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1.
Nat Neurosci ; 2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32541962

RESUMO

The ventral tegmental area (VTA) is important for reward processing and motivation. The anatomic organization of neurotransmitter-specific inputs to the VTA remains poorly resolved. In the present study, we mapped the major neurotransmitter projections to the VTA through cell-type-specific retrograde and anterograde tracing. We found that glutamatergic inputs arose from a variety of sources and displayed some connectivity biases toward specific VTA cell types. The sources of GABAergic projections were more widespread, displayed a high degree of differential innervation of subregions in the VTA and were largely biased toward synaptic contact with local GABA neurons. Inactivation of GABA release from the two major sources, locally derived versus distally derived, revealed distinct roles for these projections in behavioral regulation. Optogenetic manipulation of individual distal GABAergic inputs also revealed differential behavioral effects. These results demonstrate that GABAergic projections to the VTA are a major contributor to the regulation and diversification of the structure.

2.
Malar J ; 19(1): 185, 2020 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-32434584

RESUMO

BACKGROUND: Focus for improved malaria programme performance is often placed on the technical challenges, while operational issues are neglected. Many of the operational challenges that inhibit malaria programme effectiveness can be addressed by improving communication and coordination, increasing accountability, maintaining motivation, providing adequate training and supervision, and removing bureaucratic silos. METHODS: A programme of work was piloted in Zimbabwe with one malaria eliminating province, Matabeleland South in 2016-2017, and scaled up to include two other provinces, Matabeleland North and Midlands, in 2017-2018. The intervention included participatory, organization development and quality improvement methods. RESULTS: Workshop participants in Matabeleland South reported an improvement in data management. In Matabeleland North, motivation among nurses improved as they gained confidence in case management from training, and overall staff morale improved. There was also an improvement in data quality and data sharing. In Midlands, the poorly performing district was motivated to improve, and both participating districts became more goal-oriented. They also became more focused on monitoring their data regularly. Participants from all provinces reported having gained skills in listening, communicating, facilitating discussions, and making presentations. Participation in the intervention changed the mindset of malaria programme staff, increasing ownership and accountability, and empowering them to identify and solve problems, make decisions, and act within their sphere of influence, elevating challenges when appropriate. CONCLUSIONS: This pilot demonstrates that a participatory, organization development and quality improvement approach has broad ranging effects, including improving local delivery of interventions, tailoring strategies to target specific populations, finding efficiencies in the system that could not be found using the traditional top-down approach, and improving motivation and communication between different cadres of health workers. Scale-up of this simple model can be achieved and benefits sustained over time if the process is imbedded into the programme with the training of health staff who can serve as management improvement coaches. Methods to improve operational performance that are scalable at the district level are urgently needed: this approach is a possible tactic that can significantly contribute to the achievement of global malaria eradication goals.

5.
World J Urol ; 2019 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-31807846

RESUMO

INTRODUCTION: Lichen sclerosus (LS) is a common cause of urethral stricture disease. The purpose of this article is to review the literature over the past 5 years, to describe current treatment of lichen sclerosus as it relates to urethral stricture in men. MATERIALS AND METHODS: Literature reviews were performed using PUBMED, with search terms "lichen scleros*" and "urethral stenosis", as well as "lichen scleros*" and "urethral stricture". Relevant articles published within the past 5 years were selected for review. A summary of current treatment of lichen sclerosus was prepared and synthesized. RESULTS: For LS affecting genital skin, topical steroids are a mainstay of therapy but in advanced cases, surgery may be required such as circumcision. When LS causes urethral stricture, urethral dilatation is unlikely to be successful long term, and surgery is often required, such as meatoplasty, single- or two-stage urethroplasty, or perineal urethrostomy. Oral mucosal grafting is the graft of choice, and usage of genital skin for flaps or grafts is best avoided due to predilection for recurrence. Biopsy and long-term surveillance of LS are recommended, due to its potential association with squamous cell carcinoma development. CONCLUSION: Although debate still exists regarding the pathogenesis of LS, it is agreed that LS can pose a treatment challenge to physicians and surgeons. Treatment options for LS range from pharmacological to surgical, depending on severity and location of disease, patient factors, and response of previous treatments.

6.
J Control Release ; 316: 404-417, 2019 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-31678653

RESUMO

Messenger RNA (mRNA) has recently emerged as a promising class of nucleic acid therapy, with the potential to induce protein production to treat and prevent a range of diseases. However, the widespread use of mRNA as a therapeutic requires safe and effective in vivo delivery technologies. Libraries of ionizable lipid nanoparticles (LNPs) have been designed to encapsulate mRNA, prevent its degradation, and mediate intracellular delivery. However, these LNPs are typically characterized and screened in an in vitro setting, which may not fully replicate the biological barriers that they encounter in vivo. Here, we designed and evaluated a library of engineered LNPs containing barcoded mRNA (b-mRNA) to accelerate the screening of mRNA delivery platforms in vivo. These b-mRNA are similar in structure and function to regular mRNA, and contain barcodes that enable their delivery to be quantified via deep sequencing. Using a mini-library of b-mRNA LNPs formulated via microfluidic mixing, we show that these different formulations can be pooled together, administered intravenously into mice as a single pool, and their delivery to multiple organs (liver, spleen, brain, lung, heart, kidney, pancreas, and muscle) can be quantified simultaneously using deep sequencing. In the context of liver and spleen delivery, LNPs that exhibited high b-mRNA delivery also yielded high luciferase expression, indicating that this platform can identify lead LNP candidates as well as optimal formulation parameters for in vivo mRNA delivery. Interestingly, LNPs with identical formulation parameters that encapsulated different types of nucleic acid barcodes (b-mRNA versus a DNA barcode) altered in vivo delivery, suggesting that the structure of the barcoded nucleic acid affects LNP in vivo delivery. This platform, which enables direct barcoding and subsequent quantification of a functional mRNA, can accelerate the in vivo screening and design of LNPs for mRNA therapeutic applications such as CRISPR-Cas9 gene editing, mRNA vaccination, and other mRNA-based regenerative medicine and protein replacement therapies.

8.
BJU Int ; 124 Suppl 1: 37-41, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31638318

RESUMO

OBJECTIVES: To identify trends in the management of urethral stricture disease in Australia, assess changes in the standard of care, and examine the availability of genitourinary reconstructive surgery. METHODS: Data on eight stricture management procedures were collected online via Medicare Item Reports from the Australian Government Department of Human Services, and then matched to population data from the Australian Bureau of Statistics. A survey was disseminated via the Urological Society of Australia and New Zealand (USANZ) asking whether active members performed urethroplasty and whether this was done in a rural, regional or metropolitan setting. RESULTS: Over a 22-year period, there were 140 540 endoscopic procedures and 5136 urethroplasties, with 27.4 endoscopic procedures per urethroplasty. From 1994 to 2016, the per capita number of passage of sounds and dilatation procedures decreased by 74% and 75%, respectively, with increases in use of optical urethrotomy of 70% and in single-stage urethroplasty of 144%. Overall, the ratio of all endoscopic procedures vs urethroplasty decreased from 58.9 to 16.8. There were as few as 16 surgeons in the USANZ performing urethroplasty, with seven providing this service in regional areas. Seven had formal fellowship training. CONCLUSION: There has been a clear shift from repetitive endoscopic procedures towards urethroplasty, but the former still make up the majority of interventions. This may be explained by patients not being referred for urethroplasty earlier in the course of disease and there appears to be a gap in genitourinary reconstructive expertise in regional and rural areas.

9.
J Endourol ; 33(12): 1037-1042, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31187638

RESUMO

Purpose: Our objective was to seek correlations between the type, volume, and duration of surgical work performed, surgeon habits and characteristics, and the prevalence of neck and back musculoskeletal complaint and intervention across career from training to retirement. Materials and Methods: An anonymous web-based multinational survey of urologists was conducted. The primary outcome measured was pain. Secondary outcomes included pain requiring intervention and surgery. Responses were subgrouped according to geography, practice patterns, and demographics. Student t test, Fisher's exact test, and chi-square test were used for analysis. Results: A total of 701 complete responses were received from this multinational survey. Gender, pain distribution, and private or academic practice did not correlate with pain, whereas exercise, lower weight, and body mass index (BMI) were protective. Dose-response of surgical type was assessed with high- and low-volume density quartiles and frequency of each pain severity; no correlation was found. Secondary analysis showed that female practitioners seek invasive therapy less than male counterparts, and practitioners of direct optical cystoscopy report no more neck trouble than others. Length of career since residency shows little relationship to pain or pain-free rates. Conclusions: In this, the largest surgical ergonomic study to date: surgical type, duration, volume, setting, and physician gender were unrelated to surgeon pain throughout career. Exercise was associated with lower prevalence of pain in a dose-related manner; increasing weight and BMI were positively associated with pain. Although 47% of urologists with spinal pain blame their career, we are unable to identify any dose-response relationship that supports that assumption.

10.
Low Urin Tract Symptoms ; 11(4): 211-216, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31064032

RESUMO

OBJECTIVE: This study evaluated the outcomes of urethroplasty performed in male patients by a single surgeon. METHODS: A retrospective review of male patients who underwent substitution urethroplasty by a single surgeon was performed. Baseline and perioperative parameters were recorded. Follow-up involved a pericatheter urethrogram at 3 weeks, a flow study at 8 weeks, and cystoscopic calibration within 6 to 12 months. Patient satisfaction was assessed using the Patient Global Impression of Improvement questionnaire. Primary outcome was functional success, as defined by no need for further intervention. Secondary outcomes were complications, patient satisfaction, and factors associated with stricture recurrence. RESULTS: Sixty male patients were included; two were lost to follow-up. Median patient age was 47 years (range 17-83 years). Mean stricture length was 5 cm (range 1.5-18 cm). Urethroplasty was performed using buccal mucosa graft repair in 53 patients (92%), flap repair in three patients (5%), and a combination of both techniques in two patients (3%). All complications were Clavien-Dindo Grade I to III, recorded in 20 patients (34%). At a mean follow-up of 50 months (range 12-124 months), functional success was evident in 90% of patients. Cystoscopic calibration at 6 to 18 months was performed in 28 patients (49%). Most patients (93%) reported a better quality of life after the procedure. Oral complications were low grade and uncommon (6%). Stricture recurrence was not related to age, stricture length, or etiology (all P > 0.05). CONCLUSIONS: Substitution urethroplasty has a high success rate, durable response, and high patient satisfaction. Standardization of surveillance protocol after urethroplasty is recommended.


Assuntos
Uretra/cirurgia , Estreitamento Uretral/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
11.
World J Urol ; 37(6): 1023-1027, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31037402

RESUMO

PURPOSE: When medications fail to satisfactorily treat bothersome lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO), procedural treatments are indicated. There is much interest in minimally invasive office-based treatments which can be performed under local anesthesia, allow fast recovery and have minimal morbidity. The purpose of this article is to review recent literature regarding safety and efficacy of office-based minimally invasive therapies for BPO. METHODS: A literature search using PUBMED and Medline was performed regarding minimally invasive office-based treatments for BPO, including the prostatic urethral lift (Urolift), water vapor therapy (Rezum) and stents. Literature published within the last 5 years were reviewed. RESULTS: The prostatic urethral lift (Urolift) is a safe and efficacious treatment for LUTS-BPO whilst also preserving sexual function. Rezum appears to be a safe and effective treatment in Phase 2 trials. Memokath prostatic stents do not appear to be a durable treatment; Allium prostatic stents warrant further investigation prior to recommendation. CONCLUSIONS: The prostatic urethral lift (Urolift) is a safe and effective treatment for LUTS-BPO whilst preserving sexual function. Rezum also appears to be a safe and effective treatment in small RCTs comparing performance with TURP. Memokath prostatic stents do not appear to have treatment durability. Further studies would be warranted to determine whether Allium prostatic stents are safe effective treatments for LUTS-BPO.


Assuntos
Sintomas do Trato Urinário Inferior/terapia , Hiperplasia Prostática/terapia , Obstrução Uretral/terapia , Humanos , Sintomas do Trato Urinário Inferior/complicações , Masculino , Visita a Consultório Médico , Hiperplasia Prostática/complicações , Obstrução Uretral/etiologia
12.
J Urol ; 201(4): 777-782, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30672843

RESUMO

PURPOSE: In a multi-institutional setting we studied the efficacy and safety outcomes at multiple high volume centers where collagenase Clostridium histolyticum is used to treat Peyronie's disease. MATERIALS AND METHODS: We collected retrospective data on consecutive patients with Peyronie's disease who underwent treatment with collagenase C. histolyticum between April 2014 and March 2018 at a total of 5 institutions. Included in the study were 918 patients. Main outcomes of interest included the change in curvature after receiving collagenase C. histolyticum therapy and the frequency of serious treatment related adverse events. The 2-tailed paired Student t-test was used to compare continuous variables. Univariate and multivariate regression analyses were performed to assess predictors of the success of collagenase C. histolyticum therapy to improve curvature. RESULTS: In the cohort of 918 patients curvature improved from a mean of 48.2 degrees before treatment to 32.9 degrees after treatment, a 30.1% improvement from baseline (p <0.0001). Of the men 68.7% had a 20% or greater improvement in curvature. In the 502 patients who completed 4 or more cycles curvature improved from a mean of 49.7 degrees before to 32.7 degrees after treatment, a 33% improvement from baseline (p <0.0001). Of these men 74.4% experienced a 20% or greater improvement in curvature. A complication of treatment developed in 9% of patients. The number of cycles of collagenase C. histolyticum received was predictive of curvature improvement (p <0.0001). CONCLUSIONS: This large multi-institutional analysis confirms the safety and efficacy of collagenase C. histolyticum therapy in men with Peyronie's disease. Intralesional collagenase C. histolyticum for Peyronie's disease according to the IMPRESS (Investigation of Maximal Peyronie's Reduction Efficacy and Safety Studies) trial protocol produced an improvement in penile curvature in men with Peyronie's disease with a low rate of complications.


Assuntos
Colagenase Microbiana/administração & dosagem , Induração Peniana/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Injeções Intralesionais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
13.
eNeuro ; 5(5)2018.
Artigo em Inglês | MEDLINE | ID: mdl-30417081

RESUMO

Here we used mouse models of heart and brain ischemia to compare the inflammatory response to ischemia in the heart, a protein rich organ, to the inflammatory response to ischemia in the brain, a lipid rich organ. We report that ischemia-induced inflammation resolves between one and four weeks in the heart compared to between eight and 24 weeks in the brain. Importantly, we discovered that a second burst of inflammation occurs in the brain between four and eight weeks following ischemia, which coincided with the appearance of cholesterol crystals within the infarct. This second wave shares a similar cellular and molecular profile with atherosclerosis and is characterized by high levels of osteopontin (OPN) and matrix metalloproteinases (MMPs). In order to test the role of OPN in areas of liquefactive necrosis, OPN-/- mice were subjected to brain ischemia. We found that at seven weeks following stroke, the expression of pro-inflammatory proteins and MMPs was profoundly reduced in the infarct of the OPN-/- mice, although the number of cholesterol crystals was increased. OPN-/- mice exhibited faster recovery of motor function and a higher number of neuronal nuclei (NeuN) positive cells in the peri-infarct area at seven weeks following stroke. Based on these findings we propose that the brain liquefies after stroke because phagocytic cells in the infarct are unable to efficiently clear cholesterol rich myelin debris, and that this leads to the perpetuation of an OPN-dependent inflammatory response characterized by high levels of degradative enzymes.


Assuntos
Aterosclerose/complicações , Isquemia Encefálica/complicações , Encéfalo/patologia , Osteopontina/farmacologia , Acidente Vascular Cerebral/complicações , Animais , Encéfalo/metabolismo , Modelos Animais de Doenças , Inflamação/metabolismo , Macrófagos/metabolismo , Masculino , Camundongos Endogâmicos C57BL , Doenças Neurodegenerativas/patologia , Acidente Vascular Cerebral/metabolismo
14.
J Control Release ; 290: 75-87, 2018 11 28.
Artigo em Inglês | MEDLINE | ID: mdl-30290244

RESUMO

Activation of the Wnt signaling pathway promotes lung cancer progression and contributes to poor patient prognosis. The porcupine inhibitor LGK974, a novel orally bioavailable cancer therapeutic in Phase I clinical trials, induces potent Wnt signaling inhibition and leads to suppressed growth and progression of multiple types of cancers. The clinical use of LGK974, however, is limited in part due to its low solubility and high toxicity in tissues that rely on Wnt signaling for normal homeostasis. Here, we report the use of host-guest chemistry to enhance the solubility and bioavailability of LGK974 in mice through complexation with cyclodextrins (CD). We assessed the effects of these complexes to inhibit Wnt signaling in lung adenocarcinomas that are typically driven by overactive Wnt signaling. 2D 1H NMR confirmed host-guest complexation of CDs with LGK974. CD:LGK974 complexes significantly decreased the expression of Wnt target genes in lung cancer organoids and in lung cancer allografts in mice. Further, CD:LGK974 complexes increased the bioavailability upon oral administration in mice compared to free LGK974. In a mouse lung cancer allograft model, CD:LGK974 complexes induced potent Wnt signaling inhibition with reduced intestinal toxicity compared to treatment with free drug. Collectively, the development of these complexes enables safer and repeated oral or parenteral administration of Wnt signaling inhibitors, which hold promise for the treatment of multiple types of malignancies.


Assuntos
Adenocarcinoma de Pulmão/tratamento farmacológico , Antineoplásicos/administração & dosagem , Ciclodextrinas/administração & dosagem , Neoplasias Pulmonares/tratamento farmacológico , Pirazinas/administração & dosagem , Piridinas/administração & dosagem , Proteínas Wnt/antagonistas & inibidores , Via de Sinalização Wnt/efeitos dos fármacos , Adenocarcinoma de Pulmão/metabolismo , Animais , Antineoplásicos/química , Antineoplásicos/farmacocinética , Linhagem Celular Tumoral , Ciclodextrinas/química , Ciclodextrinas/farmacocinética , Humanos , Neoplasias Pulmonares/metabolismo , Camundongos Nus , Pirazinas/química , Pirazinas/farmacocinética , Piridinas/química , Piridinas/farmacocinética
15.
Asian J Urol ; 5(1): 22-27, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29379732

RESUMO

Transurethral resection of the prostate (TURP) became the gold standard surgical treatment for benign prostatic obstruction without undergoing randomized controlled trials against the predecessor standard in open suprapubic prostatectomy. TURP has historically been associated with significant morbidity and this has fuelled the development of minimally invasive surgical treatment options. Improvements in perioperative morbidity for TURP has been creating an ever increasing standard that must be met by any new technologies that are to be compared to this gold standard. Over recent years, there has been the emergence of novel minimally invasive treatments such as the prostatic urethral lift (PUL; UroLift System), convective WAter Vapor Energy (WAVE; Rezum System), Aquablation (AQUABEAM System), Histotripsy (Vortx Rx System) and temporary implantable nitinol device (TIND). Intraprostatic injections (NX-1207, PRX-302, botulinum toxin A, ethanol) have mostly been used with limited efficacy, but may be suitable for selected patients. This review evaluates these novel minimally invasive surgical options with special reference to the literature published in the past 5 years.

16.
Neurobiol Dis ; 112: 63-78, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29331263

RESUMO

Following stroke, the damaged tissue undergoes liquefactive necrosis, a stage of infarct resolution that lasts for months although the exact length of time is currently unknown. One method of repair involves reactive astrocytes and microglia forming a glial scar to compartmentalize the area of liquefactive necrosis from the rest of the brain. The formation of the glial scar is a critical component of the healing response to stroke, as well as other central nervous system (CNS) injuries. The goal of this study was to evaluate the toxicity of the extracellular fluid present in areas of liquefactive necrosis and determine how effectively it is segregated from the remainder of the brain. To accomplish this goal, we used a mouse model of stroke in conjunction with an extracellular fluid toxicity assay, fluorescent and electron microscopy, immunostaining, tracer injections into the infarct, and multiplex immunoassays. We confirmed that the extracellular fluid present in areas of liquefactive necrosis following stroke is toxic to primary cortical and hippocampal neurons for at least 7 weeks following stroke, and discovered that although glial scars are robust physical and endocytic barriers, they are nevertheless permeable. We found that molecules present in the area of liquefactive necrosis can leak across the glial scar and are removed by a combination of paravascular clearance and microglial endocytosis in the adjacent tissue. Despite these mechanisms, there is delayed atrophy, cytotoxic edema, and neuron loss in regions adjacent to the infarct for weeks following stroke. These findings suggest that one mechanism of neurodegeneration following stroke is the failure of glial scars to impermeably segregate areas of liquefactive necrosis from surviving brain tissue.


Assuntos
Infarto Cerebral/metabolismo , Cicatriz/metabolismo , Gliose/metabolismo , Neuroglia/metabolismo , Acidente Vascular Cerebral/metabolismo , Animais , Encéfalo/metabolismo , Encéfalo/patologia , Células Cultivadas , Infarto Cerebral/patologia , Cicatriz/patologia , Gliose/patologia , Humanos , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Neuroglia/patologia , Acidente Vascular Cerebral/patologia
17.
Sci Rep ; 7(1): 11120, 2017 09 11.
Artigo em Inglês | MEDLINE | ID: mdl-28894175

RESUMO

The ventral tegmental area (VTA) dopamine system is important for reward, motivation, emotion, learning, and memory. Dysfunctions in the dopamine system are linked to multiple neurological and neuropsychiatric disorders, many of which present with sex differences. Little is known about the extent of heterogeneity in the basic organization of VTA dopamine neurons with regard to sex. Here, we characterized the cell-specific connectivity of VTA dopamine neurons, their mRNA translational profile, and basic electrophysiological characteristics in a common strain of mice. We found no major differences in these metrics, except for differential expression of a Y-chromosome associated mRNA transcript, Eif2s3y, and the X-linked, X-inactivation transcript Xist. Of note, Xist transcript was significantly enriched in dopamine neurons, suggesting tight regulation of X-linked gene expression to ensure sexual congruency. These data indicate that the features that make dopamine neurons unique are highly concordant and not a principal source of sexual dimorphism.


Assuntos
Conectoma , Neurônios Dopaminérgicos/metabolismo , Área Tegmentar Ventral/fisiologia , Animais , Biomarcadores , Biologia Computacional , Fenômenos Eletrofisiológicos , Feminino , Imunofluorescência , Perfilação da Expressão Gênica , Imuno-Histoquímica , Masculino , Camundongos , Camundongos Transgênicos , Fatores Sexuais
18.
Transl Androl Urol ; 6(4): 674-681, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28904900

RESUMO

The AdVance sling (American Medical Systems, Minnetonka, MN, United States of America) is a synthetic transobturator sling, which is a safe and effective minimally invasive treatment for mild to moderate stress urinary incontinence (SUI) in male patients. This article provides a step-by-step description of our technique for placement of the AdVance male sling, including details and nuances gained from surgical experience, advice for avoidance of complications and discussion on management of complications and sling failures. Patient selection is very important, including exclusion and preoperative treatment of urethral stenosis and bladder dysfunction. Previous pelvic radiation is a poor prognostic factor. In brief, the steps of sling placement are: (I) mobilization of the corpus spongiosum (CS); (II) marking and mobilization of the central tendon; (III) passage of the helical trocar needles exiting at the apex of the angle between the CS and inferior pubic ramus; (IV) fixation of the broad part of the sling body to the CS at the previous mark; (V) cystoscopy during sling tensioning; (VI) placement of a Foley urethral catheter; (VII) Subcutaneous tunnelling of the sling arms back toward the midline; (VIII) wound closure. The most common early postoperative complication is urinary retention but long-term retention is extremely rare. Management of sling failures include placement of an artificial urinary sphincter, repeat AdVance sling, urethral bulking agent or ProACT device.

20.
Curr Urol Rep ; 18(9): 70, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28718163

RESUMO

Lower urinary tract symptoms (LUTS) after urethral stricture repair are not uncommon. Urgency has been reported in 40% of men and urge incontinence in 12% of men after anterior urethroplasty. De novo urgency and urge incontinence is seen in 9 and 5% of men, respectively, after urethroplasty. Once a complication of urethroplasty (such as recurrent urethral stricture or diverticulum) has been excluded as a cause, evaluation of LUTS in such patients should focus on differentiating bladder dysfunction (overactive bladder, underactive bladder), from other outlet obstruction (such as benign prostatic obstruction), dysfunctional voiding, or medical causes (such as nocturnal polyuria). Management of overactive bladder may include behavioural modification, physical therapy, anticholinergic and/or beta-3 agonist medications, intravesical onabolulinum toxin, sacral neuromodulation or peripheral tibial nerve stimulation. Definitive treatment for underactive bladder is limited. Treatment of benign prostatic obstruction may include alpha-blocker and/or 5-alpha reductase inhibitor medication, or surgery to cavitate the prostate. Minimally invasive prostatic procedures are also an option. Although management of LUTS for patients after urethral stricture repair can usually proceed similarly as for patients without prior history of urethral reconstruction, special consideration and alterations in management need to be made when instrumenting the urethra, as the urethral lumen may be narrower in these patients.


Assuntos
Sintomas do Trato Urinário Inferior/epidemiologia , Sintomas do Trato Urinário Inferior/terapia , Estreitamento Uretral/cirurgia , Humanos , Incidência , Masculino
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