Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 31
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Urology ; 117: 131-136, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29649545

RESUMO

OBJECTIVE: To demonstrate the long-term outcome of a contemporary series of 64 children who underwent complete primary repair of bladder exstrophy (CPRE) in a single tertiary referral center. MATERIALS AND METHODS: Between 1998 and 2012, 64 children, 47 boys and 17 girls, were identified. Only 60 of the 64 cases were available for follow-up. The follow-up was done by renal bladder ultrasound and serum creatinine every 3 months and voiding cystourethrogram from 6 to 12 months postoperatively. Continence was defined as dryness ≥3 hours. RESULTS: Median (range) follow-up is 14 years (from 5 to 19 years). Voided continence was achieved in 14 children (23%) after CPRE only. Additionally, 6 children were continent after bladder neck reconstruction (BNR) and 2 after bladder neck injection (BNI), raising the percentage of voided continence to 36%. The remaining 38 (64%) patients were using clean intermittent catheterization. All cases were continent at last assessment. The results of BNR or BNI were better in de novo than in redo cases (P <.05). The percentage of cases that needed augmentation ileocystoplasty in combination with multiple bladder neck procedures was lower in both female and de novo cases (P <.05). CONCLUSION: The percentage of children with classic bladder exstrophy who underwent CPRE who will achieve continence with volitional voiding via the urethra is 36%. The continence results after BNR and BNI are better in de novo cases than in redo ones. Continence in female and de novo cases is more likely to be achieved with lower number of continence procedures.

2.
Urology ; 108: 171-174, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28705578

RESUMO

Cloacal duplication is an exceedingly rare group of anomalies with a limited number of cases reported so far. The anomaly may be confined to partial bladder duplication or it may involve complete duplication of the urogenital tract, hindgut, spine, lower limbs, and vascular structures. Every case is unique and ought to be approached individually. By means of imaging studies and endoscopy, anatomic details should be carefully defined before endorsing surgical correction. A satisfactory outcome can be achieved in the majority of cases. In this report, we describe 3 girls with cloacal duplication, and review pertinent imaging and surgical management.


Assuntos
Cloaca/anormalidades , Gerenciamento Clínico , Procedimentos Cirúrgicos Reconstrutivos/métodos , Anormalidades Urogenitais/cirurgia , Procedimentos Cirúrgicos Urogenitais/métodos , Criança , Pré-Escolar , Cloaca/diagnóstico por imagem , Cloaca/cirurgia , Cistoscopia , Feminino , Humanos , Lactente , Imagem por Ressonância Magnética , Doenças Raras , Ultrassonografia , Anormalidades Urogenitais/diagnóstico
3.
Urology ; 101: 161-162, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27993712

RESUMO

Bladder neck closure (BNC) is the ultimate bladder neck reconstruction. If reconstruction fails, closure must be considered as it gives the highest continence rate. The vast majority of BNCs are performed through an abdominal approach (either transvesical or extravesical approach), but perineal approach remains an option for BNC with considerable success rate. Perineal hernia, which is defined as protrusion of abdominal contents through the perineal defect, is a very rare complication after urologic procedures. We report a case of perineal hernia post perineal BNC.


Assuntos
Epispadia/cirurgia , Hérnia/etiologia , Herniorrafia/métodos , Períneo , Complicações Pós-Operatórias/etiologia , Telas Cirúrgicas , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Criança , Hérnia/diagnóstico , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Reoperação , Tomografia Computadorizada por Raios X , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/cirurgia , Urografia
5.
Neurourol Urodyn ; 35(4): 497-502, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25663249

RESUMO

AIMS: Post-exstrophy incontinence is a challenge because continence is difficult to achieve and more difficult to maintain. Feasibility and outcomes of a bulbourethral sling to treat post-exstrophy incontinence is shown in this report. METHODS: A retropubic bulbourethral sling was applied to male patients with incontinence post-exstrophy-epispadius repair. The study included children with total (continuous) incontinence who underwent multiple previous anti-incontinence procedures, ranging from bladder neck injection to bladder neck reconstruction. Preoperative assessment includes urinalysis, renal US, VCUG, 1-hr pad test and urodynamics. The bulbourethral sling applied is made of polypropylene and is suspended by 4 pairs of nylon sutures, to support the bulbar urethra within its covering muscles with the sutures tied on the rectus muscles. Continence was evaluated as well as adverse events. RESULTS: Seventeen children, (median age 8.7 years) completed 24-month of follow up. All had CPRE. Five children (29.27%) were dry. Four micturated through the urethra and one by catheterizing his cutaneous stoma every 3-4 hr. In none, PVR exceeded 10% of expected capacity. Four children underwent re-tightening 1-4 weeks after removal of urethral catheter. Perineal wound dehiscence occurred in one, perineal/suprapubic pain in seven and epididymo-orchitis in one child. CONCLUSION: The current technique is promising for difficult cases of incontinence after CPRE. It is safe, as no serious adverse events occurred during follow up period. It is economic and re-tightening is easy to perform. Neurourol. Urodynam. 35:497-502, 2016. © 2015 Wiley Periodicals, Inc.


Assuntos
Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Slings Suburetrais , Uretra/cirurgia , Incontinência Urinária/cirurgia , Adolescente , Criança , Pré-Escolar , Seguimentos , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Bexiga Urinária/cirurgia , Incontinência Urinária/etiologia , Urodinâmica
6.
J Urol ; 194(5): 1414-9, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25986509

RESUMO

PURPOSE: We sought to evaluate long-term outcomes of the Bricker conduit urinary diversion in children. MATERIALS AND METHODS: We retrospectively reviewed the database of a single tertiary center for children who had undergone ileal conduit between 1981 and 2011. Patients followed for less than 1 year were excluded. Patient files were reviewed for demographics, diversion indication, preoperative imaging, surgical details, hospital readmissions and followup data. Renal function at baseline and last followup was assessed by estimated glomerular filtration rate, calculated using the modified Schwartz or MDRD (Modified Diet in Renal Disease) formula. Growth charts elucidated patient growth patterns, while an internally designed quality of life questionnaire demonstrated patient and family satisfaction with the procedure. RESULTS: We evaluated 29 children who underwent Bricker conduit at a median age of 10 years (range 2 to 18) and were followed for a median of 91 months (16 to 389). Neuropathic bladder was the underlying diagnosis in 72.4% of cases. Hydronephrosis improved or remained stable in 39 of 55 studied renal units (70.9%). Although no statistically significant difference was observed between mean ± SD baseline (64.5 ± 46 ml/minute/1.73 m(2)) and last followup estimated glomerular filtration rate (54.1 ± 44.9 ml/minute/1.73 m(2)), chronic kidney disease stage had worsened in 13 patients (44.8%), end-stage kidney disease had developed in 11 patients and 9 patients had died. Six patients underwent undiversion after stabilization of renal function. Linear growth was negatively affected in 12 patients (41.4%), and 85% reported poor quality of life. A total of 19 hospital readmissions were required in 14 patients to treat diversion related complications. CONCLUSIONS: The Bricker conduit does not seem to halt renal deterioration in children. Negative impact on growth and quality of life, and the anticipated rate of complications are significant limitations of the procedure in the pediatric population.


Assuntos
Íleo/cirurgia , Nefropatias/cirurgia , Complicações Pós-Operatórias/epidemiologia , Qualidade de Vida , Derivação Urinária/métodos , Adolescente , Criança , Pré-Escolar , Egito/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Derivação Urinária/psicologia
7.
J Urol ; 192(1): 194-9, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24518781

RESUMO

PURPOSE: Staging of childhood renal tumors is crucial for treatment planning and outcome prediction. We sought to identify whether computerized tomography could accurately predict the local stage of childhood renal tumors. MATERIALS AND METHODS: We retrospectively reviewed our database for patients diagnosed with childhood renal tumors and treated surgically between 1990 and 2013. Inability to retrieve preoperative computerized tomography, intraoperative tumor spillage and nonWilms childhood renal tumors were exclusion criteria. Local computerized tomography stage was assigned by a single experienced pediatric radiologist blinded to the pathological stage, using a consensus similar to the Children's Oncology Group Wilms tumor staging system. Tumors were stratified into up-front surgery and preoperative chemotherapy groups. The radiological stage of each tumor was compared to the pathological stage. RESULTS: A total of 189 tumors in 179 patients met inclusion criteria. Computerized tomography staging matched pathological staging in 68% of up-front surgery (70 of 103), 31.8% of pre-chemotherapy (21 of 66) and 48.8% of post-chemotherapy scans (42 of 86). Computerized tomography over staged 21.4%, 65.2% and 46.5% of tumors in the up-front surgery, pre-chemotherapy and post-chemotherapy scans, respectively, and under staged 10.7%, 3% and 4.7%. Computerized tomography staging was more accurate in tumors managed by up-front surgery (p <0.001) and those without extracapsular extension (p <0.001). CONCLUSIONS: The validity of computerized tomography staging of childhood renal tumors remains doubtful. This staging is more accurate for tumors treated with up-front surgery and those without extracapsular extension. Preoperative computerized tomography can help to exclude capsular breach. Treatment strategy should be based on surgical and pathological staging to avoid the hazards of inaccurate staging.


Assuntos
Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Tomografia Computadorizada por Raios X , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estadiamento de Neoplasias/métodos , Valor Preditivo dos Testes , Estudos Retrospectivos
8.
Can Urol Assoc J ; 8(11-12): E906-9, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25553164

RESUMO

INTRODUCTION: We compare percutaneous nephrolithotomy (PCNL) and open surgery in the treatment of staghorn stones in children. METHODS: We retrospectively reviewed the electronic records of children who underwent treatment for staghorn stones between September 2000 and August 2013. They were divided between Group 1 (patients who underwent PCNL) and Group 2 (patients who underwent open surgery). We compared stone-free and complications rates, need for multiple procedures, and hospital stay. RESULTS: The study included 41 patients (35 boys and 6 girls), with mean age 7.4 ± 3.1 years (range: 2-15). Of these 41 patients, 26 had unilateral renal stone and 15 had bilateral renal stones. The total number of treated renal units was 56: 28 underwent PCNL and 28 underwent open surgery. The complication rate was comparable for both groups (32% for open surgery vs. 28.6%, p = 0.771). Multiple procedures were more needed in PCNL group (60.7% vs. 32% in open surgery, p = 0.032). The stone-free rate was 71.4% after PCNL and 78.6% after open surgery (p = 0.537). A significant difference was observed in shorter hospital stay after PCNL (5 vs. 8.8 days, p < 0.001). Our study's limitations include its retrospective design and relatively small sample size. CONCLUSIONS: For the treatment of staghorn stones in children, PCNL was comparable to open surgery in complication and stone-free rates. PCNL had the advantage of a shorter hospital stay and open surgery showed a decreased need for multiple procedures.

9.
Arab J Urol ; 12(2): 130-6, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26019937

RESUMO

OBJECTIVES: To review our 10-year experience with uncommon testicular tumours in children (prepubertal testicular and paratesticular), to review previous reports, and to determine the appropriate management of these rare tumours, specifically the role of testicular-sparing surgery. PATIENTS AND METHODS: We retrospectively reviewed all cases of testicular tumours managed at our institution between 1999 and 2009. Boys aged <16 years were included in the study. The patients' characteristics, presentation, the diagnostic tools, tumour markers, mode of treatment, pathological findings and outcome were assessed. We reviewed previous reports that addressed testicular and paratesticular tumours in prepubertal boys, using a Medline/PubMed search. RESULTS: From 80 patients, 13 boys (median age 8.7 years) presented with testicular tumours (16%) and were included in the study. Two boys presented with precocious puberty and one with gynaecomastia. The level of α-fetoprotein was high in three boys, and the human chorionic gonadotrophin level was elevated in one, and both markers were high in one. Testicular-sparing surgery was performed in three boys. Six of the 13 tumours were malignant and seven were benign. None of the patients developed a recurrence or testicular atrophy after testicular-sparing surgery. From the review of previous reports we devised an evidence-based algorithm for managing prepubertal testicular tumours. CONCLUSIONS: Paediatric testicular tumours are rare but they require an inguinal approach for either orchidectomy or testicular-sparing surgery; we recommend the latter option as long as frozen sections are analysed and a safety margin is maintained.

10.
J Urol ; 185(6 Suppl): 2491-5, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21555022

RESUMO

PURPOSE: Posterior urethral valves represent the most common obstructive uropathy in children with a broad spectrum of clinical severity. We evaluated prognostic variables affecting the outcome of renal function in such children. MATERIALS AND METHODS: Between 1987 and 2004, 120 patients with a mean age of 2 years with posterior urethral valves were treated initially with valve ablation at our center. We studied certain parameters, including age at presentation, serum creatinine (initial and nadir), initial creatinine clearance, renal ultrasound findings (hydronephrosis and renal parenchymal echogenicity), vesicoureteral reflux on initial voiding cystourethrogram, bladder dysfunction and popoff mechanisms such as the syndrome of large vesical diverticulum, urinoma and ascites. Long-term renal outcome was assessed. RESULTS: Followup was 2 to 16 years (median 3.6). Renal insufficiency developed at the end of followup in 44 patients (36.5%). Serum creatinine at hospital admission, nadir serum creatinine, initial creatinine clearance and renal parenchymal echogenicity were significant predictors of the final renal outcome (p < 0.05). Patient age at diagnosis (2 or less vs greater than 2 years), upper tract dilatation, the presence or absence of vesicoureteral reflux, popoff mechanisms and bladder dysfunction had no significant impact on future renal function. On multivariate analysis nadir serum creatinine was the only independent prognostic factor. CONCLUSIONS: Our data confirm the high prognostic value of nadir creatinine after primary valve ablation. Also, initial serum creatinine, creatinine clearance and renal parenchymal echogenicity on initial renal ultrasound correlate significantly with long-term renal function in children with posterior urethral valves.


Assuntos
Uretra/anormalidades , Uretra/cirurgia , Pré-Escolar , Creatinina/sangue , Humanos , Testes de Função Renal , Masculino , Análise Multivariada , Resultado do Tratamento
11.
J Pediatr Urol ; 7(3): 252-6, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21527220

RESUMO

OBJECTIVE: Urolithiasis in children can cause considerable morbidity. Our aim was to evaluate the impact of intervention on the recoverability of kidney functions. MATERIALS AND METHODS: This prospective study included 93 children (66 boys and 27 girls) with median age of 3 years (range 0-14). Inclusion criteria were presence of anuria, oliguria, serum creatinine >2 mg% and/or hyperkalemia ≥ 6 mmol/L. The mean duration of anuria or oliguria was (mean ± SE) 5.3 ± 0.4 days. On presentation, mean plasma creatinine was 6.5 ± 0.29 mg/dl with a mean estimated glomerular filtration rate (eGFR) of 14 ml/min and creatinine clearance (CC) of 8.24 ml/min. Dialysis was performed in 21 (22.6%) patients. When condition allowed, emergency surgery was performed. RESULTS: Mean follow up was 1.5 years with compliance of 82%. At the end of treatment, 83% of patients had complete clearance of calculi. Mean plasma creatinine after treatment was 3.3 ± 0.35 mg/dl with an average GFR of 24.5 ml/min. After treatment renal function returned to normal in 57%, improved in 27% and deteriorated in 16% of children. Renal function recoverability rate was 94.6%. Chronic renal failure developed in 3 (3.2%) patients and 2 (2.2%) patients died. When absolute plasma creatinine concentration [P(cr)] improved 20-50% the eGFR and CC were doubled, and when improved 50-70% eGFR and CC tripled. Beyond 70% improvement in [P(cr)], eGFR and CC improved 7-8 times. Using Spearman's correlation, the mode of presentation and the type of management had a significant correlation with renal function outcome (P = 0.019 and 0.013 respectively). CONCLUSION: Urgent management of calcular anuria both medically and surgically is the cornerstone for favorable outcome. The mode of presentation and the type of management are significant factors affecting final renal function outcome.


Assuntos
Anuria/fisiopatologia , Cálculos Renais/complicações , Rim/fisiopatologia , Recuperação de Função Fisiológica , Adolescente , Anuria/etiologia , Criança , Pré-Escolar , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular , Humanos , Lactente , Cálculos Renais/fisiopatologia , Falência Renal Crônica/epidemiologia , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos
12.
Int Urol Nephrol ; 43(4): 1019-24, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21516474

RESUMO

INTRODUCTION: The aim of this study is to review our experience with sporadic pheochromocytoma in pediatrics and adolescents focusing upon surgical approach, incidence of malignancy, and recurrence rate. MATERIALS AND METHODS: Between 1990 and 2007, 8 pediatric patients were diagnosed with sporadic pheochromocytoma. Demographic data, clinical and radiological findings, laboratory profile, preoperative preparation, surgical approach, operative findings, postoperative course as well as pathologic diagnosis of the removed specimen were reviewed. RESULTS: Mean age of presentation was 13.1 ± 4.7 years. Five patients had right-sided masses, 1 harbored left-sided mass, and bilaterality was observed in 2 with mean size of 5.7 ± 1.3 cm. Computed tomography showed no evidence of local infiltration, regional lymphadenopathy or distant metastasis in all patients but two. Six masses were excised through thoraco-abdominal approach, 3 were removed laparoscopically, while percutaneous alcohol ablation was adopted for the last. We had one postoperative death (12.5%:1/8), and the remaining 7 patients were followed for a mean of 8.6 ± 3 years. Five patients never had recurrence. Bilateral recurrence developed in 2 patients, where they were safely excised in one patient and was a part of disseminated disease in the other. Malignant nature of the disease was proved in 2 patients and showed poor survival. CONCLUSION: Under adequate anesthetic control, pediatric pheochromocytoma could be safely managed through both the open and laparoscopic approaches. Advanced radiological stage would suggest the malignant nature of the disease with dismal outcome. Long-term follow-up is warranted for possibility of delayed curable recurrence.


Assuntos
Neoplasias das Glândulas Suprarrenais/patologia , Neoplasias das Glândulas Suprarrenais/cirurgia , Recidiva Local de Neoplasia/cirurgia , Feocromocitoma/patologia , Feocromocitoma/cirurgia , Adolescente , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Anestesia Geral/métodos , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Metástase Neoplásica , Feocromocitoma/diagnóstico por imagem , Radiografia , Estudos Retrospectivos
13.
Int Urol Nephrol ; 43(1): 1-5, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20526809

RESUMO

PURPOSE: Non-iatrogenic ureteral injuries in children are rare. Only sparse literature reports are available regarding management and outcome. We reviewed our experience in diagnosis and treatment of complex non-iatrogenic ureteral injuries in children. MATERIALS AND METHODS: From 2000 to 2010, children who were treated for non-iatrogenic ureteral injuries were reviewed. Patients' characteristics, mechanism of trauma, affected ureteral segment, time of recognition, associated injuries, presentation, mode of treatment and postoperative complications were studied from the medical records of those patients. RESULTS: Five children (four boys and one girl) with a median age of 10 (range 2-15) were treated at our center. Blunt abdominal trauma was documented in three children, while in another two penetrating trauma was inflicted. Associated hepatic tear was noted in one child and bowel injury in another. The affected segment was UPJ in three and mid-ureter in two. All cases presented with Urinoma. Diagnosis was confirmed after fixation of percutaneous nephrostomy and antegrade pyelography in four children, while reterograde pyelography was done in the remaining child. Surgical interventions included uretero-calyceal anastomosis in two, while nephrectomy was necessitated in another two with poor kidney function. In the child to whom retrograde pyelography was done, a double J stent was fixed for 3 months and the patient did well. CONCLUSIONS: Pediatric non-iatrogenic ureteral injuries are rare. A raised index for suspicion should be considered intra-operatively during initial exploration. Missed injuries are more common and may end in dense scarring and up to nephrectomy.


Assuntos
Traumatismos Abdominais/complicações , Nefrostomia Percutânea/métodos , Stents , Ureter/lesões , Doenças Ureterais/etiologia , Ferimentos não Penetrantes/complicações , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/cirurgia , Adolescente , Anastomose Cirúrgica , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Doença Iatrogênica , Masculino , Estudos Retrospectivos , Ureter/cirurgia , Doenças Ureterais/diagnóstico , Doenças Ureterais/cirurgia , Urografia , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/cirurgia
14.
BJU Int ; 107(5): 829-833, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20735380

RESUMO

OBJECTIVE: • To evaluate the functional and morphological outcome after open pyeloplasty for ureteropelvic junction obstruction (UPJO) with huge renal pelvis. PATIENTS AND METHODS: • A retrospective review of all cases who underwent pyeloplasty for huge renal pelvis was conducted. • Records were evaluated with respect to age at presentation, preoperative imaging, surgical details and postoperative course. Patients were followed up regularly for both functional and morphological outcome. • Success was defined as both symptomatic relief and radiographic resolution of obstruction at last follow-up. RESULTS: • Between 1998 and 2008, 526 cases of primary UPJO underwent open dismembered pyeloplasty at our centre. • Of these patients, 41 (8%) had UPJO with huge renal pelvis. • No perioperative complications were encountered in the study group. Mean (range) follow-up was 34 (18-84) months and nine patients were lost to follow-up. The overall success rate was 91%. • Two patients underwent redo pyeloplasty, whereas secondary nephrectomy was necessary in one. • Improvement of hydronephrosis was evident in all patients, except in three patients who underwent secondary procedures. • However, persistent obstruction on diuretic renography was seen in most cases (65%). CONCLUSIONS: • Open pyeloplasty for huge pelvis UPJO is feasible with a high success rate. • Varying degrees of hydronephrosis and radiological obstruction after pyeloplasty are not uncommon. • Nephrectomy is rarely indicated in cases with severely deteriorated renal function.


Assuntos
Hidronefrose/cirurgia , Pelve Renal/cirurgia , Obstrução Ureteral/cirurgia , Criança , Pré-Escolar , Métodos Epidemiológicos , Feminino , Humanos , Hidronefrose/etiologia , Hidronefrose/fisiopatologia , Lactente , Pelve Renal/diagnóstico por imagem , Pelve Renal/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Complicações Pós-Operatórias/etiologia , Renografia por Radioisótopo , Resultado do Tratamento , Obstrução Ureteral/complicações , Obstrução Ureteral/fisiopatologia
15.
J Pediatr Surg ; 45(11): 2222-6, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21034948

RESUMO

PURPOSE: The aim of the study was to report the surgical complications that may occur during or after primary ablation of posterior urethral valve (PUV) in a large number of cases treated using different modalities. MATERIALS AND METHODS: We retrospectively reviewed a database of 291 patients with PUV treated by primary valve ablation from 2 separate centers between 1987 and 2006. Primary valve ablation was performed in all patients regardless of serum creatinine level or upper tract configuration. A hot loop resectoscope was used in 122 patients, cold knife urethrotome in 108, a hook diathermy electrode in 18, a diathermy coagulation bugbee electrode in 20, whereas stripping using a Fogarty catheter was performed in 23. RESULTS: The follow-up duration ranged from 1.5 to 20 years (median, 6.5). Early postoperative complications occurred in 22 patients (7.5%). The most common complication was urinary retention in 16 patients (5.5%). Urinary extravasations occurred in 3 cases, significant hematuria from urethral bleeding occurred in 2, and obstructive anuria developed in 1 patient. Most of cases were treated conservatively. Urethral strictures developed in 6 patients (2%) mainly after endoscopic loop resection (4/6). All were treated by visual internal urethrotomy and urethral dilatation with successful results without the need of open urethroplasty. CONCLUSIONS: Primary valve ablation seems to be safe and is associated with low rate of postoperative complications. All the complications could be treated conservatively. Urethral stricture may occur after valve ablation in a minority of cases and can be successfully treated endoscopically. Loop resection is associated with more strictures.


Assuntos
Anuria/etiologia , Ablação por Cateter/efeitos adversos , Uretra/lesões , Obstrução Uretral/etiologia , Obstrução do Colo da Bexiga Urinária/cirurgia , Retenção Urinária/etiologia , Adolescente , Anuria/diagnóstico , Anuria/fisiopatologia , Criança , Pré-Escolar , Seguimentos , Humanos , Lactente , Masculino , Complicações Pós-Operatórias , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Obstrução Uretral/diagnóstico , Obstrução Uretral/fisiopatologia , Obstrução do Colo da Bexiga Urinária/congênito , Retenção Urinária/diagnóstico , Retenção Urinária/fisiopatologia , Urodinâmica , Adulto Jovem
16.
J Trauma ; 69(5): 1300-3, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21068625

RESUMO

OBJECTIVES: We report our experience in the management of urethrorectal fistulae in children with emphasis on the complexity of this rare disease. PATIENTS AND METHODS: A retrospective review was performed in cases that underwent repair of urethrorectal fistula at our center between 1997 and 2007. Records were reviewed for age, history, presentation, radiologic data, operative data, and condition at last follow-up. RESULTS: Five children were managed for urethrorectal fistula. Their mean age was 6.8 years (range, 2 months-12 years). One case had congenital urethrorectal fistula and four had acquired fistulas including two after abdomino-perineal pull through for imperforate anus, one case post perineal urethroplasty, and another post repair of posttraumatic rectal tear. All patients presented with history of passing urine both through the rectum and the urethral meatus. We have three urinary diverted cases: one case in whom urinary and fecal diversions were performed and the remaining case was operated without diversion. Perineal approach was adopted in four procedures and abdomino-perineal approach in one. One patient required optical internal urethrotomy for anastomotic stricture at 6 months follow-up. CONCLUSIONS: Urethrorectal fistula is a rare complication whether congenital or iatrogenic. Perineal repair is challenging, necessities meticulous dissection, adequate vascularity of the edges, and interposition of vascularized flaps and is potentially successful.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Fístula Retal/cirurgia , Doenças Uretrais/cirurgia , Fístula Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Criança , Pré-Escolar , Seguimentos , Humanos , Lactente , Masculino , Estudos Retrospectivos , Resultado do Tratamento
17.
World J Urol ; 28(2): 199-204, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19517113

RESUMO

PURPOSE: Presentation of bladder exstrophy epispadias complex (BEEC) during adulthood is rare. A major surgical challenge encountered in adults with BEEC is the closure of the anterior abdominal wall defect. In this case series we report our experience with the abdominal closure without osteotomy. MATERIALS AND METHODS: Five adult male patients with BEEC were managed at our center. None of the patients had any prior attempts of surgical correction. A right renal tumor was incidentally discovered in one patient and a right partial nephrectomy was performed. All patients underwent urinary diversion and abdominal wall closure at the same operative setting except one. Cystectomy was performed in two patients while the vesical plate muscular coat was utilized for providing support to the anterior abdominal wall in the other three patients. One patient underwent an ileal conduit, while the other patients underwent continent cutaneous diversion. None of our patients underwent osteotomy. RESULTS: Follow-up ranged from 6 to 52 months (mean = 31). Patients who underwent continent cutaneous diversion were continent by day and night. One patient had wound infection and partial disruption and secondary sutures were performed. One patient developed stomal stenosis and was managed by stomal dilatation. All patients showed marked satisfaction with their body image following surgery. CONCLUSION: Management of BEEC in adults is challenging. Utilization of the vesical plate muscular coat for supporting the anterior abdominal wall is a reliable method for abdominal reconstruction. Urinary diversion and abdominal wall closure in one surgical procedure without osteotomy is feasible.


Assuntos
Parede Abdominal/cirurgia , Extrofia Vesical/cirurgia , Epispadia/cirurgia , Derivação Urinária/métodos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Músculos Abdominais/cirurgia , Adulto , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia , Satisfação do Paciente , Ossos Pélvicos , Complicações Pós-Operatórias/prevenção & controle , Qualidade de Vida , Inquéritos e Questionários , Adulto Jovem
18.
J Pediatr Surg ; 44(9): 1750-3, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19735820

RESUMO

PURPOSE: The aim of the study was to report the experience with renal cell carcinoma (RCC) in children. MATERIALS AND METHODS: We conducted a retrospective study on renal adenocarcinoma cases treated in our center between 1993 and 2008. The age limit was established at 15 years. We collected data on personal history, diagnostic age, sex, clinical presentation, tumor laterality, diagnostic procedure, and tumor stage according to TNM classification proposed by the International Union Against Cancer (2002), surgical technique, pathologic subtype, and outcome. RESULTS: Six children were included in this study (4 girls and 2 boys) with a mean age of 9.5 years (range, 4-14 years). Tumor affected the right side in 4 patients and the left side in 2. Follow-up ranged from 9 to 140 months (mean, 85). Two patients were diagnosed as stage T1aN0M0, another was T1bN2M0, and 2 were T2N0M0, whereas the last one was T3N2M0. Radical nephrectomy was performed in 5 patients, whereas partial nephrectomy was adopted in one patient. The most common histologic subtype was translocation morphology RCC. One patient had local recurrence, whereas the other 5 are currently disease-free. CONCLUSION: Renal cell carcinoma is a rare histologic type of tumor in children, with certain features that differ from those in adults. In general, RCC in children tends to present later than Wilms' tumor and is usually associated with signs and/or symptoms of disease. In localized cases, the treatment of choice is radical nephrectomy.


Assuntos
Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/terapia , Neoplasias Renais/diagnóstico , Neoplasias Renais/terapia , Adolescente , Biópsia , Carcinoma de Células Renais/patologia , Criança , Pré-Escolar , Meios de Contraste , Humanos , Neoplasias Renais/patologia , Estadiamento de Neoplasias , Nefrectomia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
19.
J Pediatr Urol ; 5(5): 378-82, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19632898

RESUMO

PURPOSE: To review our experience of tubularized incised plate (TIP) urethroplasty in children with hypospadias defects. METHODS: Of 500 children (mean age 6 years) who received a TIP urethroplasty, 439 (87.8%) had primary hypospadias and 61 had one failed previous repair. The hypospadias defects were coronal in 110 (22%), distal penile in 261 (52.2%), midpenile in 78 (15.6%) and proximal in 51 (10.2%). Chordee was present in 98 (19.6%) patients. Presence of complications requiring re-operation and overall general appearance was recorded. RESULTS: The mean (SD, range) follow-up was 34 (18, 7-77) months. Overall success rate was 81.4%. Re-operation was required in 93 patients (18.6%); for urethrocutaneous fistula in 47 (9.4%), complete disruption of the repair in 32 (6.4%) and meatal stenosis in 14 (2.8%). In univariate analysis, complications were significantly higher in stented repairs, posterior hypospadias, those with no neourethral coverage (spongioplasty), and repairs early in the study. The last three factors were the only significant independent risk factors in multivariate analysis. CONCLUSIONS: TIP is a reliable method for treating both distal and proximal hypospadias and is suitable for both primary and re-operative cases with a low rate of complications. A significantly better outcome is achieved with distal hypospadias, covering the neourethra with the mobilized corpus spongiosum (spongioplasty) or a flap, and experience. Stenting of the repair, patient age, or previous failed repair has no statistically significant impact on outcome.


Assuntos
Hipospadia/cirurgia , Uretra/cirurgia , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
20.
Urology ; 73(6): 1247-50, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19362329

RESUMO

OBJECTIVES: To review our experience with pediatric xanthogranulomatous pyelonephritis (XGPN) with special focus on surgical management. METHODS: From 1983 to 2007, 6 pediatric patients were found to harbor XGPN. The demographic data, mode of presentation, clinical and radiologic findings, laboratory profile, preoperative diagnosis, operative findings, and pathologic diagnosis of the removed specimen were recorded. RESULTS: The patients included 5 boys and 1 girl, with a mean age at presentation of 7.8 +/- 2 years. The symptoms included loin pain with or without anorexia or weight loss in all; however, a palpable mass was elicited in only 1 patient. All had pyuria on urinalysis, with positive cultures in 3. The 6 patients were anemic with normal kidney function. Abdominal ultrasonography revealed an enlarged kidney with multiple stones in 4 and a space-occupying lesion in 2 patients. Computed tomography was requested for 3 patients, and the findings raised the suspicion of Wilms tumor in 2. All 6 patients underwent nephrectomy. The lumbar approach was used for 3 patients with high complication rates. Laparoscopic nephrectomy was tried in 1 patient and was converted to open nephrectomy with a lumbar approach. The remaining 2 patients underwent exploration through a transperitoneal paramedian approach, with safer and easier surgical access. Pathologically, focal XGPN was diagnosed in only 1 patient, with the diffuse form diagnosed in 5 patients. CONCLUSIONS: Magnifying the clinical awareness of XGPN in pediatric practice is fundamental to achieving the correct preoperative diagnosis. Nephrectomy through the paramedian transperitoneal approach is probably acceptable as the access route of choice, with a minimal complication rate.


Assuntos
Pielonefrite Xantogranulomatosa/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pielonefrite Xantogranulomatosa/diagnóstico , Estudos Retrospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA