunos subgrupos especiales de la población como son las embarazadas y los niños y valorar aspectos de coste-efectividad del TME en comparación con otras opciones de tratamiento de litiasis ureterales (ureterorrenoscopia o litotricia extracorpórea por ondas de choque). MATERIAL Y MÉTODOS: Hemos realizado una revisión de los ensayos clínicos y metaanálisis de mayor relevancia que valoran la efectividad de los diferentes fármacos disponibles para el TME. Para la búsqueda bibliográfica hemos utilizado algunos términos como medical expulsive treatment/therapy", "ureteral lithiasis", "urolithiasis", "effectiveness", "alpha-blockers" y "calcium-antagonists", siendo la principal base de datos consultada MEDLINE (a través del portal web PubMed). RESULTADOS: Aún los estudios de mayor calidad presentan importantes limitaciones metodológicas, lo que condiciona que la evidencia obtenida sea heterogénea y restringida a pacientes y litiasis que cumplan determinadas condiciones. En líneas generales, el TME puede tener cierto papel en la expulsión de litiasis de tamaño ≥ 5 mm y ≤ 10 mm localizadas en uréter distal, aunque no se ha logrado demostrar que alguno de los fármacos utilizados pueda tener especial superioridad en términos de efectividad. En gestantes y niños las indicaciones del TME tampoco estan estandarizadas. Por último, el TME en comparación con opciones de tratamiento, parece ser una alternativa más coste-efectiva y la preferida por los pacientes según estudios sobre QoL. CONCLUSIONES: Es necesario realizar ensayos clínicos de mayor calidad para poder indicar el TME con un mayor nivel de evidencia. Con la evidencia actual, parece que el TME puede favorecer la expulsión de litiasis localizadas en uréter distal y con un tamaño ≥ 5 mm y ≤ 10 mm. A pesar de ello no se han podido encontrar diferencias entre las distintas opciones farmacológicas disponibles


INTRODUCTION: Medical Expulsive Treatment (MET) for ureteral stones has been questioned for the last few years. OBJECTIVES: The main goal of our study is to define the indications of MET, the different drugs that are used and their effectiveness and to propose a follow-up strategy. Secondary objectives include the effectiveness of MET in some special subgroups such as pregnant women and children and to assess aspects of MET cost-effectiveness compared with other options for ureteral lithiasis treatment (ureterorenoscopy or extracorporeal shock wave lithotripsy). MATERIAL AND METHODS: We have reviewed the most relevant clinical trials and meta-analysis evaluating the impact of the different drugs available for MET. For the research we used some keywords like "medical expulsive treatment/therapy", "ureteral lithiasis", "urolithiasis", "effectiveness", "alpha-blockers" and "calcium-antagonists". MEDLINE database was used for the research (using the portal web Pubmed). RESULTS: Highest quality studies currently available show significant methodological limitations leading to heterogeneous and restricted evidence, which is only applicable to patients and lithiasis with specific conditions. Nevertheless, in general terms, it seems that MET can play a certain role in the expulsion of lithiasis ≥ 5 mm y ≤ 10 mm located in the distal ureter, although it has not been possible to demonstrate that any of the drugs used may have special superiority in terms of effectiveness. In pregnancy and children, the recommendations of MET are also irregular. Finally, MET seems to be an alternative cost-effective compared to active options of treatment. CONCLUSIONS: Higher quality clinical trials are needed to reliably advice MET. With the current evidence, it appears that MET can improve the expulsion of distal ureteral lithiasis ≥ 5 mm and ≤ 10 mm, even though we have not found differences between the drugs that are available for MET


Assuntos
Humanos , Feminino , Gravidez , Criança , Litotripsia , Ureter , Cálculos Ureterais/tratamento farmacológico , Ureterolitíase/terapia , Antagonistas Adrenérgicos alfa , Ureteroscopia , Avaliação de Custo-Efetividade , Litotripsia/métodos , Diálise Renal
6.
Arch. esp. urol. (Ed. impr.) ; 74(1): 94-101, ene.-feb. 2021.
Artigo em Inglês | IBECS | ID: ibc-199440

RESUMO

OBJECTIVE: To determine if the stone free rate (SFR) can be used as a preventive method for urolithiasis recurrence and to describe which would be the best medical management of residual fragments. METHODS: Narrative overview of the most relevant articles published in PubMed and Scopus database about this subject, together with the experiences of personal practice. RESULTS: Residual fragments, when ≤4 mm, sometimes are included in the SFR definition. Most reports shown that these fragments may growth and cause complications and re-intervention when found in the follow-up of the patient that underwent any endourological procedure. The majority of the publications found show that the residual fragment medical management is necessary to assure a lower recurrence rate. CONCLUSION: Assuring a SFR can serve as a preventive method for recurrence, but not alone but in combination with medical therapy. Medical therapy is important in the follow-up and personalized for each patient. Drug therapy must be promoted if the patient continues to have the urolithiasis risk factors despite the dietary objectives have been reached


OBJETIVO: Determinar si la tasa libre de litiasis se puede utilizar como un método preventivo de la recurrencia y describir cual sería el mejor manejo médico de los fragmentos residuales. MÉTODOS: revisión narrativa de los artículos publicados en Pubmed y Scopus sobre este tema, así como la experiencia personal. RESULTADOS: Los fragmentos residuales, cuando son de menos de 4 mm, a menudo están incluidos en el concepto de tasa libre de litiasis. La mayoría de artículos demuestran que estos fragmentos pueden crecen y generar complicaciones e re-intervenciones cuando son encontrados durante el seguimiento de pacientes que han recibido un tratamiento endourologico. La mayoría de publicaciones encontradas que en los fragmentos residuales el manejo medico es necesario para disminuir la tasa de recurrencias. CONCLUSIONES: Asegurarse de tener una tasa libre de litiasis baja puede funcionar como método preventivo de recurrencia, junto con el tratamiento médico. EL tratamiento médico es importante en el seguimiento de estos pacientes y debe ser personalizado por paciente. Los tratamientos farmacológicos deben ser utilizados en caso de pacientes con riesgo persistente de litiasis aunque el tratamiento dietético este establecido


Assuntos
Humanos , Cálculos Renais/terapia , Litotripsia , Cálculos da Bexiga Urinária/prevenção & controle , Recidiva , Fatores de Risco , Ureteroscopia , Nefrolitotomia Percutânea
7.
Arch Esp Urol ; 74(1): 80-93, 2021 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-33459624

RESUMO

INTRODUCTION: Medical Expulsive Treatment (MET) for ureteral stones has been questioned for the last few years. OBJECTIVES: The main goal of our study is to define the indications of MET, the different drugs that are used and their effectiveness and to propose a follow-up strategy. Secondary objectives include the effectiveness of MET in some special subgroups such as pregnant women and children and to assess aspects of MET cost-effectiveness compared with other options for ureteral lithiasis treatment (ureterorenoscopy or extracorporeal shock wave lithotripsy). MATERIAL AND METHODS: We have reviewed the most relevant clinical trials and meta-analysis evaluating the impact of the different drugs available for MET. For the research we used some keywords like "medical expulsive treatment/therapy", "ureteral lithiasis", "urolithiasis", "effectiveness", "alpha-blockers" and "calcium-antagonists". MEDLINE database was used for there search (using the portal web Pubmed). RESULTS: Highest quality studies currently availables how significant methodological limitations leading to heterogeneous and restricted evidence, which is only applicable to patients and lithiasis with specific conditions. Nevertheless, in general terms, it seems that MET can play a certain role in the expulsion of lithiasis ≥ 5mm y ≤ 10 mm located in the distal ureter, although it has not been possible to demonstrate that any of the drugs used may have special superiority in terms of effectiveness. In pregnancy and children, the recommendations of MET are also irregular. Finally, MET seemsto be an alternative cost-effective compared to active options of treatment. CONCLUSIONS: Higher quality clinical trials are needed to reliably advice MET. With the current evidence, it appears that MET can improve the expulsion of distal ureteral lithiasis ≥ 5 mm and ≤ 10 mm, even though we have not found differences between the drugs that are available for MET.


Assuntos
Litotripsia , Ureter , Cálculos Ureterais , Antagonistas Adrenérgicos alfa , Criança , Feminino , Humanos , Gravidez , Resultado do Tratamento , Cálculos Ureterais/tratamento farmacológico , Ureteroscopia
8.
Medicina (Kaunas) ; 57(1)2021 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-33435420

RESUMO

Background and Objectives: Vesicoureteral reflux (VUR) describes a common pediatric anomaly in pediatric urology with a prevalence of 1-2%. In diagnostics, in addition to the gold standard of voiding cystourethrography (VCUG), contrast-enhanced urosonography (ceVUS) offers a radiation-free procedure, which, despite its advantages, is not yet widely used. In the present single-center study, subsequent therapeutic procedures and outcomes after ceVUS of 49 patients were investigated. The aim of the study is to investigate the efficacy of ceVUS with the intention of broader clinical implementation. Materials and Methods: Between 2016 and 2020, 49 patients were retrospectively included and received a ceVUS to evaluate VUR. With a distribution of 47:2 (95.9%), a clear female predominance was present. The age of the patients varied between 5 months and 60 years at the time of ceVUS. All examinations were all performed and subsequently interpreted by a single experienced radiologist (EFSUMB level 3). Results: Compared to intraoperative findings, ceVUS shows a sensitivity of 95.7% with a specificity of 100%. Allergic reactions to the contrast medium could not be observed. Conclusion: With its high sensitivity and intraoperative validation, ceVUS offers an excellent alternative to VCUG, the gold standard in the diagnosis of VUR. In addition, ceVUS is a radiation-free examination method with a low risk profile that offers an exceptional diagnostic tool in the diagnostic clarification of recurrent urinary tract infections with the suspected diagnosis of VUR and should also be included in the consideration of a diagnosis next to the established VCUG, especially in younger children.


Assuntos
Meios de Contraste , Técnicas de Diagnóstico Urológico , Ultrassonografia/métodos , Refluxo Vesicoureteral/diagnóstico por imagem , Adolescente , Adulto , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Cistografia , Feminino , Humanos , Lactente , Injeções , Laparoscopia , Masculino , Pessoa de Meia-Idade , Fosfolipídeos , Politetrafluoretileno , Exposição à Radiação , Recidiva , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Hexafluoreto de Enxofre , Ureteroscopia , Uretra/diagnóstico por imagem , Bexiga Urinária/diagnóstico por imagem , Infecções Urinárias/etiologia , Infecções Urinárias/prevenção & controle , Urografia , Refluxo Vesicoureteral/classificação , Refluxo Vesicoureteral/complicações , Refluxo Vesicoureteral/terapia , Adulto Jovem
9.
Urologe A ; 60(1): 19-26, 2021 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-33315134

RESUMO

Management of urolithiasis has undergone fundamental changes with the introduction of extracorporeal shock wave lithotripsy (ESWL) and percutaneous and ureterorenoscopic techniques in the 1980s. Since then, these minimally invasive techniques have been continuously optimized and specific laser techniques for stone disintegration have emerged. Besides the established holmium laser, other types of lasers are also emerging. Especially the thulium fiber laser is the subject of promising research due to its variable adjustment options. In terms of patient safety, both holmium and thulium techniques seem to be similar . While serious direct physical lesions are rare, there is increasing evidence of clinically relevant secondary thermal injury due to increased temperatures in the upper urinary tract during treatment. Our research group has recently demonstrated in both in vitro and in vivo (porcine animal model) experiments that monitoring the fluorescence spectra of calculi allows precise target differentiation between stone, tissue, and endoscope components. Consequently, pulse emissions were only emitted when stone material was detected. We believe that target monitoring will minimize the risk of laser-induced urothelial damage and decrease energy release into the upper urinary tract allowing adequate temperature management.


Assuntos
Lasers de Estado Sólido , Litotripsia a Laser , Litotripsia , Urolitíase , Animais , Humanos , Lasers de Estado Sólido/uso terapêutico , Segurança do Paciente , Suínos , Ureteroscopia/efeitos adversos , Urolitíase/terapia
10.
J Urol ; 205(1): 159-164, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32717166

RESUMO

PURPOSE: We determined the association between ureteral diameter and ureteral injury during ureteral access sheath placement. MATERIALS AND METHODS: Patients were prospectively enrolled in the study from July 2014 to September 2015. All patients underwent preoperative noncontrast computerized tomography and had a 12Fr to 14Fr ureteral access sheath placement without pre-stenting. A measurement of proximal ureteral diameter was carried out by 2 urologists and 1 radiologist. Ureteral wall injuries were evaluated by 2 endourologists using the 5-grade classification. RESULTS: A total of 68 patients were included and the overall success rate for sheath placement was 94.1% (64). Among this group 46 patients (71.9%) had evidence of any type of injury to the ureter wall and the rate of high grade injuries was 26.1% (12). The ureteral diameter of patients who had a high grade injury was significantly smaller compared to those with low grade injuries (mean±SD 3.29±0.46 mm vs 4.5±0.97 mm, p <0.001). On multivariate analysis narrower proximal ureteral diameter was associated with a higher risk of high grade ureteral injury (OR 2.8, 95% CI 1.9-3.4, p <0.001), regardless of age, gender, body mass index, and middle and distal ureteral diameter. CONCLUSIONS: The proximal ureteral diameter is associated with high grade ureteral injury. A smaller ureteral diameter increases the risk and the severity of ureteral injury. Therefore, preoperative measurement of the ureteral diameter is recommended for ureteral access sheath placement to predict the risk of ureteral injury.


Assuntos
Complicações Intraoperatórias/epidemiologia , Ureter/lesões , Doenças Ureterais/epidemiologia , Ureteroscopia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Escala de Gravidade do Ferimento , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos Prospectivos , Estudos Retrospectivos , Medição de Risco/métodos , Tomografia Computadorizada por Raios X , Ureter/anatomia & histologia , Ureter/diagnóstico por imagem , Doenças Ureterais/diagnóstico , Doenças Ureterais/etiologia , Ureteroscopia/instrumentação
12.
Zhonghua Nan Ke Xue ; 26(1): 48-53, 2020 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-33345477

RESUMO

Objective: To investigate the impact of two different ureteral stents on the quality of life and erectile function of young and middle-aged men after ureteral laser lithotripsy. METHODS: A total of 118 male patients aged 22-45 years underwent ureteral laser lithotripsy followed by indwelling of the traditional double-J stent (the DJS group, n = 60) or Polaris loop stent (the PLS group, n = 58). We obtained the general information, intra- and post-operative clinical data, and scores on QOL, IPSS, Visual Analogue Scale (VAS) and IIEF, and compared them between the two groups of patients. RESULTS: There were no statistically significant differences in the body mass index, height, stone diameter, hydronephrosis degree, operation time, intra-operative adverse events, or post-operative stenting time between the two groups of patients. The PLS outperformed the DJS group in such clinical indexes as inflammation markers, lower urinary tract symptoms (LUTS), backache at urination, and QOL, IPSS and VAS scores during stenting at 4 weeks after operation(P < 0.05). The IIEF scores of the PLS and DJS groups were 8.44 ± 2.10 vs 12.50 ± 1.78 (P = 0.003) at 2 weeks, 8.65 ± 1.90 vs 13.42 ± 1.88 (P = 0.002) at 4 weeks, and 13.57 ± 1.01 vs 17.38 ± 2.47 (P = 0.003) at 6 weeks after operation, with no statistically significant difference between the two groups at 8 weeks. CONCLUSIONS: Ureteral stenting affects the quality of life and erectile function of young and middle-aged male patients after ureteral laser lithotripsy. The Polaris loop stent affects less the quality of life and erectile function of the patients than the traditional double-J stent during postoperative stenting.


Assuntos
Disfunção Erétil , Litotripsia a Laser , Qualidade de Vida , Stents , Adulto , Disfunção Erétil/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Stents/classificação , Ureteroscopia , Adulto Jovem
13.
BMJ Case Rep ; 13(12)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334751

RESUMO

A 55-year-old male presented to our emergency department with haematuria and abdominal pain. Investigations including a computed tomography (CT) scan revealed an intraluminal filling defect within the left collecting system, consistent in appearance with blood clot. With an initial working diagnosis of upper tract urothelial cell carcinoma, he was discharged with plans for an urgent cystoscopy and ureteroscopy. He subsequently represented with ongoing frank haematuria, anasarca, dropping haemoglobin and new right collecting system blood clot. Subsequent investigations showed that the patient had acquired haemophilia A resulting in the episodes of haematuria, highlighted after an elevated activated partial thromboplastic time prompted a thrombophilia screen. The patient was subsequently treated with factor eight inhibitor bypass activity, corticosteroids and cyclophosphamide.


Assuntos
Dor Abdominal/etiologia , Lesão Renal Aguda/diagnóstico , Hematúria/etiologia , Hemofilia A/diagnóstico , Dor Abdominal/sangue , Dor Abdominal/urina , Lesão Renal Aguda/sangue , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/urina , Fatores de Coagulação Sanguínea/uso terapêutico , Cistoscopia , Fator VIIa/uso terapêutico , Hematúria/sangue , Hematúria/urina , Hemofilia A/sangue , Hemofilia A/complicações , Hemofilia A/tratamento farmacológico , Humanos , Túbulos Renais Coletores/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tempo de Tromboplastina Parcial , Proteínas Recombinantes/uso terapêutico , Resultado do Tratamento , Ureteroscopia , Urografia
14.
Prog. urol. (Paris) ; 30(12): S52-S77, Nov. 2020.
Artigo em Francês | BIGG - guias GRADE | ID: biblio-1146626

RESUMO

The purpose was to propose an update of the French guidelines from the national committee ccAFU on upper tract urothelial carcinomas (UTUC). A systematic Medline search was performed between 2018 and 2020, as regards diagnosis, options of treatment and follow-up of UTUC, to evaluate different references with levels of evidence.The diagnosis of this rare pathology is based on CT-scan acquisition during excretion and ureteroscopy with histological biopsies. Radical nephroureterectomy (RNU) remains the gold standard for surgical treatment, nevertheless a conservative endoscopic approach can be proposed for low risk lesion: unifocal tumor, possible complete resection and low grade and absence of invasion on CT-scan. Close monitoring with endoscopic follow-up (flexible ureteroscopy) in compliant patients is therefore necessary. After RNU, bladder instillation of chemotherapy is recommended to reduce risk of bladder recurrence. A systemic chemotherapy is recommended after RNU in pT2­T4 N0­3 M0 disease. These updated guidelines will contribute to increase the level of urological care for diagnosis and treatment for UTUC.


L'objectif était de proposer une mise à jour des recommandations du Comité de cancérologie de l'Association française d'urologie (AFU) pour la prise en charge des tumeurs de la voie excrétrice supérieure (TVES). Une revue systématique de la littérature (Medline) a été effectuée de 2018 à 2020 sur les éléments du diagnostic, les options de traitement et la surveillance des TVES en évaluant les références avec leur niveau de preuve. Le diagnostic de cette pathologie rare repose sur l'uro-TDM avec acquisition au temps excréteur et l'urétérorénoscopie souple avec prélèvements biopsiques. Le traitement chirurgical de référence est la néphro-urétérectomie totale (NUT), mais un traitement conservateur peut être discuté pour les lésions dites « à bas risque ¼ : tumeur de bas grade, sans infiltration sur l'imagerie, unifocale < 2 cm, accessible à un traitement complet et nécessitant alors une surveillance endoscopique rapprochée par urétéroscopie souple chez un patient compliant. Une instillation postopératoire de chimiothérapie est recommandée et permet de diminuer le risque de récidive vésicale après NUT. La chimiothérapie adjuvante a démontré son bénéfice clinique comparée à la surveillance après NUT pour les tumeurs (pT2­T4 N0­3 M0). Ces nouvelles recommandations doivent contribuer à améliorer non seulement la prise en charge des patients, mais aussi le diagnostic et la décision thérapeutique des TVES.


Assuntos
Humanos , Sistema Urinário/patologia , Neoplasias Urogenitais/prevenção & controle , Ureteroscopia/métodos , Nefroureterectomia
15.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1936-1939, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018381

RESUMO

Urolithiasis is a common disease around the world and its incidence has been growing every year. There are various diagnosis techniques based on kidney stone identification aiming to find the formation cause. However, most of them are time consuming, tedious and expensive. The accuracy of the diagnosis is crucial for the prescription of an appropriate treatment that can eliminate the stones and diminish future relapses. This paper presents two effective supervised learning methods to automate and improve the accuracy of the classification of kidney stones; as well as a dataset consisting of kidney stone images captured with ureteroscopes. In the proposed methods, the image features that are visually exploited by urologists to distinguish the type of kidney stones are analyzed and encoded as vectors. Then, the classification is performed on these feature vectors through Random Forest and ensemble K Nearest Neighbor classifiers. The overall classification accuracy obtained was 89%, outperforming previous methods by more than 10%. The details of the classifier implementation, as well as their performance and accuracy, are presented and discussed. Finally, future work and improvements are proposed.


Assuntos
Cálculos Renais , Ureteroscopia , Algoritmos , Humanos , Cálculos Renais/diagnóstico por imagem , Recidiva
16.
Medicine (Baltimore) ; 99(43): e22704, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120764

RESUMO

With improvements in endoscopy and laser technology, flexible ureteroscopy (FURS) has been a viable treatment option for large renal stones. Here, we share our experience of the FURS treatment for renal stones 2 cm or greater.We evaluated 251 consecutive patients who underwent FURS and holmium laser lithotripsy for renal stones 2 cm or greater between January 2015 and April 2019. Stone size was defined as the longest axis on non-contrast computed tomography. Data were retrospectively collected from electronic medical records. Patient demographics, stone clearance rates and perioperative complications were evaluated.There were 165 male patients and 86 female patients with an average age of 46.9 years (range 22-80 years). Mean stone size was 2.7 cm and the average number of procedures was 1.4 (range 1-5). The stone-free rate at the end of the first, second and third procedure was 61.9%, 82.9%, and 89.5%, respectively. The final stone-free rate decreased as stone size grows, and it was only 58.3% for kidney stones larger than 4 cm after an average of 2.3 procedures. The lowest clearance rates were observed in lower calyx calculi (87.2%) and multiple calyx calculi (83.5%). The overall complication rate was 15.1%, and the most common complication was postoperative fever (9.6%). One patient required blood transfusion, owing to postoperative coagulation disorders induced by urosepsis.Single or staged FURS is a practical treatment option for the renal stones sized 2 to 4 cm with acceptable efficacy and safety. Stone clearance rate of FURS treatment is mainly affected by stone size and location.


Assuntos
Cálculos Renais/terapia , Litotripsia a Laser/métodos , Ureteroscopia/métodos , Adulto , Feminino , Humanos , Cálculos Renais/patologia , Lasers de Estado Sólido/uso terapêutico , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos
17.
Arch. esp. urol. (Ed. impr.) ; 73(8): 767-776, oct. 2020. tab, graf, ilus
Artigo em Inglês | IBECS | ID: ibc-197474

RESUMO

The SuperPulsed Thulium fiber laser has recently become available to the urologist. It can be safely and efficiently applied to humans for the purposes of laser lithotripsy. Particularly, this innovative technology overcomes the main limitations of Holmium:YAG lasers, which had been the principal source of energy for lithotripsy over the past decades. The SuperPulsed Thulium fiber laser allows a broader range of pulse energy (0.025 to 6.0 J), pulse frequency (up to 2000 Hz) and pulse duration (0.05 to 12 ms), as well as smaller operating laser fibers (50-150 μm core), compared to Holmium:YAG lasers. The laser emission at 1940 nm leads to a four-fold higher energy absorption in water, which ensures precise lithotripsy and a high degree of safety. Multiple comparative in vitro studies suggest a 1.5 to 4 times faster stone ablation rate in favor of the SuperPulsed Thulium fiber laser, when compared to Holmium:YAG lasers. It has also been shown to generate particularly fine stone dust, and electronic pulse modulation allows superior stone stabilization. The SuperPulsed Thulium fiber laser, like the Holmium:YAG laser, has been repeatedly reported thermodynamically safe, provided that a minimal irrigation flow (10-15 ml/min) and relatively low average power (≤ 25 W) is maintaining throughout the lithotripsy process. These new standards are particularly advantageous for fine and rapid ureteroscopic stone dusting, and open paths that were not been amenable to the Holmium:YAG laser


El tulio superpulsado ha salido al mercado recientemente. Se puede usar en humanos para la litotricia. En concreto, esta nueva tecnología mejora las limitaciones del laser holmium, usado hasta ahora. Las fibras de laser tulio permite un pulso de energía (0.025 a 6 J), frecuencia de pulso (hasta 2000 Hz) y duración de este pulso (0.05 a 12 ms) así como diámetros menores (50-150 nm) en comparación con el holmium. La emisión de laser a 1940 nm permite una mejoría hasta 4 veces en la absorción de agua, lo que permite una litotricia mas eficiente y segura. Múltiples estudios comparativos in vitro sugieren que la litotricia es entre 1,5 y 4 veces mas rápida con el tulio superpulsado. Además produce un polvo secundario a litotricia mas fino y el pulso electrónico modulado permite una mejor estabilización de la litiasis. Las fibras de tulio superpulsado, como las de holmium, son térmicamente seguras teniendo en cuenta que la irrigación mínima continua (10-15 ml/min) y el bajo voltaje (menos de 25 W) se mantienen durante el tratamiento de litotricia. Estos nuevos estándares confieren particular ventaja en la litotricia ureteroscopica y permitirán una mejor aceptación que el laser homium


Assuntos
Humanos , Litotripsia a Laser/métodos , Túlio/uso terapêutico , Lasers de Estado Sólido/uso terapêutico , Ondas de Choque de Alta Energia , Urolitíase/cirurgia , Ureteroscopia/métodos
18.
J Urol ; 204(4): 776-777, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32898972
19.
J Urol ; 204(4): 776, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32898973
20.
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
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