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1.
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
2.
Biomed Res Int ; 2019: 9046430, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31139658

RESUMO

To date, urethral stricture disease in men, though relatively common, represents an often poorly managed condition. Therefore, this article is dedicated to encompassing the currently existing data upon anatomy, etiology, symptoms, diagnosis, and treatment of the disease, based on more than 40 years of experience at a tertiary referral center and a PubMed literature review enclosing publications until September 2018.


Assuntos
Estreitamento Uretral/etiologia , Estreitamento Uretral/patologia , Humanos , Masculino , Retalhos Cirúrgicos , Ultrassonografia , Estreitamento Uretral/diagnóstico , Estreitamento Uretral/terapia
3.
Urology ; 126: e3-e4, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30707965

RESUMO

A 35-year-old male of 165 cm height and weight of 65 kg, had a suprapubic catheter indwelling for 4 years without replacement for urethral stricture. The catheter became gradually obstructed, and urine leaked out around the suprapubic catheter. A lumbar abdominal distension, an inferior abdominal mass and renal failure prompted him to seek medical attention in our hospital in September 2018. This clinical case is hereby presented from 3 aspects of imaging, lab examination, and operation.


Assuntos
Cateteres de Demora , Estreitamento Uretral/terapia , Cateteres Urinários , Adulto , Remoção de Dispositivo , Falha de Equipamento , Humanos , Masculino , Fatores de Tempo
4.
World J Urol ; 37(9): 1959-1964, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30535714

RESUMO

PURPOSE: Local injection of platelet-rich plasma (PRP) is postulated to work by delivering growth factors and cytokines that recruit healer cells and enhance recovery process at the injection site. As new scar formation leads to stricture recurrence after internal urethrotomy, we proposed to improve post-internal urethrotomy stricture recurrence rate by injecting local submucosal PRP at the time of urethrotomy. METHODS: From July 2015 to June 2018, 87 male patients with symptomatic bulbar urethral stricture (diagnosed by retrograde urethrography) randomized into two groups of internal urethrotomy and submucosal normal saline injection (control group, 43 patients), and internal urethrotomy with submucosal autologous platelet-rich plasma injection (PRP injection group, 44 patients). According to the endpoint, which happened sooner, each patient was followed at 3-month intervals for 2 years after internal urethrotomy or until urethral stricture recurrence. RESULTS: Twelve-month recurrence rates were 26.82 and 9.09% in the control and the PRP injection groups, respectively (p 0.032). After 2 years of follow-up, stricture recurrence was identified in 18 (43.90%) and 9 (21.95%) patients in the control and the PRP injection groups, respectively (p 0.34). CONCLUSION: In our study, submucosal PRP injection at the site of internal urethrotomy decreased the rate of stricture recurrence a year after the intervention. This protective effect lasted for 24 months, at least. Submucosal PRP injection at the time of internal urethrotomy also decreased the length of stricture in case of recurrence.


Assuntos
Plasma Rico em Plaquetas , Estreitamento Uretral/terapia , Adulto , Humanos , Injeções Intralesionais , Masculino , Pessoa de Meia-Idade , Recidiva , Método Simples-Cego , Estreitamento Uretral/cirurgia , Adulto Jovem
5.
Low Urin Tract Symptoms ; 11(2): O34-O37, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29119701

RESUMO

OBJECTIVE: Urethral stenosis is a disease in which the lumen of the urethra becomes constricted by fibrosis. Such stenoses have been treated by urethral dilation using a bougie and optical internal urethrotomy (OIU). Recently, high-pressure balloon dilation (BD) has been developed as a new treatment method for urethral stenosis. The present study compared the effectiveness of urethral dilation by BD and OIU. METHODS: Twenty-two patients of urethral stenosis were treated at Yokohama City University Medical Center between 2005 and 2015. Of these, 13 underwent BD, whereas OIU was performed in 9. BD was performed at 30 atm twice for 5 min each time. In OIU, an endoscopic knife was used to cut out the stenotic lesion in 3 directions. The endpoint was set as restenosis, which required additional surgical treatment, including BD, OIU, and the use of a urethral bougie. RESULTS: The causes of urethral stricture were endoscopic surgery (n = 7; 31.8%), development after total prostatectomy (n = 4; 18.2%), iatrogenic reasons associated with catheter insertion (n = 5; 22.7%), development after a prostate needle biopsy (n = 3; 13.6%), and unknown (n = 3; 13.6%). The site of the stenotic lesion site was the anastomosis (n = 3; 13.6%), bladder neck (n = 6; 27.3%), prostatic urethra (n = 4; 18.2%), anterior urethra (n = 7; 31.8%), and membranous urethra (n = 2; 9.1%). The stenosis-free rate was 84% for those undergoing BD and 22% for those receiving OIU. The median stenosis-free time was significantly longer after BD than OIU (1675 vs. 244 days, respectively; P < .01). CONCLUSION: The stenosis-free time was significantly longer after BD than OIU.


Assuntos
Dilatação/métodos , Uretra/cirurgia , Estreitamento Uretral/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista , Estreitamento Uretral/cirurgia
6.
Urol J ; 16(1): 67-71, 2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-30058064

RESUMO

PURPOSE: Infra-vesical obstruction is uncommon in infants and generally due to urethral valves. Congenital urethral strictures (CUS), instead, defined as a concentric narrowing of the urethral lumen, are exceedingly rare in infants. MATERIALS AND METHODS: We reviewed our experience with 7 patients treated at our institution for CUS

Assuntos
Estreitamento Uretral/complicações , Estreitamento Uretral/terapia , Anormalidades Múltiplas/terapia , Canal Anal/anormalidades , Dilatação , Humanos , Lactente , Síndrome do Abdome em Ameixa Seca/terapia , Procedimentos Cirúrgicos Reconstrutivos , Reto/anormalidades , Estudos Retrospectivos , Estreitamento Uretral/congênito , Estreitamento Uretral/diagnóstico por imagem , Derivação Urinária , Refluxo Vesicoureteral/complicações
8.
J Cell Mol Med ; 22(11): 5607-5616, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30179296

RESUMO

The treatment of complicated long segment strictures remains to a challenge, and the substitution urethroplasty treatment is often accompanied by subsequent tissue fibrosis and secondary stricture formation. In situ injection of human adipose tissue-derived stem cells (hADSC) could potential be applied for prevention of urethral fibrosis, but the cells transplantation alone may be insufficient because of the complicated histopathological micro-environmental changes in the injury site. This study investigated whether miR-21 modification can improve the therapeutic efficacy of ADSCs against urethral fibrosis to limit urethral stricture recurrence. MiR-21-modified ADSCs (miR-21) were constructed via lentivirus-mediated transfer of pre-miR-21 and GFP reporter gene. In vitro results suggested that miR-21 modification can increase the angiogenesis genes expression of ADSCs and enhance its anti-oxidative effects against reactive oxygen species (ROS) damage. In vivo results showed that miR-21 modification contributes to increased urodynamic parameters and better formation of the epithelium and the muscle layer as compared to ADSCs transplantation alone groups. The results demonstrated that miR-21 modification in ADSCs could improve urethral wound healing microenvironment, enhance stem cell survival through ROS scavenging and promote the neovascularization via regulating angiogenic genes expression, which eventually increase the ADSCs' therapeutic potential for urethral wound healing.


Assuntos
Fibrose/terapia , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/metabolismo , MicroRNAs/genética , Animais , Proliferação de Células/genética , Epitélio/metabolismo , Epitélio/patologia , Fibrose/induzido quimicamente , Fibrose/genética , Fibrose/patologia , Regulação da Expressão Gênica no Desenvolvimento/genética , Células HEK293 , Humanos , Peróxido de Hidrogênio/toxicidade , Lentivirus/genética , MicroRNAs/administração & dosagem , Músculos/citologia , Ratos , Espécies Reativas de Oxigênio/metabolismo , Nicho de Células-Tronco/genética , Uretra/crescimento & desenvolvimento , Uretra/patologia , Estreitamento Uretral/genética , Estreitamento Uretral/patologia , Estreitamento Uretral/terapia , Cicatrização/genética
9.
Int Urol Nephrol ; 50(10): 1795-1800, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30121720

RESUMO

OBJECTIVE: Because of the complexity of the abnormalities and limited options for reconstruction of failed hypospadias, creating a neourethra presents a challenge to surgeons. We reviewed our experiences with staged urethroplasty strategies to repair the penis of failed hypospadias. MATERIALS AND METHODS: We retrospectively reviewed 56 consecutives patients following multiple unsuccessful hypospadias repairs from 2010 to 2016. Patients were divided into the following two groups based on their penile conditions and urethroplasty procedures: staged buccal mucosa graft Bracka urethroplasty (group1) and two-stage urethroplasty with additional buccal mucosa graft augmentation of the dorsal urethral plate (group2). RESULT: Median follow-ups were 26.5 months (12-59 months) and 28.6 months (14-59 months) in the group 1 and group 2. After the second stage, three patients (11.1%) in group 1 and two patients (6.89%) in group 2 did not have a meatal opening at the top of the glans. Three patients (11.1%) in group 1 and 4 patients (13.79%) in group 2 had urethrocutaneous fistulas. One patient (3.70%) in group 1 and no patients in group 2 had meatal stenosis. Two patients (6.89%) in group 2 and no patients in group 1 had urethral strictures; all patients with strictures were cured using dilations, so follow-up surgeries were not required. No patients in either group had signs of diverticulum or residual chordee. Three patients (11.1%) in group 1 and 4 patients (13.79%) in group 2 needed reoperations. CONCLUSION: Failed hypospadias repairs were often due to the underestimation of the penile conditions at the prior surgery. The results indicated that two-staged strategies were preferred for treating complex situations during the intermediate period of our study. Staged buccal mucosa graft Bracka urethroplasty and two-stage urethroplasty with additional buccal mucosa graft augmentation of the dorsal urethral plate severed as reliable approaches in complex hypospadias cases and could improve the overall success rate.


Assuntos
Fístula Cutânea/etiologia , Hipospadia/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reoperação/métodos , Estreitamento Uretral/etiologia , Fístula Urinária/etiologia , Adolescente , Adulto , Dilatação , Seguimentos , Humanos , Masculino , Mucosa Bucal/transplante , Pênis/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Reoperação/efeitos adversos , Estudos Retrospectivos , Falha de Tratamento , Uretra/cirurgia , Estreitamento Uretral/terapia , Adulto Jovem
10.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 43(5): 520-527, 2018 May 28.
Artigo em Chinês | MEDLINE | ID: mdl-29886468

RESUMO

OBJECTIVE: To explore the etiology of male urethral stricture, analyze the therapeutic strategies of urethral stricture, and summarize the complicated cases.
 Methods: The data of 183 patients with urethral stricture were retrospectively analyzed, including etiology, obstruction site, stricture length, therapeutic strategy, and related complications.
 Results: The mean age was 49.7 years, the average course was 64.7 months, and the constituent ratio of 51 to 65 years old patients was 38.8% (71/183). The traumatic injury of patients accounted for 52.4% (96/183), in which the pelvic fracture accounted for 35.5% (65/183) and the straddle injury accounted for 16.9% (31/183). There were 54 cases of iatrogenic injury (29.5%). The posterior urethral stricture accounted for 45.9% (84/183), followed by the anterior urethral stricture (44.8%, 82/183) and the stenosis (6.6%, 12/183). A total of 99 patients (54.1%) received the end to end anastomosis, and 40 (21.9%) were treated with intracavitary surgery, such as endoscopic holmium laser, cold knife incision, endoscopic electroknife scar removal, balloon dilation, and urethral dilation. In the patients over 65-years old, the urethral stricture rate was 14.8% and the complication rate (70.4%) for transurethral resection of the prostate (TURP) was significantly higher than that of all samples (P<0.01).
 Conclusion: Both the etiology of male urethral stricture and the treatment strategy have changed and the incidence of traumatic and iatrogenic urethral stricture has increased in recent 3 years. The main treatment of urethral stricture has been transformed from endoscopic surgery into urethroplasty.


Assuntos
Fraturas Ósseas/complicações , Doença Iatrogênica , Ossos Pélvicos/lesões , Estreitamento Uretral/etiologia , Estreitamento Uretral/terapia , Idoso , Animais , Dilatação , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ressecção Transuretral da Próstata , Resultado do Tratamento , Estreitamento Uretral/patologia
11.
BMC Urol ; 18(1): 46, 2018 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-29783971

RESUMO

BACKGROUND: The incidence of posterior urethral valve (PUV) is estimated at 1:5000-1:8000 males. It is the most common paediatric urologic urgency and the most common cause of male obstructive uropathy and chronic renal failure in children. The study aimed to describe the experience of Yaoundé gynaeco-obstetrics and paediatric hospital in the management of PUV. METHODS: Retrospectively, medical records were retrieved over a ten year period and all data recorded and analyzed for study objectives. Patients were called and evaluated for outcomes regarding morbidity and mortality. RESULTS: A total of 18 patients all males were managed over the ten year period, given prevalence of 13 cases/100,000 admissions and an admission rate of 2 per annum. The median age at presentation was 22 months and 13 (72.2%) participants presented late. Voiding urethrocystogram was done in all the participants where it showed dilated and elongated posterior urethral valves in 16 (88.9%) of the cases. Endoscopic valve ablation resulted in the relief of obstruction in all but 3 (16.7%) participants that had residual valves and 2 (11.2%) participants that had urethral stenosis. Type I valves were most common in 14 (78.0%) participants. The mean duration of follow up was 34.56 ± 21.47 months. Complications at final follow up were: 10 (55.6%) chronic renal failure, 2 (11.2%) end-stage renal failure. The case fatality rate was 5.6%. CONCLUSION: Many patients present late in our setting with already established complications. There is the need to counsel parents/guardians on the importance of long-term follow up after relief of obstruction.


Assuntos
Hospitais Pediátricos/tendências , Auditoria Médica/tendências , Obstrução Uretral/diagnóstico por imagem , Obstrução Uretral/epidemiologia , Estreitamento Uretral/diagnóstico por imagem , Estreitamento Uretral/epidemiologia , Camarões/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Fatores de Tempo , Obstrução Uretral/terapia , Estreitamento Uretral/terapia
12.
Urologe A ; 57(1): 29-33, 2018 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-29209754

RESUMO

BACKGROUND: The development of a stricture of the vesicourethral anastomosis is a serious complication after radical prostatectomy. Strictures occur in 5-8% of patients after radical prostatectomy. SYMPTOMS: Usually the clinical symptoms include an irritative and obstructive component similar to benign prostatic hyperplasia. In rare cases, patients suffer from partial or complete stress incontinence as a result of the anastomotic stricture. DIAGNOSTICS: The diagnostic workup is similar to the procedure for urethral strictures. In addition to uroflowmetry, a cystourethrogram (CUG) or, if necessary, a micturating cystourethrogram (MCU) can be performed. A urethrocystoscopy can be performed to ensure the diagnosis. THERAPY: In most cases, endoscopic procedures were performed for treatment. Beside a transurethral dilation of the stricture or the Sachse urethrotomy, the most common procedure is transurethral resection to treat the stricture. However, all procedures are associated with a high recurrence rate. In recurrent strictures, open surgical procedures, usually a perineal reanastomosis, should performed early. CONCLUSION: Endourological procedures like transurethral resection are a good treatment option, but due to the high recurrence rates, open surgical procedures should be discussed and if necessary should be performed early.


Assuntos
Anastomose Cirúrgica , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Estreitamento Uretral/etiologia , Estreitamento Uretral/terapia , Adenocarcinoma/diagnóstico , Adenocarcinoma/cirurgia , Anastomose Cirúrgica/efeitos adversos , Constrição Patológica , Humanos , Masculino , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/cirurgia , Uretra
13.
Neurourol Urodyn ; 37(4): 1286-1293, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29226987

RESUMO

AIMS: Urethral stricture (US) formation is caused by fibrosis after excessive collagen formation following an injury or trauma to the urethra. In this study, we aimed to evaluate the effects of platelet-rich plasma (PRP) on a urethral injury (UI) model of male rats. METHODS: A UI model was used by applying a coagulation current to the urethras of male rats. There were four groups with six rats in each: control group, PRP applied to naive urethra, UI group, and UI with PRP application. PRP was applied to the urethra after a coagulation current-induced injury as soon as possible. On the 14th day, all rats were sacrificed and urethral tissues were investigated for collagen type I, collagen type III, platelet-derived growth factor-α, platelet-derived growth factor-ß, and transforming growth factor-ß using quantitative real-time polymerase chain reaction and Western blot analysis. The effect of urethral damage and healing was evaluated for collagen type I-to-collagen type III ratio. RESULTS: The collagen type I-to-collagen type III ratio was significantly higher in UI group (P < 0.05) than in the others, while UI with PRP application group had comparable results with the control group (P > 0.05). CONCLUSIONS: The results of this study show that PRP has a preventive effect on stricture formation in a UI model of rats, as shown by its effect on collagen synthesis. Further studies that eventually show the effects of PRP on human tissues are necessary and promising.


Assuntos
Plasma Rico em Plaquetas , Estreitamento Uretral/terapia , Cicatrização/fisiologia , Animais , Colágeno Tipo I/metabolismo , Colágeno Tipo III/metabolismo , Masculino , Fator de Crescimento Derivado de Plaquetas/metabolismo , Ratos , Fator de Crescimento Transformador beta/metabolismo , Uretra/metabolismo , Estreitamento Uretral/metabolismo
14.
Sex Med Rev ; 6(1): 143-156, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28454897

RESUMO

INTRODUCTION: Peyronie's disease (PD) is a connective tissue disorder resulting in the abnormal accumulation of type I to III collagen, fibrin, and disorganized elastic fibers in the tunica albuginea of the penis. Many medical and non-pharmacologic modalities have been used in the treatment of PD; however, these approaches have proved largely ineffective, with surgery being the only definitive treatment. Intralesional injection of collagenase Clostridium histolyticum (CCH) has recently become the gold standard for minimally invasive treatment of PD, and studies have suggested the role of CCH could expand to the treatment of other urologic conditions such as urethral stricture disease. AIM: To provide an update on available data on the use of CCH in the treatment of PD and other urologic conditions. METHODS: Comprehensive review of recent clinical trials and in vivo studies that examined the safety and efficacy of CCH in urologic disease. MAIN OUTCOME MEASURES: Assessing the efficacy of CCH in the management of PD as determined by improvement in the severity of penile fibrosis, curvature deformity, and pain. RESULTS: Several well-designed clinical trials have demonstrated the efficacy and tolerability of CCH in the treatment of PD. CCH has demonstrated significant decreases in penile curvature and plaque consistency and improvements in patient satisfaction. Treatment durability and long-term adverse effects are still being assessed; however, outcomes of PD management with CCH continue to replicate the results obtained during the IMPRESS clinical trials. Preliminary studies support the premise that CCH can modify disease progression in patients with acute-phase PD. Furthermore, one in vivo study showed that CCH also could be applied to urethral stricture disease without serious adverse complications. CONCLUSION: CCH continues to be the mainstay for non-surgical management of stable-phase PD. However, its role in the treatment of acute-phase PD, PD with ventral plaques, and urethral stricture disease could expand in the coming years. Gabrielson AT, Spitz JT, Hellstrom WJG. Collagenase Clostridium Histolyticum in the Treatment of Urologic Disease: Current and Future Impact. Sex Med Rev 2018;6:143-156.


Assuntos
Saúde do Homem , Colagenase Microbiana/uso terapêutico , Induração Peniana/tratamento farmacológico , Pênis/efeitos dos fármacos , Estreitamento Uretral/tratamento farmacológico , Clostridium histolyticum , Humanos , Injeções Intralesionais , Masculino , Satisfação do Paciente , Induração Peniana/fisiopatologia , Induração Peniana/psicologia , Pênis/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Estreitamento Uretral/fisiopatologia , Estreitamento Uretral/terapia
15.
Urol Oncol ; 35(12): 672.e15-672.e19, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28844555

RESUMO

PURPOSE: To report the safety and efficacy of mitomycin-C (MMC) injection followed by urethral dilatation for the treatment of recurrent vesicourethral anastomotic stenosis (VUAS) post-radical prostatectomy, and to report the outcome for patients treated for concomitant postprostatectomy incontinence. MATERIALS AND METHODS: A total of 29 patients with postprostatectomy incontinence and diagnosed with recurrent VUAS were recruited between March 2009 and January 2014 in this longitudinal case series. Under sedation, MMC was injected at the 3, 6, and 9 o'clock position, followed by urethral dilatation to 26F. Cystoscopy was performed to evaluate for patency at set intervals. Patients had the possibility to receive a salvage MMC injection if recurrence was noted. Patients with resolved VUAS were offered an anti-incontinence surgery. RESULTS: Median (interquartile range [IQR]) patient age was 67 years (63-72). Overall, 17 patients had ≥2 prior treatments for the VUAS (median = 2, IQR: 1-3 treatments); 23 patients (79%) had a patent bladder neck at the 12 months follow-up cystoscopy after a single MMC injection and dilatation. Overall, 3 patients opted for a salvage MMC injection for recurrence, and 2 of those were salvaged, improving the success rate to 86%. No adverse events were reported. Overall, 20 patients (69%) opted for an anti-incontinence surgery, and all were either cured or improved of their incontinence after a median (IQR) follow-up of 58 months (48-77). CONCLUSIONS: MMC injection with urethral dilatation is a safe, effective, and minimally invasive treatment option for recurrent VUAS after radical prostatectomy. Favorable long-term results can be expected even after anti-incontinence procedures.


Assuntos
Dilatação/métodos , Mitomicina/administração & dosagem , Prostatectomia/métodos , Estreitamento Uretral/terapia , Idoso , Anastomose Cirúrgica/métodos , Antibióticos Antineoplásicos/administração & dosagem , Cistoscopia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Prostatectomia/efeitos adversos , Recidiva , Uretra/efeitos dos fármacos , Uretra/patologia , Uretra/cirurgia , Incontinência Urinária/etiologia , Incontinência Urinária/terapia
16.
Urology ; 104: 198-203, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28130178

RESUMO

OBJECTIVE: To evaluate the influence of both repair type and degree of cuff erosion on postoperative urethral stricture rate. Sparse literature exists regarding patient outcomes after artificial urinary sphincter (AUS) cuff erosion. Surgeons from 6 high-volume male continence centers compiled a comprehensive database of post-erosion patients to examine outcomes. MATERIALS AND METHODS: This retrospective multi-institution study included 80 patients treated for AUS cuff erosions. Seventy-eight patients had specific information regarding post-cuff erosion urethral strictures. Erosion patients were categorized into 1 of 3 repair types at the time of explant surgery: catheter only, single-layer capsule-to-capsule repair (urethrorrhaphy), and formal urethroplasty. Operative notes and available medical records were extensively reviewed to collect study data. RESULTS: Twenty-five of 78 patients manifested a urethral stricture after AUS cuff erosion (32%). More strictures occurred among patients who underwent urethrorrhaphy (40% vs 29% for catheter only and 14% for urethroplasty). Stricture rates did not vary significantly by repair type (P = .2). Strictures occurred significantly more frequently in patients with complete cuff erosions (58%) as compared to partial erosions (25%, P = .037). A trend was detected regarding increased percentage of erosion correlating with increased stricture rate, but this did not reach statistical significance (P = .057). Partially eroded patients were more likely to undergo urethrorrhaphy repair (60%, P = .002). CONCLUSION: Urethral stricture was more likely to occur after complete cuff erosion as opposed to partial erosion in this multicenter retrospective population. Repair type, whether catheter only, urethrorrhaphy, or formal urethroplasty, did not appear to influence postoperative stricture rate.


Assuntos
Uretra/cirurgia , Estreitamento Uretral/terapia , Esfíncter Urinário Artificial/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Reparo do DNA , Remoção de Dispositivo , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Falha de Prótese , Estudos Retrospectivos , Fatores de Risco , Procedimentos Cirúrgicos Urológicos , Adulto Jovem
17.
Urology ; 100: 79-83, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27658662

RESUMO

OBJECTIVE: To evaluate the nationwide practice patterns of the management of acute urinary retention (AUR) secondary to urethral stricture (US) in an emergency department (ED) setting. MATERIALS AND METHODS: We used the 2006-2010 Nationwide Emergency Department Sample to identify men with US who received treatment for AUR. We excluded patients with benign prostatic hyperplasia, vesicourethral anastomotic stenosis, neurogenic bladder, and bladder cancer. Primary outcome was urethral dilation or suprapubic tube (SPT) placement as initial AUR management. Patient demographics and hospital factors were also examined. Multivariate logistic regression was performed to examine factors associated with initial AUR management. RESULTS: We identified 4794 weighted ED encounters of men with US who underwent urethral dilation or SPT placement for AUR. Mean age was 58.6 ± 0.8 years. A total of 4084 (85%) men received urethral dilation, whereas 710 had SPT (15%) placement. In bivariate analysis, patients who received SPT were likely to be younger (P <.001), treated in recent years (P = .002), and in hospitals in the West region (P = .003). In multivariate analysis, SPT placement was significantly associated with younger age (P = .004), public insurance (P = .03), recent treatment years (P = .02), and hospitals in the West region (P = .02). Income and hospital teaching status did not have significant association with initial treatment choice. CONCLUSION: Urethral dilation remains the most common urologic intervention in the ED for AUR due to US; however, there is an increasing trend toward SPT placement. Patients who are younger, publicly insured, or who receive care in the West region are more likely to receive a SPT for initial treatment of AUR due to US.


Assuntos
Serviço Hospitalar de Emergência , Padrões de Prática Médica/estatística & dados numéricos , Estreitamento Uretral/terapia , Retenção Urinária/terapia , Doença Aguda , Fatores Etários , Estudos de Coortes , Bases de Dados Factuais , Dilatação , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Estados Unidos , Estreitamento Uretral/complicações , Cateterismo Urinário , Retenção Urinária/etiologia
18.
Turk J Med Sci ; 47(6): 1912-1919, 2017 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-29306257

RESUMO

Background/aim: To evaluate the effects of mesenchymal stem cell (MSC) therapy in an experimental bladder and posterior urethral injury model. Materials and methods: The study subjects consisted of 40 male Wistar albino rats that were divided into four groups: control group (n = 10) (the bladder was only surgically opened and closed), sham group (n = 10) (surgical procedure), IVMSC group (n= 10) (surgical procedure and intravenous MSC treatment), and LMSC group (n = 10) (surgical procedure and local MSC treatment). Histopathological evaluation was performed for the degree of fibrosis and inflammation and the extent and intensity of staining of vascular endothelial growth factor (VEGF) and endoglin (CD105). Results: There were no significant differences between the control and LMSC groups with respect to fibrosis (P = 0.070) or inflammation (P = 0.048). Fibrosis and inflammation were significantly lower in the IVMSC (P = 0.034 for fibrosis, P = 0.080 for inflammation) and LMSC (P = 0.01 for fibrosis, P = 0.013 for inflammation) groups when compared with the sham group. No significant differences regarding fibrosis and inflammation were observed between the IVMSC and LMSC groups (P = 0.198 for fibrosis, P = 0.248 for inflammation). A significant difference was noted between the sham and LMSC groups concerning VEGF staining intensity (P = 0.017). However, no significant difference was found among the groups with regard to the extent or intensity of CD105 staining (P > 0.05). Conclusion: MSC treatment significantly decreased the development of fibrosis in a uroepithelial injury model.


Assuntos
Transplante de Células-Tronco Mesenquimais , Neoplasias Uretrais/patologia , Estreitamento Uretral/patologia , Bexiga Urinária/patologia , Animais , Células Cultivadas , Masculino , Células-Tronco Mesenquimais , Ratos , Ratos Wistar , Neoplasias Uretrais/terapia , Estreitamento Uretral/terapia , Bexiga Urinária/lesões
19.
Urologiia ; (6): 72-75, 2017 Dec.
Artigo em Russo | MEDLINE | ID: mdl-29376599

RESUMO

AIM: To evaluate the effectiveness of laparoscopic repair of primary strictures of ureteropelvic junction (UPJ) depending on baseline renal function of the ipsilateral kidney. MATERIALS AND METHODS: The study analyzed results of 134 patients (78 women and 56 men, age from 18 to 56 years) who underwent various types of laparoscopic repair of the UPJ stricture from 2012 to 2015. Depending on the surgical technique all patients were divided into three groups: group 1 (n=34) underwent spiral flap technique by Culp and DeWeerd, group 2 (n=59) - Anderson-Hynes pyeloplasty and group 3 (n=41) had antevasal dismembered pyeloplasty. All interventions ended with internal ureteral stenting for up to 6-8 weeks. Also, all patients were divided into three subgroups, depending on the degree of renal function deficiency - less than 25%, 25-50%, and 51-75%. Treatment effectiveness criteria included the following parameters: complete relief of the pain syndrome, a decrease in the degree of pyeloectasia, stabilization or improvement of the functional state of the renal parenchyma (according to radioisotope renography), and the absence of recurrence of the UPJ stricture. RESULTS: The overall effectiveness of UPJ laparoscopic reconstruction was 94.7% (127 of 134). The effectiveness of the treatment was independent of the surgical technique, the initial thickness of the renal parenchyma and the degree of PCS dilatation. There was an inverse correlation between the treatment effectiveness the degree of kidney function deficiency. CONCLUSION: In patients with hydronephrosis secondary to UPJ stricture, the effectiveness of surgical treatment is mainly determined by its timeliness. The best treatment results were observed in patients with better renal function. The degree of renal function deficiency should be considered the main prognostic factor for the effectiveness of the forthcoming operation.


Assuntos
Pelve Renal/cirurgia , Laparoscopia/métodos , Ureter/cirurgia , Estreitamento Uretral/terapia , Adolescente , Adulto , Feminino , Humanos , Pelve Renal/patologia , Masculino , Pessoa de Meia-Idade , Ureter/fisiologia , Estreitamento Uretral/patologia
20.
Actas Urol Esp ; 41(1): 1-10, 2017.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27133545

RESUMO

INTRODUCTION: Posterior urethral stenoses and contractures are complications after treatment of benign prostatic hyperplasia (BPH), localised prostate cancer (PCa), and orthotopic neobladder formation, compromising prognosis and functional outcomes. OBJECTIVES: To identify factors related to aetiology, prevention and treatment of non-traumatic posterior urethral stenosis and contractures. ACQUISITION OF EVIDENCE: Review of the published evidence related to posterior urethral stenosis and contractures after PCa treatment, BPH therapies and orthotopic neobladder formation. PubMed database search with English and Spanish papers considered. Cohort studies, case series, prospective and retrospective studies and review papers were included. SYNTHESIS OF EVIDENCE: Posterior urethral stenoses and contractures are common, leading to significant morbidity. A worsening on voiding quality should rise some concerns. Careful surgical and/or radiotherapic techniques prevent their development. Endoscopic therapies are the initial approach, with complex urethroplasties often required. Subsequent urinary incontinence, the most important sequelae, may need artificial sphincters. CONCLUSIONS: Non-traumatic posterior urethral stenoses could be important complications, potentially compromising the outcomes of initial therapy. They could require complex surgeries leading to urinary incontinence.


Assuntos
Complicações Pós-Operatórias , Estreitamento Uretral , Procedimentos Cirúrgicos Urológicos , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Prostatectomia , Estreitamento Uretral/diagnóstico , Estreitamento Uretral/etiologia , Estreitamento Uretral/terapia
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