Urodinamics in the child’s lower urinary disease

Objective: The urodynamics aim is to establish the nature and causes of urinary symptoms at little patient after the vesico-urethral maturation. Material and Methods: During 1996 and 2000 were studied in our center 54 children aged between 4 and 14 years, most of them admitted in «M.S. Curie» Pediatric Hospital from Bucharest. 70% were surgically treated in Center of Urological Surgery, Dialysis and Renal Transplantation (Prof. I. Sinescu) or at the Pediatric Surgical Department (Prof. Pesamosca). The urodynamic studies on children are more complicated than on adults due to the necessity of special equipment, active presence of urodynamic specialist and the pediatric also. Results: The urodynamic disorders' maximum incidence appear after the age of 4 years when the bladder volume is adequate and the neurological center controlled the voluntary urethral sphincter and the detrusor contractility. Therefore, there were identified as causes: persistent urinary infections (80 cases), micturition difficulty or urine loss (60% cases) due to the congenital urinary malformations or neurological diseases (30% cases), sometimes mixed through their complexity (10%). The urodynamic investigation consists on: flowmetry, cystometry, EMG of the pelvic floor, combined studies including micturitional cystography, and in special cases were evaluated the detrusor and the bladder neck, the eventual vesico-ureteral ebb tide or other pathological causes (urethral valves, fisulas, ureterocel, etc). Conclusions: The urodynamic studies on child's persistant urinary disorders are strictly necessary for diagnosis and treatment to follow establishment, especially when there indicated surgical in te rventions are required to correct some complexe urinary and neurologic malformations

Right RCC with cavo-cardiac tumor thrombus

Introduction: One of the unique features of RCC is the frequent pattern of growth intraluminally into the renal venous circulation in extreme cases this growth may extend into the inferior vena cava with cephaled migration in the heart. Material and method: It has been pur experience that an anterior surgical approach through c subcostal and pararectal incision provides excellent exposure for performing radical nephrectomy. A second cardio-vascular team, through a median sternotomy, canulated the ascending aorta ana the right atrium and cardiopulmonary bypass is initiated. The tumor thrombus is gently removed from the IVC. Results: In our department we performed more than 1305 radical nephrectomies for RCC. We have had 117 lateral or total IVC resection and in 8 cases we removed the thrombus from the right atrium. Conclusions: This approach allows such thrombus to be removed completely in a controlled operative setting that provides excellent exposure and reduces the potential for massive blood loss a major vascular injury

Extension - surgical technique

Introduction: Surgical technique for left renal cell carcinoma with infradiaphragmatic caval extension is presented. Technique: A transperitoneal bilateral subcostal approach was used. After left colon reflection, the renal artery is ligated and divided, the left renal vein is dissected on. The right colon reflection is perform ed, the right renal vein and vena cava is dissected. Satinsky clamp is placed on infrarenal vena cava, a bulldog clamp is placed on the right renal vein and a Satinsky clamp is placed on vena cava above the thrombus. Circular incision on vena cava at the level of left renal vein is performed and en block perifascial nephrectomy including the thrombus is done. The vena cava incision is repaired with a continuos 4-0 vascular suture. Extensive lymph node dissection is performed. Conclusions: Out of more than 1305 RCC operated in our Department between 1975 - 2000, 142 cases have had caval extension. Using appropriate surgical technique, the patient's survival is almost similar to those without caval extension

The efficacy of percutaneous nephrolithotomy in elderly patients

Clinica de Urologie, Spitalul Clinic Județean Mureș, România, Universitatea de Medicină, Farmacie, Științe și Tehnologie din Tg. Mureș, Al VII-lea Congres de Urologie, Dializă si Transplant Renal din Republica Moldova cu participare internațională 19-21 iunie 2019Obiectiv: Acest studiu își propune evidențierea eficienței nefrolitotomiei percutanate (NLP) în tratamentul litiazei renale la pacienții vârstnici și evaluarea celor mai frecvente complicații asociate cu acesta intervenție chirurgicala. Material și metodă: Am efectuat un studiu retrospectiv pe o perioadă de 10 luni (Iunie 2016-Aprilie 2017) în care am inclus 200 de pacienți cu litiază renală care au fost internați în Clinica de Urologie Tg Mureș, România și au fost tratați prin NLP. Am efectuat 263 de intervenții chirurgicale și am comparat complicațiile apărute intra și postoperator înte Grupa 1 (pacienți cu vârsta sub 70 ani) și Grupa 2 (pacienți cu vârsta peste 70 ani). Rezultate: Vârsta medie a pacienților a fost de 53,65 ani +/-12,18 DS cu limite între 25 și 81 de ani. 178 de pacienți au avut vârsta sub 70 nai (Grupa 1) și 22 pacienți sub 70 ani (Grupa 2). Calculii au fost localizați la nivelul bazinetului (142), calicele inferior (46) și joncțiune pielo-ureterală (4). Calculii coraliformi s-au evidențiat în 28 de cazuri. Diametrul calculilor a fost mai mare de 2 cm in 76% dintre cazuri, mai mic de 2 cm in 13% dintre cazuri, iar 11% au prezentat litiază multiplă. Complicațiile intraoperatorii au fost: migrarea fragmentelor (22%), sângerare (12%), leziuni ale bazinetului și puncția renală dificilă sau dilatații dificile (6%). Complicațiile postoperatorii au constat în: hematurie (20%), obstrucția ureterului cu fragmente restante (22,5%), hidronefroză (18%), fistulă lombară (13%). Nu s-a evidențiat o corelație semnificativă între apariția complicațiilor intra și postoperatorii și vârsta pacienților (p>0,005). Durata medie de spitalizare a fost de 5,58 zile +/-2,69 DS. Rata de stone free a fost de 77,5%. Concluzii: Nefrolitotomia percutanată este o metodă de tratament eficientă și sigură a litiazei renale, care poate fi practicată atât la tineri cât și la vârstnici. Complicațiile intra și postoperatorii pot să apară la ambele grupe de pacienți, însă vârsta nu reprezintă un factor decisiv în alegerea acestei alternative terapeutice.Objective. The aim of this study is to highlight the importance of percutaneous nephrolithotomy (PCNL) in the treatment of renal stones in elderly patients and to evaluate the most frequent complications associated with this procedure. Material and method. We performed a ten-months (June 2016 - April 2017) retrospective study and we included 200 patients with kidney stones who were admitted to the Urology Clinic, Tirgu Mures, Romania. We performed 263 interventions (NLP) and we compared intra and postoperative complications between Group 1 (including patients under the age of 70 years old) and Group 2 (patients older than 70). Results: The mean age of patients was 53.65 years old (12.18 Standard Deviation - SD) with limits between 25 and 81 years old. 178 patients were younger than 70 years (Group1) and 22 were older than 70 (Group2). The stones were mostly localized in the renal pelvis (142), inferior calyx (46) and ureteropelvic junction (4). 28 cases were staghorn calculi. The diameter of the stone was larger than 2 cm in 76% and less than 2 cm in 13% of the cases and 11% of the patients had multiple lithiasis. Intraoperative complications were: migrating fragments (22%), hemorrhage (12%), lesions of the renal pelvis and difficulties of percutaneous access or dilatation (6%). The postoperative complications were: haematuria (20%), obstruction caused by stone fragments (22.5%), hydronephrosis (18%), fistula (13%). There were no significant correlations between intra and postoperative complications and the age of the patients (p > 0.05). The average length of hospitalization days after PCNL was 5.58 +/- 2.69 days SD. The stone-free rate was: 77.5%. Conclusions: PCNL is a safe and effective method used in the treatment of kidney lithiasis that can be performed to both young and elderly patients. Intra and postoperative complications may occur in both age groups but this is not a decisive factor regarding therapeutic choice, which also applies to patients older than 70 years

The correlation between histopathological results post-prostate biopsy and after radical prostatectomy

Clinica Urologie, Spitalul Clinic Județean Mureș, Universitatea de Medicină, Farmacie, Științe și Tehnologie, Târgu Mureș, Al VII-lea Congres de Urologie, Dializã si Transplant Renal din Republica Moldova cu participare internațională 19-21 iunie 2019Introducere: Adenocarcinomul de prostată este cel mai frecvent cancer în rândul bărbaților, fiind a doua cauză de deces, după cancerul de plămâni, de aceea interesul pentru studierea acestei afecțiuni este tot mai mare. Sistemul de grading pentru carcinoamele prostatice este sistemul Gleason, care se bazează pe gradul de diferențiere glandulară si pe pattern-ul de crestere al tumorii (1-5). Scopul: Scopul studiului este de a compara rezultatele EHP de la puncția biopsie prostatică si prostatectomia totală. Materiale și metode: Studiul este unul retrospectiv, pe o perioadă de trei ani, cuprinzând un număr de 42 pacienti internați în Clinica Urologie Tg. Mures în perioada 1 Ianuarie 2016 – 31 decembrie 2018. Au fost incluși în studiu toți pacienții cu cancer de prostată confirmat prin puncție biopsie prostatică, care au beneficiat de prostatectomie totală. Au fost excluși pacienții cu cancer de prostată dovedit prin PBP care au beneficiat de alt tip de tratament. Rezultate: Din cei 42 de pacienți, 25 (59.52%) au fost operați clasic, iar 17 (40.48%) au fost operați laparoscopic. Preoperator, 11 pacienți au avut scorul Gleason 6 (3+3) – 26.19%, 19 pacienți 7 (3+4) – 45.23%, 9 pacienți au avut 7 (4+3) – 21.43%, 2 pacienți au avut Gleason 8 (4+4) – 4.76% si 1 pacient a avut scorul 9 (4+5) – 2.39%. Postoperator, la 21 de pacienți – 50%, scorul Gleason a ramas nemodificat, la 16 pacienți – 38.09, a fost mai mare, la 3 pacienți – 7.15%, a fost mai mic, iar la 2 pacienți – 4.76 – cancerul de prostată nu a mai fost pus în evidență pe piesa de prostatectomie. Concluzii: În ansamblu, fiabilitatea rezultatele EHP a biopsiilor transrectale în prognosticul diagnosticului a fost una bună. Cu toate acestea, limitările clasificării Gleason bazate pe biopsie trebuie luate în considerare atunci când se indică modalitatea terapeutică.Introduction: Prostate adenocarcinoma is the most common type of cancer among men, being the second cause of death, after lung cancer, therefore the interest in studying this disease is increasing. Grading system of prostate carcinoma is Gleason Score, which is based on the degree of glandular differentiation and the tumor growth pattern. Aim: The aim of the study is compare the histopathological results from prostate biopsy and radical prostatectomy. Materials and methods: The study is a retrospective one which included 42 patients admitted in Urology Clinic of Mures County Clinica Hospital between 1 January 2016 – 31 Decembre 2018. The including criteria were patients with prostate cancer confirmed by prostate biopsy, who underwent radical prostatectomy. The excluding criteria were patients with prostate cancer confirmed by prostate biopsy, who received another type of treatment. Results: Out of the 42 patients included in the study, 25 (59.52%) of them were classically operated and 17 (40.48%) were operated laparoscopically.Preoperatively, 11 patients had Gleson score 6 (3+3) – 26.19%, 19 patients had it 7 (3+4) – 45.23%, 9 patients had Gleason score 7 (4+3) – 21.43%, 2 patients hat it 8 (4+4) – 4.76% and 1 had it 9 (4+5) – 2.39%. Postoperatively, 21 patients – 50% had the Gleason score unchanged, 16 patients – 38.09% had a higher Gleason score, 3 patients – 7.16% and in 2 patients the prostate cancer couldn’t be revealed on prostatectomy pieces. Conclusions: Overall, the reliability of histopathological results of transrectal biopsies in prognosis of diagnostic was good. However, the limitations of Gleason score established on prostate biopsies should be considered when indicating the therapeutic mode