Bacterial cellulose to reinforce urethrovesical anastomosis. A translational study

Purpose: To evaluate the efficacy of the cellulosic exopolysaccharide membrane (CEM) as a urethral reinforcement for urethrovesical anastomosis. Methods: Twenty eight rabbits were submitted to urethrovesical anastomosis with or without CEM reinforcement. The animals were divided into 4 groups: C7, CEM7, C14 and CEM14: (C= only anastomosis or CEM = anastomosis + CEM), evaluated after 7 weeks, and 14 weeks. The biointegration and biocompatibility of CEM were evaluated according to stenosis, fistula, urethral wall thickness, urethral epithelium, rate of inflammation and vascularization. Results: Between the two experimental groups, the difference in the number of stenosis or urinary fistula was not statistically significant. The morphometric analysis revealed preservation of urethral lumen, well adhered CEM without extrusion, a controlled inflammatory process and implant vascularization. The urothelium height remained constant over time after CEM reinforcement and the membrane wall was thicker, statistically, after 14 weeks. Conclusion: The absence of extrusion, stenosis or urinary fistula after 14 weeks of urethrovesical anastomosis demonstrates cellulosic exopolysaccharide membrane biocompatibility and biointegration with tendency to a thicker wall.(AU)

Radical prostatectomy with Van Velthoven Suture to canine perineal / Prostatectomia radical com sutura de Van Velthoven na herniorrafia perineal de canino

Background: Prostatectomy excision is indicated for patients with neoplasm, trauma or recurrent prostatic abscess; Van Velthoven suture have been used in urethrovesical laparoscopic anastomosis in humans. This report aimed to describe the use of Van Velthoven suture after excisional prostatectomy in a canine, which suffered partial loss and deformation of the urinary bladder after complications of perineal hernia.Case: A thirteen-year-old male dog presented dyschezia, hypophagia and had increased water ingestion; furthermore, owner verifi ed a swelling lateral to the anus. On clinical examination it was observed left perineal hernia with incarcerated content, and peritonitis was diagnosed by ultrasonography exam. Antimicrobial and fl uid therapy were initiated, and one day after the patient was referred to surgery. Through perineal access was observed retrofl exed urinary bladder partially necrotic and multiple prostatic cysts; due to great extent of the necrotic urinary bladder, associated with impossibility of complete necrotic bladder tissue removal, prostate and urinary vesicle were placed in the peritoneal cavity. It was proceeded hernia reconstruction using polypropylene mesh and monofi lament nylon suture. Through median celiotomy, the bladder necrotic tissue was removed; due to hemodynamic patient instability, the total prostatectomy that was initiated was postponed, pe

Background: Prostatectomy excision is indicated for patients with neoplasm, trauma or recurrent prostatic abscess; Van Velthoven suture have been used in urethrovesical laparoscopic anastomosis in humans. This report aimed to describe the use of Van Velthoven suture after excisional prostatectomy in a canine, which suffered partial loss and deformation of the urinary bladder after complications of perineal hernia.Case: A thirteen-year-old male dog presented dyschezia, hypophagia and had increased water ingestion; furthermore, owner verifi ed a swelling lateral to the anus. On clinical examination it was observed left perineal hernia with incarcerated content, and peritonitis was diagnosed by ultrasonography exam. Antimicrobial and fl uid therapy were initiated, and one day after the patient was referred to surgery. Through perineal access was observed retrofl exed urinary bladder partially necrotic and multiple prostatic cysts; due to great extent of the necrotic urinary bladder, associated with impossibility of complete necrotic bladder tissue removal, prostate and urinary vesicle were placed in the peritoneal cavity. It was proceeded hernia reconstruction using polypropylene mesh and monofi lament nylon suture. Through median celiotomy, the bladder necrotic tissue was removed; due to hemodynamic patient instability, the total prostatectomy that was initiated was postponed, pe

Prostatectomia radical com sutura de Van Velthoven na herniorrafia perineal de canino / Radical Prostatectomy with Van Velthoven Suture to Canine Perineal Herniorrhaphy

Background: Prostatectomy excision is indicated for patients with neoplasm, trauma or recurrent prostatic abscess; Van Velthoven suture have been used in urethrovesical laparoscopic anastomosis in humans. This report aimed to describe the use of Van Velthoven suture after excisional prostatectomy in a canine, which suffered partial loss and deformation of the urinary bladder after complications of perineal hernia. Case: A thirteen-year-old male dog presented dyschezia, hypophagia and had increased water ingestion; furthermore, owner verified a swelling lateral to the anus. On clinical examination it was observed left perineal hernia with incarcerated content, and peritonitis was diagnosed by ultrasonography exam. Antimicrobial and fluid therapy were initiated, and one day after the patient was referred to surgery. Through perineal access was observed retrofl exed urinary bladder partially necrotic and multiple prostatic cysts; due to great extent of the necrotic urinary bladder, associated with impossibility of complete necrotic bladder tissue removal, prostate and urinary vesicle were placed in the peritoneal cavity. It was proceeded hernia reconstruction using polypropylene mesh and monofilament nylon suture. Through median celiotomy, the bladder necrotic tissue was removed; due to hemodynamic patient instability, the total prostatectomy that was initiated was postponed, performing cystopexy and cystostomy with Foley catheter. The prostatectomy was performed at the 21st day. In that time, prostatic urethra stenosis was observed. After probing urethral repair points in the pelvic urethra and urinary bladder, the prostate was resected and was applied a Van Velthoven suture. Omentalization of the anastomotic site was done before cavity washing with NaCl 0,9%. The abdominal access was closed in three layers. The patient remained probed for six days, and after this bladder compression was initiated. After 21 days of the second operative intervention, it was necessary to correct a perineal hernia in the opposite side; reconstruction was performed by mobilizing obturator internus muscle. Discussion: In many cases of perineal herniation it was observed prostatic hypertrophy and cysts, as observed in our clinical case. After castration, prostate involutes in two or three weeks, and occur clinical signs reliefs. But the patient related shows presence of urethral stricture, helding an excisional prostatectomy. After excision of the prostate, special attention should be given to the anastomosis between urinary bladder and urethra. With the circular Van Velthoven suture was observed low incidence of bladder contraction in humans, condition which could lead to, among other things, urinary incontinence. It was observed easy and speed of execution of the technique as well as obtaining an anastomosis without tension and adequate to anastomosis healing, as well appropriated patient recovery. We concluded that Van Velthoven suture is effective to prostatectomy in dogs and that the perineal hernia may be associated with several complications that could be adequately treated by surgery.

Radical prostatectomy with Van Velthoven Suture to canine perineal / Prostatectomia radical com sutura de Van Velthoven na herniorrafia perineal de canino

Background: Prostatectomy excision is indicated for patients with neoplasm, trauma or recurrent prostatic abscess; Van Velthoven suture have been used in urethrovesical laparoscopic anastomosis in humans. This report aimed to describe the use of Van Velthoven suture after excisional prostatectomy in a canine, which suffered partial loss and deformation of the urinary bladder after complications of perineal hernia.Case: A thirteen-year-old male dog presented dyschezia, hypophagia and had increased water ingestion; furthermore, owner verifi ed a swelling lateral to the anus. On clinical examination it was observed left perineal hernia with incarcerated content, and peritonitis was diagnosed by ultrasonography exam. Antimicrobial and fl uid therapy were initiated, and one day after the patient was referred to surgery. Through perineal access was observed retrofl exed urinary bladder partially necrotic and multiple prostatic cysts; due to great extent of the necrotic urinary bladder, associated with impossibility of complete necrotic bladder tissue removal, prostate and urinary vesicle were placed in the peritoneal cavity. It was proceeded hernia reconstruction using polypropylene mesh and monofi lament nylon suture. Through median celiotomy, the bladder necrotic tissue was removed; due to hemodynamic patient instability, the total prostatectomy that was initiated was postponed, pe

Background: Prostatectomy excision is indicated for patients with neoplasm, trauma or recurrent prostatic abscess; Van Velthoven suture have been used in urethrovesical laparoscopic anastomosis in humans. This report aimed to describe the use of Van Velthoven suture after excisional prostatectomy in a canine, which suffered partial loss and deformation of the urinary bladder after complications of perineal hernia.Case: A thirteen-year-old male dog presented dyschezia, hypophagia and had increased water ingestion; furthermore, owner verifi ed a swelling lateral to the anus. On clinical examination it was observed left perineal hernia with incarcerated content, and peritonitis was diagnosed by ultrasonography exam. Antimicrobial and fl uid therapy were initiated, and one day after the patient was referred to surgery. Through perineal access was observed retrofl exed urinary bladder partially necrotic and multiple prostatic cysts; due to great extent of the necrotic urinary bladder, associated with impossibility of complete necrotic bladder tissue removal, prostate and urinary vesicle were placed in the peritoneal cavity. It was proceeded hernia reconstruction using polypropylene mesh and monofi lament nylon suture. Through median celiotomy, the bladder necrotic tissue was removed; due to hemodynamic patient instability, the total prostatectomy that was initiated was postponed, pe