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Int. braz. j. urol ; 47(2): 464-467, Mar.-Apr. 2021.
Article in English | LILACS | ID: biblio-1154453


ABSTRACT Purpose: To report a case of successful removal of right staghorn renal calculi in a 3-year-old girl with Arnold-Chiari malformation and multiple urogenital anomalies. Case report: A 3-year-old female child with the diagnosis of Arnold-Chiari type 2 malformation was referred to our clinic due to presence of 9 kidney stones with a total volume of 10743mm3. The total of the longest diameters of all stones was calculated as 11.4cm. The patient had a urogenital septum, bifid bladder, and duplicated collecting system on the right side. An 18F Amplatz sheath was placed and mini-percutaneous nephrolithotomy was performed successfully by laser and pneumatic lithotripter. Any residual urinary tract stones or urinary tract infection were not detected during the 6th-month follow-up. Conclusion: Urolithiasis requires a thorough understanding of the underlying causes, as well as an effective and minimally invasive treatment. It is important for urologists to understand the complexity of the optimal stone management in pediatric patients in order to maximize treatment efficacy and minimize morbidity. We conclude that it is essential to treat urolithiasis in a single session in children with urogenital anomalies and accompanying congenital anomalies who have past surgical history.

Humans , Child , Nephrostomy, Percutaneous , Kidney Calculi/surgery , Kidney Calculi/diagnostic imaging , Solitary Kidney , Nephrolithotomy, Percutaneous , Kidney Diseases , Retrospective Studies , Treatment Outcome , Kidney/surgery , Kidney/diagnostic imaging
Int. braz. j. urol ; 46(6): 1021-1028, Nov.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1134271


ABSTRACT Objective To study the arterial segments of ovine kidney, present a proportional volume analysis of each kidney arterial segment, and analyze arterial injuries caused by simulated partial nephrectomy of cranial pole. Materials and Methods Forty-eight ovine kidneys injected with polyester resin into the renal arteries and collecting system were used in this study. Eighteen kidneys were used to study the arterial segments and the proportional volume of each renal segment. Other 30 kidneys were submitted to superior pole resection at a distance of 1.0cm, 0.5cm, or exactly at the cranial hilar edge, just before the resin hardening. These endocasts were used to evaluate the arterial injuries caused by these different resection planes. Results Ovine renal artery divided into two (ventral and dorsal) or three segmental arteries. Dorsal segment presented higher proportional volume than ventral segment. For kidneys with three segments, the third segment was on the caudal region (caudo-ventral or caudo-dorsal segment) and presented the lowest proportional volume. None of the resected kidneys (at 1.0, 0.5 or at the cranial hilar edge) presented injury of arterial branches that irrigate non-resected region. Conclusion The segmental distribution of renal artery, the proportional volume of each segment and arterial injuries after cranial pole resection in ovine kidneys are different from what is observed in human kidneys. Meanwhile, ovine kidneys show a primary segmental division on anterior and posterior, as in humans, but different from swine. These anatomical characteristics should be considered when using ovine as animal models for renal experimental and/or training procedures.

Animals , Vascular System Injuries , Nephrectomy/adverse effects , Renal Artery , Swine , Sheep , Models, Animal , Kidney/surgery
Int. braz. j. urol ; 45(2): 332-339, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1002209


ABSTRACT Purpose: To explore the potential association between renal mass characteristics and a history of chemotherapy. Materials and methods: A retrospective review of records of patients surgically treated for a localized renal mass between 2000 and 2012 was undertaken following an institutional review board approval. Patients age and sex, renal mass clinical characteristics (radiological size and mode of presentation) and pathological characteristics (diagnosis, renal cell carcinoma subtype, Fuhrman grade and stage) were compared between patients with and without a history of chemotherapy, using Fisher's exact test, Student's t-test and Wilcoxon rank sum test. A multivariate logistic analysis was performed to evaluate the independent association of chemotherapy and tumor pathology. Results: Of the 1,038 eligible patients, 33 (3%) had a history of chemotherapy. The distribution of clinical stage, renal mass diagnosis, renal cell carcinoma subtype, Fuhrman grade, pathological stage, sex and median age were similar between the general population and the chemotherapy group. However, the latter had a higher rate of incidental presentation (P = 0.003) and a significantly smaller median radiological tumor size (P = 0.01). In a subset analysis of T1a renal cell carcinoma, the chemotherapy group presented an increased rate of high Fuhrman grade (P = 0.03). On multivariate analysis adjusted for radiological tumor size, sex and age the chemotherapy cohort had a 3.92 higher odds for high Fuhrman grade. Conclusion: Patients with a history of chemotherapy typically present with smaller renal masses that, if malignant, have higher odds of harboring a high Fuhrman grade and thus may not be suitable for active surveillance.

Humans , Male , Female , Adult , Aged , Carcinoma, Renal Cell/pathology , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Kidney/pathology , Kidney Neoplasms/pathology , Carcinoma, Renal Cell/surgery , Carcinoma, Renal Cell/drug therapy , Survival Analysis , Retrospective Studies , Cohort Studies , Follow-Up Studies , Kidney/surgery , Kidney Neoplasms/surgery , Kidney Neoplasms/drug therapy , Middle Aged , Neoplasm Staging
Int. braz. j. urol ; 44(5): 952-957, Sept.-Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-975629


ABSTRACT Background: Three-dimensional (3D) printing has been introduced as a novel technique to produce 3D objects. We tried to evaluate the clinical usefulness of 3D-printed renal model in performing partial nephrectomy (PN) and also in the education of medical students. Materials and Methods: We prospectively produced personalized renal models using 3D-printing methods from preoperative computed tomography (CT) images in a total of 10 patients. Two different groups (urologist and student group) appraised the clinical usefulness of 3D-renal models by answering questionnaires. Results: After application of 3D renal models, the urologist group gave highly positive responses in asking clinical usefulness of 3D-model among PN (understanding personal anatomy: 8.9 / 10, preoperative surgical planning: 8.2 / 10, intraoperative tumor localization: 8.4 / 10, plan for further utilization in future: 8.3 / 10, clinical usefulness in complete endophytic mass: 9.5 / 10). The student group located each renal tumor correctly in 47.3% when they solely interpreted the CT images. After the introduction of 3D-models, the rate of correct answers was significantly elevated to 70.0% (p < 0.001). The subjective difficulty level in localizing renal tumor was also significantly low (52% versus 27%, p < 0.001) when they utilized 3D-models. Conclusion: The personalized 3D renal model was revealed to significantly enhance the understanding of correct renal anatomy in patients with renal tumors in both urologist and student groups. These models can be useful for establishing the perioperative planning and also education program for medical students.

Humans , Male , Female , Adult , Education, Medical, Graduate , Printing, Three-Dimensional , Kidney/anatomy & histology , Kidney/surgery , Nephrectomy/education , Prospective Studies , Middle Aged , Models, Anatomic
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 ; 44(2): 409-410, Mar.-Apr. 2018.
Article in English | LILACS | ID: biblio-1040039


ABSTRACT Introduction and objective Urethral duplication is a rare congenital anomaly, with roughly 200 cases reported in the literature (1). It is more frequent in males, with few cases reported in females. The clinical presentation differs according to the anatomical variant present. The duplication most commonly occurs in the sagittal plane with one urethra located ventrally and the other dorsally (2). Usually the ventral urethra is the more functional of both. Duplications occurring in the coronal plane are quite rare and they are usually associated with bladder duplication (3). The purpose of this paper was to present a video of a boy with an unusual urethral duplication form. Materials and Methods Patient was born premature due to oligohydramnios at 7 months-gestational age and he has initial diagnosis of hypospadia. Since then, he presented at least 7 febrile UTI and mother complained of difficult micturition and a presence of a mass at lower abdomen. Patient was referred to our institution and we identified urethral duplication with a glandar and scrotal meatus, palpable bladder and left penile-hemiscrotum transposition. US and CT-scan showed left kidney agenesis and overdistended bladder. VCUG and retrograde urethrography showed duplication, presence of contrast in the seminal vesicles and complete catheterizing of both urethras was not possible. Results The topic urethra was dysplastic and not patent to a 4Fr plastic tube so we were unable to access it endoscopically. We performed initially a Mitrofanoff procedure to allow CIC and treat chronic retention. Six months later, we assessed both urethras surgically and concluded that dorsal urethra was dysplastic after 3cm still in the penile area and scrotal urethra was not possible to be catheterized. We excised the ventral urethra because of dribbling complaints up to bulbar area and reconstructed the scrotal transposition, keeping the topic urethra for cosmetic issues. Patient had excellent outcome, performs CIC every 4 hours and has not presented further UTI episodes. Discussion and conclusion The urethral duplication is an anomaly that has multiple anatomical presentations. There are several theories about the etiology, but none can explain all types of presentations. There is also more than one rating available, and the Effmann classification is the most detailed. The case exemplifies this varied spectrum of anatomic urethral duplication. It resembles the urethral duplication type IIa-Y, however, ventral urethra meatus was located in penoscrotal area and both urethras were at least partially hypoplastic/dysplastic associated with obstruction and bladder retention. In determining how to best manage a patient with Y-type urethral duplication, the caliber and quality of the orthotopic urethra must first be assessed. Published reports suggest that best outcomes are those using the ventral duplicated urethra for the reconstruction (4). In this case, none of urethras were functional and a supravesical outlet channel had to be provided. The treatment of this condition requires an individualized planning and a vast technical knowledge of reconstructive surgery.

Humans , Male , Infant, Newborn , Urethra/abnormalities , Congenital Abnormalities/surgery , Urinary Retention/surgery , Hypospadias/surgery , Kidney/abnormalities , Kidney Diseases/congenital , Chronic Disease , Urinary Retention/complications , Hypospadias/complications , Kidney/surgery , Kidney Diseases/surgery , Kidney Diseases/complications
Medicina (B.Aires) ; 78(1): 47-49, feb. 2018. ilus
Article in Spanish | LILACS | ID: biblio-894548


El tumor fibroso solitario es raro. Si bien su localización más frecuente es la pleura, han sido informados algunos casos de ubicación retroperitoneal. Es difícil diferenciarlo imagenológicamente de otras neoplasias, por lo que casi siempre el diagnóstico es histológico. Dado que los tumores fibrosos solitarios tienen presentaciones clínicas muy diversas, una mejor compresión de la ubicación y sus características imagenológicas ayudaría a abreviar la lista de diagnósticos diferenciales. Comunicamos un tumor fibroso solitario de localización retroperitoneal cuyo diagnóstico fue confirmado por examen histológico.

The solitary fibrous tumor is uncommon. Even though it frequently locates in the pleura, a few cases have been reported in the retroperitoneum. Differentiation from other neoplasms is difficult, and therefore the diagnosis is always attained through histological examination. Although solitary fibrous tumors have variable clinical behaviors, a better comprehension of the location and its imaging characteristics would help to decrease the list of differential diagnoses. We report a solitary fibrous tumor located in the retroperitoneum whose diagnosis was confirmed by histological examination.

Humans , Male , Aged , Retroperitoneal Neoplasms/diagnostic imaging , Congenital Abnormalities/diagnostic imaging , Solitary Fibrous Tumors/diagnostic imaging , Kidney/abnormalities , Kidney Diseases/congenital , Retroperitoneal Neoplasms/surgery , Congenital Abnormalities/surgery , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Solitary Fibrous Tumors/surgery , Kidney/surgery , Kidney/diagnostic imaging , Kidney Diseases/surgery , Kidney Diseases/diagnostic imaging
Yonsei Medical Journal ; : 303-309, 2018.
Article in English | WPRIM | ID: wpr-713194


PURPOSE: To investigate 100 consecutive cases of videoscopic retrograde intrarenal surgery (RIRS) by a single surgeon and to evaluate factors associated with stone-free status and the learning curve thereof. MATERIALS AND METHODS: We analyzed the results of videoscopic RIRS in 100 patients who underwent primary treatment for renal stones from January 2015 to August 2016. Videoscopic RIRS were performed with URF-V and URF-V2 flexible video uteroscopes (Olympus) or a Flex-Xc flexible ureterorenoscope (KARL STORZ). Non-contrast computed tomography was taken at 3 months postoperatively to confirm the absence of stones. The stone characteristics included the location, maximal stone length (MSL), stone heterogeneity index (SHI), and mean stone density (MSD). Fragmentation efficacy was calculated as operative time (min) divided by removed MSL (mm), and was evaluated in the sequential order of operations. RESULTS: The mean age of the total patient was 60.0±14.0 years. The mean MSL was 13.1±6.2 mm. The average MSD was 734.2±327.6 Hounsfield unit (HU) and the SHI was 241.0±120.0 HU. The mean operation time was 65.1±45.7 min considering each renal unit. The stone-free rate at 3 months post-surgery was 87%. The estimated cut-off of the time-to-MSL ratio below 5 min/mm was 50. Multivariate analyses indicated a lower MSD [odds ratio (OR): 0.998; 95% confidence interval (CI): 0.996–0.999; p=0.047) and the last 50 cases (OR: 5.408, 95% CI: 1.337–30.426; p=0.030) as independent predictors of stone-free status after videoscopic RIRS. CONCLUSION: Low MSDs and the last 50 cases were significant predictors of stone-free rate in videoscopic RIRS.

Demography , Endoscopy , Female , Humans , Kidney/surgery , Kidney Calculi/surgery , Logistic Models , Male , Middle Aged , Multivariate Analysis , Operative Time , Postoperative Period , Time Factors , Treatment Outcome
Acta cir. bras ; 32(5): 334-341, May 2017. tab, graf
Article in English | LILACS | ID: biblio-837710


Abstract Purpose: To investigate the glomerular number after different warm ischemia times. Methods: Thirty two pigs were assigned into four groups. Three groups (G10, G20, and G30) were treated with 10, 20, and 30 minutes of left renal warm ischemia. The sham group underwent the same surgery without renal ischemia. The animals were euthanized after 3 weeks, and the kidneys were collected. Right kidneys were used as controls. The kidney weight, volume, cortical-medullar ratio, glomerular volumetric density, volume-weighted mean glomerular volume, and the total number of glomeruli per kidney were obtained. Serum creatinine levels were assessed pre and postoperatively. Results: Serum creatinine levels did not differ among the groups. All parameters were similar for the sham, G10, and G20 groups upon comparison of the right and left organs. The G30 group pigs' left kidneys had lower weight, volume, and cortical-medullar ratio and 24.6% less glomeruli compared to the right kidney. A negative correlation was found between warm ischemia time and glomerular number. Conclusions: About one quarter of glomeruli was lost after 30 minutes of renal warm ischemia. No glomeruli loss was detected before 20 minutes of warm ischemia. However, progressive glomerular loss was associated with increasing warm ischemia time.

Animals , Male , Warm Ischemia/adverse effects , Kidney/blood supply , Kidney Cortex/blood supply , Kidney Glomerulus/blood supply , Time Factors , Random Allocation , Creatinine/blood , Models, Animal , Sus scrofa , Kidney/surgery , Kidney/physiopathology , Kidney Cortex/physiopathology , Kidney Glomerulus/surgery , Kidney Glomerulus/physiopathology
Medicina (B.Aires) ; 77(2): 95-99, Apr. 2017. tab
Article in Spanish | LILACS | ID: biblio-894439


Nefrectomía radical se asocia a disminución progresiva de función renal. Los parámetros en insuficiencia renal post-nefrectomía están identificados, no así la importancia de la histopatología vascular en la pieza de nefrectomía. Nuestro objetivo fue evaluar si la gravedad de la aterosclerosis en tejido renal no neoplásico puede predecir la evolución del filtrado glomerular en pacientes con nefrectomía total. Se incluyeron 31 pacientes con nefrectomía radical unilateral, no donantes. Edad promedio 68.5 ± 11.8 años, 80% tenían antecedentes de hipertensión, 64% sobrepeso, 51% fumadores. Se estimó tasa de filtración glomerular preoperatoria, postoperatoria y a 6, 12 y 24 meses de cirugía. Se determinó grado de arteriolosclerosis según porcentaje de estrechamiento de luz vascular (grado 0: sin estrechamiento vascular; grado 1: menos del 25%; grado 2: 25-50%; grado 3: más del 50%). Los 10 pacientes con arteriolosclerosis grado 0 tuvieron mayor tasa de filtración glomerular basal (75 ± 13 ml/min/1.73 m²) que los 8 con grado 2 y 3 (55 ± 22 ml/min/1.73 m2) (p 0.0886). En la última evaluación, la tasa de filtrado glomerular fue 60 ± 13 ml/min/1.73 m² (grado 0) y 39 ± 11 ml/min/1.73 m² (grados 2 y 3) (p = 0.05). La disminución del filtrado glomerular fue mayor en grados más graves de ateroesclerosis (sin significación estadística). El análisis histológico de piezas quirúrgicas de nefrectomía permitiría identificar aquellos con mayor riesgo de progresión de enfermedad renal según gravedad de las lesiones vasculares ateroscleróticas.

Radical nephrectomy is associated with a progressive decline in renal function. Clinical parameters in post-nephrectomy insufficiency were described but the impact of histopathologic vascular findings in the non-neoplastic kidney of nephrectomy specimen, has been poorly studied. Our aim was to evaluate whether the severity of atherosclerosis in non-neoplastic renal tissue predicts the evolution of glomerular filtration rate in patients undergoing total nephrectomy. Thirty-one non-donor patients with unilateral radical nephrectomy were included. Average age was 68.5 ± 11.8 years, 80% had a history of hypertension, 64% overweight and 51% were smokers. The glomerular filtration rate was estimated preoperatively, postoperatively and at 6, 12 and 24 months after surgery. Arteriolosclerosis was scored based on degree of narrowing of the vascular lumen (stage 0: no vascular narrowing; stage 1: less than 25%; stage 2: 25-50%; stage 3: more than 50%). Ten patients in stage 0 had higher basal glomerular filtration rate (75 ± 13 ml/min/1.73 m²) than eight patients in stage 2 or 3 (55 ± 22 ml/min/1.73 m²) (p 0.0886). At the last postoperative evaluation, the glomerular filtration rate was 60 ± 13 ml/min/1.73 m² (stage 0) and 39 ± 11 ml/min/1.73 m² (stage 2 or 3) (p = 0.05). The decrease in glomerular filtration rate was higher in patients with more severe degrees of atherosclerosis but the difference was not statistically significant. The histological evaluation of the severity of arteriosclerosis in the whole kidney allows the identification of patients with a greater risk of decreased glomerular filtration rate after a post radical nephrectomy.

Humans , Male , Female , Middle Aged , Aged , Renal Insufficiency, Chronic/etiology , Atherosclerosis/complications , Kidney/blood supply , Nephrectomy/adverse effects , Time Factors , Severity of Illness Index , Retrospective Studies , Risk Factors , Disease Progression , Atherosclerosis/pathology , Glomerular Filtration Rate , Kidney/surgery , Kidney/pathology
Rev. Asoc. Méd. Argent ; 130(1): 30-33, mar. 2017. ilus
Article in Spanish | LILACS | ID: biblio-973067


Los angiomiolipomas renales son formaciones renales que se presentan de forma aislada o asociadas con otras patologías como esclerosis tuberosa o enfermedad de Von Hippel Lindau. Los angiomiolipomas renales se pueden presentar clínicamente con un shock hipovolémico por lesión de uno de sus vasos o con dolor abdominal por efecto masa debido a su tamaño. La resolución de los angiomiolipomas puede ser de manera programada o de urgencia, siendo las vías elegidas la nefrectomía parcial o la embolización arterial selectiva, dependiendo siempre de los recursos que se tengan y la experiencia del equipo quirúrgico.

Renal angiomyolipomas are kidney formations presented in isolation or associated with other diseases such as tuberous sclerosis or Von Hippel Lindau disease. Renal angiomyolipoma may present clinically with hypovolemic shock due to injury of one of its vessels or with abdominal pain due to mass effect because of its size. Angiomyolipomas can be resolved on scheduled basis or emergency, where the chosen ways are partial nephrectomy or selective arterial embolization, always depending on the resources you count on and the experience of the surgical team.

Female , Humans , Young Adult , Kidney/surgery , Tuberous Sclerosis/complications , Tuberous Sclerosis/surgery , Angiomyolipoma/diagnosis , Angiomyolipoma/surgery , Urogenital Abnormalities/surgery , Organ Sparing Treatments , Emergencies , Sex Distribution , Hypovolemia , Sepsis
Arq. bras. cardiol ; 108(3): 237-245, Mar. 2017. graf
Article in English | LILACS | ID: biblio-838708


Abstract Background: Radiofrequency ablation of renal sympathetic nerve (RDN) shows effective BP reduction in hypertensive patients while the specific mechanisms remain unclear. Objective: We hypothesized that abnormal levels of norepinephrine (NE) and changes in NE-related enzymes and angiotensinconverting enzyme 2 (ACE2), angiotensin (Ang)-(1-7) and Mas receptor mediate the anti-hypertensive effects of RDN. Methods: Mean values of systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were assessed at baseline and follow-up. Plasma and renal norepinephrine (NE) concentrations were determined using highperformance liquid chromatography with electrochemical detection, and levels of NE-related enzyme and ACE2-Ang(1-7)- Mas were measured using real time PCR, Western blot and immunohistochemistry or Elisa in a hypertensive canine model fed with high-fat diet and treated with RDN. The parameters were also determined in a sham group treated with renal arteriography and a control group fed with normal diet. Results: RDN decreased SBP, DBP, MAP, plasma and renal NE. Compared with the sham group, renal tyrosine hydroxylase (TH) expression was lower and renalase expression was higher in the RDN group. Compared with the control group, renal TH and catechol-o-methyl transferase (COMT) were higher and renalase was lower in the sham group. Moreover, renal ACE2, Ang-(1-7) and Mas levels of the RDN group were higher than those of the sham group, which were lower than those of the control group. Conclusion: RDN shows anti-hypertensive effect with reduced NE and activation of ACE2-Ang(1-7)-Mas, indicating that it may contribute to the anti-hypertensive effect of RDN.

Resumo Fundamentos: A denervação simpática renal por radiofrequência (DSR) mostra redução eficaz da pressão arterial (PA) de pacientes hipertensos, ainda que os mecanismos específicos permaneçam obscuros. Objetivo: Fizemos a hipótese de que níveis alterados de noradrenalina (NA) e mudanças nas enzimas relacionadas à NA e enzima conversora de angiotensina 2 (ECA-2), angiotensina (Ang)-(1-7) e receptor Mas são mediadores dos efeitos antihipertensivos da DSR. Métodos: Foram avaliados os valores médios de pressão arterial sistólica (PAS), pressão arterial diastólica (PAD) e pressão arterial média (PAM) no início e durante o seguimento. Foram medidas as concentrações plasmática e renal de noradrenalina (NA) por cromatografia líquida de alta eficiência com detecção eletroquímica, e os níveis de enzima relacionada à NA e ECA2-Ang-(1-7)-Mas através de PCR em tempo real, Western blot e imunohistoquímica ou Elisa em um modelo canino de hipertensão que recebeu ração rica em gordura e foi tratado com DSR. Os parâmetros também foram determinados em um grupo de cirurgia simulada submetido à arteriografia renal e em um grupo controle que recebeu dieta normal. Resultados: DSR causou diminuição da PAS, PAD, PAM e das concentrações plasmática e renal de NA. Em comparação ao grupo placebo, a expressão da tirosina hidroxilase (TH) renal foi menor e a da renalase foi maior no grupo DSR. Em comparação ao grupo controle, os níveis de TH renal e de catecol-o-metil-transferase (COMT) foram maiores e os de renalase foram menores no grupo cirurgia simulada. Além disso, os níveis renais de ECA2, Ang-(1-7) e Mas foram maiores no grupo DSR do que no grupo cirurgia simulada, que, por sua vez, foram menores do que no grupo controle. Conclusões: A DSR mostra efeitos anti-hipertensivos com redução da NA e ativação da ECA2-Ang-(1-7)-Mas, o que indica que pode contribuir com o efeito anti-hipertensivo da DSR.

Animals , Dogs , Sympathectomy/methods , Catheter Ablation/methods , Hypertension/surgery , Kidney/surgery , Kidney/innervation , Peptide Fragments/analysis , Reference Values , Renal Artery/surgery , Tyrosine 3-Monooxygenase/analysis , Body Weight , Angiotensin I/analysis , Immunohistochemistry , Random Allocation , Catechol O-Methyltransferase/analysis , Blotting, Western , Reproducibility of Results , Chromatography, High Pressure Liquid , Treatment Outcome , Peptidyl-Dipeptidase A/analysis , Models, Animal , Norepinephrine Plasma Membrane Transport Proteins/analysis , Diet, High-Fat , Monoamine Oxidase/analysis
Rev. bras. anestesiol ; 66(4): 423-425,
Article in English | LILACS | ID: lil-787627


Abstract Nephrectomies are usually performed under general anesthesia alone or in combination with regional anesthesia and rarely under regional anesthesia alone. We report the management of a patient with chronic obstructive pulmonary disease with a history of recurrent spontaneous pneumothorax undergoing nephrectomy under regional anesthesia alone.

Resumo Geralmente, as nefrectomias são feitas sob anestesia geral, isoladamente ou em combinação com anestesia regional, e raramente sob anestesia regional sozinha. Relatamos o tratamento de um paciente com doença pulmonar obstrutiva crônica e história de pneumotórax espontâneo recorrente submetido à nefrectomia sob anestesia regional isolada.

Humans , Male , Pneumothorax/complications , Pulmonary Disease, Chronic Obstructive/complications , Hydronephrosis/surgery , Hydronephrosis/complications , Anesthesia, Conduction/methods , Nephrectomy/methods , Recurrence , Kidney/surgery , Middle Aged
Ciênc. cuid. saúde ; 15(1): 36-43, 07/06/2016.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1120081


O objetivo foi compreender o cotidiano da pessoa na vivência da hemodiálise. Pesquisa qualitativa com embasamento fenomenológico de Martin Heidegger. Participantes foram 14 pessoas cadastradas na lista de espera do transplante renal em tratamento hemodialítico em uma clínica de terapia renal substitutiva, sediada em um município Mineiro. Realizou a técnica de entrevista fenomenológica. Os resultados foram anunciados por um início abrupto e os sinais e sintomas da doença. Caracterizando sua descoberta, como o não conhecimento sobre a doença e sua terapêutica, expressando sentimento de tristeza, raiva, revolta, incomodo e ao mesmo tempo um dever a realização do tratamento. Relatam a necessidade da informação e divulgação sobre a doença renal crônica. A discussão possibilita a compreensão dos sentidos do ser-aí-hemodialítico mostrado pelo falatório, curiosidade e publicidade do cotidiano, como angústia imprópria guiando o ser a inautenticidade. Além da relação entre enfermeiro e ser cuidado que desvelou o cuidar com solicitude substitutiva. Conclui-se que a melhoria da atuação do enfermeiro pode ser pautada por abordagens teóricas e filosóficas dando suporte para um cuidar autentico buscando uma visão de saúde pela ótica do ser cuidado em interação com o cuidador embasando tanto nos aspectos objetivos como subjetivos.

The goal was to understand the person's daily life in hemodialysis experience. Qualitative research with phenomenological basis of Martin Heidegger. Participants were 14 people registered on the waiting list for kidney transplant hemodialysis treatment at a clinic of renal replacement therapy, based on a Collier county. He performed the phenomenological interview technique. The results were announced by an abrupt onset and symptoms and signs of the disease. Featuring its discovery,as no knowledge about the disease and its treatment, expressing feelings of sadness, anger, anger, discomfort and at the same time a duty to completion of treatment. Report the need for information and publicity about chronic kidney disease. The discussion provides an understanding of the way of being-there-hemodialysis shown by gossip, curiosity and daily advertising such as improper anguish guiding be inauthenticity. In addition to the relationship between nurse and be careful that unveiled the care withsubstitute care. We conclude that the improvement of nursing work can be guided by theoretical and philosophical approaches supporting care for authentic seeking a vision of health from the perspective of being careful interaction with the caregiver basing both objective aspects as subjective.

Humans , Male , Female , Adult , Middle Aged , Renal Dialysis/nursing , Renal Insufficiency, Chronic , Anxiety/psychology , Kidney Transplantation/nursing , Emotions , Sadness/psychology , Kidney/surgery , Nurses
Med. infant ; 23(2): 86-89, junio 2016. ilus, tab
Article in Spanish | LILACS | ID: biblio-882145


La heminefrectomía puede constituir el tratamiento definitivo en el 85% de los pacientes con diagnóstico de doble sistema con uno de los mismos no funcionante. Actualmente el abordaje laparoscópico es de elección tanto por sus resultados estéticos como evolución postoperatoria. Materiales y métodos: se efectuó una revisión y análisis retrospectivo de todos los pacientes operados de heminefrectomía desde el año 2000 a 2014. Resultados: 44 pacientes fueron operados de forma convencional durante el período 2000-2010 y 30 de forma laparoscópica transperitoneal durante el período 2010-2014. La media de duración del procedimiento fue menor para el grupo convencional (89,6 vs 128 min, p = 0,000) mientras que la media de estadía hospitalaria fue menor para el grupo laparoscópico (4,2 vs 5,1, p = 0,19). La tasa de reoperación fue mayor en el grupo convencional (20,4% vs 6,7%, p = 0,18) y la principal causa fue por la presencia un muñón ureteral sintomático. En los controles por centellograma DMSA (en 19 pacientes del segundo grupo) no se objetivó la pérdida de función de la unidad remanente en ningún individuo. Conclusiones: La heminefrectomía es un procedimiento seguro con baja tasa de complicaciones cuya tendencia actual es realizar la cirugía de forma laparoscópica obteniendo resultados similares y menor tasa de complicaciones que en la forma convencional (AU)

Heminephrectomy may be the definitive treatment in 85% of patients diagnosed with a duplex kidney system of which one is not working. Currently, a laparoscopic approach is the treatment of choice because of both esthetic results and postoperative outcome. Material and methods: A retrospective analysis of all patients who underwent heminephrectomy between 2000 and 2014 was conducted. Results: 44 patients underwent conventional surgery in the period 2000-2010 and 30 underwent transperitoneal laparoscopy in the period 2010-2014. Mean duration of the procedure was less in the conventional group (89.6 vs 128 min, p = 0.000), while the mean hospital stay was less in the laparoscopic group (4.2 vs 5.1, p = 0.19). Reoperation rate was higher in the conventional group (20.4% vs 6.7%, p = 0.18) and the main cause was presence of a symptomatic ureteral stump. On DMSA whole body scan controls (in 19 patients in the second group) no loss of function of the remaining unit was observed in any of the patients. Conclusions: Heminephrectomy is a safe procedure with a low complication rate and a current trend to be performed using laparoscopy with similar results and a lower complication rate than in conventional surgery (AU)

Humans , Infant , Child, Preschool , Child , Adolescent , Kidney/abnormalities , Kidney/surgery , Laparoscopy/methods , Nephrectomy/methods , Treatment Outcome , Urologic Diseases/congenital , Retrospective Studies
Int. braz. j. urol ; 42(2): 383-388, Mar.-Apr. 2016. tab, graf
Article in English | LILACS | ID: lil-782865


ABSTRACT Purpose: To evaluate effectiveness of canine renal capsule for augmentation cystoplasty. Materials and Methods: Ten adult dogs participated in this study. After induction of anesthesia each animal underwent bed side urodynamic study, bladder capacity and bladder pressure was recorded. Then via mid line incision abdominal cavity was entered, right kidney was identified and its capsule was dissected. Bladder augmentation was done by anastomosing the renal capsule to the bladder. After 6 months bed side urodynamic study was performed again and changes in bladder volume and pressure were recorded. Then the animals were sacrificed and the augmented bladders were sent for histopathology evaluation. Results: Mean maximum anatomic bladder capacity before cystoplasty was 334.00±11.40cc which increased to 488.00±14.83cc post-operatively (p=0.039). Mean anatomic bladder pressure before cystoplasty was 19.00±1.58cmH2O which decreased to 12.60±1.14cmH2O post-operatively (p=0.039). Histopathology evaluation revealed epithelialization of the renal capsule with urothelium without evidence of fibrosis, collagen deposits or contracture. Conclusions: Our data shows that renal capsule is a favorable biomaterial for bladder augmentation in a canine model.

Animals , Dogs , Urologic Surgical Procedures/methods , Biocompatible Materials/therapeutic use , Urinary Bladder/surgery , Kidney/surgery , Time Factors , Urodynamics , Urinary Bladder/pathology , Fibrosis , Reproducibility of Results , Treatment Outcome , Models, Animal , Tissue Scaffolds , Kidney/pathology
Int. braz. j. urol ; 42(1): 90-95, Jan.-Feb. 2016. tab, graf
Article in English | LILACS | ID: lil-777320


ABSTRACT Objective to prospectively evaluate the ability of post-graduate students enrolled in a laparoscopy program of the Institute for Teaching and Research to complete single port total nephrectomies. Materials and Methods 15 post-graduate students were enrolled in the study, which was performed using the SILStm port system for single-port procedures. All participants were already proficient in total nephrectomies in animal models and performed a left followed by a right nephrectomy. Analyzed data comprised incision size, complications, and the time taken to complete each part of the procedure. Statistical significance was set at p<0.05. Results All students successfully finished the procedure using the single-port system. A total of 30 nephrectomies were analyzed. Mean incision size was 3.61 cm, mean time to trocar insertion was 9.61 min and to dissect the renal hilum was 25.3 min. Mean time to dissect the kidney was 5.18 min and to complete the whole procedure was 39.4 min. Total renal hilum and operative time was 45.8% (p<0.001) and 38% (p=0.001) faster in the second procedure, respectively. Complications included 3 renal vein lesions, 2 kidney lacerations and 1 lesion of a lumbar artery. All were immediately identified and corrected laparoscopically through the single-port system, except for one renal vein lesion, which required the introduction an auxiliary laparoscopic port. Conclusion Laparoscopic single-port nephrectomy in the experimental animal model is a feasible but relatively difficult procedure for those with intermediate laparoscopic experience. Intraoperative complications might be successfully treated with the single-port system. Training aids reducing surgical time and improves outcomes.

Humans , Animals , Laparoscopy/education , Models, Animal , Education, Medical/methods , Nephrectomy/education , Students, Medical , Swine , Swine, Miniature , Task Performance and Analysis , Prospective Studies , Reproducibility of Results , Clinical Competence , Laparoscopy/methods , Operative Time , Intraoperative Complications , Kidney/surgery , Nephrectomy/methods
Salvador; s.n; 2016. 65 p. ilus, tab.
Thesis in Portuguese | LILACS | ID: biblio-1001032


INTRODUÇÃO: A bovinocultura no Brasil é uma das principais atividades que compõem o agronegócio do país, sendo o segundo maior rebanho do mundo. O estado da Bahia tem papel importante neste setor, sendo o 10º estado em número de animais abatidos no Brasil em 2015 (4,4% dos animais abatidos no Brasil). Mesmo com índices animadores, a produtividade da pecuária baiana ainda é baixa, tendo as doenças infecciosas e parasitárias como principais entraves à sua melhora. Dentre essas doenças a leptospirose apresenta uma prevalência de 45,42% nos bovinos no estado da Bahia em prévio inquérito. OBJETIVOS: Assim, o presente projeto teve como objetivo: i) analisar a sororeatividade contra Leptospira de bovinos abatidos em estabelecimento com serviço de inspeção federal, no estado da Bahia, utilizando o teste microaglutinação (MAT), ii) avaliar qual o sorovar predominante na população animal pesquisada, iii) avaliar os rins dos animais abatidos em estabelecimento com serviço de inspeção federal, no estado da Bahia quanto a presença de lesões macroscópicas e a sua associação com as reações positivas ao MAT, vi) avaliar possíveis fatores de risco que poderão propiciar o desencadeamento da infecção por Leptospira. Foram analisados soros de 400 bovinos abatidos...

INTRODUCTION: cattle raising in Brazil is one of the activities that comprise the agribusiness of the country, the second largest herd in the world. The state of Bahia has an important role in this sector, being the 10th state in the number of animals slaughtered in Brazil in 2015 (4.4% of the animals slaughtered in Brazil). Despite encouraging rates, productivity of the Bahian livestock is still low, and infectious and parasitic diseases as major barriers to improvement. Among these diseases leptospirosis has a prevalence of 45.42% in cattle in the state of Bahia in a previous survey. OBJECTIVES: The present project aimed to: i) analyze the seroreactivity against Leptospira from bovine animals slaughtered in establishments with federal inspection service in the state of Bahia, using the microscopic agglutination test (MAT), ii) assess what the predominant serovar in animal population studied, iii) evaluate the kidneys of animals slaughtered in an establishment with federal inspection service in the state of Bahia and the presence of gross lesions and their association with the positive reactions to the MAT, vi) evaluate possible risk factors that may promote the onset of Leptospira infection. 400 slaughtered cattle sera were analyzed...

Animals , Cattle , Kidney/abnormalities , Kidney/surgery , Kidney/growth & development , Kidney/immunology , Kidney/injuries , Kidney/parasitology , Kidney/pathology , Serology/methods
Rev. Col. Bras. Cir ; 42(6): 382-385, Nov.-Dec. 2015. tab
Article in Portuguese | LILACS | ID: lil-771149


Objective: To analyze the characteristics of trauma patients with renal lesions treated at a university hospital in Curitiba. Methods: We conducted a retrospective, cross-sectional study guided by review of medical records of trauma victims who underwent surgical treatment. The variables analyzed were age, gender, mechanism of injury, degree of kidney damage, conduct individualized according to the degree of renal injury, associated injuries, complications and deaths. We classified lesions according to the American Association of Trauma Surgery (TSAA). Results: We analyzed 794 records and found renal lesions in 33 patients, with mean age 29.8 years, most (87.8%) being male. Penetrating trauma accounted for 84.8% of cases. The most common renal injuries were grade II (33.3%), followed by grade I (18.1%), III, IV and V. Nephrectomy treated 45.4% of injuries, 73.3% being total nephrectomy, and 45.4% by nephrorraphy. In 9% treatment was non-surgical. Only 12.1% of patients had isolated renal lesions. Complications ensued in 15.1% and mortality was 6.06%. Conclusion: The surgical approach was preferred due to penetrating trauma mechanism. We achieved low rates of complications and deaths, and neither case could be directly related to kidney damage, and there were patients with multiple lesions. In this sample, we could not observe a direct relationship between kidney damage and complications, deaths or the type of conduct employed.

Objetivo: analisar as características de pacientes vítimas de trauma, com lesões renais atendidos em um hospital universitário de Curitiba. Métodos: estudo transversal retrospectivo guiado por revisão de prontuários de vítimas de trauma submetidos ao tratamento cirúrgico. As variáveis analisadas foram idade, sexo, mecanismo de trauma, grau das lesões renais, conduta individualizada de acordo com o grau da lesão renal, lesões associadas, complicações e óbitos. As lesões foram classificadas de acordo com a Associação Americana de Cirurgia do Trauma (AAST). Resultados: foram analisados 794 prontuários, a lesão renal foi encontrada em 33 pacientes, a média de idade foi 29,8 anos, a maioria dos pacientes era (87,8%) do sexo masculino. O trauma penetrante foi responsável por 84,8% dos casos. As lesões mais frequentes foram as de grau II (33,3%), seguidas pelas lesões de grau I (18,1%) e pelas lesões de grau III, IV e V. Foram tratadas com nefrectomia, 45,4% das lesões, 73,3% por nefrectomia total e 45,4%, por nefrorrafia. Em 9% o tratamento não foi cirúrgico. Apenas 12,1% dos pacientes apresentaram lesões renais isoladas. Complicações foram observadas em 15,1% e a taxa de óbito foi 6,06%. Conclusão: a abordagem cirúrgica foi a preferencial devido ao mecanismo de trauma penetrante. Obtivemos baixos índices de óbitos e complicações, sendo que nenhum dos casos pôde ser relacionado diretamente à lesão renal, e ocorreram em pacientes com múltiplas lesões. Nesta amostra, não foi possível provar relação direta entre lesão renal e complicações, óbitos ou com o tipo de conduta empregada.

Humans , Male , Female , Adult , Multiple Trauma/epidemiology , Hospitals, University , Kidney/injuries , Wounds, Nonpenetrating , Multiple Trauma/surgery , Cross-Sectional Studies , Retrospective Studies , Kidney/surgery
Int. braz. j. urol ; 41(4): 669-675, July-Aug. 2015. tab
Article in English | LILACS | ID: lil-763070


ABSTRACTPurpose:We compared the effects of local levobupivacaine infiltration, intravenous paracetamol, intravenous lornoxicam treatments on postoperative analgesia in patients submitted to transperitoneal laparoscopic renal and adrenal surgery.Materials and Methods:Sixty adult patients 26 and 70 years who underwent laparoscopic renal and adrenal surgery were randomized into three groups with 20 patients each: Group 1 received local 20mL of levobupivacaine 0.25% infiltration to the trocar incisions before skin closure. In group 2, 1g paracetamol was given to the patients intravenously 30 minutes before extubation and 5g paracetamol was given intravenoulsy in the 24 postoperative period. In group 3, 8mg lornoxicam i.v. was given 30 minutes before extubation and 8mg lornoxicam i.v. was given in the 24 postoperative period. In the postoperative period, pain scores, cumulative tramadol, and additional pethidine consumption were evaluated.Results:Postoperative pain scores significantly reduced in each group (p < 0.05). Although pain levels of the groups were not significantly different at 1, 2, 4, 8, 12 and 24 hours postoperatively, cumulative tramadol consumptions were higher in group 1 than the others. (Group 1 = 370.6 ± 121.6mg, Group 2: 220.9 ± 92.5mg, Group 3 = 240.7 ± 100.4mg.) (p < 0.005). The average dose of pethidine administered was significantly lower in groups 2 and 3 compared with group 1 (Group 1: 145mg, Group 2: 100mg, Group 3: 100mg) (p = 0.024).Conclusions:Levobupivacaine treated group required significantly more intravenous tramadol when compared with paracetamol and lornoxicam groups in patients submitted to transperitoneal laparoscopic renal and adrenal surgery.

Adult , Female , Humans , Male , Middle Aged , Adrenal Glands/surgery , Kidney/surgery , Laparoscopy/methods , Pain Management/methods , Pain, Postoperative/drug therapy , Administration, Intravenous , Acetaminophen/administration & dosage , Acetaminophen/therapeutic use , Analgesics, Non-Narcotic/therapeutic use , Anesthesia, Local/methods , Anesthetics, Local/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Bupivacaine/analogs & derivatives , Bupivacaine/therapeutic use , Pain Measurement/methods , Piroxicam/administration & dosage , Piroxicam/analogs & derivatives , Piroxicam/therapeutic use , Visual Analog Scale