International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology最新文献_第5页

Role of the three-dimensional printing technology in complex laparoscopic renal surgery: a renal tumor in a horseshoe kidney 三维打印技术在复杂腹腔镜肾脏手术中的作用:马蹄形肾肿瘤

International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology

Pub Date : 2019-11-01 DOI: 10.1590/S1677-5538.IBJU.2019.0085

C. Mercader, A. Vilaseca, J. Moreno, A. López, M. Sebastià, Carles Nicolau, M. Ribal, L. Peri, M. Costa, A. Alcaraz

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.

目的:报告我们使用患者特异性3d打印肾肿瘤模型进行马蹄形肾复杂半肾切除术的手术计划的初步经验。材料和方法:我们选择了一个复杂的腹腔镜手术的临床病例，包括一个53岁的男性，他的马蹄肾肿瘤局部复发，血管异常，之前曾接受过腹腔镜部分肾切除术。他现在被建议进行腹腔镜左肾切除术。在常规成像的基础上，采用了一个真实尺寸的3d打印肾脏模型来规划手术入路。记录手术组围手术期经验。结果:手术团队发现患者特定的3D打印模型有助于更好地理解解剖结构和更容易的手术计划。结论:3d打印肾脏模型的应用有助于复杂肾脏肿瘤的手术规划。

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引用次数: 16

A new Surgical Technique: Transvesical Prostate Resection 一种新的手术技术:经膀胱前列腺切除术

International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology

Pub Date : 2019-11-01 DOI: 10.1590/S1677-5538.IBJU.2018.0488

H. Türk, Erkan Arslan

ABSTRACT Objectives: Surgical treatment is indicated in patients where medical therapy fails to prove beneficial or in patients who develop complications related with bladder outlet obstruction. In our study, we developed a new surgical technique which can be defined as Transvesical Resection of Prostate (TVRP) without using the urethra. This method was previously described in our articles (1). Materials and Methods: A 62-years-old male patient, using an alpha blocker agent for 5 years, reported increased discomfort with urination. His findings were as follows: PSA: 1.2 ng/dL, prostate volume: 45 cc, digital rectal examination: benign, IPSS: 30, QoL: 5, Qmax: 6, urine volume: 225 cc, post-mictional residue: 65 cc. Eventually the patient was informed and prostate resection decision was made. Results: Suprapubic catheter was removed 1 day after surgery and the patient was discharged. Urethral catheter was removed 4 days after urine output became clear. No complications developed after the operation. At postoperative 1st month, Qmax was 22, urine volume was 260 cc, post-mictional residue was 40 cc, IPSS was 8, QoL was 1, and the pathology was benign prostate tissue. Conclusions: Urethral stricture is one of the most important postoperative complications of TURP. The incidence of urethral stricture is reported between 2.2% and 9.8% in different series (2–5). In this technique which we developed, urethra is not used and prostate is removed through the bladder, similar to open prostatectomies. For this reason, we suggest that it has an advantage over TURP, regarding urethral stricture development.

目的:在药物治疗无效或出现膀胱出口梗阻相关并发症的患者中，应采用手术治疗。在我们的研究中，我们开发了一种新的手术技术，可以定义为不经尿道的经膀胱前列腺切除术(TVRP)。该方法在我们之前的文章(1)中有描述。材料和方法:一名62岁男性患者，使用α受体阻滞剂5年，报告小便不适增加。结果如下:PSA: 1.2 ng/dL，前列腺体积:45 cc，直肠指检:良性，IPSS: 30, QoL: 5, Qmax: 6，尿量:225 cc，尿后残留物:65 cc，最终告知患者并决定前列腺切除术。结果:术后1天取出耻骨上导尿管，出院。尿清后4天拔除导尿管。术后无并发症发生。术后1个月Qmax为22，尿量260 cc，尿后残留40 cc, IPSS为8,QoL为1，病理为前列腺组织良性。结论:尿道狭窄是TURP术后最重要的并发症之一。尿道狭窄的发生率在2.2%至9.8%之间，在不同的系列(2-5)。在我们开发的这项技术中，不使用尿道，通过膀胱切除前列腺，类似于开放式前列腺切除术。因此，我们认为在尿道狭窄的发展方面，它比TURP有优势。

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引用次数: 0

The association between CHA2DS2-VASc score and erectile dysfunction: a cross-sectional study CHA2DS2-VASc评分与勃起功能障碍的相关性:一项横断面研究

International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology

Pub Date : 2019-11-01 DOI: 10.1590/S1677-5538.IBJU.2019.0058

Dilay Karabulut, Umut Karabulut, F. Çağlar, M. Ekşi, M. Yenice, Ekrem Güner, Esra Dönmez Íşler, E. Oflar, Ali İhsan Taşçl, F. Aktürk

ABSTRACT Purpose: This study aims to assess the association between CHA2DS2-VASc score and erectile dysfunction in patients who were admitted to cardiology outpatient clinics. Materials and methods: One hundred and two male patients who were admitted to the cardiology outpatient clinic were included to the study. Erectile dysfunction was evaluated in the urology outpatient clinic in the same hospital and scored using Turkish Version of The International Index of Erectile Function. CHA2DS2-VASc score was calculated for every patient using the current associated guidelines. Results: There was a negative correlation between The International Index of Erectile Function score and CHA2DS2-VASc score, age, hypertension, heart failure, diabetes mellitus, stroke respectively. Smoking and dislipidemia were not correlated with The International Index of Erectile Function score (p>0.05). Conclusion: CHA2DS2-VASc score can be used to detect Erectile dysfunction in patients who are admitted to the cardiology outpatient clinics.

摘要目的:本研究旨在评估在心脏病科门诊就诊的患者CHA2DS2-VASc评分与勃起功能障碍之间的关系。材料与方法:研究纳入了102例在心脏病科门诊就诊的男性患者。在同一医院泌尿科门诊评估勃起功能障碍，并使用土耳其版国际勃起功能指数评分。使用现行相关指南计算每位患者的CHA2DS2-VASc评分。结果:The International Index of勃起功能指数评分与CHA2DS2-VASc评分分别与年龄、高血压、心力衰竭、糖尿病、脑卒中呈负相关。吸烟、低脂血症与The International Index of勃起功能评分无相关性(p>0.05)。结论:CHA2DS2-VASc评分可用于心内科门诊患者的勃起功能障碍检测。

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引用次数: 1

The Harbin Medical University nephrectomy score: a quantitative system for evaluating the complexity of laparoscopic retroperitoneal simple nephrectomy. 哈尔滨医科大学肾切除术评分：评估腹腔镜腹膜后单纯肾切除术复杂性的定量系统。

International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology

Pub Date : 2019-11-01 DOI: 10.1590/S1677-5538.IBJU.2018.0634

Yiwen Liu, Chunyang Wang, Xiuhai Wu, Linglong Kong, Shaobin Ni

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 classifi cation (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 fi ndings. 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.

背景：腹腔镜腹膜后单纯肾切除术（LRSN）已被广泛接受为治疗良性无功能肾脏的主要方法。然而，该手术的复杂程度各不相同，仍存在争议：目的：开发一套标准化的哈尔滨医科大学肾切除术评分（HMUNS）系统，用于评估 LRSN 的复杂性：哈尔滨医科大学肾切除术评分（HMUNS）系统包括原发疾病、上尿路手术史、体重指数（BMI）、外科医生学习曲线、肾脏体积和梅奥粘连概率（MAP）评分共 6 个不同因素的变量。用 HMUNS 将在本院接受 LRSN 手术的 95 例连续患者分为低复杂度组（2 至 6 分）和高复杂度组（7 至 17 分），并研究了两组患者在手术时间（OT）、估计失血量（EBL）、术后住院时间（PHT）、术中转为开放手术的比例以及 Clavien-Dindo 分级（CDC）方面的差异：结果：两组平均手术时间更长（193.2±69.3 分钟 vs. 151.9±46.3 分钟，PHMUNS 能有效反映 LRSN 的复杂性，从而为风险评估和治疗决策提供一个定量系统。由于存在一些局限性，有必要进一步开展设计良好的研究来证实我们的结论。患者总结：包括原发疾病、上尿路手术史、体重指数、外科医生学习曲线、肾脏体积和 MAP 评分在内的 HMUNS 可为评估 LRSN 的复杂性提供有效的定量工具。

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引用次数: 0

Association between stress and lower urinary tract symptoms in children and adolescents 儿童和青少年压力与下尿路症状的关系

International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology

Pub Date : 2019-11-01 DOI: 10.1590/S1677-5538.IBJU.2019.0128

A. A. Braga, M. L. Veiga, Maria Gabrielle Correia da Silva Ferreira, H. Santana, Ubirajara BARROSO JR

ABSTRACT Introduction: Lower urinary tract dysfunction (LUTD) is a common clinical condition. Emotional and behavioral issues are increasing among children and adolescents, with stress indicating difficulties in personal and social functioning. This study evaluated whether urinary tract symptoms (LUTS) is associated with stress. Materials and Methods: A cross-sectional, analytical study with 6-14-year-old patients with LUTS and no anatomical/neurogenic urinary tract abnormalities was conducted using the Dysfunctional Voiding Scoring System, a psychological assessment and the Child Stress Scale. The overall stress score was analyzed in relation to the psychological assessment data. Answers to the seven specific DVSS urinary questions were compared with those for the four Child Stress Scale domains. Univariate and multivariate analyses were performed. The chi-square test and Pearson's correlation were used to determine associations. Significance was defined as p <0.05. Results: Most children were male (56%). Mean age was 9.0±2.25 years. Stress was detected in 20 out of 98 patients (20.4%; 95% CI: 13-30%). Of these, 90% were born from unplanned pregnancies and 67% were upset about their disorder. All the Child Stress Scale domains were significantly associated with urinary dysfunction, with dysuria being significantly associated with all four domains. In the multivariate analysis, dysuria was the only symptom that remained associated with stress. Associations with stress strengthened as the frequency of dysuria increased: physical reactions (p <0.01), emotional reactions (p <0.05), psychological reactions with a depressive component (p <0.01) and psychophysiological reactions (p <0.05). Conclusion: Stress levels are higher in children and adolescents with LUTS who have more severe symptoms. Dysuria was the symptom most associated with stress, both in the physical reactions domain, in the psychological reactions domains with or without a depressive component and in the psychophysiological reactions domain.

摘要简介:下尿路功能障碍(LUTD)是一种常见的临床疾病。儿童和青少年的情绪和行为问题正在增加，压力表明个人和社会功能方面的困难。本研究评估尿路症状(LUTS)是否与压力有关。材料和方法:采用功能障碍排尿评分系统、心理评估和儿童压力量表对6-14岁无解剖/神经源性尿路异常的LUTS患者进行横断面分析研究。综合压力评分与心理评估数据进行分析。对七个具体的DVSS泌尿问题的答案与四个儿童压力量表域的答案进行比较。进行单因素和多因素分析。采用卡方检验和Pearson相关来确定相关性。显著性定义为p <0.05。结果:患儿以男性居多(56%)。平均年龄9.0±2.25岁。98例患者中有20例(20.4%;95% ci: 13-30%)。其中，90%是意外怀孕，67%的人对自己的疾病感到不安。所有儿童压力量表域均与尿功能障碍显著相关，其中排尿困难与所有四个域均显著相关。在多变量分析中，排尿困难是唯一与压力相关的症状。随着排尿困难发生频率的增加，与应激的相关性增强:生理反应(p <0.01)、情绪反应(p <0.05)、伴有抑郁成分的心理反应(p <0.01)和心理生理反应(p <0.05)。结论:儿童和青少年LUTS患者的压力水平较高，且症状更严重。排尿困难是与压力最相关的症状，在生理反应领域，在心理反应领域有或没有抑郁成分，在心理生理反应领域。

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引用次数: 7

3D Reconstruction and physical renal model to improve percutaneous punture during PNL 三维重建和物理肾脏模型改善PNL术中经皮穿刺

International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology

Pub Date : 2019-11-01 DOI: 10.1590/S1677-5538.IBJU.2018.0799

L. Bianchi, R. Schiavina, U. Barbaresi, A. Angiolini, C. Pultrone, F. Manferrari, B. Bortolani, L. Cercenelli, M. Borghesi, F. Chessa, E. Sessagesimi, C. Gaudiano, E. Marcelli, E. Brunocilla

ABSTRACT Introduction and Objectives: We aim to present the use of 3D digital and physical renal model (1–5) to guide the percutaneous access during percutaneous nephrolithotripsy (PNL). Materials and Methods: We present the clinical case of a 30 years old man with left renal stone (25x15 mm). A virtual 3D reconstruction of the anatomical model including the stone, the renal parenchyma, the urinary collecting system (UCS) and the skeletal landmarks (lumbar spine and ribs) was elaborated. Finally, a physical 3D model was created with a 3D printer including the renal parenchyma, UCS and the stone. The surgeon evaluated the 3D virtual reconstruction and manipulated the printed model before surgery to improve the anatomical knowledge and to facilitate the percutaneous access. In prone position, combining ultrasound and fluoroscopy implemented by the preoperative anatomical planning based on the 3D virtual and printed model, an easy and safe access of the inferior calyx was achieved. Then, the patient underwent PNL using a 30 Fr Amplatz sheet with semi-rigid nephroscope and ultrasound energy to achieve a complete lithotripsy of the pelvic stone. Results: The procedure was safely completed with 1 single percutaneous puncture (time of puncture 2 minutes). Overall surgical time was 90 min. No intra and postoperative complications were reported. The CT scan performed before discharge confirmed a complete stone free state. Conclusion: The 3D-guided approach to PNL facilitates the preoperative planning of the puncture with better knowledge of the renal anatomy and may be helpful to reduce operative time and improve the learning curve.

简介和目的:我们的目的是利用三维数字和物理肾脏模型(1-5)来指导经皮肾镜碎石术(PNL)中的经皮通路。材料与方法:我们报告一例30岁男性左肾结石(25x15mm)的临床病例。详细阐述了包括结石、肾实质、尿收集系统(UCS)和骨骼标志(腰椎和肋骨)在内的解剖模型的虚拟三维重建。最后，用3D打印机创建一个包括肾实质、UCS和结石的物理3D模型。外科医生在手术前对3D虚拟重建进行评估，并对打印模型进行操作，以提高解剖学知识，方便经皮进入。俯卧位下，通过基于3D虚拟打印模型的术前解剖规划，结合超声和透视，实现了下花萼的轻松、安全进入。然后，患者在半刚性肾镜和超声能量下使用30fr Amplatz片进行PNL，以实现骨盆结石的完整碎石。结果:经皮穿刺1次(穿刺时间2分钟)，安全完成手术。手术总时间为90分钟，无术中及术后并发症报告。出院前的CT扫描证实结石完全游离。结论:3d引导入路穿刺PNL有助于术前规划穿刺，更好地了解肾脏解剖结构，有助于缩短手术时间，改善学习曲线。

{"title":"3D Reconstruction and physical renal model to improve percutaneous punture during PNL","authors":"L. Bianchi, R. Schiavina, U. Barbaresi, A. Angiolini, C. Pultrone, F. Manferrari, B. Bortolani, L. Cercenelli, M. Borghesi, F. Chessa, E. Sessagesimi, C. Gaudiano, E. Marcelli, E. Brunocilla","doi":"10.1590/S1677-5538.IBJU.2018.0799","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2018.0799","url":null,"abstract":"ABSTRACT Introduction and Objectives: We aim to present the use of 3D digital and physical renal model (1–5) to guide the percutaneous access during percutaneous nephrolithotripsy (PNL). Materials and Methods: We present the clinical case of a 30 years old man with left renal stone (25x15 mm). A virtual 3D reconstruction of the anatomical model including the stone, the renal parenchyma, the urinary collecting system (UCS) and the skeletal landmarks (lumbar spine and ribs) was elaborated. Finally, a physical 3D model was created with a 3D printer including the renal parenchyma, UCS and the stone. The surgeon evaluated the 3D virtual reconstruction and manipulated the printed model before surgery to improve the anatomical knowledge and to facilitate the percutaneous access. In prone position, combining ultrasound and fluoroscopy implemented by the preoperative anatomical planning based on the 3D virtual and printed model, an easy and safe access of the inferior calyx was achieved. Then, the patient underwent PNL using a 30 Fr Amplatz sheet with semi-rigid nephroscope and ultrasound energy to achieve a complete lithotripsy of the pelvic stone. Results: The procedure was safely completed with 1 single percutaneous puncture (time of puncture 2 minutes). Overall surgical time was 90 min. No intra and postoperative complications were reported. The CT scan performed before discharge confirmed a complete stone free state. Conclusion: The 3D-guided approach to PNL facilitates the preoperative planning of the puncture with better knowledge of the renal anatomy and may be helpful to reduce operative time and improve the learning curve.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75459363","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}

引用次数: 13

Ureteropelvic junction obstruction caused by metastatic cholangiocarcinoma 转移性胆管癌引起的输尿管盂连接处阻塞

International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology

Pub Date : 2019-11-01 DOI: 10.1590/S1677-5538.IBJU.2019.0053

Nicholas A. Pickersgill, Alec J. Wright, R. Figenshau

ABSTRACT We describe the rare case of a 61-year-old female with right ureteropelvic junction (UPJ) obstruction caused by metastatic cholangiocarcinoma. Her past medical history was notable for cholangiocarcinoma treated with neoadjuvant chemoradiation and two orthotopic liver transplants six years earlier. Urology was consulted when she presented with flank pain and urinary tract infection. Diagnostic workup demonstrated right UPJ obstruction. She was managed acutely with percutaneous nephrostomy. She subsequently underwent robotic pyeloplasty and intrinsic obstruction of the UPJ was discovered. Histological examination revealed adenocarcinoma, consistent with systemic recurrence of the patient's known cholangiocarcinoma.

摘要我们报告一例罕见的61岁女性右肾盂输尿管连接处(UPJ)梗阻由转移性胆管癌引起。她的既往病史是六年前接受新辅助放化疗和两次原位肝移植治疗的胆管癌。当她出现腹部疼痛和尿路感染时，我们咨询了泌尿科。诊断检查显示右侧UPJ梗阻。急性经皮肾造口术。随后，她接受了机器人肾盂成形术，发现了UPJ的内在阻塞。组织学检查显示为腺癌，符合患者已知胆管癌的全身复发。

引用次数: 4

Prospective evaluation of the effect of adherent perinephric fat on outcomes of robotic assisted partial nephrectomy following elimination of the learning curve 消除学习曲线后，附着性肾周脂肪对机器人辅助部分肾切除术结果影响的前瞻性评估

International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology

Pub Date : 2019-11-01 DOI: 10.1590/S1677-5538.IBJU.2019.0097

Ashley M. Shumate, Grayson Roth, C. Ball, D. Thiel

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.

目的:前瞻性评估附着性肾周脂肪(APF)与机器人辅助部分肾切除术(RAPN)手术学习曲线消除后围手术期预后的关系。材料和方法:对同一名经验丰富的外科医生连续实施的305例rapn进行分析。前100个rapn被认为是学习曲线，因此被排除在外。APF被定义为包膜下肾剥离的必要性，以动员肿瘤从周围的肾周脂肪。评估围手术期结果，包括手术时间、热缺血时间(WIT)、术后并发症、住院时间、边缘、缺血和并发症评分(MIC)、估计失血量(EBL)以及术前至术后第1天(POD 1)实验室值的变化。经多次比较校正后，认为P值≤0.0045具有统计学意义，但研究结果中也会提到P值≤0.05的相关性。结果:APF患者58例(28.3%)。与无APF患者相比，APF患者的手术时间更长(中位数，213分钟对192分钟，P <0.001)。有证据表明，与无APF患者相比，APF患者术前至POD 1的肌酐变化增高，但无统计学意义(中位数，0.2 vs. 0.1mg/dL, P=0.03)。APF的存在与围手术期结果之间没有其他统计学意义上的关联。结论:APF与手术时间增加有关，但其他围手术期预后无变化。外科医生经验不影响APF的围手术期预后。

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引用次数: 5

Effects of perioperative pelvic floor muscle training on early recovery of urinary continence and erectile function in men undergoing radical prostatectomy: a randomized clinical trial 围手术期盆底肌训练对根治性前列腺切除术患者尿失禁和勃起功能早期恢复的影响:一项随机临床试验

International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology

Pub Date : 2019-11-01 DOI: 10.1590/S1677-5538.IBJU.2019.0238

G. Lira, A. Fornari, L. Cardoso, Magda Aranchipe, Carmem Kretiska, E. Rhoden

ABSTRACT Aims: Radical prostatectomy (RP) can result in urinary incontinence (UI) and erectile dysfunction (ED), which negatively impact quality of life (QoL). This study aimed to evaluate the effects of a perioperative pelvic floor muscle training (PFMT) program versus usual care on early recovery of urinary continence and erectile function after RP. Materials and Methods: Of 59 eligible men, 31 were randomly allocated into 2 groups: Group 1 (Control, N=15) received usual post-RP care; and Group 2 (Physical therapy, N=16) received two pre-RP physical therapist-guided PFMT sessions, including exercises and electromyographic biofeedback, and verbal and written instructions to continue PFMT until RP, which was then resumed after urethral catheter removal. The International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire were used to evaluate UI and ED, respectively. Results: Demographic characteristics were similar in both groups. Three months after RP, the UI rate was 72.7% and 70.0% in Groups 1 and 2, respectively (P >0.05). The severity and frequency of UI and its impact on QoL were evaluated by the ICIQ-Short Form, with scores of 6.9±6.26 in Group 1 and 7.0±5.12 in Group 2 (P >0.05). The IIEF-5 scores were similar in Groups 1 and 2 (5.73±7.43 vs. 6.70±6.68, respectively) (P >0.05). Conclusion: Our pre-RP protocol of two physical therapist-assisted sessions of PFMT plus instructions did not significantly improve urinary continence or erectile function at 3 months after RP.

摘要目的:根治性前列腺切除术(RP)可导致尿失禁(UI)和勃起功能障碍(ED)，对生活质量(QoL)产生负面影响。本研究旨在评估围手术期盆底肌肉训练(PFMT)计划与常规护理对RP术后尿失禁和勃起功能早期恢复的影响。材料与方法:59例符合条件的男性中，31例随机分为2组:1组(对照组，N=15)接受常规rp后护理;第2组(物理治疗，N=16)接受两次RP前物理治疗师指导的PFMT疗程，包括练习和肌电生物反馈，口头和书面指示继续PFMT直到RP，然后在拔出导尿管后恢复。采用国际尿失禁简易问卷(ICIQ-SF)和5项版国际勃起功能指数(IIEF-5)分别评价UI和ED。结果:两组人口统计学特征相似。术后3个月，1组和2组患者的尿失禁率分别为72.7%和70.0% (P >0.05)。采用ICIQ-Short Form量表评估患者UI的严重程度、频次及其对生活质量的影响，1组评分为6.9±6.26分，2组评分为7.0±5.12分(P >0.05)。1、2组患者IIEF-5评分差异无统计学意义(分别为5.73±7.43∶6.70±6.68)(P >0.05)。结论:我们的RP前方案是两次物理治疗师辅助的PFMT加上指导，并没有显著改善RP后3个月的尿失禁或勃起功能。

{"title":"Effects of perioperative pelvic floor muscle training on early recovery of urinary continence and erectile function in men undergoing radical prostatectomy: a randomized clinical trial","authors":"G. Lira, A. Fornari, L. Cardoso, Magda Aranchipe, Carmem Kretiska, E. Rhoden","doi":"10.1590/S1677-5538.IBJU.2019.0238","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2019.0238","url":null,"abstract":"ABSTRACT Aims: Radical prostatectomy (RP) can result in urinary incontinence (UI) and erectile dysfunction (ED), which negatively impact quality of life (QoL). This study aimed to evaluate the effects of a perioperative pelvic floor muscle training (PFMT) program versus usual care on early recovery of urinary continence and erectile function after RP. Materials and Methods: Of 59 eligible men, 31 were randomly allocated into 2 groups: Group 1 (Control, N=15) received usual post-RP care; and Group 2 (Physical therapy, N=16) received two pre-RP physical therapist-guided PFMT sessions, including exercises and electromyographic biofeedback, and verbal and written instructions to continue PFMT until RP, which was then resumed after urethral catheter removal. The International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire were used to evaluate UI and ED, respectively. Results: Demographic characteristics were similar in both groups. Three months after RP, the UI rate was 72.7% and 70.0% in Groups 1 and 2, respectively (P >0.05). The severity and frequency of UI and its impact on QoL were evaluated by the ICIQ-Short Form, with scores of 6.9±6.26 in Group 1 and 7.0±5.12 in Group 2 (P >0.05). The IIEF-5 scores were similar in Groups 1 and 2 (5.73±7.43 vs. 6.70±6.68, respectively) (P >0.05). Conclusion: Our pre-RP protocol of two physical therapist-assisted sessions of PFMT plus instructions did not significantly improve urinary continence or erectile function at 3 months after RP.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83465714","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}

引用次数: 34

The natural history of solitary post-nephrectomy kidney in a pediatric population 儿童肾切除术后单发肾的自然病史

International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology

Pub Date : 2019-11-01 DOI: 10.1590/S1677-5538.IBJU.2018.0291

Sanchez Basto Catalina, P. Katherine, F. Nicolas, Castillo Mariangel, Espitaleta Vergara Zilac, Ana Maria Quintero Gómez, Perez Nino Jaime

ABSTRACT Introduction: Children with a solitary post-nephrectomy kidney (SNK) are at potential risk of developing kidney disease later in life. In response to the global decline in the number of nephrons, adaptive mechanisms lead to renal injury. The aim of this study was to determine the prevalence and time of onset of high blood pressure (HBP), proteinuria, glomerular filtration rate (GFR) disruption and renal tubular acidosis (RTA) in children with SNK. Materials and methods: After obtaining the approval from our institution's ethics committee, we reviewed the medical records of patients under 18 years of age who underwent unilateral nephrectomy between January 2005 and December 2015 in three university hospitals. Results: We identified 43 patients, 35 (81.4%) cases of unilateral nephrectomy (UNP) were due to a non-oncologic pathology and Wilm's tumor was identified in 8 (18.6%) cases. In patients with non-oncologic disease, 9.3% developed de novo hypertension, with an average time of onset of 7.1 years, 25% developed proteinuria de novo, with an average time of onset of 2.2 years. For GFR, 21.8% presented deterioration of the GFR in an average time of 3.4 years. Ten (43.5%) patients developed some type of de novo renal injury after UNP. Patients with oncologic disease developed the conditions slowly and none of them developed proteinuria. Conclusions: Taking into account the high rate of long term postoperative renal injury, it can be considered that nephrectomy does not prevent this disease. The follow-up of children with SNK requires a multidisciplinary approach and long-term surveillance to detect renal injury.

摘要:患有孤立性肾切除术后肾脏(SNK)的儿童在以后的生活中有发生肾脏疾病的潜在风险。为了应对肾单位数量的全球下降，适应性机制导致肾损伤。本研究的目的是确定SNK患儿高血压(HBP)、蛋白尿、肾小球滤过率(GFR)破坏和肾小管酸中毒(RTA)的患病率和发病时间。材料和方法:经我院伦理委员会批准，我们查阅了2005年1月至2015年12月在三所大学医院行单侧肾切除术的18岁以下患者的病历。结果:43例患者中，35例(81.4%)单侧肾切除术(UNP)是非肿瘤性病理，其中8例(18.6%)为肾母细胞瘤。在非肿瘤性疾病患者中，9.3%的患者新发高血压，平均发病时间为7.1年，25%的患者新发蛋白尿，平均发病时间为2.2年。对于GFR, 21.8%的患者在平均3.4年的时间内出现GFR恶化。10例(43.5%)患者在UNP后出现某种类型的新肾损伤。肿瘤患者病情发展缓慢，无一人出现蛋白尿。结论:考虑到术后长期肾损伤发生率高，可认为肾切除术不能预防本病。SNK患儿的随访需要多学科方法和长期监测来发现肾损伤。

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引用次数: 3