Urologia
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- Advances in Lasers for the Treatment of Stones-a Systematic ReviewPublication . Kronenberg, P; Somani, BPURPOSE OF REVIEW: Laser lithotripsy is increasingly used worldwide and is a continuously evolving field with new and extensive research being published every year. RECENT FINDINGS: Variable pulse length Ho:YAG lithotripters allow new lithotripsy parameters to be manipulated, and there is an effort to integrate new technologies into lithotripters. Pulsed thulium lasers seem to be a viable alternative to holmium lasers. The performance of similar laser fibers varies from manufacturer to manufacturer. Special laser fibers and "cleaving only" fiber tip preparation can be beneficial for the lithotripsy procedure. Different laser settings and the surgical technique employed can have significant impact on the success of laser lithotripsy. When safely done, complications of laser lithotripsy are rare and concern the endoscopic nature of procedure, not the technology itself, making laser lithotripsy one of the safest tools in urology. Laser lithotripsy has had several new developments and more insight has been gained in recent years with many more advances expected in the future.
- Angiomiolipoma epitelioide do rim: caso clínicoPublication . Ferrito, F; Pinheiro, C; Aparício, SO angiomiolipoma renal é considerado um tumor benigno. Apesar do volume considerável que pode atingir, da possível bilateralidade ou multiplicidade das lesões e até mesmo do envolvimento linfático regional por vezes evidenciado, não lhe tem sido reconhecido poder metastático. No entanto, a variante epitelióide deste tipo de tumor é uma raridade, de difícil caracterização histológica e comumcurso geralmente fatal a curto ou médio prazo.
- Are we all doing it wrong? Influence of stripping and cleaving methods of laser fibers on laser lithotripsy performance.Publication . Kronenberg, P; Traxer, OPURPOSE: We assessed whether stripping and cleaving the laser fiber tip with specialized tools, namely laser fiber strippers, or ceramic or metal scissors, would influence lithotripsy performance. MATERIALS AND METHODS: Laser fiber tips were stripped with a specialized laser fiber stripper or remained coated. The tips were then cleaved with metal or ceramic scissors. Laser lithotripsy experiments were performed with the 4 fiber tip combinations using an automated laser fragmentation testing system with artificial stones made of plaster of Paris or BegoStone Plus (Bego, Lincoln, Rhode Island). High frequency-low pulse energy (20 Hz and 0.5 J) and low frequency-high pulse energy (5 Hz and 2.0 J) settings were used for 30 seconds. Fissure width, depth and volume, and laser fiber tip photos were analyzed. RESULTS: Coated laser fiber tips always achieved significantly higher ablation volumes (sometimes greater than 50%) than stripped laser fiber tips (p <0.00001) regardless of cleaving scissor type, stone material or lithotripter setting. Coated fiber tips cleaved with metal scissors ablated as well as those cleaved with ceramic scissors (p = 0.16). However, stripped fibers were much less ablative when they were cut with metal scissors compared to ceramic scissors (p <0.00001). Harder stone material decreased ablation volume (p <0.00001). Low frequency-high pulse energy settings were an average of 3 times more ablative than high frequency-low pulse energy settings (p <0.00001). Stripping the fibers, a harder stone material and low frequency-high pulse energy settings were associated with increased fiber tip degradation. CONCLUSIONS: Coated laser fibers provided better lithotripsy performance and metal scissors were as good as ceramic scissors to cleave coated fibers. This knowledge may improve and simplify the way that laser lithotripsy procedures are done worldwide.
- Bladder endocervicosis - A rare diagnosis with a silent presentation.Publication . Santos-Lopes, S; Cebola, A; Afonso, A; Ferrito, FBladder endocervicosis is a benign disease, characterized by the presence of ectopic endocervical tissue in the bladder wall, with few cases described in the literature. A case of bladder endocervicosis in a 35-year-old female, with the previous history of cesarean section, subtotal hysterectomy, and right oophorectomy is reported here. The patient was asymptomatic and the bladder lesion was detected on pelvic ultrasonography. Transurethral bladder resection was performed and the histopathological analysis revealed bladder endocervicosis. 12 months of follow-up have passed without evidence of clinical or radiological recurrence. Clinical presentation, pathological features, and treatment are discussed.
- Can epigenetic and inflammatory biomarkers identify clinically aggressive prostate cancer?Publication . Santos, PB; Patel, H; Henrique, R; Félix, AProstate cancer (PCa) is a highly prevalent malignancy and constitutes a major cause of cancer-related morbidity and mortality. It emerges through the acquisition of genetic and epigenetic alterations. Epigenetic modifications include DNA methylation, histone modifications and microRNA deregulation. These generate heritable transformations in the expression of genes but do not change the DNA sequence. Alterations in DNA methylation (hypo and hypermethylation) are the most characterized in PCa. They lead to genomic instability and inadequate gene expression. Major and minor-specific modifications in chromatin recasting are involved in PCa, with signs suggesting a dysfunction of enzymes modified by histones. MicroRNA deregulation also contributes to the initiation of PCa, including involvement in androgen receptor signalization and apoptosis. The influence of inflammation on prostate tumor carcinogenesis is currently much better known. Recent discoveries about microbial species resident in the urinary tract suggest that these are the initiators of chronic inflammation, promoting prostate inflammatory atrophy and eventually leading to PCa. Complete characterization of the relationship between the urinary microbiome and prostatic chronic inflammation will be crucial to develop plans for the prevention of PCa. The prevalent nature of epigenetic and inflammatory alterations may provide potential biomarkers for PCa diagnosis, treatment decisions, evaluation of prognosis and posttreatment surveillance.
- Carcinoma de células renais com trombo gigante na veia cava inferior: abordagem cirúrgica multidisciplinarPublication . Furtado, A; Graça, B; Gonçalves, F; Ferrito, F; Morais, A; Santos, AA nefrectomia radical associada a trombectomia da veia cava inferior constitui a única opção terapêutica passível de melhoria prognóstica dos carcinomas de células renais com trombos venosos major. Descrevemos o caso de um homem, 55 anos, com o diagnóstico de tumor renal com trombo intra-cávico de grandes dimensões. O doente foi alvo de uma abordagem multidisciplinar, tendo sido submetido a nefrectomia radical à direita, trombectomia e cavoplastia, com recurso ainda a bypass cardiopulmonar e circulação extra-corpórea. O pós-operatório não registou intercorrências. A análise histológica concluiu tratar-se de um carcinoma de células renais, variante células claras e trombo excisado na totalidade, sem invasão da parede venosa. Aos dois anos de pós-operatório o doente encontra-se sem evidência de recidiva tumoral nem foram descritos eventos de embolização pulmonar.
- Carcinoma de Células Renais em Rim Pélvico - A propósito de um caso raro e revisão da literaturaPublication . Graça, B; Figueira, T; Carrasquinho, E; Lourenço, M; Fonseca, JA ectopia renal é uma malformação congénita com uma incidência estimada entre 1:500 a 1:1200 nascimentos, sendo a localização pélvica a mais frequente. O carcinoma de células renais é a neoplasia renal mais comumente encontrada sendo no entanto rara esta associação. Discutimos o caso clínico de um doente com carcinoma de células renais em rim pélvico com ênfase na caracterização vascular pré-operatória com reconstrução tridimensional por TAC e realizámos uma revisão da literatura.
- Catástrofe Peniana. Infecção de Prótese Peniana – A propósito de um Caso ClínicoPublication . Palmas, A; Lourenço, M; Coelho, M; Cardoso, AP; Fonseca, JA infecção de prótese peniana é uma das complicações mais devastadoras da cirurgia de implante, dada a magnitude da situação, podendo assumir consequências catastróficas. Relatamos o caso clínico de infecção de prótese peniana, de difícil controlo, tendo terminado em Uretrostomia Perineal e contrução de “Pseudo Pénis”, isto apesar do cumprimento rigoroso da técnica cirúrgica e da profilaxia antibiótica sistémica e local.
- Cirurgia poupadora de orgão em massa testicular bilateral: quisto epidermóidePublication . Palmas, A; Cardoso, AP; Fonseca, J; Gonçalves, LIntrodução: O quisto epidermóide do testículo é uma lesão benigna testicular pouco comum. Representa cerca de 1% a 2% de todas as massas testiculares e a sua ocorrência bilateral é muito rara. Caso clínico: Reportamos o caso de um doente de 21 anos com quisto epidermóide bilateral do testículo, submetido a cirurgia poupadora de órgão bilateral, através de abordagem inguinal após exame extemporâneo. Discussão: Discutimos ainda o diagnóstico e a abordagem deste tipo de lesões.