RESUMEN
BACKGROUND AND PURPOSE: Horseshoe kidney is an uncommon renal anomaly often associated with ureteropelvic junction (UPJ) obstruction. Advanced minimally invasive surgical (MIS) reconstructive techniques including laparoscopic and robotic surgery are now being utilized in this population. However, fewer than 30 cases of MIS UPJ reconstruction in horseshoe kidneys have been reported. We herein report our experience with these techniques in the largest series to date. MATERIALS AND METHODS: We performed a retrospective chart review of nine patients with UPJ obstruction in horseshoe kidneys who underwent MIS repair at our institution between March 2000 and January 2012. Four underwent laparoscopic, two robotic, and one laparoendoscopic single-site (LESS) dismembered pyeloplasty. An additional two pediatric patients underwent robotic Hellstrom repair. Perioperative outcomes and treatment success were evaluated. RESULTS: Median patient age was 18 years (range 2.5-62 years). Median operative time was 136 minutes (range 109-230 min.) and there were no perioperative complications. After a median follow-up of 11 months, clinical (symptomatic) success was 100%, while radiographic success based on MAG-3 renogram was 78%. The two failures were defined by prolonged t1/2 drainage, but neither patient has required salvage therapy as they remain asymptomatic with stable differential renal function. CONCLUSIONS: MIS repair of UPJ obstruction in horseshoe kidneys is feasible and safe. Although excellent short-term clinical success is achieved, radiographic success may be lower than MIS pyeloplasty in heterotopic kidneys, possibly due to inherent differences in anatomy. Larger studies are needed to evaluate MIS pyeloplasty in this population.
Asunto(s)
Riñón/anomalías , Riñón/cirugía , Laparoscopía/métodos , Obstrucción Ureteral/cirugía , Adolescente , Adulto , Índice de Masa Corporal , Niño , Preescolar , Constricción Patológica/cirugía , Femenino , Humanos , Pelvis Renal/anomalías , Pelvis Renal/cirugía , Masculino , Persona de Mediana Edad , Tempo Operativo , Robótica , Resultado del Tratamiento , Adulto JovenRESUMEN
Background and Purpose Horseshoe kidney is an uncommon renal anomaly often associated with ureteropelvic junction (UPJ) obstruction. Advanced minimally invasive surgical (MIS) reconstructive techniques including laparoscopic and robotic surgery are now being utilized in this population. However, fewer than 30 cases of MIS UPJ reconstruction in horseshoe kidneys have been reported. We herein report our experience with these techniques in the largest series to date. Materials and Methods We performed a retrospective chart review of nine patients with UPJ obstruction in horseshoe kidneys who underwent MIS repair at our institution between March 2000 and January 2012. Four underwent laparoscopic, two robotic, and one laparoendoscopic single-site (LESS) dismembered pyeloplasty. An additional two pediatric patients underwent robotic Hellstrom repair. Perioperative outcomes and treatment success were evaluated. Results Median patient age was 18 years (range 2.5-62 years). Median operative time was 136 minutes (range 109-230 min.) and there were no perioperative complications. After a median follow-up of 11 months, clinical (symptomatic) success was 100%, while radiographic success based on MAG-3 renogram was 78%. The two failures were defined by prolonged t1/2 drainage, but neither patient has required salvage therapy as they remain asymptomatic with stable differential renal function. Conclusions MIS repair of UPJ obstruction in horseshoe kidneys is feasible and safe. Although excellent short-term clinical success is achieved, radiographic success may be lower than MIS pyeloplasty in heterotopic kidneys, possibly due to inherent differences in anatomy. Larger studies are needed to evaluate MIS pyeloplasty in this population. .
Asunto(s)
Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Riñón/anomalías , Riñón/cirugía , Laparoscopía/métodos , Obstrucción Ureteral/cirugía , Índice de Masa Corporal , Constricción Patológica/cirugía , Pelvis Renal/anomalías , Pelvis Renal/cirugía , Tempo Operativo , Robótica , Resultado del TratamientoRESUMEN
From January 1987 to May 1988 11 patients with epidermoid carcinoma of the anus were treated with Chemotherapy and Radiotherapy, six female and five males, between 46 and 90 years and a medium of 66. Five patients had recurrent disease to a previous treatment of surgery, radiotherapy or both. Chemotherapy treatment consisted of Mitomicine C 15 mg/m2 on day 1 and 5--FU 1 g/m2/d IV by 96 hours infusion. In the last six patients Mitomycin C was changed to Cisplatin to a dose of 80-100 mg/m2 on day 1. Radiotherapy to the pelvis was started on the first day of QT, with the exception of two patients with disseminated disease. The total response rate was 90.8% (6 CR and 4 PR). Those patients that did not receive previous treatment, had a complete response in 83.3% of the cases. The three patients that received Cisplatin as initial treatment have a complete response. All patients that received the treatment with curative intention and had an initial complete response are without evidence of disease after 33 to 47 months of follow up.