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1.
PLoS One ; 14(12): e0226764, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31869376

RESUMO

Parallel to establishment of diagnostic surveillance protocols for detection of prostatic diseases, novel treatment strategies should be developed. The aim of the present study is to evaluate the feasibility and possible side effects of transrectal, MRI-targeted intraprostatic steam application in dogs as an established large animal translational model for prostatic diseases in humans. Twelve healthy experimental, intact, male beagle dogs without evidence of prostatic pathology were recruited. An initial MRI examination was performed, and MRI-targeted steam was applied intraprostatically immediately thereafter. Serum levels of C-reactive protein (CRP), clinical and ultrasonographic examinations were performed periodically following the procedure to assess treatment effect. Four weeks after treatment, all dogs underwent follow-up MRI examinations and three needle-core biopsies were obtained from each prostatic lobe. Descriptive statistics were performed. MRI-guided intraprostatic steam application was successfully performed in the study population. The first day after steam application, 7/12 dogs had minimal signs of discomfort (grade 1/24 evaluated with the short-form Glasgow Composite Measure Pain Scale) and no dogs showed any sign of discomfort by day 6. CRP elevations were detected in 9/12 dogs during the first week post steam application. Mild to moderate T2 hyperintense intraparenchymal lesions were identified during follow-up MRI in 11/12 dogs four weeks post procedure. Ten of these lesions enhanced mild to moderately after contrast administration. Coagulative necrosis or associated chronic inflammatory response was detected in 80.6% (58/72) of the samples obtained. MRI-targeted intraprostatic steam application is a feasible technique and displays minimal side effects in healthy dogs as translational model for human prostatic diseases. This opens the possibility of minimally invasive novel treatment strategies for intraprostatic lesions.


Assuntos
Técnicas de Ablação/métodos , Imagem por Ressonância Magnética/métodos , Próstata/cirurgia , Doenças Prostáticas/cirurgia , Animais , Cães , Estudos de Viabilidade , Masculino , Próstata/diagnóstico por imagem , Doenças Prostáticas/diagnóstico por imagem , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/cirurgia , Vapor/análise
2.
BMJ Case Rep ; 12(12)2019 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-31852690

RESUMO

A 51-year-old diabetic man diagnosed with prostatic abscess underwent its drainage twice. Following surgery he developed fever and right-sided painless visual loss due to endophthalmitis. To rule out its endogenous source CT scan was done which showed multisystem aetiology and complications. His pelvic CT and CT cystogram revealed postsurgical urethral injury along with urinary extravasation, perineal and pelvic soft tissues air densities with fat stranding ascribed to Fournier gangrene, air in distended urinary bladder due to emphysematous cystitis and right common iliac vein air containing septic thrombus. CT chest spotted bilateral multiple septic pulmonary emboli. These radiological findings were promptly handled by uro-surgical team followed by alliance with other relevant departments. With hasty surgical drainage/debridement, urological restoration of urinary obstruction, aggressive broad spectrum antibiotics, anticoagulation and radiological follow-ups the patient withstood multisystem lethal complications and come up with excellent outcome except evisceration.


Assuntos
Abscesso/cirurgia , Gangrena de Fournier/diagnóstico por imagem , Doenças Prostáticas/cirurgia , Embolia Pulmonar/diagnóstico por imagem , Sepse/diagnóstico por imagem , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêutico , Desbridamento , Complicações do Diabetes/diagnóstico por imagem , Complicações do Diabetes/terapia , Drenagem/efeitos adversos , Gangrena de Fournier/etiologia , Gangrena de Fournier/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/complicações , Embolia Pulmonar/terapia , Sepse/complicações , Sepse/terapia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
3.
BMJ Case Rep ; 12(10)2019 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-31586950

RESUMO

Periprostatic abscess is a rare complication of hydrogel spacers in radiotherapy for prostate cancer. We present the case of a 61-year-old man who developed this condition. Abdominopelvis CT scan revealed a 54×35×75 mm collection in the location of the SpaceOAR, for which ultrasound-guided transperineal percutaneous drainage of the periprostatic abscess was performed. The patient remains well with serial CT scans showing near resolution of the collection.


Assuntos
Abscesso/diagnóstico , Hidrogéis/efeitos adversos , Doenças Prostáticas/diagnóstico , Lesões por Radiação/diagnóstico , Infecções Estreptocócicas/diagnóstico , Streptococcus anginosus/isolamento & purificação , Abscesso/diagnóstico por imagem , Abscesso/cirurgia , Drenagem , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Prostáticas/diagnóstico por imagem , Doenças Prostáticas/cirurgia , Neoplasias da Próstata/radioterapia , Lesões por Radiação/diagnóstico por imagem , Lesões por Radiação/cirurgia , Infecções Estreptocócicas/diagnóstico por imagem , Infecções Estreptocócicas/cirurgia , Tomografia Computadorizada por Raios X
4.
J Laparoendosc Adv Surg Tech A ; 29(11): 1486-1491, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31486708

RESUMO

Purpose: To compare the results of two- versus three-staged laparoscopic anorectoplasty (LARP) in children with rectoprostatic and bladder neck fistulas. Materials and Methods: The present study was retrospectively initiated among 32 consecutive patients who underwent two-staged LARP from October 2010 to December 2012. The associated defects, age at the operation, operative time, complications, length of the postoperative hospital stay, total hospitalization cost, and functional results (according to the Krickenbeck scoring system) were evaluated. The results were compared with those of 19 cases who underwent three-staged LARP from October 2008 to September 2010. Results: The average age at the second operation was 4.5 ± 1.2 months in the two-staged group, and 4.2 ± 1.3 months in the three-staged group. In the two-staged group, there were statistically shorter overall operative time and postoperative hospital stay duration. Also, a significantly lower total hospitalization cost was achieved. There was no anastomotic leak in either group. The rates of perineal wound infection, recurrent fistula, and rectal prolapse were 3.85% versus 0% (P = 1.000), 0% versus 5.3% (P = .422), and 11.5% versus 15.8% (P = .686), respectively (two-staged versus three-staged group). The median follow-up time was 67 (range, 54-80) months and 88 (range, 81-104) months, respectively. No significant difference in functional outcome was observed. Conclusions: Two-staged LARP is feasible, safe, and more cost-effective, with comparable incidences of complications and functional outcomes with respect to a three-staged procedure.


Assuntos
Malformações Anorretais/cirurgia , Fístula/cirurgia , Doenças Prostáticas/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fístula Retal/cirurgia , Fístula da Bexiga Urinária/cirurgia , Adolescente , Criança , Pré-Escolar , Análise Custo-Benefício , Feminino , Humanos , Lactente , Recém-Nascido , Laparoscopia/efeitos adversos , Laparoscopia/economia , Tempo de Internação/economia , Masculino , Pescoço/cirurgia , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/economia , Prolapso Retal/etiologia , Recidiva , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/etiologia
5.
Surg Technol Int ; 35: 43-47, 2019 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-31373378

RESUMO

BACKGROUND: Utricular cysts are usually the result of incomplete involution of the Müllerian ducts and may have no urethral connection. Treatment options for symptomatic utricular cysts include an open abdominal approach, trans-vesical excision, vasoligation without excision and laparoscopic/robotic-assisted excision. PATIENTS AND METHODS: Two patients (14 and 45 years old) with recurrent urinary tract infections associated with recurrent lower urinary tract irritative symptoms and recurrent perineal pains presented to our department. Clinical, radiological and MRI examinations showed 6x3 and 5x4cm utricular cysts, respectively. Both patients underwent robotic-assisted complete dissection of the cyst, including its neck. Separation of the cysts from surrounding tissues as well as the seminal vesicles while avoiding injury to the neurovascular bundles was followed by incision of the prostate base to dissect the cyst neck from the prostatic parenchyma up to its connection to the urethra. The cyst neck was secured with either one clip or 4/0 vicryl sutures. The field was reconstructed with 4/0 sutures. The patients were followed-up at 3, 6 and 12 months postoperatively. RESULTS: There were no intraoperative complications or injuries to the neighboring structures (seminal vesicles, vas deferens and urethra). The operative time was 95 and 80 minutes, respectively, with negligible blood loss. Both patients underwent an uneventful recovery from surgery, and were discharged on the 5th postoperative day. Both patients were asymptomatic throughout the entire follow-up period (15 months). MRI at 3 months showed no abnormalities. The postoperative IIEF score in the older patient showed no difference compared to his baseline findings. The life quality score showed high patient acceptance and both patients indicated that they would recommend the procedure. CONCLUSIONS: Symptomatic presentation of utricular cysts may be associated with recurrent urinary tract infections, orchitis-epididymitis and potential for malignancy. The present cases demonstrate that robotic-assisted surgical excision of symptomatic utricular cysts is a feasible and safe procedure. It seems to provide excellent visualization and access to these lesions. This procedure provides patients the advantages of minimally invasive surgery with outcomes comparable to those with other management techniques.


Assuntos
Cistos , Doenças Prostáticas , Procedimentos Cirúrgicos Robóticos , Adolescente , Adulto , Cistos/cirurgia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Prostáticas/cirurgia , Uretra , Adulto Jovem
6.
J Urol ; 202(5): 1022-1028, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31251715

RESUMO

PURPOSE: We assessed the efficacy and safety profile of the ATOMS® (Adjustable Transobturator Male System) for post-prostatectomy incontinence in a multicenter North American setting. MATERIALS AND METHODS: We reviewed outcomes from 8 centers in men who underwent treatment of post-prostatectomy incontinence with an ATOMS. Primary study outcomes were pad changes and continence, defined as requiring 1.0 or 0 pad postoperatively in patients who required 2.0 or more pads preoperatively and 0 pad in those who required more than 1.0 or 2.0 pads preoperatively. Secondary outcomes included improvement, 90-day complications and patient satisfaction. RESULTS: A total of 160 patients were enrolled in study with a median followup of 9.0 months. Preoperative median pad use was 4 per day (IQR 3-5). Of the patients 36.3% reported severe preoperative incontinence, 31.3% received prior radiotherapy and 16.3% underwent previous incontinence surgery. Median postoperative pad use after adjustments was 0.5 per day (IQR 0-1, p <0.001). The overall continence rate was 80.0% with improvement in 87.8% of cases. Of the patients 70.1% underwent a mean ± SD of 2.4 ± 2.7 adjustments (IQR 0-16). The patient satisfaction rate was 86.3%, 22.3% experienced 90-day complications of any grade and 7 (4.4%) experienced Clavien III complications primarily related to the injection port. Patients with a history of radiotherapy were less likely to be continent (62.5% vs 87.9%, p=0.002), improved (77.1% vs 92.6%, p=0.02) or satisfied (69.8% vs 93.2%, p=0.001). Similarly patients with previous incontinence surgery had lower rates of continence, improvement and satisfaction (57.7%, 73.1% and 69.6%, respectively). CONCLUSIONS: In the short term the ATOMS is a safe and efficacious device to treat post-prostatectomy incontinence. Patients with concurrent radiotherapy and previous incontinence surgery respond to treatment but are less likely to be continent, improved or satisfied.


Assuntos
Satisfação do Paciente , Complicações Pós-Operatórias/epidemiologia , Prostatectomia/efeitos adversos , Doenças Prostáticas/cirurgia , Slings Suburetrais/efeitos adversos , Incontinência Urinária/epidemiologia , Idoso , Canadá/epidemiologia , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Desenho de Prótese , Estudos Retrospectivos , Incontinência Urinária/etiologia
7.
Pan Afr Med J ; 32: 23, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31143328

RESUMO

Prostatic lithiases are characterized by the development of stones in the prostatic tissue (acini, channels). They rarely occur in children but they are frequent in men. We report the case of a 24-year old patient with a few month-history of micturation disorders including dysuria and pollakiuria followed by perineal urinary leakage during minction. Reno-vesico-prostatic ultrasound showed voluminous prostatic calcification. Standard radiographic evaluation of the urinary tract and fistulography of the perineal orifice showed a communication with the bladder and showed large calcification projecting over the pubis. The diagnosis of prostatic lithiasis was retained. The patient was treated with antibiotic therapy before, during and after surgical extraction of the voluminous lithiasis. Surgical outcomes were favorable.


Assuntos
Fístula/diagnóstico , Litíase/diagnóstico , Períneo/patologia , Doenças Prostáticas/diagnóstico , Fatores Etários , Fístula/patologia , Humanos , Litíase/patologia , Litíase/cirurgia , Masculino , Doenças Prostáticas/patologia , Doenças Prostáticas/cirurgia , Resultado do Tratamento , Adulto Jovem
8.
Pediatr Surg Int ; 35(2): 247-251, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30406836

RESUMO

AIM: It has long been considered surgical dogma that the length of the shared common wall (CW) between a fistula and the urethra in males with anorectal malformation (ARM) and rectourethral bulbar fistula (RUBF) is considerably longer than in males with ARM and rectourethral prostatic fistula (RUPF). This belief has led surgeons who perform laparoscopic-assisted anorectoplasty (LAARP) for RUPF to avoid LAARP for RUBF for risk of potential injury to the urethra or incomplete removal of the fistula. In this study, we compared CW between RUBF and RUPF using distal colostography (DCG) and direct intraoperative measurements. METHODS: DCG of rectourethral fistula patients (n = 63; RUBF: n = 44; RUPF: n = 19) were used to measure CW retrospectively. Results were expressed as a ratio of the height of L4; i.e., CW:L4. If less than 0.7, the CW was classified as being "short"; if 0.71-1.4, as being "medium"; and if greater than 1.41, as being "long". CW that could not be measured was classified as indeterminate. 24 of these patients also had CW measured intraoperatively during LAARP as previously described. The results obtained using both techniques were also compared. RESULTS: Surprisingly, CW:L4 in RUBF patients was short in 47.7%, medium in 27.3%, long in 20.5%, and indeterminate in 4.5% on DCG, equivalent to mean lengths of 7 mm, 8.5 mm, and 10.3 mm obtained using direct intraoperative measurement for short, medium, and long CW:L4 categories, respectively. CW:L4 in RUPF was short in 73.6%, medium in 10.5%, and long in 5.2% on DCG, while mean intraoperative measurements were 5 mm, 7 mm, and 10 mm, respectively. Differences in CW measured intraoperatively were not significantly different between RUBF and RUPF (p = NS). CONCLUSION: From our findings, 47.7% of CWs in RUBF were short using two independent methods, with only 20.5% being long. Thus, LAARP should be considered actively for treating selected RUBF cases and not be excluded on the basis of CW length.


Assuntos
Malformações Anorretais/diagnóstico por imagem , Malformações Anorretais/cirurgia , Doenças Uretrais/diagnóstico por imagem , Doenças Uretrais/cirurgia , Fístula Urinária/diagnóstico por imagem , Fístula Urinária/cirurgia , Humanos , Masculino , Doenças Prostáticas/diagnóstico por imagem , Doenças Prostáticas/cirurgia , Fístula Retal/diagnóstico por imagem , Fístula Retal/cirurgia , Estudos Retrospectivos , Doenças Uretrais/patologia
9.
Prostate Cancer Prostatic Dis ; 22(2): 303-308, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30385836

RESUMO

BACKGROUND: Transurethral resection of the prostate is the most commonly performed procedure for the management of benign prostatic obstruction. However, little is known about the effect surgical duration has on complications. We assess the relationship between operative time and TURP complications using a modern national surgical registry. METHODS: We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) from 2006 to 2016 for patients undergoing TURP. Patients were separated into five groups based on operative time: 0-30 min, 30.1-60 min, 60.1-90 min, 90.1-120 min, and greater than 120 min. Standard statistical analysis, including multivariate regression, was performed to determine factors associated with complications. RESULTS: 31,813 patients who underwent TURP were included. The overall complication rate was 9.0% and increased significantly with longer surgical duration (p < 0.001). Longer operative time was associated with a greater risk of postoperative sepsis or shock, transfusion, reoperation, and deep vein thrombus or pulmonary embolism. Longer surgical duration was associated with increased odds of any complication and, specifically, blood transfusion after controlling for age, race, comorbidities, American Society of Anesthesia (ASA) class, type of anesthesia administered, and trainee involvement. The adjusted risk of each of the above complications remained significantly increased for surgeries lasting longer than 120 min. CONCLUSIONS: As surgical duration increases, there is a significant increase in the rate of complications after TURP. These data demonstrate that this procedure is safest when performed in under 90 min.


Assuntos
Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Doenças Prostáticas/complicações , Doenças Prostáticas/epidemiologia , Ressecção Transuretral da Próstata/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Prostáticas/cirurgia , Melhoria de Qualidade , Qualidade da Assistência à Saúde , Sistema de Registros , Fatores de Risco , Ressecção Transuretral da Próstata/métodos , Ressecção Transuretral da Próstata/estatística & dados numéricos , Estados Unidos/epidemiologia
10.
BJU Int ; 123(6): 1055-1060, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30578705

RESUMO

OBJECTIVES: To perform a post hoc analysis of in-hospital costs incurred in a randomized controlled trial comparing prostatic artery embolization (PAE) and transurethral resection of the prostate (TURP). PATIENTS AND METHODS: In-hospital costs arising from PAE and TURP were calculated using detailed expenditure reports provided by the hospital accounts department. Total costs, including those arising from surgical and interventional procedures, consumables, personnel and accommodation, were analysed for all of the study participants and compared between PAE and TURP using descriptive analysis and two-sided t-tests, adjusted for unequal variance within groups (Welch t-test). RESULTS: The mean total costs per patient (±sd) were higher for TURP, at €9137 ± 3301, than for PAE, at €8185 ± 1630. The mean difference of €952 was not statistically significant (P = 0.07). While the mean procedural costs were significantly higher for PAE (mean difference €623 [P = 0.009]), costs apart from the procedure were significantly lower for PAE, with a mean difference of €1627 (P < 0.001). Procedural costs of €1433 ± 552 for TURP were mainly incurred by anaesthesia, whereas €2590 ± 628 for medical supplies were the main cost factor for PAE. CONCLUSIONS: Since in-hospital costs are similar but PAE and TURP have different efficacy and safety profiles, the patient's clinical condition and expectations - rather than finances - should be taken into account when deciding between PAE and TURP.


Assuntos
Embolização Terapêutica/economia , Custos Hospitalares , Doenças Prostáticas/cirurgia , Ressecção Transuretral da Próstata/economia , Idoso , Hospitalização/economia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Prostáticas/economia , Suíça , Resultado do Tratamento
11.
Fertil Steril ; 110(7): 1410-1411, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30503140

RESUMO

OBJECTIVE: To demonstrate a safe and effective approach to the treatment of obstructing midline prostate utricle cyst with the use of a holmium laser. DESIGN: Video presentation. SETTING: University hospital. PATIENT(S): A 33-year-old man presented with chronic pelvic pain, pain with ejaculation, and infertility. Semen analysis demonstrated oligoasthenospermia with poor viability and computerized tomographic scan identified the presence of a midline 2-3-cm prostatic cyst with dilated seminal vesicles bilaterally. Transrectal ultrasound in the office confirmed the diagnosis of midline obstructing prostatic utricle cyst and estimated the distance from the urethra. INTERVENTION(S): Transurethral ablation of a midline prostate utricle cyst with the use of a holmium laser. MAIN OUTCOME MEASURE(S): Intraoperative technique highlighting the main steps for a transurethral ablation of a midline prostate utricle cyst with the use of a holmium laser. RESULT(S): This video highlights the technique for transurethral ablation of a midline prostate utricle cyst with the use of a holmium laser to unroof the cyst. Retrograde vesiculography was performed to confirm patency of the ejaculatory ducts. Outpatient surgery was tolerated well and the patient was discharged. After surgery at 4 weeks, his symptoms had abated and semen analysis revealed normozoospermia. CONCLUSION(S): We demonstrate safe and effective transurethral ablation of a midline prostate utricle cyst with the use of a holmium laser. Preoperative transrectal ultrasound or cross-sectional imaging can be useful for operative planning. When the orifices of the ejaculatory ducts can be identified, vesiculography can be performed to confirm patency of the ducts and seminal vesicles after relief of the obstructing cyst.


Assuntos
Cistos/cirurgia , Lasers de Estado Sólido/uso terapêutico , Doenças Prostáticas/cirurgia , Ressecção Transuretral da Próstata/métodos , Adulto , Cistos/complicações , Cistos/patologia , Ductos Ejaculatórios/patologia , Ductos Ejaculatórios/cirurgia , Hólmio , Humanos , Infertilidade Masculina/etiologia , Infertilidade Masculina/cirurgia , Masculino , Lesões Pré-Cancerosas/complicações , Lesões Pré-Cancerosas/cirurgia , Doenças Prostáticas/complicações , Doenças Prostáticas/patologia , Glândulas Seminais/patologia , Glândulas Seminais/cirurgia
12.
J Am Anim Hosp Assoc ; 54(6): e54606, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30272475

RESUMO

A 1 yr old intact male miniature dachshund presented for posturing to urinate without voiding and nocturia. Physical examination revealed congenital reproductive abnormalities and a fluid-filled structure caudal to the urinary bladder. The dog was diagnosed with a prostatic cyst and underwent an exploratory laparotomy with an attempt to remove the cyst. Twelve weeks later, the dog returned with recurring clinical signs, and the cyst was found to have returned back to its original size. A second intact male miniature dachshund presented at 7 mo of age for stranguria. Physical examination revealed congenital reproductive abnormalities and a fluid-filled structure on rectal palpation, much like the first dog. The dog was diagnosed with a prostatic cyst and underwent an exploratory laparotomy. An attempt was made to close communication between the prostate and cyst. The dog re-presented 3 wk later for recurrence of clinical signs, and the prostatic cyst was found to have increased in size. Both dogs were euthanized because of recurrence of clinical signs. This report describes the presence of prostatic cysts in two young dogs with congenital abnormalities of the genital and reproductive tracts and the similarities seen in human boys diagnosed with prostatic utricles.


Assuntos
Líquido Cístico , Cistos/veterinária , Doenças do Cão/patologia , Doenças Prostáticas/veterinária , Urina , Animais , Líquido Cístico/química , Cistos/patologia , Cistos/cirurgia , Doenças do Cão/congênito , Doenças do Cão/cirurgia , Doenças do Cão/urina , Cães , Eutanásia Animal , Laparotomia/veterinária , Masculino , Doenças Prostáticas/congênito , Doenças Prostáticas/patologia , Doenças Prostáticas/cirurgia , Recidiva
13.
Hum Reprod ; 33(11): 2023-2034, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30285122

RESUMO

STUDY QUESTION: When is the investigation and treatment of midline prostatic cysts (MPC) of clinical value in the work-up of males of infertile couples? SUMMARY ANSWER: With a prevalence of 10.2% in infertile men, MPC should be investigated according to a seminal algorithm detecting a MPC volume >0.117 ml, which may impair semen parameters, and could be treated to improve sperm count and achieve natural pregnancy. WHAT IS KNOWN ALREADY: MPC are frequent and are considered a correctable cause of male infertility. However, they have been poorly investigated in an infertility setting. In addition, no study has investigated clinical and ultrasound (US) characteristics of men with MPC. STUDY DESIGN, SIZE, DURATION: A cross-sectional analysis was carried out of 693 consecutive subjects consulting for couple infertility from September 2012 to March 2017. As a control group, 103 age-matched healthy, fertile men were studied. Furthermore, a longitudinal evaluation of 11 infertile men undergoing trans-rectal ultrasonically-guided cyst aspiration (TRUCA), semen analyses 1 and 3 months after TRUCA and a follow-up 1 year after TRUCA to assess natural pregnancy were performed. PARTICIPANTS/MATERIALS, SETTING, METHODS: All subjects underwent, in our outpatient clinic, clinical, hormonal, scrotal and transrectal US evaluation and semen analysis within the same day. Of 693 males of infertile couples, 648 (37.1 ± 7.9 years, mean+SD) without genetic abnormalities were studied, along with 103 fertile men (36.6 ± 5.0 years). Eleven infertile men underwent TRUCA and were followed-up as reported above. MAIN RESULTS AND THE ROLE OF CHANCE: A MPC was present in 66/648 (10.2%) males of infertile couples and in 6/103 (5.8%) fertile men. MPC occurrence and volume were higher in patients with severe oligo- or azoospermia than in fertile men (all P < 0.05). Infertile men with a MPC showed a lower seminal volume and sperm count and a higher prevalence of azoospermia than the rest of the infertile sample or fertile men, and a higher frequency of US signs suggestive of ejaculatory duct obstruction. MPC volume was negatively associated with total sperm count (r = -0.452, P < 0.0001). In fertile men, the highest MPC volume was 0.117 ml, suggesting it as a biological threshold not compromising semen quality. In infertile men, using receiver operating characteristic curve analyses, a MPC volume >0.117 ml identified subjects with severe oligo- or azoospermia with an overall accuracy of ~75% (both P < 0.005). Eleven men with infertility, semen abnormalities and large MPC (>0.250 ml) underwent TRUCA, which led to sperm count improvement in all patients 1 month after surgery. Three months after TRUCA a lower sperm count and a higher MPC volume than 2 months before were observed (P < 0.005 and P < 0.05, respectively), although improved when compared to baseline. After TRUCA a natural pregnancy occurred in four couples. Finally, we propose an algorithm, based on semen parameters, useful in identifying a MPC in males of infertile couples. LIMITATIONS, REASONS FOR CAUTION: Although in line with the sample size of previous studies (n = 7-20), the number of infertile men with MPC evaluated longitudinally after treatment is limited (n = 11). In addition, although a MPC volume >0.117 ml can negatively affect the sperm count, only MPC > 0.250 ml have been treated in this study. WIDER IMPLICATIONS OF THE FINDINGS: First, the algorithm proposed is easy to use and useful for selecting patients who can benefit from a prostate US in the infertility work-up. Second, a MPC volume ≤0.117 ml may not impair semen quality, while a larger volume can lead to severe oligo- or azoospermia and could be treated. Third, TRUCA is effective, and simpler and less invasive than other surgical techniques for MPC treatment. Finally, since the MPC can increase in size and sperm count decrease over time after TRUCA, semen cryopreservation should be considered 1 month after TRUCA. STUDY FUNDING/COMPETING INTEREST(S): Grants from the Ministry of University and Scientific Research (SIR project to F.L., protocol number: RBSI14LFMQ). No conflicts of interest.


Assuntos
Azoospermia/epidemiologia , Cistos/epidemiologia , Doenças Prostáticas/epidemiologia , Adulto , Azoospermia/etiologia , Estudos de Casos e Controles , Estudos Transversais , Cistos/cirurgia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Doenças Prostáticas/cirurgia , Curva ROC , Glândulas Seminais/patologia , Contagem de Espermatozoides/estatística & dados numéricos , Motilidade Espermática/fisiologia , Testículo/patologia
14.
Am J Case Rep ; 19: 1179-1183, 2018 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-30282963

RESUMO

BACKGROUND Urinary tract candida infection can be due either to hematogenous dissemination of the organism or a retrograde infection. In debilitated or immunosuppressed septic patients, who have upper urinary tract obstruction with renal filling defect, fungal infection should be considered. We report on a patient with sepsis and renal fungal ball who was treated with percutaneous nephrostomy and intravenous antifungal agent, but the patient did not respond so instillation of fluconazole through nephrostomy was given. CASE REPORT A 60-year-old male patient with a known case of diabetes mellitus with refractory urine retention underwent transurethral resection of the prostate. Postoperatively, the patient developed recurrent high-grade fever with left loin pain, and elevated septic parameters; urine and blood culture were positive for Candida albicans. Computed tomography urography showed left hydronephrosis with filling defect in the left renal pelvis with suspected renal fungal ball. Left percutaneous nephrostomy was performed and intravenous fluconazole started but the fever did not subside, therefore, the treatment was changed to anidulafungin. The patient improved but urine from both the bladder and the nephrostomy remained positive for candida. Instillation of fluconazole at 300 mg in 500 mL normal saline was applied through the nephrostomy tube over 12 hours at 40 mL/hour for 7 days. CONCLUSIONS Renal fungal ball is rare but can be serious, especially in immunocompromised patients. Management options for renal fungal ball include intravenous antifungal agents and percutaneous nephrostomy with antifungal instillation of antifungal agents. The objective of this case report was to document treatment success with the use of fluconazole instillation through a nephrostomy tube.


Assuntos
Antifúngicos/administração & dosagem , Candidíase/tratamento farmacológico , Complicações do Diabetes/complicações , Fluconazol/administração & dosagem , Nefropatias/tratamento farmacológico , Nefrostomia Percutânea , Administração Tópica , Candida albicans/isolamento & purificação , Candidíase/complicações , Complicações do Diabetes/imunologia , Humanos , Hospedeiro Imunocomprometido , Infusões Intravenosas , Nefropatias/complicações , Masculino , Pessoa de Meia-Idade , Doenças Prostáticas/complicações , Doenças Prostáticas/cirurgia , Sepse/complicações , Ressecção Transuretral da Próstata , Retenção Urinária/etiologia , Retenção Urinária/cirurgia
15.
Urology ; 118: 220-226, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29777788

RESUMO

OBJECTIVE: To review our experience with the modified York Mason (MYM) procedure in the treatment of rectourinary fistulas (RUFs) and to assess fecal continence using patient-reported measures. MATERIALS AND METHODS: A retrospective review was performed of patients who underwent MYM repair of nonradiated RUF with gluteal free fat graft from 2008 to 2016 at a single institution. Success was defined as resolution of the fistula without need for further surgery. The Cleveland Clinic-Florida Wexner Fecal Incontinence Score (CCFFIS) and the Patient Global Impression of Improvement (PGI-I) surveys were administered by phone. RESULTS: Of 17 patients who underwent MYM repair with a mean age of 61.8 years old, the most common fistula etiologies were prostatectomy in 11 patients (65%), cryoablation in 2 patients (12%), and transanal tumor excision (12%). Three patients (18%) failed prior perineal repairs. The mean fistula size was 10.1 mm (range 2-25), the median operative time was 231 minutes (range 151-365), and the median length of stay was 2.0 days (range 1-13). At the median follow-up of 39.4 months, 16 of the 17 patients (94%) had successful primary closures. The condition of the 10 patients who responded to the phone survey was "much better" (median PGI-I score 2), with 89.5% mean improvement. The mean CCFFIS was 1.4 (range 0-5) on a scale of 0 (total continence) to 20 (complete incontinence). Two patients (20%) reported rare (<1 per month) fecal incontinence, and 2/10 (20%) reported frequent flatal incontinence, but none reported significant lifestyle change or sought further treatment for bowel symptoms. CONCLUSION: The MYM technique has a high success rate in the treatment of nonradiated RUF with negligible impact on fecal continence.


Assuntos
Complicações Pós-Operatórias/cirurgia , Doenças Prostáticas/cirurgia , Fístula Retal/cirurgia , Fístula da Bexiga Urinária/cirurgia , Fístula Urinária/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Canal Anal , Defecação , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Estudos Retrospectivos , Procedimentos Cirúrgicos Urológicos/métodos , Adulto Jovem
16.
Hinyokika Kiyo ; 64(2): 71-74, 2018 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-29684953

RESUMO

A 40-year-old man presented to our institution with a few-month history of increased urinary frequency, urgency and voiding difficulty. He had severe lower urinary tract symptoms with an International Prostate Symptom Score of 28 and quality of life score of 6. The mean urinary frequency and voided volume was 20 times per day and 150 ml, respectively. Abdominal ultrasonography and pelvic magnetic resonance imaging revealed the prostate measuring 15 cm3 with a 3 cm midline cyst which compressed the posterior of the bladder wall. A subsequent examination indicated that his lower urinary tract symptoms could be attributed to the cystic mass which mainly affected his storage symptoms. The patient underwent transurethral unroofing of the prostate cyst. Immediately after the surgery, his storage symptoms were improved greatly. The voiding volume was increased to 250 ml, and the frequency of urination was decreased to 8 times. No recurrent symptoms were found for seven months after the surgery.


Assuntos
Cistos/complicações , Doenças Prostáticas/complicações , Bexiga Urinária Hiperativa/etiologia , Adulto , Cistos/diagnóstico por imagem , Cistos/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Doenças Prostáticas/diagnóstico por imagem , Doenças Prostáticas/patologia , Doenças Prostáticas/cirurgia
17.
Int Braz J Urol ; 44(4): 826-830, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29368875

RESUMO

Prostatic utricle cyst is a rare congenital anomaly. Symptomatic cysts require treatment. Surgical excision is the treatment of choice, but is challenging due to close proximity to vas deferens, ejaculatory ducts, bladder, prostate, rectum and pelvic nerves. Complications include rectal injury, ureteral injury, impotence, infertility and faecal incontinence. We here report a rare complication in which bladder was accidentally removed during laparoscopic excision of prostatic utricle cyst. To best of our knowledge such a complication has never been reported previously. We also describe the possible cause of this accident and suggest ways to prevent this disastrous complication.


Assuntos
Cistectomia , Cistos/cirurgia , Complicações Intraoperatórias/etiologia , Laparoscopia/efeitos adversos , Doenças Prostáticas/cirurgia , Bexiga Urinária/cirurgia , Cistos/diagnóstico por imagem , Humanos , Complicações Intraoperatórias/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Doenças Prostáticas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Bexiga Urinária/diagnóstico por imagem
18.
Nihon Hinyokika Gakkai Zasshi ; 109(2): 122-126, 2018.
Artigo em Japonês | MEDLINE | ID: mdl-31006742

RESUMO

We encountered four prostatic abscess patients. Although antimicrobial therapies were ineffective, drainage was effective in all cases. Patient 1 had lung cancer and diabetes mellitus (DM), and patient 2 developed acute prostatitis after transrectal prostatic biopsy. Culture of the urine and blood revealed extended-spectrum beta lactamase (ESBL) -producing Escherichia coli (E.coli). Patient 3 had previously sustained spinal cord injury, and urinated by self-catheterization. Patient 4 had untreated, severe DM. Patient 1, 2 and 3 had been treated by transurethral resection of the prostate (TURP). Patient 2 complained of ejaculatory incompetence after the surgery, and the symptom caused mental distress. Patient 4 was a 43-year-old man who had undergone transperineal needle aspiration under ultrasound guidance to avoid ejaculatory incompetence. The prostatic abscess disappeared in all cases after drainage without recurrence.


Assuntos
Abscesso/cirurgia , Citrobacter koseri , Drenagem/métodos , Infecções por Enterobacteriaceae/cirurgia , Infecções por Escherichia coli/cirurgia , Infecções por Klebsiella/cirurgia , Doenças Prostáticas/cirurgia , Infecções Estafilocócicas/cirurgia , Adulto , Idoso , Antibacterianos/uso terapêutico , Escherichia coli , Humanos , Klebsiella pneumoniae , Masculino , Pessoa de Meia-Idade , Staphylococcus aureus , Falha de Tratamento , Resultado do Tratamento
19.
J Robot Surg ; 12(1): 139-145, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28451939

RESUMO

We present preliminary results of a case series on refractory bladder neck contracture (BNC) treated with robot-assisted laparoscopic Y-V plasty (RAYV). Between 01/2013 and 02/2016, 12 consecutive adult male patients underwent RAYV in our hospital. BNC developed after transurethral procedures (n = 9), simple prostatectomy (n = 2) and HIFU therapy of the prostate (n = 1). Each patient had had multiple unsuccessful previous endoscopic treatments. All RAYV procedures were performed using a transperitoneal six-port approach (four-arm robotic setting). There were no intraoperative or major postoperative complications. During a median follow-up of 23.2 months two cases of refractory BNC were observed. In both cases a postoperative International Prostate Symptom Score (IPSS) of 20 and 25 was reported, respectively. In contrast, amongst the patients without evidence of refractory BNC the median IPSS was 6.5 reflecting an only mildly impaired voiding function in most cases, thus, suggesting a treatment success in 83.3% of patients. To the best of our knowledge, this is the first report on RAYV for refractory BNC. In our series RAYV was feasible in all patients, and only two cases of refractory BNC were reported during a median follow-up of almost 2 years. At the same time, no intraoperative or major postoperative complications were observed. More clinical data with a longer follow-up are needed in this promising field to reveal the actual efficacy and relevance of RAYV.


Assuntos
Contratura/cirurgia , Laparoscopia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Doenças da Bexiga Urinária/cirurgia , Obstrução do Colo da Bexiga Urinária/cirurgia , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Ablação por Ultrassom Focalizado de Alta Intensidade/efeitos adversos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Prostatectomia/efeitos adversos , Doenças Prostáticas/cirurgia , Recidiva , Resultado do Tratamento
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