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1.
N Engl J Med ; 381(1): 13-24, 2019 07 04.
Artigo em Inglês | MEDLINE | ID: mdl-31150574

RESUMO

BACKGROUND: Apalutamide is an inhibitor of the ligand-binding domain of the androgen receptor. Whether the addition of apalutamide to androgen-deprivation therapy (ADT) would prolong radiographic progression-free survival and overall survival as compared with placebo plus ADT among patients with metastatic, castration-sensitive prostate cancer has not been determined. METHODS: In this double-blind, phase 3 trial, we randomly assigned patients with metastatic, castration-sensitive prostate cancer to receive apalutamide (240 mg per day) or placebo, added to ADT. Previous treatment for localized disease and previous docetaxel therapy were allowed. The primary end points were radiographic progression-free survival and overall survival. RESULTS: A total of 525 patients were assigned to receive apalutamide plus ADT and 527 to receive placebo plus ADT. The median age was 68 years. A total of 16.4% of the patients had undergone prostatectomy or received radiotherapy for localized disease, and 10.7% had received previous docetaxel therapy; 62.7% had high-volume disease, and 37.3% had low-volume disease. At the first interim analysis, with a median of 22.7 months of follow-up, the percentage of patients with radiographic progression-free survival at 24 months was 68.2% in the apalutamide group and 47.5% in the placebo group (hazard ratio for radiographic progression or death, 0.48; 95% confidence interval [CI], 0.39 to 0.60; P<0.001). Overall survival at 24 months was also greater with apalutamide than with placebo (82.4% in the apalutamide group vs. 73.5% in the placebo group; hazard ratio for death, 0.67; 95% CI, 0.51 to 0.89; P = 0.005). The frequency of grade 3 or 4 adverse events was 42.2% in the apalutamide group and 40.8% in the placebo group; rash was more common in the apalutamide group. CONCLUSIONS: In this trial involving patients with metastatic, castration-sensitive prostate cancer, overall survival and radiographic progression-free survival were significantly longer with the addition of apalutamide to ADT than with placebo plus ADT, and the side-effect profile did not differ substantially between the two groups. (Funded by Janssen Research and Development; TITAN ClinicalTrials.gov number, NCT02489318.).


Assuntos
Adenocarcinoma/tratamento farmacológico , Antagonistas de Androgênios/uso terapêutico , Antagonistas de Receptores de Andrógenos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Próstata/tratamento farmacológico , Tioidantoínas/uso terapêutico , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adenocarcinoma/secundário , Adulto , Idoso , Idoso de 80 Anos ou mais , Antagonistas de Androgênios/efeitos adversos , Antagonistas de Receptores de Andrógenos/efeitos adversos , Método Duplo-Cego , Exantema/induzido quimicamente , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Intervalo Livre de Progressão , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/patologia , Qualidade de Vida , Radiografia , Tioidantoínas/efeitos adversos
2.
Arch Esp Urol ; 72(2): 203-210, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30855022

RESUMO

There are multiple definitions of high risk prostate cancer and each definition is associated with a different prognosis. Men classified as having high-risk disease warrant treatment because durable outcomes can be achieved. Radical prostatectomy, radiation therapy and androgen deprivation therapy play pivotal roles in the management of men with high-risk disease, and potentially in men with metastatic disease.


Assuntos
Antagonistas de Androgênios , Prostatectomia , Neoplasias da Próstata , Antagonistas de Androgênios/uso terapêutico , Humanos , Masculino , Prognóstico , Antígeno Prostático Específico , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/cirurgia
3.
Arch. esp. urol. (Ed. impr.) ; 72(2): 203-210, mar. 2019. tab
Artigo em Inglês | LILACS-Express | ID: ibc-FGT-1022

RESUMO

There are multiple definitions of high risk prostate cancer and each definition is associated with a different prognosis. Men classified as having high-risk disease warrant treatment because durable outcomes can be achieved. Radical prostatectomy, radiation therapy and androgen deprivation therapy play pivotal roles in the management of men with high-risk disease, and potentially in men with metastatic disease


Hay múltiples definiciones del cáncer de próstata de alto riesgo y cada definición se asocia con un pronóstico diferente. En varones con cáncer de próstata clasificado cómo enfermedad de alto riesgo se justifica el tratamiento porque se pueden conseguir resultados duraderos. La prostatectomía radical, la radioterapia y el tratamiento de deprivación androgénica juegan un papel fundamental en el manejo de los pacientes con enfermedad de alto riesgo, y potencialmente en varones con enfermedad metastásica

4.
Arch Esp Urol ; 71(8): 651-663, 2018 Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-30319125

RESUMO

OBJECTIVES: Prostate cancer is the most frequent neoplasia diagnosed in males. Treatment of metastatic prostate cancer is based on androgen deprivation therapy (ADT) up to its change to the castration resistance state. Recently, new molecules have been developed that significantly increase survival and quality of life of these patients. Abiraterone acetate in combination with prednisone is the first oral hormone therapy that contributed to this change in the approach of the disease. METHODS: Systematic bibliographic review about abiraterone in the treatment of metastatic castration resistant prostate cancer (CPRC), with data on efficacy, safety and quality of life. RESULTS: Treatment with abiraterone and prednisone has demonstrated a significant increase in overall survival (OS 34.7 vs 30.3 months) and radiologic progression free survival (RPFS 16.5 months vs 8.3 months) in comparison to placebo and prednisone in patients with metastatic castration resistant prostate cancer (mCPRC). It also demonstrated an increase in OS and RPFS compared to placebo plus prednisone in mCPRC patients after at least one cytotoxic chemotherapy based treatment (OS 15.8 vs 11.2 months; RPFS 5.6 vs 3.6 months). Side effects related to abiraterone therapy are mainly related with mineral corticoid excess (Hypertension, hypokalemia, fluid retention) and, to a lesser extent, transaminase alterations or cardiovascular effects. Perceived quality of life results show a benefit in the abiraterone treatment group. CONCLUSIONS: Abiraterone acetate is a new hormonal treatment for metastatic castration resistant prostate cancer both before and after chemotherapy. The results of the available studies demonstrate a significant improvement in terms of efficacy, with a tolerability profile generally acceptable, predictable and manageable, and an improvement in patient's perceived quality of life.

5.
Arch. esp. urol. (Ed. impr.) ; 71(8): 651-663, oct. 2018. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-178743

RESUMO

Objetivo: El cáncer de próstata es la neoplasia más frecuentemente diagnosticada en varones. El tratamiento del cáncer de próstata metastásico se basa en la terapia de deprivación androgénica (TDA) hasta su paso a un estado de resistencia a la castración. Recientemente, se han desarrollado moléculas que han aumentado significativamente la supervivencia y la calidad de vida de estos pacientes. Acetato de abiraterona en combinación con prednisona es la primera hormonoterapia oral que ha contribuido a este cambio en el abordaje sobre la enfermedad. Metodos: Revisión sistemática de la literatura existente sobre abiraterona en el tratamiento del cáncer de próstata metastásico resistente a la castración, con datos de eficacia, seguridad y calidad de vida. Resultados: El tratamiento con abiraterona y prednisona ha demostrado aumentar de manera significativa la supervivencia global (SG 34,7 vs 30,3 meses) y libre de progresión radiológica (SLPr: 16,5 meses vs 8,3 meses) respecto a placebo y prednisona de los pacientes con cáncer de próstata resistente a la castración metastásico. Asimismo, demostró aumentar la SG y SLPr frente a placebo más prednisona en pacientes con CPRCm tras al menos un tratamiento basado en quimioterapia citotóxica (SG 15,8 versus 11,2 meses; SLPr 5,6 versus 3,6 meses). Los efectos secundarios del tratamiento con abiraterona se relacionan fundamentalmente con el exceso de mineralcorticoides (hipertensión, hipopotasemia, retención de líquidos) y, en menor medida, alteraciones de las transaminasas o efectos cardiovasculares. Los resultados de calidad de vida percibidos por los pacientes muestran un beneficio en el grupo de tratamiento con abiraterona. Conclusiones: Acetato de abiraterona es un nuevo tratamiento hormonal para el cáncer de próstata metastásico resistente a la castración tanto previamente como después de quimioterapia. Los resultados de los estudios existentes demuestran una mejoría significativa en términos de eficacia, con un perfil de tolerabilidad por lo general aceptable, predecible y manejable, y una mejora en la calidad de vida percibida por el paciente


Objectives: Prostate cancer is the most frequent neoplasia diagnosed in males. Treatment of metastatic prostate cancer is based on androgen deprivation therapy (ADT) up to its change to the castration resistance state. Recently, new molecules have been developed that significantly increase survival and quality of life of these patients. Abiraterone acetate in combination with prednisone is the first oral hormone therapy that contributed to this change in the approach of the disease. Methods: Systematic bibliographic review about abiraterone in the treatment of metastatic castration resistant prostate cancer (CPRC), with data on efficacy, safety and quality of life. Results: Treatment with abiraterone and prednisone has demonstrated a significant increase in overall survival (OS 34.7 vs 30.3 months) and radiologic progression free survival (RPFS 16.5 months vs 8.3 months) in comparison to placebo and prednisone in patients with metastatic castration resistant prostate cancer (mCPRC). It also demonstrated an increase in OS and RPFS compared to placebo plus prednisone in mCPRC patients after at least one cytotoxic chemotherapy based treatment (OS 15.8 vs 11.2 months; RPFS 5.6 vs 3.6 months). Side effects related to abiraterone therapy are mainly related with mineral corticoid excess (Hypertension, hypokalemia, fluid retention) and, to a lesser extent, transaminase alterations or cardiovascular effects. Perceived quality of life results show a benefit in the abiraterone treatment group. Conclusions: Abiraterone acetate is a new hormonal treatment for metastatic castration resistant prostate cancer both before and after chemotherapy. The results of the available studies demonstrate a significant improvement in terms of efficacy, with a tolerability profile generally acceptable, predictable and manageable, and an improvement in patient's perceived quality of life


Assuntos
Humanos , Masculino , Neoplasias de Próstata Resistentes à Castração/tratamento farmacológico , Androstenos/uso terapêutico , Androstenos/efeitos adversos , Androstenos/farmacologia
6.
J Endourol ; 32(9): 859-864, 2018 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-30024301

RESUMO

OBJECTIVE: The aim of the study was to assess the feasibility of laparoscopic nephrectomy (LN) in the treatment of patients with xanthogranulomatous pyelonephritis (XGP). METHODS: Retrospective review of medical records of 17 patients (mean age 60.0 ± 13.3 years) who underwent LN by a single surgeon from 2010 to 2018. Sociodemographic and clinical data including diagnosis, presenting clinical features, surgical management, and postoperative course were analyzed. RESULTS: LN was successfully performed in 15 (88.2%) patients. Two (12.5%) patients with disseminated disease were electively converted to open nephrectomy (ON) due to failure to progress. Two (11.8%) patients experienced intraoperative complications (grades 3b and 4b). Among patients in whom LN was successfully performed (n = 15), the mean operative time was 198.0 ± 107.1 min and was shorter when no intraoperative complications occurred (169.0 ± 48.1 min). Three (20%) of these patients required transfusions and nine (60.0%) required postoperative pelvic drainage (PD). Six (40%) patients experienced postoperative complications: one grade 1, four grade 2, and one grade 5. Mean hospital stay was 4.4 ± 4.3 days, and 3.4 ± 2.2 for those experiencing manageable or no complications. Among patients without postoperative complications (n = 6), mean hospital stay was shorter when no PD was placed (1.6 vs 2.6 days). CONCLUSION: LN is a feasible surgical option in patients with XGP although given the nature of XGP, it is associated with complications-nearly all manageable-which makes it a challenging surgical procedure. Advanced laparoscopic skills and experiences are needed. Dissemination of the disease is associated with the occurrence of more severe complications and conversion to ON. PD placement seems associated with shorter hospital stay.

7.
Arch. esp. urol. (Ed. impr.) ; 71(1): 108-113, ene.-feb. 2018.
Artigo em Espanhol | IBECS | ID: ibc-171834

RESUMO

La urología es una especialidad médico-quirúrgica que se ocupa del estudio, diagnóstico y tratamiento de las afecciones médicas y quirúrgicas del aparato urinario y retroperitoneo en ambos sexos y del aparato genital masculino sin límite de edad, motivadas por padecimientos congénitos, traumáticos, sépticos, metabólicos, obstructivos y oncológicos. La oncologia- urológica es la parte de la Urología más amplia y donde la investigación y los nuevos avances hacen que sea imprescindible un aprendizaje continuo. En este capítulo abordamos todos los aspectos académicos relacionados con la formación en el campo de la uro-oncología (AU)


Urology is a medical-surgical specialty that deals with the study, diagnosis and treatment of the medical and surgical diseases of the urinary apparatus and retroperitoneum in both sexes and the male genital apparatus without age limit, due to congenital, traumatic, septic, metabolic, obstructive and oncological conditions. Urologic oncology is the broadest urological part, where research and new advances make continuous learning essential. In this chapter we treat all academic features related with training in the field of Urooncology (AU)


Assuntos
Educação Continuada , Urologia/tendências , Oncologia/tendências , Especialização/tendências , Aprendizagem , Cursos
8.
Arch Esp Urol ; 71(1): 108-113, 2018 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-29336339

RESUMO

Urology is a medical-surgical specialty that deals with the study, diagnosis and treatment of the medical and surgical diseases of the urinary apparatus and retroperitoneum in both sexes and the male genital apparatus without age limit, due to congenital, traumatic, septic, metabolic, obstructive and oncological conditions. Urologic oncology is the broadest urological part, where research and new advances make continuous learning essential. In this chapter we treat all academic features related with training in the field of Urooncology.


Assuntos
Oncologia/educação , Urologia/educação , Educação de Pós-Graduação em Medicina/tendências , Bolsas de Estudo , Previsões
9.
Arch Esp Urol ; 70(4): 429-435, 2017 May.
Artigo em Espanhol | MEDLINE | ID: mdl-28530622

RESUMO

OBJECTIVES: The most frequent ureteral lesions are iatrogenic, mainly due to gynecologic and urologic procedures. The resolution and repair of these lesions, when they require surgery, is often the performance of ureteroneocystostomy. We describe the technique for the repair of distal ureter lesions that preserves both anatomy and function of the urinary tract (1). The operation consists in dissection and extraction of the distal ureteral stump from its intramural tract to get at least 1 cm of free ureter, percutaneous insertion of a ureteral stent, checking the absence of tension between proximal ureter and distal dissected stump, end to end anastomosis and reinsertion of the distal ureter in the previously dissected bladder muscle layer. We present 4 cases of ureteral injury after laparoscopic simple total hysterectomy for uterine myomas with complete section of the distal ureter, that were operated 3-5 days after injury, performing laparoscopic repair surgery. We performed clinical and radiological control with intravenous urography demonstrating ureteral continuity normalization and good renal function. We believe that repair of the urinary tract with anatomical and physiological preservation must be the first option in the laparoscopic treatment of complete distal ureteral injuries, and intramural ureter dissection when needed avoids the performance of ureteroneocystostomy. It is necessary to keep progressing in the technique improvement, and to increase the number of cases and experience.


Assuntos
Complicações Intraoperatórias/cirurgia , Laparoscopia , Ureter/lesões , Ureter/cirurgia , Ureterostomia/métodos , Adulto , Feminino , Procedimentos Cirúrgicos em Ginecologia , Humanos , Doença Iatrogênica , Pessoa de Meia-Idade
10.
Arch. esp. urol. (Ed. impr.) ; 70(4): 429-435, mayo 2017. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-163828

RESUMO

Las lesiones ureterales más frecuentes son las iatrógenas, fundamentalmente debidas a procedimientos ginecológicos y urológicos. Habitualmente la resolución y reparación de estas lesiones, cuando precisan cirugía, es la realización de una ureteroneocistostomía. Describimos una técnica para la reparación de lesiones de ureter distal que preserva tanto la anatomía como la función de la vía urinaria (1). La cirugía consiste en la disección y extracción del muñón ureteral distal de su trayecto intramural, para conseguir al menos 1 centímetro de uréter libre, colocación de stent ureteral por vía percutánea, comprobación de ausencia de tensión entre uréter proximal y muñón distal disecado, anastomosis término-terminal y reinserción de uréter distal en capa muscular vesical previamente disecada para la anastomosis. Presentamos 4 casos de lesión ureteral tras histerectomía total simple laparoscópica por miomas con sección completa de uréter distal, que se intervienen entre 3 y 5 días tras la lesión, realizando cirugía de reparación por vía laparoscópica. Se realiza control clínico y radiológico con urografía observando normalización de la continuidad ureteral y buen funcionalismo renal. Pensamos que la reparación con preservación anatómica y fisiológica de la vía urinaria, debe ser la primera opción en el tratamiento laparoscópico de las lesiones completas de uréter distal, y que la disección del uréter intramural en casos necesarios evita la realización de una ureteroneocistostomía. Es preciso seguir avanzando en el perfeccionamiento de la técnica y aumentar el número de casos y la experiencia (AU)


Objectives: The most frequent ureteral lesions are iatrogenic, mainly due to gynecologic and urologic procedures. The resolution and repair of these lesions, when they require surgery, is often the performance of ureteroneocystostomy. We describe the technique for the repair of distal ureter lesions that preserves both anatomy and function of the urinary tract (1). The operation consists in dissection and extraction of the distal ureteral stump from its intramural tract to get at least 1 cm of free ureter, percutaneous insertion of a ureteral stent, checking the absence of tension between proximal ureter and distal dissected stump, end to end anastomosis and reinsertion of the distal ureter in the previously dissected bladder muscle layer. We present 4 cases of ureteral injury after laparoscopic simple total hysterectomy for uterine myomas with complete section of the distal ureter, that were operated 3-5 days after injury, performing laparoscopic repair surgery. We performed clinical and radiological control with intravenous urography demonstrating ureteral continuity normalization and good renal function. We believe that repair of the urinary tract with anatomical and physiological preservation must be the first option in the laparoscopic treatment of complete distal ureteral injuries, and intramural ureter dissection when needed avoids the performance of ureteroneocystostomy. It is necessary to keep progressing in the technique improvement, and to increase the number of cases and experience (AU)


Assuntos
Humanos , Feminino , Ureterostomia/métodos , Laparoscopia/métodos , Histerectomia/efeitos adversos , Ureter/lesões , Complicações Pós-Operatórias/cirurgia , Doença Iatrogênica , Stents , Derivação Urinária , Procedimentos Cirúrgicos Reconstrutivos/métodos
11.
Arch Esp Urol ; 67(7): 628-33, 2014 Sep.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-25241836

RESUMO

OBJECTIVES: The objective of this work was to establish the analgesia protocols for different types of urological surgery and to analyze the impact on pain during the first 24 h after surgery. METHODS: The study included 186 patients undergoing urological surgery between 2011 and 2013. Seven analgesia protocols were established and applied according to the surgical procedure. At 24 h post-surgery, i.e., the initiation of analgesic treatment, patients` pain was evaluated by visual analog scale/numeric scale (VAS/NS), and their degree of satisfaction and nausea were assessed. RESULTS: The study sample comprised 137 males (73.7%) and 49 females (26.3%), with a mean age of 58.5 ± 14.7 yrs. Analgesia protocol 1 was applied in 5.9% of patients, protocol 2 in 17.8%, protocol 3 in 8.6%, protocol 4 in 38.9%, protocol 5 in 13.5%, protocol 6 in 14.6%, and protocol 7 in 0.5%. At 24 h post-surgery, the VAS/NS score was = 3 in 82.3% of patients; hence, only 17.7% required rescue analgesia; 71% of patients were highly satisfied with the treatment provided and 22.6% were satisfied. 6.4% were not satisfied. CONCLUSION: Establishing analgesia protocols according to the type of surgery is a valid and useful measure to control postoperative pain during the first 24 h and to provide appropriate treatment standardization and follow-up.


Assuntos
Analgesia , Protocolos Clínicos , Medição da Dor , Dor Pós-Operatória/prevenção & controle , Satisfação do Paciente , Procedimentos Cirúrgicos Urológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Fatores de Tempo
12.
Arch. esp. urol. (Ed. impr.) ; 67(7): 628-633, sept. 2014. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-128738

RESUMO

OBJETIVO: El objetivo de este estudio es establecer unos protocolos de analgesia distribuidos según tipos de cirugías urológicas y analizar el impacto sobre el dolor en las primeras 24 horas tras la cirugía. MÉTODOS: Estudio con 186 pacientes intervenidos de cirugía urológica entre 2011 y 2013 en los que se establecen 7 protocolos de analgesia según tipos de cirugía urológica. Analizamos a las 24 horas de la cirugía y de iniciar por tanto el tratamiento analgésico, el dolor mediante escala visual analógica/escala numérica y el grado de satisfacción del paciente y presencia de nauseas. RESULTADOS: La distribución de los pacientes según sexos fue de 137 hombres (73,7%) y 49 mujeres (26,3%), con una edad media de 58,5 ± 14,7 años. La distribución de los pacientes según el tipo de protocolo asignado fue la siguiente: 5,9% protocolo 1; 17,8% protocolo 2; 8,6% protocolo 3; 38,9% protocolo 4; 13,5% protocolo 5; 14,6% protocolo 6; 0,5% protocolo 7.Tras analizar a las 24 horas post-cirugía el nivel de dolor de los pacientes con la escala EVA/EN observamos que el 82,3% presentan un EVA/EN ≤ 3, por tanto sólo en el 17,7% de los pacientes fue preciso la utilización de analgesia de rescate. El 71% de los pacientes estaban muy satisfechos con el tratamiento pautado, y el 22,6% satisfechos. El 6,4 % no estaba satisfecho. CONCLUSIÓN: El establecimiento de protocolos de analgesia según tipos de cirugía es una medida válida, aceptable, que permite el control del dolor postoperatorio en las primeras 24 horas y que proporciona la estandarización del tratamiento y el control del mismo de forma adecuada (AU)


OBJECTIVES: The objective of this work was to establish the analgesia protocols for different types of urological surgery and to analyze the impact on pain during the first 24 h after surgery. METHODS: The study included 186 patients undergoing urological surgery between 2011 and 2013. Seven analgesia protocols were established and applied according to the surgical procedure. At 24 h post-surgery, i.e., the initiation of analgesic treatment, patients` pain was evaluated by visual analog scale/numeric scale (VAS/NS), and their degree of satisfaction and nausea were assessed. RESULTS: The study sample comprised 137 males (73.7%) and 49 females (26.3%), with a mean age of 58.5±14.7 yrs. Analgesia protocol 1 was applied in 5.9% of patients, protocol 2 in 17.8%, protocol 3 in 8.6%, protocol 4 in 38.9%, protocol 5 in 13.5%, protocol 6 in 14.6%, and protocol 7 in 0.5%.At 24 h post-surgery, the VAS/NS score was ≤ 3 in 82.3% of patients; hence, only 17.7% required rescue analgesia; 71% of patients were highly satisfied with the treatment provided and 22.6% were satisfied. 6.4% were not satisfied. CONCLUSION: Establishing analgesia protocols according to the type of surgery is a valid and useful measure to control postoperative pain during the first 24 h and to provide appropriate treatment standardization and follow-up (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Urológicos/métodos , Analgesia/métodos , Protocolos Clínicos , Satisfação do Paciente , Período Pós-Operatório , Manejo da Dor/métodos
13.
Can Urol Assoc J ; 8(5-6): E366-70, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24940468

RESUMO

We report 2 patients with ureteral injury after a simple total laparoscopic hysterectomy for uterine myoma with a complete resection of the distal ureter. One patient had unilateral injury and the other 2 patients had bilateral injury. The surgical laparoscopic repair procedure was carried out 3 to 5 days after the injury. Surgery involved intramural dissection of the distal ureteral stump to expose at least 1 cm of the ureter, percutaneous ureteral stent placement, elimination of tension between the proximal ureter and the dissected distal stump, end-to-end anastomosis, and reinsertion of the distal ureter into the bladder muscle layer, which was previously dissected for the anastomosis.

14.
Arch Ital Urol Androl ; 76(2): 75-9, 2004 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15270418

RESUMO

OBJECTIVES: Between January 1994 and February 2002, 9086 men underwent biplane TRUS at our institution for a variety of reasons. 781 of the 9086 men (8.6%) showed evidence of one or more intraprostatic cystic lesions. We propose a new classification of cystic structures located at the midline of the prostate. MATERIAL AND METHODS: We have designed a methodology that reclassifies cystic structures located at the prostate midline through the ultrasonically guided transrectal aspiration of the cystic structure, the analysis of the PSA level of the aspirated fluid and the presence of spermatozoa, radiological studies (cyst injection with contrast medium, vasography, retrograde and/or voiding cystourethrography and utricle injection with contrast medium) and endoscopic studies (cystourethroscopy). RESULTS: Upon completion of the methodology, we have classified and defined these structures as the following: simple prostatic cysts, cysts of the müllerian ducts, megautricle, megautricle with inclusion of the ejaculatory ducts, "pseudocystic" dilation of the ejaculatory ducts and utriculoceles. CONCLUSIONS: This new classification of cystic structures located at the prostate midline is simple, useful and steers one away from any possible confusion.


Assuntos
Cistos/classificação , Doenças Prostáticas/classificação , Humanos , Masculino
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