RESUMO
We report on a case of a two-year-old male dog, breed chow-chow, who suffered from urethral fistula as a result of ureterolithiasis. The urethral defect was identified intraoperatively with methylene blue. An autologous regenerative approach was combined with surgical closure of the defect, due to the well-known healing issues of the urethral wall in such conditions. A part of abdominal fat tissue was dissected to produce microfragmented adipose tissue containing mesenchymal stem cells, which was combined with platelet-rich plasma. The final product was applied in the area around the urethral defect closure. One month after the procedure, healing was confirmed with positive-contrast cystography. This therapeutic approach yielded success, and the follow-up period of one year was uneventful. The observed positive outcome of this approach in the canine model may be considered as a starting point for investigating the translational potential of the treatment in human medicine.
Assuntos
Transplante de Células-Tronco Mesenquimais , Masculino , Animais , Cães , Tecido Adiposo/citologia , Fístula Urinária/etiologia , Fístula Urinária/terapia , Fístula Urinária/veterinária , Fístula Urinária/cirurgia , Doenças do Cão/terapia , Doenças do Cão/cirurgia , Doenças do Cão/etiologia , Doenças Uretrais/etiologia , Doenças Uretrais/veterinária , Doenças Uretrais/terapia , Doenças Uretrais/cirurgia , Resultado do Tratamento , HumanosRESUMO
INTRODUCTION: Urogenital fistula is a physically, socially and psychologically devastating condition for the patient. In developed countries, these fistulae are typically related to gynecological surgery, pelvic pathology like malignancy or post radiation therapy. In contrast, classical teaching is that urogenital fistulae in the developing countries like India are usually associated with prolonged labor and obstetric complications. This retrospective study conducted at a tertiary care health Institute shows a paradigm shift in epidemiology, etiology and management of genitourinary fistulae in India in recent times. METHODS: This retrospective study included patients undergoing surgical repair for various genitourinary fistulae at our institute from 2016 to 2022. Epidemiology, etiology, site, size and number of fistulae, clinical presentation, and management records of these patients were recorded and reviewed retrospectively. RESULTS: In our study, the mean age of the patients was 38.4 ± 10.2 years. Vesicovaginal Fistula (VVF) was found to be most common fistula in the study population (87.5%) followed by vesicouterine (7.1%) and urethrovaginal fistula (5.4%). The causes of genitourinary fistula were iatrogenic (73.2%), carcinoma of cervix (16.1%), obstructed prolonged labor (7.1%), and genitourinary tuberculosis (3.57%). Among the 48 vesicovaginal fistulas that underwent surgery, 45.8% were treated using a transvaginal approach, 29.2% were managed through a laparoscopic transabdominal repair, and 25% were addressed using a robotic approach. Recurrence occurred in 7.1% of the operated patients. CONCLUSION: Enhanced healthcare services in the country have contributed to a decrease in the incidence of obstructed labor, subsequently reducing related injuries. Iatrogenic injuries resulting from gynecological surgeries and carcinoma cervix have given rise to more complex fistulas, necessitating the implementation of advanced treatment strategies.
Assuntos
Centros de Atenção Terciária , Fístula Vesicovaginal , Humanos , Feminino , Estudos Retrospectivos , Adulto , Fístula Vesicovaginal/epidemiologia , Fístula Vesicovaginal/etiologia , Pessoa de Meia-Idade , Fístula Urinária/epidemiologia , Fístula Urinária/etiologia , Fístula Urinária/terapia , Índia/epidemiologia , Fístula Vaginal/epidemiologia , Fístula Vaginal/etiologia , Fístula Vaginal/terapia , Doenças Uretrais/epidemiologia , Doenças Uretrais/etiologia , Doenças Uretrais/terapia , MasculinoRESUMO
BACKGROUND: Otis urethrotomy can sometimes lead to troublesome bleeding after seemingly uneventful procedures. This case report highlights one such case which went unnoticed initially; the bleeding was erroneously ascribed to the prostate, thereby falsely indicting the "decoy" prostate. CASE PRESENTATION: A 78-year-old Asian gentleman was referred to our hospital with complaint of intractable bleeding after undergoing laser enucleation of prostate at another institute, wherein he further underwent unsuccessful bilateral angioembolization of pudendal arteries. On endoscopy (for hemostasis), we found a spurting vessel in the navicular fossa, which was effectively controlled. CONCLUSIONS: This case report highlights the importance of performing prompt endoscopy in case of uncontrolled bleeding after prostate endoscopic surgery.
Assuntos
Uretra , Doenças Uretrais , Masculino , Humanos , Idoso , Uretra/cirurgia , Doenças Uretrais/etiologia , Doenças Uretrais/terapia , Hemorragia , Endoscopia GastrointestinalRESUMO
INTRODUCTION: Urethral bulking agents are commonly used to manage female stress urinary incontinence (SUI) as they have been suggested to be safe, efficacious, and a minimally invasive surgical option. Bulkamid is a newer bulking agent that has been introduced and promoted in the market for use. It is non-particulate in nature with high tissue biocompatibility, and consequently, it is difficult to differentiate between Bulkamid and a periurethral cyst on magnetic resonance imaging (MRI). This, therefore, presents a diagnostic dilemma. METHODS AND MATERIALS: Here we describe two cases with previous injections of Bulkamid referred to our Centre for management of a presumed periurethral diverticulum based on MRI findings. Both patients were reviewed and examined in outpatient clinics with MRI findings discussed at MDT, further imaging was required. RESULTS: We found that a limited noncontrast computed tomography (CT) pelvis, followed by a voiding cystometrogram (VCMG), and then a repeat limited noncontrast CT pelvis effectively differentiated between Bulkamid and these presumed periurethral diverticulae. The theory behind this was that during micturition, the contrast would pass through to the urethral diverticulum and appear as high-density (bright) material within the periurethral region (the pre-VCMG was required to prove that any high-density material was due to the contrast and not pre-existing high-contrast material). CONCLUSION: A CT scan done in conjunction with a VCMG is likely to be more effective in differentiating between Bulkamid and a true periurethral diverticulum than an MRI scan. Appropriate diagnostic evaluation of periurethral lesions can lead to time-saving and cost-effective patient management as this will bypass the need for unnecessary investigations and possible unwarranted surgical intervention.
Assuntos
Cistos , Divertículo , Doenças Uretrais , Incontinência Urinária por Estresse , Humanos , Feminino , Uretra/diagnóstico por imagem , Doenças Uretrais/diagnóstico por imagem , Doenças Uretrais/terapia , Incontinência Urinária por Estresse/diagnóstico por imagem , Incontinência Urinária por Estresse/terapia , Cistos/diagnóstico , Divertículo/diagnóstico por imagem , Divertículo/terapiaRESUMO
BACKGROUND: Urethrocutaneous fistula (subsequently, fistula) is a rare adverse event (AE) in voluntary medical male circumcision (VMMC) programs. Global fistula rates of 0.19 and 0.28 per 100,000 VMMCs were reported. Management of fistula can be complex and requires expert skills. We describe seven cases of fistula in our large-scale VMMC program in Zimbabwe. We present fistula rates; provide an overview of initial management, surgical interventions, and patient outcomes; discuss causes; and suggest future prevention efforts. RESULTS: Case details are presented on fistulas identified between March 2013 and October 2019. Among the seven fistula clients, ages ranged from 10 to 22 years; 6 cases were among boys under 15 years of age. All clients received surgical VMMC by trained providers in an outreach setting. Clients presented with fistulae 2-42 days after VMMC. Secondary infection was identified in 6 of 7 cases. Six cases were managed through surgical repair. The number of repair attempts ranged from 1 to 10. One case healed spontaneously with conservative management. Fistula rates are presented as cases/100,000 VMMCs. CONCLUSION: Fistula is an uncommon but severe AE that requires clinical expertise for successful management and repair. High-quality AE surveillance should identify fistula promptly and include consultation with experienced urologists. Strengthening provider surgical skills and establishment of standard protocols for fistula management would aid future prevention efforts in VMMC programs.
Assuntos
Circuncisão Masculina/efeitos adversos , Fístula Cutânea/etiologia , Doenças Uretrais/etiologia , Fístula Urinária/etiologia , Adolescente , Criança , Tratamento Conservador , Fístula Cutânea/cirurgia , Fístula Cutânea/terapia , Humanos , Masculino , Complicações Pós-Operatórias/cirurgia , Complicações Pós-Operatórias/terapia , Recidiva , Reoperação , Doenças Uretrais/cirurgia , Doenças Uretrais/terapia , Fístula Urinária/cirurgia , Fístula Urinária/terapia , Programas Voluntários , Adulto Jovem , ZimbábueRESUMO
Urethral prolapse is a very rare disease, which is most often found in prepubescent girls. It occurs in about one over 5000 girls in the context of a chronic cough or any situation that increases abdominal pressure. It is often associated with diagnostic confusion, which delays management. We report the case of a 6-year-old child brought in urgently by her parents for a minimal genital hemorrhage and presence of a mass protruding from the vulva. In the hypothesis of a urethral prolapse, a medical treatment (conservative) was prescribed. After two weeks, the mass decreased significantly in volume and disappeared completely after 2 months.
Assuntos
Hemorragia/etiologia , Prolapso de Órgão Pélvico/diagnóstico , Doenças Uretrais/diagnóstico , Criança , Feminino , Seguimentos , Humanos , Prolapso de Órgão Pélvico/terapia , Resultado do Tratamento , Doenças Uretrais/terapiaRESUMO
PURPOSE: Urethral pain syndrome is a chronic condition characterized by disturbing feeling or server pain sensed at the urethra without specific treatment. This double-center, two-arm controlled trial aimed to explore the efficacy of electrical pudendal nerve stimulation (EPNS) versus intravesical instillation (II) of heparin and alkalinized lidocaine for urethral pain syndrome (UPS). METHODS: Eighty eligible patients took three sessions of EPNS, or 1 session of II per week, for 6 consecutive weeks. The primary end point was the change of pelvic pain and urgency/frequency symptom (PUF) score from baseline to week 6. Secondary outcome measures included changes of visual analogue scale (VAS) score and three sub-score extracted from PUF score. RESULTS: The enrolled participants were all included in the intention-to-treat analyses, and baseline characteristics between the two groups were well balanced. The post-treatment PUF score decreased by 10.0 (7.00, 16.50) in the EPNS group, and by 7.0 (3.00, 10.00) in the II group. At the closure of treatment, the medians of changes in symptom score, bother score, pain-related score and VAS score were 6.50 (4.25, 10.00), 4.00 (2.00, 6.00), 6.00 (5.00, 8.00),4.50 (2.25, 6.00), respectively, in the EPNS group, and 4.00 (2.00, 7.00), 3.00 (1.00, 3.00), 3.00 (2.00, 6.00), 2.00 (1.00, 4.00), respectively, in the II group. All the between-group differences were statistically significant. CONCLUSION: Compared with the II, the EPNS results in superior pain control and better relief of lower urinary tract symptoms, and deserves further attention. TRIAL REGISTRATION: ClinicalTrials.gov (NCT03671993).
Assuntos
Anestésicos Locais/uso terapêutico , Dor Crônica/terapia , Terapia por Estimulação Elétrica/métodos , Fibrinolíticos/uso terapêutico , Heparina/uso terapêutico , Lidocaína/uso terapêutico , Dor Pélvica/terapia , Nervo Pudendo , Doenças Uretrais/terapia , Administração Intravesical , Dor Crônica/fisiopatologia , Feminino , Humanos , Análise de Intenção de Tratamento , Sintomas do Trato Urinário Inferior/fisiopatologia , Sintomas do Trato Urinário Inferior/terapia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pélvica/fisiopatologia , Doenças Uretrais/fisiopatologiaRESUMO
BACKGROUND: Pelvic organ prolapse is a common problem in women. About 40% of women will experience prolapse in their lifetime, with the proportion expected to rise in line with an ageing population. Women experience a variety of troublesome symptoms as a consequence of prolapse, including a feeling of 'something coming down' into the vagina, pain, urinary symptoms, bowel symptoms and sexual difficulties. Treatment for prolapse includes surgery, pelvic floor muscle training (PFMT) and vaginal pessaries. Vaginal pessaries are passive mechanical devices designed to support the vagina and hold the prolapsed organs back in the anatomically correct position. The most commonly used pessaries are made from polyvinyl-chloride, polythene, silicone or latex. Pessaries are frequently used by clinicians with high numbers of clinicians offering a pessary as first-line treatment for prolapse. This is an update of a Cochrane Review first published in 2003 and last published in 2013. OBJECTIVES: To assess the effects of pessaries (mechanical devices) for managing pelvic organ prolapse in women; and summarise the principal findings of relevant economic evaluations of this intervention. SEARCH METHODS: We searched the Cochrane Incontinence Specialised Register which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 28 January 2020). We searched the reference lists of relevant articles and contacted the authors of included studies. SELECTION CRITERIA: We included randomised and quasi-randomised controlled trials which included a pessary for pelvic organ prolapse in at least one arm of the study. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed abstracts, extracted data, assessed risk of bias and carried out GRADE assessments with arbitration from a third review author if necessary. MAIN RESULTS: We included four studies involving a total of 478 women with various stages of prolapse, all of which took place in high-income countries. In one trial, only six of the 113 recruited women consented to random assignment to an intervention and no data are available for those six women. We could not perform any meta-analysis because each of the trials addressed a different comparison. None of the trials reported data about perceived resolution of prolapse symptoms or about psychological outcome measures. All studies reported data about perceived improvement of prolapse symptoms. Generally, the trials were at high risk of performance bias, due to lack of blinding, and low risk of selection bias. We downgraded the certainty of evidence for imprecision resulting from the low numbers of women participating in the trials. Pessary versus no treatment: at 12 months' follow-up, we are uncertain about the effect of pessaries compared with no treatment on perceived improvement of prolapse symptoms (mean difference (MD) in questionnaire scores -0.03, 95% confidence interval (CI) -0.61 to 0.55; 27 women; 1 study; very low-certainty evidence), and cure or improvement of sexual problems (MD -0.29, 95% CI -1.67 to 1.09; 27 women; 1 study; very low-certainty evidence). In this comparison we did not find any evidence relating to prolapse-specific quality of life or to the number of women experiencing adverse events (abnormal vaginal bleeding or de novo voiding difficulty). Pessary versus pelvic floor muscle training (PFMT): at 12 months' follow-up, we are uncertain if there is a difference between pessaries and PFMT in terms of women's perceived improvement in prolapse symptoms (MD -9.60, 95% CI -22.53 to 3.33; 137 women; low-certainty evidence), prolapse-specific quality of life (MD -3.30, 95% CI -8.70 to 15.30; 1 study; 116 women; low-certainty evidence), or cure or improvement of sexual problems (MD -2.30, 95% -5.20 to 0.60; 1 study; 48 women; low-certainty evidence). Pessaries may result in a large increase in risk of adverse events compared with PFMT (RR 75.25, 95% CI 4.70 to 1205.45; 1 study; 97 women; low-certainty evidence). Adverse events included increased vaginal discharge, and/or increased urinary incontinence and/or erosion or irritation of the vaginal walls. Pessary plus PFMT versus PFMT alone: at 12 months' follow-up, pessary plus PFMT probably leads to more women perceiving improvement in their prolapse symptoms compared with PFMT alone (RR 2.15, 95% CI 1.58 to 2.94; 1 study; 260 women; moderate-certainty evidence). At 12 months' follow-up, pessary plus PFMT probably improves women's prolapse-specific quality of life compared with PFMT alone (median (interquartile range (IQR)) POPIQ score: pessary plus PFMT 0.3 (0 to 22.2); 132 women; PFMT only 8.9 (0 to 64.9); 128 women; P = 0.02; moderate-certainty evidence). Pessary plus PFMT may slightly increase the risk of abnormal vaginal bleeding compared with PFMT alone (RR 2.18, 95% CI 0.69 to 6.91; 1 study; 260 women; low-certainty evidence). The evidence is uncertain if pessary plus PFMT has any effect on the risk of de novo voiding difficulty compared with PFMT alone (RR 1.32, 95% CI 0.54 to 3.19; 1 study; 189 women; low-certainty evidence). AUTHORS' CONCLUSIONS: We are uncertain if pessaries improve pelvic organ prolapse symptoms for women compared with no treatment or PFMT but pessaries in addition to PFMT probably improve women's pelvic organ prolapse symptoms and prolapse-specific quality of life. However, there may be an increased risk of adverse events with pessaries compared to PFMT. Future trials should recruit adequate numbers of women and measure clinically important outcomes such as prolapse specific quality of life and resolution of prolapse symptoms. The review found two relevant economic evaluations. Of these, one assessed the cost-effectiveness of pessary treatment, expectant management and surgical procedures, and the other compared pessary treatment to PFMT.
Assuntos
Prolapso de Órgão Pélvico/terapia , Pessários , Viés , Feminino , Humanos , Força Muscular , Diafragma da Pelve , Pessários/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Prolapso Retal/terapia , Doenças Uretrais/terapia , Doenças da Bexiga Urinária/terapia , Prolapso Uterino/terapiaRESUMO
Stress urinary incontinence (SUI) is a common and bothersome condition. Anti-incontinence surgery has high cure rates, but concerns about mesh tapes have resulted in the resurgence of surgical procedures that involve increased abdominopelvic dissection and morbidity. Injection therapy with urethral bulking agents or stem cell formulations have been developed as minimally invasive alternatives. Many synthetic and biological bulking agents have been trialled, but several have been discontinued owing to safety concerns. The use of Macroplastique and Contigen has the largest evidence base, but, overall, success rates seem to be similar between the various agents and positive outcomes are poorly sustained for more than 6 months. Furthermore, subjective cure rates, although initially high, also deteriorate over time. The available data consistently demonstrate manifestly poorer outcomes for injection therapies than for surgery. Stem cell treatments are thought to functionally regenerate the urethral sphincter in patients with suspected intrinsic sphincter deficiency. Autologous adipose and muscle-derived stem cells seem to be the intuitive cell source, as they are comparatively abundant, can be harvested and cause minimal donor site morbidity. To date, only a few small clinical studies have been reported and most data are derived from animal models. The success rates of stem cell injection therapies seem to be comparable with those of bulking agents.
Assuntos
Materiais Biocompatíveis/administração & dosagem , Doenças Uretrais/terapia , Incontinência Urinária por Estresse/terapia , Humanos , Injeções Intralesionais , Medicina Regenerativa/métodos , Transplante de Células-TroncoRESUMO
The use of artificial urinary sphincter (AUS) for the treatment of stress urinary incontinence has become more prevalent, especially in the "prostate-specific antigen (PSA)-era", when more patients are treated for localized prostate cancer. The first widely accepted device was the AMS 800, but since then, other devices have also entered the market. While efficacy has increased with improvements in technology and technique, and patient satisfaction is high, AUS implantation still has inherent risks and complications of any implant surgery, in addition to the unique challenges of urethral complications that may be associated with the cuff. Furthermore, the unique nature of the AUS, with a control pump, reservoir, balloon cuff, and connecting tubing, means that mechanical complications can also arise from these individual parts. This article aims to present and summarize the current literature on the management of complications of AUS, especially urethral atrophy. We conducted a literature search on PubMed from January 1990 to December 2018 on AUS complications and their management. We review the various potential complications and their management. AUS complications are either mechanical or nonmechanical complications. Mechanical complications usually involve malfunction of the AUS. Nonmechanical complications include infection, urethral atrophy, cuff erosion, and stricture. Challenges exist especially in the management of urethral atrophy, with both tandem implants, transcorporal cuffs, and cuff downsizing all postulated as potential remedies. Although complications from AUS implants are not common, knowledge of the management of these issues are crucial to ensure care for patients with these implants. Further studies are needed to further evaluate these techniques.
Assuntos
Complicações Pós-Operatórias/terapia , Falha de Prótese , Infecções Relacionadas à Prótese/terapia , Uretra/patologia , Doenças Uretrais/terapia , Estreitamento Uretral/cirurgia , Incontinência Urinária por Estresse/cirurgia , Esfíncter Urinário Artificial , Atrofia , Humanos , Complicações Pós-Operatórias/epidemiologia , Implantação de Prótese , Infecções Relacionadas à Prótese/epidemiologia , Doenças Uretrais/epidemiologia , Estreitamento Uretral/epidemiologiaRESUMO
The major challenge to treat the clinical adverse effects of long-segment urethra is in achieving viable tissue substitution. The substituted construct's properties-such as its resilience, contraction, and ability to minimize scar-stenosis formation should be considered. In the present work, a unique polyurethane-urea (PUU) fibrous membrane is fabricated by electrospinning. Then PUU was coated by collagen and formed the elasticity hydrogel after immersed in collagen solution. Meanwhile, the cPUU hydrogel exhibited a fibrous microstructure. This cPUU hydrogel had outstanding stretching property with 404 ± 40% elongation at break compared with traditional hydrogels, which satisfied the requirement of urethra. The cPUU hydrogel also supported the adhesion and growth of bladder smooth-muscle cells (BSMCs) in natural state cell morphology. Urethral defects in New Zealand male rabbits were repaired with cPUU seeded with BSMCs in vivo. After three months, more smooth-surface area of reconstructed urethral tissues was observed in the cPUU hydrogel-BMSCs groups compared with that of the control group. The luminal patency and the incidence of complications-including calculus formation, urinary fistula, and urethral-stricture occurrence were significantly lower in the cPUU group compared with that of the control group. Hence, cPUU fibrous hydrogels are promising scaffolds for application in urological tissue engineering.
Assuntos
Colágeno/química , Hidrogéis/química , Miócitos de Músculo Liso/fisiologia , Poliuretanos/química , Ureia/química , Doenças Uretrais/terapia , Animais , Materiais Biocompatíveis , Masculino , Teste de Materiais , Coelhos , Engenharia Tecidual , Alicerces Teciduais , Bexiga Urinária/citologiaRESUMO
This is a case report of lichen planus (LP) with multiple system involvement. A 35-year-old female patient was admitted in November 2014 with a 5-year history of painful/difficult sexual intercourse and loss of oral mucosa, and an 8-year history of focal hair loss. Earlier, the patient had been unable to adhere to corticosteroid therapy because of severe adverse side effects. In September 2014, labia minora mucosa defects and stricture of the urethral orifice (with dysuria), vaginal orifice, and vagina were identified. Biopsy was performed and a diagnosis of erosive LP was made. The patient was treated with an oral immunosuppressant (cyclosporine A) and urethral/vaginal dilatation. Urine flow rate and sex life were improved after 6 months and she discontinued medication. Four years later, the patient reported a good overall treatment efficacy. LP can involve multiple systems and should be considered in patients with dyspareunia. Immunosuppressive agents can achieve a satisfactory effect in patients with contraindication to corticosteroid.
Assuntos
Líquen Plano/diagnóstico , Dermatoses do Couro Cabeludo/diagnóstico , Doenças Uretrais/diagnóstico , Doenças Vaginais/diagnóstico , Adulto , Feminino , Humanos , Líquen Plano/patologia , Líquen Plano/terapia , Dermatoses do Couro Cabeludo/patologia , Dermatoses do Couro Cabeludo/terapia , Doenças Uretrais/patologia , Doenças Uretrais/terapia , Doenças Vaginais/patologia , Doenças Vaginais/terapiaRESUMO
Female urethral pathology can be challenging to diagnose clinically due to non-specific symptoms. High-resolution MRI has become a powerful tool in the diagnosis of urethral lesions and staging of malignancy. Additionally, dynamic MRI, fluoroscopy or ultrasound can evaluate for pelvic floor prolapse and the effectiveness of surgical interventions. This article will review the imaging features of common benign and malignant conditions of the female urethra including diverticula, benign cystic and solid lesions, malignancy, surgical slings, and injection of bulking agents.
Assuntos
Imagem Multimodal , Uretra/diagnóstico por imagem , Doenças Uretrais/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Uretra/patologia , Doenças Uretrais/patologia , Doenças Uretrais/terapiaRESUMO
Background: A syringocele is a cystic dilation of the ducts from the bulbourethral glands located in the bulbous part of the male urethra. It is a rare condition primarily reported in children and young adults. The objective was to evaluate the diagnostic pattern and management strategy in patients of all ages diagnosed with syringocele.Methods: A retrospective review of patients with syringocele in the period 2004-2018 was performed. Age at diagnosis, primary symptoms, the diagnostic modalities used, treatments and effects were registered.Results: In the period, 19 patients with syringoceles were identified, eight children and 11 adults. The majority of the patients presented with obstructive voiding symptoms. All patients underwent cystourethroscopy. Supplementary diagnostics as voiding cystourethrography, retrograde urethrography, uroflowmetry, magnetic resonance imaging or transrectal ultrasonography were used inconsistently. Sixteen of the patients underwent marsupialization, one child underwent open excision and two patients were managed conservatively. Three of the children were re-operated on with endoscopic marsupialization. One of the adult patients did not respond to marsupialization and was treated with and vesico-appendico-cutaneostomy.Discussion: A review of the case reports published in the period 1996-2018 was performed and compared to these results. This review found 77 cases, 50 children and 27 adults. The reported symptoms, diagnostics and treatments were in line with the findings of this study.Conclusions: Based on these findings and the literature it is recommended that syringoceles should be diagnosed by cystourethroscopy and urethrography. Patients with symptomatic syringoceles should be offered treatment. First line treatment is endoscopic marsupialization.
Assuntos
Glândulas Bulbouretrais/patologia , Doenças Uretrais , Adolescente , Adulto , Criança , Dilatação Patológica , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doenças Uretrais/diagnóstico , Doenças Uretrais/terapia , Adulto JovemRESUMO
BACKGROUND: In this case report, giant calculus in the urethral diverticulum was found through ureteroscopy investigation, the pneumatic lithotripsy combined with ultrasound lithotripsy (PLCUL) was successfully performed to break down this rare and giant urethral calculus in the diverticulum without open surgery. CASE PRESENTATION: A 82-year-old male presented to the urology department, complaining of frequent urination and dysuria. One giant, dark brown stone (6.5 × 6 × 5.5 cm) was revealed in the diverticulum of the anterior urethra using combination of local ultrasound, pelvic Computer Tomography (CT) and Magnetic Resonance Imaging (MRI). The stone was then successfully broken down via the PLCUL, and the emptied anterior urethral diverticulum was left untreated. In the 18 months' follow-up, no new calculus was found in urethral tract, anterior diverticula became gradually smaller, eventually disappeared. CONCLUSION: In the treatment of giant calculus in the urethral diverticulum, this case report provides an effective method of lithotripsy in the clinical trials.
Assuntos
Divertículo/diagnóstico por imagem , Divertículo/terapia , Litotripsia/métodos , Uretra/diagnóstico por imagem , Doenças Uretrais/diagnóstico por imagem , Doenças Uretrais/terapia , Idoso de 80 Anos ou mais , Humanos , Masculino , Cálculos Urinários/diagnóstico por imagem , Cálculos Urinários/terapiaRESUMO
OBJECTIVE: Description of clinical experience with two different lithotripsy modalities for treatment of urethral stones in dogs. MATERIAL AND METHODS: Retrospective analysis (October 2016 - November 2017) of medical records from dogs with urinary stones that underwent transurethral pneumatic or laser lithotripsy. RESULTS: In 28 male and 5 female dogs, either pneumatic lithotripsy (39â %) or laser lithotripsy (61â %) was performed. In the urethra, stone free rates of 100â % in females and over 85â % in males could be achieved using either fragmentation modality. In 3 of 28 (11â %) male dogs, after fragmentation of urethral stones, urethral patency was impaired because of endoscopically suspected polypoid urethritis requiring urethrostomy. In 8 out of 28 (29â %) male dogs and in 1 of 5 (20â %) female dogs, an additional lithocystotomy was necessary to achieve stone-free status in the lower urinary tract. CONCLUSION AND CLINICAL RELEVANCE: Transurethral pneumatic or laser lithotripsy of urinary stones is a successful procedure in dogs. Major pathological conditions of the urethral mucosa may require further surgical or interventional methods for the restoration of a functional urethra.
Assuntos
Doenças do Cão/terapia , Litotripsia a Laser/veterinária , Litotripsia/veterinária , Doenças Uretrais/veterinária , Cálculos Urinários/veterinária , Animais , Cães , Feminino , Litotripsia/métodos , Masculino , Registros/veterinária , Estudos Retrospectivos , Doenças Uretrais/terapia , Cálculos Urinários/terapiaRESUMO
OBJECTIVES: Determining the incidence and causes of lower urinary tract injury in patients undergoing total laparoscopic hysterectomy and examining the procedures applied for management. METHODS: Patients who underwent total laparoscopic hysterectomy in a large referral center between 1 January 2015 and 31 October 2017 for benign gynecological reasons were included in the study. Patients who underwent laparoscopic supracervical hysterectomy, laparoscopy-assisted vaginal hysterectomy and robot-assisted laparoscopic hysterectomy were not included in this study. The hospital records of all patients included in the study were examined and the incidence, causes and management of lower urinary tract injuries were reviewed. RESULTS: Total lower urinary tract injury rate was found as 2.01%, and these injuries were evaluated separately as bladder and ureter injuries. All the bladder injuries had occurred on the posterior wall of the bladder during vesicouterine dissection; six cases were intraoperatively detected and one case was detected on the first postoperative day. Most of ureteral injury cases were detected in the early postoperative period (75%). The rates of previous cesarean section and endometriosis were significantly higher in patients with injury to the bladder and ureter than in the control group (p<0,001). There was no significant difference between the patients with lower urinary tract injury and the control group regarding uterine weight, estimated blood loss, bilateral salpingo-oophorectomy, the presence and location of fibroids, and laparoscopic or vaginal closure of the vaginal cuff. CONCLUSION: Laparoscopic hysterectomy may be a good option in appropriate patients, but in case of previous cesarean section and endometriosis cases, patients should be informed about the possible complications in detail before the operation and care should be taken during dissection.
Assuntos
Cesárea , Endometriose , Histerectomia/efeitos adversos , Complicações Intraoperatórias , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias , Ureter/lesões , Doenças Uretrais , Doenças da Bexiga Urinária , Bexiga Urinária/lesões , Adulto , Cesárea/estatística & dados numéricos , Endometriose/epidemiologia , Feminino , Humanos , Histerectomia/estatística & dados numéricos , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/terapia , Laparoscopia/estatística & dados numéricos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Doenças Uretrais/epidemiologia , Doenças Uretrais/etiologia , Doenças Uretrais/terapia , Doenças da Bexiga Urinária/epidemiologia , Doenças da Bexiga Urinária/etiologia , Doenças da Bexiga Urinária/terapiaRESUMO
This is a case report of lichen planus (LP) with multiple system involvement. A 35-year-old female patient was admitted in November 2014 with a 5-year history of painful/difficult sexual intercourse and loss of oral mucosa, and an 8-year history of focal hair loss. Earlier, the patient had been unable to adhere to corticosteroid therapy because of severe adverse side effects. In September 2014, labia minora mucosa defects and stricture of the urethral orifice (with dysuria), vaginal orifice, and vagina were identified. Biopsy was performed and a diagnosis of erosive LP was made. The patient was treated with an oral immunosuppressant (cyclosporine A) and urethral/vaginal dilatation. Urine flow rate and sex life were improved after 6 months and she discontinued medication. Four years later, the patient reported a good overall treatment efficacy. LP can involve multiple systems and should be considered in patients with dyspareunia. Immunosuppressive agents can achieve a satisfactory effect in patients with contraindication to corticosteroid.
Assuntos
Humanos , Feminino , Adulto , Dermatoses do Couro Cabeludo/diagnóstico , Doenças Uretrais/diagnóstico , Doenças Vaginais/diagnóstico , Líquen Plano/diagnóstico , Dermatoses do Couro Cabeludo/patologia , Dermatoses do Couro Cabeludo/terapia , Doenças Uretrais/patologia , Doenças Uretrais/terapia , Doenças Vaginais/patologia , Doenças Vaginais/terapia , Líquen Plano/patologia , Líquen Plano/terapiaRESUMO
We report a rare complication of rectourethral fistula formation 6 weeks after a 70-year-old man underwent an uneventful HoLEP procedure. Cystourethrogram confirmed the diagnosis and the patient was managed conservatively with chronic indwelling catheter placement for 6 weeks. After this, his symptoms resolved completely and a repeat cystourethrogram showed marked resolution of the fistulous tract. The cause of the fistula formation is believed to be due to a delayed thermal or infectious reaction. Post-procedure follow up is necessary in all patients to monitor for complications that do not arise immediately after surgery.