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Rev. cuba. med. mil ; 49(4): e697, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1156525


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)

Humans , Female , Adult , Urinary Fistula/surgery , Filariasis , Nephrectomy/methods
Int. braz. j. urol ; 46(5): 871-872, Sept.-Oct. 2020.
Article in English | LILACS | ID: biblio-1134225


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.

Humans , Female , Robotic Surgical Procedures/methods , Kidney Neoplasms/surgery , Nephrectomy/methods , Robotics , Treatment Outcome , Kidney Neoplasms/pathology , Middle Aged
Int. braz. j. urol ; 46(2): 234-241, Mar.-Apr. 2020. tab, graf
Article in English | LILACS | ID: biblio-1090590


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.

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
Rev. argent. radiol ; 84(1): 3-8, tab, graf, il.
Article in Spanish | LILACS | ID: biblio-1125846


Resumen Objetivo: Describir la evolución perioperatoria de pacientes sometidos a nefrectomía con y sin embolización de la arteria renal (EAR) prequirúrgica, en un hospital de alta complejidad de Medellín, Colombia. Materiales y Métodos: Observacional descriptivo retrospectivo; se incluyeron pacientes de 18-90 años con diagnóstico de tumor renal, sometidos a nefrectomía con y sin EAR prequirúrgica. Las variables cualitativas se expresaron por medio de frecuencias y proporciones, y las cuantitativas mediante medidas de tendencia central y dispersión. Resultados: Se incluyeron 71 pacientes con una media de edad de 58,1 (DE: 10,6) años, 41 eran mujeres y el 69% tenía diagnóstico de carcinoma de células claras. La media del volumen de sangrado intraoperatorio fue de 540,8 cc, y 19,7% requirió transfusión. El tiempo quirúrgico promedio fue de 2,6 horas y el 38% presentó alguna complicación, con una mortalidad total del 4,2%. Al observar comparativamente los pacientes con EAR (15 pacientes) versus aquellos sin ella (56 pacientes), se identificó un mayor volumen de sangrado intraoperatorio y la necesidad de transfusión en los primeros. Conclusión: Los pacientes sometidos a EAR presentaron un mayor volumen de sangrado, mayor frecuencia de transfusión y complicaciones postoperatorias, siendo necesario un consenso sobre su real pertinencia terapéutica.

Abstract Aim: To describe the perioperative outcomes of patients undergoing nephrectomy with and without preoperative Renal Artery Embolization (RAE) in a high-complexity hospital in Medellín, Colombia. Materials and Methods: Retrospective, descriptive and observational study; 18-90 years old patients with renal tumor diagnosis, submitted to nephrectomy with and without preoperative RAE were included. Qualitative variables were expressed by measures of frequencies and proportions, and quantitative variables were expressed by measures of central tendency and dispersion. Results: 71 patients with a media age of 58,1 (SD: 10,6) years were included, 41 were women and 69% were diagnosed with clear cell carcinoma. The blood loss volume media was 540.8 cc, and 19.7% required transfusion. The operative time media was 2.6 hours and 38% had any complication, with a total mortality of 4.2%. Comparatively observing patients with RAE (15 patients) versus patients without RAE (56 patients), a higher intraoperative blood loss and transfusion requirements were identified in the first ones. Conclusion: Patients submitted to RAE presented greater volume of bleeding, greater frequency of transfusion and post-operative complications, requiring a consensus on its real therapeutic relevance.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Renal Artery/surgery , Kidney Neoplasms/surgery , Nephrectomy/methods , Epidemiology, Descriptive , Retrospective Studies , Colombia , Embolization, Therapeutic
Int. braz. j. urol ; 45(6): 1283-1284, Nov.-Dec. 2019.
Article in English | LILACS | ID: biblio-1056351


ABSTRACT Objective & Introduction: To show the feasibility of a combined transperitoneal (TP) and retroperitoneal (RP) laparoscopic approach in a Von Hipple-Lindau (VHL) patient with multiple kidney tumors. VHL is an autosomal dominant inherited syndrome characterized by a high incidence of benign and malignant tumors and cysts in many organs. Renal cell carcinoma is one of the most common and a leading cause of mortality (1). Surgical approach is usually complex because of its multiplicity and the need of maximum kidney function preservation due to the risk of future recurrences (2, 3). Intracorporeal renal hypothermia may be useful in these cases to prevent permanent renal function loss (4). Materials and Methods: A 40 years old male was being monitored for multiple bilateral renal masses. Family history included a VHL syndrome affecting his mother and sister. Past medical history included a VHL syndrome with multiple cerebellar and medular hemangioblastomas, a pancreatic cystoadenoma and bilateral kidney tumors which had significantly grown up during follow-up. The patient was scheduled for laparoscopic multiple partial nephrectomy. A combined TP and RP approach with intracorporeal hypothermia was chosen. Results: A total of six right kidney tumors were removed. Operative time was 240 min. Cold ischemia time was 50 min. Average kidney temperature was 23.7°C. Blood losses were negligible. The patient was discharged after 72 hours. No major changes in serum creatinine were found during the follow-up. Final pathology revealed a clear cell renal cell carcinoma, pT1a, ISUP grade 2 in most of the tumors but one ISUP grade 3. Surgical margins were negative. Conclusions: Combined TP and RP is a feasible alternative for the treatment of multiple renal tumors. It's safe and effective, allowing the use of intracorporeal hypothermia which may improve postoperative renal function. Consistent experience is needed before embarking on this surgery.

Humans , Male , Adult , Carcinoma, Renal Cell/surgery , Laparoscopy/methods , von Hippel-Lindau Disease/surgery , Hypothermia, Induced/methods , Kidney Neoplasms/surgery , Nephrectomy/methods , Peritoneal Cavity/surgery , Reproducibility of Results , Treatment Outcome
Int. braz. j. urol ; 45(6): 1129-1135, Nov.-Dec. 2019. graf
Article in English | LILACS | ID: biblio-1056327


ABSTRACT Purpose: To report our initial experience using a patient-specific 3D-printed renal tumor model for the surgical planning of a complex heminephrectomy in a horseshoe kidney. Materials and Methods: We selected a clinical case for a complex laparoscopic surgery consisting in a 53 year-old male presenting a local recurrence of a renal tumor in a horseshoe kidney with aberrant vascularisation previously treated with a laparoscopic partial nephrectomy. He is now proposed for a laparoscopic left heminephrectomy. Along with conventional imaging, a real-size 3D-printed renal model was used to plan de surgical approach. The perioperative experience of the surgical team was recorded. Results: The surgical team found the patient-specific 3D printed model useful for a better understanding of the anatomy and an easier surgical planning. Conclusion: The use of patient-specific 3D-printed renal models seem to be helpful for the surgical planning in complex renal tumors.

Humans , Male , Carcinoma, Renal Cell/surgery , Laparoscopy/methods , Printing, Three-Dimensional , Fused Kidney/surgery , Kidney Neoplasms/surgery , Models, Anatomic , Carcinoma, Renal Cell/diagnostic imaging , Reproducibility of Results , Treatment Outcome , Imaging, Three-Dimensional/methods , Computed Tomography Angiography , Kidney Neoplasms/diagnostic imaging , Middle Aged , Nephrectomy/methods
Int. braz. j. urol ; 45(6): 1144-1152, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1056343


ABSTRACT Background: Laparoscopic retroperitoneal simple nephrectomy (LRSN) has been widely accepted as a mainstay option for benign non-functioning kidney. The complexity of the procedure, however, differs and remains a subject of controversy. Objective: To develop a standardised Harbin Medical University nephrectomy score (HMUNS) system for evaluating LRSN complexity. Subjects and methods: A total of 6 variables with different factors comprising primary diseases, history of upper urinary tract surgery, body mass index (BMI), surgeon's learning curve, kidney volume, and Mayo Adhesive Probability (MAP) scores were included in the HMUN score. 95 consecutive patients who underwent LRSN at our institution were divided into low (2 to 6 points) and high (7 to 17 points) complexity groups with HMUNS and investigated the differences of operative time (OT), estimated blood loss (EBL), postoperative hospitalisation time (PHT), rate of intraoperative conversion to open surgery, and the Clavien-Dindo classification (CDC) between both groups. Results: Longer mean operative times (193.2±69.3 min vs. 151.9±46.3 min, p <0.05), more median estimated blood loss (100.0mL vs. 50.0mL, p <0.05), and higher rates of conversion to open surgery (1.2% vs. 25%, p <0.05) were observed in the high-complexity group (n=12) than in the low-complexity group (n=83). However, there were no remarkable differences between the two groups related to the baseline characteristics, post-surgical hospitalisation times, and postoperative complications. Conclusions: The HMUNS can effectively reflect LRSN complexity, thus providing a quantitative system for risk estimation and treatment decisions. Because of some limitations, further well-designed studies are necessary to confirm our findings. Patient summary: The HMUNS, including primary diseases, history of upper urinary tract surgery, BMI, surgeon's learning curve, kidney volume, and MAP score, can provide an effective quantitative tool to evaluate the complexity of LRSN.

Humans , Male , Female , Adult , Aged , Laparoscopy/methods , Risk Assessment/methods , Nephrectomy/methods , Postoperative Complications , Reference Values , Retroperitoneal Space/surgery , Reproducibility of Results , Retrospective Studies , Risk Factors , Laparoscopy/standards , Statistics, Nonparametric , Operative Time , Length of Stay , Middle Aged , Nephrectomy/standards
Int. braz. j. urol ; 45(6): 1136-1143, Nov.-Dec. 2019. tab
Article in English | LILACS | ID: biblio-1056335


ABSTRACT Purpose: To prospectively evaluate the association of adherent perinephric fat (APF) on perioperative outcomes of robotic-assisted partial nephrectomy (RAPN) following elimination of the surgical learning curve. Materials and Methods: 305 consecutive RAPNs performed by a single experienced surgeon were analyzed. The first 100 RAPNs were considered the learning curve and therefore excluded. APF was defined as the necessity of subcapsular renal dissection to mobilize the tumor from surrounding perinephric fat. Perioperative outcomes were evaluated including operative time, warm ischemia time (WIT), postoperative complications, length of stay, margins, ischemia, and complications score (MIC), estimated blood loss (EBL), and change in pre-operative to postoperative day 1 (POD 1) laboratory values. After correction for multiple comparisons, P values ≤0.0045 were considered statistically significant but associations with P values ≤0.05 were also mentioned in the study results. Results: Fifty-eight (28.3%) patients had APF. Patients with APF had longer operative times compared to those without APF (median, 213 vs. 192 minutes, P <0.001). There was some evidence of higher increase in change in creatinine from preoperative to POD 1 among those with APF compared to those without APF, although this was not statistically significant (median, 0.2 vs. 0.1mg/dL, P=0.03). There were no other statistically significant associations between presence of APF and perioperative outcomes. Conclusions: APF is associated with increased operative time but no change in other perioperative outcomes. Surgeon experience does not affect perioperative outcomes associated with APF.

Humans , Male , Female , Adult , Aged , Aged, 80 and over , Young Adult , Clinical Competence , Adipose Tissue, White/surgery , Learning Curve , Robotic Surgical Procedures/methods , Nephrectomy/methods , Postoperative Complications , Body Mass Index , Prospective Studies , Treatment Outcome , Statistics, Nonparametric , Perioperative Period , Operative Time , Robotic Surgical Procedures/adverse effects , Glomerular Filtration Rate , Middle Aged , Nephrectomy/adverse effects
Int. braz. j. urol ; 45(5): 932-940, Sept.-Dec. 2019. tab
Article in English | LILACS | ID: biblio-1040076


ABSTRACT Purpose We investigated the association between preoperative proteinuria and early postoperative renal function after robotic partial nephrectomy (RPN). Patients and Methods We retrospectively reviewed 1121 consecutive RPN cases at a single academic center from 2006 to 2016. Patients without pre-existing CKD (eGFR≥60 mL/min/1.73m2) who had a urinalysis within 1-month prior to RPN were included. The cohort was categorized by the presence or absence of preoperative proteinuria (trace or greater (≥1+) urine dipstick), and groups were compared in terms of clinical and functional outcomes. The incidence of acute kidney injury (AKI) was assessed using RIFLE criteria. Univariate and multivariable models were used to identify factors associated with postoperative AKI. Results Of 947 patients, 97 (10.5%) had preoperative proteinuria. Characteristics associated with preoperative proteinuria included non-white race (p<0.01), preoperative diabetes (p<0.01) and hypertension (HTN) (p<0.01), higher ASA (p<0.01), higher BMI (p<0.01), and higher Charlson score (p<0.01). The incidence of AKI was higher in patients with preoperative proteinuria (10.3% vs. 4.6%, p=0.01). The median eGFR preservation measured within one month after surgery was lower (83.6% vs. 91%, p=0.04) in those with proteinuria; however, there were no significant differences by 3 months after surgery or last follow-up visit. Independent predictors of AKI were high BMI (p<0.01), longer ischemia time (p<0.01), and preoperative proteinuria (p=0.04). Conclusion Preoperative proteinuria by urine dipstick is an independent predictor of postoperative AKI after RPN. This test may be used to identify patients, especially those without overt CKD, who are at increased risk for developing AKI after RPN.

Humans , Male , Female , Adult , Aged , Postoperative Complications/etiology , Proteinuria/complications , Preoperative Period , Acute Kidney Injury/etiology , Nephrectomy/adverse effects , Reference Values , Logistic Models , Predictive Value of Tests , Retrospective Studies , Risk Factors , Treatment Outcome , Statistics, Nonparametric , Risk Assessment , Acute Kidney Injury/physiopathology , Glomerular Filtration Rate/physiology , Kidney Neoplasms/surgery , Middle Aged , Nephrectomy/methods
Int. braz. j. urol ; 45(4): 834-842, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1019873


ABSTRACT The very rare thyroid-like carcinoma of the kidney (TLCK) is microscopically similar to thyroid follicular cell carcinoma (TFCC). Differential diagnosis with secondary thyroid tumors depends on non-reactivity to immunohistochemical (IHC) markers for TFCC (thyroglobulin - TG and TTF1). We herein describe the fourth Pediatric case in literature and extensively review the subject. Only 29 cases were published to the moment. Most cases were asymptomatic and incidentally detected. Most tumors are hyperechoic and hyperdense with low grade heterogenous enhancement on CT and MRI. Most patients were treated with radical nephrectomy, but partial nephrectomy was used in some cases, apparently with the same results. Metastases are uncommon and apparently do not change prognosis, but follow-ups are limited. Up to the moment, TLCK presents as a low grade malignancy that may be treated exclusively with surgery and frequently with partial kidney renal preservation. A preoperative percutaneous biopsy is a common procedure to investigate atypical tumors in childhood and adult tumors. To recognize the possibility of TLCK is fundamental to avoid unnecessary thyroidectomies in those patients, supposing a primary thyroid tumor.

Humans , Female , Child , Thyroid Neoplasms/pathology , Adenocarcinoma, Follicular/pathology , Kidney Neoplasms/surgery , Thyroid Neoplasms/diagnosis , Magnetic Resonance Imaging , Carcinoma, Renal Cell/surgery , Carcinoma, Renal Cell/diagnosis , Carcinoma, Renal Cell/pathology , Adenocarcinoma, Follicular/surgery , Adenocarcinoma, Follicular/diagnosis , Diagnosis, Differential , Kidney Neoplasms/diagnosis , Kidney Neoplasms/pathology , Lymph Node Excision/methods , Nephrectomy/methods
Int. braz. j. urol ; 45(4): 754-762, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1019881


ABSTRACT Purpose This study aimed to study morphological and renal structural changes in relation to different ischemic times and types of renal vascular pedicle clamping. Methods Sixteen pigs were divided into two groups (n = 8): Group AV - unilateral clamping of the renal artery and vein and Group A - unilateral clamping of the renal artery only, both with the contralateral kidney used as control. Serial biopsies were performed at 0, 10, 20, 30, 40, 50, 60, 70, 80, and 90 minutes after clamping. Results there is a correlation between the occurrence of renal damage as a function of time (p <0.001), with a higher frequency of Group A lesions for cellular alterations (vascular congestion and edema, interstitial inflammatory infiltrate, interstitial hemorrhage and cell degeneration), with the exception of in the formation of pigmented cylinders that were evidenced only in the AV Group. Conclusion the number of lesions derived from ischemia is associated with the duration of the insult, there is a significant difference between the types of clamping, and the AV Group presented a lower frequency of injuries than Group A. The safety time found for Group A was 10 minutes and for Group AV 20 minutes.

Animals , Female , Renal Artery/pathology , Renal Veins/pathology , Ischemia/pathology , Kidney/blood supply , Kidney/pathology , Nephrectomy/methods , Reference Values , Swine , Time Factors , Biopsy , Reproducibility of Results , Constriction
Rev. Assoc. Med. Bras. (1992) ; 65(7): 977-981, July 2019. tab, graf
Article in English | LILACS | ID: biblio-1013013


SUMMARY INTRODUCTION Angiomyolipoma is one of the most common benign solid renal tumors. We investigated the characteristics of renal angiomyolipomas and the clinical outcomes of patients in the last thirteen years. METHODS The medical records of the patients who underwent nephrectomy were reviewed retrospectively from July 2005 to May 2018. The laboratory data, radiology, and pathology reports were recorded. Patients diagnosed with angiomyolipoma were included in the study. RESULTS A total of 28 patients were included in the study, eight of them male. The mean age of the patients was 55.89+14.49 years. The patients were treated with open and laparoscopic techniques. Partial nephrectomy was performed in 12 patients(42.85%). After pathological examination, 23 patients were diagnosed as fat rich, four patients as fat poor, and one as epithelioid angiomyolipoma. There were no recurrences in the follow-up 91.21+48.31 months. CONCLUSION Angiomyolipoma is a rare renal tumor in daily urology practice. Clinicians must be aware of its complications and manage patients well.

RESUMO OBJETIVO O angiomiolipoma é um dos tumores renais benignos sólidos mais comuns. Investigamos as características dos angiomiolipomas renais e os desfechos clínicos dos pacientes nos últimos treze anos. MÉTODOS Os prontuários dos pacientes, para os quais a nefrectomia foi realizada, foram revisados retrospectivamente de 2008 a 2018. Os dados laboratoriais, relatórios de radiologia e patologia foram registrados. Os pacientes diagnosticados como angiomiolipoma foram incluídos no estudo. RESULTADOS Vinte e oito pacientes foram incluídos no estudo, oito deles do sexo masculino. A média de idade dos pacientes foi de 55,89 + 14,49 anos. Os pacientes foram tratados com técnicas abertas e laparoscópicas. Nefrectomia parcial foi realizada em 12 pacientes (42,85%). Depois de exame patológico, 23 pacientes foram diagnosticados como ricos em gordura, quatro pacientes como gordurosos e um paciente como angiomiolipoma epitelioide. Nenhum paciente teve recorrências no seguimento. CONCLUSÕES O angiomiolipoma é um tumor renal raro na prática urológica diária. Os médicos devem estar cientes das complicações e gerenciar bem os pacientes.

Humans , Male , Female , Adult , Aged , Angiomyolipoma/pathology , Kidney Neoplasms/pathology , Immunohistochemistry , Magnetic Resonance Imaging/methods , Retrospective Studies , Angiomyolipoma/surgery , Tumor Burden , Kidney Neoplasms/surgery , Middle Aged , Nephrectomy/methods
Int. braz. j. urol ; 45(3): 531-540, May-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1012328


ABSTRACT Purpose: Radical treatment in elderly patients with renal tumor remains debatable due to uncertainties regarding the risk of surgical complications, risk of end-stage renal disease (ESRD) and survival benefit. The aim of the study was to assess outcomes of radical treatment for renal cancer in elderly patients. Materials and Methods: This retrospective analysis enrolled 507 consecutive patients treated with partial or radical nephrectomy due to renal mass. Patients with upfront metastatic disease (n=46) and patients lost to follow-up (n=110) were excluded from the analysis. Surgical, functional (screen for ESRD development) and survival outcomes were analyzed in patients aged >75 years in comparison to younger individuals. Results: The analyzed group included 55 elderly patients and 296 younger controls. Within the cohort a total of 148 and 203 patients underwent radical and partial nephrectomies respectively. The rate of surgical complications, including grade ≥3 Clavien- Dindo complications, did not differ between groups (3.6% vs. 4.4%, p=0.63). Median length of hospital stay was equal in both groups (7 days). During a follow-up (median 51.9 months, no difference between groups), ESRD occurred in 3.4% of controls and was not reported in elderly group (p=0.37). Younger patients demonstrated a statistically significant advantage in both overall survival and cancer-specific survival over elderly patients (OS 94.6% vs. 87% p=0.036, CSS 97.3% vs. 89.1% p=0.0008). Conclusions: Surgical treatment in elderly patients with renal tumor is as safe as in younger individuals and does not increase the risk of ESRD. However, cancer specific survival among these patients remains shorter than in younger patients.

Humans , Male , Female , Aged , Aged, 80 and over , Carcinoma, Renal Cell/surgery , Kidney Neoplasms/surgery , Nephrectomy/methods , Postoperative Complications , Carcinoma, Renal Cell/mortality , Retrospective Studies , Risk Factors , Treatment Outcome , Statistics, Nonparametric , Kaplan-Meier Estimate , Kidney Neoplasms/mortality , Middle Aged , Nephrectomy/adverse effects , Nephrectomy/mortality
Rev. Hosp. Ital. B. Aires (2004) ; 39(1): 19-21, mar. 2019. ilus., graf.
Article in Spanish | LILACS | ID: biblio-1022121


La policitemia primaria es producida por una mutación adquirida o heredada en las células progenitoras de los glóbulos rojos, mientras que la poliglobulia secundaria está relacionada con un aumento de la eritropoyetina sérica como respuesta a la hipoxia tisular o a la producción autónoma tumoral. Hace más de medio siglo que se conoce que la hidronefrosis puede actuar como una rara causa de eritrocitosis debido al aumento de producción de eritropoyetina por un riñón que censa una disminución de oxígeno, mecanismo también observado en la estenosis de la arteria renal y en los quistes renales. Se describe a continuación el caso de un paciente de 38 años con poliglobulia atendido en el Hospital Italiano de San Justo (Argentina), que presenta como hallazgo una hidronefrosis unilateral severa y cuya resolución quirúrgica a través de una nefrectomía revierte el cuadro hematológico de base. (AU)

Primary polycythemia is produced by an acquired or inherited mutation in progenitor cells of red blood cells, while secondary polyglobulia is related to an increase in serum erythropoietin in response to tissue hypoxia or autonomous tumor production. Since the middle of the twentieth century, the hydronephrosis is known to be a rare etiology of secondary polycythemia, with increased erythropoietin production caused by diminished oxygen sensing by the kidney, also seen in renal artery stenosis and kidney cysts. We describe a case of a 38 year old patient with polycythemia studied in the "Hospital Italiano de San Justo" (Argentina) that presented an incidental severe unilateral hydronephrosis, and nephrectomy was carried out as a final resolution of the hematological disorder. (AU)

Humans , Animals , Male , Adult , Middle Aged , Polycythemia/diagnosis , Pyelonephritis/diagnosis , Urinary Tract Infections/complications , Erythropoietin/blood , Hydronephrosis/diagnosis , Nephrectomy/trends , Polycythemia/complications , Polycythemia/etiology , Pyelonephritis/blood , Renal Artery Obstruction/pathology , Low Back Pain , Hypoxia-Ischemia, Brain/pathology , Erythrocytes/physiology , Kidney Diseases, Cystic/pathology , Dysuria , Fever , Hydronephrosis/surgery , Hydronephrosis/complications , Anemia , Nephrectomy/methods
Int. braz. j. urol ; 45(1): 193-193, Jan.-Feb. 2019.
Article in English | LILACS | ID: biblio-1040052


ABSTRACT Introduction: Laparoscopic donor nephrectomy (LDN) has become the standard of care and popular among most of the transplant centres across the globe. Objective of this video is to report different vascular injuries, their management during LDNs and propose risk reduction strategies. Patient and methods: This was a retrospective analysis of all the LDNs performed between January 2011 and March 2016. All donor nephrectomies were performed laparoscopically by transperitoneal route, under ideal operative conditions by expert laparoscopic surgeons and by novice surgeons. Results: 858 LDNs (left, n = 797; right, n = 61) were performed during the study period with 5 cases of vascular injuries. Mean (SD) donor age was 45.5 (± 10.76) years and the operative time was 165 (± 44.4) min. Of these five cases, two had renal vein injury, while the three others had renal artery, inferior vena cava and aortic injury (one each). Four injuries occurred during left LDN and only one during a right LDN. Vascular injuries were managed using the Rescue stitch or metallic clips as indicated. Risk reduction strategy was developed to avoid vascular injuries during LDN, which include - meticulous attention to port placement, addition of fourth port, complete dissection of upper pole and pedicle before clipping, and judicious use of ultrasonic diathermy. Conclusions: Careful evaluation of computed tomography angiography just before surgery will act like a global positioning system (GPS) for the operating surgeon. Rescue stitch is a saviour. Not to panic and being well versed with the risk reduction strategies of laparoscopy and rescue measures is of paramount importance.

Humans , Kidney Transplantation/adverse effects , Laparoscopy/adverse effects , Vascular System Injuries/etiology , Nephrectomy/adverse effects , Retrospective Studies , Living Donors , Risk Reduction Behavior , Computed Tomography Angiography , Middle Aged , Nephrectomy/methods
Rev. Col. Bras. Cir ; 46(3): e20192092, 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1013157


RESUMO Objetivo: investigar os fatores de risco de conversão para cirurgia aberta na nefrectomia laparoscópica (NL) para urolitíase. Métodos: foram revisados os dados de todos os pacientes maiores de 18 anos de idade submetidos à NL entre janeiro de 2006 e maio de 2013 em nossa Instituição. Índice de Charlson, escore ASA, função renal pela equação e estágio de MDRD (Modification of Diet in Renal Disease), achados de tomografia computadorizada (TC) pré-operatória, complicações pela classificação de Clavien-Dindo e taxa de conversão foram analisados. Determinaram-se os fatores de risco para conversão por meio de regressão logística. Resultados: oitenta e quatro pacientes foram submetidos à LN, sendo que 16 (19%) tiveram seu procedimento convertido para cirurgia aberta devido à forte aderência do hilo renal aos órgãos adjacentes. Outras causas associadas à conversão foram sangramento excessivo (n=6) e lesão do intestino grosso (n=3). Na análise univariada, cirurgia renal prévia, borramento da gordura perirrenal, abscesso renal, abscesso perirrenal, abscesso pararrenal, fístula, aderência ao fígado ou baço e aderência ao intestino foram associados à conversão. Na análise multivariada, abscesso pararrenal e aderência ao intestino foram fatores de risco significativos para a conversão. Conclusão: abscesso pararrenal e aderência ao intestino demonstrados na TC pré-operatória são fatores de risco de conversão para cirurgia aberta em LN por urolitíase.

ABSTRACT Objective: to investigate the risk factors for conversion to open surgery in laparoscopic nephrectomy (LN) for urolithiasis. Methods: we reviewed data on all patients over 18 years of age submitted to LN between January 2006 and May 2013 at our institution. We analyzed the Charlson's index, the ASA score, renal function by the equation and stage of MDRD (Modification of Diet in Renal Disease), preoperative computed tomography (CT) findings, complications by the Clavien-Dindo classification and conversion rate. We used logistic regression analysis to determine the risk factors for conversion. Results: eighty-four patients underwent LN, 16 (19%) sustaining convertion to open surgery due to the strong adhesion of the renal hilum to the adjacent organs. Other causes associated with conversion were excessive bleeding (n=6) and lesion of the large intestine (n=3). In the univariate analysis, previous renal surgery, perirenal fat blurring, renal abscess, perirenal abscess, pararenal abscess, fistula, adherence to the liver or spleen, and adherence to the intestine were associated with conversion. In the multivariate analysis, pararenal abscess and adherence to the intestine were significant risk factors for conversion. Conclusion: pararenal abscess and bowel adhesions demonstrated in the preoperative CT are risk factors for conversion to open surgery in LN due to urolithiasis.

Humans , Male , Female , Adult , Laparoscopy/methods , Urolithiasis/surgery , Nephrectomy/methods , Tomography, X-Ray Computed , Retrospective Studies , Risk Factors , Laparoscopy/adverse effects , Urolithiasis/diagnostic imaging , Preoperative Period , Middle Aged , Nephrectomy/adverse effects
Rev. Assoc. Med. Bras. (1992) ; 64(12): 1061-1068, Dec. 2018. tab
Article in English | LILACS | ID: biblio-976822


The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.

Humans , Kidney Transplantation/methods , Living Donors , Nephrectomy/methods , Evidence-Based Medicine , Nephrectomy/standards
Rev. bras. anestesiol ; 68(6): 653-656, Nov.-Dec. 2018. graf
Article in English | LILACS | ID: biblio-977405


Abstract Background and objectives: Quadratus lumborum block was first described in 2007 and currently there are descriptions of its achievement through four different injection points. This blockage provides abdominal wall and visceral analgesia, and one of its mechanisms is the dispersion of the local anesthetic into the paravertebral space. We describe the performance of a continuous quadratus lumborum type II block for postoperative analgesia in a partial nephrectomy. Case report: A 64-year-old woman, scheduled for partial left laparoscopic nephrectomy. During the procedure, due to technical difficulties, an incision was made in the left flank to facilitate the surgical approach. In the early postoperative period, a continuous quadratus lumborum type II block was performed using ultrasonography as part of the multimodal analgesic strategy. Initially, 20 ml of 0.2% ropivacaine was administered and 3 cm of catheter were introduced into the interfascial space. Subsequently, a continuous infusion of 5.2 mL.h−1 of 0.2% ropivacaine was given for 48 hours. In the first 24 postoperative hours, the patient reported no pain at rest or on movement. In the following 24 h, she was free of pain at rest and only a slight pain (2/10) on movement. Conclusions: Continuous quadratus lumborum type II block was an effective postoperative analgesic option. Blocking of somatic nerves and visceral afferent pathways provided abdominal and visceral wall analgesia, allowing the reduction of opioid consumption. We consider relevant to explore the analgesic capacity of the quadratus lumborum block and its different approaches, as well as the possibility of it becoming an alternative in patients scheduled for kidney surgery.

Resumo Justificativa e objetivos: O bloqueio do quadrado lombar foi descrito pela primeira vez em 2007 e atualmente existem descrições da sua realização através de quatro pontos de injeção. Esse bloqueio promove analgesia da parede abdominal e analgesia visceral e um de seus mecanismos é a dispersão do anestésico local para o espaço paravertebral. Descrevemos a realização do bloqueio do quadrado lombar tipo II contínuo para analgesia pós-operatória numa nefrectomia parcial. Relato de caso: Mulher de 64 anos, agendada para nefrectomia parcial à esquerda por via laparoscópica. Durante o procedimento, por dificuldades técnicas, foi feita uma incisão no flanco esquerdo para facilitar a abordagem cirúrgica. No pós-operatório imediato, fez-se o bloqueio do quadrado lombar tipo II contínuo, recorrendo-se a ultrassonografia, como parte da estratégia analgésica multimodal. Inicialmente foram administrados 20 ml de ropivacaína 0,2% e introduzidos 3 cm de cateter no espaço interfascial. Posteriormente, colocou-se uma perfusão contínua de 5,2 mL.h−1 de ropivacaína 0,2% durante 48 horas. Nas primeiras 24 horas de pós-operatório, a paciente não referiu dor em repouso ou com movimento. Nas 24 horas seguintes, manteve-se sem dor em repouso e apenas com dor ligeira (2/10) com o movimento. Conclusões: A realização do bloqueio quadrado lombar tipo II contínuo foi uma opção analgésica pós-operatória eficaz. O bloqueio de nervos somáticos e das vias aferentes viscerais promoveu analgesia da parede abdominal e visceral, permitiu reduzir o consumo de opioides. Consideramos relevante explorar a capacidade analgésica do bloqueio do quadrado lombar e suas diferentes abordagens, bem como a possibilidade de se tornar uma opção em doentes propostos para cirurgia renal.

Humans , Female , Pain, Postoperative/prevention & control , Analgesia/methods , Nephrectomy/methods , Nerve Block/methods , Abdominal Muscles , Middle Aged , Nerve Block/classification
Int. braz. j. urol ; 44(5): 922-932, Sept.-Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-975643


ABSTRACT Objective: To evaluate the preoperative imaging manifestation and therapeutic effect of laparoscopic simple enucleation (SE) for localized chromophobe renal cell carcinoma (chRCC). Materials and Methods: Clinical data of 36 patients who underwent laparoscopic SE of localized chRCC at our institute were retrospectively analyzed. All patients underwent preoperative renal protocol CT (unenhanced, arterial, venous, and delayed images). CT scan characteristics were evaluated. After intraoperative occlusion of the renal artery, the tumor was free bluntly along the pseudocapsule and enucleated totally. The patients were followed up regularly after the operation. Results: Mean tumor diameter was 3.9±1.0 cm, 80% of tumors were homogeneous and all the tumors had complete pseudocapsule. The attenuation values were slightly lower than normal renal cortex and degree of enhancement of the tumors were significantly lower than normal renal cortex. Mean operation time was 104.3±18.2 min. Mean warm ischemia time (WIT) was 21.3±3.5 min. Mean blood loss was 78.6±25.4 mL. No positive surgical margin was identified. Mean postoperative hospital stay was 5.3±1.5 d. Hematuria occurred in 3 patients and all disappeared within 3 days. After a mean follow-up of 32.1±20.6 months, no patient had local recurrence or metastatic progression. Conclusion: Localized chRCCs have a great propensity for homogeneity and complete pseudocapsule. The attenuation values were slightly lower than normal renal cortex and small degree of enhancement. Laparoscopic SE is a safe and effective treatment for localized chRCC. The oncological results were satisfactory.

Humans , Male , Female , Carcinoma, Renal Cell/surgery , Laparoscopy/methods , Kidney Neoplasms/surgery , Nephrectomy/methods , Carcinoma, Renal Cell/diagnostic imaging , Tomography, X-Ray Computed , Retrospective Studies , Treatment Outcome , Operative Time , Kidney Neoplasms/diagnostic imaging , Middle Aged