RESUMO
INTRODUCTION: Continent cutaneous urinary diversion (CCUD) is proposed to patients suffering from chronic neurologic retention and undergoing intermittent self-catheterization (ISC). In case of neurogenic detrusor overactivity (NDO), augmentation enterocystoplasty is often required. The aim was to identify the prevalence of urinary stomal and/or urethral leakage in patients who had not undergone enlargement. METHODS: Monocentric, retrospective study of patients who underwent CCUD surgery in a neuro-urological context. Mitrofanoff's, Monti's or Casale's channels were performed. Patients selected had an underactive, stable, or stabilized bladder under adjuvant therapy with proper cystomanometric capacity. Prior or concomitant enterocystoplasty were excluded. Failure was defined as the occurrence of clinical leakage whatever it is through urinary stomal, or urethral. Urodynamic parameters were also reported. RESULTS: Thirty-one patients underwent surgery. Nine women had a concomitant bladder neck sling and 1 urethral closure. The mean follow-up was 7 years. 8/31 (26%) had stomal leakage and 9 urethral leakage (29%). Five spinal cord injured patients (n=14) had stomal leakage (36%) and 6 urethral leakage (43%). Of the 25 postoperative urodynamic parameters, cystomanometric bladder capacity was 419mL (vs. 514mL) and 2 additional patients had de novo NDO (9 vs. 7). DISCUSSION: The morbidity of augmentation enterocystoplasty is weighed against the presence of a well-controlled bladder preoperatively. Our study shows the appearance of leakage in some patients despite a well-balanced bladder, a decrease in mean cystomanometric capacity and an increase in the rate of NDO postoperatively. Good selection criteria for an isolated CCUD should be carefully revised and defined. LEVEL OF EVIDENCE: Grade C - retrospective study.
Assuntos
Cistostomia , Bexiga Urinaria Neurogênica , Humanos , Estudos Retrospectivos , Feminino , Cistostomia/métodos , Bexiga Urinaria Neurogênica/cirurgia , Bexiga Urinaria Neurogênica/etiologia , Pessoa de Meia-Idade , Adulto , Masculino , Idoso , Urodinâmica , Bexiga Urinária/cirurgia , Bexiga Urinária/fisiopatologia , Resultado do Tratamento , Adulto Jovem , Coletores de Urina/efeitos adversos , Traumatismos da Medula Espinal , Retenção Urinária/etiologia , Retenção Urinária/epidemiologiaRESUMO
INTRODUCTION: Our goal was to determine the rate of complications, early revision and removal after full ambulatory implantation of bulbar AUS in men; secondly, to describe satisfaction and short-term continence rate. MATERIAL AND METHODS: Between April 2018 and April 2019, 28 consecutive patients underwent AUS implantation in a newly organised ambulatory setting. A prospective database of all included patients was established with comprehensive data collected on medical history, aetiology and severity of SUI, surgical procedures, postoperative complications and patient satisfaction. RESULTS: Twenty-eight patients were included (30 consecutive procedures: 22 primary AUS placement, 6 complete revisions, 2 partial revisions), with a mean follow up of 223±220.5 days. Fourteen patients had prior radiotherapy. Readmission rate was 6.7% in the first 30 days after surgery. Both revision and removal rates were 6.7%. Complications were reported in 26.7% of procedures, mainly Clavien-Dindo I. Patient satisfaction of ambulatory surgery organisation and experience was high (87/5% satisfied or very satisfied). Full continence & social continence were achieved for, respectively, 55.6% and 88.9% of procedures. CONCLUSION: Ambulatory placement of AUS is safe and can be performed successfully. Larger patient cohorts and randomised trials are crucial to improve knowledge on non-indications for full ambulatory AUS implantation in men.
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Incontinência Urinária por Estresse , Esfíncter Urinário Artificial , Humanos , Masculino , Esfíncter Urinário Artificial/efeitos adversos , Resultado do Tratamento , Implantação de Prótese/métodos , Estudos de Viabilidade , Incontinência Urinária por Estresse/cirurgia , Estudos RetrospectivosRESUMO
INTRODUCTION: Improved life expectancy and prenatal screening have changed the demographics of spina bifida (spinal dysraphism) which has presently become a disease of adulthood. Urinary disorders affect almost all patients with spinal dysraphism and are still the leading cause of mortality in these patients. The aim of this work was to establish recommendations for urological management that take into account the specificities of the spina bifida population. MATERIALS AND METHODS: National Diagnosis and Management Guidelines (PNDS) were drafted within the framework of the French Rare Diseases Plan at the initiative of the Centre de Référence Maladies Rares Spina Bifida - Dysraphismes of Rennes University Hospital. It is a collaborative work involving experts from different specialties, mainly urologists and rehabilitation physicians. We conducted a systematic search of the literature in French and English in the various fields covered by these recommendations in the MEDLINE database. In accordance with the methodology recommended by the authorities (Guide_methodologique_pnds.pdf, 2006), proposed recommendations were drafted on the basis of this literature review and then submitted to a review group until a consensus was reached. RESULTS: Bladder dysfunctions induced by spinal dysraphism are multiple and varied and evolve over time. Management must be individually adapted and take into account all the patient's problems, and is therefore necessarily multi-disciplinary. Self-catheterisation is the appropriate micturition method for more than half of the patients and must sometimes be combined with treatments aimed at suppressing any neurogenic detrusor overactivity (NDO) or compliance alteration (anticholinergics, intra-detrusor botulinum toxin). Resort to surgery is sometimes necessary either after failure of non-invasive treatments (e.g. bladder augmentation in case of NDO resistant to pharmacological treatment), or as a first line treatment in the absence of other non-invasive alternatives (e.g. aponeurotic suburethral tape or artificial urinary sphincter for sphincter insufficiency; urinary diversion by ileal conduit if self-catheterisation is impossible). CONCLUSION: Spinal dysraphism is a complex pathology with multiple neurological, orthopedic, gastrointestinal and urological involvement. The management of bladder and bowel dysfunctions must continue throughout the life of these patients and must be integrated into a multidisciplinary context.
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Disrafismo Espinal , Bexiga Urinaria Neurogênica , Bexiga Urinária Hiperativa , Gravidez , Feminino , Humanos , Adulto , Bexiga Urinaria Neurogênica/etiologia , Disrafismo Espinal/complicações , Bexiga Urinária , Bexiga Urinária Hiperativa/etiologia , Procedimentos Cirúrgicos Urológicos/efeitos adversosRESUMO
OBJECTIVE: To perform a narrative review of the contemporary literature on the diagnosis, prognosis and adjuvant management of muscle-invasive bladder cancer (MIBC) patients with pathological pelvic lymph node involvement (pN+) at radical cystectomy. METHOD: A narrative review of the contemporary literature available on Medline was conducted to report studies evaluating the diagnosis, prognosis and/or adjuvant treatments for MIBC patients with pN+ disease at radical cystectomy. RESULTS: Open or robotic extended pelvic lymph node dissection up to the crossing of the ureter with common iliac vessels can enhance the diagnosis of pN+ MIBC, especially using separate packages for the submission of a maximum number of lymph nodes. The main prognosis factors for pN+ patients are the number of positive and retrieved lymph nodes, lymph node density, extranodal extension as well as lymph node metastasis diameter. Adjuvant chemotherapy is likely to prolong overall survival in pN+ patients treated with radical cystectomy alone while adjuvant immunotherapy using nivolumab has been shown to decrease the risk of recurrence in all pN+ patients, especially those with ypN+ disease after neoadjuvant chemotherapy followed by radical cystectomy. However, few data are currently available on the role of adjuvant radiation therapy, which remains currently experimental for these patients. CONCLUSION: Multiple parameters have been reported to impact the diagnosis and prognosis of patients with pN+ MIBC at radical cystectomy. Adjuvant management is currently based on chemotherapy and immunotherapy with preliminary data on radiation therapy.
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Cistectomia , Neoplasias da Bexiga Urinária , Humanos , Neoplasias da Bexiga Urinária/patologia , Bexiga Urinária/patologia , Linfonodos/patologia , Prognóstico , Excisão de Linfonodo , Músculos/patologia , Estudos Retrospectivos , Estadiamento de NeoplasiasRESUMO
PURPOSE: In this study, we aimed at evaluating the long-term adjustable peri-urethral balloons (PUB) durability in both male and female with neurogenic or non-neurogenic stress urinary incontinence. MATERIAL AND METHODS: Each consecutive patient who underwent surgery for PUB placement before 2008 was included in this study. A PUB was proposed for patients with refractory to perineal reeducation stress urinary incontinence (SUI) caused by intrinsic sphincter deficiency. There were no exclusion criteria. Demographic, clinical and perioperative data were collected retrospectively from our clinical follow-up notes. RESULTS: A total of 177 patients were included in the study. Median [IQR] follow-up was 5 years [1.8-11.2]. The 3 main causes of SUI were radical prostatectomy (n=82, 46.3%), idiopathic intrinsic sphincter deficiency (n=55, 31.1%) and neurogenic sphincter deficiency (n=32, 18.1%). Complete continence (no pad necessary) was achieved for 109 patients (61.6%). At the end of the follow-up, the PUB global survival rate was 47.5% (Fig. 1). Median [IQR] PUB survival without removal was 57.8 months [42.3-81.7]. PUB survival without failure rate was 68.4% accounting for a median [IQR] survival duration of 116.9 months [86.2-176.9] CONCLUSION: In this study, we evidenced acceptable long-term efficiency and survival of PUB in the management of SUI in both neurogenic and non-neurogenic population. Given those results it could be a good alternative to AUS on unfit or unwilling population.
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Doenças Uretrais , Incontinência Urinária por Estresse , Esfíncter Urinário Artificial , Humanos , Masculino , Feminino , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária por Estresse/cirurgia , Resultado do Tratamento , Estudos Retrospectivos , Próteses e Implantes/efeitos adversos , Prostatectomia/efeitos adversos , Doenças Uretrais/complicações , Esfíncter Urinário Artificial/efeitos adversosRESUMO
PURPOSE: This study aimed to determine the long-term effectiveness of augmentation ileocystoplasty (AI) associated with supra-trigonal cystectomy on clinical and urodynamic variables, and the safety of the intervention in individuals with spinal cord injury (SCI). MATERIALS AND METHODS: Single-center, retrospective study of all patients with SCI who underwent AI with supra-trigonal cystectomy from January 1994, with a follow-up of more than 8 years. The primary outcome was the sustained long-term effectiveness of AI with supra-trigonal cystectomy on clinical and urodynamic variables. The secondary outcome was the long-term safety of this procedure. RESULTS: We included 77 patients: 57% were female, mean (SD) age was 52.0 (13.0) years, 77% had paraplegia, and median time since onset was 25.0 [19; 30] years. Long-term success rate (evaluated 13 [10; 15] years post AI) was 93.5% for urodynamic parameters and 76.6% for urinary incontinence. Results of the short- and long-term post-AI assessments did not differ for any urodynamic or clinical variables. Bladder lithiasis occurred in 20.5% of cases and ≥ 1 febrile urinary tract infection occurred in 55.8%, mostly within the first 2 years of follow-up. No cases of bladder cancer were diagnosed. CONCLUSION: AI associated with supra-trigonal cystectomy in patients with SCI is safe and effective in both the short term and long term. Regular urodynamic assessment is not necessary in clinically stable patients with low bladder risk; however, close monitoring is important because of the risk of urological complications.
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Traumatismos da Medula Espinal , Bexiga Urinaria Neurogênica , Cistectomia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/cirurgia , Resultado do Tratamento , Bexiga Urinária/cirurgia , Bexiga Urinaria Neurogênica/diagnóstico , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinaria Neurogênica/cirurgia , UrodinâmicaRESUMO
PURPOSE: Management of pregnancy and delivery in women with lower urinary tract reconstruction is challenging and the currently available literature is insufficient to guide clinical practice. We report pregnancy and delivery outcomes in this specific population. MATERIALS AND METHODS: We conducted a national multicenter retrospective study (16 centers) including 68 women with 96 deliveries between 1998 and 2019. These women had at least 1 successful pregnancy and delivery after augmentation enterocystoplasty, catheterizable channel creation and/or artificial urinary sphincter implantation. Maternal and fetal complications during pregnancy and delivery were reported, as well as postpartum functional outcomes, according to the delivery mode. The chi-square test and Student's t-test were used to compare categorical and continuous variables, respectively. RESULTS: Overall 32% of reported pregnancies were complicated by febrile urinary tract infections, 13.5% by renal colic and 14.6% required upper urinary tract diversion. In addition, 10% of patients reported transient self-catheterization difficulties and 13.5% reported de novo or increased urinary incontinence. The preterm delivery rate was 35.3%. Elective C-section was performed in 61% of pregnancies. Twenty complications occurred during delivery (20%), including 19 during elective C-section. Urinary continence at 1 year was unchanged for 93.5% of deliveries. Delivery mode (p=0.293) and multiparity (p=0.572) had no impact on urinary continence. CONCLUSIONS: In this population C-section appeared to be associated with a high risk of complications. In the absence of any obstetric or neurological contraindications, vaginal delivery should be proposed as the first line option to the majority of these women.
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Cesárea/efeitos adversos , Procedimentos de Cirurgia Plástica/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Adolescente , Adulto , Cesárea/estatística & dados numéricos , Feminino , França/epidemiologia , Humanos , Esclerose Múltipla/cirurgia , Complicações Pós-Operatórias/etiologia , Gravidez , Complicações na Gravidez/etiologia , Complicações na Gravidez/cirurgia , Nascimento Prematuro/etiologia , Cólica Renal/epidemiologia , Cólica Renal/etiologia , Estudos Retrospectivos , Traumatismos da Medula Espinal/cirurgia , Disrafismo Espinal/cirurgia , Bexiga Urinária/anormalidades , Bexiga Urinária/cirurgia , Derivação Urinária/estatística & dados numéricos , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologia , Esfíncter Urinário Artificial/efeitos adversos , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Adulto JovemRESUMO
INTRODUCTION: As a result of the COVID-19 pandemic in France, all non-emergency surgical activity has been cancelled since March 12, 2020. In order to anticipate the reinstatement of delayed interventions, surgical activity reduction analysis is essential. The objective of this study was to evaluate the reduction of urological surgery in adult during the COVID-19 pandemic compared to 2019. MATERIAL: The data regarding urological procedures realized in the 8 academic urological departments of Parisians centres (AP-HP) were compared over two similar periods (14-29 March 2019 and 12-27 March 2020) using the centralized surgical planning software shared by these centres. Procedure title, type of surgery and outpatient ratio were collected. The interventions were sorted into 16 major families of urological interventions. RESULTS: Overall, a 55% decrease was observed concerning urological procedures over the same period between 2019 and 2020 (995 and 444 procedures respectively). Oncology activity and emergencies decreased by 31% and 44%. The number of kidney transplantations decreased from 39 to 3 (-92%). Functional, andrological and genital surgical procedures were the most impacted among the non-oncological procedures (-85%, -81% and -71%, respectively). Approximatively, 1033 hours of surgery have been delayed during this 16-day period. CONCLUSION: Lockdown and postponement of non-urgent scheduled urological procedures decisions has led to a drastic decrease in surgical activity in AP-HP. Isolated kidney transplantation has been stopped (national statement). Urologists must anticipate for lockdown exit in order to catch-up delayed surgeries. LEVEL OF EVIDENCE: 3.
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Infecções por Coronavirus/epidemiologia , Transplante de Rim/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Adulto , COVID-19 , Hospitais/estatística & dados numéricos , Humanos , Pandemias , Paris/epidemiologia , Estudos Retrospectivos , Urologia/estatística & dados numéricosRESUMO
PURPOSE: We report the natural history and prognosis of tumors after augmentation enterocystoplasty, with a molecular analysis using an oncogene panel to search for potential targeted therapies. MATERIALS AND METHODS: This multicenter, nationwide, retrospective study included 16 patients. A panel of 21 clinically relevant oncogenes was tested on archival tumor specimens using next-generation sequencing. Survival rate was the main clinical outcome and sequences were compared to the reference genome for the genetic outcome. RESULTS: Augmentation enterocystoplasties were performed mainly for congenital neurogenic bladder and bladder exstrophy at a median patient age of 17 years (range 4 months to 45 years). Most of the malignancies were diagnosed because of clinical manifestations, with a median latency period of 20 years. Adenocarcinomas were mainly found after gastrocystoplasty, whereas urothelial cell carcinomas were typically found after colocystoplasty. Of the 16 patients 13 were diagnosed at an advanced stage of the disease (positive lymph nodes in 7, distant metastases in 6). The overall 1-year survival rate was 56%. Only 3 patients remained disease-free at a median followup of 70 months. Of the 9 tumors with analyzable DNA 4 were wild-type and 5 harbored missense mutations (KIT-p.Pro573Ser, PDGFRA-p.Glu587Lys, KRAS-p.Gly12Asp, ERBB4p.Arg484Lys, CTNNB1-p.Ser37Phe and p.Ser47Asn). CONCLUSIONS: Malignancy after augmentation enterocystoplasty is diagnosed late with frequent metastases and a very low 1-year survival rate. More than half the tested samples harbored missense mutations in oncogenes accessible to targeted therapies. An international collaboration to enlarge the genetic panel analysis of these tumors may offer new therapeutic hope to patients.
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Oncogenes/genética , Neoplasias da Bexiga Urinária/mortalidade , Bexiga Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adolescente , Adulto , Extrofia Vesical/cirurgia , Carcinoma de Células de Transição/mortalidade , Carcinoma de Células de Transição/patologia , Criança , Análise Mutacional de DNA , Feminino , França , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Masculino , Mutação de Sentido Incorreto , Metástase Neoplásica , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias da Bexiga Urinária/patologia , Bexiga Urinaria Neurogênica/congênito , Bexiga Urinaria Neurogênica/cirurgia , Adulto JovemRESUMO
INTRODUCTION: The aim was to assess the risk of postoperative infections in patients with preoperative polymicrobial urine culture and to provide the urologist with practices to minimise the risk of infection in these clinical situations. METHODS: A systematic literature review was carried. All national and international recommendations have been reviewed. Data collection has been performed from the Cochrane, LILACS and the Medline database. 31 publications were selected for inclusion. RESULTS: Risk of infection in patients without ureteral stents or urinary catheters with previous polymicrobial urine culture is low. In the absence of leukocyturia, the urine sample can be considered as sterile. With ureteral stents or urinary catheters, the colonisation by biofilm ranges from 4 to 100% depending on the duration and ureteral stents or urinary catheters type. Urine culture is positive 24 to 45% of the time when ureteral stents or urinary catheters are known to be colonised. The post-operative risk of infection in endo-urological surgery in a patient with ureteral stents or urinary catheters is estimated around 8 to 11% depending on the type of surgery. A retrospective study reports a postoperative infections rate of 18.5% in photo selective vaporization of the prostate with preoperative polymicrobial urine culture. CONCLUSIONS: Scientific data are limited but for patients without ureteral stents or urinary catheters, in the absence of leukocyturia, the polymicrobial urine culture can be considered as negative. Considering a preoperative polymicrobial urine culture as sterile in patients with colonised ureteral stents or urinary catheters is at risk of neglecting a high risk of postoperative infections or sepsis even in case of perioperative antibiotic prophylaxis. It should not always be considered sterile and therefore, a perioperative antibiotic therapy could be an acceptable option.
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Bacteriúria/terapia , Complicações Pós-Operatórias , Guias de Prática Clínica como Assunto/normas , Infecções Urinárias/epidemiologia , Infecções Urinárias/prevenção & controle , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Antibioticoprofilaxia , Técnicas Bacteriológicas , Bacteriúria/epidemiologia , Bacteriúria/urina , Feminino , França/epidemiologia , Humanos , Masculino , Período Perioperatório , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/urina , Fatores de Risco , Sociedades Médicas/organização & administração , Sociedades Médicas/normas , Urinálise , Procedimentos Cirúrgicos Urológicos/normas , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Urologia/métodos , Urologia/normasRESUMO
OBJECTIVE: The aim of the study was to report the very long-term functional outcomes of artificial urinary sphincter (AUS) in male neurological patients. MATERIAL AND METHODS: Male neurological patients diagnosed with stress urinary incontinence due to sphincter deficiency and undergoing AUS (AMS 800®) implantation between 1985 and 1992 were enrolled. Continence, defined by no pad/condom usage, explantation and revision rates were reported. RESULTS: Fourteen patients with a median age of 27.3 years (IQR: 27.3-40.8) were included: four had a spinal cord injury and ten a spina bifida. Prior continence surgery was reported by 6 patients (42.9 %). Artificial urinary sphincter was implanted in a peribulbar (n=4) or periprostatic position (n=10). Median follow-up was 18.3 years (IQR: 10.1-20.3). At last follow-up, all patients were alive. Three native devices were still in place, eight were revised (four of them were secondarily explanted) and three were explanted due to erosion or infection. The 5-, 10-, 15-, 20-year explantation-free survival rates were respectively 85.7, 62.3, 52.0, 39.0 %. The 5-, 10-, 15-, 20-year revision-free survival rates were respectively 78.6, 42.9, 28.6, 7.1 %. At last follow-up, 50 % patients were continent. CONCLUSION: In the very long run, AUS provided a 50 % continence rate in male neurological patients but the revision rates were important. LEVEL OF EVIDENCE: 4.
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Incontinência Urinária por Estresse/cirurgia , Esfíncter Urinário Artificial , Adulto , Humanos , Masculino , Desenho de Prótese , Estudos Retrospectivos , Doenças da Medula Espinal/complicações , Traumatismos da Medula Espinal/complicações , Fatores de Tempo , Resultado do Tratamento , Incontinência Urinária por Estresse/etiologia , Procedimentos Cirúrgicos Urológicos Masculinos/métodosRESUMO
INTRODUCTION: Among available urinary diversion, continent cutaneous urinary diversion (CCUD) is not frequently used after cystectomy for malignancy. The aim of our work was to assess mid-term oncological and functional outcomes of CCUD in case of malignancies. PATIENTS AND METHODS: We retrospectively included all patients who underwent CCUD after radical cystectomy for cancer (according Mitrofanoff or Monti's principle) between July 2001 and November 2015 in our department. Perioperative data, oncological and functional outcomes were reported. To measure disease specific quality of life, we used the French version of Bladder Cancer Index. RESULTS: Overall 12 patients were involved in the study. With a median follow-up of 32 months, we noticed one death due to cancer recurrence. Early postoperative complications occurred in 8 patients, with one requiring reoperation. The late postoperative complication rate was 66%, whose 4 patients (33%) presented cutaneous stenosis. Overall satisfaction rate was scored 8.9/10 and body image was preserved for 75% of patients. At last follow-up, continence (no urinary leakage) was achieved for 62.5% of patient. Sexual impairment was significant for 5 patients. CONCLUSION: The CCUD is a valid alternative to other urinary diversions with similar oncological results and with a similar rate of complications. The high satisfaction rate was related to the preservation of body image and the high rate of continence. LEVEL OF EVIDENCE: 5.
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Cistectomia , Neoplasias da Bexiga Urinária/cirurgia , Coletores de Urina , Adulto , Idoso , Procedimentos Cirúrgicos Dermatológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Derivação Urinária/métodosRESUMO
OBJECTIVES: Vesico-ureteral reimplantations (VUR) for adults are complex procedures, often practicing for distal ureteral lesions. Our goal was to synthesis the main indications for VUR, different techniques and their functional outcomes. MATERIAL AND METHODS: A literature review in English by Medline, Embase and Google scholar was performed using the following keywords: ureter; laparoscopy; robotics, reimplantation; surgery; obstruction; morbidity; complications; psoas hitch; Boari flap; ureteroneocystostomy. RESULTS: In more than half of the cases, aetiology was a iatrogenic ureteral lesion. When the ureteral defect was less than 2 cm, direct or non-refluxing VUR was the technique of choice. If defect was superior than 2 cm the Boari flap or vesicopsoas hitch were preferred. Several surgical approaches were feasible: open, laparoscopic only, robot assisted laparoscopic. Estimated blood loss, pain and mean hospital stay seemed better with conventional or robotic coelioscopy. Nevertheless, complications, pre-/post-operative renal function and mean operative time seemed similar. The most frequent major complication was the anastomotic urine leakage. CONCLUSIONS: The VUR techniques are well codified now even if it's a rare procedure. Functional outcomes are satisfied according to literature and morbidity is more and more decreasing but the level of evidence of the studies is low.
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Reimplante/métodos , Ureter/cirurgia , Adulto , Humanos , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Ureter/irrigação sanguínea , Doenças Ureterais/cirurgiaRESUMO
OBJECTIVE: To compare the functional outcomes and complication rates following laparoscopic sacrocolpopexy (LS) with those occurring in robot-assisted laparoscopic sacrocolpopexy (RALSCP) in obese women. PATIENTS AND METHODS: A comparative retrospective multicentre study was made, involving 39 obese women (BMI≥30 kg/m2) who underwent LS, and 17 obese women who underwent RASCLP. The operative parameters (length of operation, associated procedures, complication rate and length of hospitalization) and the objective and subjective results were evaluated at 12 months follow-up. RESULTS: The median (IQR) BMI was 30.5 kg/m2 (30-32) in the LS group vs 31.6 kg/m2 (30-34) in the RALSCP group (P=0.402). The anatomical results were comparable in both groups (LS vs RALSCP): post-operative stage of prolapse (POP-Q-ICS): stage 0-1: 34/39 (88%) vs 16/17 (94.1%), P=0.7; stage 2: 4/39 (10%) vs 0/17 (0%), P=0.7; stage 3-4: 1/39 (2%) vs 1/17 (5.9%), P=0.7. The complication rate was similar in both groups (LS vs RALSCP): bladder injury 2.5% (1/39) vs 0% (0/17), P=0.6, laparoconversion 5.1% (2/39) vs 5.9% (1/17), P=0.5. The overall reoperation rate was (LS vs RALSCP): 18% (7/39) vs 5.9% (1/17), P=0.4. CONCLUSION: Laparoscopic sacrocolpopexy and robot-assisted laparoscopic sacrocolpopexy have equal results in obese women. The complication rates and outcomes appear to be similar in both groups of obese women. LEVEL OF EVIDENCE: 3.
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Procedimentos Cirúrgicos em Ginecologia/métodos , Laparoscopia , Obesidade/complicações , Prolapso de Órgão Pélvico/cirurgia , Procedimentos Cirúrgicos Robóticos , Idoso , Conversão para Cirurgia Aberta/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Reoperação/estatística & dados numéricos , Estudos RetrospectivosRESUMO
INTRODUCTION: Botulinum toxin-A detrusor injections are now approved for use (extension of marketing authorization) in the management of refractory idiopathic overactive bladder. The goal of the current study was to study the value and efficacy of this therapy. PATIENTS AND METHODS: A literature review was performed on Medline, Embase and Cochrane databases, using the following keywords: botulinum toxin; overactive bladder syndrome; urinary incontinence; detrusor injection. RESULTS: The recommended first step dose is 50 units of BOTOX(©) (dose selected for tolerance assessment). However, the cure rates for urge incontinence are greater with 100 units. Before proposing an injection, it is recommended to ensure the feasibility and acceptability of self-catheterisation by the patient, because of the risk of urinary retention (6%). The administration of BOTOX(©) comprises an intra-detrusor injection using a cystoscope, performed under local anesthesia. Clinical improvement is generally observed in the first two weeks after the injection. Patients should be considered for reinjection when the clinical effect of the previous injection has diminished, approximately 6-9 months after the first injection. An injection of 100 units may be considered when the clinical benefit of the 50-unit injection is not satisfactory concerning incontinence symptoms. CONCLUSION: Botulinum toxin detrusor injections may be offered to women who develop refractory OAB.
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Toxinas Botulínicas Tipo A/administração & dosagem , Fármacos Neuromusculares/administração & dosagem , Bexiga Urinária Hiperativa/tratamento farmacológico , Adulto , Toxinas Botulínicas Tipo A/farmacologia , Feminino , Humanos , Fármacos Neuromusculares/farmacologiaRESUMO
INTRODUCTION: The aim of the current study was to provide an overview about the surgical and medical management of acquired and congenital penile's curvature. MATERIALS AND METHODS: [corrected] A systematic review of the literature was done from the PubMed database by searching the following keywords alone or in combination: Congenital penile curvature; Congenital penile deviation; Acquired penile curvature; Acquired penile deviation; Peyronie's disease. RESULTS: The treatment of congenital curvature is only surgical. The most common technique is the Nesbit's technique which consists in making elliptical excisions of the tunica albuginea. There are also incison or plication procedures which are efficient as well. Acquired curvature is most of the time represented by the Peyronie's disease or is post-traumatic. Among oral treatments available, the Potaba is the only drug which has proved a significant reduction in penile plaque size. Injections of interferon and nicardipine have also shown their efficacy. Ionotophoresis and extracorporeal shock-wave therapy may be beneficial for penile pain. Other therapies (vacuum, traction devices, topical Verapamil) can be interesting but other studies are necessary to recommend them. Surgical treatment is recommended during the fibrotic phase. The most common technique is also the Nesbit's technique. In case of severe curvature (curve superior to 60°), small penis, major deformations, graft techniques can be used. Moreover, if there is a sexual dysfunction, penile prosthesis is recommended. CONCLUSION: Other studies are necessary to prove the efficacy of most of the drugs already available in the treatment of the penile curvature. It seems to be interesting to combine the different treatments to improve the results of those therapies.
Assuntos
Induração Peniana/terapia , Pênis/anormalidades , Pênis/cirurgia , Anormalidades Congênitas/terapia , Humanos , Masculino , Induração Peniana/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodosRESUMO
OBJECTIVES: Provide guidelines for practical usage of botulinum toxin type A (BoNTA) for refractory idiopathic Overactive Bladder management. PATIENTS AND METHODS: Guidelines using formalized consensus guidelines method. These guidelines have been validated by a group of 13 experts quoting proposals, subsequently reviewed by an independent group of experts. RESULTS: In the case of patients with urinary tract infection, it must be treated and injection postponed. Before proposing an injection, it is recommended to ensure the feasibility and acceptability of self-catheterisation by patient. The injection can be performed after local anesthesia of the bladder and urethra (lidocaine), supplemented where necessary by nitrous oxide inhalation and sometimes under general anesthesia. Injection is performed in the operating room or endoscopy suite. The bladder should not be too filled (increased risk of perforation). Treatment should be applied in 10 to 20 injections of 0.5 to 1mL homogeneously distributed in the bladder at a distance from the urethral orifices. It is not recommended to leave a urinary catheter in place except in cases of severe hematuria. The patient should be monitored until resumption of micturition. After the first injection, an appointment must be scheduled within 3 months (micturition diary, uroflowmetry, measurement of residual urine and urine culture). Performance of self-catheterisation should be questioned in the case of a symptomatic post-void residual and/or a residue>200mL. A new injection may be considered when the clinical benefit of the previous injection diminishes (between 6 and 9 months). A period of three months must elapse between each injection. CONCLUSIONS: Implementation of these guidelines may promote best practice usage of BoNTA with optimal risk/benefit ratio.
Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Fármacos Neuromusculares/uso terapêutico , Bexiga Urinária Hiperativa/tratamento farmacológico , Administração Intravesical , Anestésicos Locais/administração & dosagem , Antibioticoprofilaxia , Anticoagulantes/efeitos adversos , Contraindicações , Cistoscopia , Esquema de Medicação , França , Humanos , Lidocaína/administração & dosagem , Inibidores da Agregação Plaquetária/efeitos adversos , Autocuidado , Cateterismo Urinário , Infecções Urinárias/complicações , Infecções Urinárias/prevenção & controleRESUMO
PURPOSE: To assess functional outcomes obtained after surgical management of post-radiation urinary incontinence after prostate cancer. PATIENTS AND METHOD: A retrospective review of the data from patients treated in our centre between September 2004 and February 2012 by surgery for vesicosphincteric injuries after prostatic external beam radiation therapy was performed. RESULTS: A total of seven men with a median age of 70 years ± 4.1 were included. Mean follow-up was 32.3 months ± 29 (3-86). All patients underwent a partial cystectomy and augmentation enterocystoplasty. The vesicocutaneous fistula rate was 33% occurring within a mean time of 18.5 days ± 2.1 (17-20). The mean length of urinary catheter and hospital stay were respectively 16 days ± 8.4 (12-35) and 18 days ± 7.8 (13-37). Five patients underwent asynchronous insertion of artificial urinary sphincter. The success rate of partial cystectomy and augmentation enterocystoplasty with asynchronous implantation of artificial urinary sphincter to treat post-radiation urinary incontinence was 71.5%. The median time between partial cystectomy and augmentation enterocystoplasty and artificial urinary sphincter implantation was 27.6months ± 26.4 (7-72). CONCLUSION: Surgical management of post-radiation urinary cystitis offers good functional outcomes albeit its morbidity is not negligible. It should be proposed only in expert surgical centres.