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2.
J Urol ; 205(1): 68-77, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32856981

RESUMO

PURPOSE: Encrustation is a common phenomenon that can occur following placement of a ureteral stent into the urinary tract, and it can lead to serious complications. The following review addresses the mechanism of encrustation, the management of these stents and the newest technology developed to mitigate this issue. MATERIALS AND METHODS: We performed a comprehensive literature search on stent encrustation including peer-reviewed publications, public product listings, and material on current and future stent technology. RESULTS: The mechanism of encrustation is complex and multifaceted, including dwell time, patient specific risk factors, conditioning film formation, biofilm formation and mineral deposition. Several technological developments in stent materials and coatings may have a role in reducing the risk of stent encrustation. It is important to identify the extent of stent encrustation and plan treatment strategies accordingly. We propose a novel treatment algorithm for the management encrusted ureteral stents. CONCLUSIONS: The ubiquity of ureteral stents in urology practice mandates updated knowledge about the prevention of stent encrustation, identification of high risk patients and preparedness for removal using multimodal techniques.


Assuntos
Calcinose/cirurgia , Remoção de Dispositivo/métodos , Complicações Pós-Operatórias/cirurgia , Stents/efeitos adversos , Ureter/cirurgia , Calcinose/epidemiologia , Calcinose/etiologia , Calcinose/prevenção & controle , Cistoscopia , Dilatação/efeitos adversos , Dilatação/instrumentação , Humanos , Litotripsia , Masculino , Nefrostomia Percutânea , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Desenho de Prótese , Fatores de Risco , Tecnologia , Tomografia Computadorizada por Raios X , Ultrassonografia , Ureter/diagnóstico por imagem , Ureter/microbiologia , Ureter/patologia , Obstrução Ureteral/cirurgia , Ureterolitíase/etiologia , Ureterolitíase/prevenção & controle
3.
Medicine (Baltimore) ; 99(35): e21793, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871899

RESUMO

The role of endoscopic balloon dilatation (EBD) using double-balloon catheters in patients with cricopharyngeal muscle dysfunction (CPD) is still unclear. Thus, the aim of this study was to compare the functional outcomes between patients receiving EBD and rehabilitative balloon swallowing (RBS).A total of 36 patients with CPD, who visited a teaching hospital from February 2014 to June 2017, were included in the study. Among them, 12 patients with severe dysphagia underwent EBD. After propensity score matching, 24 patients who underwent RBS were selected for comparison. We compared the effects of EBD and RBS using 4 functional swallowing parameters: functional dysphagia scale score, penetration-aspiration scale score, pharyngeal transit time, and percentage of pharyngeal remnant (PR) at baseline and after the first and second treatments. Using simple and multiple regression, we examined the associations between EBD/RBS and changes of 4 parameters after the treatments since the baselineAll functional parameters significantly decreased after RBS and EBD (P < .05). After the first therapy session, significant differences in the pharyngeal transit time (P = .034), percentage of PR (P = .008), and penetration-aspiration scale score (P = .014) were observed in the EBD group, compared with those in the RBS group. The regression analysis showed significant improvements in the PR after EBD compared with that after RBS (ß = 0.95, SE = 0.31, P = .005).EBD may be an alternative treatment for patients with severe CPD. A significant improvement would be expected in such patients with PR.


Assuntos
Transtornos de Deglutição/terapia , Dilatação/instrumentação , Endoscópios , Esfíncter Esofágico Superior/fisiopatologia , Estenose Esofágica/terapia , Transtornos de Deglutição/fisiopatologia , Estenose Esofágica/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
4.
Saudi Med J ; 41(7): 720-725, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32601640

RESUMO

OBJECTIVES: To report the results of endoscopic dilatation of esophageal strictures in children, its complications, and their management. The outcomes of esophageal dilatation differ according to the underlying etiology. METHODS: The study included 46 patients who underwent esophageal dilatation between 2014-2019. All patients underwent a contrast study of the esophagus before endoscopic dilation to determine the location, number, and length of the narrowing. In addition, the type of dilators (balloon versus semi-rigid dilators), the number of dilatation sessions, the interval between them, and the duration of follow-up were also documented. The median age was 2.47 years, and 26 patients were females. Dysphagia was the main presenting symptom, and the leading cause of stricture was esophageal atresia. RESULTS: The main treatment modality was endoscopic balloon dilatation (n=29, 63%). The esophageal diameter was significantly increased after dilation (9 [7-11] versus 12 [10-12.8]) mm; p less than 0.001). Topical mitomycin-C was used as adjuvant therapy in 3 patients (6.5%). Esophageal perforation was reported in 2 cases (4.3%). Patients needed a median of 3 dilatation sessions, 25-75th percentiles: 1-5, and the median duration between the first and last dilatation was 2.18 years 25-75th percentiles: 0.5-4.21. CONCLUSION: Esophageal dilatation is effective for the management of children with esophageal stricture; however, repeated dilatation is frequent, especially in patients with corrosive strictures. Complications are not common, and open surgery is not frequently required.


Assuntos
Transtornos de Deglutição/etiologia , Dilatação/efeitos adversos , Dilatação/métodos , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/métodos , Perfuração Esofágica/etiologia , Estenose Esofágica/terapia , Pré-Escolar , Transtornos de Deglutição/epidemiologia , Dilatação/instrumentação , Atresia Esofágica/complicações , Perfuração Esofágica/epidemiologia , Estenose Esofágica/etiologia , Feminino , Humanos , Lactente , Masculino , Reoperação , Estudos Retrospectivos , Fatores de Tempo
5.
J Laryngol Otol ; 134(6): 481-486, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32616097

RESUMO

BACKGROUND: Advances in endoscopic technology have allowed transnasal oesophagoscopy to be used for a variety of diagnostic and therapeutic procedures. METHOD: A review of the literature was carried out to look into the extended role of transnasal oesophagoscopy within otolaryngology, using the Embase, Cinahl and Medline databases. RESULTS: There were 16 studies showing that transnasal oesophagoscopy is safe and cost effective and can be used for removal of foreign bodies, tracheoesophageal puncture, laser laryngeal surgery and balloon dilatation. CONCLUSION: This study presents a summary of the literature showing that transnasal oesophagoscopy can be used as a safe and cost-effective alternative or adjunct to traditional rigid endoscopes for therapeutic procedures.


Assuntos
Esofagoscopia/métodos , Nariz/cirurgia , Otolaringologia/normas , Análise Custo-Benefício , Dilatação/instrumentação , Esofagoscopia/efeitos adversos , Esôfago/cirurgia , Corpos Estranhos/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Laringe/cirurgia , Terapia a Laser/instrumentação , Otolaringologia/estatística & dados numéricos , Punções , Segurança , Traqueia/cirurgia
6.
J Urol ; 204(5): 1012-1018, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32396409

RESUMO

PURPOSE: We determined if the "bag squeeze" technique decreases pain during flexible cystoscopy in men. MATERIALS AND METHODS: This single center, prospective, double-blind, randomized controlled trial recruited 200 consenting participants who were ambulatory, outpatient males who had undergone prior cystoscopy and were not expected to require any secondary procedures. Men with prior urethral stricture or bladder neck contracture were excluded from study. Once eligibility was assessed and consent obtained, participants were randomized to undergo cystoscopy with the bag squeeze (group A) or the sham bag squeeze procedure (group B). Following cystoscopy, participants completed a pain questionnaire (visual analogue scale). Differences in mean pain score between groups were evaluated using Students' t-test with a 2-sided alpha of 0.05. RESULTS: A total of 200 patients were randomized and underwent flexible cystoscopy. Ten participants were ineligible because they required secondary procedures. Among the 190 eligible patients 97 were randomized to bag squeeze (group A) and 93 to sham bag squeeze (group B) with mean pain scores of 1.91 and 3.39, respectively (p <0.005). CONCLUSIONS: This study demonstrated a clinically meaningful decrease in pain for men undergoing flexible cystoscopy when the irrigation bag squeeze technique was used vs placebo bag squeeze. Accordingly, this useful, simple and free method to improve patient comfort during flexible cystoscopy should be adopted by clinicians.


Assuntos
Cistoscopia/efeitos adversos , Dilatação/métodos , Manejo da Dor/métodos , Dor Processual/prevenção & controle , Solução Salina/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Dilatação/instrumentação , Método Duplo-Cego , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/instrumentação , Medição da Dor , Dor Processual/diagnóstico , Dor Processual/etiologia , Estudos Prospectivos , Resultado do Tratamento
7.
Phys Ther ; 100(8): 1357-1371, 2020 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-32367126

RESUMO

OBJECTIVE: The aim of this systematic review was to identify, evaluate, and synthesize the evidence from studies that have investigated the effect of nonsurgical, nonpharmacological, pelvic floor muscle interventions on any type of pelvic floor dysfunction or health-related quality of life in patients after any type of treatment for gynecological cancer. METHODS: Six electronic databases (Cochrane Library 2018, CINAHL 1982-2018, MEDLINE 1950-2018, EMBASE 1980-2018, PsycINFO 1806-2018, and EMCARE 1995-2018) were systematically searched in June 2018. Reference lists of identified articles were hand searched. Randomized controlled trials (RCTs), cohort studies, and case series were included if they investigated the effects of conservative treatments, including pelvic floor muscle training or dilator training, on bladder, bowel, or sexual function in patients who had received treatment for gynecological cancer. Risk of bias was assessed using the Physiotherapy Evidence Database scale for RCTs and the Newcastle-Ottawa scale for cohort studies. RESULTS: Five RCTs and 2 retrospective cohort studies were included (n = 886). The results provided moderate-level evidence that pelvic floor muscle training with counseling and yoga or core exercises were beneficial for sexual function (standardized mean difference = -0.96, 95% CI = -1.22 to -0.70, I2 = 0%) and health-related quality of life (standardized mean difference = 0.63, 95% CI = 0.38 to 0.88, I2 = 0%) in survivors of cervical cancer and very low-level evidence that dilator therapy reduced vaginal complications in survivors of cervical and uterine cancer (odds ratio = 0.37, 95% CI = 0.17 to 0.80, I2 = 54%). There were insufficient data for meta-analysis of bladder or bowel function. CONCLUSION: Conservative pelvic floor muscle interventions may be beneficial for improving sexual function and health-related quality of life in survivors of gynecological cancer. Given the levels of evidence reported in this review, further high-quality studies are needed, especially to investigate effects on bladder and bowel function. IMPACT: This review provides moderate-level evidence for the role of pelvic floor rehabilitation to improve health outcomes in the gynecological cancer survivorship journey. Clinicians and health service providers should consider how to provide cancer survivors the opportunity to participate in supervised pelvic floor rehabilitation programs.


Assuntos
Tratamento Conservador/métodos , Neoplasias dos Genitais Femininos/terapia , Distúrbios do Assoalho Pélvico/terapia , Qualidade de Vida , Adulto , Idoso , Idoso de 80 Anos ou mais , Aconselhamento , Dilatação/instrumentação , Dilatação/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Contração Muscular/fisiologia , Força Muscular , Avaliação de Resultados em Cuidados de Saúde , Distúrbios do Assoalho Pélvico/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Comportamento Sexual , Bexiga Urinária/fisiologia , Ioga
8.
Am J Cardiol ; 125(9): 1369-1377, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32098656

RESUMO

Safety and feasibility of transfemoral Acurate neo implantation without systematic predilatation are not fully investigated. Our aim was to evaluate the use and impact of pre-implantation balloon aortic valvuloplasty (pre-BAV) before transcatheter aortic valve implantation (TAVI) with Acurate neo. The NEOPRO Registry retrospectively included 1,263 patients who underwent transfemoral TAVI with Acurate neo at 18 centers between January 2012 and March 2018. Information on pre-BAV was available for 1,262 patients (99.9%). Primary end points were pre-discharge moderate-to-severe paravalvular aortic regurgitation (PAR II+), 30-day new permanent pacemaker implantation, and 30-day all-cause mortality or stroke. A total of 1,262 patients who underwent TAVI with (n = 1,051) or without predilatation (n = 211) were included. A reduction in the pre-BAV rate was observed during the study period (from 95.7% in the first date quintile to 78.4% in the last date quintile). Patients who underwent pre-BAV had higher degrees of aortic valve (AV) and left ventricular outflow tract (LVOT) calcification. Primary endpoints were similar between pre-BAV and no pre-BAV groups (PAR II+ 5.5% vs 3.4%, p = 0.214; 30-day permanent pacemaker implantation 9.0% vs 8.0%, p = 0.660; 30-day death or stroke 4.9% vs 4.4%, p = 0.743). The need for postdilatation and other procedural outcomes were comparable between groups. Predilatation did not have a significant impact on primary endpoints across AV and LVOT calcification subgroups (subgroup analyses) and was not independently associated with primary endpoints (multivariate analyses). In conclusion, transfemoral Acurate neo implantation without predilatation appears to be feasible and safe, especially in patients with milder degrees of AV and LVOT calcification.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valvuloplastia com Balão/instrumentação , Dilatação/instrumentação , Substituição da Valva Aórtica Transcateter/métodos , Idoso , Idoso de 80 Anos ou mais , Desenho de Equipamento , Feminino , Humanos , Masculino , Período Pré-Operatório , Sistema de Registros , Estudos Retrospectivos
9.
Gen Thorac Cardiovasc Surg ; 68(6): 655-658, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32048145

RESUMO

We reported a new minimally invasive procedure to treat tracheal stenosis below tracheostomy tube using standard Ciaglia Blue Dolphin kit for percutaneous tracheostomy. Under endoscopic view, the Dolphin kit was inserted through the stoma into the stenosis; the balloon was inflated until a sufficient tracheal diameter was obtained; then, a longer tracheostomy tube was inserted through the stenosis and the distal tip placed near the carina. This procedure was succesfully applied in seven patients.


Assuntos
Dilatação/métodos , Estenose Traqueal/terapia , Adulto , Idoso , Dilatação/instrumentação , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traqueostomia
11.
Lancet Gastroenterol Hepatol ; 5(4): 393-405, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31954438

RESUMO

Stricture formation is a common complication of Crohn's disease, resulting from the disease process, surgery, or drugs. Endoscopic balloon dilation has an important role in the management of strictures, with emerging techniques, such as endoscopic electroincision and stenting, showing promising results. The underlying disease process, altered bowel anatomy from disease or surgery, and concurrent use of immunosuppressive drugs can make endoscopic procedures more challenging. There is an urgent need for the standardisation of endoscopic procedures and peri-procedural management strategies. On the basis of an extensive literature review and the clinical experience of the consensus group, which consisted of representatives from the Interventional Inflammatory Bowel Disease Group, we propose detailed guidance on all aspects of the principles and techniques for endoscopic procedures in the treatment of inflammatory bowel disease-associated strictures.


Assuntos
Constrição Patológica/terapia , Doença de Crohn/diagnóstico por imagem , Dilatação/instrumentação , Endoscopia Gastrointestinal/métodos , Consenso , Constrição Patológica/etiologia , Constrição Patológica/patologia , Doença de Crohn/complicações , Doença de Crohn/epidemiologia , Doença de Crohn/patologia , Intervalo Livre de Doença , Humanos , Imunossupressores/efeitos adversos , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/terapia , Avaliação de Resultados em Cuidados de Saúde , Guias de Prática Clínica como Assunto , Fatores de Risco , Stents/efeitos adversos
12.
Urol J ; 17(1): 68-72, 2020 01 26.
Artigo em Inglês | MEDLINE | ID: mdl-31984473

RESUMO

PURPOSE: The most common option for the management of urethral stricture (US) is direct visual internal urethrotomy (DVIU), because it is an easy and minimally invasive technique but the low success and high recurrence rates of this technique make urologists research for different types of therapeutic alternatives in stricture treatment. In this study we aimed to compare the internal urethrotomy with amplatz dilation for the treatment of male US. MATERIALS AND METHODS: A total of sixty patients, who have been operated due to urethral stricture were enrolled into this study. Group 1 was treated with amplatz renal dilators and the group 2 was treated with cold knife urethrotomy. All patients were evaluated for Qmax preoperatively and at the first, 3rd, 9th and 12th months postoperatively. RESULTS: In the 3 month uroflowmetry results, mean Q max values were 15.6±2 ml/sec in amplatz group and 15.5±1.6 ml/sec in DVIU group. There was no statisticaly difference between the two groups. However the Q max values in the postoperative 9 and 12 months were significantly decreased in the DVIU group. In the DVIU group 9 recurrences (36%) appeared and 2 of these reccurrences were in the first 3 months, whereas in the amplatz group no recurrences appeared in the first 3 months. The urethral stricture recurrence rate up to the 12 month follow up was statistically significant for group 1 when it is compared with group 2. Conclusions: In our experience, amplatz dilation is a good option as the initial treatment for urethral stricture.


Assuntos
Dilatação , Estreitamento Uretral/terapia , Procedimentos Cirúrgicos Urológicos Masculinos , Idoso , Dilatação/efeitos adversos , Dilatação/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Estreitamento Uretral/fisiopatologia , Urodinâmica , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
13.
J Laryngol Otol ; 134(1): 41-45, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31865922

RESUMO

OBJECTIVE: To explore the opinions of the UK consultant body on endoscopic Eustachian tube balloon dilatation in the context of Eustachian tube dysfunction. METHOD: A 10-question online survey was distributed to ENT consultants currently practising in the UK (July-September 2018). RESULTS: A total of 137 ENT consultants responded. Twenty-three per cent reported experience of Eustachian tube balloon dilatation, with a further 10 per cent planning to start performing the procedure. Of those performing the procedure, 16 per cent had more than two years' experience. Thirty-two per cent were performing zero to five procedures a year. Eustachian tube balloon dilatation was primarily conducted to treat Eustachian tube dysfunction symptoms, as well as retraction pockets, baro-challenge-induced Eustachian tube dysfunction and otitis media with effusion. The most common reason for not undertaking Eustachian tube balloon dilatation was insufficient evidence of efficacy (65 per cent). Seventy-two per cent of consultants thought that creating a national database for audit and monitoring purposes would benefit the specialty. CONCLUSION: The majority of UK ENT consultants do not practise Eustachian tube balloon dilatation, citing a lack of high-level evidence to support its use. A national database for auditing and research could facilitate the creation of guidelines.


Assuntos
Dilatação/instrumentação , Otopatias/cirurgia , Tuba Auditiva/cirurgia , Cateterismo/instrumentação , Competência Clínica/estatística & dados numéricos , Consultores , Estudos Transversais , Humanos , Guias de Prática Clínica como Assunto , Inquéritos e Questionários , Resultado do Tratamento , Reino Unido
14.
Am J Emerg Med ; 38(1): 163.e3-163.e5, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31495520

RESUMO

Impacted esophageal foreign bodies typically first present to the emergency department, with coins being most common in children and food boluses most common in adults. Controversy exists regarding the best treatment options in these cases. We report two cases, one pediatric and one adult, where the use of a novel substitute Hurst dilator constructed of materials regularly found in all EDs was successfully used to treat impacted esophageal foreign bodies.


Assuntos
Dilatação/instrumentação , Dilatação/métodos , Serviço Hospitalar de Emergência , Esôfago/lesões , Corpos Estranhos/terapia , Pré-Escolar , Esôfago/diagnóstico por imagem , Feminino , Corpos Estranhos/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade
15.
Dig Surg ; 37(1): 10-21, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30654363

RESUMO

BACKGROUND: Bile duct injury (BDI) is a devastating complication following cholecystectomy. After initial management of BDI, patients stay at risk for late complications including anastomotic strictures, recurrent cholangitis, and secondary biliary cirrhosis. METHODS: We provide a comprehensive overview of current literature on the long-term outcome of BDI. Considering the availability of only limited data regarding treatment of anastomotic strictures in literature, we also retrospectively analyzed patients with anastomotic strictures following a hepaticojejunostomy (HJ) from a prospectively maintained database of 836 BDI patients. RESULTS: Although clinical outcomes of endoscopic, radiologic, and surgical treatment of BDI are good with success rates of around 90%, quality of life (QoL) may be impaired even after "clinically successful" treatment. Following surgical treatment, the incidence of anastomotic strictures varies from 5 to 69%, with most studies reporting incidences around 10-20%. The median time to stricture formation varies between 11 and 30 months. Long-term BDI-related mortality varies between 1.8 and 4.6%. Of 91 patients treated in our center for anastomotic strictures after HJ, 81 (89%) were treated by percutaneous balloon dilatation, with a long-term success rate of 77%. Twenty-four patients primarily or secondarily underwent surgical revision, with recurrent strictures occurring in 21%. CONCLUSIONS: The long-term impact of BDI is considerable, both in terms of clinical outcomes and QoL. Treatment should be performed in tertiary expert centers to optimize outcomes. Patients require a long-term follow-up to detect anastomotic strictures. Strictures should initially be managed by percutaneous dilatation, with surgical revision as a next step in treatment.


Assuntos
Ductos Biliares/lesões , Ductos Biliares/cirurgia , Colecistectomia/efeitos adversos , Doença Iatrogênica , Anastomose em-Y de Roux/efeitos adversos , Colangite/etiologia , Colecistectomia/métodos , Constrição Patológica/etiologia , Dilatação/instrumentação , Humanos , Jejuno/cirurgia , Cirrose Hepática Biliar/etiologia , Prognóstico , Qualidade de Vida , Recidiva , Reoperação , Estudos Retrospectivos
16.
J Invest Surg ; 33(4): 301-306, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30380354

RESUMO

Aim: To investigate regarding the safety and effectiveness of a balloon catheter (Aqueduct-100 device) to dilate the uterine cervix before operative hysteroscopies. Secondary objectives were to evaluate the duration of the dilatation procedure and to investigate on physicians' satisfaction with the device. Methods: Fifty women younger than 40 years, wishing pregnancies and diagnosed with apparently benign intrauterine lesions and/or uterine anomalies, were enrolled into this study and submitted to cervical priming with Aqueduct-100 device before operative hysteroscopy. Results: Initial cervical dilatation was ≤4 mm in all but one patient. Adequate (10 mm) cervical dilatation was achieved in only one patient, the remaining forty-nine needed additional cervical dilatation. All women, however, presented with a ≥6 mm cervical width after balloon catheter removal. The mean time to final cervical dilatation was 8.5 minutes. No perioperative complications occurred. Physicians reported, in the majority of cases, satisfaction for the dilatation achieved (66%), the ease of balloon catheter insertion/use (82%), and for the ease of additional dilatation (96%). Conclusions: Aqueduct-100 device before operative hysteroscopy is safe and useful to increase the baseline cervical width and facilitate additional dilatation, with good effects on physician satisfaction and acceptable dilatation times.


Assuntos
Dilatação/instrumentação , Histeroscopia/métodos , Complicações na Gravidez/diagnóstico por imagem , Cuidados Pré-Operatórios/instrumentação , Anormalidades Urogenitais/diagnóstico por imagem , Útero/anormalidades , Adulto , Colo do Útero , Dilatação/efeitos adversos , Feminino , Humanos , Projetos Piloto , Gravidez , Cuidados Pré-Operatórios/efeitos adversos , Útero/diagnóstico por imagem
17.
J Minim Invasive Gynecol ; 27(1): 206-211, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31228594

RESUMO

Our objective was to provide a minimally invasive neovaginoplasty technique to construct a nearly physiologic vagina to facilitate sexual functioning and appropriate vaginal length in patients with congenital vaginal agenesis. This retrospective study at a tertiary care hospital comprised 52 patients with congenital vaginal agenesis because of Mayer-Rokitansky-Küster-Hauser syndrome or androgen insensitivity syndrome presented for vaginal reconstruction. Modified McIndoe vaginoplasty was done in all patients between 2010 and 2018 using a vaginal mold created with glove, nonadherent petroleum gauze, and Interceed absorbable adhesion barrier (Ethicon, Johnson & Johnson, Somerville, NJ) that was placed in the neovagina space created between the bladder and rectum for 7 days. Operative details, complications, length and width of the neovagina, and functional outcome were evaluated. The mean operation time was 35 minutes. The mean length of the constructed neovagina was 8.4 cm × 3.4 cm at 6 weeks follow-up. Epithelialization was completed by 4 to 6 months. All patients reported satisfactory sexual activity with no pain and good mucosal sensitivity. This modified neovaginoplasty technique is easy to perform, involves painless postoperative dilatations as the cornerstone of treatment, and results in adequate secretion, allowing lubrication and acceptable physiologic results.


Assuntos
Transtornos 46, XX do Desenvolvimento Sexual/cirurgia , Implantes Absorvíveis , Celulose Oxidada/uso terapêutico , Anormalidades Congênitas/cirurgia , Ductos Paramesonéfricos/anormalidades , Procedimentos Cirúrgicos Reconstrutivos/métodos , Vagina/anormalidades , Vagina/cirurgia , Transtornos 46, XX do Desenvolvimento Sexual/complicações , Adolescente , Adulto , Assistência ao Convalescente , Dilatação/instrumentação , Dilatação/métodos , Feminino , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Membrana Mucosa/cirurgia , Ductos Paramesonéfricos/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Estudos Retrospectivos , Aderências Teciduais/prevenção & controle , Resultado do Tratamento , Adulto Jovem
18.
Rev Esp Enferm Dig ; 111(12): 935-940, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31718197

RESUMO

Background To observe the outcome of endoscopic papillary large balloon dilation (EPLBD) with minor sphincterotomy (mEST) for periampullary diverticular papilla related to stone removal. Methods Patients with confirmed periampullary diverticulum (PAD) during stone removal from May 2016 to April 2018 were reviewed retrospectively. The Chi-square test with Yates correction or Fisher's exact test was used for the analysis of categorical data and a normality test was applied for continuous data. Results A total of 154 consecutive patients (89 males and 65 females, aged 51-87 years) with confirmed PAD during stone removal were included in the study. Cases were divided into the conventional EST group (n = 79) and the mEST plus EPLBD group (n = 75). The number of patients with an initial treatment success was greater in the EPLBD+mEST group compared with the EST group (96% vs 86.1%, p=0.03) and the procedure time for EPLBD+mEST was shorter than that for EST alone (46.1±13.7 min vs 53.3±11.6 min, p=0.01). The rate of complications in the EPLBD+mEST group was lower than in the EST group (17.3% vs 32.9%, p=0.04). When PAD was >15 mm, the initial success rate was higher (92.6% vs 73.9%, p=0.04) and the rate of overall complications was lower (14.8% vs 41.7%, p=0.03) in the EPLBD+mEST group than those in the EST group. Although, this was similar when PAD was <15 mm. Conclusion EPLBD+mEST might be safer and more effective than conventional EST alone for stone removal in the presence of PAD.


Assuntos
Ampola Hepatopancreática , Coledocolitíase/cirurgia , Dilatação/métodos , Divertículo/terapia , Esfinterotomia Endoscópica/métodos , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangite/etiologia , Dilatação/efeitos adversos , Dilatação/instrumentação , Dilatação/estatística & dados numéricos , Divertículo/diagnóstico , Divertículo/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/etiologia , Estudos Retrospectivos , Esfinterotomia Endoscópica/efeitos adversos , Esfinterotomia Endoscópica/estatística & dados numéricos
19.
Medicine (Baltimore) ; 98(44): e17714, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689807

RESUMO

This study aimed to compare clinical results, symptom relief, quality of life and patient satisfaction after the 2 most common procedures for achalasia treatment: laparoscopic Heller myotomy (LHM) and endoscopic balloon dilatation (EBD).Patients treated at University Hospital of Heidelberg with LHM or EBD were included. A retrospective chart review of perioperative data and a prospective follow-up of therapeutic efficiency, Gastrointestinal Quality of Life Index (GIQLI) and patient satisfaction was conducted.Follow-up data (mean follow-up: 75.1 ±â€Š53.9 months for LHM group and 78.9 ±â€Š45.6 months for EBD) were obtained from 36 patients (19 LHM; 17 EBD). Eckardt score (median (q1,q3): 2 (1,4) in both groups, P = .91, GIQLI (LHM: 117 (91.5, 126) vs EBD: 120 (116, 128), P = .495) and patient satisfaction (3 (2,3) vs 3 (2,4), P = .883) did not differ between groups. Fifteen patients (78.9%) in LHM group and 11 (64.7%) in EBD group (P = .562) stated they would undergo the intervention again. All patients with EBD had at least 2 dilatations (100%), whilst only 2 patients (10.5%) had dilatation after LHM (P < .001). There were no complications after EBD, but 2 after LHM (10.5%, P = .517).Both LHM and EBD are able to control symptoms and provide similar quality of life and patient satisfaction. However, reintervention rate was higher following EBD, hence LHM provided a more sustained treatment than EBD.


Assuntos
Dilatação/estatística & dados numéricos , Acalasia Esofágica/cirurgia , Esofagoscopia/estatística & dados numéricos , Miotomia de Heller/estatística & dados numéricos , Dilatação/instrumentação , Dilatação/métodos , Esofagoscopia/métodos , Feminino , Seguimentos , Miotomia de Heller/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Estudos Prospectivos , Qualidade de Vida , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
20.
Arch Ital Urol Androl ; 91(3)2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31577102

RESUMO

OBJECTIVES: Introduction of the "access sheet" is one of the most important steps steps of the percutaneous nephrolithotomy (PNL) intervention. In creating the access tract, various dilatators (balloon, metal) are used and different need-based dilatation tools were developed. In this study, we aimed to compare the mechanical Amplatz dilatation (AD), balloon dilatation (BD) and one-shot dilatation (OSD) methods in a retrospective manner. METHODS: A total of 182 patients (127 males and 55 females), who underwent PNL surgery in Urology Department of Fatih Sultan Mehmet Research and Training Hospital between January 2016 and September 2018, were included in this study. RESULTS: The average age was 47.34 ± 12.68 years (age range 15-80) and average BMI was 27.15 ± 5.01 kg/m2 (range between 17.12 and 40.75 kg/m2). There was a prominent difference in terms of operation duration (p = 0.032). Meaningful difference was found among the groups in terms of dilation fluoroscopy time (p = 0.001), with a notable shorter time in OSD group than the others (p < 0.05). Beside this, there was no difference between the AD and BD groups in terms of fluoroscopy times (p > 0.05). Also, there was no difference among the groups by Clavien complication rate (p > 0.05). There was a prominent difference among the groups in terms of hemoglobin decrement (p = 0.012; p < 0.05). The hemoglobin decrease in OSD group was significantly lower than in AD and BD groups (p < 0.05; p < 0.01). On the contrary, there was no meaningful difference between AD and BD groups with this regard (p > 0.05). CONCLUSIONS: As a result, we have concluded that the use of OSD modality in PNL interventions could be superior to other methods with respect to its feasibility, cost-effectiveness, shorter radiation exposure / fluoroscopy time and it could be a preferable way of treatment especially in developing countries.


Assuntos
Dilatação/métodos , Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dilatação/efeitos adversos , Dilatação/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Estudos Retrospectivos , Adulto Jovem
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