ABSTRACT
Abstract Urothelial carcinoma is a rare malignant neoplasm, accounting for only 5% to 7% of kidney tumors and 5% of urothelial tumors. During the management of urothelial carcinoma, anatomopathological evaluation is used for stratifying the tumors into different prognostic groups to aid in the evaluation of treatment results and to optimize the management of patients. Percutaneous image-guided biopsy is a safe and feasible procedure, with high sensitivity and accuracy rates. Although image-guided percutaneous biopsy of the urinary tract is a relatively uncommon procedure, it can be considered an option in selected cases or when traditional methods, such as the ureteroscopic technique, are not possible.
Resumo O carcinoma urotelial é uma neoplasia maligna rara, responsável por apenas 5% a 7% dos tumores renais e 5% dos tumores uroteliais. No manejo do carcinoma urotelial, a determinação anatomopatológica tem por objetivo estratificar os tumores em diferentes grupos prognósticos, para permitir avaliar resultados do tratamento e otimizar o gerenciamento dos pacientes. Biópsia percutânea guiada por imagem é um procedimento seguro e tecnicamente viável, com alta sensibilidade e taxa de precisão. Apesar de as biópsias percutâneas guiadas por imagem do trato urinário serem um procedimento relativamente incomum, podem ser consideradas como opção em casos selecionados ou quando os métodos tradicionais, como o a técnica ureteroscópica, não são possíveis.
ABSTRACT
Resumen Objetivo: Evaluar la efectividad obtenida con la compresión ecoguiada como primera elección para lograr la trombosis del pseudoaneurisma iatrogénico post estudio o intervencionismo. Material y Método: Estudio retrospectivo observacional de 9 pacientes en quienes se realizó la compresión ecoguiada como primera alternativa de manejo frente a pseudoaneurismas iatrogénicos secundarios a procedimientos diagnósticos o terapéuticos ocurridos entre agosto de 2012 y diciembre de 2015 en el Hospital Regional de Talca. Resultados: De 4.070 procedimientos se presentó la complicación en 9 pacientes, un 0,22%; 7 posterior a procedimientos terapéuticos (0,4%), y 2 en el grupo de diagnósticos (0,08%). La muestra se compone por 6 hombres y 3 mujeres de edad promedio 70 años. El vaso comprometido fue principalmente la arteria femoral con un 77%. Los pseudoaneurismas ocurrieron mayoritariamente posteriores a procedimientos terapéuticos (77%); y el éxito de la compresión ecoguiada se obtuvo en el 67%. No hubo complicaciones asociadas al tratamiento. Conclusiones: La compresión ecoguiada tiene un porcentaje de éxito menor en esta pequeña serie que los obtenidos por otros autores, pero al no presentar complicaciones y por su bajo costo creemos debe mantenerse como primera alternativa.
Objective: To evaluate the effectiveness obtained with echo guided compression as the first choice to achieve thrombosis of iatrogenic pseudoaneurysm after study or interventionism. Material and Method: Retrospective observational study of 9 patients who underwent echo-guided compression as the first management alternative to iatrogenic pseudoaneurysms following diagnostic or therapeutic procedures that occurred between August 2012 and December 2015 at the Regional Hospital of Talca. Results: Of 4,070 procedures the complication was presented in 9 patients, 0.22%; 7 after therapeutic procedures (0.4%), and 2 in the diagnostic group (0.08%). The sample consists of 6 men and 3 women of average age 70 years. The involved vessel was mainly the femoral artery with 77%. Pseudoaneurysms occurred mostly after therapeutic procedures (77%); and the success of the echogenic compression was obtained in 67%. There were no complications associated with treatment. Conclusions : Image guided compression has a lower success rate in this small series than those obtained by other authors, but since there are no complications and because of its low cost, we believe that it should be kept as the first alternative.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Catheterization/adverse effects , Hemostatic Techniques , Ultrasonography/methods , Aneurysm, False/therapy , Pressure , Time Factors , Retrospective Studies , Treatment Outcome , Aneurysm, False/etiology , Aneurysm, False/epidemiology , Aneurysm, False/diagnostic imaging , Femoral Artery/injuries , Iatrogenic DiseaseABSTRACT
ABSTRACT Purpose: To evaluate the efficiency of a novel device coupled with ultrassound for renal percutaneous puncture. Materials and Methods: After establishing hydronephrosis, ten pigs had three calyxes of each kidney punctured by the same urology resident, with and without the new device ("Punctiometer"). Time for procedure completion, number of attempts to reach the calyx, puncture precision and puncture complications were recorded in both groups and compared. Results: Puncture success on the first attempt was achieved in 25 punctures (83%) with the Punctiometer and in 13 punctures (43%) without the Punctiometer (p=0.011). The mean time required to perform three punctures in each kidney was 14.5 minutes with the Punctiometer and 22.4 minutes without the Punctiometer (p=0.025). The only complications noted were renal hematomas. In the Punctiometer group, all kidneys had small hematomas. In the no Punctiometer group 80% had small hematomas, 10% had a medium hematoma and 10% had a big hematoma. There was no difference in complications between both groups. Conclusions: The Punctiometer is an effective device to increase the likelihood of an accurate renal calyx puncture during PCNL, with a shorter time required to perform the procedure.
Subject(s)
Animals , Kidney Calices/surgery , Nephrostomy, Percutaneous/instrumentation , Punctures/instrumentation , Ultrasonography, Interventional/instrumentation , Equipment Design , Models, Animal , Nephrostomy, Percutaneous/methods , Punctures/methods , Random Allocation , Reproducibility of Results , Swine , Time Factors , Ultrasonography, Interventional/methodsABSTRACT
O acesso totalmente percutâneo para o implante de endopróteses aórticas, através da preclose technique, é possível mesmo quando utilizadas bainhas introdutoras de elevado perfil. Relatamos sete casos de tratamento endovascular de doenças da aorta, todos realizados de modo percutâneo, e discutimos os principais aspectos desta técnica.
Total percutaneous access for aortic endograft delivery, using the preclose technique, is feasible even with the use of large-diameter introducer sheaths. We report seven cases of percutaneous approach in endovascular treatment of aortic diseases and discuss the main technical aspects.