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Article ; Online: Where next for the endoscope?

Natalin, Ricardo A / Landman, Jaime

2009 Volume 6, Issue 11, Page(s) 622–628

Abstract: The concept of examining the body's interior and its organs dates back to ancient times. The roots of modern endoscopy lie in early nineteenth century Europe, and the intervening centuries have seen a steady evolution of devices and techniques. Nowadays, ...

Abstract	The concept of examining the body's interior and its organs dates back to ancient times. The roots of modern endoscopy lie in early nineteenth century Europe, and the intervening centuries have seen a steady evolution of devices and techniques. Nowadays, a wide variety of urinary tract disorders are successfully managed in a minimally invasive manner thanks to the endoscope and related technologies. Distal-sensor, 'digital', endoscopes have the potential to revolutionize the field, and change the way in which we use and think about endoscopy. Virtual endoscopy, capsule endoscopy, and a range of other techniques derived from physics and molecular biology all promise great improvements in visualization of the urinary tract and other urologic structures. Ultimately, the continued improvement of these minimally invasive technologies will enhance the quality of care that we can offer our patients.
MeSH term(s)	Cystoscopes/history ; Cystoscopes/trends ; Cystoscopy/history ; Cystoscopy/trends ; Equipment Design ; Forecasting ; History, 19th Century ; History, 20th Century ; History, 21st Century ; Humans ; Ureteroscopes/history ; Ureteroscopes/trends ; Ureteroscopy/history ; Ureteroscopy/trends
Language	English
Publishing date	2009-11-05
Publishing country	England
Document type	Historical Article ; Review
ZDB-ID	2493737-X
ISSN	1759-4820 ; 1759-4812
ISSN (online)	1759-4820
ISSN	1759-4812
DOI	10.1038/nrurol.2009.199
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Article ; Online: Which ureteral access sheath is compatible with your flexible ureteroscope?

Al-Qahtani, Saeed M / Letendre, Julien / Thomas, Alexandre / Natalin, Ricardo / Saussez, Thibaud / Traxer, Olivier

Journal of endourology

2014 Volume 28, Issue 3, Page(s) 286–290

Abstract: Purpose: Our aim is to evaluate different ureteral access sheaths (UASs), which are available in the international market and their compatibility with different available flexible ureteroscopes (F-URSs) to help the urologist choose the proper ureteral ... ...

Abstract	Purpose: Our aim is to evaluate different ureteral access sheaths (UASs), which are available in the international market and their compatibility with different available flexible ureteroscopes (F-URSs) to help the urologist choose the proper ureteral access sheath for his or her endoscope before commencing the procedure. Materials and methods: A total of 21 UASs and 12 F-URSs were evaluated. Measurements were obtained in French (F) units considering different characteristics for each UAS and each F-URS. Insertion test without friction between F-URS and UAS was considered as a successful test and was referred as (YES). Results: All UASs and F-URSs were successfully submitted to the insertion test. All F-URSs that were inserted into UASs without friction had an internal diameter of at least 12F. Different lengths of UAS did not influence the test outcome. Conclusion: This study was able to establish a correlation table between different UASs and different flexible ureteroscopes. As of now, the 12/14F UAS is considered the universal UAS that accepts all F-URSs that are available in the endourology field. Nevertheless, we are expecting a significant change with the new standard size 10/12F UAS as well as huge advances in minimizing the size of different endoscopes.
MeSH term(s)	Equipment Design ; Humans ; Kidney Calculi/surgery ; Reproducibility of Results ; Ureteroscopes ; Ureteroscopy/methods
Language	English
Publishing date	2014-03
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	356931-7
ISSN	1557-900X ; 0892-7790
ISSN (online)	1557-900X
ISSN	0892-7790
DOI	10.1089/end.2013.0375
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Article: Urologic laser types and instrumentation.

Natalin, Ricardo A / Phillips, Courtney K / Clayman, Ralph V / Landman, Jaime

Archivos espanoles de urologia

2009 Volume 61, Issue 9, Page(s) 971–977

Abstract: Though the primary role of lasers in urology has always been in the treatment of urolithiasis, there are several other indications for their use. There are many different types of lasers currently available, each with unique properties conducive to ... ...

Abstract	Though the primary role of lasers in urology has always been in the treatment of urolithiasis, there are several other indications for their use. There are many different types of lasers currently available, each with unique properties conducive to treating certain disorders. As such, it is critical that today's urologist understands each laser's characteristics in order to optimize patient selection and treatment. The lasers which are primarily used in urologic applications include the carbon dioxide (CO2) laser; the Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG); the Potassium Titanyl Phosphate (KTP) laser and the Holmium:YAG (Ho:YAG) laser. This review focuses on the unique characteristics of each of these lasers as well as the instrumentation needed utilize and deploy these tools in the urinary tract.
MeSH term(s)	Humans ; Laser Therapy/instrumentation ; Urologic Diseases/therapy
Language	English
Publishing date	2009-01-08
Publishing country	Spain
Document type	Journal Article ; Review
ZDB-ID	211673-x
ISSN	0004-0614
ISSN	0004-0614
DOI	10.4321/s0004-06142008000900005
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Article ; Online: Management of OAB in those over age 65.

Natalin, Ricardo / Lorenzetti, Fabio / Dambros, Miriam

Current urology reports

2013 Volume 14, Issue 5, Page(s) 379–385

Abstract: The International Continence Society (ICS) defines overactive bladder (OAB) as an association of symptoms including "urgency, with or without urge incontinence, usually with increased frequency and nocturia". This conditon has been associated with a ... ...

Abstract	The International Continence Society (ICS) defines overactive bladder (OAB) as an association of symptoms including "urgency, with or without urge incontinence, usually with increased frequency and nocturia". This conditon has been associated with a decrease in quality of life and a higher related risk of overall health condition decrease, and is rising since its prevalence increases with age and the forecast for the world population estimates an increase of those over 65 years old. Aging alone can be considered a major risk factor for developing OAB symptoms that are considered multifactorial and due to body tissue and anatomic changes, lifestyle-associated factors, comorbidities and personal characteristics. The high prevalence of this condition and multiple etiology factors makes of its treatment a challenge-especially in the older population. A major concern over OAB treatment of elderly patients is the risk of cognitive side effects due to the pharmacologic treatment with anticholinergic drugs. First-line treatment for OAB symptoms are the use of pharmacologic therapy with antimuscarinic drugs, which has been proved to be effective in controlling urgency, urge incontinence episodes, incontinence episodes, and nocturia. The impact caused by this condition is significant regarding the economic and human costs associated bringing into attention the need of studying and reviewing this specific population. Conservative Management and Lifestyle Modifications: Behavioral therapy's aims are to reduce urinary frequency and urgency to an accepted level and to increase bladder outlet volume. It consists of actions to teach patients to improve and learn bladder control. Lifestyle modifications are a conjunct of daily activities that can be managed to have the lowest interference on the functioning of the urinary tract. Pharmacologic Therapy: There are various medications with antimuscarinic properties available for the treatment of OAB symptoms. The most commonly used are oxybutinin, tolterodine, solifenacin, darifenacin, fesosterodine and trospium. Second-line Therapy: OAB treatment accounts for some refractory to conventional treatment patients who will require alternative therapies to achieve improvement of symptoms as the use of intradetrusor injection of botulinum A toxin by binding to receptors on the membrane of cholinergic nerves causing temporary chemodenervation and consequent muscle relaxation. Neuromodulation is also an effective therapy that aims to achieve inhibition of detrusor activity by continuous neural stimulation through peripheral nerves as the use of the tibial nerve or central as it is performed by direct spine stimulation on sacral roots through the implantation of an automated generator. In conclusion, evidence from the literature has shown that antimuscarinic treatment of OAB in the elderly population is safe and effective in improving symptoms and patient's quality of life. Managing OAB symptoms in this population is a great challenge. An optimal therapeutic approach to treat should involve medical treatment with drug and behavioral therapy in addition to lifestyle advice.
MeSH term(s)	Age Factors ; Aged ; Behavior Therapy/methods ; Cholinergic Antagonists/therapeutic use ; Humans ; Life Style ; Muscarinic Antagonists/therapeutic use ; Quality of Life ; Treatment Outcome ; Urinary Bladder, Overactive/therapy
Chemical Substances	Cholinergic Antagonists ; Muscarinic Antagonists
Language	English
Publishing date	2013-08-07
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2057354-6
ISSN	1534-6285 ; 1527-2737
ISSN (online)	1534-6285
ISSN	1527-2737
DOI	10.1007/s11934-013-0338-5
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Article ; Online: Prevalence of thyroid dysfunction in systemic lupus erythematosus.

Appenzeller, Simone / Pallone, Ana T / Natalin, Ricardo A / Costallat, Lilian T L

Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases

2009 Volume 15, Issue 3, Page(s) 117–119

Abstract: Objective: To report the prevalence and clinical relevance of autoimmune thyroid disease and thyroid antibodies in 524 patients with SLE.: Methods: The medical charts of SLE patients followed in our rheumatology unit were reviewed to determine the ... ...

Abstract	Objective: To report the prevalence and clinical relevance of autoimmune thyroid disease and thyroid antibodies in 524 patients with SLE. Methods: The medical charts of SLE patients followed in our rheumatology unit were reviewed to determine the prevalence and clinical associations of autoimmune thyroid disease. These findings were compared with the prevalence of autoimmune thyroid disease in 50 female adults. Chi(2) tests and Fisher exact tests were used in the comparison of the groups for the categorical variables and Mann-Whitney U test for the continuous variables. Spearman rank correlation was used to identify an association between thyroid symptoms and disease activity. Results: Symptomatic autoimmune thyroid disease was observed in 32 of 524 (6.1%) SLE patients and in 1 of 50 controls (P > 0.05), predominantly hypothyroidism (28 SLE patients vs. in 1 control). Subclinical thyroid disease was identified in 60 (11.5%) and positive thyroid autoantibodies in the absence of thyroid disease in 89 of 524 (17%) SLE patients. Thyroid autoantibodies preceded the occurrence of clinical autoimmune thyroid disease in 70% of SLE patients. Sjögren syndrome (P = 0.001) and positive rheumatoid factor (P = 0.04) were more frequently observed in SLE patients with autoimmune thyroid disease when compared with SLE patients without autoimmune thyroid disease. Disease activity of the SLE was correlated with the presence of symptoms of hyperthyroidism (r = 0.4; P = 0.004). Conclusion: Our patients with SLE had a high prevalence of symptomatic and significantly more subclinical hypothyroidism and positive thyroid autoantibodies. Thyroid autoantibodies may precede the appearance of clinical autoimmune disease. Sjögren syndrome and positive rheumatoid factors were more frequently observed in SLE patients with autoimmune thyroid disease. We believe that, since symptoms of SLE and thyroid disease can be similar, that SLE patients should routinely been investigated for autoimmune thyroid disease.
MeSH term(s)	Adolescent ; Adult ; Brazil/epidemiology ; Child ; Female ; Graves Disease/complications ; Graves Disease/epidemiology ; Humans ; Lupus Erythematosus, Systemic/complications ; Lupus Erythematosus, Systemic/epidemiology ; Male ; Middle Aged ; Prevalence ; Retrospective Studies ; Sjogren's Syndrome/complications ; Sjogren's Syndrome/epidemiology ; Thyroiditis, Autoimmune/complications ; Thyroiditis, Autoimmune/epidemiology ; Young Adult
Language	English
Publishing date	2009-04
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1283266-2
ISSN	1536-7355 ; 1076-1608
ISSN (online)	1536-7355
ISSN	1076-1608
DOI	10.1097/RHU.0b013e31819dbe4c
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Article ; Online: Contemporary applications and limitations of magnetic resonance imaging contrast materials.

Natalin, Ricardo A / Prince, Martin R / Grossman, Marc E / Silvers, David / Landman, Jaime

The Journal of urology

2010 Volume 183, Issue 1, Page(s) 27–33

Abstract: Purpose: Improvements in imaging technologies have dramatically increased the ability to accurately diagnose and treat many urological disease processes. As urological patients often have chronic kidney disease, the well characterized nephrotoxicity of ... ...

Abstract	Purpose: Improvements in imaging technologies have dramatically increased the ability to accurately diagnose and treat many urological disease processes. As urological patients often have chronic kidney disease, the well characterized nephrotoxicity of contrast induced nephropathy when using iodine based contrast materials has long been a concern. With the development of gadolinium based contrast agents it seemed that the concern regarding nephrotoxicity had been resolved. In 1997 a new disorder, nephrogenic systemic fibrosis, appeared in patients with severe renal failure. Nephrogenic systemic fibrosis is a serious and potentially devastating disorder characterized by progressive thickening and hardening of the skin and other body tissues, and complicated by flexion contractures of the joints. Materials and methods: We performed a survey of the available literature on nephrogenic systemic fibrosis and magnetic resonance contrast media. We focused on mechanisms in the development of nephrogenic systemic fibrosis as well as its association with magnetic resonance contrast media, disease treatment and prevention, and its relevance to clinical urology. Results: An association between nephrogenic systemic fibrosis and gadolinium based contrast agents has been reported. Gadolinium is a toxic metal and it must be chelated to be a safe injectable contrast agent. It is now hypothesized that the majority of nephrogenic systemic fibrosis cases present with gadolinium based contrast agent exposure as the triggering factor, although this mechanism has not been elucidated. As gadolinium enhanced magnetic resonance imaging is an important tool in the diagnosis and surveillance of urological diseases, the severe consequences of nephrogenic systemic fibrosis demand that practicing urologists understand and know its history and treatment strategies. Conclusions: This review provides clarification of the gadolinium based contrast agent characteristics, tissue interactions that lead to the development of nephrogenic systemic fibrosis, prevention possibilities and available treatment options.
MeSH term(s)	Contrast Media/adverse effects ; Gadolinium/adverse effects ; Humans ; Magnetic Resonance Imaging ; Nephrogenic Fibrosing Dermopathy/chemically induced ; Nephrogenic Fibrosing Dermopathy/diagnosis ; Urologic Diseases/diagnosis
Chemical Substances	Contrast Media ; Gadolinium (AU0V1LM3JT)
Language	English
Publishing date	2010-01
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	3176-8
ISSN	1527-3792 ; 0022-5347
ISSN (online)	1527-3792
ISSN	0022-5347
DOI	10.1016/j.juro.2009.09.029
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Article ; Online: The final stage of the laparoscopic procedure: exploring final steps.

Natalin, Ricardo A / Lima, Fabio S / Pinheiro, Thomé / Vicari, Eugenio / Ortiz, Valdemar / Andreoni, Cassio / Landman, Jaime

International braz j urol : official journal of the Brazilian Society of Urology

2012 Volume 38, Issue 1, Page(s) 4–16

Abstract: Despite significant advances in laparoscopic technique and technologies, laparoscopic Urologic surgery remains technically demanding regarding various surgical steps including the challenge of specimen retrieval and extraction, whether to install a ... ...

Abstract	Despite significant advances in laparoscopic technique and technologies, laparoscopic Urologic surgery remains technically demanding regarding various surgical steps including the challenge of specimen retrieval and extraction, whether to install a drainage system and the best option for wound closure. Laparoscopic specimen entrapment and extraction occurs at what is falsely considered the ″end of the procedure″. During open surgery, after the specimen has been mobilized, the specimen is simply lifted out of the larger incision which has been made to achieve the surgical objectives. In contrast, significant laparoscopic skill is required to entrapand safely extract laparoscopic specimens. Indeed, the Urologist and surgical team which are transitioning from open surgery may disregard this important part of the procedure which may lead to significant morbidity. As such, it is imperative that during laparoscopic procedures, the ″end of the procedure″ be strictly defined as the termination of skin closure and dressing placement. Taking a few minutes to focus on safe specimen entrapment and extraction will substantially reduce major morbidity. The following review focus on the technology and technique of specimen entrapment and extraction, on the matter of whether to install a drainage system of the abdominal cavity and the options for adequate closure of trocar site wounds. This article 's primary objectives are to focus on how to minimize morbidity while maintain the advantages of a minimally invasive surgical approach.
MeSH term(s)	Abdominal Cavity/surgery ; Bandages ; Humans ; Kidney Diseases/surgery ; Laparoscopy/instrumentation ; Laparoscopy/standards ; Nephrectomy/instrumentation ; Nephrectomy/standards ; Sutures ; Treatment Outcome
Language	English
Publishing date	2012-04-01
Publishing country	Brazil
Document type	Journal Article ; Review
ZDB-ID	2206649-4
ISSN	1677-6119 ; 1677-5538
ISSN (online)	1677-6119
ISSN	1677-5538
DOI	10.1590/s1677-55382012000100002
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Article ; Online: Impact of obesity on ureteroscopic laser lithotripsy of urinary tract calculi.

Natalin, Ricardo / Xavier, Keith / Okeke, Zephaniah / Gupta, Mantu

International braz j urol : official journal of the Brazilian Society of Urology

2009 Volume 35, Issue 1, Page(s) 36–41; discussion 41–2

Abstract: Purpose: The treatment of urinary tract stones in obese patients may differ from the treatment of non-obese patients and their success rate varies. Our objective was to compare ureteroscopic treatment outcomes of ureteral and renal stones, stratified ... ...

Abstract	Purpose: The treatment of urinary tract stones in obese patients may differ from the treatment of non-obese patients and their success rate varies. Our objective was to compare ureteroscopic treatment outcomes of ureteral and renal stones, stratified for stone size and location, between overweight, obese and non-obese patients. Materials and methods: Charts were reviewed for 500 consecutive patients presenting at our institution for renal and ureteral stones. A total of 107 patients underwent flexible or semi-rigid ureteroscopy with Ho:YAG laser lithotripsy and met criteria for review and analysis. Results: Overall, initial stone-free rates were 91%, 97%, and 94% in normal, overweight and obese individuals respectively. When compared to non-obese patients, there were no significant differences (p value = 0.26; 0.50). For renal and proximal ureteral stones, the stone-free rate in overweight and obese individuals was 94% in both groups; and a stone-free rate of 100% was found for distal stones, also in both groups. Conclusions: Ureteroscopic treatment of stones in obese and overweight patients is an acceptable treatment modality, with success rates similar to non-obese patients.
MeSH term(s)	Case-Control Studies ; Female ; Humans ; Lasers, Solid-State/therapeutic use ; Lithotripsy, Laser/methods ; Male ; Middle Aged ; Obesity/complications ; Treatment Outcome ; Ureteral Calculi/therapy ; Ureteroscopy/methods
Language	English
Publishing date	2009-04-02
Publishing country	Brazil
Document type	Journal Article
ZDB-ID	2206649-4
ISSN	1677-6119 ; 1677-5538
ISSN (online)	1677-6119
ISSN	1677-5538
DOI	10.1590/s1677-55382009000100006
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Article ; Online: The final stage of the laparoscopic procedure

Ricardo A. Natalin / Fabio S. Lima / Thomé Pinheiro / Eugenio Vicari / Valdemar Ortiz / Cassio Andreoni / Jaime Landman

International Brazilian Journal of Urology, Vol 38, Iss 1, Pp 04-

exploring final steps

2012 Volume 16

Abstract	Despite significant advances in laparoscopic technique and technologies, laparoscopic Urologic surgery remains technically demanding regarding various surgical steps including the challenge of specimen retrieval and extraction, whether to install a drainage system and the best option for wound closure. Laparoscopic specimen entrapment and extraction occurs at what is falsely considered the "end of the procedure". During open surgery, after the specimen has been mobilized, the specimen is simply lifted out of the larger incision which has been made to achieve the surgical objectives. In contrast, significant laparoscopic skill is required to entrap and safely extract laparoscopic specimens. Indeed, the Urologist and surgical team which are transitioning from open surgery may disregard this important part of the procedure which may lead to significant morbidity. As such, it is imperative that during laparoscopic procedures, the "end of the procedure" be strictly defined as the termination of skin closure and dressing placement. Taking a few minutes to focus on safe specimen entrapment and extraction will substantially reduce major morbidity. The following review focus on the technology and technique of specimen entrapment and extraction, on the matter of whether to install a drainage system of the abdominal cavity and the options for adequate closure of trocar site wounds. This article's primary objectives are to focus on how to minimize morbidity while maintain the advantages of a minimally invasive surgical approach.
Keywords	Laparoscopy ; urology ; kidney ; outcomes ; Diseases of the genitourinary system. Urology ; RC870-923 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Urology ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Language	English
Publishing date	2012-02-01T00:00:00Z
Publisher	Sociedade Brasileira de Urologia
Document type	Article ; Online
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Article: Procedimiento cabestrillo autólogo versus sintético: tasa de éxito y frecuencia de obstrucción del tracto urinario inferior.

Natalin, Ricardo A / Riccetto, Cassio / Nardi Pedro, Renato / Prudente, Alessandro / Salvador Navarrete, Guillermo / Rodrigues Palma, Paulo C

Actas urologicas espanolas

2009 Volume 33, Issue 2, Page(s) 154–158

Abstract: Objectives: Voiding dysfunction and urinary retention were frequent complications of sling. More recently synthetic supplies such as polypropylene mesh have been included in the armamentarium for sub urethral support.: Methods: A prospective non ... ...

Title translation	Autologous versus synthetic sling procedure: success rate and bladder outlet obstruction rates.
Abstract	Objectives: Voiding dysfunction and urinary retention were frequent complications of sling. More recently synthetic supplies such as polypropylene mesh have been included in the armamentarium for sub urethral support. Methods: A prospective non randomized study was conducted. Sling procedure was performed in 436 consecutive patients with SUI. Patients were divided in groups according to mesh type, being 210 on autologous and 226 on synthetic. Patients were surveyed on voiding condition, continence and satisfaction. Surgical results were assessed according to Blaivas classification. Results were considered significant p<0.05. Results: Mean patient age was 48.4 years. Mean operative time for autologous sling was of 107.6 min versus 20.6 min for synthetic. Mean hospitalization was 36h on autologous versus 24h on synthetic and mean follow up was 25 months. We found 87.1% and 92.9% of patients continent in autologous and synthetic group, respectively. Failure was presented by 7% in autologous and 4.8% in synthetic group (p=0.1961). The global rate of BOO was of 4.5% (20/436), when analysed by groups we found on autologous a rate of 8.5% (18/210), compared to 0.9% on synthetics (2/226) (p=0.000126). Conclusions: Autologous and synthetic slings presented comparable success rates, however BOO was more common among patients treated by autologous slings.
MeSH term(s)	Adult ; Aged ; Female ; Humans ; Middle Aged ; Prospective Studies ; Prosthesis Design ; Remission Induction ; Suburethral Slings/adverse effects ; Urinary Bladder Neck Obstruction/etiology ; Urinary Incontinence, Stress/surgery
Language	Spanish
Publishing date	2009-02
Publishing country	Spain
Document type	Clinical Trial ; Comparative Study ; English Abstract ; Journal Article
ZDB-ID	604530-3
ISSN	0210-4806
ISSN	0210-4806
DOI	10.4321/s0210-48062009000200010
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