Tumor de vías excretoras urinarias superiores. Presentación de caso / Upper urinary excretory tract tumor. A case report

RESUMEN Los tumores del tracto urinario superior representan menos del 5 % de todas las neoplasias uroteliales, con un porcentaje de recurrencia superior al 90 % y una supervivencia a los 5 años que oscila entre el 30-60 %. Por tales razones se presenta el caso de un paciente de 79 años que fue ingresado en el Hospital General Universitario Dr. Gustavo Aldereguía Lima de Cienfuegos, con un cuadro clínico caracterizado por hematuria, sin otra sintomatología. Mediante estudios imagenológicos le fue diagnosticado un tumor en la pelvis del riñón derecho. Se realizó tratamiento quirúrgico, practicándose una nefrectomía total, cuyo resultado histológico fue un carcinoma de células transicionales grado II con infiltración a planos musculares. La evolución clínica fue favorable luego de un año de la cirugía. Podemos concluir que en el diagnóstico precoz tienen un papel fundamental las imágenes tomográficas, pues permitieron identificar un tumor de las vías excretoras urinarias superiores en pelvis renal derecha. Se trazó una estrategia terapéutica inicialmente quirúrgica y a continuación quimioterapia; se logró una evolución satisfactoria y contribuir a la sobrevida de este paciente.

ABSTRACT Upper urinary tract tumors represent less than 5% of all urothelial neoplasms, with a recurrence rate greater than 90% and a 5-year survival that ranges from 30-60%. Therefore a 79-years-old patient was admitted to the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos, with a medical history characterized by hematuria, without other symptoms. Through imaging studies, he was diagnosed with a tumor in the pelvis of the right kidney. Surgical treatment was performed and a total nephrectomy was performed, the histological result of which was a grade II transitional cell carcinoma with infiltration to the muscular planes. The clinical evolution was favorable one year after surgery. We conclude that tomographic images play a fundamental role in early diagnosis, since they allowed the identification of a tumor of the upper urinary excretory tract in the right renal pelvis. A therapeutic strategy was initially designed for surgery and then chemotherapy; a satisfactory evolution was achieved and contributes to the survival of this patient.

Villous adenoma of the renal pelvis: a common entity at an uncommon location

Villous adenoma is uncommonly seen in the urogenital tract and is even more rarely seen in the upper urinary tract and renal pelvis. Like colorectal adenomas, these neoplasms can transform into adenocarcinoma. The preoperative diagnosis is challenging due to their frequent association with hydronephrosis. Herein, we present the case of a villous adenoma of the renal pelvis in a 62-year-old man presenting with recurrent urinary tract infection. The computed tomography scan showed marked hydronephrosis but no suspicious mass in the right kidney. A laparoscopic right nephrectomy was performed. Gross examination revealed a dilated renal pelvis with an irregular exophytic lesion in the renal pelvis's upper surface. The histopathological examination showed slender, elongated villi with thin fibrovascular cores, consistent with villous adenoma morphology. Isolated villous adenomas have a favorable prognosis. However, the pathologist should undertake a search for an invasive component.

The outcomes of mini-laparoscopic pyeloplasty in children - brazilian experience

ABSTRACT Objetive Pelvicureteric junction (PUJ) obstruction is the main cause of hydronephrosis in childhood. Open pyeloplasty has been the gold standard treatment of this condition with success rate above 90%. The role of laparoscopic pyeloplasty (LP) in children is less well defined and has slowly emerged as an alternative procedure. We report outcomes of our initial experience with LP in 38 children from 2 months of age. Materials and Methods From June 2015 to December 2017 38 children aged 2-60 months (mean age 1.7 years) underwent LP for correction of PUJ obstruction. The mean pre operative anteroposterior diameter of the renal pelvis (APD) was 43,5mm and all patients had hydronephrosis (APD 21.4-76 mm) and obstructed curve on diuretic renogram. Anderson-Hynes pyeloplasty was the performed technique. Results are reported. Results Mean operative time was 107 minutes (70-180) with no conversion to open procedure. Pain control was needed mainly in the first 12hs. Mean hospitalization was 2 days (1-5). There were complications in 5 children not affecting the final outcome. Two patients had a re-obstruction requiring a second procedure with good result. The mean follow up was 18 months (13-36). The mean reduction on the postoperative APD was 41% - p<0,001 (end APD 5 to 41mm). Overall success rate was 94,7%. All children had good cosmetic results. Conclusions This is a small series limited by short follow up, however its data suggest that LP has good functional and cosmetic results, not compromising the success of the open procedure, regardless patient age.

Modelos de entrenamiento en cirugía mínimamente invasiva para pieloplastia laparoscópica: revisión de la literatura / Training models in minimally invasive surgery for laparoscopic pyeloplasty: review of the literature

Introducción: la pieloplastia laparoscópica es un procedimiento mínimamente invasivo empleado para solucionar quirúrgicamente estenosis, bloqueo u obstrucción de la unión ureteropélvica o pieloureteral. Objetivo: explorar los diferentes modelos de entrenamiento en cirugía mínimamente invasiva para pieloplastia laparoscópica que se encuentran reportados en la literatura. Materiales y métodos: se revisó la literatura con búsqueda sistemática en PubMed, Google Académico y SciELO, mediante la declaración PRISMA y la combinación de los descriptores médicos en salud Model training AND laparoscopic pyeloplasty. Además, se empleó GoPubMed para obtener información bibliométrica que contextualizara las redes de investigación y publicación entre los diferentes modelos de entrenamiento para pieloplastia laparoscópica. Resultados: Se incluyeron 17 referencias en la búsqueda sistemática de la literatura con los que se realizó la discusión a partir de la usabilidad, la estética y el tiempo operatorio de la pieloplastia laparoscópica. Conclusión: Todos los modelos de entrenamiento contribuyen a que los operadores disminuyan los tiempos quirúrgicos, alcanzando valores próximos a la pieloplastia laparoscópica in situ, inclusive, a la pieloplastia abierta. De forma particular, los modelos anatomopatológicos elaborados con modelamiento de siliconas logran un notable acercamiento a la realidad morfológica a partir de la estética de las estructuras y permiten aumentar el número de intentos quirúrgicos y la cantidad de horas de práctica.

Introduction: Laparoscopic pyeloplasty is a minimally invasive procedure used to surgically correct stenosis, blockage or obstruction of the ureteropelvic junction or pyeloureteral junction. Objective: To explore the different models of training in minimally invasive surgery for laparoscopic pyeloplasty that are reported in the literature. Materials and methods: A literature review with systematic search was carried out in PubMed, Google Scholar and SciELO, through the PRISMA Declaration and the combination of the medical descriptors in health "Model training AND laparoscopic pyeloplasty". In addition, GoPubMed was used to obtain bibliometric information that contextualized the research and publication networks among the different training models for laparoscopic pyeloplasty. Results: We included 17 references in the systematic review of the literature with which the discussion was made based on the usability, aesthetics and operative time of laparoscopic pyeloplasty. Conclusion: All the training models contribute to those operators reduce surgical times, reaching values close to laparoscopic pyeloplasty in situ, including open pyeloplasty. In particular, anatomopathological models made with silicone modeling achieve a remarkable approach to the morphological reality from the aesthetics of the structures and allow increasing the number of surgical attempts and the number of hours of practice.

Laparoscopic management of recurrent ureteropelvic junction obstruction following pyeloplasty: a single surgical team experience with 38 cases

ABSTRACT Purpose To describe and analyze our experience with Anderson-Hynes transperitoneal laparoscopic pyeloplasty (LP) in the treatment of recurrent ureteropelvic junction obstruction (UPJO). Materials and methods 38 consecutive patients who underwent transperitoneal laparoscopic redo-pyeloplasty between January 2007 and January 2015 at our department were included in the analysis. 36 patients were previously treated with dismembered pyeloplasty and 2 patients underwent a retrograde endopyelotomy. All patients were symptomatic and all patients had a T1/2>20 minutes at pre-operative DTPA (diethylene-triamine-pentaacetate) renal scan. All data were collected in a prospectively maintained database and retrospectively analyzed. Intraoperative and postoperative complications have been reported according to the Satava and the Clavien-Dindo system. Treatment success was evaluated by a 12 month-postoperative renal scan. Total success was defined as T1/2≤10 minutes while relative success was defined as T1/2between 10 to 20 minutes. Post-operative hydronephrosis and flank pain were also evaluated. Results Mean operating time was 103.16±30 minutes. The mean blood loss was 122.37±73.25mL. The mean postoperative hospital stay was 4.47±0.86 days. No intraoperative complications occurred. 6 out of 38 patients (15.8%) experienced postoperative complications. The success rate was 97.4% for flank pain and 97.4% for hydronephrosis. Post-operative renal scan showed radiological failure in one out of 38 (2.6%) patients, relative success in 2 out of 38 (5.3%) patients and total success in 35 out of 38 (92.1%) of patients. Conclusion Laparoscopic redo-pyeloplasty is a feasible procedure for the treatment of recurrent ureteropelvic junction obstruction (UPJO), with a low rate of post-operative complications and a high success rate in high laparoscopic volume centers.

Ruptura pieloureteral espontánea bilateral durante un urotac: caso clínico / Bilateral spontaneous renal pelvis rupture during a computed tomography: report of one case

Spontaneous rupture of the urinary excretory system is a rare condition. It is mainly associated with obstruction of the excretory system and is usually unilateral. We report a 58 years old male who, during the performance of a computed tomography of the urinary system, felt an intense lumbar pain. A bilateral rupture at the level of the fornix was found. The patient had an uneventful evolution thereafter. Fifteen days later a new computed tomography showed indemnity of the urinary excretory system.

Diffusion tensor imaging in differential diagnosis of clear cell renal cell carcinoma and transitional cell carcinoma / 中国介入影像与治疗学

Objective To evaluate the value of ADC and FA of diffusion tensor imaging (DTI) in differentiating clear cell renal cell carcinoma (ccRCC) and transitional cell carcinoma (TCC) of kidney pelvis.Methods Thirty-eight histopathology proven ccRCC and TCC patients (29 cases of ccRCC and 9 cases of TCC) were retrospectively enrolled.All the patients were performed abdominal MR fat saturation T1WI,fat saturation T2WI,LAVA and DTI (b=0,600 s/mm2).MR images were reviewed and analyzed by two radiologists in a double-blind manner with the value of ADC and FA measured using the Functool on AW 4.4 workstation.The data of two observers were analyzed with intra-class correlation coefficients (ICC) to assess inter-observer consistency.The differences of ADC values and FA values between ccRCC and TCC were compared by independent t-test.The ROC curves were used to analyze and compare the diagnostic value of DTI in differentiating ccRCC and TCC.Results The inter-observer agreements were good (ICC＞0.75).The ADC value of ccRCC was statistically higher than that of TCC ([2.03 ± 0.49] × 10-3 mm2/s vs [1.57 ± 0.43] × 10-3 mm2/s,P =0.015).But the FA value of ccRCC was statistically lower than that of TCC ([0.24±0.10] vs [0.42±0.22],P=0.002).The area under the ROC curve of ADC was 0.761 (P＜0.05),and the sensitivity and specificity were 79.3％ and 77.8％.The ADC threshold for differentiating ccRCC from TCC was 1.59× 10-3 mm2/s.The area under the ROC of FA was 0.762 (P＜ 0.05),and the sensitivity and specificity were 66.7 ％ and 93.1％.The FA threshold for differentiating ccRCC from TCC was 0.326.Conclusion MR DTI can effectively discriminate ccRCC and TCC.FA values has good diagnostic specificity in differentiating between ccRCC and TCC.

Rim pélvico de doador vivo-relacionado para transplante: relato de caso e revisão da literatura / Pelvic kidney for living transplantation: case report and review of the literature

ResumoIntrodução:É cada vez maior a discrepância entre a fila de espera e a oferta para um transplante renal. Fica evidente a necessidade de se usar enxertos com critérios expandidos, como, por exemplo, rim pélvico, conforme relatamos a seguir.Relato de caso:Paciente masculino de 25 anos, com doença renal crônica estádio 5, recebe como enxerto rim pélvico do pai, 49 anos, com história prévia de hipertensão arterial sistêmica bem controlada e urolitíase há mais de 10 anos sem novos episódios. Função e anatomia do rim pélvico foram avaliadas com exames de imagem como ressonância magnética, tomografia computadorizada e cintilografia. Após rejeição inicial tratada adequadamente, paciente apresenta boa evolução.Conclusão:Para aumentar oferta de rins para doação, é possível a utilização de rim pélvico, desde que adequadamente estudado no pré-operatório.

AbstractIntroduction:The difference between available kidneys and the number of patients on waiting list for kidney transplantation continues to grow. For this reason the trend is to use donors with expanded criteria, such as a pelvic kidney, as we describe below.Case report:Male patient 25 years-old with end-stage kidney disease, receives as a graft a pelvic kidney from his father, 49 years-old, known to have controlled systemic arterial hypertension and nephrolithiasis by history without new episodes in the last 10 years. Function and anatomy of the pelvic kidney were evaluated through magnetic angioressonance, computarized tomography and scintigraphy. After an initial rejection episode promptly treated, the patient has had an uneventful recovery.Conclusion:To increase the number of kidneys available for transplantation, it is reasonable to use a pelvic kidney, after a thorough investigation.

Application study on flexible ureteroscope /holmium laser therapy of parapelvic cyst complicating with renal calculi / 中华老年医学杂志

Objective To investigate the safety and feasibility of flexible ureteroscope/holmium laser therapy of parapelvic cyst complicating with renal calculi.Methods The clinical data of 8 patients diagnosed as parapelvic cyst with renal calculi and hospitalized in our hospital from Nov.2012 to Nov.2014 were retrospectively analyzed.They were 5 males and 3 females,aged 54 78 years,with an average of 63 years old.The largest kidney calculis were at the size of (1.2 cm× 1.1 cm) to (1.5cm×2.0 cm),and the size of parapelvic cysts ranged between (3.2 cm×3.6 cm) and (5.1 cm×4.2cm).Waist pain was found in 6 patients,hematuria in 3 patients,hydronephrosis in 1 patient,circumscribed hydrocalycosis in 2 patients,hypertension in 3 patients,and infection of urinary tract in 3 patients.Incision and internal drainage of parapelvic cyst and lithotripsy for renal calculi were conducted by flexible ureteroscope/holmium laser under general anesthesia.Results All of the 8 patients had successful operations without any complications such as massive haemorrhage,pararenal hematoma,extravasation of urine,infectious shock and kidney atrophy during or after the operation.The operation time ranged between 52 to 120 minutes,with the average of 76 minutes.All patients showed no residual renal calculus during a follow-up period of 3 to 12 months.Renal cysts were disappeared in 6 patients,and the size of renal cysts was significantly decreased in the other 2 cases.No parapelvic cyst and renal calculus recurred during the follow-up.Conclusions Flexible transurethral ureteroscope/Holmium laser therapy is a good method with the advantages of minimal trauma,quick recovery,simple operation,economic,safety and effectiveness in treating parapelvic cyst complicating with renal calculus.

Impact of adjuvant chemotherapy in patients with upper tract urothelial carcinoma and lymphovascular invasion after radical nephroureterectomy

PURPOSE: To evaluate the impact of adjuvant chemotherapy (AC) in patients with upper tract urothelial carcinoma and lymphovascular invasion (LVI) after radical nephroureterectomy (RNU). MATERIALS AND METHODS: We retrospectively analyzed the clinical records and clinicopatholgic outcomes of patients (n=552) treated with RNU between 1986 and 2013. Patients treated with neoadjuvant chemotherapy and those for whom LVI status was not recorded were excluded. Patients were divided into two groups according to LVI (n=86) or no LVI (n=256). RESULTS: The study included 344 patients (240 men and 104 women) with a median of 53.9 months of follow-up (range, 1-297 months) after RNU. Tumors were organ confined (T2/N0) in 211 (61.3%) and tumor grade high in 291 (84.6%). AC was administered in 64 patients (18.6%). A total of 280 patients (81.4%) were treated with surgery alone. Patients with LVI tended to be older (p=0.049), have a higher pT stage (pT3/T4, p<0.001), be pN+ (p<0.001), have a high tumor grade (p<0.001), and experience recurrence (p<0.001). In the multivariate analysis, LVI was an independent prognostic factor for cancer-specific survival and overall survival (p=0.002 and p<0.001, respectively). The multivariate analysis demonstrated that in the subgroup of patients with LVI, AC was a significant prognostic factor for cancer-specific survival and overall survival (hazard ratio, 0.51; p=0.027 and hazard ratio, 0.50; p=0.025, respectively). CONCLUSIONS: AC does not seem to reduce mortality in patients with advanced upper tract urothelial carcinoma after RNU. In the subgroup of patients with LVI, AC had a positive impact on cancer-specific survival and overall survival. LVI would be helpful for selecting patients who are appropriate for AC.

Predictive factors for flexible ureterorenoscopy requirement after rigid ureterorenoscopy in cases with renal pelvic stones sized 1 to 2 cm

PURPOSE: To evaluate the outcomes of rigid ureterorenoscopy (URS) for renal pelvic stones (RPS) sized 1 to 2 cm and to determine the predictive factors for the requirement for flexible URS (F-URS) when rigid URS fails. MATERIALS AND METHODS: A total of 88 patients were included into the study. In 48 patients, the RPS were totally fragmented with rigid URS and F-URS was not required (group 1). In 40 patients, rigid URS was not able to access the renal pelvis or fragmentation of the stones was not completed owing to stone position or displacement and F-URS was utilized for retrograde intrarenal surgery (RIRS) (group 2). The predictive factors for F-URS requirement during RIRS for RPS were evaluated. Both groups were compared regarding age, height, sex, body mass index, stone size, stone opacity, hydronephrosis, and previous treatments. RESULTS: The mean patient age was 48.6+/-16.5 years and the mean follow-period was 39+/-11.5 weeks. The overall stone-free rate in the study population was 85% (75 patients). In groups 1 and 2, the overall stone-free rates were 83% (40 patients) and 87% (35 patients), respectively (p>0.05). The independent predictors of requirement for F-URS during RIRS were male gender, patient height, and higher degree of hydronephrosis. CONCLUSIONS: Rigid URS can be utilized in selected patients for the fragmentation of RPS sized 1 to 2 cm with outcomes similar to that of F-URS. In case of failure of rigid URS, F-URS can be performed successfully in this group of patients.

Eight prehilar branches of the right renal artery / 대한해부학회지

Imaging technology with its advancement in the field of urology is the boon for the patients who require minimally invasive approaches for various kidney disorders. These approaches require a precise knowledge of the normal and variant anatomy of vessels at the hilum of the kidney. During routine dissections, a variation in the branching pattern of the right renal artery was noted in an adult male cadaver. The right renal artery divided into upper and lower divisions 6cm away from the hilum of the kidney. The upper division gave 4 branches, and the lower division gave two branches. These two branches further bifurcated and gave 2 branches each. Thus, there were 8 prehilar branches of renal artery. The multiple prehilar branches led to a congested atmosphere at the hilum of the kidney. This arterial congestion might result in hindering the blood flow at the renal hilum. Apart from this, it might cause difficulties in diagnostic and therapeutic invasive procedures. Knowledge of this variation is of importance to radiologists and urologists in particular.

Involução espontânea da hidronefrose isolada / Spontaneous involution of hydronephrosis

Objetivo: Estudar a involução espontânea do grau de gravidade da hidronefrose em 141 crianças com diagnóstico de hidronefrose isolada atendidos na Unidade de Nefrologia Pediátrica do Hospital das Clínicas da UFMG, entre 1999 e 2008. Métodos: Crianças com diagnóstico pré-natal hidronefrose foram acompanhadas com avaliação clínica e exames ultrassonograficos periódicos. O diâmetro anteroposterior da pelve renal (DAP), variável capaz de caracterizar o grau de hidronefrose dos pacientes, foi medido em três sucessivos momentos: antes do nascimento, imediatamente depois do nascimento e no final do periodo de acompanhamento. Os graus considerados são: normal (DAP < 5mm), leve (5mm ≤ DAP < 10mm), moderada (10mm ≤ DAP < 15mm), e grave (DAP > 15mm). A involução do grau de hidronefrose é a transição, no tempo, de um grau mais próximo de grave para outro mais próximo de normal. No primeiro estudo foi avaliado se a involução do grau de gravidade da hidronefrose ocorre com significância estatística. No segundo estudo foi avaliado se a ocorrência da involução pode ser associada com a lateralidade do rim ou com o sexo da criança. Resultados: Nas análises efetuadas, a hipótese de involução espontânea da dilatação foi comprovada com significância estatística. Constatou-se também que a involução ocorre em proporção mais acentuada nas unidades de lateralidade direita, e em pacientes do sexo feminino. Conclusão: Os resultados corroboram estudos de outros autores que demontram a involução espontânea do grau de gravidade) em pacientes com hidronefrose isolada, e que sugerem influência da lateralidade e do sexo na involução espontânea.(AU)

Objective: To study the spontaneous involution of the severity of hydronephrosis in 141 children diagnosed with isolated hydronephrosis treated in the Pediatric Nephrology Unit of Hospital das Clínicas ­ UFMG, between 1999 and 2008. Methods: Children diagnosed with prenatal hydronephrosis were followed with clinical evaluation and periodic ultrasound examinations. The anteroposterior diameter of the renal pelvis (APD), a variable capable of characterizing the degree of hydronephrosis of the patients, was measured in three successive stages: before birth, immediately after birth and at the end of follow-up period. The considered degree of hydronephrosis is: normal (APD < 5mm), light (5mm ≤ APD <10mm), moderate (10mm ≤ APD <15mm) or severe (APD > 15mm). The spontaneous regression of hydronephrosis gravity is the transition over time from a closer to severe level to a closer to normal level. Two studies were done. At first, we evaluated if the regression of hydronephrosis severity occurs with statistical significance. In the second study, we evaluated if the occurrence of involution may be associated with the laterality of the kidney or the sex of the child. Results: In the analysis, the spontaneous regression hypothesis of hydronephrosis was confirmed with statistical significance. Also, it was found that the regression is more pronounced in units on the right side, and in females.Conclusion: The results corroborate findings of other authors that demonstrate spontaneous involution of the degree of severity in patients with isolated hydronephrosis, and suggest the influence of laterality and sex on spontaneous involution.(AU)

Caracterização e avaliação quantitativa da variabilidade do diâmetro ântero posterior (DAP) da pelve renal / Characterization and quantitative evaluation of renal anteroposterior pelvis diameter (APD) variability

Objetivo: Avaliar a variabilidade em medidas do diâmetro ântero posterior da pelve renal (DAP) em 244 crianças com diagnóstico de hidronefrose isolada atendidos na Unidade de Nefrologia Pediátrica do Hospital das Clínicas da Universidade Federal de Minas Gerais, entre 1999 e 2008. Métodos: Os pacientes foram submetidos a acompanhamento clínico e a exames ultrassonográficos periódicos. As informações registradas ao longo do tempo nos prontuários foram transformadas em "séries de medidas", resultando em vinte e duas series de medidas para cada paciente (duas clínicas e dez ultrassonográficas para cada rim). A variabilidade dessas séries foi caracterizada em um índice que foi, na sequencia, avaliado para todas as series de medida. Os dados de variabilidade foram agrupados, conforme a variável medida e conforme a ocorrência ou não de evento cirúrgico. As médias dos grupos foram comparadas em análise estatística. Resultados: Os resultados mostraram que a variabilidade é muito pequena nas medidas clínicas (estatura e peso), relativamente pequena no comprimento e no volume renal e mais acentuada nas séries de DAP. Verificou-se que, nas series de medidas de comprimento e volume renal, há maior variabilidade em unidades submetidas a cirurgia. Nas medidas de DAP a variabilidade foi grande, independentemente de uropatia e/ou evento cirúrgico. Conclusão: Os resultados corroboram estudos de outros autores que mostram a ocorrência de variabilidade nas medidas do DAP, e colocam em evidência a necessidade de se levar em conta esta variabilidade nas situações em que o DAP serve de apoio a diagnóstico e na indicação de procedimento cirúrgico.(AU)

To evaluate the variability in measures of anteroposterior diameter of renal pelvis (APD) in 244 children diagnosed with isolated hydronephrosis and treated at the Pediatric Nephrology Unit of Hospital das Clinicas ­ Federal University of Minas Gerais, between 1999 and 2008. Methods: All patients were subjected to clinical follow-up ultrasound exams and periodicals. The information collected over time in the medical records were turned into "series of measures", resulting in twenty-two series of measurements for each patient (two clinic and ten ultrasound related for each kidney). The variability of these series was synthesized on an index that was, in sequence, evaluated for all series of measures. The variability data was grouped according to the measured variable and to the occurrence of surgical events. Statistical analysis was performed to compare the means og the groups. Results: The results showed that the variability is very small in clinical measures (height and weight), relatively small in length and renal volume and more pronounced in the series of APD. It was found that, in the series of measurements of length and volume kidney, there is greater variability in units subjected to surgery. In APD measures the variability was large, regardless of uropathy and / or surgical event. Conclusion: The results corroborate findings of other authors that show the occurrence of variability in measures of APD, and make evident the need to take into account this variability in situations where the APD is used to support diagnosis and indication for surgery.

Surgical Treatment of Inferior Vena Cava Invasion in Patients with Renal Pelvis Transitional Cell Carcinoma by Use of Human Cadaveric Aorta

We herein report a case of radical nephroureterectomy and replacement of the inferior vena cava (IVC) with ahuman cadaveric aortic graft for a patient with renal pelvis transitional cell carcinoma associated with IVC infiltration. In advanced disease, radical surgery is essential to achieve long-term survival. This case entails the use of another treatment option among the numerous options currently available for the management of patients with advanced renal cancer associated with IVC invasion.

Diagnosis and treatment of pyelogenic cyst / 中华全科医师杂志

The clinical data of 32 patients with pyelogenic cyst were reviewed retrospectively. The diagnosis of 25 cases was confirmed by intravenous pyelography (IVP) , in which the ultrasonography and computed tomography ( CT) failed to provide accurate diagnosis. Eighteen cases were treated by surgical operations, among them 16 cases were cured, one case lost follow-up, and one case recurred in 6 months after surgery. The data indicate that the diagnosis of pyelogenic cyst mainly depends on IVP examination and the laparoscopic technique can be effectively applied for treatment of pyelogenic cyst.

Clinical analysis of squamous cell carcinoma of renal pelvis / 中华泌尿外科杂志

Objective To review the diagnosis and treatment of squamous cell carcinoma of renal pelvis. Methods The clinical data from October 1991 to May 2009 of eight cases of squamous cell carcinoma of renal pelvis were reviewed and analyzed retrospectively. The symptoms of the patients were hematuria (eight cases), pain (seven cases) and abdominal mass (one case). All patients underwent B-ultrasound and IVU examination and four cases underwent CT scan. Three cases were diagnosed as having a tumor before surgery. Five cases were diagnosed as renal calculus, two of the five cases were diagnosed by intraoperative frozen section. Radical nephroureterectomy were performed in four cases, nephrectomy in three cases and palliative resection in one case. Results Histological classification revealed that six cases were moderately differentiated, one case was well differentiated and one case was poorly differentiated. Two cases had stage pT1/pT2 and six cases had stage pT3/pT4. 2 cases had regional lymph nodes metastasis. Seven cases were followed-up. All patients died of tumor recurrence or metastasis. The median tumor specific survive time was six months (range from two months to 42 months). Conclusions Squamous cell carcinoma of renal pelvis is often occurs concurrently with urolithiasis which could lead to difficulty in diagnose before operation. As the most of the patients were diagnosed with advanced stage disease, squamous cell carcinoma of renal pelvis tended to early recurrence and metastasis and the prognosis was very poor.

Comparison of different radical resection of renal pelvis carcinoma / 肿瘤研究与临床

Objective To investigate the surgical technique and clinical effectiveness of retroperitoneal laparoscopic nephroureterectomy with transurethral bladder-cuff excision and open nephroureterectomy in pelvis carcinoma. Methods We retrospectively analysed the records of all 62 patients who underwent retroperitoneal laparoscopic or open nephroureterectomy in Tianjin Dagang Hospital or the Second Affiliated Hospital of Tianjin Medical University from July 2001 to July 2009. Variables analyse were compared including operative time, blood loss, turning to open operation, complications, length of stay, tumor recurrence and metastasis. Groups were compared using Student's t-test, and a probability (P) value of less than 0.05 was taken to indicate statistical significance. Results The respective mean operative duration [(47.34±39.16) vs (118.17±44.65) ml], length of hospital stay [(9.15±2.19) vs (11.64±3.71) d], time to ambulation [(3.58±0.79) vs (5.67±1.24) d]and blood loss [(70.64±27.33) vs (118.17±44.65) ml]in retroperitoneal laparoscopic nephroureterectomy with transurethral bladder-cuff excision group was significantly reduce to open nephroureterectomy group (t = 3.3167, 2.0587, 8.0494, 5.1777, P ＜0.05). There was no significantly difference between two groups in complication of during operation and post operation [4.8 % (2/42) vs 5.0 %(1/20), 0 vs 0, respectively](P ＞0.05). 4 cases were failed and conversed to open surgery in retroperitoneal laparoscopic nephroureterectomy group. During the follow up period range from 8-48 months, there was no significantly difference between two groups in tumor recurrence and metastasis [4.8 % (2/42) vs 5.0 % (1/20),2.4 % (1/42) vs 5.0 % (1/20), respectively](P ＞0.05). Conclusion Retroperitoneal laparoscopy in upper urinary tract transitional carcinoma uses a small incision, incurs less blood loss, and allows for a more rapid recovery, suggesting it is a safe and effective method for treating patients with renal and pelvis cancer.

Diagnosis and treatment of carcinoma of renal pelvis accompanied with kidney stones / 中华泌尿外科杂志

Objective To discuss the diagnosis and treatment of carcinoma of renal pelvis ac-companied with kidney stones. Methods Twenty-one cases of carcinoma of renal pelvis with kidney stones were reviewed. The urinary stones history was from 10 d to 24 years with an average of 27 months. Four cases had recurrent fever, weight loss. Seventeen cases had gross hematuria. CT scan-ning was performed in 17 cases, which indicated 9 cases of carcinoma of renal pelvis, 4 cases of possi-ble renal mass and enlarged renal hilum lymph nodes. MRU was performed in 10 cases, which showed 9 cases of stones concomitant with carcinoma of renal pelvis. IVU indicated 13 cases of light filling of contrast and 8 cases of complete negative filling. Nine cases who had been diagnosed before surgery were performed radical nephrectomy and local lymph nodes dissection. Five cases were carried out ne-phrostomy first because of pyonephrosis, then secondary subcapsule nephrectomy was performed, 2 of them who were diagnosed with carcinoma of renal pelvis after surgery were performed with ureterecto-my and excision of bladder cuff. Three cases were performed with subcapsule nephrectomy because of dense perinephric adhesion. Three cases with complicated calculi and nonfunctional kidney were per-formed with nephroureterectomy, 2 of them who were diagnosed with carcinoma of renal pelvis were carried out with ureterectomy and excision of bladder cuff. One case who was performed PCNL under ultrasound guidance was found a mass in the renal pelvis. The pathological examination indicated ade-nocarcinoma. Radical nephrectomy and lymphadenectomy of renal hilum were performed afterwards. Resnlts Twenty-one cases were performed with pathological examination, in which there were 4 ca-ses of transitional cell carcinoma, 16 cases of squamous cell carcinoma and 1 case of adenocarcinoma. All the 21 cases were discharged after surgery. Nine of them were followed up with 4 to 28 months. Six cases were dead. The post-surgery survival time was 3 to 21 months. Two of them died of heart infarction, 4 died of metastasis. Conclusions The carcinoma of renal pelvis should be considered be-fore surgery in the patients with long history of renal calculi, hydronephrosis and infection. CT scan-ning and MRU are helpful for the diagnoses of renal calculi concomitant with carcinoma of renal pel-vis. Earlier diagnosis, earlier management of renal calculi can extend survival time of the patients with renal calculi concomitant with carcinoma of renal pelvis.

Transforming growth factor-β1 in congenital ureteropelvic junction obstruction: diagnosis and follow-up

OBJECTIVE: To assess the role of transforming growth factor-β1 (TGF-β1) in congenital ureteropelvic junction obstruction at diagnosis and during postoperative follow-up. MATERIAL AND METHODS: We conducted a case-control study including 19 patients with a mean age of 6.7 years and 19 matched controls. All patients presented negative voiding cystourethrography, obstructive diuretic renogram and underwent dismembered pyeloplasty. Urinary TGF-β1 and other markers were measured pre-, intra- and postoperatively. RESULTS: The mean bladder urine TGF-β1 concentration in obstructed patients prior to pyeloplasty was higher than in controls (92.5 pg/mL ± 16.8 vs. 35.8 pg/mL ± 16.2; p = 0.0001). The mean renal pelvic urine TGF-β1 concentration in the hydronephrotic kidney was higher than in the preoperative bladder urine sample (122.3 pg/mL ± 43.9 vs. 92.5 pg/mL ± 16.8; p = 0.036). Postoperative mean TGF-β1 concentration was significantly lower than preoperative TGF-β1 (48.7 pg/mL ± 13.1 vs. 92.5 pg/mL ± 16.8; p = 0.0001). CONCLUSION: TGF-β1 is a cytokine leading to renal fibrosis. The measurement of urinary TGF-β1 could become a useful tool for the diagnosis of obstructive hydronephrosis and the evaluation of the parenchyma function status, pre and postoperatively.