[Urology images. Ultrasonography in corpus cavernosum rupture].
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Humans↗
Biomedical subjects
J Duarte Novo
Publications and source records attributed to J Duarte Novo.
[Urinary lithiasis in transplanted kidney].
OBJECTIVE: We reviewed the records of patients submitted to renal transplantation at our institution to determine the incidence and risk factors for calculus formation in these patients. METHODS: Of 794 functioning renal grafts that had been transplanted from January, 1981 to May, 1996, 16 patients (2%), 9 males and 7 females, had upper urinary tract calculi post-transplantation. All 16 patients had received kidneys from cadaver donors. Three had donor graft lithiasis. The calculi were located predominantly in the calyces, at multiple sites in 7 patients and the mean size was 8.3 mm. The composition of the calculi was predominantly uric acid. Four patients who developed sudden obstructive anuria with elevated serum creatinine, underwent percutaneous drainage. RESULTS: All patients had one or more stone-predisposing factors, such as obstructive uropathy, recurrent urinary tract infection or metabolic abnormalities (predominantly hyperuricosuria). Five patients passed their stones spontaneously, 7 patients with uric acid stones were treated with urinary alkalinization, two patients underwent open pyelolithotomy, one underwent percutaneous nephrolithotomy and one patient with a small asymptomatic caliceal stone was managed conservatively (watchful waiting). During long-term follow-up (mean 69 months), 4 patients lost the real graft [only one case was related to urinary calculi (primary hyperoxaluria)] and 4 patients had recurrent calculi. CONCLUSION: Urinary lithiasis after renal transplantation is a relatively uncommon complication. A multifactorial etiology for calculus formation has been observed. The predisposing factors and composition of the calculi, but not frequency, are identical to those of non-transplant patients. A variety of methods are used to treat posttransplant calculi. The least invasive treatment available should be utilized according to the likelihood of recurrence and the need to preserve renal function. With adequate treatment and prophylaxis, posttransplant urolithiasis does not appear to affect graft function.
Adolescent↗
[Effect of complete androgen block before radical prostatectomy for cancer of the prostate].
OBJECTIVE: To evaluate the efficacy of complete androgen deprivation in downstaging advanced localized prostate cancer prior to radical prostatectomy. The study evaluated positive margins, prostate volume, PSA and histological changes. METHODS: We evaluated 22 patients with stage T2 (13 pts, 59%) and T3 (13 pts, 59%) prostate cancer treated with complete androgen deprivation for at least 3 months prior to radical prostatectomy. RESULTS: PSA levels dropped in 97% (51.1-1.4 ng/dl) after treatment (p < 0.001); 20 (90%) had PSA < 3 ng/dl, including 3 cases (14%) with positive nodes; 2 cases (9%) with pT2 tumor had PSA > 3 ng/ml. The mean prostate volume dropped 33% from 52.6 to 35.2 cc (p < 0.001). Of the 22 cases, only one T2 (4%) was staged down; 10 (45.5%) had positive margins versus 17 (53%) of the control group (p > 0.05). The Gleason score increased in 19 (86%) and 90% had cytoplasmic vacuolization and pyknosis with moderate nuclear lysis in 50%. CONCLUSION: Neoadjuvant treatment significantly reduces PSA levels and prostate volume. The decrease in PSA levels, however, does not appear to have a direct correlation with the final pathologic stage. Tumor stage changed slightly in patients with T2 tumors and no response was observed in those with T3. Patients receiving neoadjuvant therapy had a slight advantage with respect to positive margins. The histological findings were suggestive of cellular lysis.
Adenocarcinoma↗
[Renal carcinoma with tumor thrombus in the vena cava and auricle. Experience and review].
OBJECTIVES: To report on our experience in the treatment of renal cell carcinoma with vena caval or right atrial extension, with special reference to the level of involvement and the surgical technique indicated for each case. METHODS: From early 1975 to April, 1997, 212 patients underwent surgery for renal cell carcinoma. Of these, 15 patients (11 male, 4 female), aged 27 to 73 years, had a tumor thrombus extending to the inferior vena cava. The tumor was located in the right kidney in 11 patients and in the left kidney in 4 patients. The tumor thrombus was infrahepatic in 10 cases, it extended beyond the suprahepatic veins in 3 cases, and 2 cases showed right atrial extension. The 10 patients with infrahepatic caval thrombus underwent radical nephrectomy with cavotomy and thrombus removal. In the remaining 5 patients with suprahepatic or atrial extension, thrombus removal was performed via cardiopulmonary by-pass with hypothermic circulatory arrest, with the assistance of a team of cardiac surgeons. RESULTS: Pathological staging showed 2 T3cNoMo, 1 T3bNoMo and 2 T3bN1Mo in the patients who underwent cardiopulmonary bypass. There were 5 T3bNoMo, 2 T3bN2Mo, 1 T3bN2M1, 1 T4NoMo and 1 T4N1M1 in the group of patients with infrahepatic thrombus. There were two postoperative deaths. The overall survival rate was poor. Six patients are alive at 3-26 months' follow-up and 9 have died from disease progression. Patients with lymph node involvement or metastasis at the time of diagnosis had a worse survival rate. CONCLUSIONS: Surgical treatment of renal cancer with vena caval extension is specially difficult depending on the level of involvement, which must therefore be determined with precision. MRI is an effective and noninvasive technique. Tumors with thrombus below the suprahepatic veins can be managed by the direct approach with cavotomy. The use of cardiopulmonary bypass is advocated for tumors with suprahepatic caval or atrial extension. Tumors with caval-atrial extension have a negative influence on survival.
Adult↗