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1.
Medicine (Baltimore) ; 99(26): e20803, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590764

RESUMO

RATIONALE: Voiding difficulty is more common in males, although it is not uncommon in females. Female voiding difficulty can be caused by iatrogenic, anatomic, and neurogenic factors, and specifically urethra stricture, impaired detrusor contractility, primary bladder neck obstruction, and detrusor-external sphincter dyssynergia. Labial adhesion is a rare cause of female voiding difficulty.The incidence of labial fusion has been reported to be 0.6% to 1.4% in children; however, the incidence in the elderly has yet to be fully elucidated. PATIENT CONCERNS: We present the case of a postmenopausal and sexually inactive 76-year-old female patient who had nearly total vaginal and urethral occlusion due to labial adhesion. She had no underlying diseases and came to our clinic with a 10-month history of voiding difficulty, postmicturition dribbling, and involuntary urinary leakage when getting up. DIAGNOSIS: A genital examination revealed nearly total fusion of the labia minor with only a 3-mm pinhole opening at the posterior end. INTERVENTIONS: Treatment included surgical separation, the local application of estrogen cream, and self-dilatation. She also received an antimuscarinic agent to treat overactive bladder secondary to bladder outlet obstruction which was caused by labial adhesion. OUTCOMES: No surgical complications occurred. Moreover, no labial adhesion or voiding dysfunction was found immediately after the surgery or after 6 months of follow-up. LESSONS SUBSECTIONS: Genital examinations are a basic but very important noninvasive skill for physicians. This case report highlights that genital examinations should be a priority for patients with gynecological or urological symptoms.


Assuntos
Estrogênios/administração & dosagem , Obstrução do Colo da Bexiga Urinária , Bexiga Urinária Hiperativa , Procedimentos Cirúrgicos Urogenitais/métodos , Doenças da Vulva , Idoso , Feminino , Humanos , Antagonistas Muscarínicos/uso terapêutico , Pós-Menopausa , Resultado do Tratamento , Uretra/patologia , Uretra/fisiopatologia , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/fisiopatologia , Obstrução do Colo da Bexiga Urinária/cirurgia , Bexiga Urinária Hiperativa/tratamento farmacológico , Bexiga Urinária Hiperativa/etiologia , Micção , Cremes, Espumas e Géis Vaginais/administração & dosagem , Doenças da Vulva/complicações , Doenças da Vulva/diagnóstico , Doenças da Vulva/fisiopatologia , Doenças da Vulva/cirurgia
6.
Urologe A ; 59(4): 432-441, 2020 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-32270241

RESUMO

Vesicovaginal fistulas (VVF) represent a detrimental condition causing psychological, physical and social strain on patients. In developed countries they are predominantly the result of pelvic surgery or radiation therapy, whilst obstetric VVF are common in developing countries due to prolonged and complicated births. The majority of VVF require surgical therapy, thus a comprehensive diagnostic workup is needed. Depending on diagnostic characteristics fistula repair can be performed by a transvaginal, transabdominal or minimally invasive approach. Timing of surgery, appropriate interposition of vascularized grafts, optimized postoperative management and surgical expertise are determining factors for successful treatment. This review describes the diagnostic workup and therapeutic management of VVF including various surgical techniques.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Urogenitais/métodos , Procedimentos Cirúrgicos Urológicos/métodos , Fístula Vesicovaginal/diagnóstico , Fístula Vesicovaginal/cirurgia , Feminino , Humanos , Histerectomia , Retalhos Cirúrgicos , Fístula Vesicovaginal/etiologia
10.
Updates Surg ; 72(1): 205-211, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31927754

RESUMO

Recto-vaginal (RVF) and recto-urethral (RUF) fistulas are infrequent but disabling conditions that severely affect patients' quality of life. Considering the high recurrence rate after conservative approaches, the best surgical treatment is still challenging. The aim of this study was to evaluate the outcome of graciloplasty to treat patients with complex RVF or RUF, and to investigate its effect on the quality of life. Fourteen patients with RVF and RUF who underwent graciloplasty between 2003 and 2017 were retrospectively enrolled. The main outcome was the healing rate of fistulas. Postoperative patients satisfaction was evaluated administering the Clinical Patient Grading Assessment Scale (CPGAS), SF-36 questionnaires and Changes in Sexual Functioning (CSF) questionnaires. The Wexner score was calculated in case of preoperative faecal incontinence. RVF and RUF were iatrogenic in 11 patients and due to Crohn's disease in 3 cases. After 1 year of follow-up (IQR 10-14 months), the success rate of the procedure was 78%. Out of three patients with RVF due to Crohn's disease, two healed after the procedure. Six months after surgery, all eight SF-36 domains significantly improved except for "body pain"; CSF score significantly increased from 35.5 (IQR 31-38.7) to 44 (IQR 37.7-48.5); CPGAS score improved from a median value of 0 (IQR 0-0) to 4 (IQR 3.2-4). The Wexner score was calculated only in 5 patients with preoperative faecal incontinence and it significantly decreased from a median value of 12 (IQR 11-14) to 5 (IQR 4-5). Graciloplasty could be considered as a first option treatment for complex or recurrent RVF and RUF. It shows a good healing rate even in case of unfavourable factors like Crohn's disease.


Assuntos
Fístula/fisiopatologia , Fístula/cirurgia , Qualidade de Vida , Recuperação de Função Fisiológica , Doenças Retais/fisiopatologia , Doenças Retais/cirurgia , Doenças Uretrais/fisiopatologia , Doenças Uretrais/cirurgia , Fístula Urinária/fisiopatologia , Fístula Urinária/cirurgia , Procedimentos Cirúrgicos Urogenitais/métodos , Doenças Vaginais/fisiopatologia , Doenças Vaginais/cirurgia , Feminino , Humanos , Masculino , Satisfação do Paciente , Inquéritos e Questionários , Resultado do Tratamento
11.
BMJ Case Rep ; 12(12)2019 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-31826903

RESUMO

This case report describes the case of a 37-year-old man that noticed an intrascrotal right mass with 1 month of evolution. During physical exam presented with a large mass at the inferior portion of the right testicle, clearly separated from the testicle, with a tender consistency and mobile. An ultrasound was performed that showed a solid and subcutaneous nodular lesion, extra testicular, heterogeneous, measuring 7.2 cm. Pelvic magnetic resonance imageMRI showed a lesion compatible with a lipoma. The patient was subjected to surgical excision of the lesion by scrotal access, having histology revealed a lipoblastoma (LB) of the scrotum. Histological diagnosis was obtained by microscopic characteristics (well-circumscribed fatty neoplasm) and immunohistochemistry (stains for CD34, S100 protein and PLAG1 were positive; stains for MDM2 and CDK4 were negative). LB is extremely rare after adolescence in any location, being this first described case of intrascrotal LB described in adulthood.


Assuntos
Lipoblastoma/patologia , Escroto/patologia , Neoplasias Testiculares/patologia , Procedimentos Cirúrgicos Urogenitais/métodos , Adulto , Humanos , Imuno-Histoquímica , Lipoblastoma/cirurgia , Imagem por Ressonância Magnética , Masculino , Neoplasias Testiculares/cirurgia , Resultado do Tratamento
12.
Urology ; 134: 2-23, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31415778

RESUMO

BACKGROUND: This study reports the re-operation and symptom resolution rates of different techniques used in surgical excision of genitourinary mesh erosions. METHODS: A comprehensive systematic review was completed after searching electronic databases for studies involving outcomes of mesh erosion in humans that were managed surgically using a transvaginal, cystoscopic, or abdominal approach. Surgical outcomes were reported in percentages, ranges, and simple pooling to generate trends in management techniques. RESULTS: There were 177 cases that met our inclusion criteria. Forty-one patients underwent cystoscopic removal of eroded urethral mesh while 40 cases underwent transvaginal removal of urethral mesh. CONCLUSIONS: For mesh eroded into the urethra, a transvaginal vs. cystoscopic approach showed a trend toward resolution of symptoms and fewer interventions. For mesh eroded into the bladder, abdominal and cystoscopic approaches had similar symptom resolution, but abdominal approach required fewer interventions.


Assuntos
Falha de Prótese , Reoperação , Telas Cirúrgicas/efeitos adversos , Procedimentos Cirúrgicos Urogenitais , Pesquisa Comparativa da Efetividade , Humanos , Falha de Prótese/efeitos adversos , Falha de Prótese/etiologia , Reoperação/efeitos adversos , Reoperação/métodos , Procedimentos Cirúrgicos Urogenitais/efeitos adversos , Procedimentos Cirúrgicos Urogenitais/instrumentação , Procedimentos Cirúrgicos Urogenitais/métodos
13.
Fertil Steril ; 112(3): 406-407, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31446899

RESUMO

This month's Views and Reviews continues with part two of the series regarding reproductive surgery. The roles of reproductive surgery in müllerian anomalies, tubal and pelvic disease, fertility preservation, and male reproductive surgery are included. Augmenting each contribution, authors have added images and videos to their reflections.


Assuntos
Preservação da Fertilidade/métodos , Histeroscopia/métodos , Laparoscopia/métodos , Feminino , Preservação da Fertilidade/tendências , Previsões , Humanos , Histeroscopia/tendências , Laparoscopia/tendências , Procedimentos Cirúrgicos Urogenitais/métodos , Procedimentos Cirúrgicos Urogenitais/tendências
14.
Fertil Steril ; 112(3): 408-416, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31446900

RESUMO

Disorders of development, fusion, or resorption of paired müllerian ducts and urogenital sinus may cause various congenital malformations of the corpus uteri, cervix, vagina, and fallopian tubes. Classification systems have been developed to better characterize these anomalies, and each has advantages and disadvantages. Clinical correlation of classification of anomalies with pre- and postsurgical outcomes is needed to better direct treatment. Methods to evaluate these anomalies are primarily radiologic studies, with diagnostic surgery rarely used. Treatment of müllerian anomalies used to focus on relief of symptoms. Now, as diagnostic and surgical options have expanded, preservation or improvement of reproductive potential is a primary goal. As a consequence, controversies in surgical management have also developed. Future directions in this field include better-quality studies with the use of consistent diagnostic criteria to evaluate impacts of treatment on clinical outcomes.


Assuntos
Ductos Paramesonéfricos/anormalidades , Ductos Paramesonéfricos/cirurgia , Procedimentos Cirúrgicos Urogenitais/tendências , Feminino , Genitália Feminina/anormalidades , Genitália Feminina/cirurgia , Humanos , Anormalidades Urogenitais/diagnóstico , Anormalidades Urogenitais/cirurgia
15.
Turk J Med Sci ; 49(4): 1132-1137, 2019 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286757

RESUMO

Background/aim: It was aimed to describe the external-internal ureteral catheterization technique and evaluate its safety, efficacy, and reliability in iatrogenic and traumatic ureteral injuries. Materials and methods: A retrospective review was performed on patients with iatrogenic and traumatic ureteral injury, treated using the external-internal ureteral catheterization technique between May 2012 and January 2018 in our hospital. A total of 14 patients were investigated with clinical, postoperative, and follow-up findings, as well as technical outcomes. Results: The urology, gynecology, and general surgery departments referred patients for treatment at a rate of 57% (n = 8), 36% (n = 5), and 7% (n = 1), respectively. The causes were urological procedures for lithiasis (43%, n = 6), gynecological surgery (36%, n = 5), rectosigmoid surgery (7%, n = 1), penetrating injury (7%, n = 1), and partial nephrectomy (7%, n = 1). The most commonly affected segment was the distal third of the ureter, at a rate of 79% (n = 11). The mean duration of catheterization in all of the patients was 39 days. The overall technical success was 100% and no major complications occurred. Conclusion: The external-internal ureteral catheterization technique in patients with ureteral injury is easy to apply and effective not only in reducing costs but also complications that may result from recurrent percutaneous interventions.


Assuntos
Complicações Pós-Operatórias/cirurgia , Ureter/lesões , Cateterismo Urinário/métodos , Procedimentos Cirúrgicos Urogenitais/efeitos adversos , Adulto , Feminino , Humanos , Doença Iatrogênica , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
17.
Curr Opin Pediatr ; 31(4): 570-574, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31246626

RESUMO

PURPOSE OF REVIEW: The review focuses on genitoplasty, performed on young children with disorders/differences of sex development (DSD) to 'typify' ambiguous external genitalia and intended to result in either male or female-appearing genitals. Consensus on whether or not early genitoplasty is optimal or appropriate has yet to be achieved. This article reviews arguments in favor of early surgery as well as those disputing their justification. RECENT FINDINGS: Arguments supporting early genitoplasty include the assumption that a child's genital anatomy should match their gender of rearing for optimal psychosocial development and that outcomes are better physically and psychologically than when surgery is deferred. Those disputing their justification argue that they deny patients the right to participate in irreversible decisions related to anatomy and gender, revoke the possibility of an open future, and violate basic human rights. Clinical management includes recommendations for interdisciplinary care integrating psychologists, and shared decision-making processes to assist families in carefully considering options. SUMMARY: Early genital surgery in DSD care is controversial with compelling arguments put forth by both proponents and opponents. Relevant issues can be examined from ethical, psychological, cultural and medical perspectives - all of which need to be accounted for in both research and standard of care development.


Assuntos
Transtornos do Desenvolvimento Sexual/cirurgia , Desenvolvimento Sexual , Procedimentos Cirúrgicos Urogenitais/métodos , Criança , Pré-Escolar , Tomada de Decisões , Transtornos do Desenvolvimento Sexual/psicologia , Feminino , Identidade de Gênero , Humanos , Masculino
18.
J Pediatr Endocrinol Metab ; 32(6): 643-646, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31145695

RESUMO

Background Shared decision-making (SDM) is the process by which patients/families and providers make healthcare decisions together. Our team of multidisciplinary disorders of sex development (DSD) has developed an SDM tool for parents and female patients with congenital adrenal hyperplasia (CAH) and associated genital atypia. What is new Elective genital surgery is considered controversial. SDM in a patient with genital atypia will allow patient/family to make an informed decision regarding surgical intervention. Case presentation Our patient is a 2.5-year-old female with CAH and genital atypia. Initially, her parents had intended to proceed with surgery; however, after utilizing the SDM checklist, they made an informed decision to defer urogenital sinus surgery for their daughter. Conclusions We successfully utilized an SDM tool with parents of a female infant with CAH and genital atypia, which allowed them to make an informed decision regarding surgery for their daughter. Future directions include a prospective enrolling study to determine the generalizability and applicability of SDM with families of children diagnosed with CAH.


Assuntos
Hiperplasia Suprarrenal Congênita/cirurgia , Tomada de Decisão Compartilhada , Transtornos do Desenvolvimento Sexual/cirurgia , Pais/psicologia , Procedimentos Cirúrgicos Urogenitais/psicologia , Pré-Escolar , Feminino , Humanos , Recém-Nascido , Disseminação de Informação , Prognóstico , Procedimentos Cirúrgicos Urogenitais/estatística & dados numéricos
19.
Urology ; 131: 36-39, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31136768

RESUMO

OBJECTIVE: To review the Society of Genitourinary Reconstructive Surgeons fellowship and matching process. There are currently 20 fellowships offered. A centralized match began in 2013-2014. Fellowship directors and graduated fellows were surveyed regarding their experience in their matching process, fellowship, employment opportunities, and their current practice. METHODS: A web-based survey was distributed to fellowship graduates and directors. A total of 20 and 14 open ended and multiple-choice questions were asked, respectively. Multiple choice questions were rated using a Likert scale. RESULTS: A total of 24/41 (59%) graduated fellows and 14/17 (82%) fellowship directors completed the survey. Overall satisfaction for the application and match process was 4/5 for both groups. Fellow respondents reported a 96%, 92%, 92%, and 88% feeling of competency in urethral reconstruction, male incontinence, urinary diversion/ureteral reconstruction, and male sexual health, respectively. A total of 92% of graduates practice in a location that they consider in their top 3 destinations. The majority, 58%, practice in academia. CONCLUSION: The Society of Genitourinary Reconstructive Surgeons has offered a recognized fellowship since 2014. Recent graduates express positive support of their fellowship training with excellent competency and employment opportunities. Fellowship directors continue to discuss broadening training to further advance this dynamic field.


Assuntos
Educação de Pós-Graduação em Medicina , Procedimentos Cirúrgicos Urogenitais/educação , Urologia/educação , Adulto , Bolsas de Estudo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato
20.
Panminerva Med ; 61(2): 152-163, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30990285

RESUMO

Varicoceles exert deleterious effect on testicular function. The condition has been associated with male infertility, testicular hypotrophy and pain. These comprises the common indications for varicocele repair currently. Significant improvement in semen parameters and pregnancy outcomes had been suggested by reports decades ago. However, selection of the best candidates remains an issue since not all patients respond positively to treatment. Consensus has been reached in recent decade after the publication of a series of meta-analyses. Significant improvement in pregnancy outcomes were reported in patients with clinical varicocele and abnormal semen parameters. Varicocelectomy in adolescents with testicular hypotrophy was supported by the positive implication on catch-up growth and semen parameters. However, little is known about the treatment effect of adolescence varicocelectomy on long term fertility and paternity rate. Recent studies on outcome of varicocele repair for pain consistently demonstrated a resolution rate of approximately 90% and support varicocele-associated pain as an indication for surgery. Alternate indications for varicocele repair have been proposed in recent decade. Despite the encouraging preliminary data, most studies were uncontrolled retrospective series. Although varicocelectomy may not obviate the need for assisted reproductive techniques in patients with non-obstructive azoospermia, it potentially increases sperm retrieval rate. The significant increase in serum testosterone after varicocelectomy in patients with androgen deficiency may open an alternative treatment for hypogonadism. The adjunctive role of varicocelectomy before assisted reproduction and the significant decrease in sperm DNA fragmentation after varicocele repair deserve further well-designed controlled studies.


Assuntos
Varicocele/cirurgia , Adolescente , Androgênios/deficiência , Azoospermia/complicações , Fragmentação do DNA , Humanos , Infertilidade Masculina/etiologia , Infertilidade Masculina/cirurgia , Masculino , Estresse Oxidativo , Técnicas de Reprodução Assistida , Testículo/patologia , Procedimentos Cirúrgicos Urogenitais , Varicocele/fisiopatologia
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