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Int. braz. j. urol ; 48(2): 328-335, March-Apr. 2022. tab
Article in English | LILACS | ID: biblio-1364937


ABSTRACT Objectives: To compare thulium laser enucleation of prostate (ThuLEP) versus laparoscopic trans-vesical simple prostatectomy (LSP) in the treatment of benign prostatic hyperplasia (BPH). Materials and Methods: Data of patients who underwent surgery for "large" BPH (>80mL) at three Institutions were collected and analyzed. Two institutions performed ThuLEP only; the third institution performed LSP only. Preoperative (indwelling catheter status, prostate volume (PVol), hemoglobin (Hb), Qmax, post-voiding residual volume (PVR), IPSS, QoL, IIEF-5) and perioperative data (operative time, enucleated adenoma, catheterization time, length of stay, Hb-drop, complications) were compared. Functional (Qmax, PVR, %ΔQmax) and patient-reported outcomes (IPSS, QoL, IIEF-5, %ΔIPSS, %ΔQoL) were compared at last follow-up. Results: 80 and 115 patients underwent LSP and ThuLEP, respectively. At baseline, median PVol was 130 versus 120mL, p <0.001; Qmax 9.6 vs. 7.1mL/s, p=0.005; IPSS 21 versus 25, p <0.001. Groups were comparable in terms of intraoperative complications (1 during LSP vs. 3 during ThuLEP) and transfusions (1 per group). Differences in terms of operative time (156 vs. 92 minutes, p <0.001), Hb-drop (-2.5 vs. −0.9g/dL, p <0.001), catheterization time (5 vs. 2 days, p <0.001) and postoperative complications (13.8% vs. 0, p <0.001) favored ThuLEP. At median follow-up of 40 months after LSP versus 30 after ThuLEP (p <0.001), Qmax improved by 226% vs. 205% (p=0.5), IPSS decreased by 88% versus 85% (p=0.9), QoL decreased by 80% with IIEF-5 remaining almost unmodified for both the approaches. Conclusions: Our analysis showed that LSP and ThuLEP are comparable in relieving from BPO and improving the patient-reported outcomes. Invasiveness of LSP is more significant.

Humans , Male , Prostatic Hyperplasia/surgery , Prostatic Hyperplasia/complications , Laparoscopy , Laser Therapy , Lasers, Solid-State/therapeutic use , Prostate/surgery , Prostatectomy , Quality of Life , Thulium/therapeutic use , Treatment Outcome
Int. braz. j. urol ; 44(4): 740-749, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-954072


ABSTRACT Introduction: eGFR-categories are used to predict functional outcome after partial nephrectomy (PN); no study categorized patients according to preoperative renal scan (RS) data. Aim of the study was to evaluate if stratification of patients according to RS is a reliable method to predict minor/major loss of renal function after PN. Materials and Methods: We considered patients who underwent PN and RS pre-/post-PN for T1 tumor in our Institution (2007-2017). Demographics, perioperative and specifically functional data were analysed. On the basis of the baseline Split Renal Function (SRF), patients were stratified into risk-categories: 1) baseline operated-kidney SRF range 45-55%; 2) baseline operated-kidney SRF <45%. Risk categories were analysed with postoperative functional outcome: postoperative operated-kidney SRF decrease below 90% of baseline was considered significant loss of function. Contingency tables and univariate/multivariate regression were analysed looking for independent factors of postoperative functional impairment. Results: 224 patients were analysed, 125 (55.8%) maintained >90% of their baseline function. Worse probability of maintaining ≥90 baseline renal function was found in patients with Charlson's Comorbidity Index (CCI≥3) (p=0.004) and patients with PADUA score ≥8 (p=0.023). After stratification by baseline renal function, ischemia was the only independent factor: no effect on patients with poorer baseline renal function. Patients with baseline SRF 45-55% who did not experience ischemia had the highest probability to maintain ≥90% baseline SRF (p=0.028). Ischemia >25 minutes was detrimental (p=0.017). Conclusions: Stratification of patients by SRF before PN is not a reliable predictor of renal functional outcome. Ischemia seems to scarcely influence patients with poorer renal function.

Humans , Male , Female , Aged , Carcinoma, Renal Cell/surgery , Carcinoma, Renal Cell/physiopathology , Risk Assessment/methods , Kidney/physiopathology , Kidney Neoplasms/surgery , Kidney Neoplasms/physiopathology , Nephrectomy/methods , Postoperative Period , Reference Values , Time Factors , Carcinoma, Renal Cell/pathology , Logistic Models , Predictive Value of Tests , Reproducibility of Results , Retrospective Studies , Risk Factors , Treatment Outcome , Statistics, Nonparametric , Creatinine/blood , Warm Ischemia/methods , Preoperative Period , Glomerular Filtration Rate , Kidney/surgery , Kidney/blood supply , Kidney/pathology , Kidney Neoplasms/pathology , Middle Aged , Nephrectomy/adverse effects
Int. braz. j. urol ; 38(4): 480-488, July-Aug. 2012. ilus, tab
Article in English | LILACS | ID: lil-649441


PURPOSE: To evaluate the results of our technique of clampless laparoscopic partial nephrectomy (LPN) and its impact as an emerging treatment for small renal masses (SMRs). MATERIALS AND METHODS: We reviewed our prospectively maintained database: data of 117 patients who consecutively underwent LPN at our Institution from January 2009 to December 2011 were studied. Patients were divided into 2 Groups based on operative technique: Group A: clampless-LPN (cl-LPN); Group B: conventional LPN (clamping of renal artery). Demographic and peri-operative data, complications, pre- and post-operative serum creatinine and estimated glomerular filtration rate (eGFR) were registered and compared by Student’s t- and Chi-square-tests (p-values < 0.05 considered statistically significant). RESULTS: 41 patients were in Group A and 76 in Group B. Groups were comparable in terms of preoperative data except for tumour’s size (2.35 ± 1.10 vs. 3.19 ± 1.57, Group A vs. B, respectively, p = 0.0029). Concerning perioperative data, warm ischemia time (WIT) was 0 min. in all Group A cases; mean WIT in Group B was 20.90 ± 9.27 min. One case (2.4%) in Group A (central tumour) was converted to conventional LPN. Mean eGFR postoperative decrease was higher in Group B (0.17 ± 9.30 vs. 4.38 ± 11.37 mL/min., A vs B, respectively, p = 0.0445). CONCLUSIONS: Notwithstanding the limits of the study, our results suggest that cl-LPN is a safe and effective technique, which allows surgeon to surgically treat SRMs even in case of complex location, without injuring kidney by ischemia.

Aged , Female , Humans , Male , Middle Aged , Laparoscopy/methods , Nephrectomy/methods , Nephrons/surgery , Organ Sparing Treatments/methods , Chi-Square Distribution , Glomerular Filtration Rate , Laparoscopy/statistics & numerical data , Nephrectomy/statistics & numerical data , Postoperative Period , Preoperative Period , Retrospective Studies , Time Factors , Treatment Outcome