RESUMO
AIM: The objectives of this study were to evaluate the impact of preoperative urine culture and the infected nature of stones on the occurrence of postoperative urinary sepsis. MATERIAL AND METHODS: A prospective monocentric study included 29 patients operated on for urolithiasis between January and June 2018. RESULTS: Postoperative urinary sepsis was observed in 4 patients (14%). Urinary colonization rate on preoperative CBU exam was 27.6% (8 of 29) while the rate of colonized stones was 31% (9 of 29). The occurrence of urinary sepsis was observed in 37.5% (3 of 8) of patients with urinary colonization, compared to 44.4% of patients with colonized stones (4 of 9). By comparing the bacteriological results observed during sepsis, the germs isolated in postoperative urine were the same found in the culture of stones. The chemical nature of the colonized stones was mainly calcium oxalate (monohydrate, dihydrate) P=0.02. There was a statistically significant correlation between the preoperative urine culture, the bacteriological culture of stones and the postoperative urinary sepsis (P=0.05, P=0.005) respectively. CONCLUSION: Our study demonstrated a strong association between the bacteriological culture of stones and postoperative urinary sepsis superior to preoperative urine culture. It makes it possible to anticipate the occurrence of sepsis in patients requiring many endoscopic treatments. However, several multicentric prospective series may prove necessary to validate these results. LEVEL OF EVIDENCE: 3.
Assuntos
Bactérias/isolamento & purificação , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/microbiologia , Sepse/epidemiologia , Cálculos Urinários/microbiologia , Cálculos Urinários/cirurgia , Infecções Urinárias/epidemiologia , Adulto , Correlação de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Marrocos , Período Pré-Operatório , Estudos Prospectivos , Medição de Risco , Cálculos Urinários/urina , Urina/microbiologia , Urolitíase/microbiologia , Urolitíase/cirurgia , Urolitíase/urinaRESUMO
PURPOSE: Amongst the unanswered questions regarding prostate cancer (PCa), the optimal management of oligometastatic disease remains one of the major concerns of the scientific community. The very existence of this category is still subject to controversy. Aim of this systematic review is to summarize current available data on the most appropriate management of oligometastatic PCa. EVIDENCE ACQUISITION: All relevant studies published in English up to November the 1st were identified through systematic searches in PubMed, EMBASE, Cochrane Library, CINAHL, Google Scholar and Ovid database. A search was performed including the combination of following words: (prostate cancer) and (metastatic) and [(oligo) or (PSMA) or (cytoreductive) or (stereotaxic radiotherapy) or (prostatectomy)]. 3335 articles were reviewed. After title screening and abstract reading, 118 papers were considered for full reading, leaving a total of 36 articles for the systematic review. EVIDENCE SYNTHESIS: There is still no consensus on the definition of oligometastatic disease, nor on the imaging modalities used for its detection. While retrospective studies suggest an added benefit with the treatment the primitive tumor by cytoreductive prostatectomy (55% survival rate vs 21%, p < 0.001), prospective studies do not validate the same outcome. Nonetheless, most studies have reported a reduction in local complications after cytoreductive prostatectomy (< 10%) compared to the best systemic treatment (25-30%). Concerning radiotherapy, an overall survival benefit for patients with a low metastatic burden was found in STAMPEDE (HR 0.68, 95% CI 0.52-0.90; p = 0.007) and suggested in subgroup analysis of the HORRAD trial. Regarding the impact of metastases-directed therapy (MDT), the STOMP and ORIOLE trials suggested that metastatic disease control might improve androgen deprivation therapy-free survival (in STOMP: 21 vs 13 months for MDT vs standard of care). Nonetheless, the impact of MDT on long-term oncologic results remains unclear. Finally, oligometastatic disease appears to be a biologically different entity compared to high-burden metastatic disease. New findings on exosomes appear to make them intriguing biomarkers in the early phases of oligometastatic PCa. CONCLUSION: Oligometastatic PCa is today a poorly understood disease. The implementation of new imaging techniques as whole-body MRI and PSMA PET/CT has increased exponentially the number of oligometastatic patients detected. Data of available trials suggest a benefit from cytoreductive prostatectomy to reduce local complication, though its impact on survival remains unknown. Radiotherapy may be beneficial for patients with low-burden metastatic PCa, while MDT may delay the need for androgen deprivation therapy. Results from ongoing trials data are eagerly awaited to draw reliable recommendations.
Assuntos
Neoplasias da Próstata/terapia , Humanos , Masculino , Metástase Neoplásica , Neoplasias da Próstata/patologiaRESUMO
INTRODUCTION: Orthotopic neobladder (ONB) and ileal conduit (IC) are the most commonly practiced techniques of urinary diversion (UD) after radical cystectomy (RC) in bladder cancer patients. Data in the literature is still discordant regarding which UD technique offers the best HR-QoL. OBJECTIVE: The objective was to compare HR-QoL in patients undergoing ONB and IC after RC, through a systematic review of the literature and meta-analysis. MATERIAL AND METHODS: We performed a literature search of PubMed, ScienceDirect, CochraneLibrary and ClinicalTrials.Gov in September 2017 according to the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes. The studies were evaluated according to the "Oxford Center for Evidence-Based Medicine" criteria. The outcome measures evaluated were subdomains' scores of Bladder Cancer Index BCI: urinary function (UF), urinary bother (UB), bowel function (BF), bowel bother (BB), sexual function (SF) and sexual bother (SB). Continuous outcomes were compared using weighted means differences, with 95% confidence intervals. The presence of publication bias was examined by funnel plots. RESULTS: Four studies met the inclusion criteria. The pooled results demonstrated better UF and UB scores in IC patients: differences were -18.17 (95% CI: -27.49, -8.84, P=0.0001) and -3.72 (95% CI: -6.66, -0.79, P=0.01) respectively. There was no significant difference between IC and ONB patients in terms of BF and BB. SF was significantly better in ONB patients: the difference was 12.7 (95% CI, 6.32, 19.08, P<0.0001). However no significant difference was observed regarding SB. CONCLUSION: This meta-analysis of non-randomized studies demonstrated a better HR-QoL in urinary outcomes in IC patients compared with ONB patients.
Assuntos
Cistectomia/métodos , Qualidade de Vida , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária , Coletores de Urina , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Derivação Urinária/métodosRESUMO
INTRODUCTION: Postoperative ileus occurs in different degrees, in the majority of patients undergoing radical cystectomy, which may increase the length of hospital stay. The use of chewing gum has demonstrated its effectiveness in reducing time-to-bowel function and the length of hospital stay in several surgical procedures. OBJECTIVE: To evaluate the benefit of post-operative chewing gum use in patients undergoing radical cystectomy through a systematic review of the literature and meta-analysis. MATERIAL AND METHODS: We performed a literature search of MedLine, Scopus, CochraneLibrary and ClinicalTrials.Gov in March 2017 according to the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes. The studies were evaluated according to the "Oxford Center for Evidence-Based Medicine" criteria. The outcome measures evaluated were time-to-flatus, time-to-defecation, length of the hospital stay, and the rates of general and gastrointestinal postoperative complications. Continuous and dichotomous variables were compared respectively using weighted means differences and odds ratios with 95 % confidence intervals. The presence of publication bias was examined by funnel plots. RESULTS: Three studies (including 274 patients in total) met the inclusion criteria. The pooled results demonstrated a 11.82hour reduction in time-to-flatus (95 % CI : -15.43, -8.22h, P <0.00001), and 19.57hours in time-to-defecation (95 % CI : -29.33, -9.81h, P <0.0001), and a decreasing trend of 2.85 days in the length of the hospital stay (95 % CI : -6.13, -0.43, P=0.09), by the use of chewing gum. There was no significant difference between the "chewing gum" and "control" groups in terms of general and gastrointestinal complications (Peto Odds ratio 1.04 [0.60, 1.79], 95 % CI, P=0.89 and Peto Odds ratio 0.65 [0.26, 1.61], 95 % CI, P=0.35 respectively). CONCLUSION: Chewing gum may be recommended postoperatively in patients undergoing radical cystectomy to improve time-to-bowel function.
Assuntos
Goma de Mascar , Cistectomia , Motilidade Gastrointestinal , Pseudo-Obstrução Intestinal/prevenção & controle , Tempo de Internação , Cuidados Pós-Operatórios , Recuperação de Função Fisiológica , Defecação , Humanos , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/prevenção & controle , Fatores de TempoRESUMO
Retroperitoneal leiomyoma is a rare benign tumor of the retroperitoneum. We report a clinical case of a 43-year-old patient, who suffered from back pain and weight loss. Imaging revealed a retroperitoneal mass, then the patient had a total excision of the tumor. Histological examination of the surgical specimen concluded to retroperitoneal leiomyoma. The evolution was good without recurrence after 12 months.
Assuntos
Leiomioma/patologia , Neoplasias Retroperitoneais/patologia , Adulto , Feminino , Humanos , Leiomioma/cirurgia , Dor Lombar/etiologia , Neoplasias Retroperitoneais/cirurgia , Redução de PesoRESUMO
The history of pelvic prolapse back to the era of the pharaohs, about 1500 years before Christ. Hippocrates practiced succussion. Grenades, pieces of soaked linen were used as pessaries.Over the centuries, the eolution in understanding of this female pathology led to different treatment modalities, some of which we can currently seem strange.
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Prolapso Uterino/história , Feminino , História do Século XVI , História do Século XVII , História do Século XVIII , História do Século XIX , História do Século XX , História Antiga , Humanos , Pessários/históriaRESUMO
La variete de corps etrangers introduits dans l'appareil genito- urinaire defie l'imagination et peut confronter l'urologue aux difficultes de leur extraction. Si leur presence releve souvent d'une pratique douteuse d'origine psychiatrique; il faut noter la possibilite d'une migration a partir des espaces perivesicaux lors d'une chirurgie de voisinage ainsi qu'une introduction accidentelle durant une intervention transvesicale. Les symptomes du bas appareil urinaire; non specifiques; sont les circonstances fortuites de decouverte de corps etrangers intravesicaux. Bien que le pronostic vital ne soit pas engage; l'extraction chirurgicale ou endoscopique s'avere necessaire du fait de l'inflammation severe associee aux dommages vesicaux secondaires a ce corps etranger.Nous rapportons le cas d'un jeune patient admis aux urgences chez qui on trouve une broche d'osteosynthese compliquee d'une lithiase situee dans la vessie
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Administração Intravesical , Corpos Estranhos , Fixação de FraturaRESUMO
OBJECTIVE: To discuss the diagnostic and the prognostic problems of vesicouterine fistulas (VUF) emphasizing on the therapeutic characteristics that lead to successful treatment. MATERIALS AND METHODS: The authors retrieve retrospective series of 16 cases, collected between 1989 and June 2006, and they analyze the clinical, diagnostic and therapeutic aspects. RESULTS: The patients were young (29-40 years) with an average having three children. Cesarean was the most frequent etiology. The presentation symptoms were hematuria (in five cases), a urinary incontinence through the vagina (in eight cases) and both of them (in three cases). The diagnosis was suspected from the history and confirmed by the additional analyses. The treatment was surgical (excision of the fistulas) in 15 cases with an average follow-up of 2.5 years, the results on the functional aspect were satisfactory hence they were marked by the absence of urinary incontinence as well as the hematuria. On the obstetric aspect, the occurrence of pregnancy was noted in a patient at four years post-VUF repair. CONCLUSION: Vesicouterine fistulas are not very frequent and most often secondary to a cesarean or to consequences of difficult delivery. The treatment is essentially preventive by improving the obstetrical techniques through avoiding the bladder injuries during the cesareans.
Assuntos
Fístula/cirurgia , Fístula da Bexiga Urinária/cirurgia , Doenças Uterinas/cirurgia , Adulto , Cesárea/efeitos adversos , Feminino , Fístula/diagnóstico , Fístula/etiologia , Hematúria/etiologia , Humanos , Pessoa de Meia-Idade , Complicações do Trabalho de Parto , Gravidez , Estudos Retrospectivos , Fístula da Bexiga Urinária/diagnóstico , Fístula da Bexiga Urinária/etiologia , Incontinência Urinária/etiologia , Doenças Uterinas/diagnóstico , Doenças Uterinas/etiologiaRESUMO
Evaluer les résultats d'une série homogène de sténoses urétrales traitées de façon univoque par urétrotomie interne endoscopique (UIE) et d'étudier les éléments à valeur prédictive du résultat.Patients et méthodes. Entre 1989 et 2007, 244 patients ont été hospitalisés pour sténose de l'urètre. Ils ont bénéficié d'une UIE sous contrôle de la vue. Résultats.Il y a eu 34,3% de bons résultats après la première UIE. Le recul moyen était de 3,5 ans. La mortalité était nulle et la morbidité était évaluée à 5%. Le résultat était d'autant meilleur que le geste concernait une sténose courte (inférieure à 2 cm), unique sur l'urètre proximal. La durée moyenne du cathétérisme post-opératoire a été de 2 jours; maintenir ce cathétérisme au delà n'a pas apporté d'amélioration significative. Les mauvais résultats (65,6%) ont été rapportés dans les cas de sténose étendue, siégeant sur l'urètre distal ou concernant des patients âgés. 62,5% ont été guéris après une deuxième urétrotomie, les autres cas ont nécessité des séances de dilatations urétrales d'entretien, voire un geste de plastie. Conclusion. L'UIE est une intervention simple, dépourvue de morbidité majeure et ne nécessitant qu'une hospitalisation courte. Avec un taux de succès stable de l'ordre de 75,4% à 3,5 ans, il nous paraît licite de proposer l'UIE en première intention pour toute sténose urétrale courte, unique, proximale et qu'elle survient chez un sujet jeune, sans antécédents urétraux
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Relatos de Casos , Endoscopia , Marrocos , Estreitamento Uretral/diagnóstico , Estreitamento Uretral/etiologiaRESUMO
Objectif : Etudier les aspects epidemiologiques; diagnostiques et therapeutiques des tumeurs primitives de l'uretre chez l'homme. Patients et methodes : Il s'agit d'une etude retrospective portant sur 7 cas de tumeurs de l'uretre masculin colliges dans notre institution sur une periode de 16 ans (1989-2005). Plusieurs parametres ont ete analyses a savoir l'age des patients; les antecedents; les signes cliniques; l'imagerie et le traitement ainsi que le suiviResultats: L'age moyen des patients etait de 56;1 ans. Les antecedents montraient des uretrites a repetition (4 cas) et une stenose cervico-uretrale traitee (4 cas). Les circonstances de decouverte de la tumeur etaient des signes irritatifs et obstructifs chroniques chez tous nos patients; une notion de retention aigue d'urine chez 5 patients; une uretrorragie et une pyurie dans 5 cas et une alteration de l'etat general dans 3 cas. La plupart de nos patients avaient plus d'un signe. Le diagnostic a ete evoque par l'uretrocystographie retrograde et mictionnelle et confirme par l'uretrocystoscopie avec biopsie. Tous nos patients avaient un carcinome epidermoide. La tumeur etait diagnostiquee au stade locoregional dans 6 patients. Le traitement etait endoscopique (une resection trans-uretrale) chez un patient et chirurgical dans 2 cas: uretrectomie associee a une cystoprostatectomie et une derivation urinaire type Coffey chez un patient qui presentait une tumeur de l'uretre prostatique stade T3N0M0: amputation de verge avec uretrostomie perineale et orchidectomie chez un patient qui presentait une tumeur au niveau de l'uretre bulbomembraneux (stade T4N0M0 avec atteinte scrotale). Une radiotherapie adjuvante a ete realisee dans ces 2 cas. Un parage chirurgical d'un phlegmon de verge provoque par la tumeur de l'uretre a ete realise chez 3 patients avec la mise en place d'une sonde vesicale a demeure dans un cas; d'une cystostomie definitive chez les 2 autres. Le dernier patient avait un envahissement ganglionnaire bilateral et a ete confie pour radiotherapie preoperatoire; mais 3 mois plus tard il a developpe des metastases pulmonaires et il est decede. La chimiotherapie n'a pas ete utilisee chez nos malades. Le recul moyen etait de 9;5 mois. Trois patients ont ete en remission complete: deux avaient beneficie d'un traitement chirurgical et un d'un traitement endoscopique. Un patient est decede et les 3 autres ont ete perdus de vue .Conclusion: Les tumeurs de l'uretre masculin restent d'un pronostic gravissime malgre les divers traitements proposes. Leur rarete rend difficile l'evaluation des moyens therapeutiques qui seront fonction de l'extension ganglionnaire et du stade de la tumeur
Assuntos
Homens , Neoplasias Uretrais , Neoplasias Uretrais/diagnóstico , Neoplasias Uretrais/epidemiologiaRESUMO
Objectif : Rapporter les particularites epidemiologiques; anatomo-cliniques; pronostiques et therapeutiques de l'atteinte genitale masculine de la tuberculose avec revue de la litterature. Patients et methodes : Il s'agit d'une etude retrospective portant sur 22 cas de lesions genitales de tuberculose confirmees. Le diagnostic a ete pose sur un faisceau d'arguments cliniques; bacteriologiques; radiologiques et histologiques. Un traitement anti-tuberculeuse a ete instauree systematiquement. La surveillance a ete clinique; biologique et radiologique. Resultats: Les motifs de consultation ont ete par ordre de frequence decroissant : l'epididymite chronique (11 cas); une fistule scrotale (6 cas); une hydrocele (6 cas); une retention d'urine (3 cas) et une sterilite (1 cas). L'examen clinique a retrouve un nodule epididymaire dans 11 cas et une hydrocele dans 10 cas. Une leucocyturie sans germe a ete retrouvee dans un cas. L'echographie scrotale realisee a mis en evidence des lesions epididymaires dans 8 cas. Le diagnostic de certitude a ete pose sur l'examen anatomopathologique des pieces operatoires (13 cas); de fragments biopsiques (8 cas); et par la decouverte du bacille de Koch dans les urines (1 cas). L'urographie intraveineuse realisee systematiquement a retrouve des lesions urinaires associees dans 5 cas. L'evolution a ete favorable dans tous les cas.Conclusion: L'atteinte tuberculeuse isolee des organes genitaux masculins est de diagnostic difficile en dehors d'un contexte endemique tuberculeux. Une etiologie tuberculeuse doit etre suspectee devant toute orchiepidydimite trainante; particulierement sur terrain debilite ou devant une notion d'hypofertilite. Le traitement medical reste efficace en cas de diagnostic precoce; alors que la chirurgie est reservee aux cas resistants ou compliques
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Antituberculosos , Prostatite , Tuberculose Urogenital , Tuberculose Urogenital/epidemiologia , Tuberculose Urogenital/patologiaRESUMO
The authors report a series of three cases of Youssef syndrome observed over a 10 year period. All the fistulas were secondary to cesarian section. The diagnosis was established on clinical findings in one case. The intravenous urography was performed in all the cases and visualised the uterine cavity in one case. In the remaining cases the diagnosis was established by the retrograd cystography. The treatment was surgical for two patients and the third one refused any treatment. With a mean recoil of fifteen months the results judged on the disappearance of the clinic signs were good in the two patients opered. The objective of this study is to analyse the aetiological, diagnosis and therapeutic aspects of this pathology.
Assuntos
Fístula/etiologia , Fístula da Bexiga Urinária/etiologia , Doenças Uterinas/etiologia , Adulto , Cesárea/efeitos adversos , Diagnóstico Diferencial , Feminino , Fístula/patologia , Fístula/cirurgia , Humanos , Síndrome , Resultado do Tratamento , Fístula da Bexiga Urinária/patologia , Fístula da Bexiga Urinária/cirurgia , Doenças Uterinas/patologia , Doenças Uterinas/cirurgiaRESUMO
Rare congenital malformation, bladder exstrophy is usually treated soon after birth. Based on three cases report of bladder exstrophy in adulthood (two men and one women aged from 21 to 25 years), the authors emphasize the importance of psychological, sexual, and social disorders caused by this affection treated at this age. Urinary problems were excluded of this study. The authors stress the necessity of an early management of this malformation, if possible at birth in order to minimize these consequences.
Assuntos
Extrofia Vesical/complicações , Extrofia Vesical/psicologia , Disfunções Sexuais Fisiológicas/etiologia , Adulto , Fatores Etários , Extrofia Vesical/cirurgia , Feminino , Humanos , Relações Interpessoais , Masculino , Comportamento Social , Estresse PsicológicoRESUMO
The authors report two cases of endoscopic treatment of vesico-ureteral reflux by submeatic injection of autologous fat. We describe the technique of prelevement and injection. The immediate results confirm the efficacity of this procedure. The long-term follow-up will allow us to adopt it and to give it some modifications.
Assuntos
Tecido Adiposo , Refluxo Vesicoureteral/terapia , Adolescente , Adulto , Endoscopia , Feminino , Humanos , MasculinoRESUMO
We report one case of retroperitoneal liposarcoma treated by surgery and radiotherapy. With the literature, we discuss the pathologic and therapeutic aspect of this lesion.
Assuntos
Lipossarcoma/patologia , Lipossarcoma/cirurgia , Neoplasias Retroperitoneais/patologia , Neoplasias Retroperitoneais/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Lipossarcoma/radioterapia , Pessoa de Meia-Idade , Prognóstico , Radioterapia Adjuvante , Neoplasias Retroperitoneais/radioterapia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
We describe a cheap and simply technique of percutaneous nephrostomy which can be used anywhere. It consists, under local anesthesia, of insertion of a drain into renal cavity using only a needle, a sheat and dilatator. With this technique, we placed 81 PCN with 97% of success, without complication.
Assuntos
Nefrostomia Percutânea/métodos , Adulto , Idoso , Emergências , Desenho de Equipamento , Humanos , Pessoa de Meia-Idade , Nefrostomia Percutânea/economia , Nefrostomia Percutânea/instrumentaçãoRESUMO
OBJECTIVE: To approach the treatment of Fournier's gangrene. So, pathophysiology and etiology are recalled. METHODS: The authors present 51 cases of Fournier's gangrene treated from 1989 to 1998, their age ranged from 19 to 89 years. Data were collected on admission signs and symptoms, physical examination. Aggressive surgical debridement of all necrotic tissues was performed, Intravenous antibiotics and resuscitation fluid were also administered. RESULTS: All patients were male. In 20 cases (39%), there was no identifiable cause, and in 31 cases (61%), the etiology of gangrene was urethral (33%), anorectal (28%) and unknown (19%). The average hospital stay was 30 days. Three cases underwent unilateral orchidectomy, six colostomy and in 17 cases, a suprapubic catheter was inserted. Mortality was high (18%) and essentially associated to debilated state and toxi-infectious context. CONCLUSION: Fournier's gangrene is a true urologic emergency potential lethal, which requires aggressive antibiotic and surgical treatment.
Assuntos
Gangrena de Fournier/diagnóstico , Gangrena de Fournier/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Períneo , EscrotoRESUMO
We report an adrenal cyst discovered in a 26-year-old woman with abdominal pain. Imaging (ultrasonography, computed tomography) demonstrated a 12 cm adrenal cystic mass suggestive of hydatic cyst of adrenal. She undergoes surgical exploration, when blood pressure increases. Pheochromocytoma diagnosis is reconsidered. Cystic pheochromocytoma is a rare tumour of the adrenal gland that can pose a diagnostic challenge.
Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico , Feocromocitoma/diagnóstico , Adulto , Feminino , HumanosRESUMO
The authors report a case of transitional cell carcinoma of the left ureteral stump in a 66-year old man treated by nephrectomy for pyonephrosis 6 years previously and cystoprostatectomy for bladder tumour 13 years previously. In the light of this case and based on a review of the literature, they essentially discuss the diagnostic and aetiopathogenic problems raised by this disease.