摘要
Introduction Vesicovaginal fistula is a rare disease with great impact for the patients. Laparoscopic repair can be an interesting option in selected cases with goods results but few experience is reported.Objectives Detailed demonstration of our laparoscopic vesicovaginal fistula repair technique. Initial results for ten patients are provided Methods: We treated all cases by the same technique. The surgical steps were: Patient positioning in Lloyd-Davis; Cystoscopy and implant of guide wire on fistula and ureteral catheters (that was removed after procedure); Transperitoneal access and 4 or 5 ports in V or W shape; Opening the bladder wall; Dissection between bladder and vagina for tension free repair; Fistula resection; Vagina repair with Vicryl 3-0; Bladder repair with Vicryl 3-0; Peritoneum/omentum interposition; Positioning 20 Fr urethral catheter.Results Mean age was 50 years. Mean number of fistulas was 1,2. The most common etiology was gynecologic surgery (7). Mean operative time was 2,5 (1,8-3,2) hours. Mean blood loss was 150 (100-200)mL. Complication rate was 10% (one case of urinary infection treated conservatively). Mean hospital stay was 1,2 (1-2) days. Mean return to normal and activities was 20 (15-30) days. For nine patients mean sexual intercourse time was 3 (1-6) months. Success rate after 1 year was 90% (one case of recurrence in patient with previous radiotherapy). Mean follow-up was 36 (12-60) months.Conclusions Laparoscopic repair is feasible, reproducible and present all advantages of minimally invasive surgical procedure. Long term results are similar to conventional open approaches.
Subject(s)
Female , Humans , Middle Aged , Laparoscopy/methods , Vesicovaginal Fistula/surgery , Reproducibility of Results , Treatment Outcome摘要
Apesar de constituírem complicação incomum, as fístulas vesicovaginais apresentam expressivo impacto na qualidade de vida dos pacientes. As abordagens minimamente invasivas têm ganhado mais espaço no tratamento de doenças geniturinárias. Ainda são poucos os relatos do acesso laparoscópico para correção das fístulas vesicovaginais. Relata-se aqui um caso de fístula pós-histerectomia tratada totalmente de forma laparoscópica com ótimo resultado. As vantagens do acesso laparoscópico, assim como alguns detalhes técnicos, são discutidos...
Despite being an uncommon complication, vesicovaginal fistulas have significant impact on patient quality of life. Minimally invasive approaches have gained more space in the treatment of genitourinary diseases. There are few reports on laparoscopic approaches for correction of vesicovaginal fistulas. This is a case report of a post-hysterectomy fistulatreated exclusively through laparoscopy with excellent results. The advantages of the laparoscopic approach, as well as some technical details, are discussed...
Subject(s)
Humans , Female , Adult , Vesicovaginal Fistula/surgery , Vesicovaginal Fistula/complications , Laparoscopy摘要
Introdução: o tratamento cirúrgico da hiperplasia benigna da próstata inclui a ressecção transuretral e a prostatectomia suprapúbica, dependendo do volume prostático. O acesso videolaparoscópico criou alternativa minimamente invasiva à prosatatectomia suprapúbica convencional. Objetivo: avaliar a viabilidade da técnica aberta por via laparoscópica. Pacientes e métodos: entre junho de 2006 e outubro de 2009, 15 pacientes foram submetidos à prostatectomia retropúbica videolaparoscópica no tratamento da hiperplasia prostática benigna (HPB). O acesso videolaparoscópico foi utilizado como alternativa minimamenteinvasiva à adenomectomia aberta. Foram avaliadas as características dos pacientes, o volume prostático e as complicações no per e pós-operatórios imediato e tardio. Resultados: a idade média foi de 68 anos (62-75 anos); o peso prostático médio foi de 123 gramas (70-190 gramas); o tempo cirúrgico variou de 120 minutos a 220 minutos. A perda de sangue estimada foi de 450 mL na média, sendo necessária transfusão em apenas um paciente. A permanência hospitalar média foi de três dias. O tempo com sonda vesical de demora foi de seis dias; e o tempo de irrigação vesical de um dia em todos os pacientes. O estudoanatomopatológico confirmou o diagnóstico de HPB em todos os casos. Nas complicações pós-operatórias, um paciente apresentou infecção superficial da ferida operatória, com boa resposta à antibioticoterapia. Conclusões: a prostatectomia retropúbica laparoscópica parece ser procedimento seguro, que permite reproduzir os princípios da cirurgia aberta. Neste trabalho observou-se baixa taxa de complicações, similar à da literatura.
Introduction: The surgical treatment of benign prostatic hyperplasia includes transurethral resection and suprapubic prostatectomy depending on prostate volume. The laparoscopic access creates a minimally invasive alternative to conventional suprapubic prostatectomy. Objective: to assess the feasibility of the open laparoscopic technique. Patients and methods: Between June 2006 and October 2009, 15 patients underwent laparoscopic retropubic prostatectomy in the treatment of benign prostatic hyperplasia (BPH). Laparoscopic access was used as a minimally invasive alternative to open adenomectomy. Patient characteristics and prostate volume were assessed, as well as complications in the early and late perioperative and postoperative stages. Results: Mean age was 68 years (62-75 years), mean prostate weight 123 grams (70-190 grams). Time of surgery ranged from 120 to 220 minutes. Mean estimated blood loss was 450 mL and transfusion was required for one patient. Mean hospital stay was three days. Time with indwelling catheter was six days and time of bladder irrigation was of one day for all patients. Anatomicopathological studies confirmed the diagnosis of BPH in all cases.Among postoperative complications, one patient had a superficial surgical wound infection, which responded well to antibiotic therapy. Conclusions:Laparoscopic retropubic prostatectomy appears to be a safe procedure that reproduces the principles of open surgery. In this study we observed a low rate of complications, similar to previous studies.
摘要
Apesar de ser o padrão-ouro no tratamento dos tumores invasivos de bexiga, a cistoprostatectomia ainda apresenta significativo impacto na qualidade de vida dos pacientes. As abordagens minimamente invasivas têm ganhado cada vez mais espaço no tratamento das neoplasias urológicas. Ainda são poucas as séries na literatura sobre o acesso videolaparoscópico para confecção de neobexiga ortotópica após a cistoprostatectomia radical. Relata-se um caso de câncer invasor de bexiga tratado de forma laparoscópica com ótimo resultado. As vantagens do acesso laparoscópico, assim como alguns detalhes técnicos, são discutidas.
Although it is not considered a gold standard in treating invasive bladder tumors, cystoprostatectomy still has significant impacts on patients? life quality. The minimally invasive approaches have gained importance in the treatment of bladder neoplasia. There are sill few reports on the use of laparoscopy for providing orthotopic bladder upon radical cystoprostatectomy. This is a case report of invasive bladder cancer that was treated with laparoscopy and yielded optimal result. The advantages of laparoscopy and some technical details are herein discussed.
Subject(s)
Humans , Male , Middle Aged , Cystectomy/methods , Laparoscopy , Urologic Neoplasms/surgery摘要
Apesar da laparoscopia ser amplamente utilizada na abordagem de doenças retroperitoneais, ainda são poucos os relatos de ressecção laparoscópica de tumores retroperitoneais. Este estudo descreve um caso de Schwannoma retroperitoneal benigno tratado por retroperitoneoscopia e discute a dificuldade no diagnóstico e as vantagens do acesso retroperioneal por via laparoscópica.
In spite laparoscopy has been widely utilized in the management of retroperitoneals pathologies, there are still few reports of laparoscopic resections of retroperitoneals tumors. We report a case of a retroperitoneal benign Schwannoma treated by retroperitoneoscopy. The troubles on diagnostic and advantages of the retroperitoneal approach by laparoscopic way are discussed.
Subject(s)
Humans , Female , Middle Aged , Retroperitoneal Neoplasms/surgery , Neuroma/diagnosis , Diagnosis, Differential , Laparoscopy摘要
A fratura do pênis é definida como a ruptura da túnica albugínea do corpo cavernoso que ocorre exclusivamente durante a ereção. O principal mecanismo de trauma é o intercurso sexual traumático. Devido ao baixo número de casos, alguns pontos do tratamento ainda são controversos, entretanto, é recomendada a intervenção cirúrgica imediata. Este estudo retrospectivo observacional realizado entre abril de 2006 e abril de 2008 descreve os resultados da abordagem cirúrgica em 11 pacientes com fratura peniana tratados no Hospital Alberto Cavalcanti - FHEMIG. Foram avaliadas as características dos pacientes, o mecanismo do trauma, o tipo da lesão e as complicações no per e no pós-operatório imediato.
Objectives: To review the diagnostic and therapeutic options in patients with penile fracture and describe our experience. Patients & Methods: From April 2006 through April 2008, eleven consecutive men with diagnosis of penile fracture were treated at "AlbertoCavalcanti" Hospital. The etiology, interval from injury to presentation, presence of associated injuries and immediate postoperative complications were evaluated. Results: All patients were submitted to surgical intervention and nine had the diagnosis confirmed.None of them had per-operative complications. One patient had skin infection in the post-operative period. Conclusions: Penile fracture can be clinically diagnosticated, the management should be surgical and immediate.
Subject(s)
Humans , Male , Penis/injuries , Retrospective Studies , Penis/surgery , Rupture摘要
Este é um estudo retrospectivo observacional que descreve a experiência com 87 pacientes submetidos a implante de prótese peniana em Serviço de Urologia. O acompanhamento foi feito no Hospital Governador Israel Pinheiro (HGIP) em pacientes operados entre junho de 1999 e fevereiro de 2006. Foram avaliadas as características dos pacientes, a etiologia da disfunção erétil e as complicações no per e pós-operatórios imediato e tardio do implante de prótese peniana maleável.