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1.
Curr Urol Rep ; 22(3): 15, 2021 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-33534013

RESUMO

PURPOSE OF REVIEW: Patients with congenital urologic conditions present unique challenges as adults. Herein, we review the literature relevant to the adult reconstructive urologist confronted with complex surgical concerns affecting their patients with a history of hypospadias, spina bifida, and other syndromes affecting the genitourinary tract. RECENT FINDINGS: Urethral stricture disease related to hypospadias is complex, but successful urethroplasty and penile curvature correction can be achieved with an anatomically minded approach. Multiple urinary diversion techniques can be considered in a patient-centered approach to bladder management in the adult spina bifida patient, but complications are common and revision surgeries are frequently required. Strong evidence is lacking for most surgical techniques in this population, but experiences reported by pediatric and adult urologists with genitourinary reconstruction training can help foster consensus in decision-making. Urologists trained in genitourinary reconstruction may be uniquely positioned to care for the transitional urology patient as they enter adolescence and adulthood.


Assuntos
Papel do Médico , Procedimentos Cirúrgicos Reconstrutivos , Disrafismo Espinal/complicações , Transição para Assistência do Adulto , Anormalidades Urogenitais/cirurgia , Procedimentos Cirúrgicos Urológicos , Adolescente , Adulto , Criança , Feminino , Humanos , Hipospadia/cirurgia , Masculino , Reoperação , Estreitamento Uretral/etiologia , Estreitamento Uretral/cirurgia , Sistema Urinário/cirurgia , Anormalidades Urogenitais/terapia , Doenças Urológicas/etiologia , Doenças Urológicas/cirurgia , Urologistas
2.
Urologiia ; (5): 73-77, 2020 Nov.
Artigo em Russo | MEDLINE | ID: mdl-33185351

RESUMO

AIM: Urethral stenosis is one of the serious complications after proximal hypospadias repair. A variety of techniques has been suggested for its correction, such as urethral dilation using bougies, endoscopic incisions and one- or two-staged urethroplasty with buccal mucosa. The aim of our study was to improve results of urethral stenosis correction in children after multiple proximal hypospadias repairs. MATERIALS AND METHODS: A total of 24 patients with urethral stenosis after proximal hypospadias repairs underwent treatment in the Department of Uroandrology of the Russian Childrens Clinical Hospital from 2015 to 2019. The age of the patients was from 3-17 years (average - 4.2) with penoscrotal form of hypospadias in 12, scrotal in 8, and perineal in 4 patients. All children previously underwent 2-8 hypospadias repairs. Patients were divided into 2 groups. In group I, 16 patients had urethral stenosis from the glans of the penis to the penoscrotal area, urethral diameter of 3-4 Ch and ventral penile curvature of 45-60o. These patients were treated with a two-staged urethroplasty, similar to Brackas technique. In group II, 8 patients with urethral stenosis in the penile shaft area, urethral diameter of 6 Ch, without penile curvature were included. They underwent to a one-stage urethroplasty with buccal mucosa graft, which was sutured on the dorsolateral aspect of the urethra, with a formation of the age-appropriate urethra (Dorsolateral Inlay). RESULTS: All patients in both groups had successful results with flow rate of 8-12 ml/sec. CONCLUSIONS: The correction of urethral stenosis in children after proximal hypospadias repairs can be performed using buccal mucosa. In cases of long urethral stenosis, urethral diameter of 3-4 Ch, penile curvature, and scarring of the penile skin, a two-staged urethroplasty is recommended. In patients with stenosis of the penile shaft, urethral diameter of 6 Ch and lack of penile curvature, a one-stage urethroplasty with buccal mucosa fixation on the dorsolateral aspect of the urethra (Dorsolateral Inlay) allows to achieve successful results.


Assuntos
Hipospadia , Procedimentos Cirúrgicos Reconstrutivos , Estreitamento Uretral , Criança , Humanos , Hipospadia/cirurgia , Lactente , Masculino , Pênis/cirurgia , Federação Russa , Resultado do Tratamento , Uretra/cirurgia , Estreitamento Uretral/etiologia , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
3.
J Urol ; 204(6): 1326-1332, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32614254

RESUMO

PURPOSE: We sought to determine the number of cases to achieve competency and proficiency in tubularized incised plate technique for distal hypospadias repair using cumulative sum analysis. MATERIALS AND METHODS: From 2001 to 2015 we reviewed all distal tubularized incised plate repairs performed by a single surgeon since independent practice. Data for 450 consecutive cases included age, meatal location, presence of curvature, operative time, occurrence of complications and followup duration. A cumulative sum analysis cohort chart was used to determine trends in complication rate and operative time during the evaluation period. In order to account for surgical experience with time, the highest peak, plateau, and down trends in operative time and complication rate were identified on the plot and set as the transition points between learning (phase 1), competence (phase 2) and proficiency (phase 3). RESULTS: Based on the cumulative sum analysis learning curve, the competence phase with plateau of operative time and complication rate commences beyond the 127th case, and the proficiency phase with notable decline in operative time and complication rate was noted beyond the 234th case. When comparing case characteristics and surgical outcomes between phases and learning curve, the proficiency phase involved younger patients and more severe degree of distal hypospadias being repaired using the tubularized incised plate approach with fewer complications related to meatal stenosis and fewer cosmetic complications. CONCLUSIONS: In our study competency in distal hypospadias tubularized incised plate repair was reached beyond the 127th case, while proficiency was attained beyond the 234th case.


Assuntos
Hipospadia/cirurgia , Curva de Aprendizado , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Procedimentos Cirúrgicos Urológicos Masculinos/estatística & dados numéricos , Competência Clínica , Seguimentos , Humanos , Lactente , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/educação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Cirurgiões/educação , Resultado do Tratamento , Uretra/anormalidades , Uretra/cirurgia , Estreitamento Uretral/epidemiologia , Estreitamento Uretral/etiologia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/educação , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
4.
J Urol ; 204(6): 1290-1295, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32717158

RESUMO

PURPOSE: We evaluated the success of minimally invasive management of lichen sclerosus with topical and intraurethral clobetasol, as defined by improvement in patient reported outcome measures and nonprogression to surgery. MATERIALS AND METHODS: We conducted a review of our prospective ongoing quality improvement study to determine outcomes of our current standard practice for males with penile and urethral biopsy proven lichen sclerosus. Data were collected between 2011 and 2019, and included patient demographic information, medical and surgical histories, and location and extent of lichen sclerosus related pathology. The primary outcomes for this study were voiding function and voiding related quality of life, and were assessed using the AUASS (American Urological Association Symptom Score) and quality of life bother index, respectively. RESULTS: We identified 42 patients with biopsy proven lichen sclerosus related urethral stricture disease. Of these patients 85.7% were treated with intraurethral steroids alone and did not require surgical intervention. Median AUASS significantly improved from 12 to 8, and median quality of life bother index improved from 4 ("mostly dissatisfied") to 2 ("mostly satisfied"). Average stricture length of those with penile urethral disease and bulbar urethral disease was 4.8 cm (SD 3.0) and 16.2 cm (SD 6.5), respectively. Median followup was 8.4 months (IQR 2.6-26.4). CONCLUSIONS: Lichen sclerosus related urethral stricture disease can be effectively managed with intraurethral steroids. This minimally invasive management strategy improves patient reported voiding symptoms and voiding quality of life.


Assuntos
Clobetasol/administração & dosagem , Líquen Escleroso e Atrófico/tratamento farmacológico , Qualidade de Vida , Estreitamento Uretral/tratamento farmacológico , Micção/fisiologia , Administração Tópica , Adulto , Biópsia , Seguimentos , Humanos , Líquen Escleroso e Atrófico/complicações , Líquen Escleroso e Atrófico/patologia , Líquen Escleroso e Atrófico/fisiopatologia , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Pênis/efeitos dos fármacos , Pênis/patologia , Estudos Prospectivos , Estudos Retrospectivos , Creme para a Pele/administração & dosagem , Resultado do Tratamento , Uretra/efeitos dos fármacos , Uretra/patologia , Estreitamento Uretral/etiologia , Estreitamento Uretral/patologia , Estreitamento Uretral/fisiopatologia
5.
Isr Med Assoc J ; 22(4): 241-243, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32286028

RESUMO

BACKGROUND: Transurethral prostatectomy is the gold standard surgical treatment of bladder outlet obstruction due to benign enlargement of the prostate, with more than 30,000 procedures performed annually in the United States alone. The success rate of this minimally invasive procedure is high and the results are durable. The development of urethral stricture is a long-term complication of the procedure and is noted in about 2% of patients. The stricture narrows the urethral lumen, leading to re-appearance of obstructive urinary symptoms. Traditionally, the evaluation of the stricture was performed by retrograde urethrography. Advancements in the fields of flexible endoscopy allowed rapid inspection of the urethra and immediate dilatation of the stricture in selected cases. OBJECTIVES: To compare the efficacy of urethrography versus cystoscopy in the evaluation of urethral strictures following transurethral prostatectomy. METHODS: A retrospective review was conducted of a series of 32 consecutive patients treated due to post-transurethral resection of prostate (TURP) urethral stricture. RESULTS: Twenty patients underwent both tests. In 16 there was concordance between the two tests. Four patients had no pathological findings in urethrography but had strictures in cystoscopy. All strictures were short (up to 10 mm) and were easily treated during cystoscopy, with no complaints or re-surgery needed in 24 months follow-up. CONCLUSIONS: Cystoscopy was superior to urethrography in the evaluation of post-TURP strictures. Strictures where often short and treated during the same procedure. We recommend that cystoscopy be the procedure of choice in evaluating obstructive urinary symptoms after TURP, and retrograde urethrography be preserved for selected cases.


Assuntos
Cistoscopia/métodos , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Uretra/diagnóstico por imagem , Estreitamento Uretral/diagnóstico , Urografia/métodos , Idoso , Estudos de Coortes , Cistografia/métodos , Seguimentos , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Ressecção Transuretral da Próstata/efeitos adversos , Resultado do Tratamento , Estreitamento Uretral/etiologia , Estreitamento Uretral/cirurgia , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/cirurgia
6.
J Urol ; 204(1): 104-109, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32073943

RESUMO

PURPOSE: We determined the urological complications and lower urinary tract function after genital gender affirming surgery with urethral lengthening in transgender men. MATERIALS AND METHODS: A single center, retrospective cohort study was performed from January 2013 to January 2018. Patient demographics, medical history, perioperative data, surgical and urological complications, and preoperative and postoperative urological outcomes were obtained. RESULTS: Of the 63 patients included in the study 8 (13%) underwent metoidioplasty and 55 (87%) phalloplasty, comprised of 27 (43%) free radial forearm flap, 19 (30%) anterolateral thigh flap and 9 (14%) superficial circumflex iliac artery perforator flap surgeries. In phalloplasty the types of urethral lengthening were tube-in-tube free radial forearm flap in 27 (49%), free radial forearm flap (second fasciocutaneous flap) in 18 (33%), superficial circumflex iliac artery perforator flap in 5 (9%) or labial in 5 (9%). Mean followup was 23 months (range 12 to 71). Stricture formation occurred in 35 (63%) phalloplasty and 5 (63%) metoidioplasty cases. Urethral fistula formation occurred in 15 (27%) phalloplasty and 4 (50%) metoidioplasty cases. Mean time to strictures and fistulas was approximately 3 months. Overall 46 (73%) patients needed revision surgery because of fistulas/strictures. After treatment 44 (70%) patients were able to void from the tip of the phallus. No clinically relevant differences in International Prostate Symptom Scores, frequency volume charts and uroflowmetry were found preoperatively vs postoperatively. CONCLUSIONS: Genital gender affirming surgery with urethral lengthening is a complex procedure with a high complication rate. After treating complications no clinically relevant differences in urological functioning were recorded. The majority of transgender men could void from the tip of the penis and showed favorable urological outcomes.


Assuntos
Cirurgia de Readequação Sexual , Transexualidade/cirurgia , Uretra/cirurgia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Complicações Pós-Operatórias , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Cirurgia de Readequação Sexual/efeitos adversos , Retalhos Cirúrgicos , Pessoas Transgênero , Estreitamento Uretral/etiologia , Fístula Urinária/etiologia , Micção
7.
Int Braz J Urol ; 46(4): 511-518, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31961622

RESUMO

The surgical treatment of bulbar urethral strictures is still one of the most challenging reconstructive surgery problems. Bulbar urethral strictures are usually categorized as traumatic and non-traumatic strictures depending on the aetiology. The traumatic strictures are caused by trauma and they determine disruption of the urethra with obliteration of the urethral lumen, ending with fibrotic gaps between the urethral ends. Differently, the non-traumatic urethral strictures are mainly caused by catheterization, instrumentation, and infection, or they can also be idiopathic. They are usually asso-ciated with spongiofibrosis of the segment of the urethra that has been involved. Worldwide, two different surgical approaches are currently adopted for bulbar urethral repair: transecting techniques with end-to-end anastomosis and non-transecting techniques followed by grafting. Traumatic obliterated strictures require transection of the urethra allowing complete removal of the fibrotic tissue that involves the urethral ends. Conversely, non-traumatic, non-obliterated urethral strictures require augmentation of the urethral plate using oral mucosa grafts. Nowadays, it is still difficult to choose the correct surgical management for non-obliterated bulbar stricture repair. Indeed, different surgical techniques have been proposed (pedicled flap vs free graft, dorsal vs ventral placement of the graft, non-transecting technique using or non-using free graft, etc.) but none emerged as the best solution since all techniques have showed similar success and complication rates. Consequently, the final choice is still based on surgeon's preferences and patient's characteristics. Within the current manuscript, we like to present some of our tips and tricks that we developed along our prolonged surgical experience on the treatment of bulbar urethral strictures. These might be of interest for surgeons that approach this complex surgery. Moreover, our suggestions want to be useful regardless the type of chosen technique being adaptable for different scenario.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Estreitamento Uretral , Humanos , Masculino , Mucosa Bucal , Resultado do Tratamento , Uretra/cirurgia , Estreitamento Uretral/etiologia , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos
8.
Urology ; 137: 183-189, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31926195

RESUMO

OBJECTIVE: To characterize the bulbospongiosus muscle (BSM) in patients with bulbar urethral strictures. MATERIALS AND METHODS: We studied 21 patients divided into 2 groups: Stricture Group (n = 14; mean age = 62.00 years) with bulbar stricture submitted to open urethroplasty; and Control Group (n = 7; mean age = 60.14 years) with penile strictures (hypospadias cripples, penile cancer and/or penile infection) who were submitted to perineal urethrostomy. Samples of the BSM were dissected and histologic sections were stained by histochemical and immunohistochemical techniques. Histomorphometric analyzes were performed on photomicrographs. Means were statistically compared using the unpaired Student t test and the Mann-Whitney test (P <.05). RESULTS: The etiology of bulbar urethral stricture was idiopathic in 2 cases (14.29%), post-TURP in 6 (42.86%), post open radical prostatectomy in 5 (35.71%) and post open prostatectomy in 1 case (7.14%). The average length of the stricture was 2.08 cm. The only parameter analyzed with significant difference between the groups was the vessels (significant difference between the control group: 5.11 ± 1.98% and stricture group: 3.57 ± 1.32%, P = .0460). The quantitative analysis of collagen (Control Group: 10.63 ± 5.37% and Stricture Group: 10.83 ± 4.55%, P = .9296); diameter of BSM muscle fibers (Control Group: 41.71 ± 14.63 µm and Stricture Group: 40.11 ± 8.59 µm, P = .76 and elastic system fibers (Control Group; 3.83 ± 1.54% and Stricture Group: 5.43 ± 2.90%, P = .2601) showed no significant difference. CONCLUSIONS: Histologic analysis showed a significant decrease of the BSM vessels in urethral stricture, without changes in elastic fibers, collagen, nerves, and muscle fiber diameter. These findings show that the bulbar urethral stricture causes minimal alterations in the structure of the BSM.


Assuntos
Doenças do Pênis , Pênis , Complicações Pós-Operatórias , Uretra , Estreitamento Uretral , Procedimentos Cirúrgicos Urológicos , Pesos e Medidas Corporais/métodos , Brasil , Constrição Patológica , Correlação de Dados , Técnicas de Imagem por Elasticidade/métodos , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Doenças do Pênis/diagnóstico , Doenças do Pênis/etiologia , Pênis/patologia , Pênis/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/patologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Uretra/irrigação sanguínea , Uretra/inervação , Uretra/patologia , Uretra/cirurgia , Estreitamento Uretral/diagnóstico , Estreitamento Uretral/epidemiologia , Estreitamento Uretral/etiologia , Estreitamento Uretral/patologia , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Procedimentos Cirúrgicos Urológicos/métodos
9.
J Urol ; 203(4): 773-778, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31621469

RESUMO

PURPOSE: Urethroplasty of lichen sclerosus strictures has a significantly higher failure rate than strictures due to other causes. We sought to determine predictors of urethroplasty failure in men with lichen sclerosus urethral stricture disease by evaluating protein expression profiles. MATERIALS AND METHODS: Urethral tissue was excised from patients with lichen sclerosus who were undergoing urethroplasty of urethral stricture disease at a single institution. A tissue microarray was created with cores from each sample. Immunohistochemistry was performed to compare protein expression related to inflammation, cell cycle disruption, oxidative stress, hormone receptor status and infection. Stricture recurrence was defined by the need for a subsequent unanticipated procedure for urethral stricture disease. RESULTS: We evaluated 50 men with lichen sclerosus urethral stricture disease, including 31 with successful reconstruction and 19 with recurrent stricture. Recurrent strictures expressed lower levels of several inflammatory markers and had a lower Ki-67 mitotic index and significantly higher vascular endothelial growth factor levels than nonrecurrent strictures. CONCLUSIONS: To our knowledge this is the first study to use tissue protein expression to identify risk factors for urethroplasty failure among men with lichen sclerosus urethral stricture disease. Our findings suggest that recurrent lichen sclerosus strictures demonstrate a suppressed inflammatory response, a decreased cell turnover rate, and poor oxygenation and nutrient delivery. Prospective studies are needed to clarify the role of these pathways in the pathophysiology of lichen sclerosus urethral stricture disease, determine whether preoperative biopsy can predict urethroplasty success, help counsel patients and develop future treatments.


Assuntos
Líquen Escleroso e Atrófico/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Uretra/patologia , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Biomarcadores/análise , Biomarcadores/metabolismo , Biópsia , Feminino , Seguimentos , Perfilação da Expressão Gênica , Humanos , Imuno-Histoquímica , Líquen Escleroso e Atrófico/complicações , Líquen Escleroso e Atrófico/patologia , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Prognóstico , Estudos Prospectivos , Recidiva , Reoperação/estatística & dados numéricos , Análise Serial de Tecidos , Resultado do Tratamento , Uretra/cirurgia , Estreitamento Uretral/etiologia , Estreitamento Uretral/patologia
10.
Urology ; 135: 146-153, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31626854

RESUMO

OBJECTIVE: To evaluate the magnetic resonance imaging (MRI) findings of traumatic bulbar stricture and to evaluate their ability to estimate repair complexity. METHODS: Eighty-nine men with traumatic bulbar stricture who underwent urethrography and MRI at least 3 months postinjury and subsequent excision and primary anastomosis were retrospectively analyzed. The associations of MRI findings, including continuity of the tunica albuginea of the corpus spongiosum, periurethral fistula, spongiofibrosis length (SFL), and distal and proximal bulbar urethral length from the stricture, with urethrography and operative parameters were evaluated. RESULTS: Mean SFL was significantly longer than mean stricture length on urethrography (14.9 vs 7.9 mm, P <.0001). Periurethral fistula was found in 18 (20.2%) patients on MRI but not in 10 (55.6%) of them on urethrography. The corpus spongiosum was disrupted in 40 patients (55.1%) on MRI. On multivariate linear regression, SFL (standard coefficient, 0.25; t value, 2.31; P = .02) predicted operation time, while SFL (standard coefficient, 0.22; t value, 2.04; P = .04) and proximal bulbar urethral length (standard coefficient, -0.25; t value, -2.11; P = .04) independently predicted blood loss. Corporal splitting to reduce anastomotic tension and/or increase visualization during repair was needed in 33 patients (37.1%). Stricture length on urethrography (odds ratio [OR], 1.22; 95% confidence interval, 1.04-1.42; P = .006) and corpus spongiosum disruption (odds ratio, 5.51; 95% confidence interval, 1.57-19.34, P = .005) were independent predictors for the need of corporal splitting. CONCLUSION: In contrast to urethrography findings, MRI findings help predict traumatic bulbar stricture repair complexity.


Assuntos
Planejamento de Assistência ao Paciente , Doenças do Pênis/complicações , Pênis/lesões , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto , Estudos de Viabilidade , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças do Pênis/cirurgia , Pênis/diagnóstico por imagem , Período Pré-Operatório , Estudos Retrospectivos , Resultado do Tratamento , Uretra/diagnóstico por imagem , Estreitamento Uretral/diagnóstico por imagem , Estreitamento Uretral/etiologia
11.
Int J Dermatol ; 59(2): 191-196, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31173347

RESUMO

BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare conditions characterized by epidermal necrosis, mostly caused by drugs. Despite the rarity of these conditions, morbidity and mortality are high (even in previously healthy patients), and they may be associated with permanent sequelae. METHODS: A retrospective study conducted at a quaternary hospital in Brazil in a period of 10 years. RESULTS: The sample was composed by 41 patients with SJS, SJS/TEN, and TEN confirmed by skin biopsy. Antibiotics and anticonvulsants were the most frequently implied drug classes, and phenytoin was the most important individual culprit drug. In this study, 12.2% of the patients had sequelae, being ophthalmological lesions the most common and one case of a newly described hearing loss. The mortality rate was 16.7% in patients with TEN. CONCLUSIONS: This study describes the largest Latin American case series of SJS and TEN with the diagnosis proven by skin biopsy and adds important data regarding the profile of the disease in Brazil. It also describes a novel sequelae of hearing loss.


Assuntos
Antibacterianos/efeitos adversos , Anticonvulsivantes/efeitos adversos , Síndrome de Stevens-Johnson/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Feminino , Perda Auditiva/etiologia , Hospitais , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Síndrome de Stevens-Johnson/complicações , Síndrome de Stevens-Johnson/mortalidade , Síndrome de Stevens-Johnson/terapia , Triquíase/etiologia , Estreitamento Uretral/etiologia , Adulto Jovem
12.
Br J Radiol ; 93(1106): 20190760, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31778319

RESUMO

OBJECTIVE: A cohort of high dose-rate (HDR) monotherapy patients was analyzed to (i) establish the frequency of non-malignant urethral stricture; (ii) explore the relation between stricture formation with the dose distribution along the length of the urethra, and MRI radiomics features of the prostate gland. METHODS: A retrospective review of treatment records of patients who received 19 Gy single fraction of HDR brachytherapy (BT) was carried out. A matched pair analysis used one control for each stricture case matched with pre-treatment International Prostate Symptom Score (IPSS) score, number of needles used and clinical target volume volume for each stricture case identified.For all data sets, pre-treatment T2 weighted MRI images were used to define regions of interests along the urethra and within the whole prostate gland. MRI textural radiomics features-energy, contrast and homogeneity were selected. Wilcoxon signed-rank test was performed to investigate significant differences in dosimetric parameters and MRI radiomics feature values between cases and controls. RESULTS: From Nov 2010 to July 2017, there were 178 patients treated with HDR BT delivering 19 Gy in a single dose. With a median follow-up of 28.2 months, a total of 5/178 (3%) strictures were identified.10 patients were included in the matched pair analysis. The urethral dosimetric parameters investigated were not statistically different between cases and controls (p > 0.05). With regards to MRI radiomics feature analysis, significant differences were found in contrast and homogeneity between cases and controls (p < 0.05). However, this did not apply to the energy feature (p = 0.28). CONCLUSION: In this matched pair analysis, no association between post-treatment stricture and urethral dosimetry was identified. Our study generated a preliminary clinical hypothesis suggesting that the MRI radiomics features of homogeneity and contrast of the prostate gland can potentially identify patients who develop strictures after HDR BT. Although the sample size is small, this warrants further validation in a larger patient cohort. ADVANCES IN KNOWLEDGE: Urethral stricture has been reported as a specific late effect with prostate HDR brachytherapy. Our study reported a relatively low stricture rate of 3% and no association between post-treatment stricture and urethral dosimetry was identified. MRI radiomics features can potentially identify patients who are more prone to develop strictures.


Assuntos
Braquiterapia/métodos , Neoplasias da Próstata/radioterapia , Estreitamento Uretral/etiologia , Idoso , Braquiterapia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Dosagem Radioterapêutica , Estudos Retrospectivos , Uretra/efeitos da radiação
13.
Urology ; 136: 251-256, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31733272

RESUMO

OBJECTIVE: To compare the clinical courses of patients with straddle injuries to the bulbar urethra based on the initial management strategy for urinary drainage, mainly suprapubic tube placement (SPT) and primary realignment (PR), and to examine whether PR has a beneficial effect on subsequent urethroplasty with regards to surgical and patient-reported outcomes. METHODS: We reviewed the clinical courses of 126 patients with bulbar urethral stricture following straddle injuries who underwent delayed urethroplasty between August 2010 and April 2019. Patients were categorized as being initially treated with SPT (82 patients) or PR (44 patients). Stricture was considered complicated if preoperative urethrography or cystoscopy revealed iatrogenic scarring or a stricture away from the injury site. RESULTS: The percentage of patients who experienced delayed transurethral treatment at least once before referral was significantly higher in patients treated with PR than in those treated with SPT (25/44, 56.8% vs 16/82, 19.8%, P < .0001). Although there was no difference in stricture length in both cohorts, the fraction of patients with complicated stricture was significantly higher in patients treated with PR than in those treated with SPT (15/44, 34.1% vs 14/82, 17.1%, P = .003). There was no significant difference in the selected type of urethroplasty, operative time, blood loss, success rate, postoperative maximum urinary flow rate, voiding symptoms, or erectile function between the 2 groups. CONCLUSION: PR does not facilitate delayed urethroplasty and had no beneficial effect on urethroplasty outcome. PR might lead to delayed transurethral procedures, resulting in increased risk of complicated strictures.


Assuntos
Uretra/lesões , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Estreitamento Uretral/etiologia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Procedimentos Cirúrgicos Urológicos Masculinos/normas
14.
Curr Urol Rep ; 20(11): 74, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31705324

RESUMO

PURPOSE OF REVIEW: In this review, we describe the incidence, diagnosis, and management of urethral strictures in women. RECENT FINDINGS: Definitive repair of urethral strictures in women traditionally utilizes vaginal and labial flaps. Oral mucosal buccal graft urethroplasty also has high success rates, with larger series demonstrating feasibility and durability. Urethral strictures in women are very rare. When they do occur, they are often difficult to diagnose, requiring a high index of suspicion. Women with urethral strictures often present with symptoms of obstructed urinary flow, such as incomplete emptying, straining, and elevated postvoid residual. First line, minimally invasive treatment consists of urethral dilation and urethrotomy, though urethrotomy is rarely performed. Repeat urethral dilation has low success rates compared with urethroplasty, which is a more definitive treatment.


Assuntos
Mucosa Bucal/transplante , Uretra/cirurgia , Estreitamento Uretral/diagnóstico , Estreitamento Uretral/terapia , Dilatação , Feminino , Humanos , Retalhos Cirúrgicos , Estreitamento Uretral/etiologia , Vagina/cirurgia
15.
Med Ultrason ; 21(4): 494-496, 2019 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-31765461

RESUMO

Primary cancer of urethra (PCU) is one of rarest malignancies of the urinary tract. In early stages this type of cancer presents non specific symptoms which can be mistaken with more common urethral strictures. That is why the PCU is frequently recognize in a locally advanced stage. The basic tool used in the diagnosis is MRI, but ultrasonography can be also used at the beginning of diagnosis. We present the case of 66-year old patient with PCU, initially diagnosed due to urethral stricture. We report probably the first case of well documented sonourethrography findings in PCU.


Assuntos
Neoplasias Uretrais/complicações , Estreitamento Uretral/etiologia , Idoso , Humanos , Masculino , Ultrassonografia , Neoplasias Uretrais/diagnóstico por imagem , Estreitamento Uretral/diagnóstico por imagem
16.
Ann Dermatol Venereol ; 146(12): 812-816, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31627929

RESUMO

INTRODUCTION: Malakoplakia is a granulomatosis of infectious origin in reaction to a chronic bacterial infection (most commonly urinary Escherichiacoli) related to an acquired phagocytosis impairment. PATIENTS AND METHODS: We report a case of penile malakoplakia in a 69-year-old man with lichen sclerosis and stenosis of the urinary meatus leading to recurrent urinary tract infections. The clinical aspect was suggestive of squamous cell carcinoma of the glans developing on lichen sclerosus, but histological examination revealed penile malakoplakia. DISCUSSION: Malakoplakia of the genital mucosa is rare, with only one case of involvement of the glans being reported in the literature. The association with lichen sclerosus is probably not fortuitous but could in fact be due to chronic urinary tract infection favored by stenosis of the urethral meatus and possible local immunodepression following prolonged application of clobetasol. CONCLUSION: We report a case of penile malakoplakia associated with chronic E. coli urinary tract infection, due originally to associated genital lichen sclerosus.


Assuntos
Líquen Escleroso e Atrófico/patologia , Malacoplasia/patologia , Doenças do Pênis/patologia , Idoso , Infecções por Escherichia coli/complicações , Humanos , Masculino , Estreitamento Uretral/etiologia , Infecções Urinárias/microbiologia
17.
Clin J Am Soc Nephrol ; 14(11): 1572-1580, 2019 11 07.
Artigo em Inglês | MEDLINE | ID: mdl-31582461

RESUMO

BACKGROUND AND OBJECTIVES: Posterior urethral valve is the most common cause of bladder outlet obstruction in infants. We aimed to describe the rate and timing of kidney-related and survival outcomes for children diagnosed with posterior urethral valves in United States children's hospitals using the Pediatric Health Information System database. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This retrospective cohort study included children hospitalized between January 1, 1992 and December 31, 2006, who were in their first year of life, had a diagnosis of congenital urethral stenosis, and underwent endoscopic valve ablation or urinary drainage intervention, or died. Records were searched up to December 31, 2018 for kidney-related mortality, placement of a dialysis catheter, and kidney transplantation. Cox regression analysis was used to identify risk factors, and Kaplan-Meier survival analysis used to determine time-to-event probability. Subgroup survival analysis was performed with outcomes stratified by the strongest identified risk factor. RESULTS: Included were 685 children hospitalized at a median age of 7 (interquartile range, 1-37) days. Thirty four children (5%) died, over half during their initial hospitalization. Pulmonary hypoplasia was the strongest risk factor for death (hazard ratio, 7.5; 95% confidence interval [95% CI], 3.3 to 17.0). Ten-year survival probability was 94%. Fifty-nine children (9%) underwent one or more dialysis catheter placements. Children with kidney dysplasia had over four-fold risk of dialysis catheter placement (hazard ratio, 4.6; 95% CI, 2.6 to 8.1). Thirty-six (7%) children underwent kidney transplant at a median age of 3 (interquartile range, 2-8) years. Kidney dysplasia had a nine-fold higher risk of kidney transplant (hazard ratio, 9.5; 95% CI, 4.1 to 22.2). CONCLUSIONS: Patients in this multicenter cohort with posterior urethral valves had a 5% risk of death, and were most likely to die during their initial hospitalization. Risk of death was higher with a diagnosis of pulmonary hypoplasia. Kidney dysplasia was associated with a higher risk of need for dialysis/transplant. PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_10_03_CJN04350419.mp3.


Assuntos
Nefropatias/etiologia , Nefropatias/mortalidade , Uretra/anormalidades , Estreitamento Uretral/congênito , Estreitamento Uretral/complicações , Estudos de Coortes , Diagnóstico Precoce , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Estreitamento Uretral/diagnóstico , Estreitamento Uretral/etiologia
18.
Hinyokika Kiyo ; 65(8): 337-340, 2019 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-31501403

RESUMO

A 62-year-old man had been treated for urethral stricture developed after his right kidney was harvested for donation to his sister 34 years ago. Transurethral biopsy was performed because of positive urinary cytology and squamous cell carcinoma was detected from the site of urethral stricture. The patient with the desire to preserve the penis was referred to our department. Magneticresonanc e imaging showed no evidence of invasion to subepithelial tissue. Re-biopsy from the site of urethral stricture revealed squamous cell carcinoma in situ. Under the diagnosis of urethral carcinoma cTisN0M0, urethrectomy of anterior urethra with perineal urethrostomy was performed. Histopathological diagnosis was squamous cell carcinoma of the urethra pTis and surgical margins were negative. The patient reported complete urinary continence, normal erections and ejaculation from his urethrostomy. He showed no evidence of recurrence at 28 months after surgery.


Assuntos
Carcinoma in Situ , Neoplasias Uretrais , Estreitamento Uretral , Carcinoma in Situ/diagnóstico , Carcinoma in Situ/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Uretra , Neoplasias Uretrais/diagnóstico , Neoplasias Uretrais/cirurgia , Estreitamento Uretral/etiologia , Estreitamento Uretral/cirurgia
19.
Rev. int. androl. (Internet) ; 17(3): 110-118, jul.-sept. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-188239

RESUMO

La estenosis de la anastomosis uretrovesical es un problema relativamente poco frecuente tras la prostatectomía radical, aunque puede ser recidivante y de difícil tratamiento. Se conocen ciertos factores de riesgo que pueden ayudar a disminuir su presentación. Para la decisión del plan terapéutico debemos evaluar la estenosis y también la continencia tras la prostatectomía. Hay descritas múltiples opciones de tratamiento, pero la evidencia disponible sobre ellas es baja, limitándose a series de casos de diferente tamaño y seguimiento, y revisiones sobre el tema. Los tratamientos endoscópicos son los más extendidos, con unos porcentajes de éxito que oscilan según la técnica de incisión, resección o vaporización. Una opción adyuvante es la inyección local de fármacos que reduzcan el crecimiento fibroso. En casos recidivantes o con obstrucción completa, pueden requerirse reconstrucción quirúrgica, por vía perineal, abdominal o mixta, o derivaciones suprapúbicas


Vesicourethral anastomotic stenosis is a relatively uncommon problem after radical prostatectomy, but it could become recurrent and difficult to treat. Risk factors are known, and they can help to decrease the incidence. When discussing the therapeutic plan, we must consider the stenosis risk, and also the urinary continence after the prostatectomy. Many treatment schedules are proposed, some of them with low available evidence, limited to case series with different number of patient and follow-up length, or reviews on the subject. Endoscopic options are the commonest, obtaining different success rates depending on the incision, resection or vaporization of the tissue. They could also benefit from the use of adjuvant local injections of drugs regulating tissue growth. Recurrent or obliterated cases could require surgical reconstruction using perineal, abdominal or combined approaches, or even suprapubic urinary diversions


Assuntos
Humanos , Masculino , Neoplasias da Próstata/cirurgia , Prostatectomia/efeitos adversos , Anastomose Cirúrgica/efeitos adversos , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Estreitamento Uretral/cirurgia , Estreitamento Uretral/etiologia , Fatores de Risco
20.
Pediatr Surg Int ; 35(11): 1301-1308, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31372729

RESUMO

PURPOSE: To compare the two major complications, namely postoperative urethrocutaneous fistula and urethral stricture, between the Mathieu and tubularized incised plate (TIP) repair methods for distal hypospadias. METHODS: In this meta-analysis, electronic databases were searched for comparative studies on the two techniques. The Oxford Centre for Evidence-based Medicine Levels of Evidence was used to evaluate the included studies. The main outcome measure was the frequency of postoperative fistula and urethral stricture. RevMan 5.3 was used for statistical analyses, with P < 0.05 indicating statistical significance. RESULTS: A total of 17 studies, which included 1572 patients, met the inclusion criteria. The frequency of urethrocutaneous fistula did not differ between the Mathieu [115 (13%)] and TIP [90 (13%)] methods [odds ratio (OR) 1.1, 95% confidence intervals (CI) 0.6-1.9; P = 0.73)]. Urethral stricture was less frequent after the Mathieu [15 (2%)] method than after the TIP [37 (5%)] method (OR 0.5, 95% CI 0.3-0.8; P < 0.01), even after the subgroup analysis of eight randomized controlled trials was included. Overall, the quality of the included studies was determined to be satisfactory. The levels of evidence on which this review was based ranged from 1b to 2b using the CEBM Levels of Evidence. CONCLUSION: Compared with TIP repair, Mathieu repair for hypospadias had a significantly lower risk for urethral stricture; however, the risk for urethrocutaneous fistula was similar.


Assuntos
Fístula Cutânea/etiologia , Hipospadia/cirurgia , Estreitamento Uretral/etiologia , Fístula Urinária/etiologia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Humanos , Masculino , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
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