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INTRODUCTION: We aim to compare the safety and effectiveness of the KangDuo (KD)-Surgical Robot-01 (KD-SR-01) system and the da Vinci (DV) system for robot-assisted radical nephroureterectomy (RARNU). MATERIALS AND METHODS: This multicenter prospective randomized controlled trial was conducted between March 2022 and September 2023. Group 1 included 29 patients undergoing KD-RARNU. Group 2 included 29 patients undergoing DV-RARNU. Patient demographic and clinical characteristics, perioperative data, and follow-up outcomes were collected prospectively and compared between the two groups. RESULTS: There were no significant differences in patient baseline demographic and preoperative characteristics between the two groups. The success rates in both groups were 100% without conversion to open or laparoscopic surgery or positive surgical margins. No significant difference was observed in docking time [242 (120-951) s vs 253 (62-498) s, P = 0.780], console time [137 (55-290) min vs 105 (62-220) min, P = 0.114], operative time [207 (121-460) min vs 185 (96-305) min, P = 0.091], EBL [50 (10-600) mL vs 50 (10-700) mL, P = 0.507], National Aeronautics and Space Administration Task Load Index scores, and postoperative serum creatinine levels between the two groups. None of the patients showed evidence of distant metastasis, local recurrence, or equipment-related adverse events during the four-week follow-up. One (3.4%) patient in Group 2 experienced postoperative enterovaginal and enterovesical fistulas (Clavien-Dindo grade III). CONCLUSIONS: The KD-SR-01 system is safe and effective for RARNU compared to the DV Si or Xi system. Further randomized controlled studies with larger sample sizes and longer durations are required.
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Nefroureterectomia , Duração da Cirurgia , Procedimentos Cirúrgicos Robóticos , Humanos , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/instrumentação , Feminino , Masculino , Estudos Prospectivos , Pessoa de Meia-Idade , Nefroureterectomia/métodos , Idoso , Resultado do Tratamento , Neoplasias Renais/cirurgia , Tempo de Internação , Laparoscopia/métodos , Laparoscopia/instrumentação , Reprodutibilidade dos Testes , Complicações Pós-OperatóriasRESUMO
ABSTRACT Purpose: To compare the effects of different combinations of radical nephroureterectomy (RNU) and bladder cuff excision (BCE) surgical procedures on intravesical recurrence (IVR) in patients with upper tract urothelial carcinoma (UTUC). Materials and Methods: This retrospective observational study included 452 patients who underwent RNU with BCE for UTUC between January 2010 and December 2020. The patients were classified into three groups based on different combinations of RNU and BCE surgical procedures: open RNU with open BCE (group 1, n=104), minimally invasive (MIS) RNU with open BCE (group 2, n=196), and MIS RNU with intracorporeal BCE (group 3, n=152). Data on demographics, body mass index, history, preoperative renal function, perioperative status, tumor characteristics, histopathology, and recurrence conditions were collected. Multivariate Cox regression analyses were performed to determine the impact of the surgical procedures on IVR. P-values <0.05 were considered statistically significant. Results: After a median follow-up of 29.5 months, the IVR rate was 29.6% and the IVR-free survival rate was the lowest in group 2 (group 1 vs. group 2 vs. group 3: 69.0% vs. 55.1% vs. 67.5%; log-rank P=0.048). The overall survival rate was comparable among the three groups. Multivariate analysis revealed that group 2 had a significantly higher risk of IVR than group 1 (hazard ratio=1.949, 95% confidence interval=1.082-3.511, P=0.026), while groups 1 and 3 had similar risks. Conclusions: For patients with UTUC, MIS RNU with open BCE is associated with a higher risk of IVR than open RNU with open BCE and MIS RNU with intracorporeal BCE.
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PURPOSE: To compare the effects of different combinations of radical nephroureterectomy (RNU) and bladder cuff excision (BCE) surgical procedures on intravesical recurrence (IVR) in patients with upper tract urothelial carcinoma (UTUC). MATERIALS AND METHODS: This retrospective observational study included 452 patients who underwent RNU with BCE for UTUC between January 2010 and December 2020. The patients were classified into three groups based on different combinations of RNU and BCE surgical procedures: open RNU with open BCE (group 1, n=104), minimally invasive (MIS) RNU with open BCE (group 2, n=196), and MIS RNU with intracorporeal BCE (group 3, n=152). Data on demographics, body mass index, history, preoperative renal function, perioperative status, tumor characteristics, histopathology, and recurrence conditions were collected. Multivariate Cox regression analyses were performed to determine the impact of the surgical procedures on IVR. P-values < 0.05 were considered statistically significant. RESULTS: After a median follow-up of 29.5 months, the IVR rate was 29.6% and the IVR-free survival rate was the lowest in group 2 (group 1 vs. group 2 vs. group 3: 69.0% vs. 55.1% vs. 67.5%; log-rank P=0.048). The overall survival rate was comparable among the three groups. Multivariate analysis revealed that group 2 had a significantly higher risk of IVR than group 1 (hazard ratio=1.949, 95% confidence interval=1.082-3.511, P=0.026), while groups 1 and 3 had similar risks. CONCLUSIONS: For patients with UTUC, MIS RNU with open BCE is associated with a higher risk of IVR than open RNU with open BCE and MIS RNU with intracorporeal BCE.
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Carcinoma de Células de Transição , Neoplasias Ureterais , Neoplasias da Bexiga Urinária , Humanos , Neoplasias da Bexiga Urinária/cirurgia , Neoplasias da Bexiga Urinária/patologia , Nefroureterectomia/métodos , Carcinoma de Células de Transição/cirurgia , Carcinoma de Células de Transição/patologia , Bexiga Urinária/cirurgia , Bexiga Urinária/patologia , Nefrectomia/métodos , Recidiva Local de Neoplasia/patologia , Estudos Retrospectivos , Neoplasias Ureterais/cirurgia , Neoplasias Ureterais/patologiaRESUMO
Background: Emphysematous pyelonephritis (EPN) is an acute, severe necrotizing infection of the renal parenchyma and surrounding tissues that results in gas formation in the kidney, collecting system, or surroundings. EPN is a rare condition in veterinary medicine and occurs most frequently in dogs with diabetes mellitus. Although the prognosis of medical management in animals is poor, the standardized treatment protocol according to EPN severity is unclear. This report describes the first case of a nondiabetic female cat with extensive EPN and good prognosis following direct nephroureterectomy (NU). Case: A 10-year-old spayed female cat presented with the chief complaint of an acute loss of weight within 1 week, vomiting, and disorientation including stumbling, discoordination, circling, wobbling, head tilting, and difficulties in standing. At presentation, the patient had a body condition score of 1/9 and weighed 2.6 kg. Blood examination revealed leukocytosis, anemia, and hypoproteinemia. Abdominal radiography revealed severely decreased serosal details. A massive gas silhouette observed in the peritoneal and retroperitoneal cavities, was diagnosed as abdominal free gas. Abdominal ultrasound showed an accumulation of moderately anechoic fluid mixed with gas and cyst-like capsules around the left kidney. Left partial ureteral obstruction and dilation were also observed. Computed tomography (CT) was performed without sedatives or anesthetic drugs. The findings showed severe inflammatory changes in the peritoneum and a loss of the normal inner structure in the left kidney. A pyelogram of the left kidney was not observed after injection of the contrast material. Diffuse fat stranding and free gas observed in the mesentery of the entire abdominal cavity and around the left kidney were considered septic peritonitis. Urinalysis revealed proteinuria and hematuria. Numerous neutrophils with rod-type bacteria were observed in the ascites. Following diagnostic examinations, the patient was diagnosed with extensive left EPN, including inflammatory ascites and abdominal free gas. Therefore, emergency NU of the nonfunctional left kidney and ruptured ureter and thorough abdominal lavage were conducted. Diffuse inflammation and a nephrolith were observed in the section of the harvested kidney. The nephrolith was composed of 100% calcium oxalate monohydrate. The realtime polymerase chain reaction (RT-PCR) test for feline infectious peritonitis (FIP) was negative. Escherichia coli was detected in the ascites, and antibiotic therapy was administered following the antibiotic sensitivity test. The histological findings from the left kidney and ureter included marked chronic inflammation and fibrosis. The patient was discharged 4 days after surgery. During the 8-month follow-up period, the patient's condition improved. Discussion: This was a unique case of EPN in a nondiabetic cat and the first reported case of EPN with a ruptured ureter, including abdominal free gas, inflammatory ascites, and peritonitis. This patient had a bacterial urinary tract infection with E. coli, which is the most frequently isolated pathogen in humans. This gas-forming bacteria produced a massive amount of gas and inflammation that were considered to have ruptured the urinary tract, so that the gas was released into the abdomen. This case corresponded to class 3B, with two risk factors according to the human EPN classification system. Direct NU and abdominal lavage were performed as emergency surgeries. The patient stabilized gradually and showed a good prognosis. Immediate surgical intervention is recommended in animal patients showing the extensive EPN stage.
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Animais , Feminino , Gatos , Peritonite/veterinária , Pielonefrite/cirurgia , Pielonefrite/veterinária , Escherichia coli/isolamento & purificação , Nefroureterectomia/veterináriaRESUMO
Background: The urinary tract is composed by kidneys, urinary bladder and urethra. The kidneys produce urine that achieve urinary bladder by ureters. These have the origin in the renal pelvis, run through the retroperitoneum, end up at the dorsolateral superficies of the urinary bladder, and empty at the trigone. Ureters abnormalities are the rarest congenital defects in the canine urinary tract and ureteroceles are cystic dilatations of the distal segment of the ureter that could be associated to partial or complete urinary obstructions and could lead to megaureter and hydronephrosis. So, the aim of the present study was to describe a case of megaureter by intramural ureteral ectopia in a bitch. Case: A 1-year-old-and-8-month bitch Akita, weighing 18 kg, was referred to the Uniube Veterinary Hospital with vaginal secretion, prostration, hypodipsia, hyporexia and pyrexia related by the tutor. On physical examination, an increase in vulva volume and a vaginal discharge were observed. Nevertheless, others physical exams, blood count and biochemical tests were considered to be within normal parameters. Urinalysis showed cloudy aspect, proteinuria, occult blood, erythrocytes, pyuria, leucocytes, and discreet presence of bacteria. Abdominal ultrasonography revealed a megaureter with right uterocele and excretory urography showed absence of glomerular filtration by right kidney. The patient was submitted to surgery for right kidney and ureter exeresis. Histopathology evaluation showed intense dilation of the ureter and severe multifocal renal fibrosis. The surgery was well succeeded, and the patient recovered completely. Discussion: Once megaureter are associated with congenital abnormalities like ectopic ureter and ureterocele, it is usually diagnosed in young patients with medium age of 10 months, which is below the age of the patient in this case report. Additionally, in the patient here reported, the unilateral alteration could explain the absence of kidney fail symptoms. In more than 90% of the cases, the ureteral ectopia was associated with multiple anomalies in the urinary tract, as was observed in this patient, that presented besides ectopic ureter, ureterocele, megaureter and renal dystrophy. All these morphological alterations made impossible the complete urine elimination, which predispose to urinary tract infection, that was observed in this report. According to literature, urinary tract anomalies are associated with infection in 64 to 85% and 50% of the cases also present hydronephrosis and hydroureter. It was also described that ureteral ectopia is diagnosed by visualization of hydroureter in abdominal ultrasonography. The findings present in this report differs a little, once the right kidney was atrophic possibly by malformation or even so by a chronic renal lesion due to the difficulty in urine flow. The excretory urography showed no filtration in the right kidney, indicating non-functionality that was confirmed by histopathology, in which was observed small glomerulus and large amount of connective tissue deposition. In cases of unilateral megaureter with ipsilateral kidney commitment, there is indication of nephroureterectomy, that was performed in the patient of the present report. As far as we know, this is the first report of megaureter, ureterocele and ectopia ureteral together in the same patient. In conclusion, the procedure was secure, efficient and promote a better quality of life for the patient and prevent the recurrence of urinary tract infections.
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Animais , Feminino , Cães , Ureter/anormalidades , Cistite/veterinária , Nefroureterectomia/veterinária , Sistema Urinário/patologiaRESUMO
Los carcinomas uroteliales son el 4to tumor más común. Pueden ubicarse en el tracto urinario inferior (vejiga y uretra) o en el tracto urinario superior (cavidades renales, pelvis renal y uréter). Presentamos una serie de 3 casos, con cuadro de hematuria macroscópica, documentando tumores uroteliales, realizándose en estos casos un abordaje lumboscópico de riñón y una resección endoscópica del rodete vesical. Se realiza nefroureterectomía lumboscópica con resección de rodete vesical endoscópica transuretral. Los 3 pacientes fueron egresados al segundo día posquirúrgico sin complicaciones y en los tres casos el rodete vesical sin evidencia de actividad tumoral, y actualmente en vigilancia con excelente resultados oncológicos. La nefroureterectomía lumboscópica con resección endoscópica del rodete vesical es una técnica reproducible en manos experimentadas, con iguales resultados oncológicos que el abordaje abierto.
Urothelial carcinomas are the 4th most common tumor. They can be located in the lower urinary tract (bladder and urethra) or in the upper urinary tract (renal cavities, renal pelvis, and ureter). We present a series of 3 cases, with a picture of macroscopic hematuria, documenting urothelial tumors, performing in these cases a lumboscopic approach to the kidney and an endoscopic resection of the bladder rim. Lumboscopic nephroureterectomy was performed with transurethral endoscopic bladder rump resection. The 3 patients were discharged on the second postoperative day without complications and in the three cases the bladder rim without evidence of tumor activity, and currently under surveillance with excellent oncological results. Lumboscopic nephroureterectomy with endoscopic resection of the bladder rim is a reproducible technique in experienced hands, with the same oncological results as the open approach.
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Carcinoma , Uretra , Hematúria , Pelve RenalRESUMO
BACKGROUND: Upper urinary tract urothelial carcinoma (UTUC) represents 5-10% of urothelial carcinomas. It is managed with nephroureterectomy (NUR); however, kidney-sparing techniques are growingly used. AIM: To report the results of a 20-year series of NUR conducted in an academic center. Patients and Methods: Review of clinical and pathological characteristics of patients undergoing NUR between 1999 and 2020. Patients were followed for 63 months. Global survival curves (OS) and mortality predictors were established through Cox regression. RESULTS: We included 90 patients with a median age of 68 years undergoing NUR, of whom 68 (75%) had a pelvic tumor and 22 (25%) had a proximal ureteral tumor. A laparoscopic NUR was performed in 60 patients (66%). Thirty-three patients (37%) had tumors confined to the urothelium (pTa), penetrating the lamina propria (pT1) or carcinoma in situ (CIS), 10 patients (11%) had a tumor spreading to the muscle layer (pT2) and 47 (52%) had a tumor spreading to nearby organs (pT3 / T4). Average tumor size was 3.69 cm, nodal disease (pN) was present 12 patients (13%). Twelve patients (13%) received adjuvant chemotherapy. A higher mortality was observed among smokers (Hazard ratio (HR) 8.79, 95% confidence intervals (CI) 1.5-49.0, p = 0.01), patients with tumors classfied as pT≥ 2 (HR 1.09, 95% CI 0.01-1.0, p = 0.04) and those with tumors larger than 2 cm (HR 14.79, CI 95% 1.5-272, p = 0.01). CONCLUSIONS: Smoking patients, those with invasive tumors (T2-T4) and greater than 2 cm have higher mortality. Therefore, they should not be candidates for conservative management.
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Humanos , Idoso , Neoplasias Ureterais/cirurgia , Neoplasias Ureterais/patologia , Neoplasias da Bexiga Urinária/cirurgia , Carcinoma de Células de Transição/cirurgia , Carcinoma de Células de Transição/patologia , Neoplasias Renais/cirurgia , Prognóstico , Estudos Retrospectivos , NefroureterectomiaRESUMO
ABSTRACT Purpose: Epidemiological studies reported conflicting results about preoperative hydronephrosis in upper tract urothelial carcinoma (UTUC). This study aimed to investigate the association between preoperative hydronephrosis and pathologic features and oncologic outcomes in patients with UTUC treated by radical nephroureterectomy (RNU). Materials and Methods: This was a retrospective, single-center cohort study of 377 patients treated by RNU without perioperative chemotherapy between January 2001 and December 2014. Logistic regression, Cox regression, and survival analyses were performed. Results: Among the 226 patients with high-grade UTUC, 132 (58%) had preoperative hydronephrosis. Multivariable logistic regression revealed that hydronephrosis was independently associated with advanced pT stage (P=0.017) and lymph node or lymphovascular invasion (P=0.002). Median follow-up was 36 months (interquartile range: 20-48 months). The 3- and 5-year overall survival (OS) rates in patients with hydronephrosis were significantly lower than in those without hydronephrosis (both P <0.001). The 3- and 5-year cancer-specific survival (CSS) rates in patients with hydronephrosis were significantly lower than in those without hydronephrosis (both P=0.001). Hydronephrosis was independently associated with OS and CSS (P=0.001 and P=0.004, respectively). Among the 151 patients with low-grade UTUC, hydronephrosis was not associated with pathologic features and postoperative survival. Conclusions: Preoperative hydronephrosis was significantly associated with adverse pathologic features and postoperative survival in patients with high-grade UTUC.
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Humanos , Carcinoma de Células de Transição/cirurgia , Carcinoma de Células de Transição/complicações , Neoplasias Urológicas/cirurgia , Neoplasias Urológicas/complicações , Hidronefrose , Prognóstico , Estudos Retrospectivos , Estudos de CoortesRESUMO
PURPOSE: Epidemiological studies reported conflicting results about preoperative hydronephrosis in upper tract urothelial carcinoma (UTUC). This study aimed to investigate the association between preoperative hydronephrosis and pathologic features and oncologic outcomes in patients with UTUC treated by radical nephroureterectomy (RNU). MATERIALS AND METHODS: This was a retrospective, single-center cohort study of 377 patients treated by RNU without perioperative chemotherapy between January 2001 and December 2014. Logistic regression, Cox regression, and survival analyses were performed. RESULTS: Among the 226 patients with high-grade UTUC, 132 (58%) had preoperative hydronephrosis. Multivariable logistic regression revealed that hydronephrosis was independently associated with advanced pT stage (P=0.017) and lymph node or lymphovascular invasion (P=0.002). Median follow-up was 36 months (interquartile range: 20-48 months). The 3- and 5-year overall survival (OS) rates in patients with hydronephrosis were significantly lower than in those without hydronephrosis (both P <0.001). The 3- and 5-year cancer-specific survival (CSS) rates in patients with hydronephrosis were significantly lower than in those without hydronephrosis (both P=0.001). Hydronephrosis was independently associated with OS and CSS (P=0.001 and P=0.004, respectively). Among the 151 patients with low-grade UTUC, hydronephrosis was not associated with pathologic features and postoperative survival. CONCLUSIONS: Preoperative hydronephrosis was significantly associated with adverse pathologic features and postoperative survival in patients with high-grade UTUC.
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Carcinoma de Células de Transição , Hidronefrose , Neoplasias Urológicas , Carcinoma de Células de Transição/complicações , Carcinoma de Células de Transição/cirurgia , Estudos de Coortes , Humanos , Prognóstico , Estudos Retrospectivos , Neoplasias Urológicas/complicações , Neoplasias Urológicas/cirurgiaRESUMO
ABSTRACT Purpose: To investigate the association between preoperative retrograde pyelography (RGP), conducted to evaluate upper tract urothelial carcinoma (UTUC), and intravesical recurrence (IVR) after radical nephroureterectomy (RNU). Materials and Methods: Of 114 patients that underwent RNU, 72 patients without preoperative ureteroscopy and a history of bladder tumor were selectively enrolled. Variables associated with IVR were identified. Results: RGP was performed at a mean duration of 24.9 days prior to RNU in 41 (56.1%) of study subjects. During the mean follow-up period of 64.5 months, IVRs were identified in 32 (44.4%) patients at 22.3±18.8 (mean±SD) months after RNU. Despite similar tumor characteristics in the RGP and non-RGP groups, the incidence of IVR was considerably higher in the RGP group (63.4%) than in the non-RGP group (19.4%, p <0.001). The following variables differed significantly between the IVR and non-IVR groups: age (64.6±8.51 vs. 59.6±9.65 years), tumor location (lower or upper; 53.1% vs. 20%), tumor invasiveness (> pT2; 53.1% vs. 17.5%), preoperative hemoglobin (12.8±1.36 vs. 13.9±1.65), preoperative creatinine (1.29±0.32 vs. 1.11±0.22), and preoperative RGP (81.3% vs. 37.5%), respectively. Multivariate Cox regression model showed that tumor location (p=0.020, HR=2.742), preoperative creatinine level (p=0.004, HR=6.351), and preoperative RGP (p=0.045, HR=3.134) independently predicted IVR. Conclusion: Given the limitations of retrospective single-center series, performance of RGP before RNU was shown to have a negative effect on IVR after surgery.
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Humanos , Carcinoma de Células de Transição/cirurgia , Carcinoma de Células de Transição/diagnóstico por imagem , Neoplasias Urológicas/diagnóstico por imagem , Nefroureterectomia , Urografia , Estudos Retrospectivos , Recidiva Local de Neoplasia/diagnóstico por imagem , NefrectomiaRESUMO
OBJECTIVE: Once chronic inflammatory renal disease (IRD) develops, it creates a severe peri-fibrotic process, which makes it a relative contraindication for minimally invasive surgery (MIS). Our objective is to show that laparoscopic nephrectomy (LN) is a surgical option in IRD with fewer complications and better outcomes. METHODS: Retrospective review of patients who underwent a modified-surgical laparoscopic transperitoneal nephrectomy was performed. Data search included all operated patients between May 2013 and May 2018 that had a pathology result with any renal inflammatory condition (xanthogranulomatous pyelonephritis, chronic nephritis, and renal tuberculosis). We describe intra-operative variables such as operative time, blood loss, conversion rate, postoperative complications and length of hospital stay. RESULTS: There were 51 patients who underwent laparoscopic nephrectomy with a confirmatory pathology report for IRD. We identified four (8%) major complications; three of them required transfusion and one conversion to open surgery. The mean operative time was 233±108 min. Mean estimated blood loss was 206±242 mL excluding the conversion cases and 281±423 mL including them. The mean length of hospital stay was 3.0±2.0 days. CONCLUSION: Laparoscopic nephrectomy for IRD can safely be done. It is a reproducible technique with low risks and complication rates. Our experience supports that releasing the kidney first and leaving the hilum for the end is a safe approach when vascular structures are embedded into a single block of inflammatory and scar tissue.
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PURPOSE: To investigate the association between preoperative retrograde pyelography (RGP), conducted to evaluate upper tract urothelial carcinoma (UTUC), and intravesical recurrence (IVR) after radical nephroureterectomy (RNU). MATERIALS AND METHODS: Of 114 patients that underwent RNU, 72 patients without preoperative ureteroscopy and a history of bladder tumor were selectively enrolled. Variables associated with IVR were identified. RESULTS: RGP was performed at a mean duration of 24.9 days prior to RNU in 41 (56.1%) of study subjects. During the mean follow-up period of 64.5 months, IVRs were identified in 32 (44.4%) patients at 22.3±18.8 (mean±SD) months after RNU. Despite similar tumor characteristics in the RGP and non-RGP groups, the incidence of IVR was considerably higher in the RGP group (63.4%) than in the non-RGP group (19.4%, p <0.001). The following variables differed significantly between the IVR and non-IVR groups: age (64.6±8.51 vs. 59.6±9.65 years), tumor location (lower or upper; 53.1% vs. 20%), tumor invasiveness (> pT2; 53.1% vs. 17.5%), preoperative hemoglobin (12.8±1.36 vs. 13.9±1.65), preoperative creatinine (1.29±0.32 vs. 1.11±0.22), and preoperative RGP (81.3% vs. 37.5%), respectively. Multivariate Cox regression model showed that tumor location (p=0.020, HR=2.742), preoperative creatinine level (p=0.004, HR=6.351), and preoperative RGP (p=0.045, HR=3.134) independently predicted IVR. CONCLUSION: Given the limitations of retrospective single-center series, performance of RGP before RNU was shown to have a negative effect on IVR after surgery.
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Carcinoma de Células de Transição , Nefroureterectomia , Neoplasias Urológicas/diagnóstico por imagem , Carcinoma de Células de Transição/diagnóstico por imagem , Carcinoma de Células de Transição/cirurgia , Humanos , Recidiva Local de Neoplasia/diagnóstico por imagem , Nefrectomia , Estudos Retrospectivos , UrografiaRESUMO
Upper tract urothelial cancers (UTUC) are frequently managed by radical nephroureterectomy (RNU), a major operative procedure that may entail short-term morbidity and long-term decline in renal function. Kidney-sparing procedures offer a less invasive alternative to RNU for low-risk, low-grade UTUC (LG-UTUC). They are associated with similar disease-specific survival rates and better long-term renal function, albeit with a potentially increased risk of recurrence. Strategies to decrease LG-UTUC recurrence include improved risk stratification and enhanced endoscopic instrumentation. Chemoablation may represent an alternative, innovative kidney-sparing approach for LG-UTUC.
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RESUMEN Fundamento: los tumores del urotelio se originan a partir del epitelio de revestimiento mucoso de tipo transicional y constituyen la casi totalidad de los tumores de las vías excretoras, altos. El adenocarcinoma primario de las vías urinarias, son extremadamente infrecuentes y suelen tener un comportamiento agresivo, con un pronóstico sombrío. Objetivo: exponer la forma de presentación de un paciente con carcinoma urotelial mostrando algunas características de los mismos. Presentación de caso: paciente masculino de 70 años de edad, jubilado, fumador inveterado y con antecedentes de ingerir café en grandes cantidades, acudió a consulta por hematuria macroscópica, dolor lumbar, a veces fijo, otras veces en forma de cólicos ureterales y fiebre de 39 grados. El estudio analítico solo mostró velocidad de deshidrogenasa láctica alterada. El estudio imagenológico con ecografía mostró hidronefrosis e ilio derecho agrandado con imagen heterogénea de 2 cm en el riñón, a nivel de la unión uretero pélvica, lo cual fue corroborado por la tomografía axial computarizada. El resto de los exámenes como endoscopia, colonoscopía, cistoscopia y de diferentes regiones fueron todos negativos. Se practicó nefroureterectomía derecha, encontrándose el paciente asintomático. Conclusiones: los tumores del urotelio superior son neoplasias infrecuentes, en las vías urinarias se debe descartar un origen extraurológicos. El diagnóstico diferencial debe de realizarse con el tumor de células renales o el de vejiga.
ABSTRACT Background: the urothelial carcinomas originate from the epithelium of mucous revetment of transitional type and constitute almost totality of the tumors of the excretory, high routes. The primary adenocarcinoma of the urinary tract, are extremely infrequent and they usually have an aggressive behavior, with a shaded prognosis. Objective: to express the way of presenting a patient with urothelial carcinoma showing some aspects from the sicknesses. Case report: a 70-years-old male patient, retired, inveterate smoker and with a history of ingesting coffee in large quantities, attended consultation for gross hematuria, lumbar pain, sometimes fixed, other times in the form of ureteral colic and fever of 39 degrees. The analytical study only showed altered lactic dehydrogenase rate. The imaging study with ultrasound showed hydronephrosis and enlarged right ilium with heterogeneous image of 2 cm in the kidney, at the level of the pelvic ureter junction, which was corroborated by computerized axial tomography. The rest of the examinations such as endoscopy, colonoscopy, and cystoscopy of different regions were all negative. Right nephroureterectomy was performed, and the patient is still asymptomatic. Conclusions: the tumors of the upper urothelium are infrequent neoplasias, in the urinary tract an extraurological origin must be ruled out. The differential diagnosis must be made with the renal cell tumor or the bladder tumor.
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ABSTRACT Objective: To evaluate the safety and feasibility of total retroperitoneal laparoscopic nephroureterectomy with urinary-bladder junction resection for a tuberculous nonfunctional kidney. Materials and Methods: A total of 27 individuals diagnosed with unilateral nonfunctional kidney secondary to tuberculosis were treated between June 2011 and June 2015. All patients had normal renal function on the contralateral side and underwent the standard four-drug anti-tuberculosis treatment for at least four weeks before surgery. Total retroperitoneal laparoscopic nephroureterectomy was performed in all patients, and the urinary-bladder junction of distal ureter was managed using different auto-suture techniques. Results: Nineteen male and 8 female patients with an average age of 47.3 years (range, 36-64 years) underwent surgery. All the operations were successfully performed without conversion. The median operative time was 109.3 min (range, 75-138 min), the median blood loss was 157.5 mL (range, 70-250 mL), and the median hospitalization time was 3.7 days (range, 3-6 days). No serious perioperative complications occurred. Anti-tuberculosis chemotherapy was prescribed to all patients, with the entire course of treatment lasting six months. No recurrence of tuberculosis of the bladder or the contralateral kidney was observed during the median follow-up period of 26.7 months (range, 6-54 months). Conclusion: Retroperitoneal laparoscopic nephroureterectomy with urinary-bladder junction resection is a safe and feasible approach for the treatment of tuberculous non-functional kidneys.
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Humanos , Masculino , Feminino , Adulto , Tuberculose Renal/cirurgia , Laparoscopia/métodos , Nefroureterectomia/métodos , Espaço Retroperitoneal/cirurgia , Resultado do Tratamento , Duração da Cirurgia , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To evaluate the safety and feasibility of total retroperitoneal laparoscopic nephroureterectomy with urinary-bladder junction resection for a tuberculous non-functional kidney. MATERIALS AND METHODS: A total of 27 individuals diagnosed with unilateral non-functional kidney secondary to tuberculosis were treated between June 2011 and June 2015. All patients had normal renal function on the contralateral side and underwent the standard four-drug anti-tuberculosis treatment for at least four weeks before surgery. Total retroperitoneal laparoscopic nephroureterectomy was performed in all patients, and the urinary-bladder junction of distal ureter was managed using different auto-suture techniques. RESULTS: Nineteen male and 8 female patients with an average age of 47.3 years (range, 36-64 years) underwent surgery. All the operations were successfully performed without conversion. The median operative time was 109.3 min (range, 75-138 min), the median blood loss was 157.5 mL (range, 70-250 mL), and the median hospitalization time was 3.7 days (range, 3-6 days). No serious perioperative complications occurred. Anti-tuberculosis chemotherapy was prescribed to all patients, with the entire course of treatment lasting six months. No recurrence of tuberculosis of the bladder or the contralateral kidney was observed during the median follow-up period of 26.7 months (range, 6-54 months). CONCLUSION: Retroperitoneal laparoscopic nephroureterectomy with urinary-bladder junction resection is a safe and feasible approach for the treatment of tuberculous non-functional kidneys.
Assuntos
Laparoscopia/métodos , Nefroureterectomia/métodos , Tuberculose Renal/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Espaço Retroperitoneal/cirurgia , Resultado do TratamentoRESUMO
PURPOSE: To investigate the association between sarcopenia and sarcopenic obesity on clinical, perioperative, and oncologic outcomes in patients with upper-tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU). METHODS: Retrospective review of our institutional UTUC database was performed to identify all patients who underwent radical nephroureterectomy from 2002-2016. Skeletal Muscle Index (SMI) was measured at the L3 vertebral level and standardized according to patient height (cm2/m2). Sarcopenia was defined as<55cm2/m2 for men and<39cm2/m2 for women. Sarcopenic obesity was also assessed in patients with BMI>30kg/m2. Unadjusted logistic regression and Wilcoxon rank sum tests examined the relationship between sarcopenia and variables. RESULTS: A total of 100 patients (66 men and 34 women) with a mean age of 68 years, BMI of 30, Charlson comorbidity index of 4.0, tumor size of 3.5, and SMI of 50.8cm2/m2 were included. Furthermore, 42 patients (42%) were sarcopenic, and 18 patients (18%) had sarcopenic obesity. Median EBL was 150ml, OR duration was 322 minutes, and length of stay was 5.0 days. Sarcopenia was associated with several clinical factors including decreasing BMI, male sex, and coronary artery disease, albeit without association with any perioperative or oncologic outcomes. Sarcopenic obesity was similarly associated with several clinical variables including male sex, diabetes mellitus, hyperlipidemia, as well as increased EBL (P = 0.047) and non-bladder cancer disease relapse (P = 0.049). CONCLUSIONS: This contemporary cohort of patients undergoing RNU highlights the association of nonmodifiable risk factors with sarcopenia and disease relapse with sarcopenic obesity. Larger studies are necessary to further validate these observations.
Assuntos
Carcinoma de Células de Transição/cirurgia , Recidiva Local de Neoplasia/epidemiologia , Nefroureterectomia , Obesidade/epidemiologia , Sarcopenia/epidemiologia , Neoplasias Urológicas/cirurgia , Idoso , Biomarcadores Tumorais , Índice de Massa Corporal , Carcinoma de Células de Transição/mortalidade , Carcinoma de Células de Transição/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/patologia , Recidiva Local de Neoplasia/patologia , Obesidade/complicações , Obesidade/diagnóstico por imagem , Período Perioperatório , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Sarcopenia/complicações , Sarcopenia/diagnóstico por imagem , Resultado do Tratamento , Neoplasias Urológicas/mortalidade , Neoplasias Urológicas/patologiaRESUMO
Purpose To present our surgical techniques and experiences of retroperitoneal laparoscopic nephroureterectomy for the treatment of tuberculous nonfunctioning kidneys. Materials and Methods From March 2005 to March 2013, a total of 51 patients with tuberculous nonfunctioning kidney underwent retroperitoneal laparoscopic nephroureterectomy at our medical center. The techniques included early control of renal vessels and dissection of the diseased kidney along the underlying layer outside the Gerato’s fascia. The distal ureter was dissected through a Gibson incision and the entire specimen was removed en bloc from the incision. Patient demographics, perioperative characteristics and laboratory parameters as well as postoperative outcome were retrospectively reviewed. Results Retroperitoneal laparoscopic nephroureterectomy was successfully performed in 50 patients, whereas one case required conversion to open surgery due to non-progression of dissection. The mean operating time was 123.0 minutes (107-160 minutes) and the mean estimated blood loss was 134 mL (80-650 mL).The mean postoperative hospital stay was 3.6 days (3-5days) and the mean return to normal activity was 11.6 days (10-14days). Most intra-operative and post-operative complications were minor complications and can be managed conservatively. After 68 months (12-96 months) follow-up, the outcome was satisfactory, and ureteral stump syndrome did not occur. Conclusions Retroperitoneal laparoscopic nephroureterectomy as a minimally invasive treatment option is feasible for treatment of tuberculous nonfunctioning kidneys. .
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Rim/cirurgia , Laparoscopia/métodos , Nefrectomia/métodos , Tuberculose Renal/cirurgia , Ureter/cirurgia , Seguimentos , Complicações Intraoperatórias , Tempo de Internação , Duração da Cirurgia , Complicações Pós-Operatórias , Reprodutibilidade dos Testes , Espaço Retroperitoneal/cirurgia , Fatores de Tempo , Resultado do TratamentoRESUMO
Las indicaciones para el manejo mínimamente invasivo de los tumores del tracto urinario superior están en constante expansión. El desarrollo de equipamiento endoscópico cada vez más sofisticado ha llevado a un cambio en la práctica diaria y a una tendencia al manejo conservador. Nuestro objetivo es revisar las diferentes opciones de manejo mínimamente invasivo para el manejo de los tumores del tracto urinario superior, con énfasis en laparoscopia, ureteroscopia y cirugía percutánea.
The indications for minimally invasive treatment for are expanding. The development of more sophisticated endoscopic equipment has led to changes in everyday practice and a trend towards more conservative management. Our objective is to make a review of the different options for management UUT-TCC, with emphasis in laparoscopy, ureteroscopy and percutaneous surgery.
Assuntos
Humanos , Carcinoma de Células de Transição/cirurgia , Nefrectomia/métodos , Neoplasias Urológicas/cirurgia , Ureter/cirurgia , Laparoscopia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Sistema Urinário/cirurgia , UreteroscopiaRESUMO
Objetivo: Revisar os métodos disponíveis para avaliar a função renal, a fisiopatologia da obstrução ureteral, a nefro litíase e a ureter litíase, bem como os achados laboratoriais, radiográficos, ultrassonográficos e indicações cirúrgicas relacionados à ureter litíase obstrutiva em cães. Fontes Consultadas: Foram pesquisadas as bases de dados AGRlS de 1975 a 2004, Biological Abstracts de 1998 a 2003, CAB Abstracts de 1990 a 2004, Medline de 1966 a 2004 e o acervo da Biblioteca da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo, São Paulo, SP. Síntese dos Dados: A presença de lesões renais irreversíveis ou a funcionalidade comprometida do rim, associada à função normal do contralateral, está relacionada à decisão de realizar-se a ureteronefrectomia, em vez da uterotomia, nas ureter litíases obstrutivas. Em teoria, estimar a quantidade do prejuízo funcional ao rim ajuda a decidir entre preservar ou remover o rim e o ureter afetados, porém, na prática, determinar a contribuição relativa do rim acometido e do contralateral à função renal total é difícil. Conclusões: A redução da função renal no rim afetado é uma sequela comum da obstrução ureteral, todavia, o grau de sua recuperação depois da ocorrência natural de obstrução ureteral em cães e gatos ainda não é conhecido. Na dúvida sobre a irreversibilidade da lesão renal, tentativas de desobstrução ureteral e eliminação de sua causa devem ser sempre consideradas, visto que ao menos uma recuperação parcial da função renal pode ser possível.
Objective: To review the methods of renal function evaluation available, the pathophysiology of ureteral obstruction, the nephrolithiasis and ureterolithiasis, the laboratory, radiographic and ultrasonography findings and the surgical indications related lo canine obstructive uretero lithiasis. Data Sources: AGRlS (from1975 lo 200), Biological Abstracts(from 1998 to 2003), CAB Abstracts (from 1990 to 2004) and Medline (from 1966 to 2004) databases and the collection of the library of the Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo (School of Veterinary Medicine and Animal Science of the University of São Paulo), São Paulo, Brazil. were consulted. Data Synthesis: 1rreversible damage OI' compromised kidney function, associated to a normal functioning contralateral! kidney, supports the decision for performing an ureteronephrectomy instead of an ureterotomy when obstructive ureterolithiasis occurs. In theory, estimating the amount of fictional damage to the kidney helps to decide whether to preserve OI' remove the affected kidney and ureter; however, estimating the relative contribution of the affected and the contralateral kidney to lhe total renal fimction is difficult in practice. Conclusions: The reduced junction of the affected kidney is a cOl/1l/1on consequence of ureteral obstruction, but the degree of recovery afield' the natural occurrence of this disease in dogs and cats has not yet been established. When in doubt as to the irreversibility of the renal damage, attempts to achieve ureteral desobstruction and treatment of the underlying causes should always be considered, once at least a partial! recovery of the renal function may be possible.
Objetivo: Revisar los métodos disponibles para evaluar la función renal, la fisiopatología de la obstrucción del uréter, la nefrolitiasis y la ureterolitiasis, los datos laboratoriales, radiográficos y ecográficos e indicaciones quirúrgicas relacionados a la ureterolitiasis obstructiva en perros. Fuentes Consultadas: Se investigaron las bases de datos AGRlS de 1975 a 2004, Biological Abstracts de 1998 a 2003, CAB Abstracts de 1990 a 2004, Medline de 1966 a 2004 y el acervo de la Biblioteca de la Faculdad de Medicina Veterinaria y Zootecnia de la Universidad de São Paulo, São Paulo, Sp, Brasil. Síntesis de los Datos: Los daños irreversibles o el comprometimiento de la función del riñón, asociado a la función normal del contralateral, están relacionados a la decisión de realizar la ureteronefrectomía en vez de ureterotomía, en los casos de ureterolitiasis obstructivas. En teoría, calcular la cantidad de daño funcional del rufián, ayuda a decidir entre preservar o retirar el riñón y uréter afectados, pero en la práctica, determinar la contribución relativa del riñón comprometido y del contralateral a la función renal total se hace difícil. Conclusiones: La reducción de la función renal en el riñón afectado es una secuela común de la obstrucción natural del uréter, pero el grado de recuperación después de la obstrucción del uréter en perros y gatos se desconoce. En la duda sobre la irreversibilidad de la lesión renal, intentos de desobstrucción del uréter y eliminación de su causa deben ser siempre consideradas, porque ai menos una recuperación parcial de la función renal es posible.