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Id: biblio-1056351
Autor: Tubau, Valentí; Bauza, Jose Luis; Pieras, Enrique; Brugarolas, Xavier; Pizà, Pedro.
Título: Multiple renal tumorectomy in a Von Hipple Lindau patient. Combined retro/transperitoneal approach with intracorporeal hypotermia
Fonte: Int. braz. j. urol;45(6):1283-1284, Nov.-Dec. 2019.
Idioma: en.
Resumo: ABSTRACT Objective & Introduction: To show the feasibility of a combined transperitoneal (TP) and retroperitoneal (RP) laparoscopic approach in a Von Hipple-Lindau (VHL) patient with multiple kidney tumors. VHL is an autosomal dominant inherited syndrome characterized by a high incidence of benign and malignant tumors and cysts in many organs. Renal cell carcinoma is one of the most common and a leading cause of mortality (1). Surgical approach is usually complex because of its multiplicity and the need of maximum kidney function preservation due to the risk of future recurrences (2, 3). Intracorporeal renal hypothermia may be useful in these cases to prevent permanent renal function loss (4). Materials and Methods: A 40 years old male was being monitored for multiple bilateral renal masses. Family history included a VHL syndrome affecting his mother and sister. Past medical history included a VHL syndrome with multiple cerebellar and medular hemangioblastomas, a pancreatic cystoadenoma and bilateral kidney tumors which had significantly grown up during follow-up. The patient was scheduled for laparoscopic multiple partial nephrectomy. A combined TP and RP approach with intracorporeal hypothermia was chosen. Results: A total of six right kidney tumors were removed. Operative time was 240 min. Cold ischemia time was 50 min. Average kidney temperature was 23.7°C. Blood losses were negligible. The patient was discharged after 72 hours. No major changes in serum creatinine were found during the follow-up. Final pathology revealed a clear cell renal cell carcinoma, pT1a, ISUP grade 2 in most of the tumors but one ISUP grade 3. Surgical margins were negative. Conclusions: Combined TP and RP is a feasible alternative for the treatment of multiple renal tumors. It's safe and effective, allowing the use of intracorporeal hypothermia which may improve postoperative renal function. Consistent experience is needed before embarking on this surgery.
Descritores: Carcinoma de Células Renais/cirurgia
Laparoscopia/métodos
Doença de von Hippel-Lindau/cirurgia
Hipotermia Induzida/métodos
Neoplasias Renais/cirurgia
Nefrectomia/métodos
-Cavidade Peritoneal/cirurgia
Reprodutibilidade dos Testes
Resultado do Tratamento
Limites: Humanos
Masculino
Adulto
Tipo de Publ: Relatos de Casos
Responsável: BR1.1 - BIREME


  2 / 10873 LILACS  
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Id: biblio-1134251
Autor: Dias Filho, Aderivaldo Cabral; Maroccolo, Marcus Vinicius Osorio; Ribeiro, Homero de Paula; Riccetto, Cassio Luis Zanettini.
Título: Presentation delay, misdiagnosis, inter-hospital transfer times and surgical outcomes in testicular torsion: analysis of statewide case series from central Brazil
Fonte: Int. braz. j. urol;46(6):972-981, Nov.-Dec. 2020. tab, graf.
Idioma: en.
Resumo: ABSTRACT Purpose To estimate statewide presentation delay, misdiagnosis rate, inter-hospital transfer times and testicular salvage for testicular torsion patients treated in our state's public health system. Patients and Methods Case series of consecutive testicular torsion patients treated in our state's public health system between 2012-2018. Predictors included presentation delay (time from symptoms to first medical assessment), facilitie's level-of-care (primary, secondary, tertiary), first diagnosis (torsion, epididymitis, other), Doppler-enhanced ultrasound request (Doppler-US) and inter-hospital transfer times, with surgical organ salvage as the main response. We used Bayesian regression to estimate the effect of first examining facilitie's level-of-care, first diagnosis, and Doppler-US on transfer time. Results 505 patients were included, most (298, 59%) with presentation delay >6 hours. Misdiagnosis at first examining facility raised transfer time from median 2.8 to 23.4 (epididymitis) and 37.9 hours (other) and lowered testicular salvage rates from 60.3% (torsion) to 10.7% (epididymitis) and 18.3% (other). Doppler-US had negligible effects on transfer time once controlling for misdiagnosis in the regression model. Although organ salvage in patients presenting before 6 hours at the tertiary facility was high (94.6%, and about 20% lower for those presenting at lower levels-of-care), the overall salvage rate was more modest (46%). Conclusion Our low overall testicular salvage rates originated from a large proportion of late presentations combined with long transfer times caused by frequent misdiagnoses. Our results indicate that efforts to improve salvage rates should aim at enhancing population-wide disease awareness and continuously updating physicians working at primary and secondary levels-of-care about scrotal emergencies.
Descritores: Torção do Cordão Espermático/cirurgia
Torção do Cordão Espermático/diagnóstico por imagem
-Brasil
Estudos Retrospectivos
Teorema de Bayes
Resultado do Tratamento
Erros de Diagnóstico
Hospitais
Limites: Humanos
Masculino
Responsável: BR1.1 - BIREME


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Id: biblio-1134258
Autor: Torricelli, Fabio C. M; Monga, Manoj.
Título: Staghorn renal stones: what the urologist needs to know
Fonte: Int. braz. j. urol;46(6):927-933, Nov.-Dec. 2020. graf.
Idioma: en.
Resumo: ABSTRACT Patients with staghorn renal stones are challenging cases, requiring careful preoperative evaluation and close follow-up to avoid stone recurrence. In this article we aim to discuss the main topics related to staghorn renal stones with focus on surgical approach. Most of staghorn renal stones are composed of struvite (magnesium ammonium phosphate) and are linked to urinary tract infection by urease-producing pathogens. Preoperative computed tomography scan and careful evaluation of all urine cultures made prior surgery are essential for a well-planning surgical approach and a right antibiotics choice. Gold standard surgical technique is the percutaneous nephrolithotomy (PCNL). In cases of impossible percutaneous renal access, anatrophic nephrolithotomy is an alternative. Shockwave lithotripsy and flexible ureteroscopy are useful tools to treat residual fragments that can be left after treatment of complete staghorn renal stone. PCNL can be performed in supine or prone position according to surgeon's experience. Tranexamic acid can be used to avoid bleeding. To check postoperative stone-free status, computed tomography is the most accurate imaging exam, but ultrasound combined to KUB is an option. Intra-operative high-resolution fluoroscopy and flexible nephroscopy have been described as an alternative for looking at residual fragments and save radiation exposure. The main goals of treatment are stone-free status, infection eradication, and recurrence prevention. Long-term or short-term antibiotic therapy is recommended and regular control imaging exams and urine culture should be done.
Descritores: Nefrostomia Percutânea
Cálculos Coraliformes/cirurgia
Cálculos Coraliformes/diagnóstico por imagem
Rim
-Resultado do Tratamento
Urologistas
Limites: Humanos
Masculino
Feminino
Tipo de Publ: Revisão
Responsável: BR1.1 - BIREME


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Id: biblio-1134260
Autor: Alger, Jordan; Wright IV, Henry Collier; Desale, Sameer; Venkatesan, Krishnan.
Título: Larger patients shouldnt have fewer options: urethroplasty is safe in the obese
Fonte: Int. braz. j. urol;46(6):962-970, Nov.-Dec. 2020. tab, graf.
Idioma: en.
Resumo: ABSTRACT Objective To examine the impact of obesity on perioperative outcomes and urethral stricture recurrence after anterior urethroplasty. Material and Methods We reviewed our prospectively maintained single-surgeon database to identify men with anterior urethral strictures who had undergone anastomotic or augmentation urethroplasty between October 2012 and March 2018. In all, 210 patients were included for primary analysis of perioperative outcomes, while 193 patients with at least 12 months follow-up were included for secondary analysis of stricture recurrence. Patients grouped by BMI were compared using univariate and multivariate analyses for perioperative outcomes and log rank testing for recurrence-free survival. Results Overall, 41% (n=86) of patients were obese and 58.6% (n=123) had bulbar urethral strictures. Obese patients had significantly longer urethral strictures (mean=6.7cm±4.7) than nonobese patients (p <0.001). Though urethroplasty in obese patients was associated with increased estimated blood loss (EBL) relative to normal BMI patients on both univariate (p=0.003) and multivariate (p <0.001) analyses, there was no difference in operative time, length of stay, or complication rate between BMI groups. At a mean follow-up interval of 36.7 months, 15% (n=29) of patients had stricture recurrence, yet recurrence-free survival was not significantly different between groups (log rank p=0.299). Dorsal augmentation urethroplasty resulted in significantly fewer recurrences in obese patients compared to nonobese patients (p=0.036). Conclusion Despite the association with increased urethral stricture length and EBL, obesity is not predictive of adverse perioperative outcomes or stricture recurrence. Obese patients should be offered urethral reconstruction, but patient selection and preoperative counseling remain imperative.
Descritores: Procedimentos Cirúrgicos Urológicos Masculinos
Estreitamento Uretral/cirurgia
-Recidiva
Uretra/cirurgia
Estudos Retrospectivos
Resultado do Tratamento
Pessoa de Meia-Idade
Recidiva Local de Neoplasia
Obesidade/complicações
Limites: Humanos
Masculino
Adulto
Idoso
Responsável: BR1.1 - BIREME


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Id: biblio-1134262
Autor: Sahan, Murat; Sarilar, Omer; Akbulut, Mehmet Fatih; Demir, Eren; Savun, Metin; Sen, Oznur; Ozgor, Faruk.
Título: Flexible ureterorenoscopy and laser lithotripsy with regional anesthesia vs general anesthesia: A prospective randomized study
Fonte: Int. braz. j. urol;46(6):1010-1018, Nov.-Dec. 2020. tab, graf.
Idioma: en.
Resumo: ABSTRACT Purpose To compare the effect of general anesthesia (GA) and regional anesthesia (RA) on f-URS outcomes and surgeon comfort. Material and Methods The study was conducted between June 2017 to January 2018 and data collection was applied in a prospective, randomized fashion. 120 patients participated in the study and were divided into RA group (n=56) and GA group (n=64). Demographic, operative and post-operative parameters of patients were analysed. The end point of this study was the effect of two anesthesia regimens on the comfort of the surgeon, and the comparability of feasibility and safety against perioperative complications. Results The study including 120 randomized patients, 14 patients were excluded from the study and completed with 106 patients (45 in RA group and 61 in GA group). No difference was detected between the two groups in terms of preoperative data. During the monitorization of operative vital signs, 3 patients in RA group experienced bradycardia, and this finding was significant when compared with GA group (p=0.041). Additionally, 2 patients in RA group experienced mucosal tears and 1 patient experienced hemorrhage during the operation, but no complications were observed in the GA group (p=0.041). Postoperative surgeon comfort evaluation revealed statistically significant results in favor of GA group (p=0.001). Conclusions Both GA and RA are equally effective and safe anesthesia methods for f-URS procedures. However, RA group showed significantly increased likelihood of bradycardia and mucosal injury during surgery, and significantly decreased surgeon comfort during surgery.
Descritores: Litotripsia a Laser/efeitos adversos
Anestesia por Condução
-Estudos Prospectivos
Estudos Retrospectivos
Resultado do Tratamento
Anestesia Geral
Pessoa de Meia-Idade
Limites: Humanos
Masculino
Feminino
Adulto
Tipo de Publ: Ensaio Clínico Controlado Aleatório
Responsável: BR1.1 - BIREME


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Id: biblio-1134255
Autor: Hampl, Daniel Sá Rego.
Título: Editorial Comment: Presentation delay, misdiagnosis, inter-hospital transfer times and surgical outcomes in testicular torsion: analysis of statewide case series from central Brazil
Fonte: Int. braz. j. urol;46(6):982-983, Nov.-Dec. 2020.
Idioma: en.
Descritores: Torção do Cordão Espermático/cirurgia
Torção do Cordão Espermático/diagnóstico
-Brasil
Orquiectomia
Resultado do Tratamento
Erros de Diagnóstico
Hospitais
Limites: Humanos
Masculino
Tipo de Publ: Comentário
Editorial
Responsável: BR1.1 - BIREME


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Id: biblio-1134269
Autor: Wang, Yaxuan; Chang, Xueliang; Li, Jingdong; Han, Zhenwei.
Título: Efficacy and safety of various surgical treatments for proximal ureteral stone ≥10mm: A systematic review and network meta-analysis
Fonte: Int. braz. j. urol;46(6):902-926, Nov.-Dec. 2020. tab, graf.
Idioma: en.
Resumo: ABSTRACT Purpose Various surgical options are available for large proximal ureteral stones, such as extracorporeal shock wave lithotripsy (ESWL), ureteroscopic lithotripsy (URSL), percutaneous nephrolithotomy (PCNL) and laparoscopic ureterolithotomy (LU). However, the best option remains controversial. Therefore, we conducted a network meta-analysis comparing various surgical treatments for proximal ureteral stones ≥10mm to address current research deficiencies. Materials and methods We searched PubMed, Ovid, Scopus (up to June 2019), as well as citation lists to identify eligible comparative studies. All clinical studies including patients comparing surgical treatments for proximal ureteral stones ≥10mm were included. A standard network meta-analysis was performed with Stata SE 14 (Stata Corp, College Station, TX, USA) software to generate comparative statistics. The quality was assessed with level of evidence according to the Oxford Centre for Evidence-based Medicine and risk of bias with the Cochrane Collaboration's Review Manager (RevMan) 5.3 software. Results A total of 25 studies including 2.888 patients were included in this network meta-analysis. Network meta-analyses indicated that LU and PCNL had better stone-free rates and auxiliary procedures. PCNL could result in major complications and severe bleeding. In initial stone-free rate, final stone-free rate, and auxiliary procedures results, SUCRA ranking was: LU> PCNL> URSL> ESWL. In Clavien Dindo score ≥3 complications, SUCRA ranking was: LU> ESWL> URSL> PCNL. In fever, SUCRA ranking was: ESWL> LU> URSL> PCNL. In transfusion, SUCRA ranking was: LU> URSL> ESWL> PCNL. In Cluster analysis, LU had the highest advantages and acceptable side effects. Considering the traumatic nature of PCNL, it should not be an option over URSL. ESWL had the lowest advantages. Conclusions LU have the potential to be considered as the first treatment choice of proximal ureteral stone ≥10mm.
Descritores: Cálculos Ureterais/cirurgia
-Litotripsia
Resultado do Tratamento
Ureteroscopia
Metanálise em Rede
Nefrolitotomia Percutânea/efeitos adversos
Limites: Humanos
Masculino
Tipo de Publ: Revisão Sistemática
Responsável: BR1.1 - BIREME


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Id: biblio-1134249
Autor: Basatac, Cem; Akpinar, Haluk.
Título: Trifecta outcomes of robot-assisted partial nephrectomy: Results of the low volume surgeon
Fonte: Int. braz. j. urol;46(6):943-949, Nov.-Dec. 2020. tab.
Idioma: en.
Resumo: ABSTRACT Objective There is limited data regarding surgeon volume and partial nephrectomy outcomes. The aim of this study is to report trifecta outcomes of robot-assisted partial nephrectomy (RAPN) performed by the low volume surgeon. Materials and Methods Thirty-nine patients with clinical T1-2 renal tumors who underwent RAPN between 2012 and 2018 were included in this study. Trifecta was defined as negative surgical margins, warm ischemia time ≤20 minutes, and no operative complications. Patient demographics, R.E.N.A.L. nephrometry score, operation time, estimated blood loss, warm ischemia time, length of hospital stay, renal functions, and oncological outcomes were analyzed retrospectively. Complications were graded based on the modified Clavien-Dindo classification system. Results The median R.E.N.A.L. nephrometry score was 6 (4-10). RAPN was successfully performed in all but one patient. The median operation time was 180 (90-240) minutes. Warm ischemia was performed only by segmental renal artery control in 35 and, by main renal artery control in three patients. The off-clamp technique was used in two patients. The median warm ischemia time was 16 (0-31) minutes. Seven patients had a warm ischemia time of longer than 20 minutes. Three patients had postoperative complications. The surgical margin was positive in one patient. As a result, the trifecta was achieved in 30 of the 39 patients (77%). Conclusion RAPN is a safe and effective minimally invasive alternative in the treatment of renal masses. The present study suggests that reasonable trifecta rates can be achieved even by low volume surgeons.
Descritores: Procedimentos Cirúrgicos Robóticos
Neoplasias Renais/cirurgia
-Transfusão de Sangue
Estudos Retrospectivos
Resultado do Tratamento
Cirurgiões
Nefrectomia
Limites: Humanos
Responsável: BR1.1 - BIREME


  9 / 10873 LILACS  
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Id: biblio-1134246
Autor: Sivaraman, Arjun; Marra, Giancarlo; Stabile, Armando; Mombet, Annick; Macek, Petr; Lanz, Camille; Cathala, Nathalie; Moschini, Marco; Carneiro, Arie; Sanchez-Salas, Rafael; Cathelineau, Xavier.
Título: Does mpMRI guidance improve HIFU partial gland ablation compared to conventional ultrasound guidance? Early functional outcomes and complications from a single center
Fonte: Int. braz. j. urol;46(6):984-992, Nov.-Dec. 2020. tab, graf.
Idioma: en.
Resumo: ABSTRACT Background Focal therapy (FT) for localized prostate cancer (PCa) treatment is raising interest. New technological mpMRI-US guided FT devices have never been compared with the previous generation of ultrasound-only guided devices. Materials and Methods We retrospectively analyzed prospectively recorded data of men undergoing FT for localized low- or intermediate-risk PCa with US- (Ablatherm®-2009 to 2014) or mpMRI-US (Focal One®-from 2014) guided HIFU. Follow-up visits and data were collected using internationally validated questionnaires at 1, 2, 3, 6 and 12 months. Results We included n=88 US-guided FT HIFU and n=52 mpMRI-US guided FT HIFU respectively. No major baseline differences were present except higher rates of Gleason 3+4 for the mpMRI-US group. No major differences were present in hospital stay (p=0.1), catheterization time (p=0.5) and complications (p=0.2) although these tended to be lower in the mpMRI-US group (6.8% versus 13.2% US FT group). At 3 months mpMRI-US guided HIFU had significantly lower urine leak (5.1% vs. 15.9%, p=0.04) and a lower drop in IIEF scores (2 vs. 4.2, p=0.07). Of those undergoing 12-months control biopsy in the mpMRI-US-guided HIFU group, 26% had residual cancer in the treated lobe. Conclusion HIFU FT guided by MRI-US fusion may allow improved functional outcomes and fewer complications compared to US- guided HIFU FT alone. Further analysis is needed to confirm benefits of mpMRI implementation at a longer follow-up and on a larger cohort of patients.
Descritores: Neoplasias da Próstata/cirurgia
Neoplasias da Próstata/diagnóstico por imagem
Imageamento por Ressonância Magnética Multiparamétrica
-Estudos Retrospectivos
Ultrassonografia
Resultado do Tratamento
Antígeno Prostático Específico
Limites: Humanos
Masculino
Idoso
Tipo de Publ: Estudo Comparativo
Responsável: BR1.1 - BIREME


  10 / 10873 LILACS  
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Id: biblio-1134225
Autor: Minervini, Andrea; Grosso, Antonio Andrea; Maida, Fabrizio Di; Mari, Andrea; Vittori, Gianni; Muto, Gianluca; Carini, Marco.
Título: How far is too far? Exploring the indications for robotic partial nephrectomy in a highly complex kidney tumor
Fonte: Int. braz. j. urol;46(5):871-872, Sept.-Oct. 2020.
Idioma: en.
Resumo: ABSTRACT Purpose: The conservative management of localized renal masses has been recently widened to cT2 tumors showing encouraging functional and oncological outcomes (1). This video aims to report the conservative management of a highly complex renal tumor treated with robotic pure enucleation in our center, specifically focusing on preoperative work-up, video-reported surgical steps and perioperative outcomes. Materials and Methods: A 63 year-old lady underwent CT scan revealing a single 75 x 68mm, mainly endophytic, right renal mass dislocating the vascular pedicle (cT3a). Two renal arteries and two veins were identified. PADUA, RENAL and simplified SPARE scores were 14a, 12a and 12 respectively. Since the contralateral kidney was hypotrophic, the indication for nephron-sparing approach was considered absolute. Preoperative surgical planning included the employment of 3D-virtual models (2). Results: Operative time was 150 minutes and warm ischemia time was 25 minutes. No major complication occurred. Histopathological analysis revealed a cromophobe renal cell carcinoma with extension to perirenal fat tissue (pT3a). Resection technique was classified as pure enucleation since Surface-Intermediate-Base (SIB) score was 0-0-0 (3, 4). At seven-months follow-up no signs of local or systemic recurrence were recorded. Postoperative CT-scan revealed optimal parenchymal volume preservation with last creatinine blood level of 1.16mg/dL. Conclusion: This video highlights how, in experienced hands, robotic partial nephrectomy represents a feasible, effective treatment option for surgical management of highly complex renal tumors. The employment of intraoperative ultrasonography and 3D-virtual models allowed to accurately tailor surgical approach, improving the perception of tumor anatomy and its vascularization and maximizing perioperative outcomes.
Descritores: Procedimentos Cirúrgicos Robóticos/métodos
Neoplasias Renais/cirurgia
Nefrectomia/métodos
-Robótica
Resultado do Tratamento
Neoplasias Renais/patologia
Pessoa de Meia-Idade
Limites: Humanos
Feminino
Responsável: BR1.1 - BIREME



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