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1.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1096917

RESUMO

Objetivo: o presente artigo objetiva descrever as perspectivas do paciente submetido à penectomia e conhecer as perspectivas deste paciente após a penectomia. Métodos: trata-se de um estudo de caso realizado em um hospital federal na cidade do Rio de Janeiro com dois pacientes que estiveram internados no ano de 2017 e foram submetidos a penectomia. A coleta de dados foi realizada no ano de 2018 através de uma entrevista semiestruturada. Os participantes foram amparados pelos princípios éticos estabelecidos pela resolução 466/ 2012 do Conselho Nacional de Saúde, sendo que este estudo foi aprovado sob o número 2.769.381. Resultados: constatou-se que a penectomia nestes estudos de caso era a única terapêutica. Com isso, o desejo de estar com a família e prolongar a vida foram determinantes na adesão ao tratamento. Conclusão: concluiu-se que mesmo com as mudanças no corpo, a penectomia foi realizada na perspectiva de prolongar a vida


Objective: this article aims to describe the perspectives of patient submitted submitted to penectomy and to know the perspectives of this patient after the penectomy. Methods: its a case study realized in a federal hospital of Rio de Janeiro city with two patients who were admitted to the hospital during 2017 and underwent to penectomy surgery. The data collection was realized during 2018 with a semi-structured interview. The participants were protected by the ethics principles established by the resolution 466/ 2012 of the National Health Council and this study was approved under the number 2.769.381. Results: it was found that penectomy in this case studies was the only therapy. Thereby, the desire of being among their family and to extend their life was determinants to adhere the therapy. Conclusion: it was concluded that even with the changes in their body, the penectomy was realized to extend the life


Objetivo: el presente artículo objetiva describir las perspectivas del paciente sometido a la penectomía y conocer las perspectivas de este paciente después de la penectomía. Métodos: se trata de un estudio de caso realizado en un hospital federal en la ciudad de Río de Janeiro con dos pacientes que estuvieron internados en el año 2017 y fueron sometidos a penectomía. La recolección de datos se realizó en el año 2018 através de una entrevista semiestructurada. Los participantes fueron amparados por los principios éticos establecidos por la resolución 466/2012 del Consejo Nacional de Salud, siendo que este estudio fue aprobado bajo el número 2.769.381. Resultados: se constató que la penectomía en estos estudios de caso era la única terapéutica. Con ello, el deseo de estar con la familia y prolongar la vida fueron determinantes en la adhesión al tratamiento. Conclusión: se concluyó que incluso con los cambios en el cuerpo, la penectomía se realizó en la perspectiva de prolongar la vida


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Penianas/cirurgia , Neoplasias Penianas/complicações , Autoimagem , Enfermagem Oncológica , Neoplasias Penianas/enfermagem , Procedimentos Cirúrgicos Urológicos Masculinos/psicologia , Saúde do Homem
2.
Medicina (Ribeiräo Preto) ; 52(3)jul.-set. 2019.
Artigo em Português | LILACS | ID: biblio-1025786

RESUMO

A mucosa vesical, na presença de agentes agressores, sofre alterações inicialmente benignas, mas com a cronicidade pode sofrer modificações potencialmente metaplásicas. A cistite glandular apresenta um quadro sintomático inespecífico, sendo necessária a realização de biópsia para seu diagnóstico e diferenciação histológica, podendo dividir-se em subtipos clássico e intestinal. Após análise de prontuário médico pertencente ao Hospital Santa Rita de Maringá, objetiva-se relatar o caso de um paciente masculino, de 32 anos, com disúria e dor em hipogástrico, apresentando em ultrassonografia lesão cística de 3,8 cm de diâmetro na bexiga. Após a retirada da lesão por ressecção transuretral, a análise histopatológica revelou presença de ninhos de Von Brunn, áreas de epitélio mucossecretor e mucina extracelular na mucosa vesical, propondo a existência de lesão glandular com metaplasia intestinal. Foi realizado estudo imunohistoquímico para diagnóstico diferencial de adenocarcinoma mucossecretor bem diferenciado. A cistite glandular, quando manifestada macroscopicamente, assemelha-se a uma neoplasia por apresentar um aspecto irregular, difuso e algumas vezes ulceroso. Seu diagnóstico e tratamento podem ser simultâneos, porém, nos casos mais graves, as opções terapêuticas são restritas. O diagnóstico diferencial é extremamente importante para afastar a possibilidade de adenocarcinoma vesical, portanto, é imprescindível o acompanhamento periódico dos pacientes após o tratamento com a realização de exames específicos. O uso de marcadores imunohistoquímicos tem se tornado relevante para o correto diagnóstico, pois genes relacionados ao ciclo celular, como o fator de transcrição homebox 2 do tipo caudal (CDX2), podem representar um vínculo entre o surgimento de metaplasia e sua possível progressão a adenocarcinoma. (AU)


The bladder's mucosa, in the presence of aggressive agents, undergoes initially benign changes, but with chronicity may undergo potentially metaplastic modifications. Glandular cystitis presents nonspecific symptoms and biopsy is necessary for diagnosis and histological differentiation, subdividing it into classic and intestinal subtypes. After analyzing a medical record belonging to the Santa Rita Hospital from Maringá, the objective of this study is to report the case of a 32-year-old male patient with dysuria and pain in the hypogastric region, presenting on ultrasonography cystic lesion of 3.8 cm of diameter in the bladder. After removal of the lesion by transurethral resection, the histopathological analysis revealed the presence of Von Brunn nests, areas of mucosecretory epithelium and extracellular mucin in the bladder's mucosa, suggesting the existence of a glandular lesion with intestinal metaplasia. It was performed an immunohistochemical study for differential diagnosis of well-differentiated mucosecretory adenocarcinoma. Glandular cystitis, when manifest-ed macroscopically, resembles a neoplasm, since it can present an irregular aspect, diffuse and sometimes ulcerous. The diagnosis and treatment can be simultaneous, but in severe cases, the therapeutic options are restricted. Differential diagnosis is extremely important to rule out the possibility of bladder adenocarcinoma, therefore it is essential to follow up patients after treatment with specific tests periodically. The use of immunohistochemical markers has become rele-vant for the correct diagnosis, since genes related to the cell cycle, such as caudal type homeobox transcription factor 2 (CDX2), may represent a link between the onset of metaplasia and its possible progression to adenocarcinoma (AU)


Assuntos
Humanos , Masculino , Adulto , Procedimentos Cirúrgicos Urológicos Masculinos , Cistite , Metaplasia
4.
Int. braz. j. urol ; 41(4): 750-756, July-Aug. 2015. tab, graf
Artigo em Inglês | LILACS | ID: lil-763056

RESUMO

ABSTRACTObjective:To compare our previously published new minimally access hydrocelectomy versus Jaboulay's procedure regarding operative outcome and patient's satisfaction.Materials and Methods:A total of 124 adult patients were divided into two groups: A and B. Group A patients were subjected to conventional surgical hydrocelectomy (Jaboulay's procedure) and group B patients were subjected to the new minimal access hydrocelectomy. The primary endpoint of the study was recurrence defined as a clinically detectable characteristic swelling in the scrotum and diagnosed by the two surgeons and confirmed by ultrasound imaging study. The secondary endpoints were postoperative hematoma, wound sepsis and persistent edema and hardening.Results:The mean operative time in group B was 15.1±4.24 minutes and in group A was 32.5±4.76 minutes (P≤0.02). The mean time to return to work was 8.5±2.1 (7–10) days in group B while in group A was 12.5±3.53 (10–15) days (P=0.0001). The overall complication rate in group B was 12.88% and in group A was 37%. The parameters of the study were postoperative hematoma, degree of scrotal edema, wound infection, patients’ satisfaction and recurrence.Conclusion:Hydrocelectomy is considered the gold standard technique for the treatment of hydrocele and the minimally access maneuvers provide the best operative outcomes regarding scrotal edema and hardening and patient's satisfaction when compared to conventional eversion-excision hydrocelectomies.


Assuntos
Adolescente , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Edema/etiologia , Hematoma/etiologia , Satisfação do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Hidrocele Testicular/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos , Determinação de Ponto Final , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estudos Prospectivos , Recidiva , Resultado do Tratamento , Hidrocele Testicular , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
5.
Rev. bras. cir. plást ; 30(2): 329-334, 2015. ilus
Artigo em Inglês, Português | LILACS | ID: biblio-995

RESUMO

INTRODUÇÃO: A síndrome de Fournier é uma infecção multibacteriana de rápida progressão em região perineal. Seu tratamento inclui desbridamento, antibioticoterapia de amplo espectro e terapia com oxigênio em câmara hiperbárica. O desbridamento agressivo tipicamente resulta em perda da cobertura cutânea de toda bolsa escrotal, expondo ambos os testículos. No tratamento, é necessária a utilização de retalhos bem vascularizados para o reestabelecimento das funções. MÉTODO: Apresentamos a aplicação de um retalho fasciocutâneo, aproveitando a rica rede arterial da região interna da coxa para a reconstrução perineal, proposto por Ferreira et al., o qual permite o tratamento de amplos defeitos. CONCLUSÃO: O retalho descrito para reconstrução perineal é bastante versátil. Suas vantagens incluem a possibilidade de ser utilizado em diversas situações clínicas, baixo acometimento de gangrena na região doadora, reconstrução em único estágio e a espessura do retalho adequada para reconstrução desta região.


INTRODUCTION: Fournier gangrene is a rapidly progressing multi-bacterial infection in the perineal region. The treatment of this condition includes debridement, broad-spectrum antibiotic therapy, and oxygen therapy in a hyperbaric chamber. Aggressive debridement typically results in the loss of skin coverage of the entire scrotal sac, and the exposure of both testes. During treatment, it is essential to use well-vascularized flaps to ensure the recovery of function. METHOD: We describe the application of a fasciocutaneous flap-which takes advantage of the rich arterial network of the internal region of the thigh-in the perineal reconstruction method proposed by Ferreira et al. that allows for the treatment of large defects. CONCLUSION: The flap is quite versatile. Its advantages include its utility in various clinical situations, low risk of gangrene in the donor area, single-stage reconstruction, and adequate flap thickness for reconstruction.


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , História do Século XXI , Procedimentos Cirúrgicos Urológicos Masculinos , Retalhos Cirúrgicos , Gangrena de Fournier , Fasciite Necrosante , Farmacorresistência Bacteriana , Desbridamento , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Retalhos Cirúrgicos/cirurgia , Retalhos Cirúrgicos/normas , Gangrena de Fournier/cirurgia , Gangrena de Fournier/fisiopatologia , Gangrena de Fournier/patologia , Fasciite Necrosante/cirurgia , Fasciite Necrosante/complicações , Fasciite Necrosante/patologia , Farmacorresistência Bacteriana/efeitos dos fármacos , Desbridamento/efeitos adversos , Desbridamento/métodos
6.
Int. braz. j. urol ; 40(5): 702-707, 12/2014. graf
Artigo em Inglês | LILACS | ID: lil-731123

RESUMO

Epidermolysis bullosa (EB) is characterized by extreme fragility of the skin and mucosae. Anesthetic and surgical techniques have to be adapted to those children and routine practice may not be adequate. Urological problems are relatively common, but surgical techniques adapted to those children have not been well debated and only low evidence is available to this moment. Herein we discuss the specifics of anesthetic and surgical techniques chosen to treat a six year old EB male presenting with symptomatic phimosis.


Assuntos
Criança , Humanos , Masculino , Anestesia Geral/métodos , Epidermólise Bolhosa Distrófica/cirurgia , Fimose/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Epidermólise Bolhosa Distrófica/complicações , Fimose/etiologia , Dispositivos de Fixação Cirúrgica , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/instrumentação
7.
Int. braz. j. urol ; 40(5): 588-595, 12/2014. tab, graf
Artigo em Inglês | LILACS | ID: lil-731136

RESUMO

Purpose Tubularized Incised Plate (TIP) urethroplasty is a technique for urethral reconstruction of hypospadias although there are some controversies for its use in recurrent cases. The aim of this study was to review the results of TIP technique in various studies and the usage of different flaps for covering the repair site. Material and Methods Extensive Search was performed for articles published between 1994 and 2013 in common electronic databases. The overall TIP complication rates were estimated by a fixed effects model meta-analysis. Results 17 articles of hypospadia repair using the TIP method were reviewed. All studies performed surgery and repair on the basis of the Snodgrass’s method; however, some introduced modifications to the method. The prevalence of complications in repeated TIP surgery was 11.1 to 33.3% and the most prevalent complication in different studies was fistula. Based on the meta-analysis, the overall estimation of complications was 21.8 % (95% CI: 18.3 to 25.5). Conclusion Most studies performed the incision of the urethral plate to create a supportive coverage upon neourethra, and confirmed its success. We recommend further investigation on using different flaps in well-designed randomized controlled trials to choose the best surgical method for repairing recurrent hypospadias. .


Assuntos
Criança , Pré-Escolar , Humanos , Masculino , Hipospadia/cirurgia , Uretra/cirurgia , Complicações Intraoperatórias , Complicações Pós-Operatórias , Reoperação , Retalhos Cirúrgicos , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
8.
Int. braz. j. urol ; 40(3): 384-389, may-jun/2014. graf
Artigo em Inglês | LILACS | ID: lil-718259

RESUMO

Background Since hydrocelectomy remains the choice of surgical treatment of hydrocele and standard surgical procedures may cause postoperative discomfort and complications, a new minimal surgery procedure is needed. The scrotoscope was used for the diagnosis and treatment of intrascrotal lesions. The aim of the study is to illustrate a new minimal hydrocelectomy with the aid of scrotoscope, in an effort to decrease complications. Materials and Methods: Between 2002 and 2012, 65 patients underwent hydrocelectomy with the aid of a scrotoscope. Before carrying out hydrocelectomy, the scrotoscopy was first used to examine the intrascrotal contents to exclude any pathological lesions. After determining the condition of testis, epididymis and spermatic cord and excluding any other secondary causes of hydrocele, a 2.0cm scrotal incision was performed. The parietal tunica vaginalis was then grasped out of scrotum, and the mobilized tunica was excised. The scrotoscopy was then performed again to inspect the intrascrotal contents. Results Mean operative time was 35.4 minutes. No major complications occurred during the post-operative follow-up period. Of these 65 patients, 61 underwent scrotoscopy and minimal hydrocelectomy, two patients underwent open hydrocelectomy because thickening of hydrocele wall was identified; two patients with acute inflammation only underwent scrotoscopy. Pathological changes were observed among eight patients. All patients were satisfied with the outcomes. Conclusions Minimal hydrocelectomy shows commendable results and fewer complications. The combination of minimal hydrocelectomy and scrotoscopy seems to be an encouraging technique. This novel surgical procedure proves to be a viable option for the diagnosis and treatment of hydrocele. .


Assuntos
Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Endoscópios , Escroto/cirurgia , Hidrocele Testicular/cirurgia , Duração da Cirurgia , Dor Pós-Operatória , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/instrumentação , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Escala Visual Analógica
9.
Rev. chil. urol ; 79(4): 66-70, 2014. ilus, graf
Artigo em Espanhol | LILACS | ID: lil-785419

RESUMO

Analizar en forma retrospectiva nuestros resultados con uretroplastías en 2 grupos según la técnica utilizada. MATERIAL Y MÉTODO: En el periodo 1997-2012 se efectuaron 58 Uretroplastías, 32 de sustitución (grupo 1) en los que se utilizó principalmente colgajo de piel de pene (77 por ciento) y 26 Uretroplastías anastomóticas (grupo 2). Motivo de análisis son 30 y 24 casos respectivamente. Un buen resultado se definió por un factor subjetivo (relato del paciente), Flujometría igual o mayor de 10 ml/seg. c/s IPSS igual o < 9.RESULTADOS: En el grupo 1 el 77 por ciento la lesión era >4 cm y con 83 por ciento de buenos resultados a una mediana de seguimiento de 41meses. El 23 por ciento, requirió procedimientos complementarios. El 61 por ciento tuvo algún compromiso de vascularización de piel de pene. En el grupo 2 el 46 por ciento fue por fractura de pelvis con una tasa de buenos resultados de 92 por ciento con una mediana de seguimiento de 25.5 meses, 21 por ciento de procedimientos complementarios de retoque y sin complicaciones. CONCLUSIONES: Nuestra serie tiene resultados comparables con lo publicados en la literatura.


Throughout this study the researcher(s) personal experience in urethroplasty during the period 1997-2012 was analyzed. To conduct it, the studied cases were divided into two different groups; the first group were 30 cases of substitution urethroplasty with a forty-one-months median follow-up, where the success rate was 83 percent. The most frequent complications were impairment of vascular supply of the penile skin secondary the use of distal penile circular fascio cutaneus flap(61 percent). The second group (group nº2) was composed by 24 cases of anastomotic urethroplasty with a median follow-up of 25,5 months, in this group the success rate was 92 percent and no complications were observed. After this study, it is possible to assert that the obtained results are in concordance with what is stated in the international literature.


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos , Uretra/cirurgia , Seguimentos , Resultado do Tratamento
10.
Int. braz. j. urol ; 39(6): 884-892, Nov-Dec/2013. tab, graf
Artigo em Inglês | LILACS | ID: lil-699125

RESUMO

Purpose To compare the histological characteristics of keratinized versus non-keratinized onlay island flaps in an experimental rabbit model. Materials and Methods Sixteen male rabbits were randomly allocated into two experimental groups: keratinized and non-keratinized onlay island flaps. A defect was created in the ventral aspect of the penile urethra. In the keratinized group, a longitudinal island flap was harvested from the external prepuce and rotated to cover the urethral defect. In the non-keratinized group a transverse island flap was harvested from the inner prepuce. The animals were sacrificed after 2, 4, 8 and 12 weeks. Results The flaps were viable in all animals, and no deaths were associated with the procedure. Two urethrocutaneous fistulas were identified, one in each experimental group. A similar pattern of fibrosis was identified in both groups. The keratinized epithelium of the external prepuce kept its histological aspect and keratin production. Both keratinized and non-keratinized groups presented a slight decrease on the epithelial thickness, however without a statistically significant difference between groups. Conclusions In this short-term rabbit model, we observed that the stratified squamous keratinized epithelium from the external prepuce kept its keratin production. There was no statistical influence of the flap type on the mean epithelial thickness. .


Assuntos
Animais , Masculino , Coelhos , Prepúcio do Pênis/cirurgia , Modelos Animais , Retalhos Cirúrgicos , Uretra/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Epitélio/química , Prepúcio do Pênis/química , Queratinas , Distribuição Aleatória , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do Tratamento , Cateterismo Urinário
11.
Rev. chil. urol ; 78(2): 13-18, ago. 2013. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-774050

RESUMO

Existe un grupo de pacientes con criptorquidias palpables en los que la liberación de los vasos espermáticos y el conducto deferente en el retroperitoneo por laparoscopía, facilitaría la orquidopexia abierta en un sólo tiempo y mejoraría el pronóstico de posición y vitalidad testicular a largo plazo. Presentamos nuestra experiencia inicial de pacientes tratados con esta técnica, a la que hemos denominado Orquidopexia Video Asistida (OVA).Estudio prospectivo entre agosto de 2011 y marzo de 2012 que incluyó 15 pacientes y 16 testículos. Se incluyeron criptorquidias canaliculares altas, “peeping testis” y re-operaciones. Se excluyeron pacientes que, en el examen bajo anestesia general, se palpó testículo en posición canalicular media o baja. En 8 meses se realizaron 9 OVA izquierdas, 5 derechas y 1 bilateral. La edad operatoria promedio de los pacientes fue de 3,7 años. El tiempo quirúrgico promedio fue de 55 minutos. El tiempo de seguimiento promedio fue de 9 meses (r6-14 meses). El seguimiento clínico ha mostrado posición normal y buena vitalidad testicular evaluada por tamaño testicular al examen físico en todos los pacientes. CONCLUSIONES: Los resultados clínicos preliminares son alentadores. Proponemos agregar OVA al algoritmo de tratamiento de las criptorquidias palpables.


There is a group of patients with palpable cryptorchidism in which releasing the spermatic vessels and the vas deferens in the retroperitoneum through laparoscopy, facilitates the open orquidopexy in a single time and improves the prognosis of testicular position and vitality on the long term. We report our initial experience of patients treated with this technique, which we called Video Assisted orchidopexy (OVA).Prospective study between August 2011 and March 2012, which included 15 patients and 16 testicles. High canalicular cryptorchidism, “peeping testis” and re-operations were included. We excluded patients who, on examination under general anesthesia, had a palpable canalicular testis in middle or low position. RESULTS: In a peroid of 8 months we performed 9 left, 5 right and 1 bilateral OVA. Mean age of the patients was 3.7 years. Mean operative time was 55 minutes. Average follow-up time was 9 months (r6-14 months). Clinical follow-up shows normal position and good vitality as assessed by testicular size at physical examination on all patients. Preliminary clinical results are encouraging. We propose adding OVA treatment algorithm palpable cryptorchidism.


Assuntos
Humanos , Masculino , Criança , Criptorquidismo/cirurgia , Laparoscopia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Cirurgia Vídeoassistida , Seguimentos , Duração da Cirurgia , Estudos Prospectivos , Resultado do Tratamento , Testículo/cirurgia
12.
Rev. chil. urol ; 78(2): 66-70, ago. 2013. tab
Artigo em Espanhol | LILACS | ID: lil-774059

RESUMO

INTRODUCCIÓN: El varicocele es una causa frecuente de infertilidad en el hombre, encontrándose en el 40 por ciento de los hombres que consultan por infertilidad, existiendo diversas teorías que explican esta situación. Numerosos estudios apuntan a que la reparación del varicocele se asociaría a una mejoría en los parámetros seminales e incluso en las tasas de fertilidad. Entre las técnicas reparativas la varicocelectomía microquirúrgica (VM) se ha posicionado como la técnica gold standard dado sus mejores resultados en cuanto a éxito, recidiva y seguridad. OBJETIVO: evaluar el rol de la VM en los parámetros seminales de varones que consultan por infertilidad y que son sometidos a VM bilateral en comparación con aquellos en que se realiza VM unilateral. Materiales y método: se seleccionó a pacientes con varicocele clínico que consultaron por infertilidad y que tenían el espermiograma alterado, a los que se realizó VM uni o bilateral según tuvieran la enfermedad en uno o ambos lados. Se tomó el promedio de los parámetros seminales de 2 espermiogramas pre-operatorios y otras variables clínicas y demográficas y se comparó con los parámetros seminales a 6 meses post-cirugía. Además se comparó los resultados del grupo de VM bilateral con el unilateral. RESULTADOS: no hubo diferencias entre los grupos en el pre-operatorio, evidenciándose una mejoría en ambos grupos al analizar los resultados a los 6 meses post-VM. Esta mejoría fue significativamente mayor en el grupo de VM unilateral en cuanto a la concentración espermática (mediana de 6 mill/ml, comparado con 0.75 mill/ml en el grupo de pacientes sometidos a VM bilateral. p Value = 0.02)...


Introduction: Varicocele is a common cause of infertility in men, present in 40 percent of men with infertility, there are several theories that explain this situation. Numerous studies suggest that varicocele repair would be associated with an improvement in semen parameters and even fertility rates. Among the reparative techniques microsurgical varicocelectomy (VM) has positioned itself as the gold standard technique given the best results in terms of success, recurrence and security. Objective: To evaluate the role of the VM in semen parameters of men consulting for infertility and who undergo bilateral VM compared to those VM is performed unilaterally. Materials and Methods: We enrolled patients with clinical varicocele who consulted for infertility and had altered semen analysis, in which VM was performed unilateral or bilateral depending if they had the disease in one or both sides. The average of 2 pre-operative semen parameters was used and other clinical and demographic variables and they were compared with semen parameters at 6 months post-surgery. We also compared the results of the group with unilateral versus that with bilateral VM. Results: There were no differences between groups in the pre-operative, evidence-dose improvement in both groups in analyzing the results at 6 months post-VM. This improvement was significantly greater in the group of unilateral VM regarding sperm concentration (median of 6 mill / ml, compared with 0.75 million / ml in the group of patients undergoing bilateral VM. P Value = 0.02).Discussion: VM improves seminal parameters in patients with unilateral or bilateral varicocele, being unilateral VM group that benefits the most. This could be explained by a greater cumulative damage spermatogenesis in the case of bilateral varicocele. Randomized controlled prospective studies are needed, allowing to determine the real effect of unilateral vs. bilateral VM.


Assuntos
Humanos , Masculino , Adulto , Microcirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Varicocele/cirurgia , Infertilidade Masculina/cirurgia , Infertilidade Masculina/etiologia , Estudos Prospectivos , Varicocele/complicações
13.
Int. braz. j. urol ; 38(3): 307-316, May-June 2012.
Artigo em Inglês | LILACS | ID: lil-643029

RESUMO

We performed an overview of the surgical techniques suggested for the treatment of anterior urethral strictures using MEDLINE. In applying the MEDLINE search, we used the "MeSH" (Medical Subject Heading) and "free text" protocols. The MeSH search was conducted by combining the following terms: "urethral stricture", "flap", "graft", "oral mucosa", "urethroplasty", "urethrotomy" and "failed hypospadias". Multiple "free text" searches were performed individually applying the following terms through all fields of the records: "reconstructive urethral surgery", "end-to-end anastomosis", "one-stage", "two stage". Descriptive statistics of the articles were provided. Meta-analyses were not employed. Seventy-eight articles were determined to be germane in this review. Six main topics were identified as controversial in anterior urethra surgery: the use of oral mucosa vs penile skin; the use of free grafts vs pedicled flaps in penile urethroplasty; the use of grafts vs anastomotic repair in bulbar urethral strictures; the use of dorsal vs ventral placement of the graft in bulbar urethroplasty; the use of definitive perineal urethrostomy vs one-stage repair in complex urethral strictures; the surgical options for patients with failed hypospadias repair. Different points of view are documented and presented in the literature by various authors from different countries. The aim of this clinical overview is to survey the main controversial issues in surgical reconstruction of the anterior urethra focusing on the use of flap or graft, substitute material, type of surgery and challenging situations, such as failed hypospadias or complex urethral stricture repair.


Assuntos
Humanos , Masculino , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Pênis/cirurgia , Transplante de Pele
14.
Int. braz. j. urol ; 36(2): 198-201, Mar.-Apr. 2010. ilus
Artigo em Inglês | LILACS | ID: lil-548380

RESUMO

PURPOSE: Penile carcinoma is a rare but mutilating malignancy. In this context, partial penectomy is the most commonly applied approach for best oncological results. We herein propose a simple modification of the classic technique of partial penectomy, for better cosmetic and functional results. TECHNIQUE: If partial penectomy is indicated, the present technique can bring additional benefits. Different from classical technique, the urethra is spatulated only ventrally. An inverted "V" skin flap with 0.5 cm of extension is sectioned ventrally. The suture is performed with vicryl 4-0 in a "parachute" fashion, beginning from the ventral portion of the urethra and the "V" flap, followed by the "V" flap angles and than by the dorsal portion of the penis. After completion of the suture, a Foley catheter and light dressing are placed for 24 hours. CONCLUSIONS: Several complex reconstructive techniques have been previously proposed, but normally require specific surgical abilities, adequate patient selection and staged procedures. We believe that these reconstructive techniques are very useful in some specific subsets of patients. However, the technique herein proposed is a simple alternative that can be applied to all men after a partial penectomy, and takes the same amount of time as that in the classic technique. In conclusion, the "parachute" technique for penile reconstruction after partial amputation not only improves the appearance of the penis, but also maintains an adequate function.


Assuntos
Humanos , Masculino , Carcinoma/cirurgia , Neoplasias Penianas/cirurgia , Pênis/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Retalhos Cirúrgicos , Procedimentos Cirúrgicos Urológicos Masculinos/instrumentação
15.
Int. braz. j. urol ; 35(4): 442-449, July-Aug. 2009. ilus, tab
Artigo em Inglês | LILACS | ID: lil-527203

RESUMO

Introduction: Posterior urethral strictures after prostatic radiotherapy or surgery for benign prostatic hyperplasia (BPH) refractory to minimal invasive procedures (dilation and/or endoscopic urethrotomy) are challenging to treat. Published reports of alternative curative management are extremely rare. This is a preliminary report on the treatment of these difficult strictures by urethroplasty. Materials and Methods: Seven cases were treated: 4 cases occurred after open prostatectomy or transurethral resection of the prostate for BPH, one case after external beam irradiation and 2 after brachytherapy. The 4 cases after BPH-related surgery were in fact complete obstructions at the bladder neck and the membranous urethra with the prostatic urethra still partially patent. Anastomotic repair by perineal route was done in all cases with bladder neck incision in the BPH-cases and prostatic apex resection in the radiotherapy cases. Results: Mean follow-up was 31 months (range: 12-72 months). The operation was successful, with preserved continence, in 3 of the 4 BPH-cases and in 2 of the 3 radiotherapy cases. An endoscopic incision was able to treat a short re-stricture in the BPH-patient and a longer stricture at the bulbar urethra could be managed with a perineostomy in the radiotherapy-patient. Conclusion: Posterior non-traumatic strictures refractory to minimal invasive procedures (dilation/endoscopic urethrotomy) can be treated by urethroplasty using an anastomotic repair with a bladder neck incision if necessary.


Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Seguimentos , Prostatectomia/efeitos adversos , Resultado do Tratamento , Uretra/cirurgia , Estreitamento Uretral/etiologia
17.
Repert. med. cir ; 18(2): 70-75, 2009. tab
Artigo em Espanhol | LILACS | ID: lil-519861

RESUMO

La resección transuretral de próstata es un procedimiento común para tratar patologías urinarias obstructivas benignas. Al material obtenido se le practica estudio histológico para confirmar la naturaleza benigna, pero en algunos casos se ha encontrado como hallazgo incidental un adenocarcinoma en estadios tempranos. No se sabe con claridad cuánto material debe procesarse o si la cantidad de tejido examinado aumenta la posibilidad de encontrar cáncer. El objetivo de este trabajo es determinar la frecuencia de adenocarcinoma incidental de próstata en pacientes sometidos a RTU por causa benigna. Reune 196 casos de RTU en los que se procesó en una segunda fase todo el tejido restante obtenido, describiendo las variables edad, peso del espécimen, número de láminas procesadas, niveles de PSA y categoría diagnóstica, la cual fue clasificada como negativa para maglinidad, PIN alto de grado y adenocarcinoma de próstata estadios T1a y T1b. Se encontró que la frecuencia de cáncer próstata en pacientes a quienes se les realizó RTU por hiperplasia prostática benigna en el Hospital de San José fue muy baja, dos pacientes de 71 y 80 años, además de otro que corresponde a una neoplasia intraepitelial de alto grado (PIN de AG) con niveles normales de PSA, lo que evidencia que la frecuencia es menor que la reportada en la literatura internacional.


Transurethral resection of the prostate (TURP) is a common procedure performed to treat benign urinary obstruction conditions. The specimen obtained undergoes hystologic work-up to confirm benign nature, but in some cases, an early-stage adenocarcinoma is found incidentally. It is not clearly known how much material must be processed or if the amount of tissue examined increases likelihood of finding cancer. The purpose of this work is to determine the frequency rate of incidental prostatic adenocarcinoma in patients who undergo TURP for a benign cause. It gathers 196 cases of TURP in which all the remaining tissue obtained underwent a second phase work-out, considering variables as age, weight of specimen, number of slides processed, PSA levels and diagnostic category, which was classified as negative for malignancy, high-grade prostatic intraepithelial neoplasia (PIN) and prostatic adenocarcinoma in stages T1a and T1b. It was evidenced that the frequency of prostate cancer in patients who underwent TURP for benign prostatic hyperplasia at the San José Hospital was very low, consisting of two patients 71 and 80 years old, as well as one that corresponds to a high-grade prostatic intraepithelial neoplasia (PIN of AG) with normal PSA levels, which evidences that our frequency rate is smaller than that reported in international literature.


Assuntos
Humanos , Hiperplasia Prostática , Ressecção Transuretral da Próstata , Neoplasia Prostática Intraepitelial , Neoplasias da Próstata , Procedimentos Cirúrgicos Urológicos Masculinos
18.
Rio de Janeiro; s.n; 2009. 45 p. ilus.
Tese em Português | LILACS | ID: lil-563327

RESUMO

Objetivo: A realização meticulosa de uma incisão ou excisão do segmento estenosado e da esponjofibrose associada tanto proximal quanto distal é critica para o sucesso da uretroplastia anterior. Entretanto, a normalidade das margens da uretra estenosada são determinadas durante o procedimento cirúrgico, baseadas apenas no aspecto macroscópico do tecido. Estudos microscópicos avaliando as margens normais não foram encontrados na literatura. O objetivo deste trabalho é caracterizar o aspecto histológico das margens supostamente normais da estenose da uretra masculina e o efeito causado pela realização de uma cistostomia suprapúbica, na microestrutura da extremidade uretral proximal à estenose. Materiais e Método: As amostras foram obtidas de 29 pacientes com média de idade de 40,3 anos, variando de 20 a 65 anos, que foram submetidos à uretroplastia bulbar término-terminal. Depois que o segmento estenosado foi removido, foram realizadas biópsias das extremidades supostamente sadias (proximais e distais). A caracterização estrutural foi realizada pelas seguintes colorações histológicas: Hematoxilina e Eosina, tricrômico de Masson, resorcina-fucsina de Weigert, e picrosirius polarizado. Pelo menos um mês antes da uretroplastia, foi realizada uma cistostomia suprapúbica em 15 pacientes (52%). O grupo controle consistiu de 10 uretras bulbares obtidas de cadáveres frescos, macroscopicamente normais, com média de idade de 24,7 anos (entre 21 e 32 anos). Resultados: A estenose de uretra se decorreu da retração cicatricial do tecido fibroso que ocupou os seios vasculares do corpo esponjoso. Este tecido foi constituído por uma matriz extracelular (MEC) densa em todos os pacientes. A MEC foi constituída, na sua maioria, principalmente por colágeno e fibras elásticas. Nenhum paciente apresentou as margens uretrais normais. Todas as extremidades apresentaram alterações microscópicas agudas e/ou crônicas quando comparadas ao grupo controle...


Purpose: Meticulous incision or excision of the stenotic segment and any associated proximal and distal spongiofibrosis is critical to the reliable success of urethroplasty procedures. However, normal urethral limits are determined during surgical reconstruction based on macroscopic aspects only. To our knowledge, microscopic studies evaluating the normal urethral ends have not been done. We aimed to describe the histological pattern of the presumed healthy limits of the urethral stricture disease, and the effect of a suprapubic urinary diversion on the proximal urethral end. Materials and Methods: Samples were obtained from 29 patients 20 to 65 years old (mean age 40.3) who underwent end-to-end bulbar urethroplasty. After urethral strictured segments were excised, biopsies of the presumed healthy ends (proximal and distal) were performed. Structural characterization was evaluated by staining histological sections in Haematoxylin-Eosin, Masson's trichrome, Weigert's resorcin-fuchsin method, and picrosirius-polarization method. At least one month before urethroplasty, suprapubic urinary diversion was performed in fifteen (52%) patients. The control group consisted of 10 bulbar urethras obtained from fresh, macroscopically normal cadavers 21 to 32 years old (mean age 24.7). Results: Urethral strictures were due to contraction of the fibrous tissue which has begun to replace the normal structures of the corpus spongiosum. A replacement of the vascular sinusoids in the corpus spongiosum by a dense extracellular matrix (ECM) occurred in all patients. ECM was formed mainly by collagen (vast majority of them) and elastic fibers. No patient presented microscopic normal urethral ends. All urethral edges presented chronic and/or acute microscopic changes if compared to the control group. With regard to the proximal end, the deposit of ECM presented high cellular density in 18 (62.1%) cases. These cells were predominantly fibroblast and inflammatory cells...


Assuntos
Humanos , Masculino , Anastomose Cirúrgica/métodos , Matriz Extracelular , Estreitamento Uretral/cirurgia , Estreitamento Uretral/patologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Uretra/cirurgia , Uretra/patologia
19.
Rev. chil. urol ; 74(1): 26-29, 2009. tab, graf
Artigo em Espanhol | LILACS | ID: lil-562705

RESUMO

Introducción: La literatura no menciona la hematuria asintomática (HA), como una complicación tardía en el largo plazo de la cirugía de la Hiperplasia Benigna de la Próstata (HBP), sino más bien se le asocia con la presencia de un tumor vesical y menos frecuentemente con un tumor renal. En los últimos años hemos tenido una serie de pacientes que consultaron por HA y el antecedente común de una cirugía por HBP en el pasado. El objeto de este estudio es investigar en éstos enfermos las causas de su hematuria. Material y Métodos: Registramos desde mayo de 2003 a junio de 2007 los pacientes que consultaron por HA y tenían además el antecedente de cirugía previa por HBP. Se les realizó Anamnesis, Examen físico, Orina completa, Urocultivo, APE, Creatinina, Ecografía renal y pelviana y Cistoscopia. Resultados: Registramos 21 enfermos que consultaron por HA y tenían el antecedente de cirugía porHBP en el pasado. Edad promedio 71,4 años (53-85 años). Tiempo post-operatorio promedio 6,3años (2-15 años), 18 enfermos (85,75 por ciento) habían tenido una RTU y 3 pacientes (14,3 por ciento) una Adenomectomía prostática transvesical, 6 enfermos (28,6 por ciento) tomaban aspirina en forma permanente. En 18 de los 21 enfermos (85,7 por ciento) de los pacientes sólo encontramos la presencia de pseudopolipos y varicocidades de la logue prostática y cuello vesical como zonas originarias de la hematuria, 3 enfermos (14,3 por ciento) tenían una recidiva de la HBP parcialmente obstructiva asociada a pseudopolipos y en sólo 1 enfermo (4,8 por ciento) detectamos un tumor papilar de la vejiga. 17 pacientes (87,7 por ciento) fueron tratados en forma conservadora y 4 enfermos (19 por ciento) requirieron de una intervención quirúrgica para el control de su hematuria incluido en ellos el paciente del tumor vesical.


Introduction: The literature don´t mention the asyntomatic haemathuria (AH) as a late complication in the large follow up of the surgery of Benign hyperplasia of the prostate (BPH). Most common allude to the suspicion of a bladder neoplasm’s or kidney tumour. In the last years we had have a number of patients with AH and Surgery by BPH in the past. The object of this study is to investigate the origin of this haemathuria. Material and Methods: We recorded from May 2003 to June 2007 the patients with AH and previous surgery of BPH. We studied them with history, physical examination, urine sediment, urine culture, PSA, creatinine, renal and pelvic ultrasound, and cistoscopy. Results: We recorded 21 patients with AH and BPH surgery in the past. Average age 71,4 years (53-85 years), Average time post surgery 6.3 years (2-15 years). 18 patients (85.7 percent) had a TURP and 3 patients (14.3 percent) had an open prostatectomy. 6 patients (28.6 percent) use aspirin. In 18 of 21 patients (85.7 percent) we only fended the existence of pseudopolips and or varicose of the prostatic loge and bladder neck as the origin of the blood. 3 patients (14.3 percent) had a BPH recidive associated to the pseudopolips. In only one patient (4.8 percent) we detected a bladder tumour. 17 patients (87.5 percent) were conservativement treated and 4 patients required an surgical management for haemathuria control include them the patient with bladder tumour.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Hematúria/etiologia , Hiperplasia Prostática/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
20.
Rev. chil. cir ; 60(6): 570-574, dic. 2008. ilus
Artigo em Espanhol | LILACS | ID: lil-512406

RESUMO

Restablecer la cobertura cutánea en lesiones de urgencia es un desafío para el cirujano, más aún si se trata del pene, ya sea por desforramiento accidental o secundario a procesos sépticos de la región perineal. Se presentan 2 casos. El primero por lesión accidental en un menor de 9 años, quien pierde la totalidad de la piel peneana. El segundo caso en un paciente de 65 años, diabético e hipertenso que presentó un episodio de fasceítis necrotizante. En ambos casos se realiza una cobertura cutánea del defecto utilizando 2 colgajos fasciocutßneos de las bolsas escrotales. En el caso del ni±o, el defecto de cobertura creado en éstas se cubre con colgajo fasciocutáneo de la cara anterior del muslo, y éste último con un injerto dermoepidérmico de la extremidad contralateral, utilizando la misma técnica descrita para el menor. La técnica utilizada cumplió plenamente con los objetivos de realizar una cobertura adecuada, semejante a la piel original, sin interferir con el desarrollo sexual normal del menor y minimizando el trauma psicológico. En el paciente adulto los resultados funcionales y estéticos son adecuados. En la literatura revisada hay muy pocos casos clínicos con utilización de ésta técnica.


To restore the cutaneous coverage in urgency injuries is a challenge for the surgeon, even more if it is a question of cutaneous coverage of the penis, by accidental degloving or secondary to septic processes of perineal región. We present two cases. The first one is a 9 years oíd minor, who lost the totality of his penis skin by accidental injury. The second case is a diabetic and hypertense, 65 years oíd patient, who had an episode of necrotizing fasciitis. In both cases the defect was covered with 2 fasciocutaneous flaps from the scrotal bags. In the child case the defect created in this area was repaired by an antero-internal thigh fasciocutaneous flap and finally the thigh defect was covered by split-skin grafts taken from the contralateral lower limb. The used technique fulfilled the objectives to make a suitable cover and similar to original skin, without interfering with the normal sexual development of the minor and to attenuate the psychological trauma. In the adult patient the functional and aesthetic results are satisfactory. In reviewed Hterature, there are just a few cases of this surgical technique.


Assuntos
Humanos , Masculino , Criança , Pessoa de Meia-Idade , Pênis/lesões , Pele/lesões , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Retalhos Cirúrgicos , Escroto/cirurgia , Pênis/cirurgia , Pele/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Resultado do Tratamento
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