Pub Date : 2017-07-01DOI: 10.1590/S1677-5538.IBJU.2015.0349
George Augusto Monteiro Lins de Albuquerque, G. Guglielmetti, M. Cordeiro, W. Nahas, R. Coelho
ABSTRACT Introduction Robotic-assisted radical prostatectomy (RAP) is the dominant minimally invasive surgical treatment for patients with localized prostate cancer. The introduction of robotic assistance has the potential to improve surgical outcomes and reduce the steep learning curve associated with conventional laparoscopic radical prostatectomy. The purpose of this video is to demonstrate the early retrograde release of the neurovascular bundle without open the endopelvic fascia during RAP. Materials and Methods A 51-year old male, presenting histological diagnosis of prostate adenocarcinoma, Gleason 6 (3+3), in 4 cores of 12, with an initial PSA=3.41ng/dl and the digital rectal examination demonstrating a prostate with hardened nodule in the right lobe of the prostate base (clinical stage T2a). Surgical treatment with the robot-assisted technique was offered as initial therapeutic option and the critical technical point was the early retrograde release of the neurovascular bundle with endopelvic fascia preservation, during radical prostatectomy. Results The operative time was of 89 minutes, blood loss was 100ml. No drain was left in the peritoneal cavity. The patient was discharged within 24 hours. There were no intraoperative or immediate postoperative complications. The pathological evaluation revealed prostate adenocarcinoma, Gleason 6, with free surgical margins and seminal vesicles free of neoplastic involvement (pathologic stage T2a). At 3-month-follow-up, the patient lies with undetectable PSA, continent and potent. Conclusion This is a feasible technique combining the benefits of retrograde release of the neurovascular bundle, the preservation of the pubo-prostatic collar and the preservation of the antero-lateral cavernous nerves.
{"title":"Robot-assisted laparoscopic radical prostatectomy with early retrograde release of the neurovascular bundle and endopelvic fascia sparing","authors":"George Augusto Monteiro Lins de Albuquerque, G. Guglielmetti, M. Cordeiro, W. Nahas, R. Coelho","doi":"10.1590/S1677-5538.IBJU.2015.0349","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2015.0349","url":null,"abstract":"ABSTRACT Introduction Robotic-assisted radical prostatectomy (RAP) is the dominant minimally invasive surgical treatment for patients with localized prostate cancer. The introduction of robotic assistance has the potential to improve surgical outcomes and reduce the steep learning curve associated with conventional laparoscopic radical prostatectomy. The purpose of this video is to demonstrate the early retrograde release of the neurovascular bundle without open the endopelvic fascia during RAP. Materials and Methods A 51-year old male, presenting histological diagnosis of prostate adenocarcinoma, Gleason 6 (3+3), in 4 cores of 12, with an initial PSA=3.41ng/dl and the digital rectal examination demonstrating a prostate with hardened nodule in the right lobe of the prostate base (clinical stage T2a). Surgical treatment with the robot-assisted technique was offered as initial therapeutic option and the critical technical point was the early retrograde release of the neurovascular bundle with endopelvic fascia preservation, during radical prostatectomy. Results The operative time was of 89 minutes, blood loss was 100ml. No drain was left in the peritoneal cavity. The patient was discharged within 24 hours. There were no intraoperative or immediate postoperative complications. The pathological evaluation revealed prostate adenocarcinoma, Gleason 6, with free surgical margins and seminal vesicles free of neoplastic involvement (pathologic stage T2a). At 3-month-follow-up, the patient lies with undetectable PSA, continent and potent. Conclusion This is a feasible technique combining the benefits of retrograde release of the neurovascular bundle, the preservation of the pubo-prostatic collar and the preservation of the antero-lateral cavernous nerves.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"14 1","pages":"782 - 782"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81160314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-07-01DOI: 10.1590/S1677-5538.IBJU.2016.0483
A. Carneiro, W. Baccaglini, F. Glina, P. Kayano, Victor Nunes, O. Smaletz, W. Bernardo, Í. D. de Carvalho, G. Lemos
ABSTRACT Context Currently, standard treatment of metastatic prostatic cancer (MPCa) is androgen-deprivation therapy (ADT). Recent studies suggested that local treatment of MPCa is related to increase of survival of those patients, as observed in other tumors. Objective To evaluate the impact of local treatment on overall survival and cancer specific survival in 3 and 5 years in patients with MPCa. Materials and Methods Systematic review and meta-analysis of population studies published at PubMed, Scielo, Lilacs, Cochrane and EMBASE databases until June 2016. Several large cohorts and Post-Roc studies were included, that evaluated patients with MPCa submitted to local treatment (LT) using radiotherapy (RDT), surgery (RP) or brachytherapy (BCT) or not submitted to local treatment (NLT). Results 34.338 patients were analyzed in six included papers, 31.653 submitted to NLT and 2.685 to LT. Overall survival in three years was significantly higher in patients submitted to LT versus NLT (64.2% vs. 44.5%; RD 0.19, 95% CI, 0.17-0.21; p<0.00001; I2=0%), as well as in five years (51.9% vs. 23.6%; RD 0.30, 95% CI, 0.11-0.49; p<0.00001; I2=97%). Sensitive analysis according to type of local treatment showed that surgery (78.2% and 45.0%; RD 0.31, 95% CI, 0.26-0.35; p<0.00001; I2=50%) and radiotherapy (60.4% and 44.5%; RD 0.17, 95% CI, 0.12-0.22; p<0.00001; I2=67%) presented better outcomes. Conclusion LT using RDT, RP or BCT seems to significantly improve overall survival and cancer-specific survival of patients with metastatic prostatic cancer. Prospective and randomized studies must be performed in order to confirm our results.
目前，转移性前列腺癌(MPCa)的标准治疗是雄激素剥夺疗法(ADT)。最近的研究表明，局部治疗MPCa与其他肿瘤患者的生存率增加有关。目的探讨局部治疗对MPCa患者3年和5年总生存期和肿瘤特异性生存期的影响。材料与方法对截至2016年6月在PubMed、Scielo、Lilacs、Cochrane和EMBASE数据库发表的人口研究进行系统回顾和荟萃分析。纳入了几个大型队列和后roc研究，评估了MPCa患者接受局部治疗(LT)，包括放疗(RDT)、手术(RP)或近距离治疗(BCT)或不接受局部治疗(NLT)。结果纳入的6篇论文共分析了34.338例患者，其中接受NLT治疗的患者为31.653例，接受LT治疗的患者为2.685例。接受LT治疗的患者3年总生存率显著高于接受NLT治疗的患者(64.2% vs. 44.5%;Rd 0.19, 95% ci 0.17-0.21;p < 0.00001;I2=0%)，以及5年后(51.9% vs. 23.6%;Rd 0.30, 95% ci 0.11-0.49;p < 0.00001;I2 = 97%)。根据局部治疗方式的敏感性分析显示:手术(78.2%)和45.0%;Rd为0.31,95% ci为0.26-0.35;p < 0.00001;I2=50%)和放疗(60.4%和44.5%;Rd 0.17, 95% ci 0.12-0.22;p < 0.00001;I2=67%)的患者预后较好。结论RDT、RP或BCT联合行肝移植可显著提高转移性前列腺癌患者的总生存率和肿瘤特异性生存率。为了证实我们的结果，必须进行前瞻性和随机研究。
{"title":"Impact of local treatment on overall survival of patients with metastatic prostate cancer: systematic review and meta-analysis","authors":"A. Carneiro, W. Baccaglini, F. Glina, P. Kayano, Victor Nunes, O. Smaletz, W. Bernardo, Í. D. de Carvalho, G. Lemos","doi":"10.1590/S1677-5538.IBJU.2016.0483","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2016.0483","url":null,"abstract":"ABSTRACT Context Currently, standard treatment of metastatic prostatic cancer (MPCa) is androgen-deprivation therapy (ADT). Recent studies suggested that local treatment of MPCa is related to increase of survival of those patients, as observed in other tumors. Objective To evaluate the impact of local treatment on overall survival and cancer specific survival in 3 and 5 years in patients with MPCa. Materials and Methods Systematic review and meta-analysis of population studies published at PubMed, Scielo, Lilacs, Cochrane and EMBASE databases until June 2016. Several large cohorts and Post-Roc studies were included, that evaluated patients with MPCa submitted to local treatment (LT) using radiotherapy (RDT), surgery (RP) or brachytherapy (BCT) or not submitted to local treatment (NLT). Results 34.338 patients were analyzed in six included papers, 31.653 submitted to NLT and 2.685 to LT. Overall survival in three years was significantly higher in patients submitted to LT versus NLT (64.2% vs. 44.5%; RD 0.19, 95% CI, 0.17-0.21; p<0.00001; I2=0%), as well as in five years (51.9% vs. 23.6%; RD 0.30, 95% CI, 0.11-0.49; p<0.00001; I2=97%). Sensitive analysis according to type of local treatment showed that surgery (78.2% and 45.0%; RD 0.31, 95% CI, 0.26-0.35; p<0.00001; I2=50%) and radiotherapy (60.4% and 44.5%; RD 0.17, 95% CI, 0.12-0.22; p<0.00001; I2=67%) presented better outcomes. Conclusion LT using RDT, RP or BCT seems to significantly improve overall survival and cancer-specific survival of patients with metastatic prostatic cancer. Prospective and randomized studies must be performed in order to confirm our results.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"43 1","pages":"588 - 599"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79451774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-07-01DOI: 10.1590/S1677-5538.IBJU.2016.0291
F. Ozgor, Onur Kucuktopcu, Burak Ucpinar, F. Yanaral, M. Binbay
ABSTRACT Objective To evaluate the predictive value of the distance from skin to calyx (SCD) on the outcome and complication rates of patients undergoing mPNL. Materials and Methods Patient’s charts, who had undergone mPNL between June 2012 and June 2015, were analyzed retrospectively. Patients who had a preoperative computerized tomography (CT) were enrolled into the study. Two separateurologists evaluated the CT scans and calculated the SCD defined as the distance between the skin and surface/lateral edge of the calyx, which was the preferred site of entry for percutaneous access. The average value of the two measurements was included inthe final analysis to avoid bias. The mean SCD was 75mm. According to the median SCD value, patients were divided into two groups: group 1 (SCD ≤75) and group 2 (SCD >75). Results A total of 140 patients and 130 patients were enrolled in groups 1 and 2, respectively. The mean operation time and the mean fluoroscopy time was significantly longer in group 2 (p:0.004 vs. p:0.021). The rate of blood transfusion was significantly higher in group 1 (6 patients). None of patientsin group 2required blood transfusion (p:0.017). Stone-free status after a single session of mPNL was 67.1% in group 1 and 75.4% in group 2 (p:0.112). After additional procedures, stone-free rates increased to 84.3% and 85.4% in group 1 and group 2, respectively (p:0.802). Conclusion Our study demonstrated that longer SCD was not a predictive factor for stone-free rates after mPNL. However, SCD over 75mm was associated with longer operation time and fluoroscopy time with lower rates of transfusion.
【摘要】目的探讨皮肤到肾花萼距离(SCD)对mPNL患者预后及并发症发生率的预测价值。材料与方法回顾性分析2012年6月至2015年6月间行mPNL的患者病历。术前进行计算机断层扫描(CT)的患者被纳入研究。两名分离神经科医生评估了CT扫描并计算了SCD, SCD定义为皮肤与花萼表面/外侧边缘之间的距离，这是经皮进入的首选位置。为了避免偏差，最后的分析中包含了两次测量的平均值。平均SCD为75mm。根据SCD中位值将患者分为两组:1组(SCD≤75)和2组(SCD >75)。结果1组140例，2组130例。2组平均手术时间和平均透视时间明显长于对照组(p:0.004 vs. p:0.021)。1组输血率明显高于对照组(6例)。2组无患者需要输血(p:0.017)。单次mPNL治疗后，组1无结石率67.1%，组2无结石率75.4% (p:0.112)。在额外的手术后，组1和组2的无结石率分别增加到84.3%和85.4% (p:0.802)。结论:我们的研究表明，较长的SCD并不是mPNL术后结石清除率的预测因素。然而，超过75mm的SCD与较长的手术时间和透视时间以及较低的输血率相关。
{"title":"Skin to calyx distance is not a predictive factor for miniaturized percutaneous nephrolithotomy outcomes","authors":"F. Ozgor, Onur Kucuktopcu, Burak Ucpinar, F. Yanaral, M. Binbay","doi":"10.1590/S1677-5538.IBJU.2016.0291","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2016.0291","url":null,"abstract":"ABSTRACT Objective To evaluate the predictive value of the distance from skin to calyx (SCD) on the outcome and complication rates of patients undergoing mPNL. Materials and Methods Patient’s charts, who had undergone mPNL between June 2012 and June 2015, were analyzed retrospectively. Patients who had a preoperative computerized tomography (CT) were enrolled into the study. Two separateurologists evaluated the CT scans and calculated the SCD defined as the distance between the skin and surface/lateral edge of the calyx, which was the preferred site of entry for percutaneous access. The average value of the two measurements was included inthe final analysis to avoid bias. The mean SCD was 75mm. According to the median SCD value, patients were divided into two groups: group 1 (SCD ≤75) and group 2 (SCD >75). Results A total of 140 patients and 130 patients were enrolled in groups 1 and 2, respectively. The mean operation time and the mean fluoroscopy time was significantly longer in group 2 (p:0.004 vs. p:0.021). The rate of blood transfusion was significantly higher in group 1 (6 patients). None of patientsin group 2required blood transfusion (p:0.017). Stone-free status after a single session of mPNL was 67.1% in group 1 and 75.4% in group 2 (p:0.112). After additional procedures, stone-free rates increased to 84.3% and 85.4% in group 1 and group 2, respectively (p:0.802). Conclusion Our study demonstrated that longer SCD was not a predictive factor for stone-free rates after mPNL. However, SCD over 75mm was associated with longer operation time and fluoroscopy time with lower rates of transfusion.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"64 1","pages":"679 - 685"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85026728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-07-01DOI: 10.1590/S1677-5538.IBJU.2016.0177
Natália Gomes Parizzi, Oscar Ávila Rubini, S. H. M. de Almeida, Lais Caetano Ireno, R. Tashiro, Victor Hugo Tolotto de Carvalho
ABSTRACT Purpose The polypropylene mesh (PPM) is used in many surgical interventions because of its good incorporation and accessibility. However, potential mesh-related complications are common. Platelet-rich plasma (PRP) improves the healing of wounds and is inexpensive. Thus, the purpose of this study was to analyze the effect of the PRP-gel coating of a PPM on inflammation, production of collagen, and smooth muscle in the rabbit vagina. Materials and Methods The intervention consisted of a 1.5cm incision and divulsion of the vaginal mucosa for the implantation of a PRP-coated PPM. The PRP-coated mesh was implanted in 15 rabbits, and in the second group, the same implant was used without the PRP coating. In the sham group, the intervention consisted of the incision, divulsion, and suture. The rabbits were euthanized at 7, 30 and 90 days, and full-thickness sagittal sections of the posterior vaginal wall and rectum were scored. The inflammatory infiltrate was evaluated using hematoxylin and eosin staining. The Sirius Red stain was used to examine deposition of collagen I and III, and Masson’s trichrome staining was used to visualize the smooth muscle. Results The group with PRP-coated meshes had a lower inflammatory infiltrate count at 30 days. Deposition of collagen III increased with the use of PRP-coating at 90 days. Conclusions The area of inflammatory infiltrate was significantly increased in the group without the PRP-coated mesh at 30 days but not in the group with the PRP-coated mesh, indicating a less intense inflammatory response. In addition, a significant increase in collagen III occurred at 90 days.
{"title":"Effect of platelet-rich plasma on polypropylene meshes implanted in the rabbit vagina: histological analysis","authors":"Natália Gomes Parizzi, Oscar Ávila Rubini, S. H. M. de Almeida, Lais Caetano Ireno, R. Tashiro, Victor Hugo Tolotto de Carvalho","doi":"10.1590/S1677-5538.IBJU.2016.0177","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2016.0177","url":null,"abstract":"ABSTRACT Purpose The polypropylene mesh (PPM) is used in many surgical interventions because of its good incorporation and accessibility. However, potential mesh-related complications are common. Platelet-rich plasma (PRP) improves the healing of wounds and is inexpensive. Thus, the purpose of this study was to analyze the effect of the PRP-gel coating of a PPM on inflammation, production of collagen, and smooth muscle in the rabbit vagina. Materials and Methods The intervention consisted of a 1.5cm incision and divulsion of the vaginal mucosa for the implantation of a PRP-coated PPM. The PRP-coated mesh was implanted in 15 rabbits, and in the second group, the same implant was used without the PRP coating. In the sham group, the intervention consisted of the incision, divulsion, and suture. The rabbits were euthanized at 7, 30 and 90 days, and full-thickness sagittal sections of the posterior vaginal wall and rectum were scored. The inflammatory infiltrate was evaluated using hematoxylin and eosin staining. The Sirius Red stain was used to examine deposition of collagen I and III, and Masson’s trichrome staining was used to visualize the smooth muscle. Results The group with PRP-coated meshes had a lower inflammatory infiltrate count at 30 days. Deposition of collagen III increased with the use of PRP-coating at 90 days. Conclusions The area of inflammatory infiltrate was significantly increased in the group without the PRP-coated mesh at 30 days but not in the group with the PRP-coated mesh, indicating a less intense inflammatory response. In addition, a significant increase in collagen III occurred at 90 days.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"4 2 1","pages":"746 - 752"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73156319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-07-01DOI: 10.1590/S1677-5538.IBJU.2016.0204
Hu Han, Da-wei Xie, Xiao-guang Zhou, Xiaodong Zhang
ABSTRACT Introduction To evaluate the safety and efficacy of a novel penile circumcision suturing devices PCSD and Shang ring (SR) for circumcision in an adult population. Materials and Methods A total of 124 outpatients were randomly assigned to receive PCSD (n=62) or SR (n=62). Patient characteristics, operative time, blood loss, return to normal activities time (RNAT), visual analogue scale (VAS), scar width, wound healing time, cosmetic result, and complications were recorded. Results There were no significant differences in blood loss, RNAT, or complications between the two groups. There were no significant differences in the VAS scores at the operation, at 6 or 24 hours after surgery (P>0.05). The wound scar width was wider in the SR group than in the PCSD group (P<0.01). Patients in the SR group had significantly longer wound healing time compared with those in the PCSD group (P<0.01). Patients who underwent PCSD were significantly more satisfied with the cosmetic results (P<0.01). Conclusions SR and PCSD are safe and effective minimally invasive techniques for adult male circumcision. Compared with SRs, PCSDs have the advantages of faster postoperative incision healing and a good effect on wound cosmetics.
{"title":"Novel penile circumcision suturing devices versus the shang ring for adult male circumcision: a prospective study","authors":"Hu Han, Da-wei Xie, Xiao-guang Zhou, Xiaodong Zhang","doi":"10.1590/S1677-5538.IBJU.2016.0204","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2016.0204","url":null,"abstract":"ABSTRACT Introduction To evaluate the safety and efficacy of a novel penile circumcision suturing devices PCSD and Shang ring (SR) for circumcision in an adult population. Materials and Methods A total of 124 outpatients were randomly assigned to receive PCSD (n=62) or SR (n=62). Patient characteristics, operative time, blood loss, return to normal activities time (RNAT), visual analogue scale (VAS), scar width, wound healing time, cosmetic result, and complications were recorded. Results There were no significant differences in blood loss, RNAT, or complications between the two groups. There were no significant differences in the VAS scores at the operation, at 6 or 24 hours after surgery (P>0.05). The wound scar width was wider in the SR group than in the PCSD group (P<0.01). Patients in the SR group had significantly longer wound healing time compared with those in the PCSD group (P<0.01). Patients who underwent PCSD were significantly more satisfied with the cosmetic results (P<0.01). Conclusions SR and PCSD are safe and effective minimally invasive techniques for adult male circumcision. Compared with SRs, PCSDs have the advantages of faster postoperative incision healing and a good effect on wound cosmetics.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"115 1","pages":"736 - 745"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80622079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-05-01DOI: 10.1590/S1677-5538.IBJU.2015.0118
B. Manley, Eric H Kim, J. Vetter, A. Potretzke, S. Strope
ABSTRACT Objectives To further elucidate which patients with metastatic renal cell carcinoma (mRCC) may benefit from cytoreductive nephrectomy (CN) before targeted therapy (TT), and to assess the overall survival of patients undergoing CN and TT versus TT alone. Materials and Methods We identified 88 patients who underwent CN at our institution prior to planned TT and 35 patients who received TT without undergoing CN. Preoperative risk factors described in the literature were assessed in our patient population (serum albumin, liver metastasis, symptomatic metastasis, clinical ≥T3 disease, retroperitoneal and supradiaphragmatic lymphadenopathy). Patients were stratified by number of pretreatment risk factors and overall survival (OS) was compared. Results TT patients had significantly more risk factors compared to CN patients (3.06 vs. 2.11, p<0.01). Patients who received TT alone had median OS of 5.8 months. All but one patient receiving TT alone had two or more risk factors. A comparison of the CN and TT groups was performed by constructing Kaplan-Meier curves. There was no significant difference in median OS for those patients with exactly two risk factors (447 vs. 389 days, p=0.24), and those with three or more risk factors (184 vs. 155 days, p=0.87). Conclusions Using previously described pretreatment risk factors we found that patients with two or more risk factors derived no significant survival advantage from CN in the TT era. These risk factors should be incorporated in the assessment of patients for CN.
【摘要】目的进一步阐明转移性肾癌(mRCC)患者在接受靶向治疗(TT)之前，哪些患者可能受益于细胞减减性肾切除术(CN)，并评估接受CN和TT的患者与单独接受TT的患者的总生存率。材料和方法我们确定了88例在计划TT之前在我们机构接受了CN的患者和35例接受了TT而没有接受CN的患者。在我们的患者群体中评估文献中描述的术前危险因素(血清白蛋白、肝转移、症状性转移、临床≥T3疾病、腹膜后和膈上淋巴结病)。根据预处理危险因素数量对患者进行分层，并比较总生存期(OS)。结果TT患者的危险因素明显多于CN患者(3.06 vs 2.11, p<0.01)。单独接受TT治疗的患者平均生存期为5.8个月。除了一名单独接受TT治疗的患者外，所有患者都有两种或两种以上的危险因素。通过构建Kaplan-Meier曲线对CN组和TT组进行比较。有两个危险因素的患者(447天和389天，p=0.24)和有三个或更多危险因素的患者(184天和155天，p=0.87)的中位OS无显著差异。使用先前描述的预处理危险因素，我们发现具有两个或两个以上危险因素的患者在TT时代CN没有显著的生存优势。这些危险因素应纳入对CN患者的评估。
{"title":"Validation of preoperative variables and stratification of patients to help predict benefit of cytoreductive nephrectomy in the targeted therapy ERA","authors":"B. Manley, Eric H Kim, J. Vetter, A. Potretzke, S. Strope","doi":"10.1590/S1677-5538.IBJU.2015.0118","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2015.0118","url":null,"abstract":"ABSTRACT Objectives To further elucidate which patients with metastatic renal cell carcinoma (mRCC) may benefit from cytoreductive nephrectomy (CN) before targeted therapy (TT), and to assess the overall survival of patients undergoing CN and TT versus TT alone. Materials and Methods We identified 88 patients who underwent CN at our institution prior to planned TT and 35 patients who received TT without undergoing CN. Preoperative risk factors described in the literature were assessed in our patient population (serum albumin, liver metastasis, symptomatic metastasis, clinical ≥T3 disease, retroperitoneal and supradiaphragmatic lymphadenopathy). Patients were stratified by number of pretreatment risk factors and overall survival (OS) was compared. Results TT patients had significantly more risk factors compared to CN patients (3.06 vs. 2.11, p<0.01). Patients who received TT alone had median OS of 5.8 months. All but one patient receiving TT alone had two or more risk factors. A comparison of the CN and TT groups was performed by constructing Kaplan-Meier curves. There was no significant difference in median OS for those patients with exactly two risk factors (447 vs. 389 days, p=0.24), and those with three or more risk factors (184 vs. 155 days, p=0.87). Conclusions Using previously described pretreatment risk factors we found that patients with two or more risk factors derived no significant survival advantage from CN in the TT era. These risk factors should be incorporated in the assessment of patients for CN.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"20 1","pages":"432 - 439"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88097812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-05-01DOI: 10.1590/S1677-5538.IBJU.2016.0482
L. D. de Toledo, A. Costa-Matos, S. Hwang, R. Richetti, S. Carramão, A. Auge
ABSTRACT Introduction In high stage vaginal prolapse, recurrence risk patients, anterior and apical defects need to be addressed in the same procedure. The pre-molded commercial mesh kits are expensive and not always available. Alternative effective and safe treatment ways, with lower costs are desirable. Objective To present long term follow-up of patients treated with a homemade mesh shape to correct high stage prolapses. Materials and Methods We describe prospectively 18 patients with anterior and apical vaginal prolapses, stages III and IV, repaired using this specific design of mesh. All patients were submitted to pre-operative clinical evaluation and urodynamics. Prolapse was classified using the pelvic organ prolapse quantification (POP-Q). Intervention Prolapse surgery, using a six arms prolene mesh, through a single anterior vaginal incision. Outcome Measurements: POP-Q, patients satisfaction, descriptive statistical analysis. Results Between February 2009 and Oct 2010, 18 consecutive women underwent the above-mentioned surgery. Mean age was 68 years. At a mean follow-up of .,4 years (5 to 5.8 years), 16 (89%) patients were continent, mean Ba point came from +4.7cm to - 2.5cm, mean C point from +2.8cm to -6.6cm and mean Bp point from +1.3 to -1.7cm. There were two (11%) objective failures, but all the patients were considered success subjectively. There were two cases of mesh vaginal extrusion. Conclusions The homemade six arms prolene mesh allows concomitant correction of anterior and apical prolapses, through a single anterior vaginal incision, being an effective, safe and affordable treatment option when mesh is needed.
{"title":"Anterior six arms prolene mesh for high stage vaginal prolapse: five years follow-up","authors":"L. D. de Toledo, A. Costa-Matos, S. Hwang, R. Richetti, S. Carramão, A. Auge","doi":"10.1590/S1677-5538.IBJU.2016.0482","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2016.0482","url":null,"abstract":"ABSTRACT Introduction In high stage vaginal prolapse, recurrence risk patients, anterior and apical defects need to be addressed in the same procedure. The pre-molded commercial mesh kits are expensive and not always available. Alternative effective and safe treatment ways, with lower costs are desirable. Objective To present long term follow-up of patients treated with a homemade mesh shape to correct high stage prolapses. Materials and Methods We describe prospectively 18 patients with anterior and apical vaginal prolapses, stages III and IV, repaired using this specific design of mesh. All patients were submitted to pre-operative clinical evaluation and urodynamics. Prolapse was classified using the pelvic organ prolapse quantification (POP-Q). Intervention Prolapse surgery, using a six arms prolene mesh, through a single anterior vaginal incision. Outcome Measurements: POP-Q, patients satisfaction, descriptive statistical analysis. Results Between February 2009 and Oct 2010, 18 consecutive women underwent the above-mentioned surgery. Mean age was 68 years. At a mean follow-up of .,4 years (5 to 5.8 years), 16 (89%) patients were continent, mean Ba point came from +4.7cm to - 2.5cm, mean C point from +2.8cm to -6.6cm and mean Bp point from +1.3 to -1.7cm. There were two (11%) objective failures, but all the patients were considered success subjectively. There were two cases of mesh vaginal extrusion. Conclusions The homemade six arms prolene mesh allows concomitant correction of anterior and apical prolapses, through a single anterior vaginal incision, being an effective, safe and affordable treatment option when mesh is needed.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"223 1","pages":"525 - 532"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83653268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ABSTRACT Introduction A randomized trial was conducted prospectively to evaluate the efficacy, related complications, and convalescence of emergency percutaneous nephrolithotomy compared to percutaneous nephrostomy for decompression of the collecting system in cases of sepsis associated with large uretero-pelvic junction stone impaction. Materials and Methods The inclusion criteria included a WBC count of 10.000/mm3 or more and/or a temperature of 38°C or higher. Besides, all enrolled patients should maintain stable hemodynamic status and proper organ perfusions. A total of 113 patients with large, obstructive uretero-pelvic junction stones and clinical signs of sepsis completed the study protocol. Of those, 56 patients were placed in the emergency percutaneous nephrostomy group, while the other 57 patients were part of the percutaneous nephrolithotomy group. The primary end point was the time until normalization of white blood cells (WBC) at a count of 10.000/mm3 or less, and a temperature of 37.4°C or lower. The secondary end points included the comparison of analgesic consumption, length of stay, and related complications. Statistical analysis was performed using SPSS® version 14.0.1. The Mann-Whitney U test, chi-square test, and Fisher’s exact test were used as appropriate. Results The length of hospital stays (in days) was 10.09±3.43 for the emergency percutaneous nephrostomy group and 8.18±2.72 for the percutaneous nephrolithotomy group. This set of data noted a significant difference between groups. There was no difference between groups in regard to white blood cell count (in mm3), time to normalization of white blood cell count (in days), body temperature (in ºC), time to normalization of body temperature (in days), C-reactive proteins (in mg/dL), time taken for C-reactive proteins to decrease over 25% (in days), procalcitonin (in ng/mL), or complication rates. Conclusions This study confirms that emergency percutaneous nephrolithotomy may be as safe as early percutaneous nephrolithotomy in a selected low risk patients with sepsis-associated large, obstructive stone.
{"title":"Emergency percutaneous nephrostomy versus emergency percutaneous nephrolithotomy in patients with sepsis associated with large uretero-pelvic junction stone impaction: a randomized controlled trial","authors":"Chi-Sen Hsu, Chung-Jing Wang, Chien‐Hsing Chang, Po-Chao Tsai, Hung-Wen Chen, Yi-Chun Su","doi":"10.1590/S1677-5538.IBJU.2015.0643","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2015.0643","url":null,"abstract":"ABSTRACT Introduction A randomized trial was conducted prospectively to evaluate the efficacy, related complications, and convalescence of emergency percutaneous nephrolithotomy compared to percutaneous nephrostomy for decompression of the collecting system in cases of sepsis associated with large uretero-pelvic junction stone impaction. Materials and Methods The inclusion criteria included a WBC count of 10.000/mm3 or more and/or a temperature of 38°C or higher. Besides, all enrolled patients should maintain stable hemodynamic status and proper organ perfusions. A total of 113 patients with large, obstructive uretero-pelvic junction stones and clinical signs of sepsis completed the study protocol. Of those, 56 patients were placed in the emergency percutaneous nephrostomy group, while the other 57 patients were part of the percutaneous nephrolithotomy group. The primary end point was the time until normalization of white blood cells (WBC) at a count of 10.000/mm3 or less, and a temperature of 37.4°C or lower. The secondary end points included the comparison of analgesic consumption, length of stay, and related complications. Statistical analysis was performed using SPSS® version 14.0.1. The Mann-Whitney U test, chi-square test, and Fisher’s exact test were used as appropriate. Results The length of hospital stays (in days) was 10.09±3.43 for the emergency percutaneous nephrostomy group and 8.18±2.72 for the percutaneous nephrolithotomy group. This set of data noted a significant difference between groups. There was no difference between groups in regard to white blood cell count (in mm3), time to normalization of white blood cell count (in days), body temperature (in ºC), time to normalization of body temperature (in days), C-reactive proteins (in mg/dL), time taken for C-reactive proteins to decrease over 25% (in days), procalcitonin (in ng/mL), or complication rates. Conclusions This study confirms that emergency percutaneous nephrolithotomy may be as safe as early percutaneous nephrolithotomy in a selected low risk patients with sepsis-associated large, obstructive stone.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"7 1","pages":"481 - 488"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91237660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-05-01DOI: 10.1590/S1677-5538.IBJU.2016.0164
A. Bansal, M. Kumar, G. Kanodia, Ruchir Aeron, S. Goel
Foreign bodies are rarely found in genito-urinary system and pose a challenge to the prac-titioner. The usual causes for insertion of foreign bodies in genitourinary system include sexual cu-riosity, autoerotic stimulation, or during invasive procedures (1). These patients may remain asymp-tomatic or have minimal discomfort but usually patient presents with urinary tract infection, severe pain and hematuria (2). Foreign bodies should be removed completely and procedures used should be simple and minimally traumatic to the geni-tourinary tract (1). Herein, we present a case and management of self-inserted foreign body in the vagina of a young girl for erotic stimulation.
{"title":"Unusual intravesical foreign body in young female migrated from vagina due to autoerotism","authors":"A. Bansal, M. Kumar, G. Kanodia, Ruchir Aeron, S. Goel","doi":"10.1590/S1677-5538.IBJU.2016.0164","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2016.0164","url":null,"abstract":"Foreign bodies are rarely found in genito-urinary system and pose a challenge to the prac-titioner. The usual causes for insertion of foreign bodies in genitourinary system include sexual cu-riosity, autoerotic stimulation, or during invasive procedures (1). These patients may remain asymp-tomatic or have minimal discomfort but usually patient presents with urinary tract infection, severe pain and hematuria (2). Foreign bodies should be removed completely and procedures used should be simple and minimally traumatic to the geni-tourinary tract (1). Herein, we present a case and management of self-inserted foreign body in the vagina of a young girl for erotic stimulation.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"24 1","pages":"556 - 560"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84666790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
cAsE A 29-year-old female patient was admitted after a computed tomography (CT) scan showing a neoplasm measuring 4.5×4.0×4.5cm located in the middle and dorsal part of the left kidney (Figure-1). In the CT plain scan phase, the neoplasm had almost equal density with the normal kidney, and the CT unit was 45. It had a clear boundary, and part of the neoplasm extruded the renal contour. A multiple patchy low density area could be seen in the neoplasm Vol. 43 (3): 563-565, May June, 2017
病例一名29岁女性患者入院后，计算机断层扫描(CT)显示位于左肾中部和背侧的肿瘤4.5×4.0×4.5cm(图1)。CT平扫期肿瘤与正常肾密度基本相等，CT单位为45。边界清晰，部分肿瘤突出肾轮廓。肿瘤内可见多发斑片状低密度区Vol. 43 (3): 563-565, May / June, 2017
{"title":"Metanephric Adenofibroma in a young adult","authors":"Fei-ya Yang, Canfeng Zhang, Mingshuai Wang, Xi-quan Tian, Wenlong Wang, N. Xing","doi":"10.1590/S1677-5538.IBJU.2015.0300","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2015.0300","url":null,"abstract":"cAsE A 29-year-old female patient was admitted after a computed tomography (CT) scan showing a neoplasm measuring 4.5×4.0×4.5cm located in the middle and dorsal part of the left kidney (Figure-1). In the CT plain scan phase, the neoplasm had almost equal density with the normal kidney, and the CT unit was 45. It had a clear boundary, and part of the neoplasm extruded the renal contour. A multiple patchy low density area could be seen in the neoplasm Vol. 43 (3): 563-565, May June, 2017","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"39 1","pages":"563 - 565"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79865359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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