Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.143
Filtrar
Mais filtros











Intervalo de ano de publicação
1.
Arch Ital Urol Androl ; 96(1): 12214, 2024 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-38572722

RESUMO

INTRODUCTION AND OBJECTIVES: Artificial urinary sphincter (AUS) is a treatment option for women with stress urinary incontinence (SUI) after failure of previous surgery or as a primary procedure in severe intrinsic sphincter deficiency (ISD). The aim of the study was to assess the long-term efficacy and risk factors for surgical revision and definitive explantation of AUS laparoscopic implantation in female patients. METHODS: A retrospective review of all women submitted to AUS implantation between April 2005 and March 2023 was conducted. The AUS was implanted via transperitoneal laparoscopic approach, by two experienced surgeons. The primary endpoint was postoperative continence. Continence was defined as no leakage and no pad usage or leakage and/or pad usage with no impact on social life and failure as leakage and/or pad usage impacting social life. As secondary outcomes, clinical predictive factors for AUS revision and definitive explantation were evaluated. RESULTS: In the last 18 years, females with a mean age of 68±12 years-old were submitted to laparoscopic implantation of AUS. Early overall complication rate was 16%, but only one case was Clavien-Dindo ≥3. After a median follow-up of 67 months, 22.2% of the patients needed a device revision, the majority due to mechanical device dysfunction. AUS definitive explantation was performed in 16%, mainly due to urethral/vaginal erosion (9.9%) and infection (6.2%). Patients with age ≥70 years and follow-up ≥10 years significantly predisposed for device revision. At the time of the last follow-up, 72% of the patients were keeping the urinary continency. CONCLUSIONS: Laparoscopic AUS implantation in females is an effective treatment for SUI due to ISD. Meanwhile, adequate patient selection, multidisciplinary evaluation and careful expectation management are essential to achieving good results, concerning their significant complication rate.


Assuntos
Laparoscopia , Doenças Uretrais , Incontinência Urinária por Estresse , Esfíncter Urinário Artificial , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Esfíncter Urinário Artificial/efeitos adversos , Resultado do Tratamento , Incontinência Urinária por Estresse/cirurgia , Incontinência Urinária por Estresse/etiologia , Laparoscopia/efeitos adversos , Uretra/cirurgia , Doenças Uretrais/cirurgia , Implantação de Prótese/métodos , Estudos Retrospectivos
2.
Pediatr Surg Int ; 40(1): 104, 2024 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-38600320

RESUMO

OBJECTIVE: Children with congenital anorectal malformation (CAM) experience challenges with defecation. This study aims to assess defecation in preschool-age children with CAM and to evaluate the correlation between pelvic floor muscle developed assessed by magnetic resonance imaging (MRI) and postoperative defecation. METHODS: We collected clinical data and MRI results from 89 male children with CAM. The bowel function scores for children with Perineal (cutaneous) fistula, Rectourethral fistula(Prostatic or Bulbar), and Rectovesical fistula were computed. MRI scans were subjected to image analysis of the striated muscle complex (SMC). The association between pelvic floor muscle score and bowel function score was examined using the Cochran-Armitage Trend Test. RESULTS: We observed that 77.4% of the SMC scores by MRI for Perineal fistula were good. The Rectourethral fistula SMC score was 40.6% for moderate and 59.4% for poor. The SMC score for Rectovesical fistula was 100% for moderate. Furthermore, 77.4% of patients with Perineal fistula had bowel function scores (BFS) ≥ 17 points. Among those with Rectourethral fistula and Rectovesical fistula, 12.5% and 0 had BFS ≥ 17 points, respectively. An analysis of muscle development and bowel function in patients with Rectovesical fistula, Rectourethral fistula, and Perineal fistula revealed a correlation between SMC development and BFS. Subgroup analysis showed that the Perineal fistula had statistical significance; however, the Rectourethral fistula and Rectovesical fistula were not statistically significant. CONCLUSION: A correlation exists between pelvic floor muscle development and postoperative defecation in children with Perineal fistula.


Assuntos
Malformações Anorretais , Fístula Retal , Doenças Uretrais , Fístula da Bexiga Urinária , Fístula Urinária , Criança , Pré-Escolar , Humanos , Masculino , Reto/cirurgia , Defecação , Diafragma da Pelve/diagnóstico por imagem , Diafragma da Pelve/cirurgia , Fístula Retal/cirurgia , Canal Anal/diagnóstico por imagem , Canal Anal/cirurgia , Canal Anal/anormalidades , Fístula Urinária/cirurgia , Doenças Uretrais/cirurgia , Imageamento por Ressonância Magnética
3.
Pediatr Surg Int ; 40(1): 111, 2024 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-38641738

RESUMO

BACKGROUND: Long-term urinary outcomes after anorectal malformation (ARM) repair are affected by surgical approach and sacral anomalies. This study aimed to compare laparoscopic-assisted anorectoplasty (LAARP) and posterior sagittal anorectoplasty (PSARP) in terms of urinary complications. METHODS: Between 2001 and 2022, 45 patients were treated with LAARP or PSARP. The rectourethral fistula and inflow angle between the fistula and rectum was confirmed by preoperative colonography. The incidence of urinary complications and treatment were compared between the two groups. RESULTS: Four patients (14%) had remnant fistula and five patients (17%) had neurogenic bladder dysfunction in LAARP group, while three patients (18%) had urethral injury in PSARP group. All patients with remnant fistula were asymptomatic and followed without treatment. The incidence of remnant fistula improved between earlier decade and later decade. In all cases with urethral injury, suture repair was performed and no postoperative leakage was noted. All five patients with neurogenic bladder dysfunction had spine abnormalities that required clean intermittent catheterization (CIC) and two were free from CIC finally. CONCLUSIONS: It is important to check inflow angle preoperatively to prevent remnant fistula. For PSARP, meticulous dissection is required when separating fistula from urethra because they create common wall. The most contributing factor to neurogenic bladder is sacral anomalies. Preoperative evaluation and postoperative urinary drainage are important.


Assuntos
Malformações Anorretais , Laparoscopia , Fístula Retal , Doenças Uretrais , Bexiga Urinaria Neurogênica , Fístula Urinária , Humanos , Lactente , Reto/cirurgia , Reto/anormalidades , Malformações Anorretais/complicações , Malformações Anorretais/cirurgia , Malformações Anorretais/epidemiologia , Bexiga Urinaria Neurogênica/etiologia , Laparoscopia/efeitos adversos , Resultado do Tratamento , Fístula Retal/cirurgia , Fístula Retal/complicações , Fístula Urinária/etiologia , Fístula Urinária/cirurgia , Doenças Uretrais/etiologia , Doenças Uretrais/cirurgia , Complicações Pós-Operatórias/etiologia , Uretra/cirurgia , Estudos Retrospectivos , Canal Anal/anormalidades
4.
BMJ Case Rep ; 16(11)2023 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-38035679

RESUMO

Skene's gland duct cysts are benign, asymptomatic bulging interlabial masses that are rarely identified in female newborns. The aetiology is unknown, but it is commonly associated with in utero maternal oestrogen exposure or obstruction or stenosis of the gland duct. We report three unrelated cases of neonatal Skene's gland duct cysts that resolved spontaneously without the need for surgical intervention.


Assuntos
Cistos , Neoplasias Cutâneas , Doenças Uretrais , Humanos , Recém-Nascido , Feminino , Doenças Uretrais/cirurgia , Cistos/diagnóstico por imagem , Cistos/cirurgia
5.
Medicine (Baltimore) ; 102(46): e35825, 2023 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-37986398

RESUMO

Due to the controversy on the feasibility of laparoscopic-assisted anorectoplasty (LAARP) for the treatment of the anorectal malformation (ARM) with rectobulbar fistula (RBF), this study aimed to compare the outcomes of LAARP and posterior sagittal anorectoplasty (PSARP) for ARM with RBF. Demographic data, postoperative complications, and bowel function of RBF patients who underwent LAARP and PSARP at 2 medical centers from 2016-2018 were retrospectively reviewed. Eighty-eight children with RBF were enrolled, including 43 in the LAARP group and 45 in the PSARP group. There were no significant differences in the sacral ratio (P = .222) or sacral agenesis (P = .374). Thirty-seven and 38 patients in the LAARP and PSARP groups were followed up for a median of 4.14 years. The postoperative complications were comparable between the groups (P = .624), with no cases of urethral diverticulum. The urination of all cases was normal and no evidence of cyst formation was found on MCU or MRI during the follow-up period. The incidence of rectal prolapse was similar between the 2 groups (9.3% vs 17.8%, P = .247). The groups had equivalent Bowel Function Score (15.29 ± 2.36 vs 15.58 ± 2.88, P = .645), but the LAARP group had better voluntary bowel movement (94.6% vs 84.2%, P = .148) by Krickenbeck classification. The intermediate-term outcomes of LAARP show that the urethral diverticulum was rare by the intraluminal incision of the fistular and the bowel function was comparable to that of PSARP in ARM with rectobulbar fistula. However, LAARP was associated with smaller perineal wounds.


Assuntos
Malformações Anorretais , Divertículo , Laparoscopia , Fístula Retal , Doenças Uretrais , Criança , Humanos , Lactente , Malformações Anorretais/cirurgia , Estudos Retrospectivos , Reto/anormalidades , Laparoscopia/efeitos adversos , Fístula Retal/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Doenças Uretrais/cirurgia , Divertículo/cirurgia , Canal Anal/anormalidades , Resultado do Tratamento
6.
Urol Int ; 107(10-12): 988-994, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37903477

RESUMO

Rectourethral fistula (RUF) is an infrequent but severe complication of the treatment of prostate cancer. Herein, we describe a new surgical approach used successfully in 3 patients that incorporates a partially de-epithelialized mid-perineal scrotal flap (MPSF), used as interposition flap, that can be used in almost every patient with RUF after radiotherapy, regardless of having or not a concomitant posterior urethra or bladder neck stricture or contracture that might require a simultaneous urethroplasty. The interposition flap includes well vascularized subcutaneous fat tissue by distal vascular branches of the internal pudendal vessels that reaches without tension the deep perineum up to the posterior bladder neck. The MPSF is a time efficient procedure that allows excellent access to the bulbar urethra and to the surgical plane between rectum and prostate and it does not require a separate incision for the flap harvesting procedure when required.


Assuntos
Fístula Retal , Doenças Uretrais , Fístula Urinária , Masculino , Humanos , Períneo/cirurgia , Seguimentos , Retalhos Cirúrgicos , Fístula Retal/cirurgia , Fístula Retal/etiologia , Doenças Uretrais/cirurgia , Doenças Uretrais/etiologia , Fístula Urinária/etiologia , Fístula Urinária/cirurgia
7.
BMJ Case Rep ; 16(10)2023 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-37907309

RESUMO

Literature on the management of pelvic fracture urethral injuries (PFUI) in women is scarce. We present a case of PFUI in a woman.A woman in her 50s presented with lower abdominal pain, bleeding per vaginum and inability to void following road traffic accident. Local examination showed mid-urethral transection injury and tear over the left anterolateral aspect of the vagina. Foley's catheter bulb and bony fragments of the fractured pelvis were palpable anteriorly. Imaging revealed bilateral superior and inferior rami fractures with pubic bone diastasis. She underwent external fixation of pelvic bones with primary repair of urethral and vaginal mucosal injury.Intraoperatively external pelvic fixator was applied, following which the bony fragments in the vagina were lifted up (due to the realignment of pelvic bones). Mid-urethral transection injury was repaired using end-to-end anastomotic urethroplasty. Per-urethral catheter and suprapubic catheter were placed. Periurethral tissue and vaginal layers were closed over the urethral repair. The postoperative course was uneventful.External pelvic fixator was removed after 6 weeks of surgery. Micturating cystogram showed no evidence of contrast extravasation. Follow-up at 3 months showed no urinary symptoms with a bell-shaped uroflowmetry curve.


Assuntos
Fraturas Ósseas , Ossos Pélvicos , Doenças Uretrais , Feminino , Humanos , Fraturas Ósseas/complicações , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Ossos Pélvicos/lesões , Estudos Retrospectivos , Resultado do Tratamento , Uretra/diagnóstico por imagem , Uretra/cirurgia , Uretra/lesões , Doenças Uretrais/cirurgia , Pessoa de Meia-Idade
8.
BMC Pediatr ; 23(1): 445, 2023 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-37679663

RESUMO

BACKGROUND: Posterior urethral valve (PUV) is the most common congenital bladder outlet obstruction in boys, causing renal damage beginning in utero. There are scarce data from Thailand regarding the long-term outcomes of PUV in boys, thus the aim of this study was to examine the presentation, clinical course, complications, outcomes and renal survival in PUV boys. METHODS: We reviewed the medical records of PUV boys treated at the Pediatric Nephrology Clinic, Prince of Songkla University, Thailand, over a 30-year-period. RESULTS: Seventy-seven PUV boys were identified, with a median age at diagnosis of 4.8 months. The most common presentations were urinary tract infection (UTI), poor urine stream and urinary dribbling in 26 (33.8%), 19 (24.7%) and 11 (14.3%) boys, respectively. Renal ultrasound results in 70 boys showed 8 (11.4%) unilateral and 56 (80%) bilateral hydronephroses. Of 72 voiding cystourethrograms, 18 (25.0%) showed unilateral and 22 (30.6%) bilateral vesicoureteral refluxes. 99mTc dimercaptosuccinic acid renal scans in 30 boys showed 12 (40%) unilateral and 8 (26.7%) bilateral renal damage. Fifty-nine (76.6%) boys had 149 UTIs; 42 (54.4%) had recurrent UTI. Forty-eight boys had valve ablation at the median age of 30.3 months. 22 boys (28.6%) developed chronic kidney disease (CKD) at a median age of 15.0 years. CONCLUSION: Of 77 PUV Thai boys, UTI was the most common presentation. Recurrence of UTI and CKD was the most common consequence. Lifelong follow-up for renal and bladder functions is essential for all PUV patients.


Assuntos
Insuficiência Renal Crônica , População do Sudeste Asiático , Uretra , Doenças Uretrais , Obstrução do Colo da Bexiga Urinária , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Instituições de Assistência Ambulatorial , Rim , Insuficiência Renal Crônica/etiologia , Tailândia/epidemiologia , Uretra/anormalidades , Uretra/cirurgia , Obstrução do Colo da Bexiga Urinária/congênito , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/cirurgia , Doenças Uretrais/complicações , Doenças Uretrais/congênito , Doenças Uretrais/cirurgia , Recém-Nascido
9.
Curr Opin Obstet Gynecol ; 35(6): 517-524, 2023 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-37678190

RESUMO

PURPOSE OF REVIEW: Female periurethral masses are an uncommon occurrence. The purpose of this review is to describe etiologies of female urethral and periurethral masses and to provide an update on diagnosis and management. RECENT FINDINGS: The most common causes of periurethral and urethral masses in women are urethral caruncles, urethral diverticula, and Skene's gland cysts. Urethral meatal lesions such as urethral caruncles and prolapse can be managed conservatively with topical estrogen therapy and close follow-up or should be excised in the setting of thrombosis, significant or recurrent bleeding, acute urinary retention, or persistent pain. Benign periurethral gland masses, such as Skene's gland cysts, Gartner's duct cysts, and Mullerian duct cysts, remain rare. Recent case series reveal a high rate of surgical management of these lesions with few complications. Urethral malignancy or malignant transformation of benign etiologies are even rarer but can be aggressive in nature and should be treated promptly. SUMMARY: Nonspecific urinary and vaginal symptoms as well as similar physical presentations make diagnosis of urethral and periurethral lesions in females difficult. Magnetic resonance imaging is useful for differentiation of periurethral masses. The decision for conservative or surgical management is typically guided by patient symptom bother, as well as concern for urethral malignancy.


Assuntos
Cistos , Doenças Uretrais , Neoplasias Uretrais , Feminino , Humanos , Neoplasias Uretrais/diagnóstico , Neoplasias Uretrais/terapia , Uretra/cirurgia , Doenças Uretrais/diagnóstico , Doenças Uretrais/cirurgia , Imageamento por Ressonância Magnética/métodos , Cistos/diagnóstico , Cistos/cirurgia
10.
Int J Urol ; 30(11): 1020-1027, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37496371

RESUMO

OBJECTIVES: This study aimed to investigate the characteristics of patients who report improvement in quality of life (QOL) related to urinary status after undergoing robot-assisted radical prostatectomy (RARP) for localized prostate cancer. METHODS: We retrospectively reviewed the patients who underwent RARP between May 2010 and May 2021 at our institution and were preoperatively unsatisfied with their urinary status. Patients were grouped as Group 1 (improved patients: "satisfied" with urinary status based on international prostate symptom score QOL [IPSS-QOL] = 0-2 at 12 months after RARP) and Group 2 (unimproved group: "unsatisfied"-IPSS-QOL 3-6). Additionally, the Expanded Prostate Cancer Index Composite (EPIC) urinary subdomains (urinary function, urinary bother [UB], urinary incontinence, and urinary irritation/obstruction [UIR]) and IPSS were evaluated preoperatively and till 12 months after RARP. RESULTS: Of the 237 patients, 72 (30.4%) were Group 1, and 165 (69.6%) were Group 2. Only UB and UIR improved at 12 months after RARP in Group 1, while other EPIC urinary subdomains remained unimproved at 12 months in both groups. On the other hand, IPSS improved at 12 months in both groups. Univariate and multivariate analysis revealed that the nerve-sparing, preoperative low IPSS (<11 vs. ≥11), and low IPSS-QOL (3 vs. 4-6) were associated with improvement in urinary status-related QOL (p < 0.05). CONCLUSIONS: Improvement in UB and UIR are important factors to ascertain improvement in urinary status-related QOL after RARP. Nerve-sparing and preoperative IPSS/IPSS-QOL values are useful predictors of this improvement.


Assuntos
Neoplasias da Próstata , Procedimentos Cirúrgicos Robóticos , Robótica , Doenças Uretrais , Masculino , Humanos , Qualidade de Vida , Estudos Retrospectivos , Próstata , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Prostatectomia/efeitos adversos , Neoplasias da Próstata/cirurgia , Doenças Uretrais/cirurgia
11.
Asian J Endosc Surg ; 16(4): 814-818, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37421167

RESUMO

INTRODUCTION: A rectourethral fistula (RUF) is an infrequent complication that can be iatrogenic in most cases. Multiple surgical interventions were described for RUF repair including transsphincteric, transanal, transperineal, and transabdominal approaches. To this day, there is no consensus on a standardized surgery of choice for acquired RUF. MATERIALS AND SURGICAL TECHNIQUE: Our patient was diagnosed with RUF 4 weeks after undergoing laparoscopic low anterior resection for midrectum adenocarcinoma, with failure of conservative treatment. A three-port transabdominal approach was used to dissect the rectoprostatic space and close the fistula orifice on the anterior rectal wall. With the technical impossibility to develop an omental flap, the peritoneum on the posterior vesical wall was carefully dissected to form a rectangular flap pedicled by its inferior aspect. The harvested peritoneal flap was then anchored between the prostate and the rectum. Follow-up imaging showed the absence of RUF, concurrently with total remission of RUF symptomatology. DISCUSSION: Management of acquired RUF can be challenging, especially after failure of conservative treatment. Laparoscopic repair of acquired RUF by vesical peritoneal flap is a valid option for a minimally invasive approach for the treatment of RUF.


Assuntos
Laparoscopia , Fístula Retal , Doenças Uretrais , Fístula Urinária , Masculino , Humanos , Peritônio/cirurgia , Fístula Urinária/cirurgia , Fístula Urinária/complicações , Laparoscopia/métodos , Fístula Retal/etiologia , Fístula Retal/cirurgia , Retalhos Cirúrgicos , Doenças Uretrais/complicações , Doenças Uretrais/cirurgia
12.
Can Vet J ; 64(6): 541-544, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-37265811

RESUMO

A 10-month-old unilaterally cryptorchid male labradoodle dog was presented to a specialty surgery referral center with a reported history of persistent anal sac leakage that was unresponsive to conservative management. The dog underwent castration and left anal sacculectomy but was witnessed urinating from the anus postoperatively. A contrast urethrogram was performed, and a urethrorectal fistula located between the distal portion of the pelvic urethra and the caudal aspect of the rectum was diagnosed. One week later, the dog underwent ligation and transection of the fistula. Surgery was successful and the dog recovered unremarkably with complete resolution of clinical signs. A contrast urethrogram 1 mo after surgery confirmed the successful ligation and transection of the fistula. Key clinical message: To the authors' knowledge, this is the first clinical report of urethrorectal fistula ligation and transection in a dog with unilateral abdominal cryptorchidism and misdiagnosed anal sac disease. Our findings underscore the importance of a thorough physical examination, history taking, and clinical workup for appropriate diagnosis and treatment of multiple congenital abnormalities.


Ligature et transection de la fistule urétrorectale chez un chien ayant des antécédents de cryptorchidie abdominale unilatérale et de maladie des glandes anales mal diagnostiquée. Un chien Labradoodle mâle unilatéralement cryptorchide âgé de 10 mois a été présenté à un centre de référence en chirurgie spécialisée avec des antécédents signalés de fuite persistante du sac anal qui ne répondait pas à une prise en charge conservatrice. Le chien a subi une castration et une sacculectomie anale gauche, mais a été vu en train d'uriner par l'anus après l'opération. Un urétrogramme de contraste a été réalisé et une fistule urétrorectale située entre la partie distale de l'urètre pelvien et la face caudale du rectum a été diagnostiquée. Une semaine plus tard, le chien a subi une ligature et une section de la fistule. La chirurgie a été un succès et le chien s'est rétabli sans particularité avec une résolution complète des signes cliniques. Un urétrogramme de contraste 1 mois après la chirurgie a confirmé la réussite de la ligature et de la section de la fistule.Message clinique clé :À la connaissance des auteurs, il s'agit du premier rapport clinique de ligature et de transection de fistule urétrorectale chez un chien atteint de cryptorchidie abdominale unilatérale et d'une maladie du sac anal mal diagnostiquée. Nos résultats soulignent l'importance d'un examen physique approfondi, d'une anamnèse et d'un bilan clinique pour un diagnostic et un traitement appropriés des anomalies congénitales multiples.(Traduit par Dr Serge Messier).


Assuntos
Criptorquidismo , Doenças do Cão , Fístula Retal , Doenças Uretrais , Fístula Urinária , Masculino , Cães , Animais , Canal Anal , Criptorquidismo/diagnóstico , Criptorquidismo/cirurgia , Criptorquidismo/veterinária , Fístula Retal/congênito , Fístula Retal/cirurgia , Fístula Retal/veterinária , Fístula Urinária/diagnóstico , Fístula Urinária/cirurgia , Fístula Urinária/veterinária , Doenças Uretrais/diagnóstico , Doenças Uretrais/cirurgia , Doenças Uretrais/veterinária , Erros de Diagnóstico , Doenças do Cão/diagnóstico por imagem , Doenças do Cão/cirurgia
14.
J Pediatr Surg ; 58(8): 1588-1593, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37173214

RESUMO

BACKGROUND: The incidence and optimal management of rectal prolapse following repair of an anorectal malformation (ARM) has not been well-defined. METHODS: A retrospective cohort study was performed utilizing data from the Pediatric Colorectal and Pelvic Learning Consortium registry. All children with a history of ARM repair were included. Our primary outcome was rectal prolapse. Secondary outcomes included operative management of prolapse and anoplasty stricture following operative management of prolapse. Univariate analyses were performed to identify patient factors associated with our primary and secondary outcomes. A multivariable logistic regression was developed to assess the association between laparoscopic ARM repair and rectal prolapse. RESULTS: A total of 1140 patients met inclusion criteria; 163 (14.3%) developed rectal prolapse. On univariate analysis, prolapse was significantly associated with male sex, sacral abnormalities, ARM type, ARM complexity, and laparoscopic ARM repairs (p < 0.001). ARM types with the highest rates of prolapse included rectourethral-prostatic fistula (29.2%), rectovesical/bladder neck fistula (28.8%), and cloaca (25.0%). Of those who developed prolapse, 110 (67.5%) underwent operative management. Anoplasty strictures developed in 27 (24.5%) patients after prolapse repair. After controlling for ARM type and hospital, laparoscopic ARM repair was not significantly associated with prolapse (adjusted odds ratio (95% CI): 1.50 (0.84, 2.66), p = 0.17). CONCLUSION: Rectal prolapse develops in a significant subset of patients following ARM repair. Risk factors for prolapse include male sex, complex ARM type, and sacral abnormalities. Further research investigating the indications for operative management of prolapse and operative techniques for prolapse repair are needed to define optimal treatment. TYPE OF STUDY: Retrospective cohort study. LEVEL OF EVIDENCE: II.


Assuntos
Malformações Anorretais , Fístula Retal , Prolapso Retal , Doenças Uretrais , Fístula Urinária , Criança , Humanos , Masculino , Malformações Anorretais/epidemiologia , Malformações Anorretais/etiologia , Malformações Anorretais/cirurgia , Prolapso Retal/epidemiologia , Prolapso Retal/etiologia , Prolapso Retal/cirurgia , Estudos Retrospectivos , Incidência , Fístula Retal/cirurgia , Fístula Urinária/cirurgia , Doenças Uretrais/cirurgia , Fatores de Risco , Reto/cirurgia , Reto/anormalidades
15.
Urogynecology (Phila) ; 29(6): 552-557, 2023 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-37235804

RESUMO

IMPORTANCE: Urethral diverticulectomy is performed with or without concomitant pubovaginal sling (PVS). Patients with complex UD are more frequently offered concomitant PVS. However, there is paucity of literature comparing postoperative incontinence rates for patients with simple versus complex UD. OBJECTIVE: The objective of this study is to examine postoperative stress urinary incontinence (SUI) rates after Urethral Diverticulectomy without concomitant PVS for both complex and simple cases. STUDY DESIGN: A retrospective cohort study was conducted among 55 patients who underwent Urethral Diverticulectomy from 2007 to 2021. Preoperative SUI was patient-reported and confirmed with cough stress test result. Complex cases were defined as circumferential or horseshoe configurations, prior diverticulectomy, and/or anti-incontinence procedure. Primary outcome was postoperative SUI. Secondary outcome was interval PVS. Complex and simple cases were compared using the Fisher exact test. RESULTS: Median age was 49 years (interquartile range, 36-58 years). Median follow-up was 5.4 months (IQR, 2-24 months). Thirty of 55 (55%) cases were simple, and 25 of 55 (45%) complex. Preoperative SUI was present in 19/57 (35%) (11 complex vs 8 simple, P = 0.25). Stress urinary incontinence persisted postoperatively in 10 of 19 (52%) (6 complex vs 4 simple, P = 0.48). De novo SUI occurred in 7 of 55, 12% (4 complex vs 3 simple, P = 0.68). Overall, 17 of 55 (31%) patients had postoperative SUI (10 complex vs 7 simple, P = 0.24). Of those, 8 of 17 underwent subsequent PVS placement (P = 0.71) and 9 of 17 had resolution of pad use after physical therapy (P = 0.27). CONCLUSIONS: We did not find evidence of an association between complexity and postoperative SUI. Age at surgery and preoperative frequency were the strongest predictors of postoperative SUI in this cohort. Our findings suggest successful complex urethral diverticulum repair does not require concomitant PVS.


Assuntos
Divertículo , Doenças Uretrais , Incontinência Urinária por Estresse , Incontinência Urinária , Humanos , Pessoa de Meia-Idade , Incontinência Urinária por Estresse/cirurgia , Estudos Retrospectivos , Uretra/cirurgia , Doenças Uretrais/cirurgia , Incontinência Urinária/complicações , Complicações Pós-Operatórias/etiologia , Divertículo/cirurgia
16.
Urology ; 176: 248, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36963669

RESUMO

OBJECTIVE: To demonstrate a modified approach to the Spence-Duckett procedure for treatment of a distal urethral diverticulum. A urethral diverticulum is an outpouching of urethral mucosa occurring in 2-5% of the population.1 They are thought to commonly arise due to chronic inflammation or infection of the peri-urethral glands.2,3 MATERIALS AND METHODS: We present a 37-year-old female with vaginal bulge, dyspareunia, and dysuria. On examination, she had a 2-centimeter tender mass abutting the distal urethra. Imaging such as ultrasound or magnetic resonance imaging is critical to map the location of the diverticula along the urethra and extent of urethral involvement as it can inform surgical technique. Diverticula are typically located postero-laterally at the mid- or distal urethra; however, they can be found at any location along the urethra.2,3 Care must be taken to avoid disruption of the continence mechanism at the mid-urethra to prevent incontinence after surgery. Magnetic resonance imaging revealed a 1.7 × 1.7 × 1.8 centimeter unilocular cystic structure at the left posteromedial distal urethra consistent with a urethral diverticulum. The patient desired surgical management. RESULTS: Spence and Duckett traditionally described insertion of one blade of the Metzenbaum scissors in the urethra with incision into the diverticulum and anterior vaginal wall followed by marsupialization.4 Given the small size of the diverticular ostium identified, we opted to make an incision using a scalpel from the ostium down the posterior aspect of the urethra and proximally to the anterior vaginal wall. We then excised the diverticular sac prior to marsupialization. At 6 weeks after surgery, she had full resolution of her symptoms without development of urinary incontinence. Pathologic examination is important because while rare, cancers can originate from urethral diverticula, with a prevalence of 6-9%.5 Pathology was consistent with urethral diverticulum and negative for dysplasia. CONCLUSION: While effective, the Spence-Duckett technique is described as a "generous meatotomy" with risks of urethral shortening. Our modified approach reduces these risks, resolves bothersome symptomatology, improves cosmesis, and minimizes risk of anatomic or functional urethral compromise.


Assuntos
Divertículo , Doenças Uretrais , Incontinência Urinária , Humanos , Feminino , Adulto , Doenças Uretrais/diagnóstico , Doenças Uretrais/cirurgia , Doenças Uretrais/patologia , Uretra/patologia , Incontinência Urinária/etiologia , Imageamento por Ressonância Magnética , Divertículo/diagnóstico , Divertículo/cirurgia
17.
Tech Coloproctol ; 27(10): 937-944, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-36800073

RESUMO

BACKGROUND: Gracilis muscle interposition (GMI) has been associated with favorable outcomes in treating complex perianal fistulas. Outcomes of GMI may vary according to the fistula etiology, particularly between rectovaginal fistulas in women and rectourethral fistulas (RUF) in men. The aim of this study was to assess the outcome of GMI to treat RUF acquired after prostate cancer treatment. METHODS: This retrospective cohort study included male patients treated with GMI for RUF acquired after prostate cancer treatment between January 2000 and December 2018 in the Department of Colorectal Surgery, Cleveland Clinic Florida. The primary outcome was the success of GMI, defined as complete healing of RUF without recurrence. Secondary outcomes were length of hospital stay and postoperative complications. RESULTS: This study included 53 male patients with a median age of 68 (range, 46-85) years. Patients developed RUF after treatment of prostate cancer with radiation (52.8%), surgery (34%), or transurethral resection of the prostate (TURP) (13.2%). Median hospital stay was 5 (IQR, 4-7) days. Twenty (37.7%) patients experienced 25 complications, the most common being wound infection and dehiscence. Primary healing after GMI was achieved in 28 (52.8%) patients. Fifteen additional patients experienced successful healing of RUF after additional procedures, for a total success rate of 81.1%. Median time to complete healing was 8 (range, 4-56) weeks. The only significant factor associated with outcome of GMI was wound dehiscence (p = 0.008). CONCLUSIONS: Although the initial success rate of GMI was approximately 53%, it increased to 81% after additional procedures. Complications after GMI were mostly minor, with wound complications being the most common. Perianal wound dehiscence was significantly associated with failure of healing of RUF after GMI.


Assuntos
Músculo Grácil , Neoplasias da Próstata , Fístula Retal , Ressecção Transuretral da Próstata , Doenças Uretrais , Fístula Urinária , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Músculo Grácil/transplante , Ressecção Transuretral da Próstata/efeitos adversos , Estudos Retrospectivos , Fístula Retal/etiologia , Fístula Retal/cirurgia , Fístula Urinária/etiologia , Fístula Urinária/cirurgia , Doenças Uretrais/etiologia , Doenças Uretrais/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Neoplasias da Próstata/cirurgia , Resultado do Tratamento
18.
Photodiagnosis Photodyn Ther ; 42: 103335, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36781006

RESUMO

BACKGROUND: Rectourethral fistulae (RUF) are the most prevalent type of anorectal malformations in boys, with various surgical treatment methods investigated in recent years. Currently, research is focused on preventing urethral damage or urethral diverticulum formation caused by imprecise dissection during the laparoscopically assisted anorectal pull-through (LAARP) technique. This study aimed to determine the efficacy of indocyanine green (ICG) fluorescence imaging to improve the localization and separation of the RUF during laparoscopic surgery. METHODS: ICG was intrarectally injected through a pre-inserted gastric tube at the distal enterostomy port to locate the fistula. This retrospective analysis included children with RUF who were treated surgically with ICG fluorescence imaging localization-assisted LAARP between January and June 2022. We investigated the patient demographics, perioperative conditions, and subsequent follow-up results. RESULTS: Four patients underwent ICG-assisted LAARP. Their median age was 80 days (range, 63-120) and the median duration of each procedure was 145 min (range, 120-165). Postoperatively, the duration of catheter retention and hospital stay was eight days. The children's prognosis was based on the follow-up outcomes of gastrointestinal, urinary tract function, and imaging examination. None of the included patients was diagnosed with urinary diverticulum, urinary tract injury, anal stricture, or rectal prolapse. CONCLUSIONS: Injection of ICG at the end of the rectum during LAARP surgery is a feasible adjunct for locating the RUF, providing a greater degree of accuracy for laparoscopic separation and resection of fistulae, thereby decreasing the risk of urological complications.


Assuntos
Malformações Anorretais , Laparoscopia , Fotoquimioterapia , Fístula Retal , Doenças Uretrais , Fístula Urinária , Masculino , Criança , Humanos , Idoso de 80 Anos ou mais , Verde de Indocianina , Estudos Retrospectivos , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes , Laparoscopia/métodos , Fístula Retal/complicações , Fístula Retal/cirurgia , Doenças Uretrais/diagnóstico por imagem , Doenças Uretrais/cirurgia , Fístula Urinária/diagnóstico por imagem , Fístula Urinária/cirurgia , Fístula Urinária/complicações , Malformações Anorretais/complicações , Malformações Anorretais/cirurgia , Imagem Óptica
19.
Neurourol Urodyn ; 42(4): 746-750, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36785951

RESUMO

INTRODUCTION: This study aims to determine the accuracy of radiological imaging compared with surgical pathology in patients with periurethral (PU) and anterior vaginal wall (AVW) lesions. METHODS: This study is a retrospective analysis of 126 women who underwent surgical treatment for PU and AVW masses between 2011 and 2020. Clinicopathological data were extracted along with radiological findings from medical records. The primary outcome was the diagnostic accuracy of preoperative imaging compared to the gold standard, pathological diagnosis. The secondary outcome was the rate of imaging correcting the clinical diagnosis. RESULTS: A total of 126 women with a median age of 42 underwent surgical treatment for PU and AVW masses. The most diagnoses were periurethral cysts (PUC) (52%) and urethral diverticulum (UD) (39%). Clinical diagnosis was accurate in 102 cases (81%) for the group of pathological diagnoses. Magnetic resonance imaging (MRI) and transvaginal ultrasound (TV US) were performed in 82 (65%) and 22 (17%) cases. The accuracy of MRI and TV US for the diagnosis of PU and AVW lesions was 76% and 82%, respectively. MRI and TV US corrected the clinical diagnosis in five (6%) and two (9%) cases, respectively. Voiding cystourethrography (VCUG) and double balloon urethrography (DBU), each performed in six (5%) cases, were accurate in four (67%) and three (50%) cases. No statistical difference was found for any imaging modality compared to clinical diagnosis. CONCLUSION: Clinical diagnosis based on pelvic and cystoscopy examinations was sufficient for diagnosing PU and AVW masses and was not significantly different from imaging diagnosis. Imaging may be helpful with preoperative surgical planning in selected cases.


Assuntos
Uretra , Doenças Uretrais , Humanos , Feminino , Estudos Retrospectivos , Doenças Uretrais/cirurgia , Imageamento por Ressonância Magnética/métodos , Micção
20.
Urology ; 173: 209-214, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36669571

RESUMO

OBJECTIVE: To describe our technique for the infrapubic approach for malleable penile prosthesis (MPP) insertion after phalloplasty in transgender men and review surgical outcomes. METHODS: The infrapubic prosthesis insertion technique involves a horizontal incision anterior to the pubic symphysis, allowing dissection of the neophallus tract and anchor site on the pubic symphysis. Surgical outcomes by a single surgeon using a Spectra or Genesis MPP between October 2017 and May 2022 were retrospectively reviewed. Complications were categorized into erosions, infections, device detachment, device malposition, pain or activity limitation, urethral injury, and flap loss. Implant survival kinetics were assessed by evaluating time to surgical revision. RESULTS: Forty patients underwent infrapubic MPP insertion; 35 patients had a prior radial forearm free flap (RFFF) and 5 had a prior anterolateral thigh flap (ALT) phalloplasty. Of 30 patients who maintained follow-up, mean follow-up was 34.9 months. Complications were not mutually exclusive, with 7 implant detachments from the anchor site, 3 malpositions, 2 with pain/activity limitation, and 1 infection. Surgical revision was required in 12/30 patients (40%). There were no neophallus erosions, flap loss, nor urethral injuries. More complications occurred with the Spectra (9/17 or 53%) than the Genesis MPP (3/13 or 23%), but this was not statistically significant (P = .10). CONCLUSION: Infrapubic insertion in transmen after phalloplasty using commercially available MPPs is safe compared with other post-phalloplasty penile prosthesis insertion techniques, with similarly high surgical revision rates. Further study of techniques is needed to improve outcomes after penile prosthesis insertion in transmen.


Assuntos
Prótese de Pênis , Procedimentos de Cirurgia Plástica , Doenças Uretrais , Masculino , Humanos , Estudos Retrospectivos , Pênis/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Doenças Uretrais/cirurgia , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA