Semi-rigid ureteroscopic lithotripsy versus laparoscopic ureterolithotomy for large upper ureteral stones: a meta – analysis of randomized controlled trials
Vol. 42 (4): 645-654, July – August, 2016
Fabio C. M. Torricelli 1,2, Manoj Monga 2, Giovanni S. Marchini 1, Miguel Srougi 1, William C. Nahas 1, Eduardo Mazzucchi 1
1 Departamento de Urologia do Hospital das Clínicas da Universidade de São Paulo Faculdade de Medicina São Paulo, SP, Brasil; 2 Stevan B. Streem Center for Endourology & Stone Disease; Glickman Urological & Kidney Institute, The Cleveland Clinic, Cleveland, OH, USA
Introduction: To provide a systematic review and meta-analysis of randomized controlled trials (RCT) comparing semi-rigid ureteroscopic lithotripsy (URS) with laparoscopic ureterolithotomy (LU) for the treatment of the large proximal ureteral stone.
Materials and methods: A systematic literature review was performed in June 2015 using the PubMed, Scopus, and Web of Science databases to identify relevant studies.
Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria.
Results: Six RCT including 646 patients were analyzed, 325 URS cases (50.3%) and 321 LU cases (49.7%). URS provided a significantly shorter operative time (weighted mean difference [WMD] = -31.26 min; 95%CI -46.88 to -15.64; p<0.0001) and length of hospital stay (WMD = -1.48 days; 95%CI -2.78 to -0.18; p=0.03) than LU. There were no significant differences in terms of overall complications (OR = 0.78; 95%CI 0.21-2.92; p=0.71) and major complications – Clavien ≥3 – (OR = 1.79; 95%CI 0.59-5.42; p=0.30).
LU led to a significantly higher initial stone-free rate (OR = 8.65; 95%CI 4.18-17.91; p<0.00001) and final stone-free rate (OR = 6.41; 95%CI 2.24-18.32; p=0.0005) than URS. There was a significantly higher need for auxiliary procedures...
Extraperitoneal versus transperitoneal laparoscopic radical cystectomy for selected elderly bladder cancer patients: a single center experience
Vol. 42 (4): 655-662, July – August, 2016
Lang Feng 1, Jian Song 1, Menghua Wu 1, Ye Tian 1, Daoxin Zhang 1
1 Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
Objective: This study reports the initial experience of extraperitoneal laparoscopic radical cystectomy (ELRC) and compared with transperitoneal laparoscopic radical cystectomy (TLRC) in the treatment of selected elderly bladder cancer patients.
Patients and Methods: A total of forty male bladder cancer patients who underwent ELRC (n=19) or TLRC (n=21) with ureterocutaneostomy were investigated. Demographic parameters, perioperative variables, oncological outcomes and follow-up data were retrospectively analyzed.
Results: A significantly shorter time to exsufflation (1.5±0.7 vs 2.1±1.1 d; p=0.026) and liquid intake (1.8±0.9 vs 2.8±1.9 d; p=0.035) were observed in the ELRC group compared with the TLRC group. The incidence of postoperative ileus in the ELRC group was lower than the TLRC group (0 vs 9.5%). However, the difference had no statistical significance (p>0.05). The removed lymph node number in the ELRC group was significantly lower than the TLRC group (p<0.001). No significant differences were observed between the two groups in the overall and cancer-free survival rates (p>0.05).
Conclusions: ELRC seems to be a safe and feasible surgical strategy for the selected elderly bladder cancer patients with ≤ T2 disease. The surgical and oncological efficacy of the ELRC is similar to that of the TLRC, but with faster intestinal function recovery. Further studies with a large series including different urinary diversions are needed to confirm our results and to better evaluate the benefit of ELRC in bladder cancer patients.
A comparison of preliminary oncologic outcome and postoperative complications between patients undergoing either open or robotic radical cystectomy
Vol. 42 (4): 663-670, July – August, 2016
Antonio Cusano 1, Peter Haddock 1, Max Jackson 1, Ilene Staff 1, Joseph Wagner 1, Anoop Meraney 1
1 Urology Division, Hartford Healthcare Medical Group, Hartford, USA
Purpose: To compare complications and outcomes in patients undergoing either open radical cystectomy (ORC) or robotic-assisted radical cystectomy (RRC).
Materials and Methods: We retrospectively identified patients that underwent ORC or RRC between 2003- 2013. We statistically compared preliminary oncologic outcomes of patients for each surgical modality.
Results: 92 (43.2%) and 121 (56.8%) patients underwent ORC and RRC, respectively. While operative time was shorter for ORC patients (403 vs. 508 min; p<0.001), surgical blood loss and transfusion rates were significantly lower in RRC patients (p<0.001 and 0.006). Length of stay was not different between groups (p=0.221). There was no difference in the proportion of lymph node-positive patients between groups. However, RRC patients had a greater number of lymph nodes removed during surgery (18 vs. 11.5; p<0.001). There was no significant difference in the incidence of pre-existing comorbidities or in the Clavien distribution of complications between groups.
ORC and RRC patients were followed for a median of 1.38 (0.55-2.7) and 1.40 (0.58-2.59) years, respectively (p=0.850). During this period, a lower proportion (22.3%) of RRC patients experienced disease recurrence vs. ORC patients (34.8%). However, there was no significant difference in time to recurrence between groups. While ORC was associated with a higher all-cause mortality rate (p=0.049), there was no significant difference in disease-free survival time between groups.
Conclusions: ORC and RRC patients experience...
Presentation and surgery outcomes in elderly with pheocromocytoma: a comparative analysis with young patients
Vol. 42 (4): 671-677, July – August, 2016
Victor Srougi 1, Jose L. Chambo 1, Fabio Y. Tanno 1, Iracy S. Soares 2, Madson Q. Almeida 3, Maria A. A. Pereira 3, Miguel Srougi 1, Maria C. Fragoso 3
1 Divisão de Urologia do Hospital das Clínicas da Universidade de São Paulo, Faculdade de Medicina, São Paulo, Brasil; 2 Divisão de Anestesiologia do Hospital das Clínicas da Universidade de São Paulo, Faculdade de Medicina, São Paulo, Brasil; 3 Divisão de Endocrinologia do Hospital das Clínicas da Universidade de São Paulo, Faculdade de Medicina, São Paulo, Brasil
Purpose: To evaluate the presentation and early surgical outcomes of elderly patients undergoing adrenalectomy for phaeochromocytoma.
Patients and Methods: A retrospective search was performed of our adrenal disorders database for patients who underwent surgery for phaeochromocytoma or paraganglioma between 2009 and 2014. Patients >60 years old were classified as elderly. The clinical manifestations, intraoperative course, and early postoperative outcomes of elderly patients were compared to those of younger individuals (<60 years old).
Results: The mean (±standard deviation) age in the older (n=10) and younger (n=36) groups was 69.6±5.3 years and 34.0±12.9 years. Germ-line mutations were more common in younger patients (50.0% versus 0%; p=0.004), whereas incidental lesions were more common in the elderly (40.0% versus 5.3%; p=0.003). In both groups, surgery was most commonly performed by videolaparoscopy (90% in the elderly and 82% in the younger group), with similar intraoperative anesthetic and surgical outcomes. Postoperatively, the older group more commonly received vasoactive drugs (60.0% versus 10.5%; p<0.001) and had a longer intensive care unit stay (3.1±2.8 versus 1.4±1.0...
Vol. 42 (4): 678-684, July – August, 2016
Alper Otunctemur 1, Murat Dursun 1, Huseyin Besiroglu 1, Kutan Ozer 2, Ozan Horsanali 2, Emin Ozbek 1
1 Department of Urology, Okmeydani Training and Research Hospital, Istanbul, Turkey; 2 Department of Urology, Ataturk Training and Research Hospital, Izmir, Turkey
Introduction: We investigated the prognostic significance of the neutrophil-to-lymphocyte ratio on tumor stage and Fuhrman nuclear grade in renal cell carcinoma.
Methods: The records of 432 patients with RCC who underwent radical or partial nephrectomy between 2005 and 2014 were retrospectively reviewed. Patients were classified as group lower tumor stage (T1 + T2) and higher (T3 + T4). As like tumor stage, Fuhrman nuclear grade were classified lower (G1+G2) and higher (G3+G4) too. The best NLR cut off value was 3.01.Two sample t-test or Mann–Whitney U-test used for the continuous variables and a chi-square test or Fisher’s exact test used for the categorical variables.
Results: Among the 432 total patients analyzed in our study, there were 275 males (63.7%) and 157 females (36.3%). Mean laboratory values were CRP 2.73 ± 1.93 mg/ dL (normal less than 0.3), neutrophil count 4.23 ± 1.46/μL, lymphocyte count 1,61 ± 0.61/μL and NLR 2.64 ± 1.24. According to our data, statistically pretreatment NLR significantly
correlated with CRP (p<0.0001). And tumor patologic stage(p=008), tumor histologic grade (p<0.001) was significantly associated with NLR.
Discussion: We compared the relationship of preoperative NLR and NC parameters with RCC tumor stage and grade. And NLR were found to have statistically significant higher T stage and grade at RCC. Further...