Browsing by Author "Bravo, Juan Cristobal"

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    Contralateral necrotizing fascitis after left nephrectomy for emphysematous pyelonephritis
    (2022) Fuentes, Alberto; Rojas, Pablo A.; del Valle, Felipe; Ortega, Carlidia; Bravo, Juan Cristobal; Kompatzki, Alvaro
    Introduction: Emphysematous pyelonephritis is an acute necrotizing infection of the renal parenchyma. The management is variable, extending to total nephrectomy in severe or refractory cases. Post-nephrectomy complications are numerous and common, necrotizing fasciitis, and sepsis being among them.
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    Perioperative Outcomes of Inguinal Hernioplasty along with Holmium Laser Enucleation of the Prostate (HoLEP)
    (2023) Calvo, Carlos Ignacio; Bravo, Juan Cristobal; Navarro, Renato; Canas, Rodrigo; Pasten, Felipe; Francisco, Ignacio F. San
    Purpose: Inguinal hernias and benign prostatic hyperplasia (BPH) can coexist in about one fifth of patients under-going BPH surgery. There is scarce evidence about performing laser enucleation along with open inguinal hernia repair. Our goal is to describe the perioperative outcomes of performing both surgeries in the same operating ses-sion compared to doing HoLEP alone.Materials and Methods: A retrospective analysis of patients undergoing HoLEP and hernioplasty with mesh in the same anesthetic time (group B) at an academic center was conducted. They were compared to a randomly picked control group of patients submitted to HoLEP alone (group A). Preoperative, operative, and postoperative features were compared among both groups.Results: 107 patients submitted to HoLEP alone were compared to 29 combined approach patients (HoLEP + hernia repair). Patients in group A were found to be older and had larger prostates. Group B showed a significantly longer operative time. Length of stay and duration of catheter was comparable among groups. In multivariate anal-ysis, the combined approach was not associated with a higher complication rate.Conclusion: Performing benign prostatic hyperplasia surgery with HoLEP in conjunction with open inguinal hernioplasty is not related to a higher length of stay or a significantly increased risk of morbidity.
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    Vena cava thrombectomy in kidney cancer. Report of 32 nephrectomies
    (2022) Rojas, Pablo A.; Bravo, Juan Cristobal; Navarro, Renato; Villagran, Sofia; Zuniga, Alvaro; Troncoso, Pablo; Becker, Pedro; Briceno, Eduardo; Francisco, Ignacio F. San
    Background: Vena cava (VC) involvement in kidney tumors occurs in 4 to 10% of cases, and is associated with a higher mortality. Nephrectomy with thrombectomy of the VC, performed by a multidisciplinary team, improves survival. Aim: To report a series of consecutive nephrectomies with caval thrombectomy performed in an academic center. Patients and Methods: We report 32 patients with cT3b and 3c renal tumors, who underwent radical nephrectomy with VC thrombectomy between 2001 and 2021. A descriptive analysis of clinical, surgical and pathological variables was performed. Overall survival (OS) and cancer-specific survival (CSS) was calculated using Kaplan-Meier curves. Results: The mean tumor size was 9.7 cm. According to Mayo classification 3/32 (9%) patients had a type I thrombus, 10/32 (31%) had a type II thrombus, 8/32 (25%) had a type III thrombus, and 5/32 (16%) had a type IV thrombus. The mean bleeding was 2000 cc. There was one intraoperative death. Nineteen percent of patients had complications >= 3 according to Clavien-Dindo classification. Reoperations occurred in 9%. Pre and postoperative creatinine levels were 1.17 and 1.91 mg/dl respectively (p < 0.01). Pre and postoperative Hematocrit levels were 47.9 and 31% respectively (p = 0.02). Sixty six percent of tumors were clear cell renal cancer, 9% were papillary and 3% were chromophobic. Mean OS was 10 months. Two-year SCE was 40%. Conclusions: Our results are similar to those reported elsewhere. Despite being an unusual pathology, the surgical technique has been improving, thanks to the multidisciplinary work of urologists and surgeons.