Search

The use of 3D laparoscopic partial nephrectomy has emerged as a cornerstone in the surgical arsenal for addressing renal tumors, particularly in managing challenging cases characterized by deeply seated tumors embedded within the renal parenchyma. In these intricate scenarios, the utilization of intraoperative ultrasound (IOUS) acquires paramount importance, serving as an indispensable tool for guiding and meticulously monitoring the surgical process in real time. To further explore the efficacy of IOUS-guided techniques, we conducted a retrospective study comparing outcomes in patients who underwent partial nephrectomy with IOUS guidance (n = 60) between 2020 and 2022 with a cohort from 2018 to 2019 without IOUS guidance (n = 25). Our comprehensive analysis encompassed various post-operative parameters, including the duration until food resumption, analgesia requirements, and length of the hospital stay. While these parameters exhibited comparable outcomes between the two groups, notable distinctions emerged in the intraoperative metrics. The IOUS-guided cohort demonstrated significantly reduced blood loss, a shorter median operative duration, and diminished ischemia time (p = 0.001). These compelling findings underscore the undeniable benefits of IOUS-guided techniques in not only facilitating the attainment of negative surgical margins but also in enhancing procedural safety and precision, thereby contributing to improved patient outcomes in the management of renal tumors. [ABSTRACT FROM AUTHOR]

Introduction. More than 70% of all bladder cancers are nonmuscle invasive involving only the mucosa and the submucosa. A large percentage of patients present local recurrence after endoscopic surgery, and many of them progress to muscle invasive disease necessitating radical cystectomy. The high recurrence and progression rate is the reason to use intravesical therapy to prevent recurrences. The aim of this study is to compare the efficacity and safety of intravesical immunotherapy with Bacillus Calmette Guerin (BCG) vs. chemotherapy (Pharmoribicin) after TUR-B for NMIBC. Material and methods. Following TURB and pathological analysis, NMIBC was stratified into low, intermediate and high-risk groups depending on the probability of recurrence and progression to muscle-invasive disease. Patients were treated with adjuvant intravesical therapies, BCG or Pharmorubicin. Results. Between 2008 and 2012, a total of 125 patients with NMIBC were diagnosed in the Urology Department Sibiu. Histopathological data show: pT1 G1 - 48 patients (38.4%), pT1 G2 - 69 patients (55.2%), pT1G3 and or Tis - 8 patients (6.4%). Adjuvant intravesical therapies with Pharmorubicin was administered to 83 patients (66.4%) and with BCG 42 patients (33.6%). Pharmorubicin, the recurrence rate was 22.8% in the first year and at 5 years there was a recurrence of 36.1%. For the group of patients treated with BCG recurrent rate was 14.2% in the first year and 33,3% at 5 years. For the whole group of patients tumor progression was 2.4% in the first year and 9.6% at 5 years. For the Pharmorubicin group, in the first year, the progression was 2.4% compared with 2.3% tumor progression in the BCG-treated group. Conclusions. Intravesical instillation treatment after TURB reduce the recurrence rate and tumor progresion. In our series there are no major differences between efficacity of intravesical immunotherapy (BCG) vs. chemotherapy (Pharmoribicin). Disease-free survival and progression-free survival are comparable to the two studied lots. [ABSTRACT FROM AUTHOR]

Despite the modern advancement in endourology, percutaneous nephrostomy play an important role in many urologic conditions, which of the most important is the relief of upper urinary tract in patients with malignancies that interests the ureter or the uretero-vesical junction. The aim of the study is to compare the complications of polyurethane and silicone catheters used for percutaneous nephrostomy in patients with unilateral or bilateral uretero-hydronephrosis secondary to locally advanced abdomino-pelvin malignancies. We have retrospective analyzed 164 patients (p), admitted between January 2013 and December 2016 in Urology Department Sibiu, who benefit from unilateral or bilateral percutaneous nephrostomy for secondary uretero-hydronephrosis with acute renal failure. [ABSTRACT FROM AUTHOR]

Prostatic lithiasis is commonly found in patients over 50 years of age, is rare under 40 years of age and very rare in children. Asymptomatic prostatic calculus is frequently highlighted by routine ultrasound examination or radiological examinations. The association of prostatic lithiasis with chronic prostatitis and benign prostate hyperplasia is common. The vast majority of prostatic calculi are latent progressive, being incidentally discovered on prostate ultrasound, basin radiographs or adenomectomy. There is no pathognomonic symptomatology for prostate disease. Symptoms, when present, may be due to prostatic hypertrophy, urethral strictures or chronic prostatitis. In this review, we will describe the prevalence, ethiopathogenesis, symptomatology, diagnosis and treatment options currently available for prostatic lithiasis. [ABSTRACT FROM AUTHOR]

Objective. The objective of the study was to evaluate the internal ureteral drainage with a double J stent in treating symptomatic obstructive uropathy (lithiasic or physiologic) during pregnancy. Material and Methods. Between 2011-2017 we retrospective analysed 40 pregnant women who were admitted with renal colic, flank pain, urinary symptoms and inconstant fever. Renal ultrasound revealed hydronephrosis with clinical and paraclinical signs of acute pyelonephrytis in 19 (47.5%) patients. The age of pregnancy was between 20 - 30 weeks. All the cases where monitored by white blood cell count, serum creatinine levels, urinalysis, and urine culture. All ureteric stents were inserted successfully under local, spinal or general anesthesia. Antibiotic therapy was associated. Results. A total of 32/40 (80%) patients had a clinical improvement immediately or soon after intervention. All patients had complete resolution of the hydronephrosis on follow-up renal ultrasound and regression of hydronephrosis and urinary symptoms after ureteral stenting. Minor complications were reported as (stent irritation, stent encrustation, and stent migration). The post-natal evaluation confirmed that 18/40 (57%) patients had urinary calculus disease 22/40 (55%) patients with physiologic hydronephrosis during pregnancy. All pregnancies progressed uneventfully and 25/40 (62.5%) women had normal vaginal deliveries. The ureteric stent was removed 2 weeks after delivery and endoscopic removal of ureteral stone. Follow up renal ultrasound was normal. Conclusions. Ureteral stenting is a very efficient therapeutic option in treating pregnant women with renal colic and hydronephrosis. Ureteric double J stenting during pregnancy can be safe, with good symptom relief and has a low complication rate. [ABSTRACT FROM AUTHOR]

Introduction. Sparing kidney tissue is important because studies show that patients who have their entire kidney removed are more likely to suffer from chronic kidney disease after surgery than patients who received a kidney-sparing partial nephrectomy. The aim of study is to show the effectives of Pringle maneuver for clamping renal pedicle in order to minimize warm ischemia during open partial nephrectomy. Material and method. We retrospectively analyzed 34 patients diagnosed with cT1 renal tumors between 2012 and 2016 and underwent open partial nephrectomy in Sibiu Urology Department. During the surgery we perform clamping of renal pedicle with Satinsky clamp or with the Pringle maneuver. We analyzed the flowing parameters: operation time, blood loss, clamping time and serum creatinine before and after the surgery. Results. The mean age of patient with partial nephrectomy was 58.7±14.7 years, with 56.7±12.4 years for Satinsky group and 60.5±11.6 for Pringle group. The average duration for partial nephrectomy was 94.8±19.4 minutes. Average boold loss for all surgeries was 220±30 ml. Conclusion. Pringle maneuver is a safe and effective method with low intra and postoperative complications during open partial nephrectomy, having a good control of the renal pedical with reduced ischemia. Is a feasible method of choice in renal tumour tumor pathology on a single congenital or surgical kidney, mediorenal tumors or near the sinus and multifocal tumors. [ABSTRACT FROM AUTHOR]

Introduction. Partial nephrectomy represent the standard of care for small renal tumor. Laproscopic approach tends to replace open surgery due to similar oncologic results, but with better eastethic outcomes and earlier socio-professional reintegration. Material and methods. Between January 2010 and February 2017, 55 patients (p) underwent partial nephrectomy at our center for clinically localized renal tumor, 21p with LPN by retroperitoneal approach and 34p with OPN. All patients had a normal contralateral kidney. The selection of patients for nephron-sparing surgery was based on preoperative CT scan, location of the tumor, the individual general health status of the patient and individual surgeon preferences. Results. The mean age of patients with partial nephrectomy was 59.6±16.4 years, with 57.9±11.6 years for laparoscopic subgroup and 61.3±12.4 for open surgery. The transfusion rate was 9.52% in LPN group, while in the OPN there was no need for transfusion. The warm ischemia time was higher in the LPN group (21.8±7.2 min) than OPN group (15.7±2.9). The postoperative complication rate is comparable between LPN and OPN (23.81% v.s. 20.58%), but the LPN had higher intraoperative complications. Conclusion. Laparoscopic partial nephrectomy for renal tumors is superior to open surgery by early mobilization of the patient, the low rate of wound complications, short duration of hospitalization, fast socio-professional reintegration of patient, despite the perioperative complication rate that is higher but of low ClavienDindo grade. [ABSTRACT FROM AUTHOR]

Introduction. Genital prolapse is a pelvic static disorder, which represents the descending of the vaginal walls and the uterus in the vaginal axis with their exteriorization through vaginal introit. It is a public health problem, with a risk of occurrence of 30-40% in women over 40 years old, of 20-30% in multiparous, of about 20% after surgeries, having as the main cause injuries to pelvic supporting and suspension structures. The objective of this paper is to compare the classic transvaginal surgical technique of mounting the prosthesis to the bilateral sacrospinous ligament with the technique of fixing the mesh to the sacrospinous ligament using the I-Stitch device. Materials and methods. Between 2010 and 2017, in the Sibiu Urology Clinic, there were diagnosed 57 patients (p) with urogenital prolapse who benefited from colpopexy by fixing the polypropylene mesh to the sacrospinous ligament using the I-Stitch device and colpopexy by classically fixing the mesh. Results. In the group using the I-Stich device, mean operative time was 48.5 minutes (between 35 and 110 minutes), mean blood loss was 140 ml (90-300 ml), postoperative pain present in 5 p (8.77%), hospitalization length between 2 and 5 days with an average of 3.2 days. Conclusion. Reconstructive surgery of pelvic floor is a combination of surgical procedures designed to correct multiple defects, is definitive and curative in the treatment of prolapse. [ABSTRACT FROM AUTHOR]

Before molecular analysis is performed, morphological control with an estimation of the tumour cell percentage (%TC) could have a major impact on mutation detection. Accreditation according to NF EN ISO 15189 commands an authorization through evaluation of skills. The objective of this work was to validate the empowerment of pathologists to estimate %TC in tissue sample prior to molecular analysis. The accreditation technical guidance methods in Medical biology and histopathology were taken as references. %TC was the ratio of tumour cell nuclei on all nuclei within the area selected for the DNA extraction. External evaluations quality scores were used for accuracy. In order to assess the intermediate precision, 35 %TC estimation were performed 15 days apart in 4 samples (biopsies, transparietal biopsies or surgical specimen, either fixed or frozen) by 7 pathologists. Three other cases with interference (inflammation, mucus, necrosis) were evaluated. A result was satisfactory if %TC were within ±20 % of expected percentage obtained by the average of 35 estimates. The performances were satisfactory since no estimate was made more than 20 % of the expected percentage. Low interpathologists reproducibility has been reported in the literature and can have a consequence on molecular analysis in samples with low %TC, where the value reach the analytical sensitivity thresholds of molecular techniques. The current report is an example of a step of the accreditation process, which is a challenge for pathologists' activity in the future., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)