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2.
Int. braz. j. urol ; 47(1): 46-60, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1134331

ABSTRACT

ABSTRACT Purpose: Radical nephrectomy (RN) is the standard surgical type for pathological stage T3a (pT3a) renal cell carcinoma (RCC). Recently, some studies have suggested equivalence between partial nephrectomy (PN) and RN for oncologic control and have shown the benefits of PN for better renal function. We conducted this meta-analysis to assess oncologic outcomes, perioperative outcomes and renal function between two groups among patients with pT3a RCC. Materials and methods: PubMed, Scopus, Web of Science, Science Direct, Ovid MEDLINE, The Cochrane Library, Embase and Google Scholar were searched for eligible articles. The endpoints of the final analysis included overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), surgical complications, operative time, estimated blood loss (EBL), serum creatinine and estimated glomerular filtration rate (eGFR). Results: Twelve studies of moderate to high quality, including 14.152 patients, were examined. PN showed superiority for renal functional preservation, providing higher eGFR (WMD=12.48mL/min; 95%CI: 10.28 to 14.67; P <0.00001) and lower serum creatinine (WMD=-0.31mg/dL; 95%CI: −0.40 to −0.21; P <0.00001). There were no significant differences between PN and RN regarding operative time, EBL, surgical complications, OS, RFS and CSS. Despite inherent selection bias, most pooled estimates were consistent in sensitivity analysis and subgroup analysis. More positive margins were found in the PN group (RR=2.42; 95%CI: 1.25-4.68; P=0.009). Conclusions: PN may be more suitable for treating pT3a RCC than RN because it provides a similar survival time (OS or RFS) and superior renal function. Nevertheless, this result is still disputed, and more high-quality studies are required.


Subject(s)
Humans , Carcinoma, Renal Cell/surgery , Kidney Neoplasms/surgery , Retrospective Studies , Treatment Outcome , Margins of Excision , Glomerular Filtration Rate , Nephrectomy
3.
Int. braz. j. urol ; 47(1): 103-111, Jan.-Feb. 2021. tab
Article in English | LILACS | ID: biblio-1134316

ABSTRACT

ABSTRACT Objective: This study aims to compare renal functional outcomes of access techniques in patients who underwent off-clamp (Off-C) laparoscopic partial nephrectomy (LPN). Materials and Methods: Thirty-four Off-C LPNs in patients with functioning contralateral kidney from March 2011 to June 2018 were included in the study. Twenty-two patients underwent transperitoneal, 12 patients underwent retroperitoneal Off-C LPN. The primary outcome was glomerular filtration rate changes over time, postoperatively. The secondary outcome was the evaluation of trifecta and pentafecta rate. Results: Preoperative demographics, tumor size (26.59 vs. 22.83mm, p=0.790), RENAL score (5.45 vs. 5.33, p=0.990), operation time (79.95 vs. 81.33 min, p=0.157), blood loss (170.23 vs. 150.83mL, p=0.790) were similar in both groups. Although preservation of renal function was better in group 2 in the early period, similar results were found in both groups at the end of the first year, postoperatively. No positive surgical margin and postoperative major complications were detected in any patient. While trifecta goals were achieved in all the patients in the cohort, pentafecta rates were 90.9% and 91.7% in the transperitoneal and retroperitoneal groups, respectively. Conclusions: Transperitoneal and retroperitoneal access were found to have similar outcomes in terms of preservation of renal function at the end of the first year postoperatively. Off-C LPN may be considered as a safe and effective treatment option in patients having non-complex renal tumors.


Subject(s)
Humans , Laparoscopy , Kidney Neoplasms/surgery , Retroperitoneal Space , Retrospective Studies , Treatment Outcome , Nephrectomy
5.
Int. braz. j. urol ; 47(1): 149-158, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1134310

ABSTRACT

ABSTRACT Purpose: Renal artery pseudoaneurysms (RAPs) and arteriovenous fistulas (AVFs) are rare but potentially life-threatening complications after partial nephrectomy (PN). Selective arterial embolization (SAE) is an effective method for controlling RAPs/AVFs. We assessed the clinical factors affecting the occurrence of RAPs/AVFs after PN and the effects of SAE on postsurgical renal function. Materials and Methods: Four hundred ninety-three patients who underwent PN were retrospectively reviewed. They were placed in either the SAE or the non-SAE group. The effects of clinical factors, including R.E.N.A.L. scores, on the occurrence of RAPs/AVFs were analyzed. The influence of SAE on the estimated glomerular filtration rate (eGFR) during the first postoperative year was evaluated. Results: Thirty-three (6.7%) patients experienced RAPs/AVFs within 8 days of the median interval between PN and SAE. The SAE group had significantly higher R.E.N.A.L. scores, higher N component scores, and higher L component scores (all, p <0.05). In the multivariate analysis, higher N component scores were associated with the occurrence of RAPs/AVFs (Odds ratio: 1.96, p=0.039). In the SAE group, the mean 3-day postembolization eGFR was significantly lower than the mean 3-day postoperative eGFR (p <0.01). This difference in the eGFRs was still present 1 year later. Conclusions: Renal tumors located near the renal sinus and collecting system were associated with a higher risk for RAPs/AVFs after PN. Although SAE was an effective method for controlling symptomatic RAPs/AVFs after PN, a procedure-related impairment of renal function after SAE could occur and still be present at the end of the first postoperative year.


Subject(s)
Humans , Arteriovenous Fistula/etiology , Aneurysm, False/etiology , Kidney Neoplasms/surgery , Retrospective Studies , Treatment Outcome , Glomerular Filtration Rate , Nephrectomy/adverse effects
6.
Bol. méd. postgrado ; 36(2): 59-62, dic.2020. ilus
Article in Spanish | LILACS, LIVECS | ID: biblio-1117902

ABSTRACT

La hidronefrosis gigante se considera una entidad rara, caracterizada por la presencia de al menos 1 litro de líquido dentro del sistema pielocalicial, más frecuente en pacientes masculinos, generalmente asintomático. Se presenta el caso de una paciente femenina de 85 años de edad quien refiere desde hace 6 años dolor lumbar izquierdo y aumento de la circunferencia abdominal; en la TAC abdomino-pélvica contrastada se evidencia bolsa hidronefrótica izquierda gigante con corteza renal adelgazada que no concentra ni elimina el contraste. Se presenta el caso de paciente masculino de 85 años de edad quien refiere desde hace 5 años aumento de la circunferencia abdominal y la TAC abdomino-pélvica contrastada muestra importante dilatación del riñón y sistema colector derecho secundario a litiasis ureteral. A ambos pacientes se les practicó nefrectomía simple. Con respecto a la hidronefrosis gigante, la etiología más frecuente es la estenosis de la unión ureteropélvica seguido por la patología litiásica y tumoral; es importante considerar esta entidad como diagnóstico diferencial en caso de masas quísticas abdominales(AU)


Giant hydronephrosis is considered a rare entity, characterized by the presence of at least 1 liter of fluid within the pielocalicial system; is more frequent in males and often asymptomatic. We present an 85-year-old female patient who has a 6-year complain of left lumbar pain associated with increase in abdominal circumference. On CT scan, a giant left hydronephrotic pouch is evidenced, with a thinned renal wall that does not concentrate or eliminate contrast. We present a 61 year-old male who refers a 5-year asymptomatic increase in abdominal circumference. The CT scan reveals significant dilatation of the kidney and right collecting system secondary to ureteral lithiasis. Both patients undergo simple nephrectomy. The most frequent etiology of giant hydronephrosis is ureteropelvic junction stenosis followed by lithiasic and tumor pathology. It is important to consider this entity as a differential diagnosis in the case of abdominal cystic masses(AU)


Subject(s)
Humans , Male , Female , Urinary Tract Infections/etiology , Tomography, X-Ray Computed , Ultrasonography , Pyelocystitis/physiopathology , Hydronephrosis/etiology , Urologic Diseases , Nephrectomy
7.
Rev. cuba. med. mil ; 49(4): e697, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1156525

ABSTRACT

Introducción: La eliminación de orina que con tiene grandes cantidades de material quiloso y adquiere un aspecto lechoso se conoce con el nombre de quiluria. Salvo en las regiones donde es endémica, la filariasis linfática, principal etiología, se considera en general como un trastorno raro. Objetivo: Describir un caso de quiluria asociada al embarazo. Caso clínico: Paciente femenina de 32 años de edad, con múltiples ingresos en el Servicio de Nefrología del Hospital Celia Sánchez Manduley desde el año 2007 por presentar orinas de color blanquecino, cuadro que comenzó con el primer embarazo, el síntoma desapareció y luego reapareció con el segundo embarazo, primero de forma intermitente y después, adquirió carácter permanente, con hematuria, proteinuria, edemas y otras alteraciones clínicas y bioquímicas. Conclusiones: La nefrectomía está indicada en la quiluria, cuando pone en riesgo la vida del paciente o afecta su calidad de vida, si no se tienen otras alternativas terapéuticas(AU)


Introduction: The elimination of urine containing large amounts of chyllous material and acquiring a milky appearance is known as quiluria. Except in regions where it is endemic, lymphatic filariasis, the main etiology, is generally considered to be a rare disorder. Objective: To describe a case of chyluria associated with pregnancy. Clinical case: 32-year-old female patient with multiple admissions to the nephrology service at Hospital Celia Sánchez Manduley since 2007 for presenting whitish urine, a clinical picture that began with the first pregnancy. The symptom disappeared, then reappeared with the second pregnancy, first intermittently and then became permanent with hematuria, proteinuria, edema and other clinical and biochemical alterations. Conclusions: Nephrectomy is indicated in chyluria when it puts the patient's life at risk and affects the quality of life, if there are no other therapeutic alternatives(AU)


Subject(s)
Humans , Female , Urinary Fistula/surgery , Filariasis , Nephrectomy/methods
8.
Int. braz. j. urol ; 46(6): 943-949, Nov.-Dec. 2020. tab
Article in English | LILACS | ID: biblio-1134249

ABSTRACT

ABSTRACT Objective There is limited data regarding surgeon volume and partial nephrectomy outcomes. The aim of this study is to report trifecta outcomes of robot-assisted partial nephrectomy (RAPN) performed by the low volume surgeon. Materials and Methods Thirty-nine patients with clinical T1-2 renal tumors who underwent RAPN between 2012 and 2018 were included in this study. Trifecta was defined as negative surgical margins, warm ischemia time ≤20 minutes, and no operative complications. Patient demographics, R.E.N.A.L. nephrometry score, operation time, estimated blood loss, warm ischemia time, length of hospital stay, renal functions, and oncological outcomes were analyzed retrospectively. Complications were graded based on the modified Clavien-Dindo classification system. Results The median R.E.N.A.L. nephrometry score was 6 (4-10). RAPN was successfully performed in all but one patient. The median operation time was 180 (90-240) minutes. Warm ischemia was performed only by segmental renal artery control in 35 and, by main renal artery control in three patients. The off-clamp technique was used in two patients. The median warm ischemia time was 16 (0-31) minutes. Seven patients had a warm ischemia time of longer than 20 minutes. Three patients had postoperative complications. The surgical margin was positive in one patient. As a result, the trifecta was achieved in 30 of the 39 patients (77%). Conclusion RAPN is a safe and effective minimally invasive alternative in the treatment of renal masses. The present study suggests that reasonable trifecta rates can be achieved even by low volume surgeons.


Subject(s)
Humans , Robotic Surgical Procedures , Kidney Neoplasms/surgery , Blood Transfusion , Retrospective Studies , Treatment Outcome , Surgeons , Nephrectomy
9.
Int. braz. j. urol ; 46(6): 1021-1028, Nov.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1134271

ABSTRACT

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.


Subject(s)
Animals , Vascular System Injuries , Nephrectomy/adverse effects , Renal Artery , Swine , Sheep , Models, Animal , Kidney/surgery
10.
Int. braz. j. urol ; 46(5): 778-785, Sept.-Oct. 2020. tab, graf
Article in English | LILACS | ID: biblio-1134213

ABSTRACT

ABSTRACT Purpose: To investigate the association between preoperative retrograde pyelography (RGP), conducted to evaluate upper tract urothelial carcinoma (UTUC), and intravesical recurrence (IVR) after radical nephroureterectomy (RNU). Materials and Methods: Of 114 patients that underwent RNU, 72 patients without preoperative ureteroscopy and a history of bladder tumor were selectively enrolled. Variables associated with IVR were identified. Results: RGP was performed at a mean duration of 24.9 days prior to RNU in 41 (56.1%) of study subjects. During the mean follow-up period of 64.5 months, IVRs were identified in 32 (44.4%) patients at 22.3±18.8 (mean±SD) months after RNU. Despite similar tumor characteristics in the RGP and non-RGP groups, the incidence of IVR was considerably higher in the RGP group (63.4%) than in the non-RGP group (19.4%, p <0.001). The following variables differed significantly between the IVR and non-IVR groups: age (64.6±8.51 vs. 59.6±9.65 years), tumor location (lower or upper; 53.1% vs. 20%), tumor invasiveness (> pT2; 53.1% vs. 17.5%), preoperative hemoglobin (12.8±1.36 vs. 13.9±1.65), preoperative creatinine (1.29±0.32 vs. 1.11±0.22), and preoperative RGP (81.3% vs. 37.5%), respectively. Multivariate Cox regression model showed that tumor location (p=0.020, HR=2.742), preoperative creatinine level (p=0.004, HR=6.351), and preoperative RGP (p=0.045, HR=3.134) independently predicted IVR. Conclusion: Given the limitations of retrospective single-center series, performance of RGP before RNU was shown to have a negative effect on IVR after surgery.


Subject(s)
Humans , Carcinoma, Transitional Cell/surgery , Carcinoma, Transitional Cell/diagnostic imaging , Urologic Neoplasms/diagnostic imaging , Nephroureterectomy , Urography , Retrospective Studies , Neoplasm Recurrence, Local/diagnostic imaging , Nephrectomy
11.
Int. braz. j. urol ; 46(5): 814-821, Sept.-Oct. 2020. tab
Article in English | LILACS | ID: biblio-1134235

ABSTRACT

ABSTRACT Introduction: Recent data suggest that robotic platform has become the most accessible minimal invasive surgery even for surgeons without previous training in laparoscopy. Laparoscopic partial nephrectomy (LPN) is a well-stablished procedure, however, with high level of complexity and long learning curve that limit its use. Objective: To describe safety, efficiency and learning curve of a single surgeon without previous experience in LPN to reach "TRIFECTA" at robot-assisted partial nephrectomy (RAPN). Patients and Methods: This is a retrospective study, with prospective data collection of 101 patients submitted to RAPN by a single surgeon. In order to analyze the learning curve, sample was chronologically divided in two phases: first phase: P1: 50 first patients, second phase: P2: 51 subsequent patients. TRIFECTA was defined as: ischemia time lower than 25 minutes, negative surgical margin and absence of severe complications (Clavien >2). Results: Mean age of patients was 54 years (SD=11.85), median tumor size was 32mm (SD=17) and surgery was performed with zero ischemia time in 33.6% of patients (29.8% at P1 and 40.9% at P2). Demographic data of patients were similar between both groups, except tumor size (P1=27.5mm vs. P2=35.3mm; p=0.02) and body mass index (BMI) (P1=26.6kg/m2 vs. P2=29kg/m2; p=0.03). Rate of bleeding, surgical time, presence of positive margin and peri-operatory surgical complications were similar in both phases. TRIFECTA was higher in P2 in relation to P1 (P1: 58% vs. P2: 87.8%; p=0.002) and median time of hot ischemia was significantly lower at P2 (P1: 17.3 vs. P2: 11.7; p=0.02). At multivariate analysis independent factors related to TRIFECTA included: chronological phase (OR 10.74; 95% IC: 1.63-70.53; p=0.013) and tumor size (OR 0.95; 95% IC: 0.91-0.99; p=0.024). Conclusion: RAPN seems to be safe and efficient with good functional and oncological results (TRIFECTA) since the beginning. Experience improvement was related to treatment of larger tumors, higher proportion of patients with zero ischemia and higher rate of TRIFECTA.


Subject(s)
Humans , Laparoscopy , Robotic Surgical Procedures , Kidney Neoplasms/surgery , Prospective Studies , Retrospective Studies , Treatment Outcome , Middle Aged , Nephrectomy
12.
Int. braz. j. urol ; 46(5): 871-872, Sept.-Oct. 2020.
Article in English | LILACS | ID: biblio-1134225

ABSTRACT

ABSTRACT Purpose: The conservative management of localized renal masses has been recently widened to cT2 tumors showing encouraging functional and oncological outcomes (1). This video aims to report the conservative management of a highly complex renal tumor treated with robotic pure enucleation in our center, specifically focusing on preoperative work-up, video-reported surgical steps and perioperative outcomes. Materials and Methods: A 63 year-old lady underwent CT scan revealing a single 75 x 68mm, mainly endophytic, right renal mass dislocating the vascular pedicle (cT3a). Two renal arteries and two veins were identified. PADUA, RENAL and simplified SPARE scores were 14a, 12a and 12 respectively. Since the contralateral kidney was hypotrophic, the indication for nephron-sparing approach was considered absolute. Preoperative surgical planning included the employment of 3D-virtual models (2). Results: Operative time was 150 minutes and warm ischemia time was 25 minutes. No major complication occurred. Histopathological analysis revealed a cromophobe renal cell carcinoma with extension to perirenal fat tissue (pT3a). Resection technique was classified as pure enucleation since Surface-Intermediate-Base (SIB) score was 0-0-0 (3, 4). At seven-months follow-up no signs of local or systemic recurrence were recorded. Postoperative CT-scan revealed optimal parenchymal volume preservation with last creatinine blood level of 1.16mg/dL. Conclusion: This video highlights how, in experienced hands, robotic partial nephrectomy represents a feasible, effective treatment option for surgical management of highly complex renal tumors. The employment of intraoperative ultrasonography and 3D-virtual models allowed to accurately tailor surgical approach, improving the perception of tumor anatomy and its vascularization and maximizing perioperative outcomes.


Subject(s)
Humans , Female , Robotic Surgical Procedures/methods , Kidney Neoplasms/surgery , Nephrectomy/methods , Robotics , Treatment Outcome , Kidney Neoplasms/pathology , Middle Aged
13.
Arq. Ciênc. Vet. Zool. UNIPAR (Online) ; 23(2, cont.): e2309, jul-dez. 2020. ilus
Article in Portuguese | ID: biblio-1141378

ABSTRACT

A pionefrose consiste em uma hidronefrose contaminada, associada à destruição do parênquima renal. Tem como causas o bloqueio ureteral ou uretral por urólitos, inflamação crônica, neoplasia e ureter ectópico, seguidos de contaminação. O diagnóstico é realizado através de exames de imagem, principalmente a ultrassonografia e também através de urinálise e urocultura. Em casos avançados o tratamento preconizado é a nefrectomia. O presente trabalho tem como objetivo relatar um caso de um cão com suspeita inicial de hidronefrose. O paciente passou por nefrectomia, no pós-operatório observou-se melhora do seu quadro clínico, porém permanecendo a anemia. O diagnóstico definitivo, realizado por exame histopatológico, revelou pionefrose, entretanto sua causa não foi estabelecida.(AU)


Pyonephrosis consists of a contaminated hydronephrosis associated with the destruction of the renal parenchyma. Its causes include ureter or urethra blockage by uroliths, chronic inflammation, neoplasm, and ectopic ureter, followed by contamination. The diagnosis is made through image exams, mainly ultrasound, and also through urinalysis and uroculture. In advanced cases, nephrectomy is the recommended treatment. The objective of this study is to report a case of a dog with initial suspicion of hydronephrosis. The patient underwent nephrectomy, and during the postoperative period, an improvement in the clinical scenario was observed, despite the persistent anemia. The definitive diagnosis, carried out by histopathological examination, revealed pyonephrosis; however, its cause was not established.(AU)


La pionefrosis es una hidronefrosis contaminada, asociada con la destrucción del parénquima renal. Sus causas son el bloqueo ureteral o uretral por urolitos, inflamación crónica, neoplasia y uréter ectópico, seguido de contaminación. El diagnóstico se realiza mediante exámenes de imágenes, principalmente ultrasonografía y también mediante análisis de orina y urocultivo. En casos avanzados el tratamiento recomendado es la nefrectomía. Este artículo tiene como objetivo informar un caso de un perro con sospecha inicial de hidronefrosis. El paciente se sometió a nefrectomía; después de la operación, su estado clínico mejoró, pero la anemia permaneció. El diagnóstico definitivo realizado por el examen histopatológico reveló pionfrosis, sin embargo, su causa no se ha establecido.(AU)


Subject(s)
Animals , Dogs , Pyonephrosis , Hydronephrosis , Nephrectomy , Postoperative Period
14.
Int. braz. j. urol ; 46(supl.1): 69-78, July 2020. tab
Article in English | LILACS | ID: biblio-1134299

ABSTRACT

ABSTRACT Introduction: Recently the COVID-19 pandemic became the main global priority; main efforts and health infrastructures have been prioritized in favor of COVID-19 battle and the treatment of benign diseases has been postponed. Renal cell cancer (RCC) patients configure a heterogenous populations: some of them present indolent cases which can safely have postponed their treatments, others present aggressive tumors, deserving immediate care. These scenarios must be properly identified before a tailored therapeutic choice. Objectives We propose a risk- based approach for patients with RCC, to be used during this unprecedented viral infection time. Materials and Methods: After a literature review focused in COVID-19 and current RCC treatments, we suggest therapeutic strategies of RCC in two sections: surgical approach and systemic therapy, in all stages of this malignance. Results: Patients with cT1a tumors (and complex cysts, Bosniak III/IV), must be put under active surveillance and delayed intervention. cT1b-T2a/b cases must be managed by partial or radical nephrectomy, some selected T1b-T2a (≤7cm) cases can have the surgery postponed by 60-90 days). Locally advanced tumors (≥cT3 and or N+) must be promptly resected. As possible, minimally invasive surgery and early hospital discharge are encouraged. Upfront cytoreduction, is not recommendable for low risk oligometastatic patients, which must start systemic treatment or even could be put under surveillance and delayed therapy. Intermediate and poor risk metastatic patients must start target therapy and/or immunotherapy (few good responders intermediate cases can have postponed cytoreduction). The recommendation about hereditary RCC syndromes are lacking, thus we recommend its usual care. Local or loco regional recurrence must have individualized approaches. For all cases, we suggest the application of a specific informed consent and a shared therapeutic choice. Conclusion: In the pandemic COVID -19 times, a tailored risk-based approach must be used for a safe management of RCC, aiming to not compromise the oncological outcomes of the patients.


Subject(s)
Humans , Pneumonia, Viral/epidemiology , Carcinoma, Renal Cell/therapy , Coronavirus Infections/epidemiology , Kidney Neoplasms/therapy , Pandemics , Betacoronavirus , SARS-CoV-2 , COVID-19 , Neoplasm Recurrence, Local , Nephrectomy
15.
Salud(i)ciencia (Impresa) ; 24(1/2): 48-52, jun. 2020. tab.
Article in Spanish | LILACS, BINACIS | ID: biblio-1148249

ABSTRACT

La incidencia de tumores primarios del riñón en adultos en nuestro país está entre las más altas de Sudamérica. Su presentación clínica ha variado notoriamente en las últimas décadas y se ha incrementado la detección incidental en estadios más tempranos. Revisamos la experiencia clínica con los pacientes adultos que hubieran sido admitidos en internación en nuestro hospital, con diagnóstico de tumor renal en un período de diez años. Entre los 131 casos, con una relación varón/mujer de 1.9 a 1, la mediana de edad fue de 60 años. Los síntomas más comunes fueron hematuria y dolor, pero la detección incidental (42%) fue la forma de presentación más frecuente, en especial en los mayores de 65 años. Más de la mitad de los pacientes tenían anemia, cuya magnitud fue leve a moderada en la mayoría. En todos los casos, la extirpación se llevó cabo mediante nefrectomía abierta, y el abordaje fue por vía posterior en tres de cada cuatro. La tasa global de complicaciones posoperatorias, situada en el 15.3%, fue relativamente baja y se asoció de forma significativa e independiente con la edad mayor de 65 años y el antecedente de hipertensión arterial. Incluso con las limitaciones inherentes al diseño descriptivo y retrospectivo, articulando la epidemiología con la práctica clínica, este estudio nos permitió comprender el patrón de presentación de los tumores renales en nuestro medio y revisar la experiencia adquirida en su abordaje


Subject(s)
Humans , Middle Aged , Aged , Postoperative Complications , Diagnosis , Hypertension , Kidney Neoplasms , Nephrectomy
17.
Int. braz. j. urol ; 46(3): 322-327, May-June 2020.
Article in English | LILACS | ID: biblio-1090614

ABSTRACT

ABSTRACT Robotic surgery has been slow to be fully accepted in the world of pediatric urology largely because of its initial application directed towards adult use and because of the inherent high cost associated with it. However, as previously shown, it has now become the gold standard for adolescent pyeloplasty in The United States. As the adoption of robotic surgery in children has become more widespread, its use has been applied to a broader spectrum of procedures with similar success rates to standard laparoscopy. These procedures include nephrectomy, heminephrectomy, ureteral reimplantation, and ureteroureterostomy. However, it has also shown feasibility and comparable success when compared to open surgery in procedures that were previously deemed too complex to be done by standard laparoscopy. For example, bladder neck reconstruction with Mitrofanoff and Malone procedure as well as bladder augmentation. This review objective is to provide an overview of robotic surgery in pediatric urology, with a focus on the more common cases such as pyeloplasty and reimplantation as well as more complex bladder reconstruction procedures.


Subject(s)
Humans , Child , Adolescent , Adult , Urology , Robotics , Robotic Surgical Procedures , Urologic Surgical Procedures , Laparoscopy , Nephrectomy
18.
Int. braz. j. urol ; 46(3): 341-350, May-June 2020. tab, graf
Article in English | LILACS | ID: biblio-1090605

ABSTRACT

ABSTRACT Purpose: This study aims to evaluate the oncological and functional results of open partial nephrectomy (OPN) and laparoscopic partial nephrectomy (LPN) at the T1b clinical stage, which constitutes 25% of renal cell carcinomas (RCC) at diagnosis. Materials and Methods: The characteristics of 63 patients with stage T1b solitary tumor who underwent OPN (41) or LPN (22) were compared. The survival analysis was performed using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were performed to determine the factors affecting disease-free survival. Potential predictive factors, which might affect the postoperative glomerular filtration rate (GFR), were evaluated using multivariate linear regression analysis. Results: No differences were observed between OPN and LPN groups regarding patient and tumor characteristics. Although the warm ischemia time, intraoperative estimated blood loss, and operation duration were higher in the LPN group, no differences were noted between the two techniques regarding complication rates (p<0.001, p=0.023, p≤0.001, and p=0.190, respectively). The median hospitalization time was shorter in the LPN group than that in the OPN group (4 and 5 days, respectively), with less severe complications. No intergroup differences were observed regarding cancer-specific survival (CSS), disease-free survival (DFS), and overall survival (OS). The evaluation of the factors affecting DFS showed that age was an effective parameter (RR = 1.112, 95% CI: 1.010-8.254), but the surgical technique was not. Conclusion: No differences were observed between OPN and LPN techniques between oncological and functional outcomes in patients with clinical stage T1b RCC.


Subject(s)
Humans , Male , Female , Carcinoma, Renal Cell , Laparoscopy , Kidney Neoplasms , Retrospective Studies , Treatment Outcome , Nephrectomy
19.
Int. braz. j. urol ; 46(2): 234-241, Mar.-Apr. 2020. tab, graf
Article in English | LILACS | ID: biblio-1090590

ABSTRACT

ABSTRACT Purpose Preoperative computed tomography or magnetic resonance (MR) imaging are commonly used for radiological evaluation of renal cell carcinoma (RCC) before radical nephrectomy or nephron sparing surgery(NSS). This study aimed to assess the role of MRI for predicting postoperative renal function by preoperative estimation of renal parenchymal volume and correlation with glomerular filtration rate (GFR). Materials and Methods A prospective observational study was conducted from February 2015 to October 2016 at a tertiary care hospital in northern India. MR imaging was done on 3 Tesla MR scanner (Signa Hdxt General Electrics, Milwaukee, USA). MR volumetry was used to estimate the renal parenchymal volume. GFR was measured in all patients using Tc99m Diethyl-triamine-penta-acetic acid using Russell's algorithm. Such measurement was done preoperatively, and postoperatively 3 months after surgery. Results 30 patients with suspected RCC underwent NSS (n=10) and radical nephrectomy (n=20). Median tumour volume was 175.7cc (range: 4.8 to 631.8cc). The median volume of the residual parenchyma on the affected side was 84.25±41.97cc while that on the unaffected side was 112.25±26.35cc. There was good correlation among the unaffected kidney volume and postoperative GFR for the radical nephrectomy group (r=0.83) as well as unaffected kidney volume, total residual kidney volume and residual volume of affected kidney with postoperative GFR for the NSS group (r=0.71, r=0.73, r=0.79 respectively; P <0.05). Conclusion Preoperative residual parenchymal volume on MR renal volumetry correlates well with postoperative GFR in patients with RCC undergoing radical nephrectomy or NSS.


Subject(s)
Humans , Carcinoma, Renal Cell/surgery , Carcinoma, Renal Cell/diagnostic imaging , Kidney Neoplasms/surgery , Kidney Neoplasms/diagnostic imaging , Nephrectomy/methods , Nephrons/surgery , Postoperative Period , Prognosis , Magnetic Resonance Imaging , Prospective Studies , Glomerular Filtration Rate , Middle Aged
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