Treatment of ureteral calculi by ureteroscopy: experience of 100 cases at the Faculdade de Medicina do ABC (FMABC – Medical School)

Objective: To report the experience of treating ureteral calculi byureteroscopy at the Faculdade de Medicina do ABC – SP, with anemphasis on the efficacy and safety of the method. Methods: Aretrospective analysis of 100 ureteroscopies performed fromJanuary 2001 to August 2003 in 98 patients with ureteral calculi.Results: A 91% success rate was observed with a single procedureusing this technique. Intracorporeal lithotripsy was necessary in61% of cases before removing the stone; in the remaining cases, itwas extracted with no disintegration. Endoscopic approach wasimpossible in only one patient who required conversion toconventional open surgery. The double-J stent was inserted in73.7% of procedures. Complications were observed in 8% of cases.Conclusion: The present study demonstrated results comparablewith those reported in large series in the literature. The high successrates, low morbidity, rapid convalescence and lack of estheticconsequences corroborate the role of ureteroscopy as an attractivealternative for treating ureteral calculi

Litíase reno ureteral: (tratamento)

O autor focaliza aspectos gerais relacionados com a etiopatogenia da litíase reno-ureteral, dando destaque ao problema do tratamento

Accepted

There are many people who have contributed, in one way or another, to the success of this dissertation. I am grateful to them all. I specifically want to thank my committee chairperson, mentor, and friend, Dr. Mario Beruvides for giving me a chance when not many others would have, and for generously and relentlessly providing me with direction, motivation, and knowledge. I want to thank Dr. James Smith and Dr. Milton Smith for their continued support and guidance throughout my time in graduate school, and Dr. Keith Jones for his invaluable assistance. I also want to thank Dr. Jerry Ramsey, to whom I owe every day I spent at Texas Tech, and all my consequent accomplishments. I am humbled by his generosity, brilliance, and wisdom. I want to thank my fiancée and backbone, Angela Sandoval for supporting and tolerating me in my most difficult hours, and for sharing with me my happiest days. Without the moral support, encouragement, and expertise she provided, and without her belief in me, I would not have completed this dissertation. I am eternally grateful to my father for giving me the opportunity to fulfill my lifelong dream of pursuing graduate studies in the United States. His sacrifices and kindness are immeasurable. I am also enormously indebted to my brother, Mostafa, my sister-in-law, Mona, and my grandfather for their unconditional support

Hand-assisted bilateral nephrectomy in a patient with adult polycystic kidney disease

CONTEXT: Dominantly autosomal polycystic disease is characterized by multiple bilateral and non-functional cysts, which lead to progressive kidney failure. OBJECTIVE: Our objective was to report on a case of hand-assisted bilateral nephrectomy in a 28-year-old female patient with adult polycystic disease and recurring pyelonephritis in a kidney transplant program. CASE REPORT: A hand-assisted bilateral nephrectomy was performed through a supra-umbilical median incision of approximately 6 cm, and with 3 ports of 10 mm. The length of the surgery was 3 hours and 15 minutes. The kidneys were removed after the aspiration of some cysts through the supra-umbilical incision. Pain control was achieved via the use of analgesics. The blood loss during surgery was 160 ml. During the postoperative period, the patient developed right-side pneumothorax, which was drained with no further occurrence. This drain was kept in place for 48 hours. The length of hospitalization was 4 days

Laparoscopic Burch surgery: is there any advantage in relation to open approach?

INTRODUCTION: Surgery represents the main therapeutic modality for stress urinary incontinence. In incontinent patients with urethral hypermobility, the retropubic colposuspension by Burch technique is one of the surgeries that present better long-term results. Current trends towards performing minimally invasive techniques led proposing the Burch surgery through videolaparoscopy. The laparoscopic technique's long-term efficacy is a highly controversial issue. However, even if late results turn out to be satisfactory, the assumed advantages of laparoscopy (faster recovery, less pain, early return to daily activities, etc.) must be evident, in order to justify the use of this minimally invasive surgical access. MATERIALS AND METHODS: We reviewed our records and analyzed the medical charts of 26 female patients who underwent Burch surgery by open approach and 36 female patients by laparoscopic approach, between May 1999 and February 2001. The satisfaction level, surgical complication rates, surgery length, hospital stay and return to daily activities were analyzed. RESULTS: Mean age was 42 years, ranging from 27 to 68 years. Epidemiological data from both groups were not statistically different. Patients operated by laparoscopic route had a shorter hospital stay (p = 0.002) and a faster return to their daily activities (p < 0.001). However, there were no statistical differences in the following parameters: surgical time (p = 0.11), surgical complications (p = 0.98), patient satisfaction immediately (p = 0.77) and 90 days following surgery (p = 0.84), surgery acceptance (p = 0.85), indication of this surgery to a friend (p = 0.93) and score given to the procedure (p = 0.68). CONCLUSIONS: Even if the efficacy of both methods is similar, we did not observe significant advantages of laparoscopic surgery over open surgery, concerning the recovery in recent post-operative period