Urogenital neoplasias frequently progress with obstructive uropathy due to local spreading or pelvic metastases. The urinary obstruction must be immediately relieved in order to avoid deterioration ...in these patients. The percutaneous nephrostomy is a safe and effective method for relief the obstruction; however the indications of such procedures have been questioned in patients with poor prognosis.
A retrospective study was performed with 43 patients (29 female and 14 male) with urogenital neoplasias who were undergoing percutaneous nephrostomy during a 54-month period. The median age was 52 years. The primary tumoral site was the uterine cervix in 53.5% of patients, the bladder in 23.3%, the prostate in 11.6% and other sites in 11.6%.
Postoperative complications occurred in 42.3% of the patients. There was no procedure-related mortality. Thirty-nine per cent of the patients died during the hospitalization period due to advanced neoplasia. The mortality rate was higher in patients with prostate cancer (p = 0.006), in patients over 52 years of age (p = 0.03) and in those who required hemodialysis before the procedure (p = 0.02). Thirty-two per cent of the patients survived long enough to undergo some form of treatment focused on the primary tumor. The survival rate was 40% at 6 months and 24.2% at 12 months. The percentage of the lifetime spent in hospitalization was 17.7%. The survival rate was higher in patients with neoplasia of the uterine cervix (p = 0.007) and in patients with 52 years of age or less (p = 0.008).
Morbidity was high in this patient group; however, the majority of patients could be discharged from hospital and followed at home. Patients under 52 years of age and patients with neoplasia of the uterine cervix benefited most from the percutaneous nephrostomy when compared to patients with hormone therapy-refractory prostate cancer, bladder cancer or over 52 years of age.
Abstract Pleural effusions have not been reported after percutaneous cryoablation of the kidney. In our initial experience, we identified and treated two patients who had the complication of ...hemothorax after percutaneous cryoablation for renal malignancy. The occurrence of pleural effusions is frequently related to technical aspects of the procedure. The pathogenesis of this serious complication is discussed and preventive measures are highlighted.
To assess the incidence of conversion from laparoscopic partial nephrectomy (LPN) to open surgery or laparoscopic radical nephrectomy (LRN) when liberal selection criteria are utilized.
A ...retrospective review of medical records was done for all patients scheduled for LPN at our institution from January 2000 through March 2004. The preoperative risk factors, intraoperative course, and pathologic outcomes of patients who were converted to LRN were compared with those of the cohort of patients who underwent LPN as originally scheduled.
Among the 257 operations that started as LPN, 35 (13.6%) were converted to LRN and 4 (1.6%) to open surgery. Age, tumor size, operating time, and hypertension were significantly higher in patients requiring conversion in than those who underwent completed LPN. Patients over the age of 70 had a 3.8-fold higher risk of requiring conversion, and, independent of age, patients with tumor>4.0 cm had a 4-fold increase in the likelihood of conversion to LRN.
Of the preoperatively determined factors compared across the cohort of patients who underwent LPN and the cohort of patients converted to LRN, only tumor size and patient age were predictive of an increased risk of conversion. Other variables, including sex, side of affected kidney, clinical stage, ASA score, comorbidity with hypertension or diabetes mellitus, and surgeon were not significant in predicting conversion.
The purpose of this cross-sectional study was to evaluate patients’ satisfaction and urodynamic findings in women undergoing pubovaginal fascial sling procedure. We have evaluated, clinically and ...urodynamically, 45 women who underwent the rectus fascia pubovaginal sling for urodynamically proven stress urinary incontinence with at least 12 months of postoperative follow-up. After a mean follow-up of 25 months, 93.3% of patients reported being stress continent and 73.3% were satisfied with the result of the surgery. Patients with longer follow-up had a significantly lower satisfaction score (6.4 vs. 9.3,
p
= 0.005). Using the Blaivas–Groutz nomogram, some degree of obstruction was observed in 51.1% of women. Storage symptoms were related to obstruction (
p
= 0.004), longer follow-up (
p
= 0.022), and negative impact on quality of life. Half of the patients had some degree of obstruction, which was directly related to urge syndrome and decrease in quality of life.
To evaluate the reasons why patients reject digital rectal examination (DRE) when screening for prostate cancer.
Four hundred and fifty men were prospectively evaluated in a prostate cancer ...educational program consisting of lectures, PSA testing, and DRE. Patients rejecting DRE were compared with those accepting DRE in regard to epidemic, social and cultural variables.
DRE was rejected by 8.2% of patients. Refusal rate was not different when patients were stratified by age, prostate cancer family history, school level, family income, and PSA level. Patients with a prior history of DRE had a lower rejection rate than those undergoing DRE for the first time (4.4% vs. 10.4%, p = 0.038). Patients with mild or no lower urinary tract symptoms rejected DRE more frequently than those with moderate or severe symptoms (9.6% vs. 1.4%, p = 0.018). Misconceptions about prostate cancer screening were present in 84.4% of those rejecting DRE vs. 46.9% of controls (p = 0.002); 43.7% expected severe discomfort in the group that rejected DRE vs. 28. 1% in the control group (p = 0.090); fear of finding a cancer during DRE was present in 34.4% of patients that refused DRE vs. 46.9% of controls (p = 0. 121); and 53.1% of patients rejecting DRE responded it was a source of shame vs. 15.6% of patients in the control group (p = 0.019).
The main reasons patients reject DRE when attending prostate cancer screening are the lack of lower urinary tract symptoms, misconceptions about prostate cancer screening and shame, especially when undergoing screening for the first time.
Paratesticular sarcomas in Brazil Korkes, Fernando; Castro, Marília G; Romero, Frederico R ...
Urologia internationalis,
01/2009, Letnik:
82, Številka:
4
Journal Article
Recenzirano
Paratesticular sarcomas are rare and frequently reported as isolated case reports. Studies evaluating the relative frequency of the paratesticular sarcomas are limited, and to the best of our ...knowledge, this is the first study of paratesticular sarcomas in the Brazilian population.
Medical records of all patients undergoing treatment for paratesticular sarcomas between 1993 and 2006 were retrieved from the archives of our institution.
Complete data from 12 patients (39 +/- 23 years, range 13-78) with paratesticular sarcomas were available, which represented 6.7% of all orchiectomies performed for testicular malignancies in the same period. At the time of diagnosis, 3 patients had retroperitoneal spread of the disease, all of which had elevated serum lactic dehydrogenase levels. The remaining 9 patients had normal serum markers. There were 6 rhabdomyosarcomas, 4 leiomyosarcomas, 1 liposarcoma and 1 undifferentiated sarcoma. Median follow-up was 31.4 months. Primary surgical excision by inguinal approach was performed in all cases (radical orchiectomy in 10 and preservation of the testis in 2). Retroperitoneal lymph node dissection was performed in 3 patients and excision of the hemiscrotum in 1. Eight patients received adjuvant chemotherapy. Mean overall survival time was 27.8 +/- 6.2 months after orchiectomy.
Patients with paratesticular sarcomas are at high risk of disease progression, and systemic relapse remains a significant problem, determining poor prognosis. The high risk of local recurrence demands long-term follow-up, and intraoperative frozen section analysis might be of benefit. Elevated lactic dehydrogenase might also be a marker of retroperitoneal disease and poor prognosis. Improvement in survival requires effective systemic adjuvant therapy.
Well leg compartment syndrome is rare after laparoscopic radical prostatectomy. We report a 68-year-old man that developed compartment syndrome after laparoscopic radical prostatectomy for prostate ...cancer. There are several circumstantial risk factors associated with LRP that, when combined, may potentially predispose to the development of compartment syndrome, including: obesity, evidence of peripheral vascular disease (advanced age, hypertension, hyperlipidemia, and diabetes mellitus), thromboembolism prophylaxis with compressive leg wraps together with intermittent pneumatic devices, combined general-spinal anesthesia, prolonged operative time in Trendelenburg position, and systemic hypotension due to intraoperative bleeding. The pathogenesis of this serious complication is discussed and preventive measures are highlighted.
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