Upper urinary tract lithiasis is a condition characterized by the presence of stones which is a stony concretion of crystallized substances in the kidney and/or ureter. Objective: The objective of this work is to stud...Upper urinary tract lithiasis is a condition characterized by the presence of stones which is a stony concretion of crystallized substances in the kidney and/or ureter. Objective: The objective of this work is to study the epidemiological, clinical and therapeutic aspects of upper urinary tract stones on the one hand, then to compare the different types of surgical treatments and their results. Materials and Methods: This is a retrospective and descriptive study focusing on the surgical management of upper urinary tract stones, between January 2017 and December 2020, at the Urology department of the Hopital General Idrissa Pouye. Results: During the study period, 7.59% of surgical interventions performed were related to the treatment of upper urinary tract stones. Average age was 45.20 ± 16.4 years, the age group [41 - 60] years was more affected with 42.68%. A history of urolithiasis was present in 25.52% of cases. Lower back pain was present in 97.48% of cases. On URO-CT scan, the stone was located more at the level of the ureter (49.57%). The size between 10 to 15 mm was more frequent (30.96%) and the density greater than 1000 HU was more frequent (33.47%). The most used therapeutic procedure was ureteroscopy (52.08%), followed by PCNL (40.83%) and open surgery (7.08%). The success rate (stone free) was 93.68% for the URS, 89.36% for the PCNL. The length of hospital stay for open surgery was 6.76 ± 4.25, for PCNL 2.62 ± 2 days and for URS 1.75 ± 1.62 days. Postoperative complications were present in 23.52% for open surgery, 11.22% for PCNL and 8% for URS. Conclusion: Urolithiasis is constantly growing in our regions. Effective endourological treatment is increasingly replacing open surgery. However, global access to these new techniques in our regions is slow to be effective.展开更多
Objective:To report the outcomes of surgery for a contemporary series of patients with locally advanced non-metastatic renal cell carcinoma(RCC)treated at a referral academic centre,focusing on technical nuances and o...Objective:To report the outcomes of surgery for a contemporary series of patients with locally advanced non-metastatic renal cell carcinoma(RCC)treated at a referral academic centre,focusing on technical nuances and on the value of a multidisciplinary team.Methods:We queried our prospective institutional database to identify patients undergoing surgical treatment for locally advanced(cT3-T4 N0-1 M0)renal masses suspected of RCC at our centre between January 2017 and December 2020.Results:Overall,32 patients were included in the analytic cohort.Of these,12(37.5%)tumours were staged as cT3a,8(25.0%)as cT3b,5(15.6%)as cT3c,and 7(21.9%)as cT4;6(18.8%)patients had preoperative evidence of lymph node involvement.Nine(28.1%)patients underwent nephron-sparing surgery while 23(71.9%)received radical nephrectomy.A template-based lymphadenectomy was performed in 12 cases,with evidence of disease in 3(25.0%)at definitive histopathological analysis.Four cases of RCC with level IV inferior vena cava thrombosis were successfully treated using liver transplant techniques without the need for extracorporeal circulation.While intraoperative complications were recorded in 3(9.4%)patients,no postoperative major complications(Clavien-Dindo3)were observed.At histopathological analysis,2(6.2%)patients who underwent partial nephrectomy harboured oncocytoma,while the most common malignant histotype was clear cell RCC(62.5%),with a median Leibovich score of 6(interquartile range 5e7).Conclusion:Locally advanced RCC is a complex and heterogenous disease posing several challenges to surgical teams.Our experience confirms that provided careful patient selection,surgery in experienced hands can achieve favourable perioperative,oncological,and functional outcomes.展开更多
Cumulative evidence suggests that renal vascular endothelial injury play an important role in initiating and extending tubular epithelial injury and contribute to the development of ischemic acute renal failure.Our pr...Cumulative evidence suggests that renal vascular endothelial injury play an important role in initiating and extending tubular epithelial injury and contribute to the development of ischemic acute renal failure.Our previous studies have demonstrated that iptakalim's endothelium protection is related to activation of SUR2B/Kir6.1 subtype of ATP sensitive potassium channel(K ATP) in the endothelium.It has been reported that SUR2B/Kir6.1 channels are widely distributed in the tubular epithelium,glomerular mesangium,and the endothelium and the smooth muscle of blood vessels.Herein,we hypothesized that activating renal K ATP channels with iptakalim might have directly neroprotective effects.In this study,glomerular endothelial,mesangial and tubular epithelial cells which are the main cell types to form nephron were exposed to oleic acid(OA) at various concentrations for 24 h.0.25 μl/ml OA could cause cellular damage of glomerular endothelium and mesangium,while 1.25μl/ml OA could lead to the injury of three types of renal cells.It was observed that pretreatment with iptakalim at concentrations of 0.1,1,10 or 100 μmol/L prevented cellular damage of glomerular endothelium and tubular epithelium,whereas iptakalim from 1 to 100 μmol/L prevented the injury of mesangial cells.Our data showed iptakalim significantly increased survived cell rates in a concentration-dependent manner,significantly antagonized by glibenclamide,a K ATP blocker.Iptakalim played a protective role in the main cell types of kidney,which was consistent with natakalim,a highly selective SUR2B/Kir6.1 channel opener.Iptakalim exerted protective effects through activating SUR2B/Kir6.1 channels,suggesting a new strategy for renal injury by its endothelial and renal cell protection.展开更多
AIM To compare laparoscopic and open living donor nephrectomy,based on the results from a single center during a decade.METHODS This is a retrospective review of all living donor nephrectomies performed at the Massach...AIM To compare laparoscopic and open living donor nephrectomy,based on the results from a single center during a decade.METHODS This is a retrospective review of all living donor nephrectomies performed at the Massachusetts General Hospital,Harvard Medical School,Boston,between 1/1998- 12/2009. Overall there were 490 living donors,with 279 undergoing laparoscopic living donor nephrectomy(LLDN) and 211 undergoing open donor nephrectomy(OLDN). Demographic data,operating room time,the effect of the learning curve,the number of conversions from laparoscopic to open surgery,donor preoperative glomerular filtration rate and creatinine(Cr),donor and recipient postoperative Cr,delayed graft function and donor complications were analyzed. Statistical analysis was performed.RESULTS Overall there was no statistically significant difference between the LLDN and the OLDN groups regarding operating time,donor preoperative renal function,donor and recipient postoperative kidney function,delayed graft function or the incidence of major complications. When the last 100 laparoscopic cases were analyzed,there was a statistically significant difference regarding operating time in favor of the LLDN,pointing out the importance of the learning curve. Furthermore,another significant difference between the two groups was the decreased length of stay for the LLDN(2.87 d for LLDN vs 3.6 d for OLDN).CONCLUSION Recognizing the importance of the learning curve,this paper provides evidence that LLDN has a safety profile comparable to OLDN and decreased length of stay for the donor.展开更多
Objective: Acute kidney disease develops 16% - 30% of patients with preoperative impaired renal functions. Our aim of this study was to compare postoperative renal outcomes using two open heart surgery techniques, on-...Objective: Acute kidney disease develops 16% - 30% of patients with preoperative impaired renal functions. Our aim of this study was to compare postoperative renal outcomes using two open heart surgery techniques, on-pump beating heart (OPBH) and conventional on-pump (COP), in patients who have preoperative low glomerular filtration rate (eGFR) as an indicator of creatinine clearance. Methods: From 2004 to 2015, 341 patients with preoperative creatinine clearance were lower than 90 ml/min/1.73m2 were selected for this study. On-Pump beating heart was performed in 111 patients (Group I). Conventional on-pump technique was used in 200 patients. In the remaining patients, we measured postoperative Tumor Necrosis Factor Alpha (TNF-alpha), cardiac troponin I (cTn-I), Brain natriuretic peptid (NT-Pro- BNP), creati-nine (Cr), blood urea nitrogen (BUN) and postoperative eGFR daily until day four after surgery. Results: There were no differences in baseline levels of TNF-alpha, NT-Pro-BNP, BUN, cTn-I, Cr levels between the groups. Cardiopulmonary bypass (CPB) time were much longer and cumulative inotrope use was significantly higher in patients underwent COP (P Conclusion: Our study showed that on-pump beating heart CABG technique provides a morbidity benefit and is associated with a lower risk of peroperative LOS in patients with mild renal disfunction. Our study results suggest that OPBH is superior to the COP in terms of postoperative renal injury and cardiac mediators.展开更多
目的比较机器人辅助和开放根治性肾切除术治疗复杂大(肿瘤直径>8 cm)肾肿瘤的可行性、安全性及有效性。方法回顾性分析2015年11月-2019年8月于郑州大学第一附属医院行机器人辅助或开放根治性肾切除术的24例复杂大肾肿瘤患者的临床资...目的比较机器人辅助和开放根治性肾切除术治疗复杂大(肿瘤直径>8 cm)肾肿瘤的可行性、安全性及有效性。方法回顾性分析2015年11月-2019年8月于郑州大学第一附属医院行机器人辅助或开放根治性肾切除术的24例复杂大肾肿瘤患者的临床资料,根据手术方式分为机器人手术组(9例,37.5%)、开放手术组(15例,62.5%),收集患者的随访资料,对比两组手术参数、围手术期并发症和随访结果。结果24例手术均成功,开放手术组较机器人手术组患者的临床症状比例高(93.3%vs.44.4%,P=0.015),肿瘤最大径长(124 mm vs.95 mm,P=0.021),其他术前特征两组比较差异无统计学意义。机器人手术组较开放组的术中出血量(100 mL vs.800 mL,P=0.006)和输血率(0%vs.60.0%,P=0.007)低。中位随访时间为50(25~67)个月,4例开放手术和1例机器人手术患者术后发生新发转移,4例开放手术组患者因肿瘤处于晚期发生死亡。结论机器人辅助根治性肾切除术治疗复杂大肾肿瘤安全性较好,且术中出血量少于开放手术。展开更多
文摘Upper urinary tract lithiasis is a condition characterized by the presence of stones which is a stony concretion of crystallized substances in the kidney and/or ureter. Objective: The objective of this work is to study the epidemiological, clinical and therapeutic aspects of upper urinary tract stones on the one hand, then to compare the different types of surgical treatments and their results. Materials and Methods: This is a retrospective and descriptive study focusing on the surgical management of upper urinary tract stones, between January 2017 and December 2020, at the Urology department of the Hopital General Idrissa Pouye. Results: During the study period, 7.59% of surgical interventions performed were related to the treatment of upper urinary tract stones. Average age was 45.20 ± 16.4 years, the age group [41 - 60] years was more affected with 42.68%. A history of urolithiasis was present in 25.52% of cases. Lower back pain was present in 97.48% of cases. On URO-CT scan, the stone was located more at the level of the ureter (49.57%). The size between 10 to 15 mm was more frequent (30.96%) and the density greater than 1000 HU was more frequent (33.47%). The most used therapeutic procedure was ureteroscopy (52.08%), followed by PCNL (40.83%) and open surgery (7.08%). The success rate (stone free) was 93.68% for the URS, 89.36% for the PCNL. The length of hospital stay for open surgery was 6.76 ± 4.25, for PCNL 2.62 ± 2 days and for URS 1.75 ± 1.62 days. Postoperative complications were present in 23.52% for open surgery, 11.22% for PCNL and 8% for URS. Conclusion: Urolithiasis is constantly growing in our regions. Effective endourological treatment is increasingly replacing open surgery. However, global access to these new techniques in our regions is slow to be effective.
文摘Objective:To report the outcomes of surgery for a contemporary series of patients with locally advanced non-metastatic renal cell carcinoma(RCC)treated at a referral academic centre,focusing on technical nuances and on the value of a multidisciplinary team.Methods:We queried our prospective institutional database to identify patients undergoing surgical treatment for locally advanced(cT3-T4 N0-1 M0)renal masses suspected of RCC at our centre between January 2017 and December 2020.Results:Overall,32 patients were included in the analytic cohort.Of these,12(37.5%)tumours were staged as cT3a,8(25.0%)as cT3b,5(15.6%)as cT3c,and 7(21.9%)as cT4;6(18.8%)patients had preoperative evidence of lymph node involvement.Nine(28.1%)patients underwent nephron-sparing surgery while 23(71.9%)received radical nephrectomy.A template-based lymphadenectomy was performed in 12 cases,with evidence of disease in 3(25.0%)at definitive histopathological analysis.Four cases of RCC with level IV inferior vena cava thrombosis were successfully treated using liver transplant techniques without the need for extracorporeal circulation.While intraoperative complications were recorded in 3(9.4%)patients,no postoperative major complications(Clavien-Dindo3)were observed.At histopathological analysis,2(6.2%)patients who underwent partial nephrectomy harboured oncocytoma,while the most common malignant histotype was clear cell RCC(62.5%),with a median Leibovich score of 6(interquartile range 5e7).Conclusion:Locally advanced RCC is a complex and heterogenous disease posing several challenges to surgical teams.Our experience confirms that provided careful patient selection,surgery in experienced hands can achieve favourable perioperative,oncological,and functional outcomes.
基金supported by grants from National New Drug Research and Development of Key Project(2010ZX09401-307,2008ZX09101-006,2008ZXJ09004-018 and 2009ZX09301-002)
文摘Cumulative evidence suggests that renal vascular endothelial injury play an important role in initiating and extending tubular epithelial injury and contribute to the development of ischemic acute renal failure.Our previous studies have demonstrated that iptakalim's endothelium protection is related to activation of SUR2B/Kir6.1 subtype of ATP sensitive potassium channel(K ATP) in the endothelium.It has been reported that SUR2B/Kir6.1 channels are widely distributed in the tubular epithelium,glomerular mesangium,and the endothelium and the smooth muscle of blood vessels.Herein,we hypothesized that activating renal K ATP channels with iptakalim might have directly neroprotective effects.In this study,glomerular endothelial,mesangial and tubular epithelial cells which are the main cell types to form nephron were exposed to oleic acid(OA) at various concentrations for 24 h.0.25 μl/ml OA could cause cellular damage of glomerular endothelium and mesangium,while 1.25μl/ml OA could lead to the injury of three types of renal cells.It was observed that pretreatment with iptakalim at concentrations of 0.1,1,10 or 100 μmol/L prevented cellular damage of glomerular endothelium and tubular epithelium,whereas iptakalim from 1 to 100 μmol/L prevented the injury of mesangial cells.Our data showed iptakalim significantly increased survived cell rates in a concentration-dependent manner,significantly antagonized by glibenclamide,a K ATP blocker.Iptakalim played a protective role in the main cell types of kidney,which was consistent with natakalim,a highly selective SUR2B/Kir6.1 channel opener.Iptakalim exerted protective effects through activating SUR2B/Kir6.1 channels,suggesting a new strategy for renal injury by its endothelial and renal cell protection.
文摘AIM To compare laparoscopic and open living donor nephrectomy,based on the results from a single center during a decade.METHODS This is a retrospective review of all living donor nephrectomies performed at the Massachusetts General Hospital,Harvard Medical School,Boston,between 1/1998- 12/2009. Overall there were 490 living donors,with 279 undergoing laparoscopic living donor nephrectomy(LLDN) and 211 undergoing open donor nephrectomy(OLDN). Demographic data,operating room time,the effect of the learning curve,the number of conversions from laparoscopic to open surgery,donor preoperative glomerular filtration rate and creatinine(Cr),donor and recipient postoperative Cr,delayed graft function and donor complications were analyzed. Statistical analysis was performed.RESULTS Overall there was no statistically significant difference between the LLDN and the OLDN groups regarding operating time,donor preoperative renal function,donor and recipient postoperative kidney function,delayed graft function or the incidence of major complications. When the last 100 laparoscopic cases were analyzed,there was a statistically significant difference regarding operating time in favor of the LLDN,pointing out the importance of the learning curve. Furthermore,another significant difference between the two groups was the decreased length of stay for the LLDN(2.87 d for LLDN vs 3.6 d for OLDN).CONCLUSION Recognizing the importance of the learning curve,this paper provides evidence that LLDN has a safety profile comparable to OLDN and decreased length of stay for the donor.
文摘Objective: Acute kidney disease develops 16% - 30% of patients with preoperative impaired renal functions. Our aim of this study was to compare postoperative renal outcomes using two open heart surgery techniques, on-pump beating heart (OPBH) and conventional on-pump (COP), in patients who have preoperative low glomerular filtration rate (eGFR) as an indicator of creatinine clearance. Methods: From 2004 to 2015, 341 patients with preoperative creatinine clearance were lower than 90 ml/min/1.73m2 were selected for this study. On-Pump beating heart was performed in 111 patients (Group I). Conventional on-pump technique was used in 200 patients. In the remaining patients, we measured postoperative Tumor Necrosis Factor Alpha (TNF-alpha), cardiac troponin I (cTn-I), Brain natriuretic peptid (NT-Pro- BNP), creati-nine (Cr), blood urea nitrogen (BUN) and postoperative eGFR daily until day four after surgery. Results: There were no differences in baseline levels of TNF-alpha, NT-Pro-BNP, BUN, cTn-I, Cr levels between the groups. Cardiopulmonary bypass (CPB) time were much longer and cumulative inotrope use was significantly higher in patients underwent COP (P Conclusion: Our study showed that on-pump beating heart CABG technique provides a morbidity benefit and is associated with a lower risk of peroperative LOS in patients with mild renal disfunction. Our study results suggest that OPBH is superior to the COP in terms of postoperative renal injury and cardiac mediators.
文摘目的比较机器人辅助和开放根治性肾切除术治疗复杂大(肿瘤直径>8 cm)肾肿瘤的可行性、安全性及有效性。方法回顾性分析2015年11月-2019年8月于郑州大学第一附属医院行机器人辅助或开放根治性肾切除术的24例复杂大肾肿瘤患者的临床资料,根据手术方式分为机器人手术组(9例,37.5%)、开放手术组(15例,62.5%),收集患者的随访资料,对比两组手术参数、围手术期并发症和随访结果。结果24例手术均成功,开放手术组较机器人手术组患者的临床症状比例高(93.3%vs.44.4%,P=0.015),肿瘤最大径长(124 mm vs.95 mm,P=0.021),其他术前特征两组比较差异无统计学意义。机器人手术组较开放组的术中出血量(100 mL vs.800 mL,P=0.006)和输血率(0%vs.60.0%,P=0.007)低。中位随访时间为50(25~67)个月,4例开放手术和1例机器人手术患者术后发生新发转移,4例开放手术组患者因肿瘤处于晚期发生死亡。结论机器人辅助根治性肾切除术治疗复杂大肾肿瘤安全性较好,且术中出血量少于开放手术。
