RESUMEN
OBJECTIVE: To investigate the etiology of overactive bladder (OAB) symptoms during secondary treatment following initial unsuccessful therapy with α1-blockers in benign prostatic hyperplasia (BPH)/OAB patients. METHODS: BPH/OAB patients were selected if urinary urgency did not improve with initial α1-blocker therapy and if dose escalation was required as secondary treatment for a period of 8 weeks. The overactive bladder symptom score (OABSS), International Prostate Symptom Score (IPSS), and uroflowmetry were evaluated. On the basis of the OABSS at the end of secondary therapy, we divided patients into two groups: patients in whom OAB symptoms improved ("resolved OAB group") and patients in whom OAB symptoms persisted ("persistent OAB group"). Differences in subjective symptoms and objective parameters between the groups were analyzed. RESULTS: OAB symptoms improved in 33 of 79 patients (42%) after secondary treatment. The changes in the total OABSS and International Prostate Symptom Score from the beginning of the secondary treatment were -2.15 and -3.97, respectively, in the resolved OAB group, indicating a significant decrease in the OABSS compared to that in the persistent OAB group (-0.91 and -1.11, respectively). The change in average flow rate (Qave; +1.34) from the beginning of secondary treatment in the resolved OAB group was significantly greater than the change in the persistent OAB group (+0.58). Improvements in urgency and Qave were significantly correlated (r = -0.264, P = .031). CONCLUSION: Improvement in urinary stream contributed to the resolution of OAB symptoms in BPH/OAB patients. In the management of OAB symptoms in BPH/OAB patients, examination and therapy for both urinary stream and OAB symptoms could be substantially important.
Asunto(s)
Naftalenos/administración & dosificación , Piperazinas/administración & dosificación , Hiperplasia Prostática/complicaciones , Vejiga Urinaria Hiperactiva/tratamiento farmacológico , Micción/fisiología , Antagonistas de Receptores Adrenérgicos alfa 1/administración & dosificación , Anciano , Anciano de 80 o más Años , Relación Dosis-Respuesta a Droga , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Hiperplasia Prostática/fisiopatología , Resultado del Tratamiento , Vejiga Urinaria Hiperactiva/etiología , Vejiga Urinaria Hiperactiva/fisiopatología , Micción/efectos de los fármacosRESUMEN
INTRODUCTION: We developed a protocol to initiate surgical source control immediately after admission (early source control) and perform initial resuscitation using early goal-directed therapy (EGDT) for gastrointestinal (GI) perforation with associated septic shock. This study evaluated the relationship between the time from admission to initiation of surgery and the outcome of the protocol. METHODS: This examination is a prospective observational study and involved 154 patients of GI perforation with associated septic shock. We statistically analyzed the relationship between time to initiation of surgery and 60-day outcome, examined the change in 60-day outcome associated with each 2 hour delay in surgery initiation and determined a target time for 60-day survival. RESULTS: Logistic regression analysis demonstrated that time to initiation of surgery (hours) was significantly associated with 60-day outcome (Odds ratio (OR), 0.31; 95% Confidence intervals (CI)), 0.19-0.45; P <0.0001). Time to initiation of surgery (hours) was selected as an independent factor for 60-day outcome in multiple logistic regression analysis (OR), 0.29; 95% CI, 0.16-0.47; P <0.0001). The survival rate fell as surgery initiation was delayed and was 0% for times greater than 6 hours. CONCLUSIONS: For patients of GI perforation with associated septic shock, time from admission to initiation of surgery for source control is a critical determinant, under the condition of being supported by hemodynamic stabilization. The target time for a favorable outcome may be within 6 hours from admission. We should not delay in initiating EGDT-assisted surgery if patients are complicated with septic shock.
Asunto(s)
Perforación Intestinal/mortalidad , Perforación Intestinal/cirugía , Admisión del Paciente/normas , Choque Séptico/mortalidad , Choque Séptico/cirugía , Tiempo de Tratamiento/normas , Anciano , Anciano de 80 o más Años , Femenino , Tracto Gastrointestinal/lesiones , Tracto Gastrointestinal/cirugía , Humanos , Perforación Intestinal/diagnóstico , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Choque Séptico/diagnóstico , Tasa de Supervivencia/tendenciasRESUMEN
Little is known about the risk factors for long-term poor outcome in pediatric renal transplantation. Between 1973 and 2010, 111 renal transplants (92 living donations) were performed in 104 children (56 males, mean age, 12.5 yr) at the Social Insurance Chukyo Hospital, and followed-up for a mean period of 13.6 yr. The patient survival at 1, 5, 10, 15, 20 (living- and deceased-donor transplants), and 30 yr (living-donor transplants only) was 98.1%, 92.8%, 87.8%, 84.9%, 82.6%, and 79.3%. The graft survival at 1, 5, 10, 15, 20, and 30 yr was 92.0%, 77.3%, 58.4%, 50.8%, 38.5%, and 33.3%. The most common cause of graft loss was CAI, AR, death with functioning, recurrent primary disease, ATN, and malignancy. Donor gender, ATN, malignancy/cardiovascular events, and eras affected patient survival. AR and CAI were the risk factors for graft loss. The evolved immunosuppression protocols improved the outcome by reducing AR episodes and ATN but not CAI, suggesting CAI as the major risk factor for graft loss. CAI was correlated with AR episodes, CMV infection, and post-transplant hypertension. Strategies for preventing the risk factors for malignancy/cardiovascular events and CAI, including hypertension/infection, are crucial for better outcomes.
Asunto(s)
Terapia de Inmunosupresión/efectos adversos , Terapia de Inmunosupresión/métodos , Fallo Renal Crónico/terapia , Trasplante de Riñón , Adolescente , Niño , Femenino , Estudios de Seguimiento , Rechazo de Injerto/etiología , Supervivencia de Injerto , Humanos , Inmunosupresores/uso terapéutico , Infecciones/complicaciones , Japón , Fallo Renal Crónico/mortalidad , Donadores Vivos , Masculino , Neoplasias/complicaciones , Pediatría , Complicaciones Posoperatorias , Factores de Riesgo , Factores Sexuales , Donantes de Tejidos , Resultado del TratamientoRESUMEN
It is difficult to identify the narrow sites of the ureter from the outside while carrying out laparoscopic pyeloplasty in patients with ureteropelvic junction obstruction. We developed and named a new method, the Fogarty test, to identify the narrow sites of the ureter using a Fogarty catheter. A 4- to 5-Fr Fogarty catheter was inserted through an incision in the pelvis to the proximal ureter, inflated with air and withdrawn gently to determine resistance. The narrow lumen of the ureter was identified under direct vision and spatulated by laparoscopic scissors. This procedure was carried out repeatedly until the ureter was fully spatulated. By using the Fogarty test, we can visualize the narrow position and length of the ureter under direct vision, and confirm whether it is fully spatulated or not. This technique is very simple and easy to carry out. We believe it is useful for sufficient spatulation of intrinsic ureteral stricture, especially in patients where multiple narrow sites exist.
Asunto(s)
Embolectomía con Balón/instrumentación , Laparoscopía/instrumentación , Uréter/cirugía , Obstrucción Ureteral/cirugía , Vejiga Urinaria/cirugía , Procedimientos Quirúrgicos Urológicos/instrumentación , Algoritmos , Embolectomía con Balón/métodos , Catéteres , Humanos , Pelvis Renal/cirugía , Laparoscopía/métodos , Uréter/patología , Obstrucción Ureteral/patología , Procedimientos Quirúrgicos Urológicos/métodosRESUMEN
PURPOSE: We investigated the effect of the new sympathetic α1A-adrenoceptor antagonist silodosin for relieving benign prostatic obstruction by pressure flow study. MATERIALS AND METHODS: In this open, nonblinded, prospective study we administered 8 mg silodosin daily for 4 weeks in 60 patients with lower urinary tract symptoms associated with benign prostatic enlargement. As a primary outcome measure, we assessed changes in bladder function and benign prostatic obstruction using pressure flow study. As secondary outcome measures, changes in subjective symptoms and quality of life were assessed by the International Prostate Symptom Score. Objective changes in urination status were also assessed by free uroflowmetry in terms of maximum flow rate and post-void residual urine volume. RESULTS: A total of 57 patients were enrolled for analysis. In the storage phase of the pressure flow study bladder capacity at first desire to void increased significantly with no significant change in maximum cystometric capacity. Of 24 patients 14 (58.3%) with uninhibited detrusor contractions before administration showed apparent improvement in detrusor overactivity after administration, including 6 in whom uninhibited contractions disappeared. In the voiding phase mean detrusor pressure at maximum flow significantly decreased from 72.5 to 51.4 cm H(2)O. The mean bladder outlet obstruction index decreased significantly from 60.6 to 33.8. Obstruction grade assessed by the Schaefer nomogram improved in all except 1 patient. Total symptom and quality of life scores, maximum flow rate and post-void residual urine volume on free uroflowmetry significantly improved. CONCLUSIONS: Silodosin improved lower urinary tract symptoms by improving bladder storage function and relieving benign prostatic obstruction.
Asunto(s)
Antagonistas de Receptores Adrenérgicos alfa 1/uso terapéutico , Indoles/uso terapéutico , Obstrucción del Cuello de la Vejiga Urinaria/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Hiperplasia Prostática/complicaciones , Obstrucción del Cuello de la Vejiga Urinaria/etiología , Obstrucción del Cuello de la Vejiga Urinaria/fisiopatología , UrodinámicaRESUMEN
A 38-year-old woman visited our hospital complaining of decreased appetite and sensation of pressure on her abdomen. Computed tomographic scan revealed right giant renal angiomyolipoma. Partial nephrectomy was performed. The resected specimen weighed 970 grams. The histological diagnosis was consistent with angiomyolipoma. Partial nephrectomy was performed because the connection between the tumor and the kidney was in a small range and the tumor was detached easily from the surrounding tissue.
Asunto(s)
Angiomiolipoma/cirugía , Neoplasias Renales/cirugía , Nefrectomía , Adulto , Angiomiolipoma/patología , Femenino , Humanos , Neoplasias Renales/patologíaRESUMEN
PURPOSE: The efficacy of a loading dose of α(1)-adrenoreceptor antagonist for patients with benign prostate hyperplasia who did not improve at a low dose has not been determined. We performed a prospective study to estimate the efficacy of incremental naftopidil administration. METHODS: The efficacy of naftopidil was examined based on changes in the International Prostate Symptom Score (IPSS). We defined a "responder" as a patient who improved by ≥5 points in IPSS total score. All patients were administered naftopidil at 50 mg/day for 12 weeks, and nonresponders at 50 mg/day were increased to 75 mg/day. Efficacy was finally evaluated after an additional 12 weeks of administration at 75 mg/day. RESULTS: Among 122 patients whose data could be analyzed, the efficacy rate after administration at 50 mg/day was 52.5%. In all IPSS items except urgency score, the responders had significantly higher (poorer) values than nonresponders before the start of treatment. Of 40 patients whose dose was increased to 75 mg/day and whose data could be analyzed, prostate volume in the responder group (9 patients) was significantly smaller than that in the nonresponder group (31 patients). Multivariate analysis showed that patients with improved IPSS total score, voiding symptoms, urgency, and weak stream after administration of 50 mg/day naftopidil were more likely to improve after a dose increase. CONCLUSIONS: A dose increment of naftopidil to 75 mg/day may be useful in patients with BPH who did not improve at 50 mg/day.
Asunto(s)
Antagonistas Adrenérgicos alfa/uso terapéutico , Naftalenos/uso terapéutico , Piperazinas/uso terapéutico , Hiperplasia Prostática/tratamiento farmacológico , Antagonistas Adrenérgicos alfa/farmacología , Anciano , Anciano de 80 o más Años , Relación Dosis-Respuesta a Droga , Humanos , Japón , Masculino , Persona de Mediana Edad , Análisis Multivariante , Naftalenos/farmacología , Tamaño de los Órganos/efectos de los fármacos , Piperazinas/farmacología , Estudios Prospectivos , Próstata/diagnóstico por imagen , Próstata/patología , Hiperplasia Prostática/patología , Resultado del Tratamiento , UltrasonografíaRESUMEN
The patient was a 30-year-old man who had undergone living-donor kidney transplantation for renal failure caused by IgA nephropathy at age 29. On post-transplantation day 83, he visited our department with a chief complaint of asymptomatic hematuria. CT performed on post-transplantation day 95 revealed a tumor (size, 4 cm) in the right native kidney that had not been observed at the time of transplantation. CT performed on post-transplantation day 153 showed that the tumor had enlarged to 6 cm, while retrograde pyelogram performed on post-transplantation day 171 was negative for renal pelvic tumor. On post-transplantation day 193, radical right nephrectomy was performed. The tumor had directly invaded the diaphragm and the lower surface of the liver, and was histopathologically diagnosed as rhabdoid tumor of the kidney. As the pathological tissue was extremely malignant, hepatic posterior segmentectomy, right adrenalectomy, and lymph node dissection were further performed for metastases on post-transplantation day 200. On the 23rd day after radical right nephrectomy (post-transplantation day 216), the patient developed dyspnea. Chest CT showed pleural effusion, hemothorax in right lung and metastases in both lungs. The patient's general status gradually worsened thereafter, and he died on the 53rd day after radical right nephrectomy (post-transplantation day 246). Rhabdoid tumor of the kidney is a rare renal tumor that affects children, and only four adult cases have been reported to date. We report our experience with this rare case.
Asunto(s)
Neoplasias Renales/cirugía , Tumor Rabdoide/cirugía , Adulto , Resultado Fatal , Glomerulonefritis por IGA/cirugía , Humanos , Neoplasias Renales/patología , Trasplante de Riñón , Donadores Vivos , Escisión del Ganglio Linfático , Masculino , Nefrectomía , Tumor Rabdoide/patología , Trasplante HomólogoRESUMEN
OBJECTIVE: The aim of this study was to investigate bladder function following laparoscopic radical prostatectomy, with a focus on de novo detrusor underactivity. METHODS: Records on pre- and postoperative urodynamic studies were retrospectively investigated in 110 patients who underwent laparoscopic radical prostatectomy. Patients exhibiting de novo detrusor underactivity were selected on the basis of an overt strain voiding pattern during the postoperative pressure flow study with detrusor pressure at a maximum flow rate <10 cm H(2)O accompanied by an increase in abdominal pressure. In these patients, a follow-up urodynamic study was performed to assess subsequent long-term changes in the bladder function. RESULTS: Of the 110 patients, 10 (9.1%) were observed to exhibit de novo detrusor underactivity during the postoperative urodynamic study. During the voiding phase of the pre- and postoperative pressure flow study in these 10 patients, the mean detrusor pressure at maximum flow rate showed a significant decrease postoperatively from 57.6 to 3.0 cm H(2)O (P < 0.001), although the mean abdominal pressure at maximum flow rate significantly increased from 23.1 to 102.5 cm H(2)O (P < 0.001). The follow-up urodynamic study performed on seven patients at 36 months following surgery revealed no significant change in each urodynamic parameter. De novo detrusor underactivity persisted even over the long term following surgery, and no improvement in bladder function was observed. CONCLUSIONS: Detrusor contractility may be impaired during radical prostatectomy. Postoperative detrusor underactivity following radical prostatectomy seems to be an irreversible phenomenon persisting even over the long term.
Asunto(s)
Laparoscopía , Músculo Liso/fisiopatología , Prostatectomía/efectos adversos , Vejiga Urinaria/fisiopatología , Anciano , Humanos , Masculino , Persona de Mediana Edad , Contracción Muscular , Estudios RetrospectivosRESUMEN
PURPOSE: We investigated the effect of the new sympathetic alpha1A-adrenoceptor antagonist silodosin for relieving benign prostatic obstruction by pressure flow study. MATERIALS AND METHODS: In this open, nonblinded, prospective study we administered 8 mg silodosin daily for 4 weeks in 60 patients with lower urinary tract symptoms associated with benign prostatic enlargement. As a primary outcome measure, we assessed changes in bladder function and benign prostatic obstruction using pressure flow study. As secondary outcome measures, changes in subjective symptoms and quality of life were assessed by the International Prostate Symptom Score. Objective changes in urination status were also assessed by free uroflowmetry in terms of maximum flow rate and post-void residual urine volume. RESULTS: A total of 57 patients were enrolled for analysis. In the storage phase of the pressure flow study bladder capacity at first desire to void increased significantly with no significant change in maximum cystometric capacity. Of 24 patients 14 (58.3%) with uninhibited detrusor contractions before administration showed apparent improvement in detrusor overactivity after administration, including 6 in whom uninhibited contractions disappeared. In the voiding phase mean detrusor pressure at maximum flow significantly decreased from 72.5 to 51.4 cm H(2)O. The mean bladder outlet obstruction index decreased significantly from 60.6 to 33.8. Obstruction grade assessed by the Schaefer nomogram improved in all except 1 patient. Total symptom and quality of life scores, maximum flow rate and post-void residual urine volume on free uroflowmetry significantly improved. CONCLUSIONS: Silodosin improved lower urinary tract symptoms by improving bladder storage function and relieving benign prostatic obstruction.
Asunto(s)
Indoles/uso terapéutico , Hiperplasia Prostática/complicaciones , Hiperplasia Prostática/tratamiento farmacológico , Prostatismo/tratamiento farmacológico , Prostatismo/etiología , Obstrucción del Cuello de la Vejiga Urinaria/tratamiento farmacológico , Obstrucción del Cuello de la Vejiga Urinaria/etiología , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Persona de Mediana Edad , Presión , Estudios Prospectivos , Hiperplasia Prostática/fisiopatología , Prostatismo/fisiopatología , Obstrucción del Cuello de la Vejiga Urinaria/fisiopatología , UrodinámicaRESUMEN
In general, anti-HLA antibody belongs to the IgG subclass, but there are very few reports of detection of anti-HLA IgM antibodies. In the present study, we report a renal transplant recipient with a positive NIH-complement dependent cytotoxicity (NIH-CDC) test. The patient was a 24-year-old male with focal segmental glomerulosclerosis (FSGS) as the underlying kidney disease. He had been on maintenance hemodialysis since December 2003 and finally received a living-donor allograft from his mother in October 2008. Pre-transplantation, the NIH-CDC test was positive for both B and T cells, but the flow-cytometric crossmatch test (FCXM) was negative for both cells. The result of the panel-reactive antibody assay (PRA)-single beads test using anti-IgM antibody as the second antibody demonstrated that the positive NIH-CDC test was due to the presence of anti-HLA IgM antibody against the donor-specific antigen A24. Biopsy specimens showed thrombus formation in a small number of glomeruli immediately after the transplantation, but this finding was no longer seen at three months postoperatively. We report successful renal transplantation in a case with anti-HLA IgM antibody.
Asunto(s)
Glomeruloesclerosis Focal y Segmentaria/cirugía , Antígenos HLA-A/inmunología , Inmunoglobulina M/sangre , Trasplante de Riñón/inmunología , Adulto , Femenino , Glomeruloesclerosis Focal y Segmentaria/inmunología , Glomeruloesclerosis Focal y Segmentaria/patología , Glucocorticoides/uso terapéutico , Rechazo de Injerto/inmunología , Antígenos HLA-A/metabolismo , Antígeno HLA-A24 , Prueba de Histocompatibilidad , Humanos , Inmunosupresores/uso terapéutico , Riñón/inmunología , Riñón/patología , Riñón/cirugía , Donadores Vivos , Masculino , Metilprednisolona/uso terapéutico , Ácido Micofenólico/análogos & derivados , Ácido Micofenólico/uso terapéutico , Tacrolimus/uso terapéuticoRESUMEN
PURPOSE: In laparoscopic nephroureterectomy for upper tract urothelial carcinoma techniques for removing the lower ureter with a bladder cuff have been a matter of debate. We have developed a pure laparoscopic technique for the complete resection of the lower ureter with a bladder cuff. MATERIALS AND METHODS: Laparoscopic nephroureterectomy was performed in ten patients with upper tract urothelial carcinoma using this technique. After a working space was made retroperitoneally, the ureter was ligated at the distal site of the tumor. Retracting the ureter cranially, a stay suture was placed at an anterior point on the bladder and the bladder opened. With the patient placed in a lateral position, there was no urine leakage from the opened bladder. The ureteral orifice was confirmed laparoscopically. Incising around the ureteral orifice, the distal ureter was detached with the bladder cuff. The opened bladder wall was closed with running stitches. RESULTS: This method was technically successful in these ten cases with minimal bleeding and average operative time of 87 min. The margins of the bladder cuff were all negative and the average follow-up period of 19 months revealed only one (10%) bladder tumor recurrence. CONCLUSIONS: The ligation of the distal part of the ureter and the complete excision of the ipsilateral orifice and a bladder cuff under laparoscopic vision could reduce bladder tumor recurrence. Although this is a limited study with a small sample, the observation of low rates of bladder tumor recurrence after 19 months warrants further study.
Asunto(s)
Carcinoma de Células Transicionales/cirugía , Neoplasias Renales/cirugía , Laparoscopía , Nefrectomía/métodos , Neoplasias Ureterales/cirugía , Vejiga Urinaria/cirugía , Humanos , Procedimientos Quirúrgicos Urológicos/métodosRESUMEN
OBJECTIVES: To examine the direct renal hemodynamics during carbon dioxide pneumoperitoneum in both human and porcine models. Laparoscopic living donor nephrectomy has become widespread because of its minimally invasive nature. However, it has been clear that the renal hemodynamics and function are affected during carbon dioxide pneumoperitoneum. METHODS: The erythrocyte velocity in the cortical peritubular capillary (CPC) was monitored and measured during laparoscopic nephrectomy on human donors and laparoscopic partial nephrectomy on humans with renal cell carcinoma during carbon dioxide pneumoperitoneum (pressure of 8, 12, 15, 18, and 20 mm Hg). We used a direct imaging system of renal microcirculation by magnifying endoscopy, as previously described. We maintained the same pressure for 5 minutes. In the porcine model (6 pigs), we measured the erythrocyte velocity in the CPC using the same method during carbon dioxide pneumoperitoneum (pressure of 0, 5, 10, 15, 20, and 25 mm Hg). RESULTS: The erythrocyte velocity in the renal artery did not change during increased carbon dioxide pneumoperitoneum. When the pneumoperitoneal pressure was 25 mm Hg, we found that >90% of the erythrocyte velocity in the CPC was nonflowing. In the human model, the erythrocyte velocity in the CPC decreased when the carbon dioxide pneumoperitoneum pressure was 12 mm Hg. CONCLUSIONS: The erythrocyte velocity in the CPC decreased during carbon dioxide pneumoperitoneum in all kidneys in both the human and the porcine models. However, erythrocyte velocity in the renal artery did not change during carbon dioxide pneumoperitoneum. After stopping the pneumoperitoneum, the erythrocyte velocity in the CPC recovered immediately. The findings of our study have shown that the suitable carbon dioxide pneumoperitoneal pressure for renal microcirculation is <8 mm Hg for laparoscopic surgery.
Asunto(s)
Dióxido de Carbono/farmacología , Carcinoma de Células Renales/cirugía , Hemodinámica/efectos de los fármacos , Neoplasias Renales/cirugía , Riñón/irrigación sanguínea , Laparoscopía , Microcirculación/efectos de los fármacos , Nefrectomía/métodos , Neumoperitoneo Artificial/métodos , Arteria Renal/efectos de los fármacos , Arteria Renal/fisiología , Animales , Endoscopía , Eritrocitos , Femenino , Humanos , PorcinosRESUMEN
Malignant sertoli cell tumor is a rare disease and only a few cases have been described previously. We report a terminal case of malignant sertoli cell tumor. A 38-year-old male visited a hospital with a complaint of swelling his left testis. He underwent high left orchiectomy. His pathologic diagnosis was suspected seminoma, and all tumor markers (LDH, HCG, AFP) were negative, and CT imaging confirmed clinical stage 1 (pT1N0M0S0). One year later, a CT scan showed a small retroperitoneum lymph node swelling. Four months later, these lesions increased to 55 x 45 x 70 mm in diameter. He received 3 courses of chemotherapy with BEP (bleomycine, etoposide, cisplatin), but, lymph node size did not change. After he underwent a CT guided lymph node biopsy, his pathologic diagnosis was viable embryonal carcinoma. He then came to our hospital. We selected CPT-11 and nedaplatin for his salvage chemotherapy, but lymph node lesions did not change. After he received 3 courses of chemotherapy, we performed retroperitoneal lymphadenectomy. His pathologic diagnosis was viable sertoli cell tumor, malignant type. After 30 days, he had multiple liver metastases ane died 27 months after orchiectomy. All tumor markers were negative in his all clinical courses.
Asunto(s)
Tumor de Células de Sertoli/diagnóstico , Neoplasias Testiculares/diagnóstico , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biomarcadores de Tumor/sangre , Camptotecina/administración & dosificación , Camptotecina/análogos & derivados , Terapia Combinada , Resultado Fatal , Humanos , Irinotecán , Escisión del Ganglio Linfático , Metástasis Linfática , Masculino , Orquiectomía , Compuestos Organoplatinos/administración & dosificación , Terapia Recuperativa , Tumor de Células de Sertoli/patología , Tumor de Células de Sertoli/terapia , Neoplasias Testiculares/patología , Neoplasias Testiculares/secundario , Neoplasias Testiculares/terapia , Tomografía Computarizada por Rayos XRESUMEN
Strain voiding has been reported to be a frequent symptom following radical prostatectomy. However, pathophysiology of vesicourethral function underlying voiding difficulty has not been well studied. In the present study, we investigated detrusor underactivity following radical prostatectomy. The records on urodynamic study (pressure-flow study, urethral pressure profile) were retrospectively investigated in 80 patients undergoing laparoscopic radical prostatectomy and all urodynamic studies pre- and post-operatively. We extracted the cases with detrusor underactivity according to the criteria of overt strain voiding pattern on post-operative pressure flow study; detrusor pressure at the maximum flow rate (Pdet Q(max)) of less than 10 cmH2O in conjunction with an increase of abdominal pressure. Of the 80 patients, 6 (7.5%) were found to have detrusor underactivity. In all patients, good detrusor contraction was confirmed on the pre-operative urodynamic study performed before surgery. On the voiding phase of pressure-flow study in these patients, mean Pdet Q(max) showed a significant decrease postoperatively from 58.5 cmH2O to 3.0 cmH2O (p < 0.01), although mean abdominal pressure at Q(max) significantly increased from 24.2 cmH2O to 105.8 cmH2O (p < 0.05). Mean Q(max) on free uroflowmetry showed a significant increase from 12.8 ml/sec to 22.1 ml/sec (p < 0.05). No patient had significant post-void residual urine. On the storage phase of the study, however, maximum cystometric capacity, maximum urethral closing pressure showed no significant change between pre- and post-operative studies. Five patients acquired continence and one had mild urinary incontinence using one pad a day. The present study showed that detrusor contaractility could be impaired during radical prostatectomy, but, no apparent operative procedure related to detrusor dysfunction could be identified in the present patients.
Asunto(s)
Laparoscopía , Prostatectomía/métodos , Vejiga Urinaria/fisiopatología , Anciano , Humanos , Masculino , Persona de Mediana Edad , Contracción Muscular , Músculo Liso/fisiopatología , Complicaciones Posoperatorias , Trastornos Urinarios/etiología , UrodinámicaRESUMEN
Upper-pole apical renal tumors are difficult to see using conventional rigid laparoscopes during laparoscopic partial nephrectomy. Added to this, the instrument angle makes tumor excision and kidney reconstruction difficult. We therefore elevated the kidney using a gauze sling and observed the lesion through a flexible laparoscope. With a clear field of vision, we could excise tumors and repair the kidney more easily.
Asunto(s)
Carcinoma de Células Renales/cirugía , Neoplasias Renales/cirugía , Laparoscopios , Laparoscopía/métodos , Nefrectomía/métodos , Adulto , Anciano , Carcinoma de Células Renales/patología , Humanos , Neoplasias Renales/patología , Imagen por Resonancia Magnética , Masculino , Nefrectomía/instrumentación , Tapones Quirúrgicos de Gaza , Tomografía Computarizada por Rayos XRESUMEN
Von Hipple-Lindau (VHL) disease is a rare familial cancer syndrome that is dominantly inherited and pre-disposes affected individuals to developing various tumors, including hemangioblastoma of the retina and central nervous system, and multicentric renal cell carcinoma. We report two cases of VHL disease with bilateral renal cell carcinoma. Case 1: A 53-year-old woman was referred to our hospital because of bilateral kidney tumor incidentally found. We performed left laparoscopic radical nephrectomy and laparoscopic nephrectomy, ex vivo excision and reconstruction, and autotransplantation for the right kidney. Case 2: A 43-year-old woman was referred to our hospital because of left kidney tumor incidentally found. Because the suspectious lesion in the right kidney was very small, we decided to follow it up with no treatment. We performed laparoscopic nephrectomy, ex vivo excision and reconstruction, and autotransplantation for left kidney.
Asunto(s)
Carcinoma de Células Renales/diagnóstico , Neoplasias Renales/diagnóstico , Enfermedad de von Hippel-Lindau/complicaciones , Adulto , Carcinoma de Células Renales/cirugía , Femenino , Humanos , Neoplasias Renales/cirugía , Persona de Mediana Edad , Nefrectomía , Radiografía Abdominal , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: We report on two cases of laparoscopic bilateral nephrectomy for renal-cell carcinoma (RCC) in patients with end-stage renal disease. PATIENTS AND METHODS: Bilateral renal masses were detected in two patients with acquired renal cystic disease. They underwent bilateral laparoscopic nephrectomy. The specimens were removed intact via an umbilical incision. RESULTS: The operative times were 8 hours and 6 hours and the estimated blood loss was 154 mL and 120 mL. Both patients resumed oral intake on postoperative day 1 and were discharged on postoperative day 6. No intraoperative and postoperative complications occurred. The pathology report revealed bilateral RCC. The original length of the umbilical incision was 4 cm which shrank to 3 cm by 2 months after the operation. CONCLUSIONS: Bilateral laparoscopic radical nephrectomy including intact organ retrieval for bilateral renal masses via a small umbilical incision is feasible.
Asunto(s)
Carcinoma de Células Renales/cirugía , Neoplasias Renales/cirugía , Laparoscopía , Nefrectomía , Abdomen/cirugía , Anciano , Carcinoma de Células Renales/diagnóstico por imagen , Humanos , Neoplasias Renales/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
We retrospectively reviewed the clinical results of 24 patients who underwent laparoscopic partial nephrectomy by a diagnosis of renal cell carcinoma (RCC) between 1999 and 2004, including 16 elective cases and 8 imperative cases. Twenty-two were successfully treated laparoscopically; two cases in the imperative group required conversion to open surgery because of uncontrollable bleeding. A vascular clamp was used in 12 cases for an average of 26 minutes. The creatinine clearance changed from 98 to 93 ml/min in the elective cases and from 49 to 44 ml/min in the imperative cases. Pathological evaluation revealed RCC in 10 elective cases and 6 imperative cases. Local recurrence (renal hilum lymph node and ipsilateral kidney) was found in 2 patients in the imperative group. Although laparoscopic partial nephrectomy is useful, long-term follow-up is necessary for evaluating the tumor control.
Asunto(s)
Carcinoma de Células Renales/cirugía , Neoplasias Renales/cirugía , Laparoscopía , Nefrectomía/métodos , Anciano , Procedimientos Quirúrgicos Electivos , Femenino , Humanos , Riñón/fisiopatología , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
BACKGROUND: We developed a direct imaging system of renal microcirculation by a magnifying-endoscopy that enables visualization of the movement of erythrocyte in glomerular and cortical peritubular capillary (CPC). We investigated the microcirculation of CPC in the early phase of both living- and cadaveric-donor transplant kidneys. METHODS: Erythrocyte velocity in CPC were monitored and measured in 20 renal transplants at 20, 60, 90, and 120 minutes after reperfusion. The kidney grafts came from 11 living donors and 9 non-heart-beating cadaveric donors. RESULTS: In living-donor transplants, erythrocyte velocity in CPC at 20 minutes after revascularization declined to one third of baseline value just before nephrectomy and recovered to the prenephrectomy value 120 minutes after reperfusion. In contrast, it continued to be disturbed for 90 minutes in cadaveric-donor transplants. Erythrocyte velocity in CPC more significantly deteriorated in cadaveric transplants than in those of living transplants at 20 through 60 minutes after the revascularization. In living-donor transplants, erythrocyte velocity did not correlate with donor age, both warm (WIT) and cold ischemic time (CIT), time to the initial urination, and best creatine clearance. In the cadaveric transplants, ischemic time, both WIT and CIT, did not correlate with the erythrocyte velocity. However, donor age, duration of acute tubular necrosis, and best creatine clearance after transplantation significantly correlated with the erythrocyte velocity. CONCLUSION: The measurement of erythrocyte velocity in CPC is a reliable method for predicting the recovery of renal function and reserved renal function of kidney allografts undergoing prolonged ischemia.