RESUMO
OBJECTIVES: To test the chemo-preventative effects of omega-3 against bladder cancer (BC) induction in a rat model and its potential antineoplastic mechanisms. MATERIAL AND METHODS: Ninety male Fisher rats were divided into three groups during a 22-week protocol: group 1 (control), group 2 (Placebo + N-butyl-N-4- hydroxybutyl nitrosamine (BBN) for induction of BC and group 3 received omega-3 (1200 mg/kg/day) + BBN. At the end, blood samples and bladder tissues were collected and checked for the presence of malignancy, markers of angiogenesis (VEGF relative gene expression), inflammation (IL-6), proliferation (KI-67 expressions), oxidative stress (serum MDA and serum SOD) and epigenetic control (miRNA-145 level). RESULTS: At the end of the study, 60% and 86.6% rats survived in group 2 and 3 with significant weight loss among rats in group 2 when compared with other groups. In group 2, all rats developed visible bladder lesions of which five and 13 developed squamous cell carcinoma (SCC) and transitional cell carcinoma (TCC). In omega3-treated group, only one developed low grade SCC and one developed high grade non- invasive TCC. Bladders from omega-3-treated rats showed lower expression ofKI-67 (p < 0.05), VEGF (p < 0.001) and IL-6 (p < 0.001) and significant higher expression of mi-RNA (p < 0.001). Also, omega-3-treated group showed statistically significant lower MDA level (p < 0.001). CONCLUSION: Omega-3 inhibits bladder tumor growth in the BBN-induced BC rat model, due to anti-inflammatory, antioxidant, anti-proliferative, and anti-angiogenic properties together with epigenetic control.
Assuntos
Antineoplásicos , Carcinoma de Células de Transição , Ácidos Graxos Ômega-3 , MicroRNAs , Neoplasias da Bexiga Urinária , Animais , Antineoplásicos/uso terapêutico , Carcinogênese , Carcinoma de Células de Transição/tratamento farmacológico , Carcinoma de Células de Transição/genética , Carcinoma de Células de Transição/prevenção & controle , Ácidos Graxos Ômega-3/farmacologia , Interleucina-6 , Masculino , MicroRNAs/genética , MicroRNAs/uso terapêutico , Ratos , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/genética , Neoplasias da Bexiga Urinária/prevenção & controle , Fator A de Crescimento do Endotélio Vascular/genéticaRESUMO
OBJECTIVES: To study the efficacy of low-energy shock wave therapy (LESW) on enhancing intravesical epirubicin (EPI) delivery in a rat model of bladder cancer (BCa). MATERIALS AND METHODS: A total of 100 female Fischer rats were randomly allocated into five groups: control; BCa; LESW; EPI; and EPI plus LESW. After BCa induction by N-butyl-N-(4-hydroxybutyl)nitrosamine, EPI (0.6 mg/0.3 mL of EPI diluted in 0.3 mL saline) or saline (0.6 mL) was administered and retained in the bladders for 1 h with or without LESW treatment (300 pulses at 0.12 mJ/mm2 ). This was repeated weekly for 6 weeks. Survival was then calculated, rats were weighed and their bladders were harvested for bladder/body ratio estimation, histopathological examination, p53 immunostaining, miR-210, hypoxia-inducible factor (HIF)-1α, tumour necrosis factor (TNF)-α and interleukin (IL)-6 relative gene expression and fluorescence spectrophotometric drug quantification. Heart and blood samples were also collected for assessment of the safety profile and toxicity. RESULTS: The EPI plus LESW group had significantly lower mortality rates, loss of body weight and bladder/body ratio. Histopathological results in terms of grossly visible bladder lesions, mucosal thickness, dysplasia formation and tumour invasion were significantly better in the combined treatment group. The EPI plus LESW group also had statistically significant lower expression levels of p53 , miR-210, HIF-1α, TNF-α and IL-6. LESW increased urothelial concentration of EPI by 5.7-fold (P < 0.001). No laboratory variable exceeded the reference ranges in any of the groups. There was an improvement of the indicators of EPI-induced cardiomyopathy in terms of congestion, hyalinization and microvesicular steatosis of cardiomyocytes (P = 0.068, 0.003 and 0.046, respectively) in the EPI plus LESW group. CONCLUSIONS: The combined use of intravesical EPI and LESW results in less BCa invasion and less dysplasia formation, as LESW increases urothelial permeability of EPI and enhances its delivery into tumour tissues, without subsequent toxicity.
Assuntos
Antibióticos Antineoplásicos/administração & dosagem , Epirubicina/administração & dosagem , Tratamento por Ondas de Choque Extracorpóreas , Neoplasias da Bexiga Urinária/tratamento farmacológico , Urotélio/metabolismo , Administração Intravesical , Animais , Antibióticos Antineoplásicos/efeitos adversos , Antibióticos Antineoplásicos/farmacocinética , Peso Corporal , Butilidroxibutilnitrosamina , Sistemas de Liberação de Medicamentos , Epirubicina/efeitos adversos , Epirubicina/farmacocinética , Feminino , Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Interleucina-6/metabolismo , MicroRNAs/metabolismo , Permeabilidade , Ratos , Ratos Endogâmicos F344 , Taxa de Sobrevida , Proteína Supressora de Tumor p53/metabolismo , Neoplasias da Bexiga Urinária/induzido quimicamente , Neoplasias da Bexiga Urinária/patologiaRESUMO
OBJECTIVE: To compare high-power holmium laser lithotripsy (HP-HLL) and ultrasonic lithotripsy (US-L) for disintegration of staghorn stones during percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: A non-inferiority randomised controlled trial was conducted between August 2011 and September 2014. Inclusion criteria were patients' aged >18 years who had complete staghorn stones (branching to the three major calyces), without contraindications to PCNL. Eligible patients were randomised between two groups: HP-HLL and US- . A standard PCNL in the prone position was performed for all patients. The only difference between the treatment groups was the method of stone disintegration. In the first group (HP-HLL), a laser power of 40-60 W (2 J, 20-30 Hz) was used to pulverise the staghorn stone into very small fragments, which could pass through the Amplatz sheath with the irrigation fluid. US-L,with suction of the fragments, was used in the second group. The primary outcome (stone-free rate) was evaluated with non-contrast computed tomography after 3 months. Secondary outcomes of complications, blood transfusion, operative time, and haemoglobin deficit were compared. The outcome assessor was 'blinded' to the treatment arm. RESULTS: The study included 70 patients (35 in each group). The baseline characteristics (age, sex, body mass index, side, stone volume, and density) and operative technique (number, size of tracts, and need for second PCNL session) were comparable for both groups. Operative time was significantly shorter in US-L group, at a mean (SD) of 130 (34) vs 148.7 (35) min (P = 0.028). The haemoglobin deficit was significantly more with in the US-L group, at a mean (SD) of 1.7 (0.9) vs 1.3 (0.6) g/dL (P = 0.037). The differences in blood transfusion (17% for US-L vs 11% for HP-HLL) and the complication rates (34% for US-L vs 23% for HP-HLL) were not significant (P = 0.495 and P = 0.290, respectively). The stone-free rates at 3 months were comparable (60% for US-L and 66% for HPL-L; P = 0.621). CONCLUSIONS: Compared with US-L for intracorporeal lithotripsy of staghorn stones during PCNL, HP-HLL showed comparable safety and efficacy with a lower haemoglobin deficit but longer operative time.
Assuntos
Lasers de Estado Sólido/uso terapêutico , Litotripsia , Nefrostomia Percutânea , Cálculos Coraliformes/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Método Simples-CegoRESUMO
UNLABELLED: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Extracorporeal shockwave lithotripsy is effective for the treatment of paediatric renal stones with favourable short-term safety. Extracorporeal shockwave lithotripsy for treatment of paediatric renal stones is also safe for the kidney and the child on long-term follow-up. OBJECTIVE: To evaluate the long-term effects of extracoporeal shockwave lithotripsy (SWL) for treatment of renal stones in paediatric patients. PATIENTS AND METHODS: A database of paediatric patients who underwent SWL monotherapy for treatment of renal stones from September 1990 through to January 2009 was compiled. This study included only patients with follow-up for more than 2 years. The long-term effects of SWL were evaluated at the last follow-up with measurement of patients' arterial blood pressure, estimation of random blood sugar and urine analysis. The results of diastolic blood pressure were plotted against a standardized age reference curve. The treated kidney was examined by ultrasonography for measurement of renal length and detection of stones. The measured renal lengths were plotted against age-calculated normal renal lengths in healthy individuals. RESULTS: The study included 70 patients (44 boys (63%) and 26 girls) with mean age at the time of SWL 6.5 ± 3.6 years (range 1-14). The mean follow-up period was 5.2 ± 3.6 years (range 2.1-17.5). The mean age at last follow-up was 11.7 ± 5.3 years (range 4.4-27.5). No patients developed hypertension or diabetes. Only one treated kidney was smaller than one standard deviation of the calculated length. The cause of this was obstruction by a stone in the pelvic ureter 3 years after SWL. CONCLUSION: The long-term follow-up after SWL for treatment of renal stones in paediatric patients showed no effect on renal growth and no development of hypertension or diabetes.
Assuntos
Cálculos Renais/terapia , Litotripsia/métodos , Segurança do Paciente , Adolescente , Fatores Etários , Criança , Desenvolvimento Infantil/fisiologia , Pré-Escolar , Estudos de Coortes , Bases de Dados Factuais , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Cálculos Renais/diagnóstico por imagem , Litotripsia/efeitos adversos , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Tempo , Resultado do Tratamento , UltrassonografiaRESUMO
OBJECTIVES: To define factors affecting the stone-free rate of extracorporeal shockwave lithotripsy in the treatment of pediatric renal calculi, and to establish a regression model for pretreatment prediction of stone-free probability. METHODS: From January 1999 through February 2012, 207 children with mean age 6.4 ± 3.8 years underwent shockwave lithotripsy with Dornier Lithotripter S for treatment of renal stones. The stone-free rate was evaluated 3 months after the last shockwave lithotripsy session with non-contrast computed tomography. Treatment success was defined as complete clearance of the stones with no residual fragments. Multivariate logistic regression analysis was used to identify independent risk factors and to predict the probability of being stone free. RESULTS: The mean length of the stone was 11.6 ± 4 mm. The stone-free rate was 71%. Independent factors that adversely affect stone-free rate were increasing stone length and calyceal site of the stone. Relative risks for not being free of stones were 1.123 for stone length, 2.673 for stones in the upper or middle calyx and 4.208 for lower calyx stones. CONCLUSION: Stone length and location are prognostic factors determining stone-free rate after shockwave lithotripsy for renal calculi in pediatric patients. Based on our analysis, shockwave lithotripsy should be recommended for renal pelvis stones up to 24 mm, upper or middle calyceal stones up to 15 mm and lower calyceal stones up to 11 mm.
Assuntos
Cálculos Renais/epidemiologia , Cálculos Renais/terapia , Litotripsia/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Criança , Pré-Escolar , Intervalo Livre de Doença , Feminino , Humanos , Litotripsia/efeitos adversos , Modelos Logísticos , Masculino , Análise Multivariada , Prognóstico , Medição de Risco/métodos , Fatores de Risco , Resultado do TratamentoRESUMO
PURPOSE: To retrospectively assess the value of magnetic resonance imaging (MRI) in the diagnosis of vesicouterine fistula (VUF). MATERIALS AND METHODS: Between January 2003 and January 2011, 12 patients with a diagnosis of VUF were surgically managed at our center; among them, eight patients had MRI among their preoperative radiological investigations and those were included in our study. The clinical presentation, radiological investigations, and surgical findings of the patients were reviewed. RESULTS: The mean age of the patients was 31 years. Seven of the eight patients had complaints of cyclic hematuria and the remaining patient complained of urinary leakage through the vagina. The etiology of VUF was cesarean section in all patients. The preoperative radiological investigations included conventional cystography in five patients, intravenous urography in two, computed tomography (CT) urography in two, and MRI in eight. The sensitivities of diagnosis for these investigations were 40%, 0%, 50%, and 100%, respectively. CONCLUSION: In our small retrospective series, pelvic MRI was reliable and sensitive for diagnosis of VUF. It should be considered in the work-up of patients with suspected VUF.
Assuntos
Imageamento por Ressonância Magnética/métodos , Fístula Vesicovaginal/patologia , Adulto , Feminino , Humanos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto JovemRESUMO
Adjuvant medical expulsive therapy (MET) for shock wave lithotripsy (SWL) is controversial. With limited use of the computed tomography (CT), the stone free rate (SFR) become overestimated. Herein we evaluate tamsulosin post-SWL for renal stone using the CT to assess SFR. A randomized controlled trial (NCT05032287) was carried out for renal stone patients amenable for SWL. Patients were allocated after 1st session of SWL to receive tamsulosin 0.4 mg or placebo once daily from the 1st day of SWL and for 3-months or becoming stone free. The primary outcome was SFR, defined by presence of residual fragments (RF) ≤ 3 mm (3C-SFR). The 3C-SFR were 73.8% and 59.6% in tamsulosin and placebo groups, respectively (p = 0.03). The median (IQR) pain scores were 3 (3, 5) and 5 (3, 6) in tamsulosin and placebo groups, respectively (p = 0.04), However, the post-SWL complication and add-on analgesia needed showed no significance differences between groups. The median time for stone free were 30 days (95% CI: 27.29-32.71) in tamsulosin arm, and 36 days (95% CI: 31.01-40.99) in placebo arm, HR = 1.42 (95% CI: 1.02-1.98). Tamsulosin has more reversible adverse effect, compared to placebo (p = 0.03). In our study, the use of tamsulosin as MET following SWL facilitates expulsion of retained residual fragments. Tamsulosin shortens time to reach stone free, decreases pain scores. However, tamsulosin does not affect the add-on IV analgesics and have more reversible adverse effect, compared to placebo.
Assuntos
Cálculos Renais , Litotripsia , Cálculos Ureterais , Humanos , Cálculos Renais/etiologia , Litotripsia/efeitos adversos , Litotripsia/métodos , Dor/etiologia , Sulfonamidas/efeitos adversos , Tansulosina/uso terapêutico , Resultado do Tratamento , Cálculos Ureterais/tratamento farmacológicoRESUMO
OBJECTIVE: ⢠To study long-term results of percutaneous nephrolithotomy (PNL) for treatment of staghorn stones. PATIENTS AND METHODS: ⢠The records of patients who underwent PNL for staghorn stones between January 1998 and January 2008 were retrospectively reviewed. ⢠Patients who completed follow-up for one year or more were included. Follow-up with KUB and renal ultrasonography were performed every 3-6 months. ⢠Renal radioisotopic scan was performed for patients who had already undergone this study before doing PNL. RESULTS: ⢠The study included 122 patients (69 male and 53 female) with mean age 47.6 ± 14.5 years (5-74). They underwent 126 PNL. ⢠Perioperative complications were encountered in 28 procedures (22%). The mean period of follow-up was 3.5 ± 2.3 years (1-11.3). Among 71 stone-free kidneys, 18 (25%) developed stone recurrence. Of 55 kidneys with residuals at the start of follow-up, 36 (65%) showed growth of these residuals. ⢠Preoperative and postoperative renograms were performed for 71 patients. ⢠At the last follow-up, differential GFR was stable in 53 (74.5%), improved in 12 (17%) and deteriorated in 6 (8.5%). Among patients with deteriorated renal function, 3 had undergone embolization to control severe bleeding, one developed secondary UPJO, and one had recurrent stone obstructing the kidney. CONCLUSION: ⢠Long-term functional results of PNL for staghorn stones are satisfactory as 91.5% of kidneys showed stable or improved GFR. Long-term follow-up is mandatory especially for patients with residual stones.
Assuntos
Cálculos Renais/cirurgia , Nefrostomia Percutânea , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Cálculos Renais/fisiopatologia , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Nefrostomia Percutânea/métodos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: To determine factors affecting the success of bilateral same-session ureteroscopy (BSU) in the treatment of ureteral calculi. MATERIAL AND METHODS: From January 2003 to December 2008, BSU was carried out in 89 patients (178 renal units). A successful outcome was considered when both ureters were free of stones without intraoperative complications. Stone-free rate was evaluated with a kidney-ureter-bladder plain X-ray or non-contrast computed tomography. Factors interfering with successful completion of BSU were tested using univariate (chi-squared test and t test) and multivariate (logistic regression) analyses. Data on unilateral ureteroscopy for the treatment of multiple ureteral calculi carried out in 105 patients during the same period were compared with BSU. RESULTS: Intraoperative complications were recorded in 11 procedures (6.2%) in the form of ureteral perforation in three and mucosal injury in eight. After BSU, 153 renal units were stone free (86%) as 17 had residual fragments, stones migrated to the kidney in six and failure was encountered in two. A successful outcome was observed in 62 patients (70%). Stone impaction, stones located in the proximal ureter and stone surface area were the significant risk factors for unsuccessful BSU (relative risks 3.6, 3.3 and 1.47, respectively). Compared with unilateral ureteroscopy, no difference were found with regard to complication rate (6.7%, p = 0.5) or stone-free rate (80%, p = 0.2). CONCLUSIONS: Bilateral same-session ureteroscopy is a safe and effective procedure in the management of bilateral ureteral stones. Proximal ureteral calculi, large and impacted stones carry the highest risk of unsuccessful results.
Assuntos
Cálculos Ureterais/cirurgia , Ureteroscopia/efeitos adversos , Ureteroscopia/métodos , Adolescente , Adulto , Idoso , Feminino , Humanos , Incidência , Complicações Intraoperatórias , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Ureter/lesões , Adulto JovemRESUMO
PURPOSE: We determined the factors predicting unfavorable results of semirigid ureteroscopy for ureteral calculi. MATERIALS AND METHODS: We reviewed the computerized files of 841 patients who underwent a total of 908 ureteroscopic procedures for ureteral stones from January 2003 through December 2006. A semirigid 6/7.5Fr ureteroscope was used in pediatric patients and an 8/10Fr or 8.5/11.5Fr ureteroscope was used in adults. Patients with favorable results were those who became stone-free after a single ureteroscopic procedure without any complications. They were compared with patients who had unfavorable results using univariate (chi-square and t tests) and multivariate (logistic regression) statistical tests to identify risk factors for unfavorable results. RESULTS: The study included 567 males and 274 females with a mean age of 48.5 years (range 2 to 81). The complication rate was 6.7% (61 procedures). The stone-free rate after a single ureteroscopic intervention was 87% (791 procedures). Favorable results were documented in 751 procedures (82.7%). Significant factors for unfavorable results were proximal ureteral stones, ureteroscopy done by surgeons other than experienced endourologists, stone impaction and stone width (relative risk 4, 2.5, 1.8 and 1.2, respectively). CONCLUSIONS: Semirigid ureteroscopy is a safe and highly effective treatment modality for ureteral stones.
Assuntos
Cálculos Ureterais/terapia , Ureteroscópios , Ureteroscopia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Adulto JovemRESUMO
PURPOSE: We aimed at this study to test the value of immediate postoperative intravesical epirubicin instillation in intermediate and high-risk non-muscle-invasive bladder cancer patients. MATERIALS AND METHODS: After approval of Institutional Review Board, 260 patients were randomly allocated into 2 groups, including transurethral resection of bladder tumor (TURBT) alone in control group and TURBT plus immediate postoperative epirubicin (50 mg) in test group. Patients were monitored for postoperative complications. Adjuvant instillation therapy was administered according to risk categorization. Patients were followed every 3 months by cystourethroscopy and urine cytology. The primary end points were recurrence, progression, and/or death from cancer. RESULTS: Of the 260 patients, 236 were eligible and followed for a mean of 29 months. The 2 study groups were comparable regarding perioperative baseline demographic criteria. There was no statistically significant difference between the 2 groups regarding recurrence rate (27.1% vs. 26.2%), interval to first recurrence (16.3 ± 6.6 vs. 16.4 ± 6.4 months) or progression rate to muscle invasion (8.5% vs. 5.9%). Site, size, and number of recurrences were also comparable between the 2 groups. Recurrences and progression-free survival were comparable between the 2 groups (Log-rank Pâ¯=â¯0.88 and 0.47, respectively). Postoperative complications were all low-grade according to modified Dindo-Clavian system, with no significant difference in their rate between the 2 groups. CONCLUSIONS: Immediate post-TURBT epirubicin instillation is ineffective in intermediate and high-risk non-muscle-invasive bladder cancer. It neither prolongs time to recurrence and/or progression nor reduces number of recurrences. We advocate strict specification of patient and tumor criteria in which immediate instillation is indicated.
Assuntos
Antibióticos Antineoplásicos/administração & dosagem , Cistectomia , Epirubicina/administração & dosagem , Recidiva Local de Neoplasia/prevenção & controle , Neoplasias da Bexiga Urinária/terapia , Administração Intravesical , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante/métodos , Cistoscopia , Progressão da Doença , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/patologia , Cuidados Pós-Operatórios/métodos , Intervalo Livre de Progressão , Resultado do Tratamento , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/patologia , Bexiga Urinária/cirurgia , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologia , Adulto JovemRESUMO
PURPOSE: This study was conducted to evaluate the safety and efficacy of the supracostal approach for percutaneous nephrolithotomy in pediatric patients. MATERIALS AND METHODS: We retrospectively reviewed 60 percutaneous nephrolithotomy procedures done in 50 children (32 boys and 18 girls) between 2000 and 2007. Mean patient age was 7 +/- 4 years (range 9 months to 14 years). Noncontrast computerized tomography was the primary radiological investigation for most of the cases. The subcostal approach was used in 40 procedures, and the supracostal approach (above the 12th rib) was required in 20. We compared both approaches regarding preoperative characteristics, stone-free and complication rates, and the need for auxiliary procedures. RESULTS: The preoperative characteristics of the patients, urinary tracts and stones were comparable for both treatment groups. There were no major complications. Significant bleeding requiring blood transfusion was observed in 3 patients (5%), transient fever in 3 (5%) and urinary leakage through the nephrostomy site in 3 (5%). The distribution of complications among subcostal and supracostal approaches was comparable. Of the 60 renal units 46 (77%) were stone-free after percutaneous nephrolithotomy at discharge from the hospital. Of the remaining 14 units 9 (15%) were stone-free after shock wave lithotripsy and 5 (8%) had insignificant residual stones. Therefore, the overall stone-free rate at 3 months was 92.5%. Comparing the subcostal and supracostal approaches, there were no significant differences between hospital stays, complication rates, unplanned auxiliary procedures, and stone-free rates at discharge home and at 3-month followup. CONCLUSIONS: Percutaneous nephrolithotomy for treating renal stones in children provides a high degree of safety and efficacy whether a supracostal or subcostal approach is used.
Assuntos
Cálculos Renais/cirurgia , Litotripsia/métodos , Nefrostomia Percutânea/métodos , Adolescente , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Seguimentos , Humanos , Lactente , Cálculos Renais/diagnóstico por imagem , Tempo de Internação , Litotripsia/efeitos adversos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Nefrostomia Percutânea/efeitos adversos , Dor Pós-Operatória/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Probabilidade , Radiografia Intervencionista , Estudos Retrospectivos , Medição de Risco , Gestão da Segurança , Resultado do TratamentoRESUMO
OBJECTIVES: The aim of this study was to report the incidence, severity, outcome and risk factors of acute kidney injury (AKI) following percutaneous nephrolithotomy (PNL) in solitary kidneys. METHODS: The study included consecutive adult patients who underwent PNL for treatment of calculi in a solitary kidney between May 2012 and July 2015. Patients with congenital renal anomalies or with stages 4 and 5 chronic kidney disease (CKD) were excluded. Serum creatinine levels were measured the day before PNL, daily after PNL for 2-5 days and after 3 months. AKI was depicted according to changes in early postoperative serum creatinine levels and its severity was determined based on the Acute Kidney Injury Network (AKIN) classification. The outcome of AKI was evaluated after 3 months by changes in the stage of CKD. Univariate and multivariate statistical analyses were conducted to determine risk factors for developing AKI. RESULTS: The study included 100 patients (62 males) with a mean ± SD age of 50 ± 11.7 years. Complications were reported for 27 patients. AKI developed in 25 patients; at the 3 month follow-up, 23 of them (92%) had completely recovered from AKI and two (8%) had developed stage 4 CKD. Independent risk factors for developing AKI were multiple PNL tracts and postoperative ureteric obstruction (relative risks were 14 and 22, respectively). CONCLUSIONS: The incidence of AKI was 25% after PNL for a solitary kidney. The likelihood of renal function recovery was 92%. Multiple PNL tracts and postoperative ureteric obstruction were risk factors for developing AKI.
Assuntos
Injúria Renal Aguda/etiologia , Injúria Renal Aguda/fisiopatologia , Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/efeitos adversos , Injúria Renal Aguda/sangue , Adolescente , Adulto , Idoso , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/fisiopatologia , Fatores de Risco , Índice de Gravidade de Doença , Adulto JovemRESUMO
PURPOSE: To determine the predictors of the clinical outcome of residual fragments after extracorporeal shockwave lithotripsy (SWL). PATIENTS AND METHODS: During the last 10 years, residual fragments < or =5 mm were present in 99 male and 55 female patients (mean age 43.1 years) for >3 months after SWL for renal stones. Follow-up with history, urine examination, and non-contrast CT scanning was carried out every 6 months or when symptoms developed. Clinically insignificant residual fragments were diagnosed in patients who became stone free or had asymptomatic fragments of the same size during follow-up. A clinically significant outcome was considered to have occurred in patients requiring secondary intervention for regrowth of the fragments or medical treatment for frequent symptomatic episodes. Univariate (Kaplan-Meier) and multivariate (Cox-regression) analyses were performed to determine significant predictors of the outcome. The mean follow-up was 31 months (range 6-80 months). RESULTS: Stone-free status, regrowth of fragments, and persistence of fragments of the same size were present in 21 (13.6%), 52 (33.8%), and 81 (52.6%) patients, respectively. A clinically significant outcome was documented in 75 patients (48.7%) as percutaneous nephrolithotomy was needed in 2, repeat SWL in 50, and medical treatment for symptomatic episodes in 23 patients. Significant independent predictors of a clinically significant outcome were fragment size > or =4 mm and history of recurrent stone disease (P < 0.001). CONCLUSION: The term "clinically insignificant residual fragments" is not appropriate for all patients with post-SWL fragments, as 48.7% of patients had fragments that became clinically significant. Fragments of 4 to 5 mm and recurrent stone disease predicted clinical significance.
Assuntos
Cálculos Renais/terapia , Adolescente , Adulto , Idoso , Criança , Feminino , Seguimentos , Humanos , Litotripsia , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
PURPOSE: To determine factors affecting patients' discomfort during the period self-retaining ureteral stents are in place. PATIENTS AND METHODS: Between April 2001 and May 2003, 58 male and 42 female patients underwent temporary double-pigtail stenting. The indications were endopyelotomy in 39 patients, ureteroscopy in 32, laparoscopic pyeloplasty in 18, and endoureterotomy in 11. The stents were silicone in 56 patients and Percuflex in 44. The median stenting period was 8 weeks (range 4-16 weeks). Patient discomfort was evaluated by a questionnaire conducted by the physician before stent removal. Tested variables were patients' sex, side of the stent, urine culture, stent material, stent length and diameter, and stenting duration. The site of the upper coil (renal pelvis or calix), the site of the lower coil (in the same side or crossing the midline), and the shape of the lower coil (complete circle or not) were also tested. Univariate and multivariate analysis were carried out to determine significant independent variables, with P < 0.05 being significant. RESULTS: Of the total, 59 patients experienced discomfort consisting of dysuria, urgency, urge incontinence, loin pain, suprapubic pain, frequency, nocturia, or gross hematuria or some combination. Significant factors associated with discomfort were a positive urine culture, crossing of the lower end of the stent to the opposite side, caliceal position of the upper coil, and longer stenting duration. CONCLUSION: Proper positioning of the coils of the stent, eradication of infection, and shorter stenting duration are advised to decrease patient discomfort during the period of ureteral stenting.
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Satisfação do Paciente , Implantação de Prótese/instrumentação , Stents , Obstrução Ureteral/cirurgia , Transtornos Urinários/etiologia , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Desenho de Prótese , Implantação de Prótese/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , Obstrução Ureteral/diagnóstico por imagem , Urografia , Procedimentos Cirúrgicos Urológicos/instrumentaçãoRESUMO
[This corrects the article DOI: 10.1016/j.aju.2015.04.002.].
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[This corrects the article DOI: 10.1016/j.aju.2012.03.002.].
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OBJECTIVE: To compare the efficacy, safety and cost of extracorporeal shockwave lithotripsy (ESWL) and percutaneous nephrolithotomy (PNL) for treating a 20-30 mm single renal pelvic stone. PATIENTS AND METHODS: The computerised records of patients who underwent PNL or ESWL for a 20-30 mm single renal pelvic stone between January 2006 and December 2012 were reviewed retrospectively. Patients aged <18 years who had a branched stone, advanced hydronephrosis, a solitary kidney, anatomical renal abnormality, or had a surgical intervention within the past 6 months were excluded. The study included 337 patients with a mean (SD, range) age of 49.3 (12.2, 20-81) years. The patients' criteria (age, sex, body mass index) and the stone characteristics (side, stone length, surface area, attenuation value and skin-to-stone distance) were compared between the groups. The re-treatment rate, the need for secondary procedures, success rate, complications and the total costs were calculated and compared. RESULTS: In all, 167 patients were treated by ESWL and 170 by PNL. The re-treatment rate (75% vs. 5%), the need for secondary procedures (25% vs. 4.7%) and total number of procedures (three vs. one) were significantly higher in the ESWL group (P < 0.001). The success rate was significantly higher in the PNL group (95% vs. 75%, P < 0.001), as was the complication rate (13% vs. 6.6%, P = 0.050). The total costs of primary and secondary procedures were significantly higher for PNL (US$ 1120 vs. 490; P < 0.001). CONCLUSIONS: PNL was more effective than ESWL for treating a single renal pelvic stone of 20-30 mm. However, ESWL was associated with fewer complications and a lower cost.
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OBJECTIVE: To evaluate the long-term functional outcome of percutaneous nephrolithotomy (PNL) for calculi in solitary kidneys and to determine factors leading to renal function deterioration. MATERIALS AND METHODS: The computerized files of patients with solitary kidneys who underwent PNL between January 2002 and December 2009 were retrospectively reviewed. Patients with follow-up <2 years were excluded. Complications, secondary procedures, and stone-free rates were recorded. Changes in the renal function were judged by comparing preoperative and postoperative estimated glomerular filtration rates. Preoperative, intraoperative, and postoperative factors that may affect renal function were tested using univariate and multivariate analyses to define risk factors for deterioration of renal function on long-term follow-up. RESULTS: The study included 200 patients (133 men [66.5%] and 67 women [33.5%] with mean age 52.3 ± 11.7 years). Complications were reported in 34 patients (17%). Severe bleeding was noticed in 10 patients (5%). The overall stone-free rate was 89.5%. After a mean follow-up of 3 ± 1.4 years (range, 2-8), there was significant improvement of the estimated glomerular filtration rate from 57 to 64 mL/min (P <.001). Thirty-one patients (15.5%) showed deterioration of the renal function. Multiple punctures and postoperative bleeding were independent risk factors for renal function deterioration (odds ratio was 3.7 and 4.5, respectively). CONCLUSION: PNL for calculi in solitary kidneys provided significant improvement in renal function at long-term follow-up. Multiple punctures and severe bleeding are independent risk factors for deterioration of the kidney function.
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Cálculos Renais/cirurgia , Rim/anormalidades , Rim/fisiopatologia , Nefrostomia Percutânea , Feminino , Seguimentos , Humanos , Cálculos Renais/complicações , Cálculos Renais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: To present the results of percutaneous nephrolithotomy (PCNL) for treating staghorn stones. PATIENTS AND METHODS: A database was compiled from the computerised files of patients who underwent PCNL for staghorn stones between 1999 and 2009. The study included 238 patients (128 males and 110 females) with a mean (SD) age of 48.9 (14) years, who underwent 242 PCNLs, and included staghorn stones that were present in the renal pelvis and branched into two or more major calyces. PCNL was performed or supervised by an experienced endourologist. All perioperative complications were recorded. The stone-free status was evaluated after PCNL and again after 3 months. RESULTS: Multiple tracts were needed in 35.5% of the procedures, and several sessions of PCNL were needed in 30% of patients. There were perioperative complications in 54 procedures (22%); blood transfusion was needed in 34 patients (14%). The stone-free rate for PCNL monotherapy was 56.6% (137 patients). Secondary procedures were required for 51 patients (21%), and included shock-wave lithotripsy for 49 and ureteroscopy for two. The 3-month stone-free rate was 72.7% (176 patients). Multiple tracts resulted in an insignificantly higher overall complication rate than with a single tract (P = 0.219), but the reduction in the haemoglobin level was statistically significant with multiple tracts (P = 0.001). CONCLUSIONS: PCNL for staghorn stones must be done by an experienced endourologist in a specialised centre with all the facilities for stone management and treatment of possible complications. The patients must be informed about the range of stone-free and complication rates, and the possibility of multiple sessions or secondary procedures.