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1.
World J Urol ; 42(1): 246, 2024 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-38643250

RESUMO

PURPOSE: To assess the learning curve of Thulium laser enucleation of the prostate (ThuLEP) of a single surgeon. METHODS: Hundred patients suffering from benign prostatic hyperplasia were treated by the same surgeon. In all cases, a well-trained urologist was present in the operating room. Patients urinary function was assessed preoperatively using the International Prostate Symptoms Score (IPSS), maximum flow rate and Post-Void Residual volume. Preoperative prostate volume was recorded. Enucleation and morcellation efficiency and complication rate were evaluated. Patients were divided into 5 cohorts of 20 consecutive cases to assess changes in outcomes through time. RESULTS: Mean age of patients was 73.1 years (SD 17.5) and mean prostate volume was 89.7 ml (SD 55.1). Overall, mean enucleation and morcellation efficiency were 1.7 (SD 2.9) and 5.1 (SD 2.7) g/min. A statistically significant increase in enucleation efficiency was observed when comparing cohort 1 vs 2 (0.9 vs 1.3 g/min, p = 0.03) and cohort 2 vs 3 (1.3 vs 1.7 g/min, p = 0.02). A statistically significant increase in morcellation efficiency was observed when comparing cohort 1 vs 2 (2.8 vs 3.7 g/min, p = 0.02) and cohort 2 vs 3 (3.7 vs 4.9 g/min, p = 0.03). In both cases, no significant differences were observed when comparing the following cohorts. Complication rate showed no significant differences throughout the caseload. CONCLUSIONS: In our single-surgeon experience, we observed a learning curve of nearly 60 cases for the ThuLEP procedure in presence of a well-trained surgeon. Complication rate was low from the beginning of surgical experience.


Assuntos
Terapia a Laser , Lasers de Estado Sólido , Hiperplasia Prostática , Masculino , Humanos , Idoso , Próstata/cirurgia , Túlio , Curva de Aprendizado , Resultado do Tratamento , Terapia a Laser/métodos , Hiperplasia Prostática/cirurgia , Lasers de Estado Sólido/uso terapêutico
2.
Actas urol. esp ; 45(9): 576-581, noviembre 2021. tab
Artigo em Espanhol | IBECS | ID: ibc-217019

RESUMO

Objetivo: Comparar las lesiones ureterales intraoperatorias ocasionadas durante la CRIR con inserción de VAU con la tasa de infecciones postoperatorias tras la CRIR sin inserción de VAU.Pacientes y métodosEn este ensayo aleatorizado los pacientes que recibieron una indicación de una CRIR entre enero de 2017 y diciembre de 2017 se dividieron en 2 grupos. En el grupo A no se utilizó VAU y en el grupo B sí se utilizó VAU. Se realizó la clasificación de la escala Post-Ureteroscopic Lesion Scale (PULS) tras retirar la VAU o el ureteroscopio flexible. Las lesiones del uréter proximal, medio y distal se evaluaron y compararon según la escala PULS. Además, los pacientes de ambos grupos recibieron seguimiento postoperatorio para evaluar el desarrollo de cualquier enfermedad infecciosa.ResultadosEl estudio incluyó a 181 pacientes, 89 del grupo A y 92 del grupo B. La tasa de ausencia de cálculos global, los fragmentos residuales clínicamente insignificantes y la tasa de ausencia de cálculos final fueron del 41,4%, 53,5% y 95%, respectivamente. Hubo 33 (37,1%) pacientes con lesiones ureterales en el grupo A y 42 (45,6%) pacientes con lesiones ureterales en el grupo B, sin diferencias estadísticamente significativas. Por otra parte, la tasa de infección postoperatoria fue mucho mayor en el grupo A (37,1% frente a 16,3% p=0,03).ConclusionesNo se ha visto un mayor número de lesiones ureterales tras la inserción de la VAU. La inserción de una VAU durante la CRIR resulta en una tasa menor de infecciones postoperatorias. (AU)


Objective: To compare intraoperative ureteral injuries in RIRS with UAS insertion with the rate of postoperative infections after RIRS without UAS insertion.Patients and methodsIn this randomized trial, patients who received an indication for RIRS between January 2017 and December 2017 were divided into two groups. Group A had no UAS insertion and Group B had UAS insertion. Post-Ureteroscopic Lesion Scale (PULS) grading was performed after UAS or flexible ureteroscope removal. Proximal, middle and distal ureteral lesions were evaluated and compared according to the PULS scale. Additionally, patients in both groups were followed postoperatively to assess any infective complication.ResultsThe evaluation comprised 181 patients, 89 for group A and 92 for group B. Overall stone-free rate, clinically insignificant residual fragments, and final stone-free rate were 41.4%, 53.5%, and 95%, respectively. There were 33 (37.1%) patients with ureteral lesions in group A while 42 (45.6%) patients had ureteral lesions in group B, with no significant difference. On the other hand, the overall presence of postoperative infection rate was much higher for Group A (37.1% vs 16.3% P=.03).ConclusionsUAS insertion does not result in a higher number of ureteral injuries. UAS insertion during RIRS allows a lower rate of postoperative infections. (AU)


Assuntos
Humanos , Cálculos Renais , Ureter/cirurgia , Ureteroscópios , Estudos Prospectivos
3.
Actas Urol Esp (Engl Ed) ; 45(9): 576-581, 2021 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34697008

RESUMO

OBJECTIVE: To compare intraoperative ureteral injuries in RIRS with UAS insertion with the rate of postoperative infections after RIRS without UAS insertion. PATIENTS AND METHODS: In this randomized trial, patients who received an indication for RIRS between January 2017 and December 2017 were divided into two groups. Group A had no UAS insertion and Group B had UAS insertion. Post-Ureteroscopic Lesion Scale (PULS) grading was performed after UAS or flexible ureteroscope removal. Proximal, middle and distal ureteral lesions were evaluated and compared according to the PULS scale. Additionally, patients in both groups were followed postoperatively to assess any infective complication. RESULTS: The evaluation comprised 181 patients, 89 for group A and 92 for group B. Overall stone-free rate, clinically insignificant residual fragments, and final stone-free rate were 41.4%, 53.5%, and 95%, respectively. There were 33 (37.1%) patients with ureteral lesions in group A while 42 (45.6%) patients had ureteral lesions in group B, with no significant difference. On the other hand, the overall presence of postoperative infection rate was much higher for Group A (37.1% vs 16.3% P = 0.03). CONCLUSIONS: UAS insertion does not result in a higher number of ureteral injuries. UAS insertion during RIRS allows a lower rate of postoperative infections. CLINICAL TRIAL REGISTRATION NUMBER (ISRCTN REGISTRY NUMBER): 55546280.


Assuntos
Cálculos Renais , Ureter , Humanos , Masculino , Estudos Prospectivos , Ureter/cirurgia , Ureteroscópios , Ureteroscopia
4.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34344583

RESUMO

OBJECTIVE: To compare intraoperative ureteral injuries in RIRS with UAS insertion with the rate of postoperative infections after RIRS without UAS insertion. PATIENTS AND METHODS: In this randomized trial, patients who received an indication for RIRS between January 2017 and December 2017 were divided into two groups. Group A had no UAS insertion and Group B had UAS insertion. Post-Ureteroscopic Lesion Scale (PULS) grading was performed after UAS or flexible ureteroscope removal. Proximal, middle and distal ureteral lesions were evaluated and compared according to the PULS scale. Additionally, patients in both groups were followed postoperatively to assess any infective complication. RESULTS: The evaluation comprised 181 patients, 89 for group A and 92 for group B. Overall stone-free rate, clinically insignificant residual fragments, and final stone-free rate were 41.4%, 53.5%, and 95%, respectively. There were 33 (37.1%) patients with ureteral lesions in group A while 42 (45.6%) patients had ureteral lesions in group B, with no significant difference. On the other hand, the overall presence of postoperative infection rate was much higher for Group A (37.1% vs 16.3% P=.03). CONCLUSIONS: UAS insertion does not result in a higher number of ureteral injuries. UAS insertion during RIRS allows a lower rate of postoperative infections. Clinical Trial Registration Number (ISRCTN registry number): 55546280.

5.
Arch Ital Urol Androl ; 72(4): 241-4, 2000 Dec.
Artigo em Italiano | MEDLINE | ID: mdl-11221046

RESUMO

The increasing of andrological valuation for erectile dysfunction (ED), happened in the last ten years, and induced chemical industries and sanitary system to supply correct answers from cultural, diagnostic and therapeutic views. All these events allowed the people to approach easily to uro-andrological valuations. This situation is perhaps a unique way to involve a great number of men in a wide uro-andrological screeening, that is useful, with a total patient and couple involvement, not only for a ED causes research, but also for incidental pathology screening (neoplastic or dismethabolic). Even if more expensive than a simplified diagnostic ED protocol (95% of the patients accept it, if there is a good counseling), this way of diagnostic valuation permit to hit the targets and to add permanently andrology to scientific specialty, as the science that studies the sexuality behaviour of the man and all its pathology.


Assuntos
Disfunção Erétil/diagnóstico , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
Arch Ital Urol Androl ; 65(2): 153-6, 1993 Apr.
Artigo em Italiano | MEDLINE | ID: mdl-8330059

RESUMO

The increasing interest and progress showed by the surgical treatment of the ureteropelvic junction obstruction, have evidenced some problems that have not completely solved. Problem in which there is division in opinion concerns the role of splinting with or without nephrostomy in pyeloplasty. A strong impulse for proximal urinary diversion after pyeloplasty derived from data provided by Caine and Hermann (1), who have demonstrated in cineradiographic studies that the normal ureteral peristalsis did not return for about 3 weeks after anastomosis. The authors, who use systematically urinary diversion in pyeloplasty, emphasize the usefulness of the Kidney Internal Stent Splint Set (K.I.S.S.S.). This device developed by Max Maizels, From Children's Memorial Hospital Chicago USA, is employed after pyeloplasty, when kidney drainage is mandatory for the success of the procedure. The set contains: sof-flex stent, 55 cm. long: closed segment 25 cm. long, with 12 cm. malleable tapered positioning stylet; "cut-out" segment 30 cm. long. Silicone retention disc with pull-tie; Luer-lock adapter; 10 Fr. polyvinylchloride connecting tube 30 cm long. Introduction with the malleable stylet is the same as a nephrostomy interoperatively placed. The closed portion of the stent is sutured with adsorbable suture to the renal capsule and is performed as a nephrostomy drainage catheter. The "cut-out" portion is advanced interoperatively into the ureter. The K.I.S.S.S. explains essentially a twofold function: first to defend the neo-anastomosis, secondly like a nephrostomy drainage.


Assuntos
Pelve Renal/cirurgia , Stents , Cateterismo Urinário/instrumentação , Derivação Urinária/instrumentação , Anastomose Cirúrgica , Pré-Escolar , Desenho de Equipamento , Humanos , Masculino , Pessoa de Meia-Idade
7.
Arch Esp Urol ; 45(4): 317-9, 1992 May.
Artigo em Espanhol | MEDLINE | ID: mdl-1605685

RESUMO

The authors describe their experience of 79 operations using the Chevron anterior transperitoneal approach in the treatment of 71 renal tumors and 8 cases of renal trauma. This approach respects the physiology of the respiratory system, has a low morbidity and mortality, in the post-operative period the need for anesthesia is moderate and hospitalization is shorter. The authors underscore the following advantages of the Chute-Baron-Olsson technique: it is easy to perform and can be easily extended, dehiscence and laparoceles are uncommon (only 2 of 79 patients). Furthermore, the Chevron partial or total approach in tumors and renal trauma permits exposure of an excellent inframesocolic and supramesocolic field and perfect control of the important elements of the renal vasculature.


Assuntos
Neoplasias Renais/cirurgia , Nefrectomia/métodos , Adulto , Feminino , Seguimentos , Humanos , Rim/lesões , Masculino , Pessoa de Meia-Idade , Nefrectomia/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia
8.
Eur Urol ; 21 Suppl 1: 71-4, 1992.
Artigo em Inglês | MEDLINE | ID: mdl-1425841

RESUMO

It is a widely diffused opinion that moving backwards in time the moment of the diagnosis of cancer of prostate, so that the tumor is detected earlier than normal, means that the treatment would be more effective than the one adopted in the usual times of diagnosis. For this reason the earlier diagnosis of prostate cancer has become more and more a compulsory target of the modern urologist, at a time of booming of the third age, of increased lifetime expectancy, of significant elevation of prostate cancer rate and of the persistent uncertainty of the efficacy of available treatments. Theoretically the mortality rate of prostate cancer can be reduced by the prevention programs and by the improvements of treatment methods, but the 'earlier' diagnosis is certainly an easier and less expensive strategy to achieve the same objective. The authors have evaluated the argyrophilic-nucleolar organizer region (Ag-NOR) proteins on 40 cases of adenocarcinoma of prostate collected through a multicentric program in France and in Italy. The Ag-NOR have been stained with silver technique set up by Ploton and Derenzini while the quantitative index has been evaluated by a semiautomatic system partially commercially available, partially modified by the authors. The conclusions: (a) the Ag-NOR index is a simple and reproducible method; (b) the Ag-NOR staging system corresponds to Gleason's grading; (c) the Ag-NOR elevation is a reliable marker of increased cell proliferation and is detectable much earlier than the morphologic changes of Gleason's classification.


Assuntos
Adenocarcinoma/patologia , Biomarcadores Tumorais/análise , Proteínas de Neoplasias/análise , Região Organizadora do Nucléolo/patologia , Neoplasias da Próstata/patologia , Adenocarcinoma/química , França , Humanos , Itália , Masculino , Região Organizadora do Nucléolo/química , Prognóstico , Neoplasias da Próstata/química , Estudos Retrospectivos , Prata
9.
Eur Urol ; 21 Suppl 1: 31-3, 1992.
Artigo em Inglês | MEDLINE | ID: mdl-1385130

RESUMO

The multiform biology of superficial bladder tumors, both morphologically and evolutively, and the lack of reliable predictors of progression have led the authors to study the Ag-NOR proteins as a new marker of these tumors. It is well known that particularly the low-grade superficial tumors frequently relapse on the same histologic and proliferative module. Their potential of progression is probably present at the time of the first manifestation of the disease or it can show itself along the relapsing evolution with classic modifications translating the cellular dedifferentiation. The NOR index, set up by the authors, has several advantages: firstly, it corresponds to a functional value of normal and neoplastic cells; secondly, it can be used also with paraffin blocks. Another advantage is the semiautomatic lecture, reproducible also in the urinary cytology, mainly of low-grade tumors, reducing the number of false-negatives. The conclusion of the study of 38 cases of superficial bladder cancer has induced the authors to believe that an increased NOR index is a reliable 'marker' of their progression. Therefore, the authors suggest the use of the NOR activity for the surveillance of the urothelial disease and for a more logical therapeutic strategy.


Assuntos
Biomarcadores Tumorais/análise , Proteínas de Neoplasias/análise , Região Organizadora do Nucléolo/patologia , Neoplasias da Bexiga Urinária/patologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Prata , Coloração e Rotulagem , Fatores de Tempo , Neoplasias da Bexiga Urinária/química
10.
Arch Esp Urol ; 44(10): 1165-6, 1991 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-1687801

RESUMO

Ectopic corticoadrenal tissue is not a very uncommon finding during orchiopexy in children. The causes can be found in the period of organ development and gonadal migration (spermatic cord). From 1986 to 1990, we have performed 88 orchiopexy procedures in the Urology Service of "San Antonio Abad de Gallarate" Hospital. Only one case (1.13%) of juxta-funicular corticoadrenal ectopia has been observed. The aim of the present study is to determine the correct surgical approach to this incidental finding during surgery of the inguinal canal in pediatric patients.


Assuntos
Córtex Suprarrenal , Coristoma/cirurgia , Criptorquidismo/cirurgia , Neoplasias dos Genitais Masculinos/cirurgia , Cordão Espermático , Corticosteroides/metabolismo , Criança , Pré-Escolar , Coristoma/embriologia , Coristoma/epidemiologia , Coristoma/metabolismo , Coristoma/patologia , Criptorquidismo/complicações , Neoplasias dos Genitais Masculinos/embriologia , Neoplasias dos Genitais Masculinos/epidemiologia , Neoplasias dos Genitais Masculinos/metabolismo , Neoplasias dos Genitais Masculinos/patologia , Humanos , Incidência , Masculino , Síndromes Endócrinas Paraneoplásicas/prevenção & controle
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