RESUMEN
El síndrome de Herlyn-Werner Wünderlich, también llamado OHVIRA por sus siglas en inglés (obstructed hemivagina and ipsilateral renal anomaly), es una anomalía congénita mülleriana poco frecuente que se caracteriza por la asociación entre útero didelfo, hemivagina obstruida y agenesia renal ipsilateral. La presentación clínica más común es la masa abdominal secundaria a hematocolpos, dolor y dismenorrea. Se asocia a infertilidad, endometriosis, alteraciones menstruales y obstétricas. La ecografía es la técnica de elección para la evaluación inicial, mientras que la resonancia magnética sigue siendo el método más exacto para el diagnóstico. La septotomía vaginal es el tratamiento recomendado. Se describen 2 casos clínicos con el objetivo de destacar la importancia del diagnóstico temprano para evitar las posibles complicaciones futuras.
Herlyn-Werner-Wunderlich syndrome, also known as obstructed hemivagina and ipsilateral renal anomaly (OHVIRA), is a rare, congenital Müllerian duct anomaly characterized by the association of septate uterus, obstructed hemivagina, and ipsilateral renal agenesis. The most common clinical presentation is an abdominal mass secondary to hematocolpos, pain, and dysmenorrhea. It is associated with infertility, endometriosis, and menstrual and obstetric alterations. The ultrasound is the technique of choice for the initial assessment, while the magnetic resonance imaging remains the most accurate method for diagnosis. The resection of the vaginal septum is the recommended treatment. Here we describe 2 clinical cases to highlight the importance of an early diagnosis to prevent potential complications in the future.
Asunto(s)
Humanos , Femenino , Niño , Adolescente , Vagina/anomalías , Anomalías Múltiples/diagnóstico , Riñón/anomalías , Riñón/diagnóstico por imagen , Síndrome , Útero/anomalías , Útero/diagnóstico por imagen , Conductos Paramesonéfricos/anomalíasRESUMEN
This research aims to establish an experimental surgical model for access to the renal pedicle and kidney and to determine renal length measurement via the kidney/aorta ratio (K/AO) using ultrasound. Fifteen swine underwent ventral median celiotomy with a supraumbilical transverse incision to access the right and left renal pedicles and induce renal ischemia-reperfusion injury (IRR). The kidneys were evaluated using ultrasonography to standardize renal length, aortic diameter, and the K/AO. Assessment was performed at 2 time points: 1 h before and 24 h after the surgery to induce IRR. Blood and urine samples were collected to assess renal function. Histologic evaluation of kidney fragments was also conducted. The proposed abdominal cavity access method proved to be highly efficient for exposing the right and left renal pedicles and inducing IRR. Serum levels of urea, creatinine, calcium, and phosphorus, as well as levels of the urinary protein/urinary creatinine ratio and urinary GGT, did not show significant differences. Acute kidney injury was confirmed through histopathology. The mean lengths of the right and left kidneys were 82.63 and 87.64 mm, respectively. The values of the right and left K/AO were 9.81 and 10.38, respectively. There was no statistically significant difference in the K/AO ratio before and after IRR. The proposed surgical model allowed surgical intervention on the renal pedicles without intra- or postoperative complications. Furthermore, the K/AO could be measured through ultrasonography, establishing a reference for healthy animals.
Asunto(s)
Lesión Renal Aguda , Modelos Animales de Enfermedad , Riñón , Daño por Reperfusión , Ultrasonografía , Animales , Lesión Renal Aguda/patología , Riñón/patología , Riñón/diagnóstico por imagen , Porcinos , Daño por Reperfusión/patología , Daño por Reperfusión/veterinaria , Aorta/diagnóstico por imagen , Aorta/patología , FemeninoRESUMEN
IgG4-related disease (ER-IgG4) is a group of systemic fibro-inflammatory diseases, whose renal involvement is rare and difficult to diagnose. Diagnosis is usually made by serological and histological studies. Treatment is based on systemic corticosteroids. The renal prognosis is determined by the patient's comorbidities and the degree of fibrosis in the renal biopsy. We present the case of an elderly patient with exacerbated chronic kidney disease, whose study showed nephropathy associated with ER-IgG4.
La enfermedad relacionada a IgG4 (ER-IgG4) es un grupo de enfermedades fibro-inflamatorias sistémicas, cuya afectación renal es poco frecuente y de difícil diagnóstico. Habitualmente el diagnóstico se realiza mediante estudios serológicos e histológicos. El tratamiento se basa en corticoides sistémicos. El pronóstico renal está determinado por las comorbilidades del paciente y el grado de fibrosis en la biopsia renal. Se presenta el caso de un paciente adulto mayor con enfermedad renal crónica reagudizada, cuyo estudio demostró nefropatía asociada a ER-IgG4.
Asunto(s)
Humanos , Masculino , Anciano , Enfermedad Relacionada con Inmunoglobulina G4/complicaciones , Enfermedad Relacionada con Inmunoglobulina G4/diagnóstico , Inmunoglobulina G , Tomografía Computarizada por Rayos X , Ultrasonografía , Técnicas de Laboratorio Clínico , Enfermedad Relacionada con Inmunoglobulina G4/tratamiento farmacológico , Riñón/diagnóstico por imagen , Enfermedades RenalesRESUMEN
PURPOSE: Ultrasound-guided percutaneous biopsy (USPB) of the native kidneys is the preferred diagnostic method for several nephrological conditions in both adult and pediatric populations. Conventionally, native kidney biopsies are conducted with patients in the prone position (PP). However, an alternative approach involving the supine oblique antero-lateral position (SALP) has been explored, particularly for individuals who are obese, elderly, or critically ill. METHODS: This study aimed to assess the feasibility and outcomes of USPB performed in SALP with a Free-Flank setting (FF-SALP) in pediatric patients (Group A) compared to adults (Group B). Data from kidney biopsies conducted between 2008 and 2021 were gathered. The study focused on the safety and the prevalence of biopsy samples containing a minimum of 10 glomeruli, histopathological yield in both groups. RESULTS: Complication rates were low in both groups (5.6% vs. 3.7%; p = 0.454), without major complications noted. The pediatric group achieved a significantly higher mean number of glomeruli per biopsy compared to the adult group (20.6 ± 12.3 vs. 15.7 ± 9.4; p < 0.001). However, when evaluating the minimum threshold of 10 glomeruli (76.3% vs. 68.5%; p = 0.072) and histopathologic yield (95.3% vs. 93.5%; p = 0.408), no differences were observed between groups. CONCLUSION: USPB of native kidneys in the FF-SALP position is a safe and effective method for tissue sampling in patients with parenchymal disease. It demonstrated comparable diagnostic yields and complication rates in the pediatric and adult populations, providing advantages in terms of airway management, making it particularly useful for pediatric patients that require general anesthesia.
Asunto(s)
Biopsia Guiada por Imagen , Riñón , Posicionamiento del Paciente , Ultrasonografía Intervencional , Humanos , Niño , Masculino , Femenino , Ultrasonografía Intervencional/métodos , Adulto , Biopsia Guiada por Imagen/métodos , Posicionamiento del Paciente/métodos , Riñón/patología , Riñón/diagnóstico por imagen , Adolescente , Posición Supina , Enfermedades Renales/diagnóstico por imagen , Enfermedades Renales/patología , Persona de Mediana Edad , Anciano , Preescolar , Estudios Retrospectivos , Estudios de FactibilidadRESUMEN
BACKGROUND: Nephrocalcinosis (NC) is characterized by an excessive accumulation of calcium deposits in the kidneys. In children, it is often incidentally discovered with an uncertain prognosis. CASE-DIAGNOSIS/TREATMENT: A 3-month-old girl suspected to have a milk protein allergy underwent an ultrasound that revealed increased echogenicity in the kidney pyramids suggestive of medullary NC. At the age of 18 months, imaging findings revealed not only hyperechogenicity in the medulla but also in the cortex. Over the course of a long follow-up, her kidneys maintained size within the upper limits but showed an increase by age 7. Genetic analysis identified PKHD1 variants, which required structural predictive tools to guide clinical diagnosis. Until the age of 7, her kidney function has remained intact; however, her prognosis is uncertain. CONCLUSIONS: NC in newborns is a rare condition, but its incidence is rising. Recurrent urinary infections or kidney stones may lead to kidney failure. A proactive approach in sporadic NC enables an early diagnosis to orientate clinical supervision and facilitates counseling to support family planning decisions.
Asunto(s)
Nefrocalcinosis , Humanos , Femenino , Nefrocalcinosis/genética , Nefrocalcinosis/diagnóstico por imagen , Nefrocalcinosis/diagnóstico , Lactante , Receptores de Superficie Celular/genética , Ultrasonografía/métodos , Riñón/diagnóstico por imagen , Riñón/anomalías , Riñón/patología , MutaciónRESUMEN
OBJECTIVE: To evaluate the surgical anatomy of the kidney collecting system through a narrative review of the literature, highlighting its importance during diagnosis and its approach during surgical procedures for the treatment of renal stones. MATERIAL AND METHODS: We carried out a review about the anatomy of the kidney collecting system. We analyzed papers published in the past 40 years in the databases Pubmed, Embase and Scielo, and we included only papers in English and excluded case reports, editorials and opinions of specialists. RESULTS: Renal collecting system could be divided in four groups: A1 - kidney midzone (KM), drained by minor calyx that are dependent on the superior or the inferior caliceal groups; A2 - KM drained by crossed calyx, one draining into the superior caliceal group and another draining into the inferior caliceal group; B1 - KM drained by a major caliceal group independent of both the superior and inferior groups; and B2 - KM drained by minor calyx entering directly into the renal pelvis. Some details and anatomic variations of the collecting system are related to clinical and radiological aspects, particularly perpendicular calyces, interpyelocalyx space, position of calyces in relation to renal border, classification of the renal collecting system, infundibular diameter and the angle between the lower infundibulum and renal pelvis. CONCLUSION: The knowledge of intra-renal collecting system divisions and variations as the angle between the renal pelvis and lower infundibula, position of the calices in relationship with renal edge and the diameter and position of the calyces are important for the planning of minimally invasive renal surgeries.
Asunto(s)
Cálculos Renales , Riñón , Humanos , Riñón/diagnóstico por imagen , Riñón/cirugía , Cálices Renales/diagnóstico por imagen , Cálices Renales/cirugía , Pelvis Renal/diagnóstico por imagen , Pelvis Renal/cirugía , Cálculos Renales/diagnóstico por imagen , Cálculos Renales/cirugía , Bases de Datos FactualesRESUMEN
BACKGROUND: Acute kidney injury (AKI) is a common condition in critically ill children and is associated with increased morbidity and mortality. This study aimed to assess the performance of point-of-care ultrasonography to predict AKI in children undergoing cardiac surgery. METHODS: In this prospective study, consecutive children underwent kidney Doppler ultrasound examination within 24 h following cardiac surgery, and an experienced operator obtained both renal resistive index (RRI) and renal pulsatility index (RPI). AKI was defined by the Kidney Disease Improving Global Outcome (KDIGO) criteria. The primary outcome was the diagnosis of severe AKI (KDIGO stage 2 or 3) on day 3. RESULTS: A total of 58 patients were included. Median age and weight were 12.9 months (IQR 6.0-37.9) and 7.36 kg (IQR 5.19-11.40), respectively. On day 3, 13 patients were classified as having AKI, of which 11 were severe. RRI could effectively predict AKI (area under the ROC curve [AUC] 0.83, 95% CI 0.71-0.92; p < 0.001) as well as RPI (AUC 0.81, 95% CI 0.69-0.90; p < 0.001). The optimal cutoff value for RRI was 0.85 (sensitivity, 73%; specificity, 83%; positive predictive value [PPV], 50%; and negative predictive value [NPV], 93%), while for RPI was 1.95 (sensitivity, 73%; specificity, 78%; PPV, 44%; and NPV, 92%). Similar results were found in the analysis for prediction on day 5. Significant correlations were found between Doppler-based variables and estimated GFR and furosemide dose on day 3. CONCLUSIONS: Kidney Doppler ultrasound may be a promising tool for predicting AKI in children undergoing cardiac surgery.
Asunto(s)
Lesión Renal Aguda , Procedimientos Quirúrgicos Cardíacos , Valor Predictivo de las Pruebas , Ultrasonografía Doppler , Humanos , Lesión Renal Aguda/etiología , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/diagnóstico por imagen , Masculino , Femenino , Lactante , Estudios Prospectivos , Ultrasonografía Doppler/métodos , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Preescolar , Riñón/diagnóstico por imagen , Riñón/irrigación sanguínea , Riñón/fisiopatología , Arteria Renal/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/diagnóstico por imagen , Flujo PulsátilRESUMEN
Herlyn-Werner-Wunderlich syndrome, also known as obstructed hemivagina and ipsilateral renal anomaly (OHVIRA), is a rare, congenital Müllerian duct anomaly characterized by the association of septate uterus, obstructed hemivagina, and ipsilateral renal agenesis. The most common clinical presentation is an abdominal mass secondary to hematocolpos, pain, and dysmenorrhea. It is associated with infertility, endometriosis, and menstrual and obstetric alterations. The ultrasound is the technique of choice for the initial assessment, while the magnetic resonance imaging remains the most accurate method for diagnosis. The resection of the vaginal septum is the recommended treatment. Here we describe 2 clinical cases to highlight the importance of an early diagnosis to prevent potential complications in the future.
El síndrome de Herlyn-Werner Wünderlich, también llamado OHVIRA por sus siglas en inglés (obstructed hemivagina and ipsilateral renal anomaly), es una anomalía congénita mülleriana poco frecuente que se caracteriza por la asociación entre útero didelfo, hemivagina obstruida y agenesia renal ipsilateral. La presentación clínica más común es la masa abdominal secundaria a hematocolpos, dolor y dismenorrea. Se asocia a infertilidad, endometriosis, alteraciones menstruales y obstétricas. La ecografía es la técnica de elección para la evaluación inicial, mientras que la resonancia magnética sigue siendo el método más exacto para el diagnóstico. La septotomía vaginal es el tratamiento recomendado. Se describen 2 casos clínicos con el objetivo de destacar la importancia del diagnóstico temprano para evitar las posibles complicaciones futuras.
Asunto(s)
Anomalías Múltiples , Riñón , Vagina , Humanos , Femenino , Vagina/anomalías , Síndrome , Riñón/anomalías , Riñón/diagnóstico por imagen , Anomalías Múltiples/diagnóstico , Conductos Paramesonéfricos/anomalías , Útero/anomalías , Útero/diagnóstico por imagen , NiñoRESUMEN
The objectives of this study were to describe the gross anatomy and ultrasonographic appearance of coelomic organs in subadult and adult axolotls (Ambystoma mexicanum), to describe an ultrasound technique, and to test correlations of ultrasonographic measurement with body length, width, and weight. Necropsies of coelomic organs were conducted on 10 axolotls (females = 5; males = 5) and ultrasound on 11 (males = 5; females = 6). Animals were kept in water and maintained conscious during ultrasound. The heart, caudal vena cava, liver, gallbladder, spleen, esophagus, stomach, colon, kidneys, ovaries, and fat bodies were identified in all study subjects, although testicles were identified in only 6/7 subjects. The pancreas and adrenal glands could not be identified in any animals, either during necropsy or ultrasonography. Coelomic and pericardial effusion was present in all animals. Ultrasonographic measurements of the liver, spleen, myocardial thickness, and right and left kidney length were highly repeatable (correlation value [CV] < 5%) and the esophagus, spleen, caudal vena cava, fat bodies, gallbladder, colon thickness, right kidney height and width, and right testicle diameter were statistically repeatable (CV < 10%).
Asunto(s)
Ambystoma mexicanum , Hígado , Animales , Femenino , Masculino , Riñón/diagnóstico por imagen , Glándulas Suprarrenales , EstómagoRESUMEN
INTRODUCTION: In cardiorenal syndrome type 1 (CRS1), vascular congestion is central to the pathophysiology of heart failure and thus a key target for management. The venous evaluation by ultrasound (VExUS) system could guide decongestion effectively and thereby improve outcomes. METHODS: In this randomized clinical trial, patients with CRS1 (i.e., increase in creatinine ≥0.3 mg/dL) were randomized to guide decongestion with VExUS compared to usual clinical evaluation. The primary endpoint was to assess kidney function recovery (KFR), and the key secondary endpoint was decongestion evaluated by physical examination and changes in brain natriuretic peptide (BNP) and CA-125. Exploratory endpoints included days of hospitalization and mortality. RESULTS: From March 2022 to February 2023, a total of 140 patients were randomized 1:1 (70 in the VExUS and 70 in the control group). KFR was not statistically different between groups. However, VExUS improved more than twice the odds to achieve decongestion (odds ratio [OR]: 2.6, 95% CI: 1.9-3.0, p = 0.01) and the odds to reach a decrease of BNP >30% (OR: 2.4, 95% CI: 1.3-4.1, p = 0.01). The survival at 90 days, recongestion, and CA-125 were similar between groups. CONCLUSION: In patients with CRS1, we observed that VExUS-guided decongestion did not improve the probability of KFR but improved the odds to achieve decongestion.
Asunto(s)
Síndrome Cardiorrenal , Insuficiencia Cardíaca , Humanos , Diuréticos , Recuperación de la Función , Riñón/diagnóstico por imagen , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/diagnóstico , Péptido Natriurético EncefálicoAsunto(s)
Riñón , Insuficiencia Renal Crónica , Humanos , Riñón/diagnóstico por imagen , EnvejecimientoRESUMEN
Paciente masculino de 45 años que acude por cuadro clínico de 12 horas de evolución caracterizado por dolor abdominal, en flanco y fosa ilíaca derecha, asociado a vómitos de aspecto bilioso.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Pelvis , Anomalías Congénitas/diagnóstico por imagen , Cálculos Renales/diagnóstico por imagen , Riñón/anomalías , Riñón/diagnóstico por imagen , Dolor AbdominalRESUMEN
PURPOSE: This study aimed to analyze the diagnostic accuracy of dynamic and static ultrasound (DSUS) in detecting vesicoureteral reflux (VUR) and renal scarring in a cohort of children with neurogenic bladder (NB). MATERIALS AND METHODS: A retrospective, longitudinal, observational study was conducted using the Reporting Diagnostic Accuracy Studies guideline. The DSUS (index test) data were compared with voiding cystourethrography (VCUG) and renal scintigraphy 99mTc-dimercaptosuccinic (reference tests). Overall performance for predicting VUR and renal scarring was assessed using renal pelvic diameter (RPD)/distal ureteral diameter and renal parenchymal thinning on DSUS, respectively. RESULTS: A total of 107 patients (66 girls, median age 9.6 years) participated. Seventeen patients (15.9%) presented VUR, eight bilateral. For overall reflux grade, the AUC was 0.624 for RPD and 0.630 for distal ureteral diameter. The diagnostic performance for detecting high-grade VUR was slightly better for DSUS parameters. The AUC was 0.666 for RPD and 0.691 for distal ureteral diameter. The cut-offs of 5 mm for RPD and 6.5 mm for distal ureteral diameter presented the best diagnostic odds ratio (DOR) to identify high-grade VUR. The increase of RPD during detrusor contractions showed an accuracy of 89.2%. The thinness of renal parenchyma presented an accuracy of 88% for renal scarring. CONCLUSION: DSUS predicts VUR and renal scarring in children with NB with fair to good accuracy, and all measurements exhibited a high negative predictive value (NPV). The increase in RPD during voiding or detrusor contractions proved to be the most accurate parameter for indicating the presence of VUR in this study.
Asunto(s)
Vejiga Urinaria Neurogénica , Infecciones Urinarias , Reflujo Vesicoureteral , Femenino , Niño , Humanos , Adolescente , Lactante , Reflujo Vesicoureteral/complicaciones , Reflujo Vesicoureteral/diagnóstico por imagen , Estudios Retrospectivos , Vejiga Urinaria Neurogénica/diagnóstico por imagen , Vejiga Urinaria Neurogénica/etiología , Cicatriz , Riñón/diagnóstico por imagenRESUMEN
La evaluación de la función renal se realiza habitualmente a través de la estimación de la tasa de filtración glomerular y el análisis de la orina. La evaluación morfológica renal a través de una imagen permite complementar esta información. Sin embargo, muchas de las aplicaciones de las técnicas actuales de imágenes son desconocidas por los médicos clínicos. Además, la comunicación entre médicos clínicos y especialistas en imágenes es menos usual de lo deseable. En esta revisión describiremos los métodos de imagen más frecuentemente utilizados para la evaluación de la función renal y otras situaciones clínicas nefrológicas, además de analizar los avances más significativos, particularmente en ultrasonografía y resonancia magnética, para la pesquisa precoz y seguimiento del daño renal.
The evaluation of kidney function is usually performed through the estimation of the glomerular filtration rate and urine analysis. The evaluation of the kidney morphology through an image complements and enriches this information. However, many of the applications of current imaging techniques are unknown to clinicians. In addition, communication between clinicians and imaging specialists is less common than desirable. In this review, we will describe the imaging methods most frequently used for evaluating kidney function and other clinical situations, in addition to analyzing the most significant advances, particularly in ultrasonography and magnetic resonance imaging, for the early detection and follow-up of kidney damage.
Asunto(s)
Humanos , Tasa de Filtración Glomerular/fisiología , Riñón/fisiología , Riñón/diagnóstico por imagen , Enfermedades Renales/fisiopatología , Enfermedades Renales/diagnóstico por imagen , Imagen por Resonancia Magnética , Ultrasonografía , Pruebas de Función Renal/métodosRESUMEN
The aim of this study was to evaluate routinely used tests to diagnose cats in early stages of chronic kidney disease (CKD) and to describe a model for evaluating these variables simultaneously. Apparently healthy cats were screened using serum creatinine (sCr), point-of-care symmetric dimethylarginine (POC SDMA), urinalysis, urine protein/creatinine ratio (UPC) and imaging evaluation. Those parameters were compared to glomerular filtration rate (GFR) assessed by renal scintigraphy. Forty-four cats were included and consisted of 14 (31.8%) healthy cats (absence of abnormalities in renal morphology and sCr less than 1.6 mg/dL), 20 (45.5%) cats classified as CKD I (presence of abnormalities in renal morphology and sCr less than 1.6 mg/dL) and ten (22.7%) as CKD II (sCr equal to or greater than 1.6 mg/dL, with or without abnormalities in renal morphology). A large number (40.9%) of apparently healthy cats presented reduction in GFR, which included half of CKD I patients. Point-of-care SDMA was not a good predictor for decreased GFR, nor was it correlated with the variables GFR and sCr. Glomerular filtration rate was significantly lower in CKD I and II groups in comparison with healthy cats, but there was no significant difference between the CKD I and II groups. Multivariate logistic regression model identified three variables that affected the odds of a cat having decreased GFR (< 2.5 mL/min/kg): sCr (OR = 18.3; p = 0.019; CI = 1.6-207.2), and the ultrasonographic findings 'reduced corticomedullary definition' (OR = 19.9; p = 0.022; CI = 1.6-254.0) and 'irregular contour' (OR = 65.6; p = 0.003; CI = 4.2-1038.2). Renal ultrasonography evaluation should always be considered for screening early CKD in apparently healthy cats.
Asunto(s)
Enfermedades de los Gatos , Insuficiencia Renal Crónica , Gatos , Animales , Tasa de Filtración Glomerular/veterinaria , Creatinina , Sistemas de Atención de Punto , Biomarcadores , Riñón/diagnóstico por imagen , Arginina , Insuficiencia Renal Crónica/diagnóstico por imagen , Insuficiencia Renal Crónica/veterinaria , Cintigrafía , Enfermedades de los Gatos/diagnóstico por imagenRESUMEN
Nephrocalcinosis refers to calcium deposition in the form of calcium oxalate or calcium phosphate in the renal parenchyma and tubules. After diagnosis, the cause of nephrocalcinosis must be established to carry out a comprehensive approach to this entity. Although this is a common finding, it can be underdiagnosed due to the lack of knowledge of the different presentation patterns that exist. Many causes have been described related to this disease.A pictorial review about the most common features of cortical and medullary nephrocalcinosis both in ultrasound and CT is presented in the present work as well as a review of its main causes and graphics to easily recognize each pattern.
Asunto(s)
Nefrocalcinosis , Humanos , Nefrocalcinosis/diagnóstico por imagen , Nefrocalcinosis/etiología , Riñón/diagnóstico por imagen , Oxalato de Calcio , RadiografíaRESUMEN
OBJECTIVES: To evaluate the role of three-dimensional (3D) reconstruction in preoperative planning for complex renal tumors. MATERIALS AND METHODS: A well-planned questionnaire was distributed among the attending urologists at an international meeting. The questionnaire inquired about demographic data, surgical experience, partial nephrectomy (PN) versus radical nephrectomy (RN), surgical approach, time of ischemia, probability of postoperative urine leakage and positive surgical margins after viewing computed tomography (CT) scans and their respective 3D models of six complex renal tumors. Following the CT scans, attendees were asked to view randomly selected reconstructions of the cases. RESULTS: One hundred expert urologists participated in the study; 61% were aged between 40 and 60 years. Most of them (74%) were consultants. The overall likelihood of PN after viewing the 3D reconstructions significantly increased (7.1±2.7 vs. 8.0±2.2, p<0.001), the probability of conversion to RN significantly decreased (4.3±2.8 vs. 3.2±2.5, p<0.001), and the likelihood of urine leakage and positive surgical margins significantly decreased (p<0.001). Preference for the open approach significantly decreased (21.2% vs. 12.1%, p<0.001), while selective clamping techniques significantly increased (p<0.001). After viewing the 3D models, low expected warm ischemia time and estimated blood loss were significantly preferred by the respondents (p<0.001). Surgical decision change was significantly associated with performance or participation in more than 20 PNs or RNs annually [3.25 (1.98-5.22) and 2.87 (1.43-3.87), respectively]. CONCLUSIONS: 3D reconstruction models play a significant role in modifying surgeons' strategy and surgical planning for patients with renal tumors, especially for patients with stronger indications for a minimally invasive and/or nephron-sparing approach.
Asunto(s)
Neoplasias Renales , Márgenes de Escisión , Humanos , Adulto , Persona de Mediana Edad , Neoplasias Renales/diagnóstico por imagen , Neoplasias Renales/cirugía , Neoplasias Renales/patología , Riñón/diagnóstico por imagen , Riñón/cirugía , Riñón/patología , Nefrectomía/métodos , Tomografía Computarizada por Rayos X/métodosRESUMEN
An 11-year-old girl with a history of imperforate anus, urinary tract infection, and intermittent episodes of constipation presented with abdominal pain and nausea for 1 week. The x-rays revealed hydrometrocolpos and fused pelvic kidney with a single hydronephrotic ureter. The vaginal examination revealed a nonpermeable transverse vaginal septum. The collection was temporarily drained and symptoms resolved. The patient was scheduled for definitive vaginal reconstructive surgery. In this case, it is worth noting the association of infrequent malformations and also the signs and symptoms very common in pediatric practice due to a pathology rarely considered in the differential diagnosis, and the importance of an early and complete assessment of this type of malformations for a timely treatment.
Una niña de 11 años de edad con antecedentes de ano imperforado, infección urinaria y episodios de constipación intermitentes se presentó a la consulta con cólicos abdominales y náuseas de una semana de evolución. Estudios radiológicos revelaron hidrometrocolpos y fusión renal pélvica con uréter único hidronefrótico. El examen vaginal evidenció un tabique transverso no permeable. Se evacuó temporalmente la colección con resolución de los síntomas. La paciente fue programada para cirugía vaginal reconstructiva definitiva. Se destaca en este caso no solo la asociación de malformaciones infrecuentes, sino una sintomatología muy común en la práctica pediátrica a causa de una patología rara vez considerada en el diagnóstico diferencial, y la importancia de una evaluación precoz y completa de este tipo de malformaciones para un tratamiento oportuno.