Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.666
Filtrar
1.
Urology ; 136: 158-161, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31790784

RESUMO

OBJECTIVE: To describe the technique of robotic remnant vaginectomy/excision of urethral diverticulum in transmen and report postoperative outcomes. MATERIALS AND METHODS: Between 2015 and 2018, 4 patients underwent robotic remnant vaginectomy/excision of urethral diverticulum for relief of urinary symptoms. Patients were of mean age 36 ± 10.1 years (range 26-50) at time of vaginal remnant excision, and were 26 ± 9.1 months (range 20-39) post-op following their primary vaginectomy and radial forearm free flap (n = 3) or anterolateral thigh (n = 1) phalloplasty. All had multiple urologic complications after primary phalloplasty, most commonly urinary retention (n = 4), urethral stricture (n = 3), fistula (n = 3), dribbling (n = 2), and obstruction (n = 2). Indication for revision was obstruction and retention (n =3 ) and/or dribbling (n = 2). In each case, the robotic transabdominal dissection freed remnant vaginal tissue from the adjacent bladder and rectum without injury to these structures. Concurrent first- or second-stage urethroplasty was performed in all cases at a more distal portion of the urethra using buccal mucosa, vaginal, or skin grafts. Intraoperative cystoscopy was used in each case to confirm complete resection and closure of the diverticulum. RESULTS: At mean follow-up of 294 ± 125.6 days (range 106-412), no patients had persistence or recurrence of vaginal cavity/urethral diverticulum on cystoscopic follow-up. Of 3 patients who wished to ultimately stand to void, 2 were able to do so at follow-up. CONCLUSION: Robotic transabdominal approach to remnant vaginectomy/excision of urethral diverticulum allows for excision without opening the perineal closure for management of symptomatic remnant/diverticulum in transgender men after vaginectomy.


Assuntos
Divertículo/cirurgia , Pênis/cirurgia , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Robóticos , Cirurgia de Readequação Sexual/métodos , Doenças Uretrais/cirurgia , Transtornos Urinários/cirurgia , Vagina/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
2.
Int Braz J Urol ; 45(6): 1216-1226, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808411

RESUMO

INTRODUCTION AND OBJECTIVE: Several studies have focused on the treatment and recurrence of urethral diverticulum (UD). However, few investigations have addressed sexual function in pati-ents with UD. Therefore, we sought to examine sexual function in women affected by UD. MATERIALS AND METHODS: There were 108 accepted cases involving transvaginal diverticulectomy at our institution. Ultimately, 83 women were included for further analysis, only 61 of these wo-men had sexual partners. We collected data for the Female Sexual Function Index (FSFI) from the female patients and the Male Sexual Health Questionnaire (MSHQ) from their male partners before and after surgery. RESULTS: Preoperatively, the UD size affected the female patient's arousal and lubrication (p=0.04), and the UD location affected their satisfaction. However, no significant between-group differences were found in the total FSFI score. For all women, sexual activity improved after surgery (p=0.0087). In addition to improvements in arousal for women with a large UD, improvements in lubrication were affected by the UD size, number and shape, increases in sa-tisfaction scores were impacted by the UD location and shape, and pain relief was linked to the UD number and shape. Analysis of the MSHQ results revealed no between-group differences among the male partners. CONCLUSION: Only the UD size and location affected sexual function in women with a small UD. Surgery could improve female sexual function but did not affect the sexual function of the patient's partners.


Assuntos
Divertículo/cirurgia , Complicações Pós-Operatórias/etiologia , Disfunções Sexuais Fisiológicas/etiologia , Doenças Uretrais/cirurgia , Adulto , Divertículo/fisiopatologia , Ejaculação/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias/fisiopatologia , Valores de Referência , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Disfunções Sexuais Fisiológicas/fisiopatologia , Parceiros Sexuais , Inquéritos e Questionários , Doenças Uretrais/fisiopatologia
3.
BMJ Case Rep ; 12(7)2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31302623

RESUMO

Female-to-male transsexual patient, 22 years old, with neophallus from radial forearm free flap (phalloplasty in March 2014), history of urethral fistula and urethral stricture 1 year later treated with surgical correction (fistulectomy) and suprapubic urinary diversion. Subsequently, he developed a new urethral stenosis located in the urethral anastomosis. Immediately proximal to the stenosis, there was a urethral dilatation (pseudodiverticulum) with a fibrous septum and several retracted stones. The stones were fragmented, the fibrous septum destroyed and the urethral stricture corrected, all with holmium laser. After 40 months of follow-up the patient shows satisfactory urinary flow with no signs of residual lithiasis or stricture.


Assuntos
Terapia a Laser/instrumentação , Litíase/cirurgia , Doenças Uretrais/cirurgia , Feminino , Hólmio , Humanos , Lasers de Estado Sólido/uso terapêutico , Masculino , Complicações Pós-Operatórias/cirurgia , Cirurgia de Readequação Sexual/efeitos adversos , Adulto Jovem
4.
Ann R Coll Surg Engl ; 101(6): e139-e141, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31155906

RESUMO

Urethral diverticulum is a condition where the urethra or the periurethral glands push into the connective tissue layers that surround it. Patients of urethral diverticulum present with nonspecific symptoms such as incontinence, urinary frequency and urgency, and pain during sexual intercourse and urination. The incidence of this condition is low. We report a case of giant anterior urethra stones combined with a diverticulum with no lower urinary tract symptoms. We believe that this case is extremely rare, and the process of diagnosis and treatment is of great significance in clinical practice.


Assuntos
Divertículo/complicações , Doenças Uretrais/complicações , Cálculos Urinários/complicações , Divertículo/diagnóstico , Divertículo/diagnóstico por imagem , Divertículo/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Uretra/diagnóstico por imagem , Uretra/cirurgia , Doenças Uretrais/diagnóstico , Doenças Uretrais/diagnóstico por imagem , Doenças Uretrais/cirurgia , Cálculos Urinários/diagnóstico , Cálculos Urinários/diagnóstico por imagem , Cálculos Urinários/cirurgia
6.
J Pediatr Surg ; 54(10): 2125-2129, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31079867

RESUMO

BACKGROUND: There are only a few publications in the medical literature reporting on complication rates in proximal hypospadias surgery, particularly with regard to long-term follow-up. METHODS: Over a 17.5-year period, we operated 100 patients with penoscrotal, scrotal and perineal hypospadias. Sixty-four had a single-stage repair, including 15 who received a buccal mucosa inlay "Snodgraft" repair. Thirty-six had a two-stage Bracka repair of which 19 received buccal or lower lip grafts and 17 had preputial grafts. Overall, 34 patients received buccal grafts. The median follow-up was eight years (range 1-16 years). Three patients were operated for residual chordee years later. RESULTS: Urethral fistulae occurred in a total of 26/100 (26.0%) cases, meatal stenosis in 16/100 (16.0%), wound breakdown in six (6.0%) and graft failure in one (1.0%). The fistula rate after the single-stage approach was 15/64 (23.4%), whereas it was 11/36 (30.6%) following two-stage repair (P = 0.4811). CONCLUSIONS: Proximal hypospadias remains a challenging condition to treat. It is possible to perform a single-stage repair in 64.0% of cases. This brings down the median number of operations to only two. Lower lip grafts were used in 34.0% but are now used in redo-surgeries only. Our fistula rate was 26.0% but has decreased significantly in recent years. LEVEL OF EVIDENCE: Level III.


Assuntos
Hipospadia/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Criança , Pré-Escolar , Prepúcio do Pênis/cirurgia , Humanos , Lactente , Masculino , Mucosa Bucal/transplante , Complicações Pós-Operatórias , Estudos Prospectivos , Escroto/cirurgia , Deiscência da Ferida Operatória , Resultado do Tratamento , Uretra/cirurgia , Doenças Uretrais/etiologia , Doenças Uretrais/cirurgia , Estreitamento Uretral/etiologia , Estreitamento Uretral/cirurgia , Fístula Urinária/etiologia , Fístula Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
7.
J Pediatr Surg ; 54(8): 1708-1710, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31076157

RESUMO

Recto-urethral fistulae are the most common finding in males born with an anorectal malformation (ARM). A high pressure distal colostogram is an important tool in visualizing the fistula, although the precise level at which the fistula communicates with the urethra may be difficult to interpret and is not reported in a uniform manner. This anatomy affects the surgical plan; determining the likelihood that the rectum is reachable via a posterior sagittal incision or better approached through the abdomen via laparoscopy or laparotomy helps counsel families and stratifies diagnoses for outcomes work. Herein we present a figure used at our Center to assist with correlating findings on the distal colostogram with the anatomic level of the recto-urethral fistula in males with anorectal malformations.


Assuntos
Fístula Retal/diagnóstico por imagem , Doenças Uretrais/diagnóstico por imagem , Fístula Urinária/diagnóstico por imagem , Malformações Anorretais/complicações , Humanos , Laparoscopia , Masculino , Planejamento de Assistência ao Paciente , Radiografia , Fístula Retal/etiologia , Fístula Retal/cirurgia , Doenças Uretrais/etiologia , Doenças Uretrais/cirurgia , Fístula Urinária/etiologia , Fístula Urinária/cirurgia
8.
Urology ; 131: e7-e8, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31132425

RESUMO

OBJECTIVE: To define clinical features and surgical management of urethro-cavernosal fistulas (UCF). METHODS: A literature search was performed using PubMed to identify publications with the key word urethro-cavernosal fistula. RESULTS: We herein describe surgical techniques and long-term outcomes for UCF repair. CONCLUSION: UCFs is a rare urological condition with only 9 cases reported to date. UCFs can be diagnosed with careful history, physical examination, and retrograde urethrography. Surgical management includes basic tenets of fistula repair, including adequate mobilization, tension-free but watertight approximation, multilayered closure with nonoverlapping suture lines, and maximal bladder drainage.


Assuntos
Fístula/etiologia , Fístula/cirurgia , Doenças do Pênis/etiologia , Doenças do Pênis/cirurgia , Uretra/lesões , Doenças Uretrais/etiologia , Doenças Uretrais/cirurgia , Fístula Urinária/etiologia , Fístula Urinária/cirurgia , Adulto , Humanos , Masculino , Fatores de Tempo , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
10.
Urol Int ; 103(2): 218-222, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30970368

RESUMO

OBJECTIVES: To highlight the transvaginal route as an excellent approach for repair of a simple trigonal, supra-trigonal vesico-vaginal and urethrovaginal fistulae without compromising on the successful patient outcomes. We also determine factors affecting outcomes in such patients. MATERIALS AND METHODS: A retrospective analysis was carried out on 58 patients with simple trigonal, supra trigonal and urethrovaginal fistula who underwent transvaginal repair in the last 10 years. Simple fistulas were defined as fistula less than 3 cm in size or recurrent fistulae less than 1.5-2 cm in size and located either supra-trigonally (above the bar of mercier) or sub-trigonally (below the bar of mercier) as determined by cystoscopy. RESULTS: Obstetric cause, due to obstructed labour, was the most common cause of fistula formation (68.96%), while remaining (29.31%) were attributed to hysterectomy. Primary fistulae were found in 68.9% of patients and recurrent fiistulae in 31.1% patients. The mean age of patients was 33.4 years. Average fistula size was 1.5 cm. The success rate of primary operation was 84.12% (50/58). On using a multivariate regression model, the underlying aetiology (OR 2.2), fistula location (OR 2.5) and history of previous repair (OR 2.4) were found to be significant factors affecting outcome. CONCLUSION: The transvaginal approach is less invasive and achieves comparable success rates as compared to other methods of vesico-vaginal fistula repair. This surgery with Foley catheter has a high success rate with reduced morbidity. We postulate that vaginal approach should be preferred over abdominal approach for repair of all vaginally accessible vesico vaginal fistulae, both of obstetrical and gynaecological origin.


Assuntos
Doenças Uretrais/cirurgia , Fístula Urinária/cirurgia , Fístula Vaginal/cirurgia , Fístula Vesicovaginal/cirurgia , Adulto , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos/métodos , Vagina
11.
Urology ; 128: 42-46, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30844385

RESUMO

OBJECTIVE: To describe the outcomes of a series of women diagnosed with a urethral diverticulum at an urban tertiary care center. METHODS: An Institutional Review Board-approved review of a series of 78 women with a diagnosis of urethral diverticulum from 2009 to 2015 was performed. Clinical, radiographic, and pathologic data was collected by retrospective review of patient medical records. Data regarding treatment selection and postoperative outcomes were collected. A multivariable logistic regression was performed to identify preoperative variables that were associated with undergoing surgical resection. RESULTS: Of the 78 patients reviewed, the median age was 45.5 years (interquartile range (IQR) 36.0-53.8), median body mass index was 30.4 (IQR 24.8-34.4). The most common presenting symptoms included: incontinence (39%), recurrent urinary tract infections (23%), dysuria (18%), discharge (13%), dyspareunia (12%), and hematuria (9%). Additionally, 16 (21%) women were asymptomatic. Of these 78 cases, 40 underwent surgical excision (51%). Of the remaining 38, 13 were symptomatic and lost to follow-up, 23 were managed expectantly, and 2 underwent surgery after the study period. Review of the pathology results revealed that the most common finding was squamous metaplasia (31%). There was 1 adenocarcinoma in the series (2.5%). Of the 40 patients who had surgery, 3 (7.5%) had a diverticular recurrence and 5 (12.5%) developed stress urinary incontinence. The median follow-up was 7.5 months (IQR 1-20.25 months). CONCLUSION: A variety of presenting symptoms existed for women with a urethral diverticulum seeking medical care at an urban medical center. When controlling for age, body mass index, and race, the presence of preoperative symptoms was associated with undergoing surgical resection.


Assuntos
Divertículo/diagnóstico , Imagem por Ressonância Magnética/métodos , Radiografia/métodos , Ultrassonografia/métodos , Doenças Uretrais/diagnóstico , Procedimentos Cirúrgicos Urológicos/métodos , Centros Médicos Acadêmicos , Adulto , Diagnóstico Diferencial , Divertículo/fisiopatologia , Divertículo/cirurgia , Feminino , Seguimentos , Hospitais Urbanos , Humanos , Incidência , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Tempo , Estados Unidos/epidemiologia , Doenças Uretrais/fisiopatologia , Doenças Uretrais/cirurgia , Micção
12.
J Pediatr Surg ; 54(10): 1988-1992, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30879755

RESUMO

PURPOSE: A complication of the surgical management of anorectal malformations (ARMs) is a retained remnant of the original fistula (ROOF) formerly called a posterior urethral diverticulum (PUD). A ROOF may have multiple presentations or may be incidentally discovered during the work-up of ARM after previous surgery. We sought to define the entity and the surgical indications for excision of a ROOF when found. METHODS: We performed a retrospective cohort study of all male patients who presented to our center following previous repair for ARM at another institution, who came for evaluation of problems with urinary and/or fecal continence, from 2014 to 2017. Charts were reviewed for symptoms, original type of malformation, preoperative imaging, treatment, and postoperative follow-up. RESULTS: Of 180 referred male patients, 16 had a ROOF. 14 underwent surgical repair to address this and for other redo indications, and 2 did not require intervention. 13 patients had an additional reason for a redo such as anal mislocation or rectal prolapse. Indications for ROOF excision were urinary symptoms (e.g. UTI, dribbling, passage of mucous via urethra, stone formation), to make a smoother posterior urethra for intermittent catheterization, or for prophylactic reasons. Patients were repaired at an average age of 4.2 years, using a PSARP only approach with excision of the ROOF for all except one patient who needed a laparotomy due to abdominal extension of the ROOF. No patient needed a colostomy. The original ARM repairs of the patients were PSARP (9), laparoscopic assisted (4) and abdominoperineal pullthrough (3). Preoperative evaluation included pelvic MRI, VCUG, and cystoscopy. The ROOF was visualized on 14 of 16 MRIs, 10 of 14 VCUGs, and 14 of 15 cystoscopies. Urinary symptoms associated with a ROOF and ease of catheterization were improved in all repaired cases. CONCLUSION: Patients not doing well from a urinary or bowel standpoint post ARM pull-through need a complete evaluation which should include a check for a ROOF. Both modalities MRI and cystoscopy are needed as a ROOF can be missed on either alone. A VCUG was not reliable in identifying a ROOF. Excision is needed in patients to improve urinary symptoms associated with these lesions and to minimize the small but theoretical oncologic risk present in a ROOF. LEVEL OF EVIDENCE: Level III.


Assuntos
Malformações Anorretais/cirurgia , Divertículo/diagnóstico , Fístula/diagnóstico , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Doenças Uretrais/diagnóstico , Malformações Anorretais/fisiopatologia , Pré-Escolar , Cistoscopia , Divertículo/etiologia , Divertículo/cirurgia , Fístula/etiologia , Fístula/cirurgia , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Reoperação , Estudos Retrospectivos , Doenças Uretrais/etiologia , Doenças Uretrais/cirurgia
13.
J Vet Med Sci ; 81(5): 771-775, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-30918226

RESUMO

This is the first study of using sublingual mucosae to establish a new urination passage in male cats suffering from complications from prior urethrostomy. In total, five domestic male cats afflicted with various complications, such as urethra stricture, scalding dermatitis, and urinary tract infection, after urethrostomy were included in the study. Sublingual mucosa was harvested to graft with abdominal muscles and further made into a tube connecting with the remaining urethra of the bladder at the cranial end and with the prepuce at the caudal end, serving as a new passage for urination. Postoperatively, all cats were alive and well recovered with no complications both in the oral cavity and at the surgical site. Radiography with contrast medium at two weeks and six months after surgery showed no leakage, stricture, or abnormality of the new urination passage. Moreover, all cats were able to urinate from the prepuce without any difficulties or signs of discomfort.


Assuntos
Doenças do Gato/cirurgia , Complicações Pós-Operatórias/veterinária , Transplantes , Procedimentos Cirúrgicos Urológicos/veterinária , Animais , Gatos , Masculino , Mucosa Bucal/cirurgia , Complicações Pós-Operatórias/cirurgia , Resultado do Tratamento , Doenças Uretrais/cirurgia , Doenças Uretrais/veterinária , Procedimentos Cirúrgicos Urológicos/efeitos adversos
14.
Urology ; 128: 96-101, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30890421

RESUMO

OBJECTIVE: To describe our experience with management of lower genitourinary foreign bodies (FBs); to introduce our novel, but simple and minimally-invasive retrieval method compared with standard techniques for anterior urethral FBs; and to propose a derived, practical management algorithm. METHODS: We reviewed all male patients presenting with inserted urethral and/or bladder FBs between January2000 and October 2018. Patient characteristics and number of episodes were identified. Episodes were stratified by FB type, FB location, diagnostic modality, and removal method. We performed a subgroup analysis of anterior urethral FB management techniques comparing retrieval outcomes using our novel Retrieval of Anterior urethral Materials Safely (RAMS) technique which utilizes urethral hydrodistension via retrograde injection of lidocaine jelly to expel FBs vs forceps extraction. Cost analyses were performed, and a management algorithm was then derived. RESULTS: We identified 116 episodes. Eighty-seven of 116 (75%) episodes involved items located within the anterior urethra. A subset of episodes (14/116, 12%) was managed using the RAMS technique. There was no difference in FB extraction success rates between RAMS (13/14, 92.9%) and forceps extraction (37/40, 92.7%), P = 1.00. FBs were successfully removed using RAMS when utilized for nonembedded FBs located entirely within the anterior urethra. Among FBs located within the anterior urethra, the median total hospital cost was nearly 10 times less with utilization of RAMS compared with cystoscopic extraction ($379.09 v s$3,214.21, P <.05). CONCLUSION: Because an overwhelming majority of FBs are located within the anterior urethra, the RAMS technique represents a simple, cost-conscious, and minimally-invasive strategy with low risk and potentially high-yield for initial extraction in the emergency department.


Assuntos
Corpos Estranhos/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Uretra/lesões , Doenças Uretrais/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto , Seguimentos , Corpos Estranhos/diagnóstico , Humanos , Masculino , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Uretra/diagnóstico por imagem , Doenças Uretrais/diagnóstico
15.
BMJ Case Rep ; 12(2)2019 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-30804156

RESUMO

A 69-year-old Japanese woman with a post-hysterectomy status came to our primary care clinic. She presented with vaginal bleeding for the past 3 days which had developed after defecation. There was a palpable mass measuring approximately 2 cm on pelvic exam; however, heavy bleeding prevented in-depth observation. CT and MRI scans revealed that the mass was inside the urethral meatus and not in the vagina. She underwent surgical resection of the urethral tumour, and the pathological report showed no malignancy. A final diagnosis of urethral caruncle was made. Vaginal bleeding is commonly encountered in the primary care practice and is usually attributed to gynaecological diseases. However, patients and physicians may falsely regard urinary or gastrointestinal tract bleeding as one involving the genital tract. We present a case wherein vaginal bleeding was initially considered but was later identified to be due to a urethral caruncle.


Assuntos
Uretra/diagnóstico por imagem , Doenças Uretrais/cirurgia , Hemorragia Uterina/etiologia , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Uretra/cirurgia , Doenças Uretrais/diagnóstico por imagem
18.
Pediatr Radiol ; 49(5): 609-616, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30666353

RESUMO

BACKGROUND: Recently, it has been reported that anorectal malformation with rectourethral fistula in male neonates can be managed by primary neonatal reconstruction without colostomy. To prevent urethral injury during anorectoplasty, the fistula's location is important. To date, the use of voiding cystourethrograms to determine the presence and location of fistulas in neonates with anorectal malformations has not been studied. OBJECTIVE: To compare the accuracy of ultrasound (US) and voiding cystourethrogram for determining the presence and location of fistulas in neonates with anorectal malformation. MATERIALS AND METHODS: We included 21 male neonates with anorectal malformation with rectourethral fistula (n=16), rectovesical fistula (n=1) or no fistula (n=4) who underwent US and voiding cystourethrogram preoperatively on the day of surgery. Fistula imaging was classified into three grades (0-2), and grades 1-2 were considered fistula positive. We compared the imaging-based location of the fistula with surgical findings. RESULTS: US performed significantly better than voiding cystourethrogram for determining the presence of fistulas (area under the receiver operating characteristic curve, 0.90 vs. 0.71, respectively; P=0.044) (diagnostic accuracy 85.7%, 95% confidence interval [95% CI] 63.7-97.0% and 52.4%, 95% CI 29.8-74.3%, respectively). In cases with fistulas detected by either modality, the accuracy of locating the fistula by US was 50.0% (95% CI 24.7-75.3%) and by voiding cystourethrogram was 100% (95% CI: 59.0-100%). CONCLUSION: US accurately detected, but did not accurately locate, fistulas in neonates with anorectal malformation. When planning primary neonatal reconstruction of anorectal malformation without colostomy, voiding cystourethrogram could provide additional information about fistula location.


Assuntos
Malformações Anorretais/diagnóstico por imagem , Cistografia/métodos , Fístula Retal/diagnóstico por imagem , Ultrassonografia/métodos , Doenças Uretrais/diagnóstico por imagem , Fístula Urinária/diagnóstico por imagem , Malformações Anorretais/cirurgia , Humanos , Recém-Nascido , Masculino , Fístula Retal/cirurgia , Estudos Retrospectivos , Doenças Uretrais/cirurgia , Fístula Urinária/cirurgia
19.
Eur J Radiol ; 110: 142-147, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30599852

RESUMO

INTRODUCTION & OBJECTIVES: Percutaneous nephrostomy [1] has emerged as a pivotal approach in the therapeutic management of the obstructed urinary tract. A consecutive incorporation of ultrasonic and radiographic guidance, the approach experienced an almost ubiquitious distribution while most centers currently applying either one or both of these tools jointly. However, success of ultrasound-guidance is limited in obese patients and non-dilated uropathy. In turn, fluoroscopy usually requires an opacification of the urinary collecting system by intravenous or antegrade contrast media injection, which might be harmful for already impaired renal function, raise intrapelvic pressure and augment the risk of sepsis and hemorrhage. CT-guided PCN aids in overcoming these limitations. In the current study, we present the experience of a tertiary referral center with this technique. MATERIALS & METHODS: Epidemiological and clinical data of all patients treated with a CT-guided PCN of native kidneys at the University Hospital Frankfurt between October 2003 and October 2013 were retrospectively collected from the patient charts. Procedural parameters including radiological aspects, technical and therapeutic success, complication and mortality rate have been analyzed statistically. RESULTS: In total, 140 PCN procedures have been performed in 77 patients with a median age of 69 (± 13). The median body mass index was 27 with 66.6% of patients being overweight or obese. Charlson comorbidity index was 7 ranging 0-16. Indications for PCNs were obstructive uropathy (62.9), urine extravasation (22.9%), urinary tract fistulas (11.4%) and technical reasons (2.8%). In 68.8% of patients, initial diagnosis was malignancy. 56.4% of kidneys were non-dilated before puncture. In 78.4% prone position, otherwise supine oblique position (17.3%) or supine position (4.3%) was used. 71.4% of PCNs were carried out solely under local anesthesia. Technical success has been achieved in 90% with a complication rate of 3.6% (all grade minor B) and was not significantly different between dilated and non-dilated kidneys. 42.9% of fistulas and 64.3% of urinary tract leakages, healed after PCN placement. 30 days mortality rate was 5.2% without being directly associated with the PCN procedure itself. CONCLUSION: CT-guided PCN is a feasible approach associated with low morbidity. It is particularly useful in complex clinical scenarios e.g. critically ill, newly operated or obese patients as well as non-dilated kidneys. Moreover, it represents a minimally-invasive option for treating leakages and fistulas of the urinary tract.


Assuntos
Nefrostomia Percutânea/métodos , Doenças Urológicas/cirurgia , Idoso , Anestesia Local , Dilatação Patológica/cirurgia , Estudos de Viabilidade , Feminino , Fluoroscopia/métodos , Humanos , Rim/diagnóstico por imagem , Masculino , Obesidade/complicações , Sobrepeso/complicações , Radiografia Intervencionista , Insuficiência Renal/cirurgia , Estudos Retrospectivos , Cirurgia Assistida por Computador , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia de Intervenção , Doenças Uretrais/cirurgia
20.
Tech Coloproctol ; 23(1): 43-52, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30604248

RESUMO

BACKGROUND: The aim of this study was to evaluate the effectiveness of gracilis muscle transposition (GMT) to treat recurrent anovaginal, rectovaginal, rectourethral, and pouch-vaginal fistulas in patients with inflammatory bowel disease (IBD). METHODS: A retrospective study was conducted in patients with IBD who had GMT performed by a single surgeon between 2000 and 2018. Follow-up data regarding healing rate, complications, additional procedures, and stoma closure rate was collected. RESULTS: A total of 30 women and 2 men had GMT. In all patients fistula was associated with Crohn's disease. In 1 female patient, contralateral gracilis transposition was required after a failed attempt at repair. The primary healing rate was 47% (15/32) and the definitive healing rate (healed by the time of data collection and after secondary procedures) was 71% (23/32). Additional surgical procedures due to fistula persistence or recurrence were performed on 17 patients (53%).At least 7 patients (21%) suffered complications including one wound infection with ischemia of the gracilis muscle. Stoma closure was successful in 18 of 31 cases of patients with stoma (58% of the patients). CONCLUSIONS: GMT for the treatment of recurrent and complex anorectal fistulas in patients with IBD patient is eventually successful in almost 2/3 of patients.


Assuntos
Doença de Crohn/complicações , Fístula/cirurgia , Músculo Grácil/transplante , Fístula Urinária/cirurgia , Fístula Vaginal/cirurgia , Adulto , Feminino , Fístula/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fístula Retal/etiologia , Fístula Retal/cirurgia , Fístula Retovaginal/etiologia , Fístula Retovaginal/cirurgia , Recidiva , Estudos Retrospectivos , Retalhos Cirúrgicos , Resultado do Tratamento , Doenças Uretrais/etiologia , Doenças Uretrais/cirurgia , Fístula Urinária/etiologia , Fístula Vaginal/etiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA