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Caamiña L, Pietropaolo A, Prudhomme T, Bañuelos B, Boissier R, Pecoraro A, Campi R, Dönmez MI, Sierra A, Piana A, Somani BK, Territo A. Endourological Management of Ureteral Stricture in Patients with Renal Transplant: A Systematic Review of Literature. J Endourol 2024; 38:290-300. [PMID: 38185833 DOI: 10.1089/end.2023.0478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Purpose: To analyze the utility and outcomes of available endourologic options to treat ureteral stricture after kidney transplantation (KT). Methods: A systematic review was carried out for all English language articles from 2000 to 2023 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) standards using EMBASE, MEDLINE, SCOPUS, Google scholar, and Cochrane library. The search term combination for the string was follows: [(Ureteral stricture) OR (ureter stenosis) OR (ureteral stenosis) OR (Stricture ureter) OR (Narrowing ureter) OR (Ureter restriction) OR (ureteral restriction) OR (ureteral narrowing) OR (ureteral obstruction) OR (ureter obstruction) OR (obstructing ureter) OR (obstructive ureter) OR (narrow ureter) OR (ureteral narrow)] AND [(kidney transplant) OR (transplanted kidney) OR (transplant) OR (transplantation)] AND [(management) OR (Robotic) OR (laser) OR (stent) OR (dilatation) OR (dilation) OR (endoscopic) OR (endourological) OR (Urologic) OR (laparoscopic) OR (surgery) OR (treatment)]. Case reports, review articles, animal and laboratory studies were excluded. Risk of bias assessment was conducted using the RoB 2 and ROBINS-I tools. Results: A total of 1102 relevant articles published from 2000 to 2023 were found. After screening of titles and abstracts, a total of 19 articles were included in our systematic review. Ureteral stent/nephrostomy placement, balloon dilatation (ureteroplasty) with or without laser was used as initial approaches whereas follow-up and success rate were analyzed among other parameters. Conclusions: The management of ureteral strictures after KT is challenging and selecting the most appropriate treatment is crucial for successful outcomes. Our review suggests that, an endourologic management is a safe option with good long-term outcomes, especially in short and early strictures.
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Affiliation(s)
- Leticia Caamiña
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
| | - Thomas Prudhomme
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Beatriz Bañuelos
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Division Renal Transplantation and Reconstructive Urology, Hospital Universitario El Clínico San Carlos, Madrid, Spain
| | - Romain Boissier
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Department of Urology and Renal Transplantation, La Conception University Hospital, Marseille, France
| | - Alessio Pecoraro
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Riccardo Campi
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Muhammet Irfan Dönmez
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Alba Sierra
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Urology Department, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Alberto Piana
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Department of Urology, University of Turin, Turin, Italy
- Department of Urology, Romolo Hospital, Rocca di Neto, Italy
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Angelo Territo
- Kidney Transplantation Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU), Arnhem, The Netherlands
- Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Aguilera A, Alonso-Dorrego JM, Bañuelos B, Cisneros J, González P, Díez J. [Oncological results in high grade prostate cancer treated surgically]. ARCH ESP UROL 2016; 69:162-171. [PMID: 27225053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Prostate cancer is considered a tumour with a long natural history. However, its high-risk variants exhibit variable behaviour. We analyse the factors that affect BR and CSS (multivariate, Kaplan Meier). METHODS From 1997 to 2013, 657 patients were operated of a high-grade prostate cancer (pT2b 7.2%, pT3a 73%, pT3b 18.3%, pT4 1.5%). Gleason score was ≥8 in 23% of cases. Percentage of PSMs was 46.1%. Mean follow-up was 113 months (24-192). RESULTS BR occurred in 36.5%. Patients with Gleason score <8, 31.7% had BR, Gleason ≥8 had BR in 48% (p<0.05). PSMs recurrence occurred in 48.9%, whereas 26.1% in NSM (p<0.05). If lymphadenectomy, BR occurred in 48.7%, if not 30.9% (p<0,05). In multivariate analysis, stage, Gleason≥8 and PSMs were independent factors for BR. Treatment of BR was 36.5% radiotherapy, 24.1% HT, and 21.2% both simultaneously. Active surveillance was performed in 13.3%. Disease progression (biochemical or radiological) occurred in 23.5%. CSS was 98.93%, pT4 was the stage with the greatest mortality (10%), followed by pT3b (3.4%), p<0.05. Patients with a Gleason score ≥8 accounted for 71% CSM (p<0,05). PSMs and lymphadenectomy didn't have repercussions for survival. In multivariate analysis, Gleason≥8 was independent factor for CSM. CONCLUSIONS Radical prostatectomy plays an important role in multi-modal approach with good oncological control at medium follow up. Gleason score ≥8 was the factor with the greatest effect on CSM. Lymphadenectomy didn't affect CSS.
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Affiliation(s)
- Alfredo Aguilera
- Service of Urology. Hospital Universitario La Paz. Madrid. Spain
| | | | - Beatriz Bañuelos
- Service of Urology. Hospital Universitario La Paz. Madrid. Spain
| | - Jesús Cisneros
- Service of Urology. Hospital Universitario La Paz. Madrid. Spain
| | - Pilar González
- Service of Urology. Hospital Universitario La Paz. Madrid. Spain
| | - Jesús Díez
- Service of Urology. Hospital Universitario La Paz. Madrid. Spain
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Aguilera A, Bañuelos B, Díez J, Alonso-Dorrego JM, Cisneros J, Peña J. Biochemical recurrence risk factors in surgically treated high and very high-risk prostate tumors. Cent European J Urol 2015; 68:302-7. [PMID: 26568870 PMCID: PMC4643694 DOI: 10.5173/ceju.2015.485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 10/23/2014] [Accepted: 05/25/2015] [Indexed: 12/11/2022] Open
Abstract
Introduction High and very high-risk prostate cancers are tumors that display great variation in their progression, making their behaviour and consequent prognosis difficult to predict. We analyse preoperative and postoperative risk factors that could influence biochemical recurrence of these tumors. Material and methods We carried out univariate and multivariate analyses in an attempt to establish statistically significant preoperative (age, rectal examination, PSA, biopsy Gleason score, uni/bilateral tumor, affected cylinder percentage) and postoperative (pT stage, pN lymph node affectation, Gleason score, positive surgical margins, percentage of tumor affectation, perineural infiltration) risk factors, as well as their relationship with biochemical recurrence (PSA >0.2 ng/mL). Results We analysed 276 patients with high and very high-risk prostate cancer that were treated with laparoscopic radical prostatectomy (LRP) between 2003-2007, with a mean follow-up of 84 months. Incidence of biochemical recurrence is 37.3%. Preoperative factors with the greatest impact on recurrence are suspicious rectal exam (OR 2.2) and the bilateralism of the tumor in the biopsy (OR 1.8). Among the postoperative factors, the presence of a LRP positive surgical margins (OR 3.4) showed the greatest impact, followed by the first grade of the Gleason score (OR 3.3). Conclusions The factor with the greatest influence on biochemical recurrence when it comes to surgery and high and very high-risk prostate cancer is the presence of a positive margin, followed by the Gleason score. Preoperative factors (PSA, biopsy Gleason score, rectal examination, number of affected cylinders) offered no guidance concerning the incidence of BCR.
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Affiliation(s)
- Alfredo Aguilera
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
| | - Beatriz Bañuelos
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
| | - Jesús Díez
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
| | | | - Jesus Cisneros
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
| | - Javier Peña
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
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Aguilera Bazan A, Bañuelos B, Alonso-Dorrego JM, Diez J, Cisneros J, De la Peña Barthel J. Oncological outcomes of nephron sparing nephrectomy. 17-year analysis. ARCH ESP UROL 2014; 67:237-242. [PMID: 24840588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Nephron sparing renal surgery is considered the technique of choice for renal tumors smaller than 4 cm. We present our oncological results in a 17-year period. METHODS Between January 1995 and December 2012, 130 renal tumor surgeries (58 open, 72 laparoscopic) were performed. We analize the pathological results, presence of positive surgical margins, local relapse, distant metastases and death. RESULTS The most frequent tumor was clear cell carcinoma (73%) in a pT1 stage (87%). Mean tumor size was 3 cm. Positive surgical margin rate was 7%, currently without any tumor recurrence among these cases (follow up 37 months). Cancer specific mortality is 0% and local recurrence rate 3%. Mean follow up is 71 months. CONCLUSIONS Nephron sparing surgery results are similar to radical nephrectomy in tumors smaller than 4 cm. Positive surgical margins do not seem to have an important repercussion in cancer specific survival.
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Aguilera Bazan A, Perez S, Bañuelos B, Alonso-Dorrego JM, Diez J, De la Peña J. Incidence and management of isolated renal injury and polytrauma patients. ARCH ESP UROL 2014; 67:175-180. [PMID: 24691039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The management of renal trauma has undergone important changes in recent years, the current tendency being more conservative than in the past. The present study analyzes our experience over the last 11 years in patients with isolated renal trauma or associated to other lesions. METHODS Over an 11-year period (January 2001- December 2011 ) we documented a total of 149 renal injuries (47 isolated and 102 associated renal lesions ). An analysis was made of the demographic characteristics of the two groups, as well as of the clinical presentation, diagnostic methods, grade of injury, associated lesions, emergency management, mortality, and length of stay. RESULTS Closed trauma secondary to fall was the most frequent type of injury in both groups. The grade of injury proved similar in both (80%corresponding to grades 1-3 and 20% to grades 4-5). Conservative management was used in 93% of all isolated renal injuries and in 75.5% of the polytrauma patients with 10% and 5.7% failure rates respectively. Mortality rates were 0% and 7.8%, respectively. CONCLUSIONS Renal injures are increasingly subjected to conservative management, with treatment generally being somewhat more aggressive in polytrauma patients.
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