Resultados oncológicos da nefrectomia radical laparoscópica no tratamento do carcinoma renal

PURPOSE: To report the 5-year oncological outcomes of patients undergoing laparoscopic radical nephrectomy for renal cancer compared to a cohort of patients undergoing open radical nephrectomy. METHODS: We retrospectively analyzed the data of 88 patients undergoing radical nephrectomy for renal cell carcinoma prior to January 2000. Of these, 45 patients underwent laparoscopic radical nephrectomy, and 43 patients underwent open radical nephrectomy. Inclusion criteria comprised clinically organ-confined tumors of 15 cm or less in size without concomitant lymphadenopathy or vena cava thrombus. Oncological follow-up data were obtained from charts, radiological reports, and phone calls to patients or their families, and were calculated from the date of surgery to the date of last appointment with physician or date of death. RESULTS: All laparoscopic procedures were completed without open conversion. On comparing the laparoscopic radical nephrectomy and open radical nephrectomy groups, mean tumor size was 5. 8 vs 6.2 cm (P = . 44), mean blood loss was 183 vs 461 mL (P = . 004), and mean operative time was 2.8 vs 3.7 hrs (P < . 001). Over a mean follow-up of 5 years in the laparoscopic radical nephrectomy group and 6 years in the open radical nephrectomy group, the overall survival was 81% vs 79% (P = . 47), and cancer-specific survival was 90% vs 92% (P = . 70) , respectively. CONCLUSIONS: Laparoscopic radical nephrectomy for renal cancer confers equivalent 5-year oncological outcomes to those of open surgery.OBJETIVO: Relatar os resultados oncológicos após 5 anos de seguimento em pacientes submetidos a nefrectomia radical laparoscópica para tratamento do câncer renal, comparando esses com os resultados obtidos com um grupo de pacientes submetidos a nefrectomia radical aberta. MÉTODOS: Foram analisadas retrospectivamente as informações obtidas de 88 pacientes submetidos a nefrectomia radical para o tratamento do carcinoma renal realizadas previamente a Janeiro de 2000. Destes pacientes, 45 foram tratados com nefrectomia radical laparoscópica e 43 com nefrectomia radical aberta. Foram incluídos pacientes com tumores localizados com tamanho máximo de 15 cm, sem adenopatia ou sinal de envolvimento de veia renal na avaliação radiologica pré-operatória. As informações sobre o seguimento dos pacientes foram obtidas a partir de prontuários, laudos de exames radiológicos e ligações telefônicas para pacientes e/ou familiares. O seguimento foi calculado desde a data da cirurgia até a última consulta médica ou data de falecimento. RESULTADOS: Todos os procedimentos laparoscópicos foram realizados sem conversão para a técnica aberta. O tamanho médio tumoral foi de 5.8 e. 6.2 cm (P=0.44), perda sanguínea estimada de 183 e. 461 mL (P=0.004), e tempo operatório de 2.8 e. 3.7 horas (

Laparoscopic partial nephrectomy: Newer trends

Objectives: To report the advances in laparoscopic partial nephrectomy (LPN) for renal masses with emphasis on technically challenging cases. Methods: Literature in the English language was reviewed using the National Library of Medicine database using the key words kidney, renal, tumor, nephron sparing surgery, and laparoscopic partial nephrectomy, for the period between 1993 and 2009. Over 500 articles were identified. A total of 50 articles were selected for this review based on their relevance to the evolution of the technique and outcomes, as well as expanding indications for LPN. Results: In expert hands, LPN is safe and effective for central tumors, completely intrarenal tumors, hilar tumors, tumor in a solitary kidney, large tumors requiring heminephrectomy, cystic tumors, multiple tumors, obese patients, and even incidental stage ≥ pT2 tumors. Perioperative outcomes and 5-year oncologic outcomes after LPN are comparable to open partial nephrectomy (OPN). Conclusions: In experienced hands indications for LPN have expanded significantly. In 2009, advanced LPN remains a skill-intensive procedure that can nevertheless provide excellent outcomes for patients with renal tumors

Prospective double-blind randomized controlled trial of terazosin, finasteride and allylestrenol in the management of benign prostatic hyperplasia

Medical management is rapidly becoming a very im-portant part of the armamentarium of the urologist in-volved in the treatment of benign prostatic hyperplasia. The commonest options for medical management include alpha-blockers, 5-alpha reductase inhibitors, and pro-gestational anti-androgens. We present a double-blind randomized controlled trial evaluating the safety and efficacy of terazosin, finasteride and allylestrenol, the prototype drugs in each of these respective categories. A total of 140 patients who satisfied the inclusion and exclusion criteria were inducted into the trial after an informed consent. They were randomized into 4 groups, which received placebo, terazosin, finasteride and allylestrenol respectively for 6 months. Since 29 patients did not complete 6 months of therapy, there were 111 evaluable patients at the end of the study. We found that these 3 drugs produce comparable improvement in symp-tom score (-40%), flow rates (-60%) and PVR (-50%) which is significantly better than that in the placebo group. Both allylestrenol and finasteride bring about a comparable reduction in prostate volume (-23%), which is statistically significant as compared to the placebo and terazosin groups. Terazosin in doses of I and 2 mg/ day was, found to be effiective and well-tolerated in the vast majority of our cases. No adverse effects were seen in the placebo and finasteride groups, while 9.6% in the terazosin group had postural hypotension and 10.7% in the allylestrenol group had some loss of libido, prob-lems which were reversible upon cessation of therapy

Feasibility of robotic radical prostatectomy for medication refractory chronic prostatitis/chronic pelvic pain syndrome: Initial results

Four patients diagnosed with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), met criteria for National Institute of Health (NIH) Category III prostatitis, failed multiple medicinal treatments and underwent robotic radical prostatectomy (RRP). Median operative time (range): 157 (127–259) min. Validated functional questionnaires responses and NIH CP symptom index (NIH-CPSI) score were collected for each patient's status at different time points pre- and post-operatively. Median decreases (range) were: International Prostate Symptom Score - 14 (1–19); Sexual Health Inventory for Men - 6 (−14–22); and NIH-CPSI total - 23.5 (13–33). Median length of follow-up (range) was 34 (24–43) months. RRP appears to be an option for carefully selected patients with medication-refractory CP/CPPS who understand that baseline sexual function may not be restored postoperatively

Current status of minimally invasive management of pediatric upper urinary tract calculi

The surgical management of pediatric upper urinary tract calculi has evolved from open surgery to minimally invasive techniques. With advancement in instrumentation, endourological procedures are being performed more commonly in children. However, the endourological management of renal and ureteral stones in the pediatric population is considered challenging, owing to the smaller size of the urinary tract. Various minimally invasive techniques that are being applied in the management of pediatric urolithiasis, include shock wave lithitripsy (SWL), percutaneous nephrolithotomy (PCNL), ureterorenoscopy and a combination of these procedures. The role of SWL is well established and is considered the first line of treatment in the management of urinary calculi in pediatric patients. Recent reports have confirmed the safety of PCNL and ureteroscopy in children, although they are not as widely practiced in children as in adults. This article reviews literature published till October 2005, pertaining to the minimally invasive management of pediatric upper urinary tract calculi