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1.
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
3.
Curr Urol Rep ; 15(9): 438, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25015301

RESUMO

Overactive bladder (OAB) is one of the most common bothersome urological diseases. It also has a negative economic impact. Pathophysiology entails changes in neurogenic and myogenic factors, as well as urinary biomarkers such as nerve growth factor (NGF) and prostaglandins (PGs). With symptoms from OAB-Dry to OAB-Wet, the urodynamic pattern of OAB bladder is often characterized by idiopathic detrusor overactivity with lower threshold of sensation, diminished compliance and capacity. Treatment ranges from a combination of behavioral modifications (BM)/ pelvic floor muscle training (PFMT) to combinations of antimuscarinics, Botox injection, nerve stimulation and augmentation cystoplasty. Herein, a contemporary review on the different aspects of management of refractory OAB in patients without neuropathic disorders is presented.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Terapia por Estimulação Elétrica/métodos , Antagonistas Muscarínicos/uso terapêutico , Fármacos Neuromusculares/uso terapêutico , Modalidades de Fisioterapia , Bexiga Urinária Hiperativa/terapia , Bexiga Urinária/cirurgia , Humanos , Diafragma da Pelve
4.
Arab J Urol ; 11(4): 336-9, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26558101

RESUMO

OBJECTIVES: To study after contractions in men with lower urinary tract symptoms (LUTS) related to bladder outlet obstruction (BOO), in the absence of neuropathy, and to verify whether it is associated with the severity of symptoms or certain filling and voiding variables. PATIENTS AND METHODS: Of 380 patients with LUTS and who were assessed using urodynamic studies, we retrospectively analysed those who had after contractions (ACs). Bladder overactivity was diagnosed as any increase in the detrusor pressure of <2-s duration during the filling phase, and an AC was diagnosed as any increase in the detrusor pressure of ⩾2 s after the end of the voiding phase and complete cessation of flow. The presence of ACs was then assessed in relation to different components of the International Prostate Symptom Score (IPSS), using a two-tailed Levene's test, and to filling and voiding cystometry variables, using Mann-Whitney-Wilcoxon Rank test. RESULTS: In all, 373 of the 380 patients were included (seven had invalid voiding cystometry); ACs were detected in 51 (13.9%). There was no statistical significance for associations between AC and any of the variables assessed, including individual questions of the IPSS, detrusor overactivity, cystometric capacity, compliance, maximum urinary flow rate (Qmax), detrusor pressure at Qmax or the maximum detrusor voiding pressure. CONCLUSION: ACs detected on voiding cystometry of men with LUTS attributed to BOO do not seem to be related to symptoms, or filling and voiding variables.

5.
World J Urol ; 31(3): 645-9, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23011257

RESUMO

PURPOSE: To evaluate in a comprehensive way TVT in comparison with TOT, the results of a single-center RCT are presented. Many studies addressed efficacy and safety of TVT and TOT. METHODS: Women included were adults having predominant SUI with positive stress test. They were randomized to get either TVT (Gynecare(®)) or TOT (Aris(®)). All women were seen 1 week, 3, 6, 12, 18, and 24 months. RESULTS: Seventy-one women completed 2-year follow-up. Median age was 47 (range 33-60 years). Mean ± SD BMI in TVT group was 34 ± 5 while in TOT group was 32 ± 5 kg/m(2). POP of any degree was seen in 50 % (35 women). At 1 year, pad test-negative women were 31 and 29 for TVT and TOT, respectively. At 2 years, figures became 28 in TVT group and 27 in TOT. At 1 year, UDI 6 and IIQ 7 decreased by 78.5 and 81 % for TVT and by 69 % and 75 % for TOT group. At 2 year, comparable percentages were 73 and 79 % for TVT and 69 and 82 % for TOT. Fifteen unique patients had adverse events, 10 of them had TOT. CONCLUSIONS: Both tapes have similar efficacy, regarding cure of incontinence. TVT is more effective, albeit insignificantly, than TOT at 2 years. However, serious adverse events were more frequent with TVT, yet TOT has more unique adverse events.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Slings Suburetrais/efeitos adversos , Incontinência Urinária por Estresse/cirurgia , Adulto , Feminino , Seguimentos , Humanos , Incidência , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
6.
Maturitas ; 68(4): 374-7, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21292413

RESUMO

OBJECTIVE: To assess differences between patients suffering from severe degree of stress urinary incontinence versus those with mild degree and to detect the risk factors of severity. MATERIALS AND METHODS: 118 patients suffered from pure SUI were enrolled in a prospective study. According to VLPP, patients were categorized into 2 groups: mild (VLPP>60) and severe (VLPP<60). Risk factors included age, parity, gravidity, menopausal status, co-morbidities and surgical history were investigated. RESULTS: 35 patients had severe SUI; their mean VLPP±SD was 47±8cm H2O, while in 83 patients with mild SUI, mean VLPP was 90±20cm H2O. No significant difference was detected between both groups concerning clinical parameters except for the presence of bronchial asthma in which the difference was approaching statistical significance (P=0.07). Patients with multiple deliveries have triple risk to develop severe SUI. Obese patients with BMI>30 and those with bronchial asthma are more prone to develop severe type (OR: 1.9, 95%CI: .07-5 and OR: 9.4, 95% CI: 0.7-25 respectively). CONCLUSIONS: Bronchial asthma, obesity and multiple parities might be associated with low VLPP. Severe SUI is a resultant of multi-factors rather than one risk factor.


Assuntos
Asma/complicações , Obesidade/complicações , Complicações na Gravidez , Incontinência Urinária por Estresse/etiologia , Micção , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Paridade , Gravidez , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Incontinência Urinária por Estresse/classificação , Água
7.
Arab J Urol ; 9(2): 135-8, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26579285

RESUMO

OBJECTIVES: Data from 80 patients with a vesicovaginal fistula (VVF) were collected and analysed, to define the probable factors affecting the outcome of surgery. PATIENTS AND METHODS: In a retrospective study, the records of 80 women with a mean (SD) age of 35.8 (9) year were assessed; 40% of the VVF occurred after abdominal hysterectomy, 30% after Caesarean section, 15% after difficult vaginal delivery and 11.25% after forceps vaginal delivery. Fifteen women (18%) had a previous failed repair. The median duration of the VVF was 11.5 months. RESULTS: Of the 80 VVF, 41 were high, 30 were low, four combined high and low and five were at the bladder neck. Nine cases had multiple openings on pan-endoscopy. An abdominal approach was used in 54 patients, vaginal in 20 and a combined approach in six. The median (SD) catheter duration was 14 (3.9) days. Ureteric stents were left in 59 patients. At a mean (SD) follow-up of 33.02 (65.7) months, the VVF was cured in 65 (81%) patients. Univariate analysis of variables possibly affecting the success of surgery showed that the duration of VVF, surgical approach, previous repair and position of the VVF were significant factors. Only previous intervention and surgical approach maintained significance in multivariate analysis. CONCLUSION: An abdominal approach seems to give superior results. Previous failed repair had a significant negative effect on success. An earlier repair (<6 months) is associated with higher success rates.

8.
Int Urol Nephrol ; 43(2): 345-51, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20680451

RESUMO

OBJECTIVES: To study prevalence of UTI in women with SUI before and after mid-urethral slings based on culture-proven diagnosis. MATERIALS AND METHODS: Clean catch midstream urine samples were collected and sent for agar culture in 150 patients before and on follow-up after mid-urethral slings visit. Degree of agreement between culture-proved UTI and clinically suspected was assessed. In addition, risk factors for UTI were analyzed. RESULTS: Preoperative culture was positive in 9 (6%) patients, 7 of them were asymptomatic. UTI was primarily diagnosed in 39 (26%) patients suggested by symptoms. No bacterial growth was detected at first postoperative day. There were 6 out of 62 (9.7%) patients who had positive urine cultures at follow-up visits, all of them were symptomatic. Eleven (18%) patients were diagnosed as UTI, based on clinical suspicion. CONCLUSION: In contrast to UTI before surgery, asymptomatic UTI is unlikely to happen after mid-urethral sling.


Assuntos
Slings Suburetrais , Infecções Urinárias/epidemiologia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Período Pré-Operatório , Prevalência , Estudos Prospectivos , Fatores de Risco , Infecções Urinárias/microbiologia
9.
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
10.
J Urol ; 184(6): 2446-51, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20952002

RESUMO

PURPOSE: Post-prostatectomy incontinence is usually due to sphincter damage as a complication of prostatectomy but may result from other causes. The intermediate term outcome of the retropubic bulbourethral sling is presented. MATERIALS AND METHODS: Included in study were 40 men with post-prostatectomy incontinence who used 5 or greater pads daily for protection. All patients had undergone prostatectomy, including transurethral resection in 17, holmium laser enucleation in 3, and open retropubic and radical prostatectomy in 12 and 8, respectively. Preoperatively voiding cystourethrogram and urodynamics were done in all men as applicable. A bulbourethral sling was prepared from polypropylene mesh. Suspension was achieved using size zero nylon sutures to fix the mesh in front of the rectus sheath. Patients were followed at 1 week, 3 and 6 months, and semiannually thereafter. RESULTS: Median incontinence duration was 3 years (range 0.5 to 14). Concomitant surgery was done in 11 men (27.5%), 34 (85%) were dry at 24-month followup and 10 (25%) underwent retightening at 3 to 6 months. Urodynamics showed no significant change in filling or voiding parameters. The increase in maximum urethral closure pressure and functional urethral length was not statistically significant. CONCLUSIONS: The described retropubic bulbourethral sling is a viable option for severe male incontinence with a satisfactory cure rate at intermediate followup. It is adjustable and cost-effective.


Assuntos
Prostatectomia/efeitos adversos , Slings Suburetrais , Incontinência Urinária/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Incontinência Urinária/etiologia , Adulto Jovem
11.
Int Urogynecol J ; 21(12): 1485-90, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20607216

RESUMO

INTRODUCTION AND HYPOTHESIS: In this study, the impact of mid-urethral slings (MUS) on incontinence-related distress, quality of life and sexual function is assessed at a minimum 2 years. METHODS: Patients received either a pubovaginal sling (PVS) or a tension-free vaginal tape (TVT). The Arabic translation of urogenital distress inventory (UDI)-6, incontinence impact questionnaire (IIQ)-7, and short form Female Sexual Function Index (FSFI) were administered at baseline and 24 months. RESULTS: Sixty three women with a mean age of 47.8 years were included in this study. A median follow-up was done after 54 ± 21.9 months. Thirty nine women had PVS while 24 had TVT. Cure was defined as a significant decrease in UDI-6 and a negative stress test at 200 ml, which was found to be 93.65% and 95.2%, respectively. Overall, UDI-6 decreased from a mean preoperative value of 68.1 ± 16.9 to 27.6 ± 18.3 (p < 0.0001). IIQ-7 decreased from 70 ± 19 to 24 ± 20.8(p < 0.0001). The difference between pre- and postoperative values was insignificant. CONCLUSION: An MUS gives a cure rate of over 93% at a median follow-up of 54 months. A significant decline in UDI-6 and IIQ-7 is evident after surgery. Sexual function, as measured by the FSFI, was not significantly affected.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Qualidade de Vida , Comportamento Sexual/fisiologia , Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Coito/fisiologia , Feminino , Seguimentos , Procedimentos Cirúrgicos em Ginecologia/instrumentação , Humanos , Pessoa de Meia-Idade , Dor/etiologia , Estudos Retrospectivos , Slings Suburetrais/efeitos adversos , Resultado do Tratamento , Incontinência Urinária por Estresse/fisiopatologia
12.
Int Urogynecol J ; 21(8): 947-53, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20424826

RESUMO

INTRODUCTION AND HYPOTHESIS: Synthetic mid-urethral slings are currently considered the treatment of choice for stress urinary incontinence (SUI). In this study, two types of slings are compared: TVT vs. TOT. METHODS: In a prospective randomized study, 40 patients underwent either TVT (19 patients) or TOT (21 patients). Stress-specific and overall success was evaluated. Perioperative complications were classified according to Clavien's classification. RESULTS: Mean duration of follow-up was 20 months. At last follow-up, stress-specific success rate was 94.6% in TVT vs. 81% in TOT. No significant difference was detected in terms of post-void residual urine, symptom score, and filling and voiding parameters. Thigh pain represented the main complication in the TOT group. CONCLUSIONS: Both TVT and TOT are effective procedures for treatment of SUI. When compared to each other, TOT seems to be inferior to TVT in terms of efficacy, causing less serious complications.


Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Adulto , Feminino , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Dor/epidemiologia , Dor/etiologia , Prevalência , Estudos Prospectivos , Slings Suburetrais/efeitos adversos , Resultado do Tratamento
13.
Saudi Med J ; 30(2): 234-7, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19198712

RESUMO

OBJECTIVE: To evaluate the efficacy of in situ anterior vaginal wall sling, reinforced with polypropylene mesh, in the treatment of stress urinary incontinence (SUI). METHODS: Seventeen patients with mean age of 51.29 years (range: 27-73) underwent surgery for SUI from August 2006 to August 2007 at Osmaniye State Hospital, Osmaniye, Turkey. Two out of 17 patients gave history of previous anti-incontinence surgical intervention, while the remaining were primary cases. In situ anterior vaginal wall sling, reinforced with semi-size monofilament polypropylene tape (size of the mesh was similar to size of in situ sling), was used as an anti-incontinence procedure. The mean follow-up period was 9.29 months (range: 4-16). RESULTS: In-situ anterior vaginal wall sling reinforced with polypropylene mesh was successful in 16 (94.1%) patients, 14 of them were cured, and 2 had clinical improvement. There was no report of preoperative urethral, bladder, or bowel injury. One patient developed postoperative urinary retention that resolved after decreasing the tension of the suspension sutures, and one patient had suprapubic wound sepsis treated by oral antibiotics and anti-inflammatory drugs. No postoperatively significant post-voiding residue was detected. CONCLUSION: The early results of this technique are encouraging. It is easy to learn, economical, with a good success rate. Urethral erosion is less likely to occur due to the presence of intervening vaginal mucosa. In the future, a prospective study recruiting a larger number of patients undergoing this technique with long-term follow-up is recommended.


Assuntos
Incontinência Urinária por Estresse/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Urológicos/métodos
14.
Artigo em Inglês | MEDLINE | ID: mdl-18758681

RESUMO

Management of urethral erosion typically entails two options: sling incision (in the early postoperative period) or excision of the suburethral part of the sling (urethrolysis). This paper describes a different endoscopic technique. A forty-year-old woman with a synthetic sling implanted 10 years prior presented with persistent lower urinary tract symptoms. A kidney ureter bladder X-ray showed a stone at the level of the bladder neck. Disintegration of the stone revealed eroding mesh embedded in the urethral wall. Complete resection of the mesh using an electrocautery knife was performed. Two months since the procedure, the patient has had an uneventful course. Both vaginal and urethral walls are intact, and she is capable of normal voiding with some stress incontinence. Although it is unusual, a sling eroding the urethra is a diagnosis that needs to be considered even 10 years after surgery. Endoscopic management is feasible and can be successful.


Assuntos
Remoção de Dispositivo/métodos , Endoscopia/métodos , Procedimentos Cirúrgicos em Ginecologia/métodos , Slings Suburetrais/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Adulto , Feminino , Humanos , Infecções Urinárias/diagnóstico , Infecções Urinárias/etiologia
15.
Int Urol Nephrol ; 41(3): 491-5, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19048384

RESUMO

INTRODUCTION AND OBJECTIVES: The resting urethral pressure profile (UPP), used for the assessment of women with stress incontinence, is routine in many urodynamic units. It is time- and effort-consuming, and its diagnostic value is controversial, as well as its value in the prediction of outcome of anti-incontinence surgery. Herein, we assessed its value in the prediction of the outcome of surgery. PATIENTS AND METHODS: Sixty women were randomized to fascial sling or TVT. Urodynamics were performed preoperatively, 6 months and annually thereafter. After filling and voiding cystometry, resting UPP was performed while sitting. Automated catheter pulling, at a rate of 1 mm/s, was adopted. Averaged readings were obtained. Comparison of maximum urethral closure pressure (MUCP) in success and failure, as well as in sling and TVT, was performed, utilizing ANOVA. RESULTS: Preoperative MUCP and functional urethral length (FUL) were 72.9 +/- 27.9 cmH2O and 2.4 +/- 0.7 cm. At last follow-up, they were 71.1 +/- 20.7 cmH2O and 2.7 +/- 0.7 cm, respectively. The differences between sling and TVT as regards value of MUCP and FUL were not significant. The relationship of the outcome of surgery and UPP parameters showed no statistical difference. No significant effect was shown for the success of surgery, duration of follow-up, and interaction of outcome and time over MUCP (P = 0.82, 0.56 and 0.69, respectively) or FUL (P = 0.82, 0.11 and 0.67, respectively). CONCLUSION: The routine use of resting UPP has no added value in terms of the prediction of success of incontinence surgery. It does not help with follow-up and adds to the time and cost of the examination.


Assuntos
Slings Suburetrais , Uretra/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia , Incontinência Urinária por Estresse/cirurgia , Urodinâmica , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Pressão , Estudos Retrospectivos , Resultado do Tratamento
16.
J Pediatr Neurosci ; 4(2): 70-2, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21887186

RESUMO

AIM OF WORK: To study the effect of detethering of the cord on urodynamic changes in patients with myelomeningocele. MATERIALS AND METHODS: We retrospectively reviewed the urodynamic data of 37 patients. In all of them myelomeningocele primary repair was carried out. The patients were divided into two groups: (1) those who underwent detethering of the cord and (2) those who did not. Neurourological examination, filling cystometry, assessment of bladder management, and fecal continence were studied in all patients. RESULTS: Eleven (29.7%) out of 37 patients underwent detethering of the cord. The mean age at presentation was 10.1 ± 4 and 10.8 ± 7 years in groups 1 and 2, respectively (P 0.7). Nocturnal and diurnal enuresis was found in 45% of group 1, while it was found in 69% of group 2. Fecal soiling was detected in 18% in group 1 and in 38.5% in group 2. Mean bladder capacity was 210 ± 125 cc and 199 ± 120 cc for groups 1 and 2, respectively (P 0.8). Uninhibited detrusor contractions were noticed in nine patients (82%) of group 1 and in 21 patients (81%) of group 2. Delta det LPP was lower in group 1 (35 ± 19 cm H(2)O) than in group 2 (46 ± 40 cm H(2)0). CONCLUSION: Detethering of the cord had a positive impact on patients with myelomeningocele in terms of lowering of det LPP and accordingly decreasing the risk of upper tract deterioration.

17.
Urol Int ; 81(2): 215-7, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18758223

RESUMO

PURPOSE: To introduce new technique for covering neourethra with dorsal dartos subcutaneous tissue in Snodgrass hypospadias repair. MATERIAL AND METHODS: The study included 26 patients with primary hypospadias, aged 2-22 years (average 7.86), operated from June 2002 to August 2006. Of the patients, 21 had distal, 3 midshaft and 2 penoscrotal hypospadias. The standard technique of tubularized incised plate (TIP) with double-layer covering of the neourethra by subcutaneous tissue was used in all cases of reconstruction. The mean follow-up period was 4.5 months (range 3-12 months). RESULTS: Successful result of a normal-looking penis without fistula was achieved in all patients. One patient had meatal stenosis (3.84%) at the early postoperative period which was corrected by urethral dilatation of the external meatus at an interval of up to 2 months postoperatively. CONCLUSION: Our technique represents a reasonable option for utilizing dorsal dartos subcutaneous tissue in TIP urethroplasty. The neourethra is covered symmetrically with a double layer of well-vascularized tissue and the penis is kept without rotation. Redundancy of the flap and its excellent vascularization depend on the harvesting technique. Further follow-up and a larger number of patients are needed before a final conclusion can be made.


Assuntos
Hipospadia/cirurgia , Tela Subcutânea/transplante , Retalhos Cirúrgicos , Adolescente , Adulto , Criança , Pré-Escolar , Humanos , Masculino , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
18.
Int Urol Nephrol ; 40(3): 573-6, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18327654

RESUMO

PURPOSE: To evaluate the validity of the standard tubularized incised plate (TIP) urethroplasty technique for different kinds of hypospadia. MATERIALS AND METHODS: From June 2002 to December 2003 and from March 2006 to October 2007 38 patients aged 1-22 years (average 7.34) were operated using the concept of TIP urethroplasty. The hypospadiac meatus were subcoronal in 28 patients (73.68%), midshaft in six (15.78%), and penoscrotal in four (10.52%). Standard TIP urethroplasty in conjunction with double-layer covering of the neourethra with dorsal dartos flap were used in the primary cases (28 patients). In the secondary cases (four patients) and in boys who were circumcised before admission (six patients), modified TIP urethroplasty was used. The mean periods of hospitalization and follow-up were 0.92 days and 4.19 months, respectively. RESULTS: No fistulas were observed in boys who underwent primary reconstruction using standard TIP urethroplasty. Fistulas were observed in two patients (5.26%)-one patient with penoscrotal hypospadias who underwent two-stage repair and another who was circumcised before admission. One patient had meatal stenosis at the early postoperative period which was corrected by dilatation of the external meatus at intervals up to 2 months postoperatively. CONCLUSION: Standard TIP urethroplasty with double-layer covering of the neourethra with dorsal subcutaneous tissue is the procedure of choice for treatment of primary cases of distal/midshaft hypospadias. This technique seems suitable for reconstruction of proximal, secondary, and even complicated hypospadias.


Assuntos
Hipospadia/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos , Uretra/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Humanos , Lactente , Masculino , Resultado do Tratamento
19.
Scand J Urol Nephrol ; 41(5): 398-402, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17853033

RESUMO

OBJECTIVE: The treatment of post-prostatectomy incontinence (PPI) can be challenging. Although many injectable materials have been used to treat this problem, the results are at best unsatisfactory. Fixation of an artificial urinary sphincter has been the gold standard of care for patients with PPI for many years. In the last decade there has been a revival of male sling techniques, involving either a fixed or dynamic compressive effect. Herein, a technique for the correction of PPI is described which involves minimal incursion of exogenous material and has excellent cost-effectiveness. MATERIAL AND METHODS: A total of 23 patients underwent a bulbourethral sling procedure using mesh suspended from the anterior abdominal wall for the management of PPI. The technique is performed under spinal anesthesia and utilizes knitted polypropylene mesh, which is fastened by three pairs of sutures. A modified Stamey needle is used for transferring nylon sutures to the suprapubic wound. The sutures are tied in front of the rectus sheath, utilizing intraoperative urodynamic guidance. A 12 F suprapubic tube is utilized as a pressure channel for monitoring vesical pressure and sling tension. RESULTS: Twenty patients were completely dry at the last follow-up, one was greatly improved and in two the treatment was considered a failure. The median follow-up period was 9 months (range 6-24 months). No urethral erosion has been reported thus far. Morbidity in the form of perineal pain and limited ambulation in the first few days after surgery were reported. Five patients had scrotal and penile numbness which continued for an average of 3 months. CONCLUSIONS: The mesh sling technique described herein is efficient and cost-effective. It yielded promising results in this study, which involved a short-term follow-up period and a limited number of patients. More cases are being enrolled and a study involving a longer follow-up period is underway.


Assuntos
Glândulas Bulbouretrais/cirurgia , Prostatectomia/efeitos adversos , Slings Suburetrais , Incontinência Urinária/etiologia , Procedimentos Cirúrgicos Urológicos/métodos , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Telas Cirúrgicas , Uretra/patologia , Uretra/cirurgia
20.
J Urol ; 177(6): 2205-10, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17509321

RESUMO

PURPOSE: Female urethral anomalies, whether congenital or acquired, are rare. Urethral defects are usually if not always associated with variable degrees of incontinence. In this case series we demonstrate the approach in management and surgical outcome of congenital and traumatic urethral anomalies. MATERIALS AND METHODS: The study was conducted on 13 patients with an age range of 2 to 38 years (median 20). Of these patients 4 had female epispadias, 1 had hypospadias, 3 had traumatic urethral loss and 2 had iatrogenic trauma involving the urethra. There were 2 patients with urogenital sinus syndrome and 1 patient had urethral prolapse. RESULTS: After the first stage of repair 4 patients were dry and socially satisfied, and no further intervention was needed. However, in 9 patients a second intervention was necessary to achieve continence. Notably 3 patients empty the bladder through clean intermittent catheterization. CONCLUSIONS: Female urethral defects are usually complex. Congenital causes are associated with severe incontinence. Repair of such defects is challenging, yet 1-stage reconstruction is feasible and potentially successful.


Assuntos
Epispadia/cirurgia , Uretra/anormalidades , Uretra/lesões , Procedimentos Cirúrgicos Urológicos , Adolescente , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Epispadia/complicações , Feminino , Humanos , Prolapso , Resultado do Tratamento , Incontinência Urinária/etiologia , Incontinência Urinária/cirurgia
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