International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology最新文献

{"title":"Analysis of surgeon biometrics during open and robotic radical cystectomy with electromyography and motion capture analysis","authors":"A. Baumgarten, J. Kim, J. Robison, J. Mayer, Dustin D. Hardwick, T. Patel","doi":"10.1590/S1677-5538.IBJU.2019.0163","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2019.0163","url":null,"abstract":"ABSTRACT Purpose: To determine feasibility of measuring surgeon physical stress during both open radical cystectomy (ORC) and robotic radical cystectomy (RRC). Materials and Methods: One patient underwent ORC, while the other underwent RRC by a single surgeon. The diversion was excluded from this study. Noraxon® myoMOTION™ kinematics sensors were used to quantify the amount of joint and segmental motion of the spine, shoulders, and head. myoMUSCLE™ EMG sensors were used to measure activation levels, patterns, and fatigue characteristics of key muscle groups. The Prone Static Plank Test (PSPT) and Modified Biering-Sorensen Test (MBST) were used to assess surgeon strength and endurance of core musculature. Results: The surgeries were represented in five stages. During ORC, the percentage of time spent in cervical flexion was 98%, 91.8%, 87.5%, 100%, and 97.1%, respectively. During RRC, 100% of the time was spent in cervical flexion. Activation of key muscle groups was examined across all stages and expressed as a percentage of peak activation. MBST times were both 25 second pre-and post-surgery ORC and 25.1 seconds pre-surgery and 32.4 seconds post-surgery for RRC. PSPT times were 68 second pre-surgery and 48 seconds post-surgery for ORC, and 59 second pre-surgery and 51 seconds post-surgery for RRC. Conclusion: We were able to identify meaningful data using kinematic and EMG analysis during ORC and RRC. We were able to identify target muscle groups that will be used to conduct a larger study with multiple surgeons to help determine if there is an ergonomic advantage to RRC over traditional ORC.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"46 1 1","pages":"138 - 138"},"PeriodicalIF":0.0,"publicationDate":"2020-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89571766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Apical sling for laparoscopic sacrohisteropexy in a young virgin patient with joint hypermobility syndrome","authors":"Alcidézio Farias Santana, R. Richetti, S. Hwang, T. Nzenza, L. Toledo","doi":"10.1590/S1677-5538.IBJU.2018.0746","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2018.0746","url":null,"abstract":"ABSTRACT Introduction: We are faced with a young patient with uterine prolapse and urinary difficulties due to Joint Hypermobility Syndrome, a congenital collagen disease that predisposes woman to the development of pelvic organ prolapse. The patient had urinary difficulty requiring standing and bowing to reduce prolapse and then start urination. This video demonstrates that videolaparoscopic technique is feasible for the treatment of uterine prolapse in young and sexually virgin woman. Materials and Methods: We separated the bladder from vagina and opened the peritoneum anterior to the uterus. Next, we attached the sigmoid colon to the left abdominal wall in order to better expose the promontory. We then opened the peritoneum posterior to the uterus and medially tunnelled the right uterosacral ligament, transfixing the broad ligament and passing the end of a polypropylene mesh through this tunnel to the posterior region of the uterus. The same maneuver was performed on the other side so that the mesh surrounded the anterior portion of the cervix while its two extremities were posterior to the uterus. The mesh was fixed on the anterior surface of the uterine cervix and its two extremities were fixed to the promontory in the anterior longitudinal ligament of the spine. Finally, we closed the peritoneum. Results: Uterine prolapse was corrected, with good recovery. Conclusions: Videolaparoscopic technique is feasible for correction of uterine prolapse, being effective and safe in virgin woman.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"30 1","pages":"139 - 139"},"PeriodicalIF":0.0,"publicationDate":"2020-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72740283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High mortality rates after radical cystectomy: we must have acceptable protocols and consider the rationale of cutaneous ureterostomy for high-risk patients","authors":"F. Korkes, J. Palou","doi":"10.1590/S1677-5538.IBJU.2019.06.03","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2019.06.03","url":null,"abstract":"Bladder cancer is a common disease, and for T2-T4 stages, radical cystectomy is the first treatment option (1). An interesting Swedish study has evaluated the natural history of urothelial bladder cancer. After 6 months of diagnosis, 38% of patients develop metastasis if untreated (2). Five-year Cancer-specific survival is as low as 14% in such scenery, and overall survival is only 5% (2). On the other hand, if treated these patients have a 5-year CSS and OS of 60% and 48% respectively (2). Radical cystectomy is, therefore, the first option, as it is also stated by the EAU, NCCN, AUA / ASCO / ASTRO / SUO guidelines/consensus (3-5) is associated with a significant survival gain in comparison to observation (2), to multiple resections, chemotherapy or radiotherapy (6). In patients with stage II disease, cystectomy is associated with a three-fold increase in survival, increasing mean overall survival from 16 to 45 months (6). In a SEER study evaluating 328,560 patients, radical cystectomy and chemotherapy were the only factors associated with improvements in survival (7). Trimodal “bladder-sparing” approaches that combine maximal transurethral resection, chemotherapy, and radiotherapy or neoadjuvant chemotherapy with partial cystectomy are an option but only for a small percentage of patients (3). However, if we analyze data carefully, the guideline recommendations are rarely followed. In a SEER study that evaluated 6.737 patients in the USA with stage II disease (non-metastatic, muscle-invasive bladder cancer), only 8.3% underwent radical cystectomy (8). The odds of an octogenarian to undergo radical cystectomy in the USA is five-times lower than a young patient (8). Hispanic origin, Afro-American origin, and lower scholar level patients are also less treated properly when they have muscle-invasive bladder cancer (8). According to a very interesting study that evaluated 27,578 patients from the SEER, only 6% of patients with muscle-invasive bladder cancer (pT2-pT4) in the USA underwent radical cystectomy between 2007 and 2013 (8). Less than 19% of patients with pT2 disease in the USA undergo radical cystectomy (9). And why does this happen? The answer is because radical cystectomy is associated with high morbidity and mortality rates. When described in the late 1940s, radical cystectomy was associated with a perioperative mortality of 33% (10). In the 1970s perioperative mortality decreased to 11% (and remained around 2.1% to 4.7% after the 1980s) (11). Analyzing mortality after radical cystectomy is a slippery slope, as demonstrated in Table-1. Studies report distinctive data. In-hospital mortality is lower than 30-day mortality, which is two to three-fold lower than 90-day mortality. And these numbers vary widely (1, 12, 13). High mortality rates after radical cystectomy: we must have acceptable protocols and consider the rationale of cutaneous ureterostomy for high-risk patients _______________________________________________","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"4 1","pages":"1090 - 1093"},"PeriodicalIF":0.0,"publicationDate":"2019-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80172706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simultaneous use of oxalate-degrading bacteria and herbal extract to reduce the urinary oxalate in a rat model: A new strategy","authors":"R. Afkari, M. Feizabadi, Alireza Ansari-Moghadam, T. Safari, M. Bokaeian","doi":"10.1590/S1677-5538.IBJU.2019.0167","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2019.0167","url":null,"abstract":"ABSTRACT Objective: Urinary stones with oxalate composition can cause kidney failure. Recent findings evidenced that probiotics are effective in reducing oxalate absorption in these subjects based on their high colonic absorption levels at baseline. The purpose of this study was to evaluate the effect of the simultaneous use of oxalate-degrading bacteria, Urtica dioica and T. terrestris extract in reducing urinary oxalate. Materials and Methods: Anti-urolithiatic activity of Urtica dioica and T. terrestris extract and probiotic by using ethylene glycol induced rat model. In this study, 4 strains of Lactobacillus and 2 strains of Bifidobacterium and also 2 strains of L. paracasei (that showed high power in oxalate degrading in culture media) were used. Male Wistar rats were divided into four groups (n=6). The rats of group-I received normal diet (positive control group) and groups-II (negative control group), III, IV rats received diet containing ethylene glycol (3%) for 30 days. Groups III rats received Urtica dioica and T. terrestris extract. Groups IV rats received extracts + probiotic for 30 days. Findings: The results show that the use of herbal extracts (Urtica dioica and T. terrestris) reduced the level of urinary oxalate and other parameters of urine and serum. Also, the accumulation of calcium oxalate crystals in the kidney tissue was significantly reduced. Conclusion: Considering that the formation of calcium oxalate crystals can cause inflammation and tissue damage in the kidney, the use of herbal extracts with oxalate degrading bacteria can be a new therapeutic approach to preventing the formation of kidney stones.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"2 1","pages":"1249 - 1259"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73066552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malignant leydig cell tumor in a 91-year-old man: Case report","authors":"Roberto Mateussi Justo, Elizeu Bernabé Neto, Millian Carlos Ronchini, Eclair Lucas Filho, Gilberto Saber, Luis Cesar Lopes da Silva","doi":"10.1590/S1677-5538.IBJU.2018.0720","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2018.0720","url":null,"abstract":"ABSTRACT Testicle tumors are a rare entity among men population, accounting for only 1-1.5% of all cancers among men. The stromal tumors of the sexual cord correspond just 4% of all testicular cancers. Only 10% of them are malignant. The major representative of the sex cord-stromal tumors is the Leydig cell tumor, corresponding to 75 to 80% of the total. It has bimodal age incidence, involving children and adults between 30 and 60 years. We report the caso of a 91-year-old man with malignant Leydig cell tumor, presenting increase of the volume of scrotum, local pain and hyperemia. The are few cases in the literature, only 1 with pacient above 85 years old.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"14 1","pages":"1260 - 1265"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79319594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two-shift operation mode can improve the efficiency and comfort of flexible ureteroscopic holmium laser lithotripsy for the treatment of renal calculi larger than 1.5cm","authors":"S. Hui, Qingya Yang, Xinbao Yin, Liu Ming, Gonghui Li, Chen Jun","doi":"10.1590/S1677-5538.IBJU.2019.0219","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2019.0219","url":null,"abstract":"ABSTRACT Purpose: To compare two-shift operation mode and single player mode different impact on surgical results and operator comfort in flexible ureteroscopic holmium laser lithotripsy for renal calculi larger than 1.5cm. Materials and Methods: From december 2017 to december 2018, 92 patients with renal calculi admitted to Qilu Hospital and were treated through flexible ureteroscopy. They were randomized in two-shift group (n=50) and single player group (n=42). The operative time, blood loss, hospitalization stay after operation, residual fragments (≥4mm) rate, fragmentation speed, postoperative complications and operator's fatigue score were compared. Results: There was no significant difference between two groups regarding age, gender, illness side, stone size, blood loss, operative time, postoperative hospitalization stay, complications, etc (p >0.05). The fragmentation speed was 44.5±20.0mm3/min in two-shift group compared with 34.2±17.3mm3/min in single player group (p=0.037). Residual fragments (≥4mm) rate after first surgery was 18% in two-shift group, while the residual fragments (≥4mm) rate was 40.5% after first surgery in single player group (p=0.017). The total fatigue score of two-shift group was 8.4 compared to 29.9 in single player group (p <0.001). Conclusion: In flexible ureteroscopic holmium laser lithotripsy for the treatment of renal calculi larger than 1.5cm, two-shift operation mode can raise the fragmentation speed and stone clearance rate, as well as significantly lower operator's fatigue level and improve operator's comfort.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"10 1","pages":"1161 - 1166"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79736953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors of postoperative sexual function in patients with urethral diverticulum and their partners: A cohort study of 83 women","authors":"Yi Sun, Cai Tang, Na Li, D. Luo, L. Peng, Hong Shen, Q. Wei","doi":"10.1590/S1677-5538.IBJU.2018.0824","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2018.0824","url":null,"abstract":"ABSTRACT Introduction and Objective: Several studies have focused on the treatment and recurrence of urethral diverticulum (UD). However, few investigations have addressed sexual function in patients with UD. Therefore, we sought to examine sexual function in women affected by UD. Materials and Methods: There were 108 accepted cases involving transvaginal diverticulectomy at our institution. Ultimately, 83 women were included for further analysis, only 61 of these women had sexual partners. We collected data for the Female Sexual Function Index (FSFI) from the female patients and the Male Sexual Health Questionnaire (MSHQ) from their male partners before and after surgery. Results: Preoperatively, the UD size affected the female patient's arousal and lubrication (p=0.04), and the UD location affected their satisfaction. However, no significant between-group differences were found in the total FSFI score. For all women, sexual activity improved after surgery (p=0.0087). In addition to improvements in arousal for women with a large UD, improvements in lubrication were affected by the UD size, number and shape, increases in satisfaction scores were impacted by the UD location and shape, and pain relief was linked to the UD number and shape. Analysis of the MSHQ results revealed no between-group differences among the male partners. Conclusion: Only the UD size and location affected sexual function in women with a small UD. Surgery could improve female sexual function but did not affect the sexual function of the patient's partners.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"35 1","pages":"1216 - 1226"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90748851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors affecting fluoroscopy time during percutaneous nephrolithotomy: Impact of stone volume distribution in renal collecting system","authors":"S. Özbir, H. A. Atalay, H. Canat, M. Çulha, S. Cakir, O. Can, A. Ötünçtemur","doi":"10.1590/S1677-5538.IBJU.2019.0111","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2019.0111","url":null,"abstract":"ABSTRACT Purpose: To identify the factors increased fluoroscopy time during percutaneous nephrolithotomy and investigate the relationship between the 3D segmentation volume ratio of stone to renal collecting system and fluoroscopy time. Materials and Methods: Data from 102 patients who underwent percutaneous nephrolithotomy were analyzed retrospectively. Volume segmentation of both the renal collecting system and stones were obtained from 3D segmentation software with the images on CT data. Analyzed stone volume (ASV), renal collecting system volume (RCSV) measured and the ASV-to-RCSV ratio was calculated. Several parameters were evaluated for their predictive ability with regard to fluoroscopy time. Results: The stone-free rate was 55.9% after the percutaneous nephrolithotomy. Complications occurred in 31(30.4%) patients. The mean fluoroscopy time was 199.4±151.1 seconds. The fluoroscopy time was significantly associated with the ASV-to-RCSV ratio (p<0.001, r=0.614). The single tract was used in 77 (75.5%) cases while multiple tracts were used in 25 (24.5%) cases. Fluoroscopy time was significantly associated with multiple access (p<0.001, r=0.689). On univariate linear regression analysis, longer fluoroscopy time was related with increased stone size, increased stone volume, increased number of access, increased calyx number with stone, increased ASV-to-RCSV, increased operative time and decreased stone essence. On multivariate linear regression analysis, the number of access and the ASV-to-RCSV were independent predictors of fluoroscopy time during percutaneous nephrolithotomy. Conclusions: The distribution of the stone burden volume in the pelvicalyceal system is a significant predictor for prolonged fluoroscopy time during percutaneous nephrolithotomy. Measures to decrease FT could be beneficial in patients with a high ASV-to-RCSV ratio for precise preoperative planning.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"38 1","pages":"1153 - 1160"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85571414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metastatic non-muscle invasive bladder cancer with cervical lymph node metastasis","authors":"P. Garrido-Abad, Luis García Martín, Karen Villar Zarra, Ariel Díaz Menéndez, M. F. Arjona","doi":"10.1590/S1677-5538.IBJU.2018.0863","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2018.0863","url":null,"abstract":"ABSTRACT Bladder cancer is a common cancer that may present as superficial, invasive, or metastatic disease. Non-muscle-invasive bladder cancer (NMIBC) represents the majority of bladder cancer diagnoses, but represents a spectrum of disease with a variable clinical course, notably for significant risk of recurrence and potential for progression. NMIBC metastasis to distant organs without local invasion or regional metastasis is a very rare occurrence, so there are limited case reports about early metastasis in the literature.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"91 1","pages":"1270 - 1274"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85655546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of the three-dimensional printing technology in complex laparoscopic renal surgery: a renal tumor in a horseshoe kidney","authors":"C. Mercader, A. Vilaseca, J. Moreno, A. López, M. Sebastià, Carles Nicolau, M. Ribal, L. Peri, M. Costa, A. Alcaraz","doi":"10.1590/S1677-5538.IBJU.2019.0085","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2019.0085","url":null,"abstract":"ABSTRACT Purpose: To report our initial experience using a patient-specific 3D-printed renal tumor model for the surgical planning of a complex heminephrectomy in a horseshoe kidney. Materials and Methods: We selected a clinical case for a complex laparoscopic surgery consisting in a 53 year-old male presenting a local recurrence of a renal tumor in a horseshoe kidney with aberrant vascularisation previously treated with a laparoscopic partial nephrectomy. He is now proposed for a laparoscopic left heminephrectomy. Along with conventional imaging, a real-size 3D-printed renal model was used to plan de surgical approach. The perioperative experience of the surgical team was recorded. Results: The surgical team found the patient-specific 3D printed model useful for a better understanding of the anatomy and an easier surgical planning. Conclusion: The use of patient-specific 3D-printed renal models seem to be helpful for the surgical planning in complex renal tumors.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"39 1","pages":"1129 - 1135"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91264066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}