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1.
Chirurgia (Bucur) ; 115(1): 63-68, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32155400

RESUMO

Introduction: The retrograde flexible ureteroscopic approach is an effective and relatively safe procedure. The aim of this study was to retrospectively evaluate the safety of retrograde flexible ureteroscopic approach in patients with pyelo-caliceal stones on a significant number of cases. Material and method: We retrospectively evaluated 4500 procedures of flexible retrograde ureteroscopic approach for pyelocaliceal lithiasis, operated in two centers. The complications associated with this approach were retrospectively evaluated and data was stratified according to Clavien- Dindo classification. Results: Intraoperative incidents occurred during 5.2% of the procedures. Overall complications occurred in 18.9% of the procedures. Around two thirds of them were septic complications, the use of ureteral access sheath proving to be a protective factor against them. Most of the complications were mild. In 4.8% of the cases in which ureteral access sheath was used, we encountered grade 2 and 3 ureteral wall lesions. Conclusions: Most of the complications associated with retrograde flexible ureteroscopic approach are mild, regardless the type of flexible ureteroscope used. Reduced pressure in the pyelo-caliceal system is important to maintain the complications rate low, both septic and non-septic.


Assuntos
Cálculos Renais/cirurgia , Ureteroscopia/efeitos adversos , Humanos , Morbidade , Estudos Retrospectivos , Resultado do Tratamento , Ureteroscopia/métodos
2.
Urologiia ; (1): 39-45, 2020 Mar.
Artigo em Russo | MEDLINE | ID: mdl-32195555

RESUMO

AIM: To determine the complexity of urinary stones from the standpoint of endoscopic surgery in order to create the standard for the postoperative course of endoscopic surgery for urolithiasis. MATERIAL AND METHODS: A total of 1317 endoscopic operations (PNL, URS), performed for upper urinary tract stones, were analyzed. Treatment results of 290 patients were studied prospectively, taking into account a stone density, determined by MSCT using HU scale. In 1027 patients, results were studied retrospectively, with a consideration of stone quantitative characteristics, size and shape. RESULTS: According to the study, stone density does not have a significant impact on the frequency and severity of complications and the efficacy of endoscopic treatment for urolithiasis. The number of stones, their size and stereometric configuration have a significant influence on the surgical procedure. From the position of endoscopic interventions, single upper urinary tract stones were determined as "simple", while multiple and staghorn stones were considered as "complexed" cases. CONCLUSION: The "standard of the postoperative period" of endoscopic surgery for urolithiasis created with a consideration of specific features of endoscopic surgery for urolithiasis and the complexity of urinary stones is proved to be objective. Any deviation in the postoperative period from the standard course should be regarded as a complication and it is necessary to systematize them according to the Clavien-Dindo classification.


Assuntos
Endoscopia , Cálculos Coraliformes/cirurgia , Cálculos Urinários/cirurgia , Urolitíase/cirurgia , Humanos , Período Pós-Operatório , Estudos Retrospectivos , Resultado do Tratamento , Ureteroscopia
3.
Medicine (Baltimore) ; 99(10): e19324, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150068

RESUMO

The surgical outcomes of patients with single ureteral stones who had undergone ureteroscopic Holmium laser lithotripsy as outpatients and compare them with those of patients who had received the same procedure as inpatients. Records were obtained from January 2012 to December 2016 for selected patients who had undergone the above mentioned procedure at our institution. Patients were excluded if their ECOG performance status was ≥2, presented with multiple stones or concomitant renal stones, had histories of cancer or congenital urinary system abnormalities, or had undergone urinary system reconstruction surgery. Patients could decide whether to receive the procedure as an outpatient or inpatient. All surgeries were performed by a single surgeon. Patients preoperative, operative, and postoperative data were recorded. The clinical results, such as urinary tract infection, analgesic requirement, rate of returning to the emergency room, stone clearance, surgical complications, and medical expenditure for the treatment courses were analyzed and compared between the 2 cohorts. In total, 303 patients met the inclusion criteria. Among them, 119 patients decided to receive ureteroscopic laser lithotripsy as outpatients, whereas 184 decided to be inpatients. The outpatient cohort was younger (P < .001), had smaller stone diameters (P < .001), and fewer comorbidity factors (P = .038). Patients with a history of stone manipulation favored receiving the procedure under admission (P < .001). After 1:1 propensity score matching, no significant differences were discovered between the cohorts with regard to operative time, rate of lithotripsy failure, and operative complications. Furthermore, rates of stone clearance, post-op urinary tract infection, analgesic requirement, and returning to the emergency room were comparable between the 2 groups. However, the medical expenditure was significantly lower in the outpatient cohort (P < .001). Our data revealed that outpatient ureteroscopic lithotripsy with a Holmium laser was more economical compared with the inpatient group and achieved favorable outcomes for patients with a single ureteral stone.


Assuntos
Litotripsia a Laser/tendências , Pacientes Ambulatoriais/estatística & dados numéricos , Cálculos Ureterais/complicações , Cálculos Ureterais/terapia , Adulto , Idoso , Feminino , Humanos , Litotripsia a Laser/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Cálculos Ureterais/epidemiologia , Ureteroscopia/métodos , Ureteroscopia/tendências
4.
Urologe A ; 59(3): 289-293, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-32006059

RESUMO

Compared with adults, urolithiasis is quite rare in children (1-2% of all urinary stones occur during childhood). In principle, all therapy modalities for adults can also be used in children. However, due to some anatomic and functional peculiarities in children, the differential indication for the various treatment modalities differ. As a rule, asymptomatic renal stones are not treated but observed. More urinary stones pass spontaneously in children compared with adults. If spontaneous passage is not possible or does not occur, noninvasive and minimally invasive techniques are indicated. Extracorporeal shock wave lithotripsy is the therapy of choice in most instances. Today, endoscopic techniques, however, can be safely used even in very small infants. For larger renal stones and those consisting of cysteine or whewellite, percutaneous nephrolithotomy (PCNL) is the therapy of choice, and for distal ureteral stones ureteroscopy is the method of choice. Laparoscopic and open surgery are reserved for very rare cases, especially with concomitant pathologies. Bladder calculi are treated by transurethral or suprapubic lithotripsy.


Assuntos
Litotripsia , Nefrolitotomia Percutânea , Ureteroscopia , Urolitíase/cirurgia , Criança , Humanos , Cálculos Renais , Cálculos Ureterais , Urolitíase/diagnóstico por imagem
5.
Urology ; 136: 68-69, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32033685
7.
Arch Esp Urol ; 73(1): 47-53, 2020 Jan.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31950923

RESUMO

OBJECTIVES: To evaluate the effect of silodosin on stages of the flexible ureterorenoscopy (F-URS) procedures. METHODS: Between November 2015 and August 2017, a total of 76 patients suffering from 10-30 mm kidney stone were enrolled in this randomized prospective study. Patients were randomly divided into 2 groups for treatment: Group 1 had F-URS with preoperative daily uptake of 8 mg silodosin for 10 days, and group 2 had F-URS without silodosin uptake. None of the patients had preoperative JJ stenting. Stages of the F-URS was defined as entrance to bladder time (ETBT) with a semirigid ureterorenoscope (R-URS), entrance to ureteric orifice time (ETUOT) with R-URS using a guide wire and proceeding 2 cm inside the ureter, application of access sheath time (AAST) using the guide wire advanced through R-URS, F-URS time (FURST) + lithotripsy with laser time (LT), and total operation time (OT). We compared the time of each stage between two groups. RESULTS: There were 38 patients group1 and 2, respectively. There was one ureteral access sheath (UAS) application failure in group 1, and 3 failures in group 2 (p=0.307). The ETBT, ETUOT, and AAST were significantly short in group 1 than group 2 (p=0.001,0.007,0.002). CONCLUSIONS: Although preoperative use of silodosin facilitated only an insignificant positive effect on UAS placement failure, it eased the F-URS procedure by reducing the ETBT, ETUOT, and AAST in seconds. More studies are needed to make an exact conclusion.


Assuntos
Cálculos Renais , Litotripsia , Cálculos Ureterais , Ureteroscopia , Humanos , Indóis , Cálculos Renais/terapia , Masculino , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento , Cálculos Ureterais/terapia
8.
Urology ; 136: 63-69, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31618657

RESUMO

OBJECTIVE: To understand patient and practice-level factors impacting postoperative imaging use after ureteroscopy (URS) for urinary stone disease. METHODS: The Michigan Urological Surgery Improvement Collaborative's Reducing Operative Complications from Kidney Stones (MUSIC ROCKS) initiative is a consortium of 52 urologists from 11 practices in Michigan. From June 2016 to July 2017, we prospectively collected clinical data for patients undergoing URS for stone treatment by MUSIC ROCKS participants. We measured the proportion of these patients who underwent US, AXR, and/or CT within the first 60 days after their procedure. We then assessed variation in the use of post-URS imaging according to patient characteristics and across MUSIC ROCKS practices. RESULTS: During the 13-month study period, we identified 2850 patients who were treated with URS for stone disease. Overall, only 47.6% of these patients underwent postoperative imaging. AXR was the most common modality used (55.0% of patients), followed by US (21.9%) and CT (11.1%). As shown in the Figure, use of post-URS imaging varied widely across participating practices (23.7%-73.6%; P <.01). Imaging receipt did not differ by patient age, gender, or insurance status. However, patients with more comorbidities, renal stones and those with larger stones were more likely to receive post-URS imaging (P <.05 for each comparison). CONCLUSION: Fewer than half of patients in Michigan undergo postoperative imaging after URS for stone disease. Moreover, there is substantial variation across providers in post-URS imaging use. These findings help identify opportunities to improve the quality of care for patients with urinary stone disease in the State.


Assuntos
Cálculos Renais/cirurgia , Cuidados Pós-Operatórios/estatística & dados numéricos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Melhoria de Qualidade , Ureteroscopia , Urologia , Adulto , Idoso , Feminino , Humanos , Masculino , Michigan , Pessoa de Meia-Idade , Estudos Prospectivos
10.
Int Braz J Urol ; 45(6): 1161-1166, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808404

RESUMO

PURPOSE: To compare two-shift operation mode and single player mode different impact on surgical results and operator comfort in flexible ureteroscopic holmium laser lithotripsy for renal calculi larger than 1.5cm. MATERIALS AND METHODS: From december 2017 to december 2018, 92 patients with renal calculi admitted to Qilu Hospital and were treated through fl exible ureteroscopy. They were randomized in two-shift group (n=50) and single player group (n=42). The operative time, blood loss, hospitalization stay after operation, residual fragments (≥4mm) rate, fragmentation speed, postoperative complications and operator's fatigue score were compared. RESULTS: There was no significant difference between two groups regarding age, gender, illness side, stone size, blood loss, operative time, postoperative hospitalization stay, complications, etc (p >0.05). The fragmentation speed was 44.5±20.0mm3/min in two-shift group compared with 34.2±17.3mm3/min in single player group (p=0.037). Residual fragments (≥4mm) rate after fi rst surgery was 18% in two-shift group, while the residual fragments (≥4mm) rate was 40.5% after first surgery in single player group (p=0.017). The total fatigue score of two-shift group was 8.4 compared to 29.9 in single player group (p <0.001). CONCLUSION: In flexible ureteroscopic holmium laser lithotripsy for the treatment of renal calculi larger than 1.5cm, two-shift operation mode can raise the fragmentation speed and stone clearance rate, as well as signifi cantly lower operator's fatigue level and improve operator's comfort.


Assuntos
Cálculos Renais/cirurgia , Lasers de Estado Sólido/uso terapêutico , Litotripsia a Laser/métodos , Ureteroscopia/métodos , Adulto , Desenho de Equipamento , Ergonomia , Feminino , Humanos , Cálculos Renais/patologia , Tempo de Internação , Litotripsia a Laser/instrumentação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias , Reprodutibilidade dos Testes , Resultado do Tratamento , Ureteroscopia/instrumentação
11.
Urologiia ; (5): 114-118, 2019 Dec.
Artigo em Russo | MEDLINE | ID: mdl-31808644

RESUMO

The problem of urinary stone disease and acute destructive pyelonephritis remains to be relevant in the current urologic practice. The acute pyelonephritis is the most common infectious and inflammatory complication after retrograde ureteroscopy. According to data of leading urologists in Russian Federation and worldwide, the incidence of acute purulent pyelonephritis ranges from 0.1 to 0.2%. Infectious and inflammatory complications of retrograde ureteroscopy often require urgent interventions. Acute pyelonephritis can result in destructive changes in the renal parenchyma. In case of ineffective conservative measures, pyelonephritis can progress into sepsis with the development of multiple organ failure. Therefore, infectious and inflammatory complications require to start combined antibacterial, anti-inflammatory and detoxification therapy, as well as to resolve any upper urinary tract obstruction. If acute pyelonephritis leads to destructive phase with a formation of a carbuncle or an abscess in the kidney, an open surgery is indicated. Despite being minimally-invasive, retrograde ureteroscopy can lead to serious complications requiring an open surgical intervention. In some cases, the severity of the patients condition may require nephrectomy.


Assuntos
Abscesso/tratamento farmacológico , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Cálculos Renais/terapia , Litotripsia/efeitos adversos , Pielonefrite/tratamento farmacológico , Ureteroscopia/efeitos adversos , Humanos , Nefrectomia , Pielonefrite/complicações , Pielonefrite/microbiologia , Federação Russa , Índice de Gravidade de Doença , Cálculos Urinários
12.
Urology ; 134: 108, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31789172
13.
Arch Esp Urol ; 72(10): 1046-1050, 2019 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-31823855

RESUMO

OBJECTIVE: Intrarenal stenosis, even caliceal diverticula or neck diverticular stenosis, associated with lithiasis are infrequent therefore their management is a challenge. The aim of this article is to report two cases who underwent retrograde intrarenal surgery and Holmium laser as a modern technological tool, proposing a new gold standard. METHODS: We report 2 cases of intrarenal stenosis associated with lithiasis managed with flexible videoureteroscope (STORZ) and Holmium laser (CALCULASE II). One case presented a caliceal diverticulum and the other a caliceal ostium stenosis secondary to previous percutaneous surgery. The ostium was incised with laser to access the diverticulum in the first case and in the second case a dilatation was required. Lithiasis treatment was performed with laser. Disease free rate was defined when the cavity completely disappeared and lithiasis fragments were less than 2 mm on CT Scan one month after procedure. RESULTS: Surgical time were 60 and 82 minutes for cases 1 and 2, respectively. Both patients evolved satisfactorily with 8 hours hospital stay and without perioperative complications. The disease-free rate was 100%. CONCLUSION: Flexible videoureterorrenoscopy and Holmium laser for the management of intrarenal stenosis are highly effective and safe with the advantages of less perioperative complications, less invasiveness and being an outpatient procedure compared to percutaneous surgery.


Assuntos
Divertículo , Cálculos Renais , Litíase , Constrição Patológica , Humanos , Cálices Renais , Ureteroscopia
14.
Actas urol. esp ; 43(10): 521-525, dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185257

RESUMO

Objetivos: El objetivo de este estudio fue evaluar el rol de la aplicación de fluoroscopia en pacientes intervenidos mediante cirugía retrógrada intrarrenal y su efecto sobre los resultados quirúrgicos. Material y métodos: Los pacientes que ingresaron en nuestro centro con diagnóstico de cálculos renales se dividieron en 2 grupos. En el grupo 1 se utilizó fluoroscopia de rutina en todos los casos (n: 58). En el grupo 2 se ejecutó el mismo procedimiento sin fluoroscopia (n: 67). Posteriormente se compararon los resultados de los 2 grupos. Resultados: No hubo diferencias estadísticamente significativas entre los 2 grupos en términos de tiempo quirúrgico, tasa libre de cálculos, complicaciones, necesidad de analgésicos, requerimiento de nuevo tratamiento y escala visual analógica. Conclusión: El uso de fluoroscopia no altera la frecuencia de complicaciones ni la tasa libre de cálculos. Creemos que el uso de fluoroscopia no es indispensable en los casos en los que se consigue acceso a la pelvis renal (especialmente en procedimientos de ureteroscopia semirrígida) y que su uso debe ser limitado para evitar un aumento innecesario de exposición a la radiación


Objectives: The aim of this study was to evaluate the role of the use of fluoroscopy in patients undergoing retrograde intrarenal surgery and the effect on surgical outcomes. Material and methods: The patients who were admitted to our center with the diagnosis of kidney stones were divided into 2 groups. In group 1, routine fluoroscopy was used in all cases (n: 58). In group 2, the same procedure was performed without fluoroscopy (n: 67) and the results of the 2 groups were compared. Results: There were no statistically significant differences between the 2 groups in terms of operation time, stone-free rate, complication rate, need for analgesic and re-treatment requirement and Visual Analogic Scale score. Conclusion: The use of fluoroscopy does not alter the complication frequency and stone-free rate. We think that the use of fluoroscopy is not mandatory in cases in which renal pelvis access is achieved especially with semirigid ureteroscopy and that unnecessary fluoroscopy increases radiation exposure


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Fluoroscopia , Cálculos Renais/cirurgia , Avaliação de Resultado de Intervenções Terapêuticas , Nefrostomia Percutânea/métodos , Escala Visual Analógica , Ureteroscopia , Complicações Intraoperatórias , Procedimentos Cirúrgicos Urológicos/métodos
15.
Beijing Da Xue Xue Bao Yi Xue Ban ; 51(6): 1155-1158, 2019 Dec 18.
Artigo em Chinês | MEDLINE | ID: mdl-31848521

RESUMO

OBJECTIVE: To evaluate the safety and efficacy of endoscopic treatment for ureterovesical junction (UVJ) stenosis in patients with kidney transplantation. METHODS: A retrospective study was conducted among the patients with kidney transplantation diagnosed as UVJ stenosis from 2012 March to 2018 July in Urology and Lithotripsy Center, Peking University People's Hospital. Only the patients who received endoscopic treatment were included, with staged or same-session nephrostomy followed by a retrograde ureteroscopy to evaluate the ureteral stenosis. Incisions with laser, mono- or bipolar energy, or balloon dilation were used to manage the stenosis depending on different situations. Demographic characteristics and clinical data were gathered and analyzed, including age, gender, preoperative serum creatinine, hemoglobin, operation time, success rate, postoperative serum creatinine, hemoglobin, postoperative complications rate, and long-term stenosis recurrence rate. RESULTS: In this study, 13 patients were included (9 males and 4 females). All the UVJ stenoses were diagnosed with preoperative ultrasound, CT scan, MRI, or urethrography. The mean age was 45 years (range 34-57 years). The mean preoperative serum creatinine was 243 µmol/L. Four patients developed UVJ stenosis 1 month after kidney transplantation, while the rest developed long-term stenosis. Fifteen operations were performed in all, of which 14 cases were successful while one failed. The first 8 cases received first-stage nephrostomy and second-stage endoscopic management of the stenosis, while the last 7 cases received the same session surgery. The mean operation time was 95.4 min vs. 68.9 min, and the immediate success rate was 87.5% vs. 100.0% in the first 8 cases and last 7 cases, respectively. The mean decrease of postoperative hemoglobin was 0.6 g/L and mean postoperative serum creatinine was 105 µmol/L. No postoperative fever, severe hematuria, and urine leak were observed. The mean postoperative hospital stay was 2.8 days. Three patients were able to remove ureteral stents and no recurrence was found with a follow-up time of 9, 17, and 82 months. The long-term stenosis recurrence rate was 76.9% (10/13). CONCLUSION: Endoscopic approach for the treatment of UVJ stenosis in patients with kidney transplantation was safe and efficient in our study cohort. However, long term stenosis recurrence rate was high and needed to be paid attention to.


Assuntos
Transplante de Rim , Obstrução Ureteral , Adulto , Feminino , Humanos , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Obstrução Ureteral/etiologia , Ureteroscopia
16.
Actas urol. esp ; 43(9): 474-479, nov. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185248

RESUMO

Objetivo: Evaluar la relación del espesor de la pared ureteral (EPU) con el éxito y los parámetros relacionados con la ureteroscopia para el tratamiento de cálculos ureterales proximales. Pacientes y métodos: Se incluyó a 82 pacientes con cálculos ureterales proximales y se dividieron en 2 subgrupos de acuerdo con el grosor de la pared ureteral: un grupo con 38 pacientes, EPU > 5 mm, y el segundo con 44, EPU < 5mm. Se evaluaron los siguientes parámetros: tamaño de la piedra, grado de hidronefrosis, diámetro de la luz ureteral proximal, el EPU y los datos demográficos de los pacientes. Se realizó ureteroscopia semirrígida con láser Ho-YAG y se evaluó el posible impacto del EPU sobre las tasas de éxito y los parámetros relacionados con el procedimiento. Resultados: La media de edad de los pacientes y el tamaño de los cálculos fueron 47,55 ± 1,78 años y 8,17 ± 0,29 mm, respectivamente. Con respecto al impacto del valor del EPU sobre los parámetros mencionados anteriormente, la tasa libre de cálculos una semana después del procedimiento fue mayor en el grupo 2 y la tasa de fragmentos residuales, así como la necesidad de colocación de catéter doble J, fueron más altas en el grupo 1. Adicionalmente, la duración media del procedimiento fue significativamente más larga en el grupo 1 y se observaron alteraciones patológicas en la pared ureteral significativamente mayores en estos casos (p = 0,0243). Conclusiones: El EPU es un factor útil al predecir el éxito del tratamiento ureteroscópico y otros parámetros relacionados con el procedimiento para los cálculos ureterales proximales. Con este enfoque, se podría realizar un plan operativo más adecuado, con mayores tasas de éxito, menos complicaciones y procedimientos adicionales


Aim: To evaluate the possible impact of stone impaction in terms of ureteral wall thickness (UWT) on the success and procedure related parameters of ureteroscopic management in proximal ureteral calculi. Patients and methods: 82 patients with proximal ureteric stones were included and were divided into 2 subgroups where UWT was > 5 mm in 38 cases; and < 5 mm in 44 cases. Stone size, degree of hydronehrosis, diameter of proximal ureteral luz, UWT and patient's demographics were evaluated. Semi-rigid ureteroscopy with Ho-YAG laser was performed and the possible impact of UWT as an objective parameter for stone impaction on the success rates and procedure related parameters was evaluated. Results: Mean patient age and stone size values were 47.55 ± 1.78 years and 8.17 ± 0.29 mm respectively. Regarding the impact of UWT value at the stone site for the parameters mentioned above stone free rates particularly at 1-week after the procedure was higher in group 2 and the rate of residual fragments as well as the need for double J stent placement was higher in group 1. Additionally, mean duration of the procedures was significantly longer in Group 1 during which pathologic alterations were significantly higher in ureteral wall at stone site were observed in these cases (P = .0243). Conclusions: UWT may be used to predict the success of ureteroscopic management and other procedure related parameters for proximal ureteral stones in an effective manner. With this approach a more rational operative plan with higher success rates, limited complications and auxiliary procedures could be made


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Cálculos Ureterais/diagnóstico , Cálculos Ureterais/cirurgia , Ureteroscopia/métodos , Litotripsia/métodos , Ureter/patologia , Ureter/cirurgia , Cateteres
18.
Arch Esp Urol ; 72(8): 765-771, 2019 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-31579035

RESUMO

OBJECTIVES: Confocal lasser endomicroscopy (CLE) is an optical technique that enables in vivo cytological characterization of a tissue. Previous studies have shown it useful in the evaluation of urinary and respiratory tracts for a better characterization of mucosal lesions, showing a high concordance between in vivo and final histopathological results. Recently, the use of CLE has been proposed for the study of transitional cell carcinoma of the upper urinary tract (UUT) during ureteroscopy, because it enables real time information about tumor grade and supplements the information of ureteroscopic biopsies, which may understimate the grade and stage of the lesion up to 43% of the cases due to its limitiations. METHODS: We performed a systematic review of the literature in the Pubmed/Medline database following the PRISMA standard. We selected 20 articles that complied with the inclusion criteria for evidence synthesis. RESULTS: Equipment miniaturization has enabled CLE as part of the diagnostic options in upper urinary tract tumors. This technique performs in vivo cytological characterization of the evaluated tissue, accomplishing differentiation between tumor and normal tissue, as well as tumor grade identification. Its communicated sensitivity and specificity reach 79%/78% respectively for low grade tumors and 67%/79% for high grade, with a substantial inter observer concordance (surgeon/pathologist; k = 0.64). No complications have been communicated in the literature with the use of fluorescein or confocal laser microscopy probes in patients undergoing this technique. CONCLUSIONS: CLE represents a useful and safe tool, capable of providing cytological real time information of UUT tumors that enables tumor grade identification with substantial concordance between in vivo tumor typifying and the final histopathological analysis. For this, CLE is currently considered a tool for conservative management of UUT transitional cell carcinoma in the European Association of Urology (EAU) guidelines.


Assuntos
Carcinoma de Células de Transição , Terapia a Laser , Sistema Urinário , Neoplasias Urológicas , Carcinoma de Células de Transição/terapia , Humanos , Microscopia Confocal , Ureteroscopia , Neoplasias Urológicas/terapia
19.
J Laparoendosc Adv Surg Tech A ; 29(11): 1492-1496, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31549927

RESUMO

Objective: To evaluate the experience and result of combined laparoscope and flexible ureteroscope (f-URS) pyelolithotomy in dealing with large-burden complex renal calculi in children <1 year old. Methods: Eleven patients (7 males and 4 females) <1 year old were retrospectively reviewed between December 2015 and May 2017, who had been diagnosed with renal calculi and received combined laparoscope and f-URS pyelolithotomy. The operations were carried out under general anesthesia. Patient' characteristics, presenting symptoms, operative times, and blood loss, stone-free rate, and postoperative complications were all collected retrospectively. Results: All 11 patients received combined laparoscope and f-URS pyelolithotomy. All operations went smoothly without conversion record and blood transfusion. Average time consumed was 109 minutes (55-187 minutes), and blood loss reported was 16 mL (10-25 mL). Average hospital stay after operation was 7 days (5-11 days). On mean follow-up of 6-12 months, no symptomatic urinary tract infections and urinary calculi were detected. Conclusion: Laparoscope combined f-URS pyelolithotomy is considered safe in the treatment of large-burden multiple renal calculi in infant patients with a high stone clearance rate. It has certain advantages in the treatment of renal calculi in infants <1 year old, and it could be an alternative treatment when other treatments fail or are unavailable.


Assuntos
Cálculos Renais/cirurgia , Laparoscopia , Ureteroscopia , Perda Sanguínea Cirúrgica , Feminino , Humanos , Lactente , Laparoscopia/efeitos adversos , Tempo de Internação , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Ureteroscópios , Ureteroscopia/efeitos adversos , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Procedimentos Cirúrgicos Urológicos/métodos
20.
Urologe A ; 58(11): 1289-1297, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31501985

RESUMO

Ureterorenoscopy and percutaneous nephrolitholapaxy are minimally invasive procedures and are the standard procedures for the treatment of kidney stones and ureteral calculi. To achieve an adequate view, in both methods an optimal and sufficient irrigation flow is necessary. The intrarenal pressure is influenced by the irrigation pressure and irrigation volume and has to be controlled. Pathologically elevated intrarenal pressure can lead to irreversible damage of the kidneys. Lasers are frequently used for stone fragmentation. It has been shown in studies that the laser energy can lead to an increase in the temperature and that thermal effects can also damage the kidneys. This article provides the surgeon with an overview about the effects of temperature and pressure changes during ureterorenoscopy and percutaneous nephrolitholapaxy and how damages can be avoided.


Assuntos
Temperatura Alta/efeitos adversos , Cálculos Renais/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Nefrostomia Percutânea/métodos , Pressão/efeitos adversos , Cálculos Ureterais/cirurgia , Ureteroscopia/métodos , Humanos , Cálculos Renais/diagnóstico , Resultado do Tratamento , Cálculos Ureterais/diagnóstico
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