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1.
Urology ; 135: e1, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31604068

RESUMO

A 29-year-old female was referred to the urology clinic because of an incidentally found left renal mass discovered during workup for secondary erythrocytosis. Since 12 years of age, she has had headaches and poorly controlled hypertension refractory to trimodal antihypertensive therapy. Laboratory workup revealed markedly elevated aldosterone and renin levels. Computed tomography demonstrated a 3 cm left renal mass. The patient was admitted for intravenous blood pressure control. After partial nephrectomy, aldosterone and renin levels normalized. The patient was weaned off of blood pressure medications. Pathology was consistent with a juxtaglomerular cell tumor secreting renin (ie, reninoma).


Assuntos
Anti-Hipertensivos/farmacologia , Hipertensão/etiologia , Sistema Justaglomerular/patologia , Neoplasias Renais/complicações , Adulto , Aldosterona/sangue , Anti-Hipertensivos/uso terapêutico , Resistência a Medicamentos , Quimioterapia Combinada , Feminino , Humanos , Hipertensão/sangue , Hipertensão/tratamento farmacológico , Sistema Justaglomerular/diagnóstico por imagem , Sistema Justaglomerular/metabolismo , Neoplasias Renais/diagnóstico , Neoplasias Renais/cirurgia , Nefrectomia , Renina/sangue , Renina/metabolismo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
2.
J Endourol ; 34(2): 134-138, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31760801

RESUMO

Objectives: To report on long-term follow-up and outcomes of infants and small children who have undergone laparoendoscopic single-site (LESS) partial nephrectomy to manage upper urinary tract duplication and fusion anomalies. Materials and Methods: A retrospective review was performed evaluating outcomes of pediatric patients who underwent LESS partial nephrectomy for upper urinary tract duplication and fusion anomalies from January 2012 to July 2015, by a single surgeon at a tertiary pediatric referral center. Demographic and perioperative data were reviewed as well as follow-up imaging. Descriptive statistics were used for analysis. Results: A total of 18 patients were identified. Additional access was used for two patients to complete the procedure. Median follow-up was 39 months. No short-term complications were encountered. Three patients were noted to have abnormal postoperative ultrasounds: two perinephric fluid collections and one atrophy of the remaining ipsilateral moiety. One fluid collection resolved completely, and the other decreased in size. Complete atrophy of the ipsilateral moiety occurred. No secondary procedures were required. Conclusions: LESS partial nephrectomy is safe for renal duplication and fusion anomalies with good long-term outcomes. Although it can be safely performed, it is a technically demanding procedure and has been discontinued in favor of robotic partial nephrectomy.


Assuntos
Rim/anormalidades , Rim/cirurgia , Laparoscopia/métodos , Nefrectomia/métodos , Procedimentos Cirúrgicos Robóticos , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Pediatria , Reprodutibilidade dos Testes , Estudos Retrospectivos , Resultado do Tratamento , Sistema Urinário
3.
Urology ; 131: e3-e4, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31195008

RESUMO

Needle tract metastases can be a rare complication following percutaneous procedures for renal malignancies. We report a case of cryoprobe tract tumor seeding following cryoablation of a small biopsy proven renal cell carcinoma.


Assuntos
Carcinoma de Células Renais/secundário , Carcinoma de Células Renais/cirurgia , Criocirurgia/efeitos adversos , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Inoculação de Neoplasia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Idoso , Criocirurgia/métodos , Humanos , Masculino
4.
J Robot Surg ; 12(2): 257-260, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28639117

RESUMO

Robotic upper urinary tract reconstruction (UUTR) has been widely utilized for surgical management of congenital obstruction. To further reduce morbidity and simplify postoperative care, outpatient robotic pyeloplasty (RP) and robotic ureteroureterostomy (RUU) were performed without ureteral stents, drains, or urethral catheters. The aim of the study was to assess the safety of performing tubeless robotic UUTR as an outpatient procedure. A retrospective review was performed for patients who underwent outpatient tubeless RP and RUU between July 2015 and January 2017. All procedures were primary interventions. No ureteral stents, drains, or urethral catheters were utilized. No regional blocks were utilized. Patients were discharged from the post anesthesia care unit as a scheduled outpatient procedure without an extended stay. Primary outcomes included 30-day complications, emergency room (ER) visits, and readmissions. A total of 19 patients (14 male, 5 female) were identified (RP = 17, RUU = 3), including one patient who underwent staged bilateral RP. Median age was 21.5 months (range 3-220). Median weight was 11.5 kg (range 6-89). Median operative time was 167 min (range 108-249), defined as skin incision to closure. No 30-day complications, ER visits, or readmissions were observed for any patient. The study concludes that pediatric tubeless outpatient robotic UUTR is safe. Further evaluation is needed to assess this approach on a larger scale, as well as assessing the long-term outcomes of tubeless reconstruction.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Procedimentos de Cirurgia Plástica/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Sistema Urinário/cirurgia , Doenças Urológicas/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Duração da Cirurgia , Estudos Retrospectivos
6.
Pathology ; 45(7): 664-9, 2013 12.
Artigo em Inglês | MEDLINE | ID: mdl-24247624

RESUMO

AIM: Primary bladder urothelial carcinoma (UC) may involve the prostate with differing management depending on whether tumour is in situ or invades the prostatic subepithelium or fibromuscular stroma. We aim to understand challenges in reporting UC within prostate transurethral resection (TUR). METHODS: A retrospective review from 2007 to 2010 identified prostate TUR performed for primary bladder UC. RESULTS: 25.1% of cystoprostatectomy patients (60/239) had a prior prostate TUR; 129 patients had a prostate TUR for UC and 50.4% (65/129) were given a neoplastic diagnosis. Prostatic fibromuscular stroma was present in 84.6% of cases, with a comparable rate among surgeons. Diagnostic concordance of UC versus a non-neoplastic diagnosis was 96.7%, with rare cases initially diagnosed as non-neoplastic having in situ UC on review. Of reports with invasive tumour, 19.4% did not specify extent of invasion (e.g., bladder muscularis propria, prostate fibromuscular stroma) and 13.9% had discordant extent of invasion on review. Terminology typically used for bladder (lamina propria/muscularis propria) was found in 23.1% of reports without explicit reference to the bladder or prostate. CONCLUSION: This study reveals difficulties in reporting UC within prostatic TUR specimens. We recommend documenting tumour extent and referencing the organ of origin if ambiguous anatomical terms are used.


Assuntos
Carcinoma de Células de Transição/patologia , Próstata/patologia , Neoplasias da Bexiga Urinária/patologia , Urotélio/patologia , Carcinoma de Células de Transição/cirurgia , Cistectomia , Humanos , Masculino , Próstata/cirurgia , Prostatectomia , Estudos Retrospectivos , Neoplasias da Bexiga Urinária/cirurgia , Urotélio/cirurgia
7.
Am J Clin Pathol ; 138(2): 190-7, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22904129

RESUMO

For primary bladder tumors, distinguishing urothelial carcinoma (UC) invading the fibromuscular stroma of the prostate (pT4a) from in situ UC involving prostatic ducts can be difficult. Immunohistochemical markers (cytokeratin [CK]5/6, CK5, CK7, CK20, p53, p63, high-molecular-weight keratin [HMWK], androgen receptor, prostate-specific antigen [PSA], prostate specific acid phosphatase [PSAP], laminin, CD44s, CD141) were assessed for their usefulness in determining depth of UC invasion in the prostate. In cystoprostatectomy specimens containing in situ UC in prostatic ducts, both CK5/6 and CK5 clearly differentiated prostatic basal cells from in situ UC. The remaining markers were not effective in determining depth of tumor invasion. Double-stain combinations CK7/CK5 and p53/CK5 were performed and robustly color contrasted in situ tumor from surrounding basal cells. The use of CK5/6, CK5, CK7/CK5, or p53/CK5 is recommended to assist in determining the depth of UC invasion in the prostate when histologic findings are equivocal.


Assuntos
Biomarcadores Tumorais/análise , Carcinoma in Situ/química , Carcinoma in Situ/patologia , Neoplasias da Próstata/química , Neoplasias da Próstata/patologia , Neoplasias da Bexiga Urinária/química , Neoplasias da Bexiga Urinária/patologia , Fosfatase Ácida/análise , Humanos , Receptores de Hialuronatos/análise , Queratina-20/análise , Queratina-5/análise , Queratina-6/análise , Queratina-7/análise , Laminina/análise , Masculino , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Antígeno Prostático Específico/análise , Proteína Supressora de Tumor p53/análise , Urotélio/química , Urotélio/patologia
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