A realistic model for vasectomy reversal training using swine testicles

Purpose: To evaluate the viability of the porcine vas deferens as a realistic microsurgical training model for vasectomy reversal Methods: The model uses swine testicles (vas deferent), which are usually discarded in large street markets since they are not part of Brazilian cuisine. The spermatic cord was carefully dissected, and the vas deferens were isolated, measuring 10 cm in length. A paper quadrilateral with 5 cm2 was built to delimit the surgical training field. The objective of the model is to simulate only the microsurgical step when the vas deferens are already isolated. The parameters analyzed were: feasibility for reproducing the technique, patency before and after performing the vasovasostomy, cost of the model, ease of acquisition, ease of handling, execution time, and model reproducibility. Results: The simulator presented low cost. All models made were viable with a texture similar to human, with positive patency obtained in 100% of the procedures. The internal and external diameters of the vas deferens varied between 0.2-0.4 mm and 2-3 mm, respectively, with a mean length of 9 ± 1.2 cm. The total procedure time was 43.28 ± 3.22 minutes. Conclusions: The realistic model presented proved to be viable for carrying out vasectomy reversal training, due to its low cost, easy acquisition, and easy handling, and providing similar tissue characteristics to humans.

Image-guided study of swine anatomy as a tool for urologic surgery research and training

Purpose: To describe the anatomy of the swine urinary system using computed tomography and to discuss the role of this animal as an experimental model for urological procedures. Methods: Three male Landrace pigs underwent computed tomography and the anatomy of the urinary system and renal circulation was analyzed and described. Results: In all animals, 2 kidneys, 2 ureters and one bladder were identified. Each kidney presented a single renal artery vascularization, with a mean diameter on the right of 4.45 and 5.31 mm on the left (p < 0.0001) and single renal vein drainage, with a mean diameter on the right of 5.78 and 5.82 mm on the left (p = 0.0336). The average renal length was 9.85 cm on the right and 10.30 cm on the left (p < 0.0001). The average renal volume was 113.70 cm3 on the right and 109.70 cm3 on the left (p 0.0001). The average length of the ureter was 19.78 cm on the right and 22.08 cm on the left (p < 0.0001). The average bladder volume was 423.70 cm3. Conclusions: The data obtained show similarities with human anatomy, suggesting the viability of the swine model for planning preclinical trials, basic research, refinement in experimental surgery and surgical training for urological procedures.(AU)

Simulated training of a laparoscopic vesicourethral anastomosis

Purpose: To develop a model and curriculum for simulated training of an effective and well accepted laparoscopic vesicourethral anastomosis (VUA). Methods: Experimental longitudinal study of quantitative character. The sample consisted of 12 general surgery residents and 6 urology residents (R3). The training consisted of making twelve VUAs on synthetic organs. The training was divided into four sessions and accompanied by an instructor who performed positive feedback. The evaluation of the anastomoses considered the time and the analysis of the operative technique through the global evaluation scale Objective Structured Assessment of Technical Skills (OSATS). Results: Residents showed a reduction in operative time and evolution in the surgical technique statistically significant (p<0.01). The best-rated items were the facilitator positive feedback and the fact that the training was carried out at the teaching hospital premises. Conclusions: The proposed training model was well accepted and proved to be effective in reducing operative time and improving laparoscopic skills. The training should be fractionated (4 sessions in 3 weeks), repetitive (12 anastomoses) and have positive feedback.(AU)

Total resection of the lower urinary tract without the need of pelvic osteotomy in the treatment of urethral neoplasia in a dog

Background: Urethral neoplasias are rare in small animals and normally have slow growth, but tissue invasion and urethral obstruction are frequent. Prognosis usually is poor due to the high degree of malignity of the main neoplasias involved. Surgical excision is the main form of treatment, but it should be complete with wide safety margins, making partial or complete removal of the bladder with transplantation of the ureters necessary. This report aims at describing a surgical technique, used in a bitch with urethral tumor, which involved complete resection of vulva, vagina and bladder, followed by ureterocolic anastomosis without pelvic osteotomy. Case: A 10-year-old female White Swiss Shepherd dog, weighing 35 kg, was presented with partial ischuria and haematuria for approximately 30 days, with final development of complete ischuria, vomit and anorexia. Urethral swab was performed, and the material obtained was fixed for cytological examination, which revealed the presence of malignant epithelial neoplasias, giving the case a direction. Staging was achieved through thoracic radiographs in two recumbent views, and metastatic lesions were not found. A radical surgery was proposed to the owner for the treatment of the patiente. The surgical procedure involved complete removal of the lower urinary tract, vagina and vulva, followed by reimplantation of the ureters in the colon (ureterocolic anastomosis). The patient recovered well from surgery, and urinary continence was maintained, along with quality of life. Transitional carcinoma in the urethral mucosa was characterized by histological diagnose, which revealed safe margins. Clinical evaluations were made daily, with detailed observation of urination, urine volume and color. From the second postoperative day on, fecal consistency from pasty to liquid and fetid odor were observed. Control of urination was only achieved after the fifth day. Ten days after the surgery, the patient was discharged, when the external sutures were removed. The patient lived well for six months, when it died of an indeterminate cause. Necropsy was not allowed by the owner. Discussion: Although primary urethral neoplasias are considered to be rare in dogs, its incidence is higher in females with age around 10 years, as was observed in this case report. Surgery may be the most promising treatment for urethral neoplasias in dogs, since they are not considered chemosensitive and the results of radiotherapy do not seem satisfactory. Urethral reimplantation on the digestive tract is an old technique described in the literature with satisfactory results, but with a lot of reports of postoperative complications which did not occurred in this case. Cystectomy followed by ureterocolic anastomosis allows the bladder to be completely excised while maintaing urinary continence and quality of life. The technique used was proved suitable for the treatment of urethral neoplasias that require complete removal of lower urinary tract so that wide margins are achieved. The approach used, as described, is less complicated than the ventral approach with pubic osteotomy. The described technique, without pelvic osteotomy, may benefi t patients with urethral neoplasias, once it is a less painful procedure, with fewer post-operative complications. Good patient recovery and wide margins obtained are sufficient to valorize this surgical technique.

Cão jovem com fibrossarcoma em bexiga urinária: relato de caso / Young dog with fibrosarcoma in bladder: case report / Perro joven con fibrosarcoma en vejiga: reporte de caso

Un perro macho, 3 anos de edad, la raza Lhasa Apso, contó con la presencia de quejarse de disuria y hematuria. En el examen físico, el animal mostró sensibilidad en la región hipogástrica y la ecografía abdominal, se evidenció un irregular, estructura ecogénica heterogénea, pared y luz de la vejiga, lo que podría indicar una neoformación. La escisión quirúrgica de la formación se llevó a cabo y la estructura que se refiere retira para el examen histopatológico, que detecta la presencia de fibrosarcoma. La quimioterapia se indicó como opción de tratamiento adyuvante no en posesión del propietario. El animal se evaluó después de tres meses de la cirugía, que no presentan quejas relacionadas con el sistema urinario y sin divulgación de nódulos metastásicos en la radiografía de tórax y una ecografía del abdomen.(AU)

A male dog, 3 years old, breed Lhasa Apso, was attended complaining of dysuria and hematuria. During physical examination, the animal showed sensitivity in hypogastric region and during the abdominal ultrasonography, it was evidenced an irregular, heterogeneous, echogenic as the wall bladder structure in wall and bladder lumen, which indicate a neoformation. Surgical excision of the neoformation was carried out and the removed structure was forwarded to histopathological exams, where the presence of fibrosarcoma was detected. Chemotherapy was indicated as adjunctive treatment, and it wasn't carried out by the owner. The animal was valued after three months of surgery, which didn't show complains related to urinary system and without evidence of metastatic nodule on chest radiography and on ultrasound of the abdomen.(AU)

Um cão macho, de 3 anos de idade, da raça Lhasa Apso, foi atendido com queixa de hematúria e disúria. No exame físico, o animal apresentou sensibilidade em região hipogástrica e ao exame ultrassonográfico abdominal, foi evidenciada uma estrutura irregular, heterogênea, ecogênica em relação à parede vesical, em parede e lúmen vesical, podendo indicar a presença de neoformação. A excisão cirúrgica da neoformação foi realizada e a estrutura retirada encaminhada para exame histopatológico, onde se detectou a presença de fibrossarcoma. Foi indicado quimioterapia como tratamento coadjuvante, não realizada por opção do proprietário. O animal foi avaliado após três meses do procedimento cirúrgico, onde não apresentou queixas referentes ao sistema urinário e sem evidenciação de nódulos metastáticos nos exames de radiografia torácica e ultrassonografia do abdômen.(AU)

Cão jovem com fibrossarcoma em bexiga urinária: relato de caso / Young dog with fibrosarcoma in bladder: case report / Perro joven con fibrosarcoma en vejiga: reporte de caso

Un perro macho, 3 anos de edad, la raza Lhasa Apso, contó con la presencia de quejarse de disuria y hematuria. En el examen físico, el animal mostró sensibilidad en la región hipogástrica y la ecografía abdominal, se evidenció un irregular, estructura ecogénica heterogénea, pared y luz de la vejiga, lo que podría indicar una neoformación. La escisión quirúrgica de la formación se llevó a cabo y la estructura que se refiere retira para el examen histopatológico, que detecta la presencia de fibrosarcoma. La quimioterapia se indicó como opción de tratamiento adyuvante no en posesión del propietario. El animal se evaluó después de tres meses de la cirugía, que no presentan quejas relacionadas con el sistema urinario y sin divulgación de nódulos metastásicos en la radiografía de tórax y una ecografía del abdomen.

A male dog, 3 years old, breed Lhasa Apso, was attended complaining of dysuria and hematuria. During physical examination, the animal showed sensitivity in hypogastric region and during the abdominal ultrasonography, it was evidenced an irregular, heterogeneous, echogenic as the wall bladder structure in wall and bladder lumen, which indicate a neoformation. Surgical excision of the neoformation was carried out and the removed structure was forwarded to histopathological exams, where the presence of fibrosarcoma was detected. Chemotherapy was indicated as adjunctive treatment, and it wasn't carried out by the owner. The animal was valued after three months of surgery, which didn't show complains related to urinary system and without evidence of metastatic nodule on chest radiography and on ultrasound of the abdomen.

Um cão macho, de 3 anos de idade, da raça Lhasa Apso, foi atendido com queixa de hematúria e disúria. No exame físico, o animal apresentou sensibilidade em região hipogástrica e ao exame ultrassonográfico abdominal, foi evidenciada uma estrutura irregular, heterogênea, ecogênica em relação à parede vesical, em parede e lúmen vesical, podendo indicar a presença de neoformação. A excisão cirúrgica da neoformação foi realizada e a estrutura retirada encaminhada para exame histopatológico, onde se detectou a presença de fibrossarcoma. Foi indicado quimioterapia como tratamento coadjuvante, não realizada por opção do proprietário. O animal foi avaliado após três meses do procedimento cirúrgico, onde não apresentou queixas referentes ao sistema urinário e sem evidenciação de nódulos metastáticos nos exames de radiografia torácica e ultrassonografia do abdômen.

Ipsilateral testicular necrosis and atrophy after 1.080-degree torsion of the spermatic cord in rats / Necrose e atrofia do testículo ipsilateral após torção de 1080 graus do cordão espermático em ratos

PURPOSE: To assess the incidence of testicular necrosis/atrophy immediately after 1 to 4 hours of 1,080-degree torsion of the spermatic cord, and 60 days after detorsion of the spermatic cord. METHODS: 42 rats were divided in 7 groups. Except for the control group, surgical torsion of the right spermatic cord was performed in all groups (T0). After 1, 2, or 4 hours of torsion, each group underwent either ipsilateral orchiectomy (groups OT1, OT2, and OT4), or detorsion of the spermatic cord and observation for 60 days (groups DT1, DT2, and DT4), before they were evaluated for the presence of testicular necrosis/atrophy. RESULTS: Only one rat (5.5%) in groups OT1, OT2, and OT4 had testicular necrosis, in comparison with six rats (33.3%) in groups DT1, DT2, and DT4 (p=0.04). The incidence of testicular necrosis/atrophy was not different between subgroups T1, T2, and T4, and the control group (p>0.05). There was, however, a tendency toward greater incidence of necrosis/atrophy in the rats in group DT4. CONCLUSION: The incidence of testicular necrosis/atrophy immediately after 1 to 4 hours of 1,080-degree torsion of the spermatic cord is 5.5%, in comparison with 33.3% sixty days after detorsion of the spermatic cord.(AU)

OBJETIVO: Avaliar a incidência de necrose/atrofia testicular imediatamente após 1 a 4 horas de torção de 1080 graus do cordão espermático e 60 dias após a destorção do cordão espermático. MÉTODOS: 42 ratos foram separados em 7 grupos. Exceto para o grupo controle, todos os animais foram submetidos à torção operatória do cordão espermático direito (T0). Após 1, 2 ou 4 horas de torção, cada grupo foi submetido a orquiectomia ipsilateral (grupos OT1, OT2 e OT4), ou destorção do cordão espermático e observação por 60 dias (grupos DT1, DT2 e DT4), antes de serem avaliados para a presença de necrose/atrofia testicular. RESULTADOS: Somente um rato (5,5 por cento) nos grupos OT1, OT2 e OT4 apresentou necrose testicular em comparação com 6 ratos (33,3%) nos grupos DT1, DT2 e DT4 (p=0,04). A incidência de necrose/atrofia testicular não foi diferente entre os subgrupos T1, T2 e T4 e o grupo controle (p>0,05). Houve, no entanto, uma tendência a maior incidência de necrose/atrofia nos ratos do grupo DT4. CONCLUSÃO: A incidência de necrose/atrofia testicular imediatamente após 1 a 4 horas de torção de 1080 graus do cordão espermático é de 5,5% em comparação com 33,3% sessenta dias após a destorção do cordão espermático.(AU)

Técnicas cirúrgicas para urolitíase obstrutiva em pequenos ruminantes: relato de casos / Surgical techniques for obstructive urolithiasis in small ruminants: cases reports

Relataram-se dois casos em que a penectomia com transposição peniana perineal foram as técnicas cirúrgicas de escolha e que resultaram em 50 por cento de sucesso. Quatro casos em que as cistotomias seguidas de cistostomias apresentaram 100 por cento de sucesso, um caso em que só a cistotomia foi realizada e não se obteve sucesso, um caso em que apenas o tratamento clínico foi eficiente e dois casos em que houve 100 por cento de insucesso, independentemente da técnica cirúrgica utilizada, devido ao quadro avançado de azotemia e choque toxêmico dos animais. O estudo foi realizado durante os anos de 2003 a 2005, com a casuística de urolitíase obstrutiva em caprinos e ovinos, de forma a descrever as causas e as conseqüências das decisões terapêuticas empregadas(AU)

Two cases in wich the penectomy and perineal penile transposition were the surgical technique of choice, technique of choice were described showing 50 percent of success. There are also reported four cases in wich cystotomy followed by cystostomy showed 100 percent of success, one case in wich the cystotomy alone was unsuccessfully, one case in wich only the clinical treatment was efficient and two cases showing 100 percent of unsuccessful despite of the surgical technique used due to the advanced stage of azotemy and toxemic shock of the animals. This article presents a study of urolithiasis in goats and sheep, from 2003 to 2005, aiming to describe the causes and the consequences of the therapeutic procedures followed(AU)