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OBJECTIVE: To present the results of our case series on laparoscopic nephrectomy in xanthogranulomatous pyelonephritis (XGP). METHODS: A retrospective study was conducted that included 143 patients treated with laparoscopic nephrectomy for non-functioning kidney, of whom 15 had XGP, within the time frame of 2011 to 2019. The demographic and clinical data were collected, along with the intraoperative results, complications, and days of hospital stay. RESULTS: Transperitoneal laparoscopic nephrectomy was successfully performed on 15 patients with XGP, with no need for conversion. Mean intraoperative time was 124.4 minutes (range 70-240) and intraoperative blood loss was 148.5 ml (range 30-550), with no blood transfusion required. No intraoperative complications occurred but there was one postoperative complication (6.6%), classified as Clavien-Dindo I (surgical wound infection). Mean hospital stay was 2.85 days (range 2-7). CONCLUSIONS: Nephrectomy is the definitive management for XGP, and the laparoscopic approach should be considered a treatment modality, despite the fact that the pathology involves a severe chronic inflammatory process. Its benefits are reduced surgery duration, less blood loss, a lower complication rate, and fewer days of hospital stay, when performed by a skilled and experienced surgeon.
OBJETIVO: Presentar los resultados de nuestra serie de nefrectomía laparoscópica en pielonefritis xantogranulomatosa (PXG). MÉTODO: Se realizó un estudio retrospectivo que incluyó 143 pacientes tratados con nefrectomía laparoscópica por exclusión renal, de los cuales 15 fueron por PXG, en el periodo comprendido de 2011 a 2019. Se recolectaron datos demográficos y clínicos, resultados transoperatorios, complicaciones y días de estancia hospitalaria. RESULTADOS: Se realizó nefrectomía laparoscópica transperitoneal de forma exitosa en 15 pacientes con PXG, sin necesidad de conversión. El tiempo transoperatorio promedio fue de 124.4 minutos (rango: 70-240). El sangrado transoperatorio fue de 148.5 ml (rango: 30-550), sin requerimiento de transfusión sanguínea. No se reportaron complicaciones transoperatorias; se presentó una complicación en el posoperatorio (6.6%) clasificada como Clavien-Dindo I (infección de la herida quirúrgica). La estancia hospitalaria promedio fue de 2.85 días (rango: 2-7). CONCLUSIONES: El manejo definitivo de la PXG es la nefrectomía, y el abordaje laparoscópico debe ser considerado como una modalidad de tratamiento a pesar de ser una patología que presenta un proceso inflamatorio grave y crónico, obteniéndose beneficios como disminución en el tiempo quirúrgico, menor sangrado, menor tasa de complicaciones y menos días de estancia hospitalaria cuando es realizado por un cirujano experimentado.
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Laparoscopia , Pielonefrite Xantogranulomatosa , Humanos , Estudos Retrospectivos , Laparoscopia/métodos , Perda Sanguínea Cirúrgica , Complicações Intraoperatórias/cirurgia , Nefrectomia/métodos , Pielonefrite Xantogranulomatosa/cirurgiaRESUMO
INTRODUCCIÓN: El uréter retrocavo es una anomalía congénita rara que requiere manejo quirúrgico. OBJETIVO: Reportar los resultados en el manejo laparoscópico para uréter retrocavo y hacer una revisión bibliográfica. MÉTODO: Estudio retrospectivo, descriptivo, transversal, en pacientes con diagnóstico de uréter retrocavo que fueron sometidos a plastia laparoscópica de uréter retrocavo. RESULTADOS: Cuatro pacientes sometidos a plastia laparoscópica por diagnóstico de uréter retrocavo, 1 hombre y 3 mujeres, con una media de edad de 40.7 años. La media del tiempo operatorio fue de 138.2 minutos. La pérdida de sangre cuantificada transoperatoria media fue de 23.7 ml. Ningún paciente presentó complicaciones transoperatorias ni posoperatorias. Los pacientes permanecieron hospitalizados hasta su egreso una media de 2.5 días. Todos los pacientes presentaron mejoría de su sintomatología. CONCLUSIONES: El uréter retrocavo es una condición rara y aún no existe un consenso sobre su diagnóstico, tratamiento y seguimiento. El manejo quirúrgico laparoscópico es una opción para el tratamiento de estos pacientes. INTRODUCTION: The retrocave ureter is a rare congenital anomaly that requires surgical management. OBJECTIVE: Report the results in laparoscopic management for retrocave ureter and literature review. METHOD: Retrospective, descriptive, cross-sectional study in patients with a diagnosis of retrocave ureter who were sometimes a laparoscopic retrocave ureter. RESULTS: Four patients sometimes underwent laparoscopic plasty for diagnosis of retrocave ureter, 1 man and 3 women, with a mean age of 40.7 years. The mean operative time was 138.2 minutes. The mean intraoperative quantified blood loss was 23.7 ml. No patient presented transoperative or postoperative complications. The patients remained hospitalized until their progress with an average of 2.5 days. All patients visualize improvement in their symptoms. CONCLUSION: The retrocave ureter is a rare condition and there is still no consensus on its diagnosis, treatment and follow-up. Laparoscopic surgical management is an option for the treatment of these patients.
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Laparoscopia , Pica , Adulto , Estudos Transversais , Feminino , Hospitais , Humanos , Masculino , Estudos RetrospectivosRESUMO
ANTECEDENTES: Los quistes suprarrenales son una afección rara. Su diagnóstico y su tratamiento son un desafío debido a la escasa información, lo que genera incertidumbre respecto al mejor manejo. CASOS CLÍNICOS: Presentamos tres casos de quistes suprarrenales que recibieron tratamiento de mínima invasión con cirugía laparoscópica, sin presentar complicaciones y con una evolución favorable. DISCUSIÓN: Las nuevas técnicas quirúrgicas de mínima invasión ofrecen una oportunidad terapéutica que permite preservar estructuras y obtener material necesario para su diagnóstico histopatológico, así como la resolución de la sintomatología. BACKGROUND: Adrenal cysts are a rare entity; their diagnosis and treatment are challenging due to the lack of information, generating uncertainty regarding the best management. CASE REPORTS: We present three cases of adrenal cysts that received minimally invasive treatment with laparoscopic surgery, without complications and with a favorable evolution. DISCUSSION: The new minimally invasive surgical techniques offer a therapeutic opportunity that allows preserving structures and obtaining the necessary material for histopathological diagnosis, as well as a resolution of the symptoms.
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Cistos , Laparoscopia , Cistos/diagnóstico por imagem , Cistos/cirurgia , Humanos , Estudos RetrospectivosRESUMO
INTRODUCTION AND OBJECTIVE: Extracorporeal shock wave lithotripsy (ESWL) is the first-line treatment in the majority of cases of upper urinary tract stones. Since its introduction, attempts have been made to establish the ideal accompanying analgesic method to enable the application of shock waves of adequate duration and intensity for efficacious stone fragmentation. An open, randomized, prospective, longitudinal, comparative, and experimental clinical study was conducted to evaluate the efficacy of subcostal nerve block with lidocaine, comparing it in combination with tramadol or diclofenac for pain control during ESWL. MATERIALS AND METHODS: Seventy patients of both sexes were included in the study. Thirty-five were men and 35 were women, all above 18 years of age, with kidney stones or ureteral stones smaller than 20 mm. The patients were randomly assigned to one of the following groups: Group 1 (24 patients) Twelfth subcostal nerve block with 10 ml of lidocaine 2%, 5 min before ESWL. Group 2 (25 patients) Twelfth subcostal nerve block with 10 ml lidocaine 2% + intramuscular diclofenac sodium 45 min before ESWL. Group 3 (21 patients) Twelfth subcostal nerve block with 10 ml of lidocaine 2% + tramadol at 1 mg/Kg of weight, 45 min before ESWL. The visual analog scale (VAS) for pain was applied at minutes 10, 20, and 30 of the procedure. RESULTS: No statistically significant differences were reported by the ANOVA test for comparing the mean pain values between the three groups at minutes 10, 20, and 30 of the ESWL. There were no adverse effects. CONCLUSIONS: Even though there were no statistically significant differences between the three groups, the analgesic regimen of twelfth subcostal nerve block with lidocaine 2%, alone, was as efficacious as its combination with other analgesics and therefore can be used as a sole analgesic method during ESWL.
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Analgésicos Opioides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Diclofenaco/uso terapêutico , Litotripsia/efeitos adversos , Bloqueio Nervoso , Dor/prevenção & controle , Tramadol/uso terapêutico , Adulto , Anestésicos Locais , Feminino , Humanos , Nervos Intercostais , Cálculos Renais/terapia , Lidocaína , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/métodos , Dor/etiologia , Manejo da Dor/métodos , Estudos Prospectivos , Cálculos Ureterais/terapiaRESUMO
INTRODUCTION AND OBJECTIVE: Renal colic is one of the most intense pains known to humans. Standard treatment usually consists of nonsteroidal anti-inflammatory drugs and opiates, but they do not always provide optimum efficacy and speed in relieving the pain. For more than 25 years, our hospital has been employing twelfth subcostal nerve block. The objective of the present study was to compare the efficacy of subcostal nerve block with lidocaine versus intramuscular diclofenac in renal colic management. METHODS: Sixty patients of both sexes, above the age of 18 years, and presenting with renal colic were randomly selected for the study. The visual analog scale was applied prior to the treatment and at minutes 1, 3, 5, 30, and 45 after the application of the twelfth nerve block or the intramuscular administration of diclofenac. RESULTS: A total of 60 patients, 35 women and 25 men, were included in the study. There were statistically significant differences in the mean scores for pain from minute 1 to minute 45. There were no adverse effects. CONCLUSIONS: Twelfth Subcostal nerve block with lidocaine is an efficacious, safe, inexpensive, and very fast-acting medication for pain control related to renal colic. These characteristics make it superior to diclofenac.
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Anestésicos Locais , Inibidores de Ciclo-Oxigenase , Diclofenaco , Nervos Intercostais , Lidocaína , Bloqueio Nervoso/métodos , Cólica Renal/terapia , Adulto , Feminino , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Medição da Dor , Adulto JovemRESUMO
INTRODUCTION AND OBJECTIVE: Indwelling double J ureteral stents are used routinely in the resolution of ureteral obstruction caused by different etiologies. Evaluation of urinary symptoms related to double-J stent, indicate that these affect 73-90% of patients. We conducted a prospective, randomized study, to evaluate the efficacy of tamsulosin, oxybutinin and combination therapy in improving the urinary symptoms. METHODS: Patients who underwent ureteral stent placement after ureterolithotripsy (total 51), were randomized into three groups: Group I: Tamsulosin 0.4 mg. Once per day(17 patients), Group II: Oxybutinin 5 mg. once per day (17 patients), Group III: Tamsulosin+ oxybutynin once per day (17 patients). All the groups received the drugs for three weeks and completed a Spanish validated Ureteral Stent Symptom Questionnaire (USSQ) at day 7 and 21. RESULTS: Repeated measures ANOVA showed mean urinary symptom index score was 22.3 vs. 15.5 in group three (p<0.001) at day 7 and 21 respectively. The mean work performance index was 6.6 vs 8.1 (p=0.049) favoring tamsulosin group, the mean sexual score was 0.5 vs 1.5 (p=0.03). Among additional problems the mean was 7.2 vs 6.2 (p=0.03). No significant difference was noted among pain and general health index. No side effects were reported. CONCLUSIONS: Combination therapy with tamsulosin and oxybutynin improved irritative symptoms and work performance as well as sexual matters. Combination therapy should be considered for patients who complained of stent related symptoms.
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Sintomas do Trato Urinário Inferior/tratamento farmacológico , Sintomas do Trato Urinário Inferior/etiologia , Ácidos Mandélicos/uso terapêutico , Stents/efeitos adversos , Sulfonamidas/uso terapêutico , Agentes Urológicos/uso terapêutico , Adulto , Análise de Variância , Quimioterapia Combinada , Feminino , Humanos , Sintomas do Trato Urinário Inferior/prevenção & controle , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Reprodutibilidade dos Testes , Método Simples-Cego , Inquéritos e Questionários , Tansulosina , Fatores de Tempo , Resultado do Tratamento , Ureter , Obstrução Ureteral/complicações , Obstrução Ureteral/terapia , UreteroscopiaRESUMO
ABSTRACT Introduction and objective Indwelling double J ureteral stents are used routinely in the resolution of ureteral obstruction caused by different etiologies. Evaluation of urinary symptoms related to double-J stent, indicate that these affect 73-90% of patients. We conducted a prospective, randomized study, to evaluate the efficacy of tamsulosin, oxybutinin and combination therapy in improving the urinary symptoms. Methods Patients who underwent ureteral stent placement after ureterolithotripsy (total 51), were randomized into three groups: Group I: Tamsulosin 0.4 mg. once per day(17 patients), Group II: Oxybutinin 5 mg. once per day (17 patients), Group III: Tamsulosin+ oxybutynin once per day (17 patients). All the groups received the drugs for three weeks and completed a Spanish validated Ureteral Stent Symptom Questionnaire (USSQ) at day 7 and 21. Results Repeated measures ANOVA showed mean urinary symptom index score was 22.3 vs. 15.5 in group three (p<0.001) at day 7 and 21 respectively. The mean work performance index was 6.6 vs 8.1 (p=0.049) favoring tamsulosin group, the mean sexual score was 0.5 vs 1.5 (p=0.03). Among additional problems the mean was 7.2 vs 6.2 (p=0.03). No significant difference was noted among pain and general health index. No side effects were reported. Conclusions Combination therapy with tamsulosin and oxybutynin improved irritative symptoms and work performance as well as sexual matters. Combination therapy should be considered for patients who complained of stent related symptoms.
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Humanos , Masculino , Feminino , Adulto , Sulfonamidas/uso terapêutico , Stents/efeitos adversos , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/tratamento farmacológico , Agentes Urológicos/uso terapêutico , Ácidos Mandélicos/uso terapêutico , Qualidade de Vida , Fatores de Tempo , Ureter , Obstrução Ureteral , Obstrução Ureteral/complicações , Obstrução Ureteral/terapia , Método Simples-Cego , Estudos Prospectivos , Inquéritos e Questionários , Reprodutibilidade dos Testes , Análise de Variância , Resultado do Tratamento , Quimioterapia Combinada , Sintomas do Trato Urinário Inferior/prevenção & controle , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To analyze the outcomes of emphysematous pyelonephritis (EPN), the impact of different treatment modalities, and to determine risk factors associated with mortality. METHODS: We retrospectively reviewed cases of EPN from 3 tertiary care institutions in Mexico. The diagnosis was confirmed with computed tomographic scan. Treatment was classified as follows: medical management (MM), minimally invasive, and surgical. Demographic, clinical, biochemical, and radiological characteristics were assessed and compared between survivors and nonsurvivors. Comparison was assessed using 1-way analysis of variance and chi-square. Univariate and multivariate logistic regression analyses were performed to determine prognostic factors. Main end point was mortality. RESULTS: A total of 62 patients were included (49 women and 13 men), with a mean age of 53.9 years. The most common comorbidities were diabetes (69.3%) and hypertension (40.3%). Escherichia coli was the most common isolated microorganism (62.7%). MM was provided to 24.2%, minimally invasive treatment to 51.6%, open drainage to 19.3%, and emergency nephrectomy to 4.8%. Overall mortality was 14.5% and was similar among different treatment modalities (P=.06). Survivors were younger (P=.004), had lower creatinine (P=.002), and better estimated glomerular filtration rate (P=.007). In univariate analysis, age (P=.009), creatinine (P=.009), and need for nephrectomy (P=.03) were associated with mortality. In multivariate logistic regression analysis, creatinine (odds ratio 1.56, 95% confidence interval 1.03-2.35, P=.03) and nephrectomy (odds ratio 9.7, 95% confidence interval 1.007-93.51, P=.049) remained significant predictors of mortality. CONCLUSION: EPN needs an aggressive MM and stepwise approach; nephrectomy should be the last resort of treatment. Creatinine level and need for nephrectomy are the strongest predictors of mortality according our analysis.