INTRODUCTION: A kidney transplant is the best method for treating terminal kidney failure. Long-term results of kidney transplants from living donors are significantly better than transplants from dead donors. Living kidney donors are healthy people who undergo a major operation in order to improve the health of another person. Therefore, major emphasis is on safety, low level of invasiveness and a desirable cosmetic effect of the donor nephrectomy. Since 2012, the Department of Urology at the University Hospital in Olomouc has performed 12 kidney harvestings from living donors. The kidney harvesting was conducted using various techniques. CASE REPORT: The first robotic assisted kidney harvesting in the Czech Republic was performed in June 2022. The donor was a 57-year-old man who donated his kidney to his 32-year-old daughter. The left kidney was evaluated as suitable for kidney harvesting. The operation took 174 min. The kidney's warm ischemia was 145 s. Based on the Clavien Dindo classification, no 2nd degree or high post-operative complications were recorded. The donor's pre-operative glomerular filtration was 1.63 mL/s. Six months post-operation, it went down to 1.19 mL/s. This represents a 27% decrease. The kidney recipient did not require early dialysis. Six months post-operation, the recipient's glomerular filtration was 2.03 mL/s. CONCLUSION: In the hands of experienced professionals and transplantation centres, robotic assisted donor nephrectomy is a feasible and safe option for this operation. It not only provides all the advantages of a laparoscopic operation but it also adds other technical improvements and minimizes intraoperative stress on the surgeon. Currently, the global trend is moving towards increasing the ratio of robotic assisted donor nephrectomies.
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- nefrektomie * metody MeSH
- odběr tkání a orgánů metody MeSH
- roboticky asistované výkony * metody MeSH
- transplantace ledvin * metody MeSH
- žijící dárci * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- Geografické názvy
- Česká republika MeSH
BACKGROUND: This study highlights an unusual and previously unreported adverse event (AE) following the minimally invasive treatment of pancreatic walled-off necrosis (WON). The standard treatment for WON currently involves primary drainage via an ultrasound-guided endoscopic, typically transgastric, approach. This method is associated with lower mortality and morbidity rates compared to traditional surgery. However, emerging AEs from these procedures may necessitate the involvement of a multidisciplinary team. Our case highlights the potential for gastrovesical fistula development as a rare AE following endoscopic drainage. Treatment for our patient prioritized individualized and non-surgical strategy, although surgical revision was also considered. CASE DESCRIPTION: A 42-year-old male presented with a large symptomatic pancreatic WON refractory to conservative management, necessitating transgastric drainage. Despite the gradual evacuation of the WON contents, treatment was complicated by stent-related issues, including inadvertent bladder penetration. Rather than surgical correction, a collaborative approach among urology, gastroenterology, and surgery teams was employed, focusing on conservative treatment strategies. This approach successfully resolved the fistula, leading to the patient's full recovery. CONCLUSIONS: Given the increasing use of endoscopic transluminal drainage in (peri)pancreatic collections, it is crucial to be aware of all potential AEs. To our knowledge, this is the first documented case of gastrovesical fistula following drainage of WON. Early recognition and a multidisciplinary approach are vital to manage this event.
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
PURPOSE: To evaluate laboratory and clinical results after unilateral adrenalectomy in patients with primary aldosteronism (PHA). METHODS: A cross-sectional analysis was performed using data from patients who underwent transperitoneal laparoscopic adrenalectomy for PHA, between January 2008 and December 2019. Surgical indications were based on adrenal venous sampling without ACTH stimulation. Analyses included patient demographics; preoperative clinical, pharmacological, laboratory, and radiological data; and postoperative results assessed after a median of 4 months. Antihypertensive drug use was quantified by estimating the daily defined dose (DDD) of antihypertensive medication, thus enabling standardized comparison of dosage between the drug classes. Statistical assessments included univariable and multivariable logistic regression analysis. RESULTS: This study enrolled 87 patients. The patients were taking 5.4 DDD of antihypertensive medication before surgery, and 3.0 DDD after surgery. Complete biochemical success of surgery was reached 67 patients (77%), 19 patients (22%) had partial biochemical success. Complete clinical success with normalization of blood pressure and withdrawal of all antihypertensive drugs was achieved in 19 patients (22%). 57 patients (65%) exhibited a reduction of DDD after surgery and/or improvement of blood pressure-partial clinical success. Thus, in 76 (87%) of all enrolled patients, surgery had an overall positive effect on hypertension control. Multivariable logistic regression showed that complete clinical success was independently associated with female gender and baseline sum of antihypertensive drugs DDD < 4. CONCLUSION: A majority of patients undergoing unilateral adrenalectomy for PHA achieved markedly improved hypertension control, despite almost halving their antihypertensive medication. Almost a quarter of patients were cured and able to cease using all antihypertensive drugs.
- MeSH
- adrenalektomie MeSH
- antihypertenziva terapeutické užití MeSH
- hyperaldosteronismus * komplikace farmakoterapie chirurgie MeSH
- hypertenze * farmakoterapie etiologie chirurgie MeSH
- lidé MeSH
- průřezové studie MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Foci of splenic tissue separated from the spleen can occur as a congenital anomaly. Isolated nodules of splenic tissue are called accessory spleens or spleniculli. However, nodules of splenic tissue can merge with other organs during embryonic development, in which case we speak of spleno-visceral fusions: most often, they merge with the tail of the pancreas (thus forming spleno-pancreatic fusion or an intrapancreatic accessory spleen), with the reproductive gland (i.e., spleno-gonadal fusion), or with the kidney (i.e., spleno-renal fusion). Our case report describes the fusion of heterotopic splenic tissue with the right adrenal gland, which was misinterpreted as a metastasis of a renal cell carcinoma. To the best of our knowledge, this is the first reported case of spleno-adrenal fusion. Spleno-visceral fusions usually represent asymptomatic conditions; their main clinical significance lies in the confusion they cause and its misinterpretation as tumors of other organs. We believe that the cause of retroperitoneal spleno-visceral fusions is the anomalous migration of splenic cells along the dorsal mesentery to the urogenital ridge, together with primitive germ cells, at the end of the fifth week and during the sixth week of embryonic age. This theory explains the possible origin of spleno-visceral fusions, their different frequency of occurrence, and the predominance of findings on the left side.
- Publikační typ
- kazuistiky MeSH
AIMS: With the introduction of magnetic resonance imaging in the diagnosis of prostate cancer and its use in targeted prostate biopsy, an increased incidence of anterior-predominant prostate cancer (APC) has been observed. METHODS: We enrolled 200 patients who underwent radical prostatectomy at our department between 12/2017 and 04/2019. We evaluated tumour location in the individual segments of the prostate, index tumour location and volume, and compared the postoperative stage, Gleason score, grade group (GG), and the presence of extraprostatic extension (EPE) in APC and posterior prostate cancer (PPC). We assessed the rate of MRI scans prior to prostate surgery as well as the influence of family history and PSA on the presence of APC. RESULTS: We found a significantly higher rate of anterior tumours than previously reported (37%) and confirmed that these tumours are diagnosed with a significantly larger index tumour volume (P=0.003). We also showed that a mere 6.76% of APCs were low-risk tumours not requiring radical treatment. Furthermore, anterior tumours were found significantly more often (P=0.001) in patients who underwent preoperative MRI. No differences were observed between PSA values, family history, presence of EPE, or locally advanced disease in APC vs. PPC. CONCLUSIONS: The frequency of anterior tumours is higher than previously thought, and they include tumours requiring radical treatment. When these tumours are neglected, it may lead to patient undertreatment with impact on their life prognosis. Thus, we consider the use of MRI-targeted prostate biopsy to be a necessity both for ruling out APC in the case of repeatedly negative prostate biopsies and, in particular, before patient inclusion in active surveillance.
- MeSH
- dospělí MeSH
- lidé MeSH
- lymfangiom cystický * chirurgie diagnostické zobrazování patologie MeSH
- magnetická rezonanční tomografie metody MeSH
- nádory nadledvin * chirurgie diagnostické zobrazování patologie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Diagnostika urolitiázy je integrální a každodenní náplní činnosti urologa, vyžaduje však nezbytnou spolupráci s radiologem. CT vyšetření umožňuje nejen identifikovat skutečnou příčinu renální koliky, ale může i posoudit základní vlastnosti konkrementu - jeho velikost, počet, polohu, dále predikovat jeho složení, denzitu, homogenitu a posoudit tak účinnost plánované léčby. Článek si dává za cíl přiblížit základy CT vyšetření řadovému urologovi.
Diagnostics of urinary stones is an integral and everyday part of urologist´s activity. It requires essential cooperation with radiologist. CT enables not only the identification of the true cause of renal colic but it can also assess basic stone characteristic - size, number, location. Moreover, the CT scan can predict stone composition, its density, homogenity and predict the efficacy of the planned treatment. The aim of this article is to enlighten the basics of CT examination to ordinary urologist.
- MeSH
- dávka záření MeSH
- lidé MeSH
- počítačová rentgenová tomografie MeSH
- urolitiáza * diagnostické zobrazování terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- aorta abdominalis * MeSH
- arteriovenózní píštěl diagnóza chirurgie MeSH
- CT angiografie MeSH
- diferenciální diagnóza MeSH
- lidé MeSH
- renální kolika diagnóza MeSH
- senioři MeSH
- vena cava inferior * MeSH
- výkony cévní chirurgie metody MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Cíl: Cílem bylo zhodnotit roli single source dual-energy CT (ssDECT) při diferenciaci adenomů nadledvin od non-adenomů (metastáz, feochromocytomů a karcinomů). Metodika: Do prospektivní studie bylo zařazeno 57 pacientů s celkem 63 lézemi nadledvin, 37 z nich byly adenomy a 26 non-adenomů (11 feochromocytomů, 11 metastáz, 4 primární karcinomy). Všichni pacienti podstoupili nativní CT s využitím duální energie. U všech lézí jsme zaznamenali průměrnou hodnotu nativní denzity v monochromatických rekonstrukcích na energetické hladině 40 keV a 140 keV, efektivní protonové číslo Zeff, obsah tuku využitím materiálové dekompozice tuk/voda a podle hodnoty směrnice K jsme rozdělili spektrální křivky na stoupající, konstantní a klesající. Kvantitativní veličiny jsme statisticky srovnali pomocí t-testu nebo Mannova-Whitneyova U-testu. Četnost tří průběhů křivky jsme srovnali přesným Fischerovým testem. Zhotovili jsme Receiver Operating Characteristic (ROC) křivky pro porovnání diagnostické přesnosti jednotlivých kvantitativních veličin pro odlišení adenomů od non-adenomů. Výsledky: Prokázali jsme statisticky signifikantní rozdíl mezi adenomy a non-adenomy v hodnotách denzity při použití monochromatické energie 40 keV (17, 23 ? 22,68 vs. 52,77 ? 7,47 HU; p < 0,0001) a 140 keV (8,39 ? 9,83 vs. 24,50 ? 5,57 HU; p < 0,0001), v hodnotách Zeff (medián 7,70 vs. 7,82; p = 0, 0001) i v obsahu tuku použitím materiálové dekompozice (-41,13 ? 147,64 vs. -262,07 ? 71,45 mg/ml; p < 0,0001). Průběh spektrální křivky byl u adenomů klesající v 17 případech, konstantní v 15 případech a stoupající v 5 případech, u non-adenomů byla křivka klesající ve všech 26 případech (p = 0,001). V ROC analýzách nejlepší hodnoty dosáhla denzita při energii 40 keV (Area Under Curve 0,927). Závěr: Prokázali jsme statisticky signifikantní rozdíl ve všech vybraných parametrech. Nativní ssDECT má potenciál diferencovat adrenální adenomy od non-adenomů.
Aim: Our aim was to evaluate the role of single-source dual-energy CT (ssDECT) in the differentiation of adrenal adenomas from nonadenomas (i.e., metastases, pheochromocytomas and carcinomas). Method: The prospective study included 57 patients with a total of 63 adrenal lesions, 37 of which were adenomas and 26 non-adenomas (11 pheochromocytomas, 11 metastases and four adrenocortical carcinomas). All subjects underwent unenhanced dual-energy CT. For all lesions, we measured the mean value of unenhanced density in Hounsfield units (HU) using monochromatic reconstructions on the 40-keV and 140-keV energy levels, the effective atomic number (Zeff) and the fat content using fat-water material decomposition, and according to the K-value we divided the HU spectral curves into ascending, straight and descending ones. Quantitative parameters were statistically compared by means of a T-test or MannWhitney U-test. We compared the frequency of the shapes of the spectral curves with Fischer´s exact test. We created Receiver Operating Characteristic (ROC) curves to compare the diagnostic accuracy of individual variables to distinguish adenomas from non-adenomas. Results: Our results revealed statistically significant differences between adenomas and non-adenomas in mean attenuation using monochromatic energy of 40 keV (17.23 ? 22.68 vs. 52.77 ? 7.47 HU; p < 0.0001) and 140 keV (8.39 ? 9.83 vs. 24.50 ? 5.57 HU; p < 0.0001), in Zeff values (median 7.70 vs. 7.82; p = 0.0001) and in fat content using material decomposition (-41.13?147.64 vs. -262.07 ? 71.45 mg/ml; p < 0.0001). The shape of the spectral curve in adenomas was descending in 17 cases, straight in 15 cases and ascending in five cases; in non-adenomas the curve was descending in all 26 cases (p = 0.001). In ROC analyses, the best values were reached with a mean density at 40 keV energy level (Area Under Curve 0.927). Conclusion: Our result revealed statistically significant differences in all the selected parameters. Unenhanced ssDECT seem to have the potential to differentiate adrenal adenomas from non-adenomas.
- MeSH
- endoskopie * MeSH
- lidé MeSH
- mladý dospělý MeSH
- penis diagnostické zobrazování zranění MeSH
- replantace metody MeSH
- sebepoškozování diagnostické zobrazování chirurgie MeSH
- traumatická amputace diagnostické zobrazování chirurgie MeSH
- uretra diagnostické zobrazování chirurgie MeSH
- Check Tag
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- Publikační typ
- dopisy MeSH
- kazuistiky MeSH
