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1.
Arch Ital Urol Androl ; 79(4): 181-3, 2007 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-18303740

RESUMEN

UNLABELLED: Urinary diversion after cystectomy in old and high risk patients is associated with major complications, exspecially those related to the type of urinary diversion. Ileal conduit and orthotopic bladder substitution have been the preferred option for urinary diversion after cystectomy. In patient with physiologic status classification determined by the American Society of Anesthesiologist (ASA) score, the complications related to the kind of diversion start to go up with ASA 3 patients. In patient ASA 3e, 4 and 4e ureterocutaneostomy represents a simplified choice for urinary diversion. MATERIALS AND METHODS: At our department we performed 158 cystectomy from 2001 to 2005, 27 were female patient. In 5 (3.16%) patients ASA 4 and ASA 4e we choosed ureterocutaneostomy. RESULTS: One patient died of myocardial infarction in intensive postoperative care unit and one patient had a serious stenosis of the ureter. CONCLUSION: cutaneous ureterostomy after cystectomy may be indicated for patients ASA 3e, 4 and 4e. Operative risk is low. The first indication is for dilated ureters and not irradiated pelvis.


Asunto(s)
Cistectomía/métodos , Ureterostomía , Femenino , Humanos , Masculino
2.
Arch Ital Urol Androl ; 77(2): 131-2, 2005 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-16146282

RESUMEN

Series of free graft methroplasties for structure of the urethra according to Barbagli. Fifteen men underwent dorsal free graft methroplasty for structures situated in the penile urethra in 6 cases, in the bulbous urethra in 7 and in the urethra geno bulbous in 2. The length of the structures ranged from 1.5 to 13 cm. In all the patients but one uroflow was satisfactory at a mean follow-up of 40 months. In one patient a reument structure occurred 8 months after treatment and was successfully treated with cold urethrotomy. In conclusion, dorsal free graft urethroplasty is a safe and fairly simple procedure in long bulbous stenosis and penile multi stenosis.


Asunto(s)
Colgajos Quirúrgicos , Uretra/cirugía , Estrechez Uretral/cirugía , Procedimientos Quirúrgicos Urológicos Masculinos , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Factibilidad , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Procedimientos Quirúrgicos Urológicos Masculinos/métodos
3.
Arch Ital Urol Androl ; 74(1): 25-6, 2002 Mar.
Artículo en Italiano | MEDLINE | ID: mdl-12053446

RESUMEN

UNLABELLED: Endometriosis, surgery and radiotherapy are the main causes of ureteral injuries in gynaecologic pathology. MATERIALS AND METHODS: In this paper we present our experience about ureteral injuries. We treated 31 patients; 6 cases of endometriosis, 13 cases of pelvic radiotherapy for gynecologic tumors, 12 cases of ureteral injuries after gynecologic surgery. The treatments were different depending on the cause of the lesion and on the site of the lesion. In 3 cases we performed an ureteral-bladder implant with bladder psoas hitch, in 2 cases an end to end anastomosis was made. In 2 cases we made an ureteric substitution with Boari bladder flap. In 8 cases the ureteral stenting with DJ or a percutaneous nephrostomy was the solution. RESULTS AND CONCLUSIONS: In our experience good results can be obtained with ureteral implant and bladder psoas hitch. The end to end ureteral anastomosis had disappointing results in our hands. In case of ureteral fistula it would be better repair it as soon as possible. If the ureteral lesion is recognised during surgery and the loss of substance is not complete, the suture on stent can be performed.


Asunto(s)
Procedimientos Quirúrgicos Ginecológicos , Complicaciones Intraoperatorias/patología , Traumatismos por Radiación/etiología , Uréter/lesiones , Procedimientos Quirúrgicos Urológicos , Anastomosis Quirúrgica , Femenino , Humanos , Complicaciones Intraoperatorias/epidemiología , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/cirugía , Italia/epidemiología , Persona de Mediana Edad , Nefrostomía Percutánea , Epiplón/cirugía , Complicaciones Posoperatorias , Traumatismos por Radiación/cirugía , Radioterapia/efectos adversos , Estudios Retrospectivos , Stents , Uréter/efectos de la radiación , Fístula Urinaria/etiología , Fístula Urinaria/cirugía
4.
Arch Ital Urol Androl ; 75(1): 10-3, 2003 Mar.
Artículo en Italiano | MEDLINE | ID: mdl-12741338

RESUMEN

Primary radiation therapy may be recommended for patients with invasive bladder cancer, gynecological or prostatic cancer. When complications occur or in case of malignant recurrence, urinary diversion may be the best chance to restore an acceptable quality of life. The complication rate after this surgery is doubled. We report our experience in 32 patients submitted to urinary diversion after radiotherapy from 1985 to 2000: 2 enteric fistulas; 2 urinary fistulas; 5 stenosis of uretero-intestinal anastomosis were our complications. Radical cystectomy (24 cases) or anterior pelvic exenteration (8 females) preceded urinary diversion. Preoperative high-dose radiotherapy contributes to increased postoperative morbidity rates, particularly entero-enteric fistulas, uro-intestinal fistulas and stenosis of the uretero-intestinal anastomosis. In our experience, in most of the major urinary or enteric complications non surgical management was inefficient and surgical management was necessary.


Asunto(s)
Neoplasias Pélvicas/radioterapia , Complicaciones Posoperatorias/etiología , Traumatismos por Radiación/cirugía , Uréter/lesiones , Vejiga Urinaria/lesiones , Derivación Urinaria , Constricción Patológica , Cistectomía , Femenino , Neoplasias de los Genitales Femeninos/radioterapia , Neoplasias de los Genitales Femeninos/cirugía , Humanos , Masculino , Recurrencia Local de Neoplasia/cirugía , Neoplasias Pélvicas/tratamiento farmacológico , Neoplasias Pélvicas/cirugía , Complicaciones Posoperatorias/cirugía , Neoplasias de la Próstata/radioterapia , Neoplasias de la Próstata/cirugía , Traumatismos por Radiación/etiología , Radioterapia/efectos adversos , Radioterapia Adyuvante/efectos adversos , Obstrucción Ureteral/etiología , Obstrucción Ureteral/cirugía , Vejiga Urinaria/cirugía , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico , Neoplasias de la Vejiga Urinaria/radioterapia , Neoplasias de la Vejiga Urinaria/cirugía , Derivación Urinaria/efectos adversos , Fístula Urinaria/etiología , Neoplasias Uterinas/radioterapia
5.
Arch Ital Urol Androl ; 76(3): 140-2, 2004 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-15568307

RESUMEN

Interstitial cystitis (IC) is still considered a rare disease, but in the future its incidence will probably be revised if tendency is that of considering interstitial cystitis on the basis of clinical rather than endoscopic-histological criteria. According to some urologists, cystodistension and vesical biopsy, even if not pathognomonic, are still effective up till now, at least for their prognostic-therapeutic value as well. If on one hand in the diagnosis of this condition symptoms tend to be of more and more value unlike instrumental investigations, on the other hand little has changed in therapy.


Asunto(s)
Cistitis Intersticial , Adulto , Anciano , Cistitis Intersticial/diagnóstico , Cistitis Intersticial/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad
6.
Arch Ital Urol Androl ; 76(1): 46-8, 2004 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-15185825

RESUMEN

The Authors discuss their experience in the use of pubo-vaginal sling in the treatment of female urinary stress incontinence. In the last 5 years (1997-2002) 35 patients with type 3 incontinence underwent pubo-vaginal sling with rectus fascia or porcine skin. Healing was obtained in 74.2%, de novo urgency in 5.7%, obstruction in 8.5% and persisting incontinence in 11.4% of cases. The developments of the technique have recently turned pubo-vaginal sling into a minimally invasive procedure with low morbidity. Its indications have therefore been extended to the point that it is now considered by many authors as the treatment of choice in any type of incontinence, whether associated with genital prolapse or not.


Asunto(s)
Incontinencia Urinaria de Esfuerzo/cirugía , Procedimientos Quirúrgicos Urológicos , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Persona de Mediana Edad
7.
Urologia ; 78 Suppl 18: 21-5, 2011 Oct.
Artículo en Italiano | MEDLINE | ID: mdl-22020550

RESUMEN

INTRODUCTION: We present the video of a laparoscopic repair of a rectovesical fistula after radical retropubic prostatectomy. The rectal lesion had not been detected during the first procedure. The rectal bladder fistula appeared on the 14th post-operative day. After three weeks from the procedure,the patient underwent a laparoscopic repair of the rectovesical fistula. A temporary external colon conduit was performed at the same time. MATERIALS AND METHODS: We performed a cystoscopy before the surgery; it showed a fistula behind the bladder neck at 5 o'clock, distally to the left ureteral orifice. Two ureteral stents were inserted into both the ureters to make sure not to determine any injury to these structures during the operation. With the patient in the supine position, we introduced 5 trocars with the Hasson technique trans-peritoneally. The pouch of Douglas was opened and the bladder was divided from the rectum.The bladder posterior wall was widely opened till reaching the rectal bladder fistula.The fistula was located distally to the left ureteral orifice, very close to the bladder neck. Through a blunt dissection, we divided the margins of the rectal fistula from those of the posterior bladder wall.Indeed, we performed a suture of the rectal wall without any tension. The rectal lesion was closed in a double-layer suture with 3-0 Vicryl.We introduced a probe into the rectum to make sure there was no leakage on the suture. A flap of peritoneum of the Douglas was put between bladder and rectum.We closed the longitudinal opening of the trigone and the bladder posterior wall through a continuous suture.An external colic conduit was packaged to guarantee the closure of the fistula. The left colon was put through the abdominal wall widening the 5 mm trocar opening located on the left pararectal space. RESULTS: The operative time was 240 minutes. There were no post-operative complications. The bladder catheter was removed at 1 month after surgery,only after performing a cystography, which showed no leakage.Two months later, the colostomy was closed. At a 12-month follow-up the patient had no fistula recurrence. CONCLUSIONS: The treatment of arectovesical fistula after radical prostatectomy remains a complex procedure: different types of corrective surgical approaches have been described. The laparoscopic approach is an alternative to standard procedures. The optical magnification allows a good view of the fistula in a very deep and narrow space. It also allows easy performing of the colostomy.


Asunto(s)
Cistoscopía , Laparoscopía , Prostatectomía/efectos adversos , Fístula Rectal/cirugía , Fístula de la Vejiga Urinaria/cirugía , Humanos , Laparoscopía/métodos , Masculino , Prostatectomía/métodos , Neoplasias de la Próstata/cirugía , Fístula Rectal/diagnóstico , Fístula Rectal/etiología , Resultado del Tratamiento , Fístula de la Vejiga Urinaria/diagnóstico , Fístula de la Vejiga Urinaria/etiología
8.
Urologia ; 77 Suppl 17: 46-9, 2010.
Artículo en Italiano | MEDLINE | ID: mdl-21308675

RESUMEN

INTRODUCTION: We present the case of a male adnexal tumor of probable Wolffian origin occurred to the right seminal vesicle of a 47-year-old man. MATERIALS AND METHODS: The patient presented with a 2-month history of hematospermia. The diagnosis was achieved by transrectal ultrasound, CT of the abdomen and pelvis, and biopsy of both prostate and seminal vesicle. The patient was counseled for laparoscopic excision of the right seminal vesicle. RESULTS: The right seminal vesicle, along with the tumor and the right vas deferens, were excised and clear margins were ensured by frozen section. Total operative time was 180 with 200 mL blood loss. The patient's recovery was uncomplicated and he was discharged on the fourth post-operative day. The histologic examination demonstrated a male adnexal tumor of probable Wolffian origin, which is a rare low-grade malignant neoplasm that has been previously described in the broad ligament, ovaries and retroperitoneum of females. The patient is free of relapse at a 20-month follow-up. CONCLUSIONS: This is the second report of this entity in a male. The laparoscopic approach for the excision of seminal vesicle neoplasms is a good treatment for its obvious benefits of minimal blood loss, short hospital stay and quick return to normal activity. The magnifications of the anatomical details of the pelvic floor help the surgeon in the dissection of the seminal vesicle from the other structures.


Asunto(s)
Neoplasias de los Genitales Masculinos/cirugía , Laparoscopía/métodos , Vesículas Seminales/patología , Adenoma/complicaciones , Adenoma/diagnóstico , Adenoma/patología , Adenoma/cirugía , Enfermedades de los Anexos/complicaciones , Enfermedades de los Anexos/diagnóstico , Enfermedades de los Anexos/patología , Enfermedades de los Anexos/cirugía , Biopsia , Diagnóstico Diferencial , Neoplasias de los Genitales Masculinos/complicaciones , Neoplasias de los Genitales Masculinos/diagnóstico , Neoplasias de los Genitales Masculinos/patología , Hematospermia/etiología , Humanos , Masculino , Persona de Mediana Edad , Vesículas Seminales/cirugía , Tomografía Computarizada por Rayos X , Conducto Deferente/cirugía
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