scholarly journals Initial Experience of Self-Expanding Metal Ureteral Stent in Recurrent Ureteral Stricture After Ureteroplasty

2021 ◽  
Vol 8 ◽  
Author(s):  
Xiaoshuai Gao ◽  
Jixiang Chen ◽  
Zhongyu Jian ◽  
Menghua Wang ◽  
Wei Wang ◽  
...  
Keyword(s):  
Ureteral Stent ◽  
Ureteral Stricture ◽  
Continuous Variables ◽  
Median Hospital Stay ◽  
Distal Ureter ◽  
Before And After ◽  
Stay Time ◽  
Median Hospital ◽  
Median Operative Time

Background: The aim of this prospective study was to assess the safety and effectiveness of self-expanding metal ureteral stent (MUS) for the treatment of recurrent ureteral stricture after ureteroplasty.Methods: We prospectively included 24 patients who underwent MUS implantation between February 2019 and August 2020. The inclusion criteria for the procedure were recurrent ureteral strictures after ureteroplasty. A paired T test was used to compare continuous variables before and after surgery.Results: A total of 24 patients were finally included in this study. The stricture site was most common on the proximal ureter 19 (79.2%), followed by distal ureter 4 (16.7%) and middle ureter 1 (4.2%). The median length of ureteral stricture is 2.5 (range 1–18) cm. The median operative time was 51.5 min, and the median hospital stay time after surgery was 3 days. Post-operative complication included pain 1 (4.2%), urinary tract infection 2 (8.3%) and hematuria 2 (8.3%). After a median follow-up of 12 months, 19/24 (83.3%) patients were clinically and radiologically successful. We endoscopically adjusted or exchanged the failed stents. The volume of hydronephrosis (124.7 ± 132.5 vs. 66.4 ± 73.2 cm3, P = 0.015), blood creatinine level (104.5 ± 45.4 vs. 80.1 ± 23.2 μmol/L, P = 0.044) and urea nitrogen level (6.9 ± 2.4 vs. 4.8 ± 1.5 mmol/L, P = 0.003) decreased significantly after a median follow-up of 12 months.Conclusions: MUS is a safe and effective way to manage recurrent ureteral strictures after ureteroplasty. This technique provides a new choice for the treatment of recurrent stricture.

An Assessment of Sleep Disturbance in Patients before and after Carpal Tunnel Release

2019 ◽  
Vol 24 (02) ◽  
pp. 144-146 ◽  
Author(s):  
John Erickson ◽  
Daniel Polatsch ◽  
Steven Beldner ◽  
Eitan Melamed
Keyword(s):  
Sleep Quality ◽  
Sleep Disturbance ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Continuous Variables ◽  
Night Time ◽  
Before And After ◽  
Tunnel Syndrome ◽  
English Speaking

Background: Night time numbness is a key characteristic of CTS and relief of night time symptoms is one of the outcomes most important to patients. This study tested the null hypothesis that there is no difference between sleep quality and night symptoms before and after carpal tunnel release (CTR). Methods: Forty-four, English-speaking adult patients requesting open CTR for electrodiagnostically confirmed carpal tunnel syndrome completed questionnaires before and after surgery. Average age was 59, 24 patients were men and 20 were women. Patient with a primary or secondary sleep disorder were excluded. Before surgery, patients completed the Pittsburg Sleep Quality index (PSQI). At an average of 3 months after surgery, participants completed PSQI questionnaires. Onset of sleep quality improvement was specifically addressed. Differences between preoperative and postoperative sleep quality were evaluated using the paired t-test. Spearman correlations were used to assess the relationship between continuous variables. Results: Of the 44 patients, 32 (72%) were classified as poor sleepers (PSQI > 5.5) prior to surgery. At 3 months follow up, there was a significant improvement PSQI global scores (7.8 ± 5.1 vs 4 ± 3.5, p < 0.001) as well as subdivisions. Daytime dysfunction (0.2 ± 0.4, p < 0.001) and medication use (1.0 ± 1.2 vs 0.9 ± 1.2, p < 0.045) secondary to sleep disturbance and was improved as well. In all patients, onset of improvement was within 24 hours of surgery. Conclusions: CTR is associated with improvement in sleep quality at 3 months follow-up. CTR improves daytime dysfunction related to the sleep disturbance. The onset of sleep improvement is 24 hours after surgery in most cases.

scholarly journals Percutaneous or Transurethral Cystolithotomy for Bladder Lithiasis: Which is Safer?

2019 ◽  
Vol 36 (1-2) ◽  
pp. 17-22
Author(s):  
Joao Pimentel Torres ◽  
Vítor Fernandes ◽  
Nuno Morais ◽  
Sara Anacleto ◽  
Paulo Mota ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Prostate Hyperplasia ◽  
Median Hospital Stay ◽  
Urethral Strictures ◽  
Previous Diagnosis ◽  
Urethral Trauma ◽  
Significant Difference ◽  
Benign Prostate ◽  
Median Hospital

Introduction: Although the risk of urethral trauma while treating bladder stones is worrisome, evidence about the best treatment approach is scarce. The aim of this study is to compare the safety and efficacy of transurethral cystolithotomy and percutaneous suprapubic cystolithotomy in adults´ bladder lithiasis treatment. Methods: We retrospectively evaluated 120 patients (January 2012 to December 2017) who were surgically treated for bladder lithiasis with percutaneous suprapubic cystolithotomy (n= 20) and transurethral cystolithotomy (n= 100). Age, gender, calculi size, surgery duration, hospital stay, post-operative infections, haematuria, pain and urethral strictures were evaluated. Previous diagnosis of benign prostate hyperplasia and urethral strictures were also considered. Results: Both groups were homogeneous according to the pre-operative variables evaluated, including calculi dimensions and simultaneous diagnosis. Median surgery time in percutaneous suprapubic cystolithotomy and transurethral cystolithotomy were 65 and 58 minutes, respectively (p= 0.043). Pain and haematuria were similar in both groups. Median hospital stay was 2.0 days in both groups. Median follow-up time was 13 months. In the transurethral cystolithotomy, three patients (3%) developed urethral stricture while none of the patients treated with PSC developed urethral strictures during the follow-up (p= 0.435). Discussion: Percutaneous suprapubic cystolithotomy theoretically offers an advantage over transurethral cystolithotomy in terms of urethral trauma, although we did not observe a significant difference. However, it deserves to be considered, especially in patients with known urethral strictures that may hinder transurethral access. Further prospective studies with more patients may however confirm these theoretical advantages.

scholarly journals The resonance® metallic ureteral stent in the treatment of malignant ureteral obstruction: a prospective observational study

BMC Urology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jun Miyazaki ◽  
Mizuki Onozawa ◽  
Satoshi Takahashi ◽  
Yuka Maekawa ◽  
Mitsuru Yasuda ◽  
...  
Keyword(s):  
Ureteral Obstruction ◽  
Ureteral Stent ◽  
Stent Insertion ◽  
Ureteral Stricture ◽  
Metallic Stent ◽  
Ureteric Stenting ◽  
Malignant Ureteral Obstruction ◽  
Ureteral Stenting ◽  
The Difference

Abstract Background To study the outcomes and experiences of using metallic stents in treating patients with malignant ureteral obstruction (MUO), we examined the effects of metallic ureteral stenting using the Cook Resonance® stent in the treatment of MUO. Methods All patients who had a Resonance metallic stent inserted between April 2015 and March 2018 at one of multiple facilities were prospectively observed with a 1-year follow-up. The primary outcome was the patency rate of the metallic ureteral stent. The secondary outcomes included the complications (e.g., infection and fever). Results Although stent insertion was attempted in 50 patients, the stent could not be inserted as a ureteral stent in three patients due to severe ureteral stricture, and one ureteral cancer patient was excluded from the analysis. The remaining 46 patients’ median age was 67 years (range 28–85 years) (16 males, 30 females). Twenty-four patients died during the study; their median survival time was 226 days. The median follow-up period for the censored patients was 355 days (range 16–372 days), and just seven patients were still alive without Resonance failure > 1 year later. The women’s IPSS scores tended to be lower than those of the men. Regarding the OABSS score, although the women’s total score tended to be low, the difference between the men’s and women’s scores was nonsignificant. The bacteria detected from urine culture after stent insertion were more gram-positive than gram-negative. Conclusion Metallic ureteric stenting using the Resonance stent is safe and effective for treating MUO. Subjective symptoms were relatively less in the female patients.

scholarly journals Metal stent for the ureteral stricture after surgery and/or radiation treatment for malignancy

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wei Wang ◽  
Xiaoshuai Gao ◽  
Jixiang Chen ◽  
Zhenghuan Liu ◽  
Liao Peng ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Radiation Treatment ◽  
Ureteral Stent ◽  
Stent Insertion ◽  
Rectal Cancer Surgery ◽  
Ureteral Stricture ◽  
Metallic Stent ◽  
Stent Patency ◽  
Postoperative Fever

Abstract Background To assess the efficacy and safety of self-expanding metal ureteral stent for the stricture following surgery and/or radiation for malignancy. Methods We performed 36 metal ureteral stent insertion procedures (32 patients) between May 2019 and June 2020. The main inclusion criterion was the patients with ureteral stricture due to surgery and/or radiation treatment for malignancy. The diagnosis of stricture was ascertained by history and radiographic imaging. The etiologies underlying the strictures were: surgery and/or radiation therapy for cervical and rectal cancer, surgery for ovarian cancer. The primary outcome was the stent patency rate, and the secondary outcomes were the postoperative complications and glomerular filtration rate (GFR). Stent patency was defined as stent in situ without evident migration, unanticipated stent exchange or recurrent ureteral obstruction. Cost analysis was calculated from stent cost, anesthesia cost and operating room fee. Results The pre-metallic stent GFR was 22.53 ± 6.55 mL/min/1.73 m2. Eight patients were on double-J stents before insertion of metallic stents. The total annual cost of per patient in our study was $10,600.2 US dollars (range $9394.4–$33,527.4 US dollars). During a median follow-up time of 16 months (range 8–21 months), 27 cases (31 sides, 84%) remained stent patency. Twelve patients died from their primary malignancy carrying a patency stent. Stent migration was observed in 4 patients within 10 months after insertion. Ectopic stents were endoscopically removed and replaced successfully. Three stents were occluded, and no encrustation was seen in our study. Three and four patients had postoperative fever and gross hematuria, respectively. Infection was observed in 2 cases, mandating antibiotics therapy. In addition, postoperative volume of hydronephrosis postoperatively was significantly reduced compared with preoperation (54.18 ± 15.42 vs 23.92 ± 8.3, P = 0.019). However, no statistically significant differences regarding GFR, creatinine levels, blood urea nitrogen and hemoglobin existed between preoperation and last follow-up. Conclusions The current study demonstrated that metal ureteral stent is effective and safe in the treatment of stricture following surgery and/or radiation therapy for malignant cancer. Patients hydronephrosis could be improved by the stent placement.

scholarly journals Laparoscopic Repair of a Left Retrocaval Ureter in a 16-Year-Old Girl

2018 ◽  
Vol 06 (01) ◽  
pp. e104-e107
Author(s):  
Anna Kadar ◽  
Lorena Vatra ◽  
Anca Avram ◽  
Daniela Stoica ◽  
Marcel Oancea
Keyword(s):  
Inferior Vena ◽  
Vena Cava ◽  
Laparoscopic Approach ◽  
Female Adolescent ◽  
Ureteral Stent ◽  
Lumbar Pain ◽  
Distal Ureter ◽  
Retrocaval Ureter ◽  
History Of

AbstractLeft retrocaval ureter is an extremely rare congenital malformation which is associated with situs inversus, duplicated or translated inferior vena cava (IVC). We report a female adolescent who presented with a history of intermittent, colicky lumbar pain. Diagnostic workup revealed left retrocaval ureter and left ureterohydronephrosis. The girl underwent laparoscopy. The renal pelvis and ureter posterior to the vena cava were dissected, transected at the caudal point of the dilated ureteral segment, and uncrossed and repositioned lateral to the vena cava. Ureteroureterostomy was performed over a double-J ureteral stent after spatulation of the distal ureter. The postoperative course was uneventful and the ureteral stent removed after 5 weeks. During follow-up, the patient is symptom-free. Our case demonstrates that our laparoscopic approach is feasible in this rare anatomic anomaly.

Single-Port Laparoscopic Extraperitoneal Para-aortic Lymphadenectomy

2013 ◽  
Vol 23 (9) ◽  
pp. 1712-1716 ◽  
Author(s):  
Sara Iacoponi ◽  
Javier De Santiago ◽  
Maria D. Diestro ◽  
Alicia Hernandez ◽  
Ignacio Zapardiel
Keyword(s):  
Body Mass Index ◽  
Operative Time ◽  
Single Port ◽  
Gynecologic Cancer ◽  
Median Number ◽  
Pelvic Lymphadenectomy ◽  
Median Hospital Stay ◽  
Median Hospital ◽  
Median Operative Time ◽  
Port Device

ObjectiveThe aim of this study was to evaluate the feasibility and the safety of single-port extraperitoneal laparoscopic para-aortic lymphadenectomy for patients with gynecologic cancer.MethodsFrom July 2012 to January 2013, a total of 7 patients with gynecologic cancer underwent a laparoscopic pelvic and para-aortic lymphadenectomy with a single-port device. An extraperitoneal approach was performed for para-aortic lymphadenectomy using only one 2.5-cm incision on the left side. In 6 patients, additionally, hysterectomy and pelvic lymphadenectomy with conventional laparoscopy were performed to complete the treatment.ResultsAortic dissection was complete in all cases without complications. The median age of the patients was 63 years (range, 48–78 years), and the median patient body mass index was 31 kg/m2 (range, 19–38 kg/m2). The median number of para-aortic nodes was 17 (range, 10–25); the median operative time was 204 minutes (range, 120–300 minutes). The median hospital stay was 4 days (range, 3–6 days). No patient encountered postoperative complications.ConclusionsThis study demonstrates the feasibility of single-port laparoscopic extraperitoneal para-aortic lymphadenectomy.

scholarly journals Clinical characteristics of COVID-19 in Fujian Province: a multicenter retrospective study

2020 ◽  
Author(s):  
Sijiao Wang ◽  
Zhisheng Chen ◽  
Yijian Lin ◽  
Li Lin ◽  
Qunying Lin ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Oxygenation Index ◽  
Nasopharyngeal Swab ◽  
Fujian Province ◽  
Median Hospital Stay ◽  
Illness Onset ◽  
Tertiary Hospitals ◽  
Multi Center Study ◽  
Median Hospital

Abstract Background The coronavirus disease 2019 (COVID-19) has spread worldwide, leading to thousands of deaths. We aim to describe the epidemiological and clinical characteristics of patients with coronavirus disease 2019 (COVID-19) in Fujian province, China. Methods In this retrospective, multi-center study, we collected and analysed 165 patients of COVID-19 confirmed by real time PCR of nasopharyngeal swab specimens in five tertiary hospitals of Fujian province, China from Jan 22 to Feb 16, 2020. The final date of follow-up was February 21, 2020. Results Of the 165 hospitalized patients with COVID-19, 101 patients had relation with Wuhan within two weeks. Symptoms at illness onset mainly were fever (76.4%), cough (60%) and expectoration (38.2%). On admission, the severity of most patients were classified as mild or common and lymphopenia (33.9%), hypoxemia (15.2%), elevated and bilateral pneumonia (83.6%) was observed. Patients older than 65 years had significantly high frequency of hypertension, diabetes, severe classification, lymphopenia and hypoxemia than those younger than 65 years. Age correlated negatively with lymphocyte count and oxygenation index on admission while positively with duration from exposure to the time of negative RT-PCR. At the end of follow-up, 80 patients were discharged and one died. The median hospital stay was 17 days. Conclusions Patients with COVID-19 were mostly non-severe cases in Fujian province and older patients (>65 years) were more likely to have lymphopenia and hypoxemia, and to progress as severe cases of COVID-19 than those younger than 65.

scholarly journals Stapled Haemorrhoidopexy - the better option for surgical treatment of idiopathic haemorrhoids- 30 Our experience in BSMMU

2013 ◽  
Vol 16 (1) ◽  
pp. 30-34
Author(s):  
Md Shahadot Hossain Sheikh ◽  
Md Ibrahim Siddique ◽  
Md Atiar Rahman ◽  
Samia Mubin ◽  
Kazi Nasid Naznin ◽  
...  
Keyword(s):  
Stapled Haemorrhoidopexy ◽  
Preoperative Preparation ◽  
Open Wound ◽  
Female Ratio ◽  
Median Hospital Stay ◽  
Haemorrhoidal Disease ◽  
Long Time ◽  
Male To Female ◽  
Median Hospital

Objective: Idiopathic haemorrhoidal disease is a common problem in colorectal practice. Conventional open haemorrhoidectomy is associated with significant pain and an open wound for a long time to heal interfering normal day to day activities. Stapled haemorrhoidopexy is expected to have less pain and without a wound. This study reflects our experience with stapled haemorrhoidopexy in our population. Methods: Two hundred consecutive patients with primary haemorrhoidal disease of different degrees underwent stapled haemorrhoidopexy in BSMMU since January 2009 to April 2011. All the patients were evaluated by history, clinical examination and Proctosigmoidoscopy. With adequate preoperative preparation they underwent stapled haemorrhoidopexy under spinal anaesthesia. They were followed up post-operatively for a median 2 months duration. Results: Male to female ratio was 3.76:1 with median age of 35 years (range: 11-90 years). Median hospital stay was 2 days (24 hours-5 days) and longest 5 days after operation. 14 patients had 1st degree haemorrhoids, 66 patients had 2nd degree haemorrhoids, 104 patients had 3rd degree haemorrhoids and 16 patients had 4th degree haemorrhoids. Median time for the procedure was 25 minutes. Urgency of defecation was complained by 46 patients who ultimately felt comfortable within 2-4 weeks. 6 patients complained of annorectal pain who responded to conventional analgesics. Rest of the patients available after 8 weeks follow up were found to be fully satisfied. Conclusion: Contrary to open haemorrhoidectomy this procedure is associated with least chance of anal incontinence because of preservation of normal anal cushion. It can safely be concluded that stapled haemorrhoidopexy is a better option in treating primary haemorrhoidal disease. DOI: http://dx.doi.org/10.3329/jss.v16i1.14445 Journal of Surgical Sciences (2012) Vol. 16 (1) : 30-34

VATS Anatomic Pulmonary Resection in Octogenarians

2005 ◽  
Vol 71 (9) ◽  
pp. 791-793 ◽  
Author(s):  
Carie L. Mcvay ◽  
Allan Pickens ◽  
Clark Fuller ◽  
Ward Houck ◽  
Robert Mckenna
Keyword(s):  
Lung Cancer ◽  
Pulmonary Resection ◽  
Medical Center ◽  
Large Cell ◽  
Common Complication ◽  
Small Cell Lung ◽  
Vats Lobectomy ◽  
Median Hospital Stay ◽  
Median Hospital

Although modern techniques in anesthesia and surgery have reduced morbidity and mortality for pulmonary resection, some physicians still consider advanced age a contraindication to resection of lung cancer. We examined our experience with VATS lobectomy in octogenarians at Cedars-Sinai Medical Center over 12 years (1992–2004). There were 159 patients. Mean age was 83 years (range, 80–94 years) consisting of 61 males (38%) and 96 females (62%). Operations included 153 lobectomies (96%), 3 bilobectomies (2%), and 3 pneumonectomies (2%). Two operations were converted to thoracotomy (1%), one due to bleeding, and one due to poor visualization. Median hospital stay was 4.00 ± 6.39 days. One hundred thirty-one patients (82%) had no complications. The most common complication was arrhythmias occurring in 8/159 (5%) patients. There were three perioperative deaths (1.8%). Pathology revealed 104 adenocarcinomas (65%), 25 squamous cell carcinomas (16%), 5 adeno-squamous carcinomas (3%), 7 bronchoalveolar carcinomas (4%), 7 large cell carcinomas (4%), 4 carcinoid tumors (3%), 4 non-small cell lung cancer (NSCLC) (3%), 1 mucoepidermoid carcinoma (<1%), 1 lymphoma (<1%), and 1 pulmonary metastasis (<1%). Median follow-up was 29 months. The results of this series show that age alone is not a contraindication to the surgical treatment of lung cancer.

scholarly journals Pediatric laparoscopic pieloplasty

2017 ◽  
Vol 34 (1-2) ◽  
pp. 28-32
Author(s):  
Sofia Morão ◽  
Vanda Pratas Vital ◽  
Aline Vaz Silva ◽  
Dinorah Cardoso ◽  
Fátima Alves ◽  
...  
Keyword(s):  
Urinary Tract Obstruction ◽  
Upper Urinary Tract ◽  
Success Rates ◽  
Median Hospital Stay ◽  
Age At Surgery ◽  
Open Pyeloplasty ◽  
One Year ◽  
Upper Urinary Tract Obstruction ◽  
Median Hospital

Introduction: Ureteropelvic junction obstruction (UPJO) is the most common congenital cause of upper urinary tract obstruction in children. Our objective is to report our experience concerning the first 20 laparoscopic pyeloplasties. Material and methods: Retrospective study including twenty children with diagnosis of UPJO that underwent laparoscopic pyeloplasty by a single surgeon, at our Hospital, between November 2010 and December 2014, with at least one year of follow-up. Success was defined as absence of conversion, resolution of symptoms and radiologic criteria improvement. Results: Median age at surgery was 9.5 years (range between 10 months and 17 years-old). Intrinsic obstruction was found in 7 cases, extrinsic obstruction in 12 cases and one case with both situations. Median operative time was 235 minutes (range between 165-275 minutes), with need for conversion in 2 cases (10%).  Median hospital stay was 2 days (range between 2-5 days. Four patients (20%) had early postoperative complications and two cases (10%) needed surgical revision during follow-up. Median follow-up time was 33 months (range between 12-60 months). In follow-up, all but two patients were asymptomatic. There was radiologic improvement of hydronephrosis in all patients but one, although he had non-obstructive pattern in renographic drainage. Conclusion: Our results are similar to those found in literature, with success rates comparable to open pyeloplasty with advantages of minimally invasive surgery.

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