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1.
Urolithiasis ; 47(2): 207-214, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29549382

RESUMO

To compare the outcome of mini-percutaneous nephrolithotomy (Mini-PNL) versus standard-PNL for renal stones. Retrospective study was performed between March 2010 and May 2013 for patients treated by Mini-PNL or standard-PNL through 18 and 30 Fr tracts, respectively, using pneumatic lithotripsy. Semirigid ureteroscope (8.5/11.5 Fr) was used for Mini-PNL and 24 Fr nephroscope for standard-PNL. Both groups were compared in stone free rate(SFR), complications and operative time using Student-t, Mann-Whitney, Chi square or Fisher's exact tests as appropriate in addition to logistic regression analysis. P < 0.05 was considered statistically significant. Mini-PNL (378) and standard-PNL (151) were nearly comparable in patients and stones criteria including stone burden (3.77 ± 2.21 vs 3.77 ± 2.43 cm2; respectively). There was no significant difference in number of tracts or supracostal puncture. Mini-PNL had longer operative time (68.6 ± 29.09 vs 60.49 ± 11.38 min; p = 0.434), significantly shorter hospital stay (2.43 ± 1.46 vs 4.29 ± 1.28 days) and significantly higher rate of tubeless PNL (75.1 vs 4.6%). Complications were significantly higher in standard-PNL (7.9 vs 20.5%; p < 0.001). SFR was significantly lower in Mini-PNL (89.9 vs 96%; p = 0.022). This significant difference was found with multiple stones and large stone burden (> 2 cm2), but the SFR was comparable between both groups with single stone or stone burden ≤ 2 cm. Logistic regression analysis confirmed significantly higher complications and SFR with standard-PNL but with significantly shorter operative time. Mini-PNL has significantly lower SFR when compared to standard-PNL (but clinically comparable) with markedly reduced complications and hospital stay. Most of cases can be performed tubeless. The significant difference in SFR was found with multiple stones or large stone burden (> 2 cm2), but not with single stones or stone burden ≤ 2 cm2.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Ureteroscópios , Adulto , Idoso , Feminino , Seguimentos , Humanos , Rim/diagnóstico por imagem , Rim/cirurgia , Cálculos Renais/diagnóstico por imagem , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/instrumentação , Nefrolitotomia Percutânea/métodos , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
2.
Urology ; 120: 62-67, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30031834

RESUMO

OBJECTIVE: To compare safety and efficacy of bilateral single-session mini-percutaneous nephrolithotomy (BSS-Mini-PNL) vs staged-Mini-PNL. PATIENTS AND METHODS: Adult patients with bilateral renal stones indicated for PNL were managed with BSS-Mini-PNL (45 patients and 90 renal units) and prospectively compared vs staged-Mini-PNL (55 patients and 110 renal units) between July 2014 and December 2017. Mini-PNL was done through 18-Fr tract in prone position under regional anesthesia and fluoroscopy using pneumatic lithotripsy. A semirigid ureteroscope (8.5/11.5 Fr) was used. Mann-Whitney, Student t, chi-square, or Fisher's exact tests were used as appropriate. RESULTS: Both groups were comparable in characteristics of stones and patients. Stone burden was 3.36 ± 1.61 vs 3.38 ± 1.18 cm2 in BSS-Mini-PNL vs staged-Mini-PNL, respectively. Staghorn stones were present in 13.3% vs 8.2% in BSS-Mini-PNL vs staged-Mini-PNL, respectively. There was no significant difference in the number of required tracts (1.34 ± 0.6 vs 1.25 ± 0.51 tract/renal unit) as well as the rate of tubeless Mini-PNL (81.1% vs 85.5%) or stone-free rate (90% vs 92.7%) in BSS-Mini-PNL vs staged-Mini-PNL, respectively. BSS-Mini-PNL had significantly shorter operative time (126.22 ± 37.2 vs 169.63 ± 61.28 minutes), shorter hospital stay (2 [1-8] vs 4 [2-16] days) and higher hemoglobin loss (1.1 [0.1-2.8] vs 0.5 [0.1-2.17] gm/d) than staged-Mini-PNL. The complications profile (17.8% vs 13.6%) and rate of blood transfusion (4.4% vs 3.6%) were comparable in BSS-Mini-PNL vs staged-Mini-PNL, respectively, without significant difference. CONCLUSION: BSS-Mini-PNL is comparable to staged-PNL as regard stone-free rate and complications according to the selection criteria of the present study. However, BSS-Mini-PNL is associated with significant reduction in the cumulative operative time and hospital stay, which are reflected on the overall cost.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Adolescente , Adulto , Idoso , Feminino , Humanos , Rim/patologia , Rim/cirurgia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Duração da Cirurgia , Estudos Prospectivos , Resultado do Tratamento , Ureteroscopia , Adulto Jovem
3.
Arab J Urol ; 16(1): 181-187, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29713549

RESUMO

Objective: To evaluate the detailed vascular anatomy of the spermatic cord during subinguinal microscopic varicocelectomy and to assess the outcome of the cases with regard to varicocele recurrence and hydrocele formation. Patients and methods: In all, 100 varicocele cases including 74 left-sided and 26 bilateral, comprising 126 spermatic cord units with clinically palpable varicoceles underwent microscopic subinguinal varicocelectomy. Detailed description of vascular anatomy of the spermatic cords was reported. The number of spermatic, cremasteric, and inguinal veins was recorded. A record of testicular arteries and lymphatics was noted. Testicular delivery was done in all the cases and assessment of the gubernacular veins was reported. The patients underwent clinical evaluation, as well as scrotal Doppler ultrasonography, to detect varicocele recurrence and hydrocele formation. The mean (range) postoperative evaluation period was 6 (3-12) months. Results: The mean number of spermatic veins was 14 on both sides. The mean number of spermatic arteries on both sides was 1.3. For lymphatics, the mean number was around three on both sides. The gubernacular veins were noted in 75% of the cases on the left side (mean number of 1.2) and in 85% on the right-side, (mean number of 1). The mean number of cremasteric veins on the left and right sides was 1.4 and 1.2, respectively. Finally, inguinal floor vessels were noted in 9% on the left-side and were not seen in the right-side cases. The incidence of varicocele recurrence was 2% and for hydrocele that was not clinically significant was 0.07%. Conclusion: Microscopic subinguinal varicocelectomy accurately evaluated the detailed vascular anatomy of the spermatic cord, achieving excellent surgical outcome with minimal varicocele recurrence and hydrocele formation. Microscopic subinguinal varicocelectomy should be the 'gold standard' for varicocelectomy.

4.
Ther Adv Urol ; 9(9-10): 219-226, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28932275

RESUMO

BACKGROUND: The aim of this study was to report current practices of percutaneous nephrolithotomy (PCNL) among endourologists. METHODS: An internet survey was administered to Endourological Society members. Responders were distributed into three groups according to the number of PCNL cases per year (<50, 50-100, >100). PCNL technical details as well as opinions regarding specific clinical case scenarios were evaluated and compared between groups. RESULTS: We received 300 responses from 47 different countries. Prone position was used in 77% of cases, while 16% used supine position and only 7% used modified lateral decubitus. Most endourologists performed their own access. There were no significant differences between the three groups regarding patient position (p = 0.1), puncture acquisition by urologist or radiologist (p = 0.2) and fluoroscopic puncture technique (p = 0.2). Endourologists with high annual PCNL practice (>100) had least probability to utilize nephrostomy tube (p = 0.0005) or use balloon dilator (p = 0.0001). They also had the highest probability of performing mini-PERC (p = 0.0001). CONCLUSIONS: The majority of endourologists performing PCNL obtain their own access. Prone positioning is predominant, while totally tubeless PCNL are uncommon. Mini-PERC is gaining more popularity among endourologists. Most endourologists follow the guidelines for their choice of treatment modality in different sizes and locations of upper tract calculi.

5.
Urolithiasis ; 45(4): 407-414, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27704184

RESUMO

To evaluate safety and efficacy of minipercutaneous nephrolithotomy (Mini-PNL) in management of stones in different types of renal anomalies. Patients with stones ≥2 cm or SWL-resistant stones in anomalous-kidneys treated by Mini-PNL between March 2010 and September 2012 were included prospectively. Mini-PNL was done under regional anesthesia in prone position with fluoroscopic guidance through 18 Fr sheath using semirigid ureteroscope (8.5/11.5 Fr) and pneumatic lithotripter. All patients were followed-up for 2-3 years. Stone-free rate was defined as absence of residual fragments ≥2 mm. Student-T, Mann-Whitney, Chi square (χ 2), Fisher-exact, one way ANOVA or Kruskal-Wallis test were used for analysis. Mini-PNL was performed for 59 patients (20 horseshoe, 15 malrotated, 7 polycystic, 13 duplex and 4 ectopic pelvic-kidneys). Mean age was 40.18 ± 12.75 (14-78) years. Mean stone burden was 31.72 ± 21.43 (7.85-141.3) mm2. Two tracts were required in 7 (11.9 %) patients. Tubeless Mini-PNL with double-J insertion was performed in all patients except two. Operative time was 50.17 ± 18.73 (15-105) min. Hemoglobin loss was 0.44 ± 0.30 (0-1.4) g/dL. Complications were reported in 15 (25.4 %) patients. No pleural injury, sepsis, perinephric-collection or renal-pelvis perforation were reported. Stone-free rate was 89.8 % (converted to open-surgery in one patient, second-look PNL in two patients, auxiliary SWL in three patients). Stone-free rate improved to 98.3 % after retreatment and auxiliary SWL. Site of puncture was mostly upper calyceal in horseshoe-kidney (80 %), mid calyceal in polycystic-kidney (85.7 %) and lower calyceal in duplex-kidney (46.2 %). Punctures were also significantly infracostal in horseshoe-kidney (100 %) and supracostal in both duplex (53.8 %) and malrotated-kidneys (66.7 %). Mini-PNL is safe for management of stones in anomalous-kidney with SFR comparable to standard-PNL but with less complications.


Assuntos
Cálculos Renais/cirurgia , Rim/anormalidades , Litotripsia/efeitos adversos , Nefrolitotomia Percutânea/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Feminino , Fluoroscopia , Seguimentos , Humanos , Rim/diagnóstico por imagem , Cálculos Renais/diagnóstico por imagem , Litotripsia/instrumentação , Litotripsia/métodos , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/instrumentação , Nefrolitotomia Percutânea/métodos , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Resultado do Tratamento , Ureteroscópios , Adulto Jovem
6.
Med Princ Pract ; 26(1): 30-34, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27648954

RESUMO

OBJECTIVES: The aim of this study was to describe the management protocol for intermittent testicular torsion (ITT) in adults and report the outcome of this clinical condition, which is commonly overlooked in adults. SUBJECTS AND METHODS: Sixty-three patients were included in the study. The inclusion criterion was the presence of sudden intermittent testicular pain over a duration of 3 months. All the patients underwent clinical examination, urine analysis, culture, and scrotal ultrasound with Doppler. The testicle was in an abnormal or in transverse lie and/or could easily be twisted. Scrotal support and analgesia were given for 1 month, then patients were offered orchidopexy or conservative treatment. Nineteen patients chose orchidopexy while 44 chose conservative treatment. Follow-up ranged from 3 months to 2 years. The improvement was assessed using a visual analog pain score. The outcome of the treatment was compared between the surgical and conservative groups using a χ2 test. RESULTS: The median age of the patients was 28 years (range: 17-50). Of the 19 patients who underwent orchidopexy, the pain resolved or visual analog pain scores improved (median 1/10) in 18 (94.7%) cases. On the other hand, 21 of the 44 (47.7%) cases that chose the conservative approach claimed their pain resolved or improved (visual analog pain scores: median 3/10) with a median of 13 months of follow-up. CONCLUSION: In this study, scrotal orchidopexy proved to be superior to conservative measures in cases of ITT in adults.


Assuntos
Analgésicos/uso terapêutico , Orquidopexia , Torção do Cordão Espermático/tratamento farmacológico , Torção do Cordão Espermático/cirurgia , Adolescente , Adulto , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Dor/tratamento farmacológico , Dor/etiologia , Dor/cirurgia , Manejo da Dor/métodos , Torção do Cordão Espermático/complicações , Escala Visual Analógica , Adulto Jovem
7.
Arab J Urol ; 14(4): 275-279, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27900217

RESUMO

OBJECTIVE: To evaluate the influence of fellowship training in endourology on different endourological procedures in a single institution. SUBJECTS AND METHODS: The operative records of endourological and open surgeries were reviewed. Data analysed included numbers, types, and technical issues related to surgeries. The early study period ranged from September 1998 to September 2004, and the later period from January 2014 to June 2016. The study duration was classified into three periods according to the availability of an endourology fellowship trained member of staff (EFTS). In period A (September 1998 to September 2001) no EFTS was available, in period B (October 2001 to September 2004) an EFTS joined the urology unit, and in period C (January 2014 to June-2016) the EFTS had left the urology unit. RESULTS: In periods B and C the number of rigid ureteroscopy (URS) significantly increased compared with period A. Also, flexible URS was used for the first time in period B and continued in period C. The number of percutaneous nephrolithotomies increased in period B and continued to be performed in period C. Laparoscopic urological surgery was not undertaken in period A, and only done in four cases in period C, whilst it was performed in 62 patients in period B. Holmium laser enucleation of the prostate was carried out in 36 patients during period B and not performed in periods A and C. Finally, the number of open stone surgeries decreased in periods B and C. CONCLUSION: The introduction of an EFTS definitely enhanced the practice of minimally invasive procedures.

8.
J Endourol ; 29(10): 1204-9, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26102617

RESUMO

BACKGROUND AND PURPOSE: Endoureterotomy is a viable option for treating patients with benign ureteral stricture. We compared the efficacy and safety of double versus single ureteral stent placement after laser endoureterotomy. PATIENTS AND METHODS: This study included 55 patients with benign ureteral strictures; all patients underwent retrograde laser endoureterotomy. Patients were randomized either to single or double ureteral stents. Single stents were placed in 27 ureters while double stents were placed in 28 ureters. The stent diameter used was 7 F, and stents were indwelling for 8 weeks. Imaging was performed 1 month after stent removal and repeated regularly every 3 months. Clinical characteristics, operative results, and functional outcomes were compared for strictures managed in both groups. Success was evaluated both subjectively and objectively. RESULTS: Fifty-five patients with a mean age of 46 (16-75) years had benign ureteral strictures; the mean stricture length was 1.92 (1-3) cm. The mean follow-up was 25.7 (9-42) months. The overall success rate was 67.3% (37 patients) with no radiologic evidence of obstruction, 6 (10.9%) patients showed symptomatic improvement while 12 (21.8%) patients underwent surgical reconstruction. Success was significantly higher for ureteral strictures (>1.5 cm) managed with double stent placement (82.4%), compared with single stent placement (38.9%) with a P value of 0.009. CONCLUSIONS: Double stent placement of the ureter after laser endoureterotomy achieved a higher success rate compared with single stent placement in cases of benign ureteral strictures. Although ureteral strictures (≤1.5 cm) achieved better outcome after laser endoureterotomy, strictures (>1.5 cm) favored better with double stent versus single stent placement.


Assuntos
Stents , Ureter/cirurgia , Obstrução Ureteral/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Adolescente , Adulto , Idoso , Constrição Patológica , Feminino , Humanos , Lasers de Estado Sólido/uso terapêutico , Masculino , Pessoa de Meia-Idade , Período Perioperatório , Radiografia , Resultado do Tratamento , Ureter/diagnóstico por imagem , Adulto Jovem
9.
Urology ; 74(2): 273-7, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19501888

RESUMO

OBJECTIVES: To evaluate the role of percutaneous nephrolithotomy in management of the patients with autosomal dominant polycystic kidney disease and associated nephrolithiasis. METHODS: A total of 19 patients with autosomal dominant polycystic kidney disease and upper urinary tract stones were included in the study. One patient had bilateral renal stones. Most of the stones were located in the renal pelvis and/or calices with a stone size >2 cm in the largest diameter. All patients were treated by percutaneous nephrolithotomy at 2 centers. Therefore, 20 percutaneous nephrolithotomy procedures were performed. Most of the procedures were performed in 1 stage by the urology team under fluoroscopic guidance; 6 cases were done in 2 stages. The success rate and morbidity and mortality of the technique and hospital stay were recorded. RESULTS: The pelvicaliceal system was successfully approached in all cases but 1. The overall stone-free rate was 89.4%. Renal function improved in the patients who presented with azotemia and was stable in the others. No patient died. Complications occurred in 3 procedures and consisted of mild postoperative hematuria in 1, bleeding through the nephrostomy tube in 1, and low-grade fever in 1. The mean hospital stay was 3 days. CONCLUSIONS: Percutaneous nephrolithotomy is a safe and effective method for the treatment of patients with autosomal dominant polycystic kidney disease and associated upper urinary tract stones.


Assuntos
Cálculos Renais/cirurgia , Nefrostomia Percutânea , Rim Policístico Autossômico Dominante/complicações , Adulto , Idoso , Feminino , Fluoroscopia , Humanos , Cálculos Renais/complicações , Cálculos Renais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Rim Policístico Autossômico Dominante/diagnóstico por imagem , Radiografia Intervencionista
10.
J Urol ; 180(3): 961-5, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18639269

RESUMO

PURPOSE: We determined the differences in outcome between ureteral stenting and nonstenting following uncomplicated ureteroscopy for distal ureteral stones. MATERIALS AND METHODS: A total of 220 patients treated with successful ureteroscopy for distal ureteral stones were randomized to 2 equal groups according to postoperative placement of a ureteral stent (Cook Ireland, National Technological Park, Ireland), including group 1--without a stent and group 2--with a stent. Outcome measures were flank pain and dysuria at 48 hours and 1 week, early postoperative complications, analgesia need, rehospitalization, return to normal physical activity, stone-free rate, stone recurrence and late postoperative complications. Patients were followed a mean +/- SD of 25 +/- 9 months (range 12 to 49). RESULTS: Early postoperative complications, including low grade fever, hematuria and urinary tract infection, were observed in 22 patients (20%) in group 1 and 19 (19%) in group 2, a difference of no significant value. Mean initial hospitalization and time to return to normal physical activity were not different between the 2 groups. At 48 hours and 1 week there was no significant difference in flank pain between the 2 groups, while dysuria was significantly less in the nonstented group. The amount of analgesics required in the recovery room was not different but after discharge from the hospital stented patients used a larger amount of analgesia while the stent was still in the ureter. The stone-free rate at 4 weeks was 100% in each group. Late postoperative sequelae, including stone recurrence and ureteral narrowing, were reported in 6 patients (5.5%) in group 1 and 4 (3.6%) in group 2, a difference of no significant value. CONCLUSIONS: Uncomplicated ureteroscopy for treatment of distal ureteral stones is safe without stent placement. Patients without stents have significantly fewer irritative bladder symptoms and are not at risk of increased complications.


Assuntos
Stents , Cálculos Ureterais/cirurgia , Ureteroscopia , Adulto , Distribuição de Qui-Quadrado , Feminino , Seguimentos , Humanos , Masculino , Medição da Dor , Complicações Pós-Operatórias , Estudos Prospectivos , Recidiva , Resultado do Tratamento , Cálculos Ureterais/diagnóstico
11.
Urology ; 71(4): 611-5, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18295308

RESUMO

OBJECTIVES: To present our experience with a modification of tubularized incised plate (TIP) urethroplasty for treatment of anterior penile hypospadias. METHODS: A total of 764 children with primary anterior penile hypospadias (462 subcoronal and 302 coronal) underwent hypospadias repair by using modified TIP urethroplasty. The technique involves, in addition to the standard TIP, the use of the dorsal prepuce which was divided in 2 flaps. The right flap was de-epithelialized on both the outer and inner sides and transferred as interposing layer between the neourethra and the coverings. The left flap was de-epithelialized on the inner side and transferred ventrally as skin coverage. The follow-up ranged between 3 and 52 months with a mean of 17 months. RESULTS: Excellent functional and cosmetic results were achieved in 738 patients (96.6%). Urethral fistulae were encountered in 16 cases (2%) and were repaired successfully. Meatal stenosis was noted in 8 cases (1%) and successfully treated. Two patients had complete disruption of the wound (0.2%), which was corrected. CONCLUSIONS: Excellent functional and cosmetic results can be achieved after repair of anterior penile hypospadias by using TIP urethroplasty with the modification of using double breasted de-epithelialized skin flap.


Assuntos
Hipospadia/cirurgia , Stents , Retalhos Cirúrgicos , Técnicas de Sutura , Pré-Escolar , Seguimentos , Humanos , Hipospadia/patologia , Lactente , Masculino , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Cicatrização
12.
J Endourol ; 21(7): 698-702, 2007 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-17705753

RESUMO

PURPOSE: To evaluate the effect of the position of the proximal and distal ends of Double-J ureteral stents on postprocedural flank pain, lower urinary-tract symptoms, and quality of life. PATIENTS AND METHODS: The study included 120 patients who required unilateral Double-J ureteral stents for various indications. They were randomized into two equal groups. Group 1 had longer stents, with the proximal end in the upper calix and the distal end crossing the midline of the bladder. Group 2 had proper stent length with the proximal end in the pelvis and the lower end just beyond the vesicoureteral junction. Patients answered a questionnaire regarding flank pain, dysuria, and urgency as well as quality of life after 1 week of stenting. RESULTS: Forty patients (67%) of group 1 and 43 (72%) of group 2 had mild flank pain, especially during urination. There was no significant difference in the degree of flank pain in the two groups. Moderate to severe dysuria was reported by 53 patients (88%) in group 1 and 11 patients (18%) in group 2 (P < 0.001). Moderate to severe urgency was reported by 48 patients (80%) in group 1 and in 14 (23%) in group 2 (P < 0.001). A worse quality of life was reported by patients in group 1, among whom moderate to severe bother was noted by 51 (85%) compared with group 2, in which moderate to severe bother was reported by only 13 patients (22%) (P < 0.001). CONCLUSION: Ureteral stents are associated with flank pain and lower urinary-tract symptoms. The flank pain was not affected by the length of stent. Urgency and dysuria as well as a worse quality of life were significantly more common in the patients who had longer stents.


Assuntos
Complicações Pós-Operatórias/etiologia , Qualidade de Vida , Stents/efeitos adversos , Ureter/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
13.
J Urol ; 178(1): 204-7, 2007 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-17499785

RESUMO

PURPOSE: We present our referral experience with patients who had extensive urethral obstruction following UroLume insertion and were treated with urethroplasty. MATERIALS AND METHODS: We retrospectively analyzed the records of 13 men with urethral stricture who experienced recurrent obstruction following placement of a UroLume endoprosthesis. In all patients several attempts at urethral dilation and optical urethrotomy failed to overcome the obstruction. Complete excision of the obstructed urethra containing the stent with the surrounding periurethral fibrosis was done in all patients. In 12 patients a 1-stage bipedicled penile island tubularized flap was used to bridge the urethral defect. In 1 patient 1-stage urethroplasty was performed and he is awaiting stage 2. Followup assessment included urine flow, post-void residual urine measurement, retrograde urethrogram and urethroscopy at different intervals. RESULTS: Of the 12 patients who underwent complete treatment 1 had a short segment stricture at the site of the distal anastomosis 3 months after catheter removal, which was successfully managed by internal urethrotomy. He was doing well at the 12-month followup. In 11 patients a successful outcome was noted immediately after catheter removal and it was maintained at a mean followup of 1.8 years (range 1 to 4). CONCLUSIONS: Complete excision of the obstructed urethra containing the UroLume stent with the surrounding periurethral fibrosis is an important first step in reconstruction. Subsequent use of a 1-stage bipedicled penile island tubularized flap resulted in excellent long-term results. In a small subset of cases delayed stage 2 repair after skin inlay is a valuable option.


Assuntos
Stents/efeitos adversos , Obstrução Uretral/cirurgia , Estreitamento Uretral/cirurgia , Adulto , Humanos , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Obstrução Uretral/etiologia
14.
Urology ; 69(3): 417-20, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17382134

RESUMO

OBJECTIVES: To compare the outcomes of the different surgical techniques used in varicocelectomy. METHODS: The study included 120 patients with 147 clinically palpable varicoceles who underwent varicocelectomy. The patients were randomly allocated to one of three equal groups according to the varicocelectomy technique, which included the open inguinal approach, a laparoscopic approach, and subinguinal microscopic varicocelectomy. The assessment included operative and postoperative parameters, together with semen analysis and pregnancy rate. The mean follow-up was 18 months (range 11 to 26). RESULTS: The operative time in the microscopic group was significantly longer than that for the other two groups. At follow-up, none of the patients of the microscopic group had developed postoperative hydrocele; however, it was observed in 7 (13%) of 52 varicoceles in the open group and 10 (20%) of 50 in the laparoscopic group. This difference was statistically significant in favor of the microscopic group only. Only 1 patient in the microscopic group experienced recurrence of one varicocele compared with 7 and 9 patients in the open and laparoscopic groups, respectively. This difference was statistically significant in favor of the microscopic group only. Improvement in sperm motility and/or concentration was comparable and observed in 65%, 67%, and 76% of the open, laparoscopic, and microscopic groups, respectively. Also, the pregnancy rate at 1 year was not significantly different and was 28%, 30%, and 40% in three groups, respectively. CONCLUSIONS: The findings of our study have demonstrated that, compared with open inguinal and laparoscopic varicocelectomy, subinguinal microsurgical varicocelectomy offers the best outcome.


Assuntos
Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Varicocele/cirurgia , Adolescente , Adulto , Feminino , Humanos , Laparoscopia , Masculino , Microcirurgia , Gravidez , Taxa de Gravidez , Contagem de Espermatozoides , Motilidade Espermática , Hidrocele Testicular/etiologia , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
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