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1.
Curr Urol Rep ; 20(11): 67, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31599353

RESUMO

PURPOSE OF REVIEW: To describe the complexities of diagnosis and management of neobladder-vaginal fistula (NVF) following orthotopic urinary diversion in women. RECENT FINDINGS: Multiple recent single-institution series confirm the variability of outcomes for NVF repairs and caution regarding comorbid stress urinary incontinence which may necessitate further interventions including conversion to alternate diversions. Although both abdominal and transvaginal approaches have been advocated for surgical management of NVF, contemporary series from reconstructive surgeons favor a vaginal approach to decrease overall operative morbidity. Patients should be carefully counseled regarding neobladder and sphincter function following fistula repair along with the risks of secondary urinary diversion.


Assuntos
Estruturas Criadas Cirurgicamente/efeitos adversos , Derivação Urinária/efeitos adversos , Fístula Vaginal/cirurgia , Cistectomia , Feminino , Humanos , Fístula Vaginal/diagnóstico
3.
Female Pelvic Med Reconstr Surg ; 25(2): e43-e44, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-28914704

RESUMO

BACKGROUND: Rectoneovaginal fistulae (RnVFs) are abnormal connections between the rectum and a surgically created neovagina. Although very uncommon, they confer significant morbidity in patients and may require a multidisciplinary team approach to the repair. Risk factors for RnVF include rectal injury at the time of neovaginoplasty, malignancy in the neovagina, trauma (iatrogenic or otherwise), radiation, and neovaginal revision surgery. CASE DESCRIPTION: The patient is a 64-year-old transgender woman with recurrent RnVF following penile skin inversion neovaginoplasty, which was complicated by an intraoperative rectal injury. After failing an initial attempt at repair, the fistula was successfully repaired with a buccal mucosa graft. CONCLUSIONS: In some cases, RnVFs following vaginoplasty surgery for gender affirmation may be repaired successfully with a buccal mucosa graft.


Assuntos
Mucosa Bucal/transplante , Fístula Retovaginal/cirurgia , Procedimentos de Readequação Sexual/efeitos adversos , Estruturas Criadas Cirurgicamente/efeitos adversos , Vagina/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Reto/lesões , Recidiva
4.
Eur J Surg Oncol ; 44(10): 1513-1517, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30017328

RESUMO

BACKGROUND: Multi-visceral resection, including parts of the urinary tract, is sometimes warranted to achieve cancer clear resection margins and optimize survival in patients with locally advanced colorectal and anal cancer. The aim of this study was to assess morbidity after urinary tract reconstruction dictated by colorectal and anal malignancy and to identify potential predictors of urological complications. METHODS: All patients undergoing surgery for colorectal or anal malignancy, including urinary tract resection and synchronous reconstruction, performed at the Karolinska University Hospital during 2004-2015 were included in this retrospective cohort study. Data was collected from medical records with follow-up until at least one year after the index surgery. Complications were graded according to the Clavien-Dindo classification system of surgical complications. RESULTS: The study included 189 patients; 121 underwent cystectomy and 68 partial ureter resection. The rate of high grade urological complications was 22%. The risk of major urological complications was significantly higher in patients subjected to ureter resection compared to after cystectomy (OR 2.60, 95% CI 1.23-5.49). Also, preoperative radiotherapy and intestinal anastomotic dehiscence significantly increased the risk of high grade urological complications. CONCLUSION: To achieve potentially curative resections with uninvolved margins in patients with locally advanced colorectal and anal cancer, multi-visceral resection including urinary tract reconstruction can be performed with reasonable morbidity.


Assuntos
Neoplasias do Ânus/cirurgia , Neoplasias Colorretais/cirurgia , Cistectomia/efeitos adversos , Intestinos/cirurgia , Ureter/cirurgia , Doenças Urológicas/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/efeitos adversos , Complicações Pós-Operatórias/etiologia , Radioterapia Adjuvante/efeitos adversos , Estudos Retrospectivos , Estruturas Criadas Cirurgicamente/efeitos adversos , Derivação Urinária/efeitos adversos , Adulto Jovem
5.
Investig Clin Urol ; 59(3): 213-219, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29744480

RESUMO

Purpose: To report our initial experience with urethral reconstruction using a combined dorsal lingual mucosal graft (LMG) and ventral onlay preputial flap for long obliterative or near-obliterative strictures in circumcised patients. Materials and Methods: This was a retrospective study of 10 patients from January 2015 to June 2017 with long obliterative or near-obliterative anterior urethral strictures and circumcised prepuces. All patients underwent a combined approach using a dorsally LMG and a narrow preputial onlay flap ventrally to create a 26-30 Fr. neourethra over a 14-Fr Foley catheter. Success was defined as no requirement for additional urethral instrumentation. The follow-up period ranged from 6 to 32 months. Results: The patients ranged in age from 17 to 44 years (mean, 32.3±9.59 years) and stricture length ranged from 9 to 12.5 cm (mean, 10.77±1.15 cm). Four strictures were obliterative and six were near-obliterative. Two patients had a history of prior urethroplasty. The length of the LMGs harvested ranged from 11 to 14 cm (mean, 12.8±1.03 cm). The preputial flaps available were from 1 to 1.5 cm in width (1.29±0.16 cm) and the desired length. Maximum urinary flow rate (Qmax) achieved ranged from 12 to 26 mL/s (mean, 20.46±3.71 mL/s) after 3 months. One patient needed a single direct visualized internal urethrotomy and another patient develop temporary superficial penile necrosis. The success rate was 90%. Conclusions: Long obliterative and near-obliterative penile and penobulbar urethral strictures can still be treated in circumcised patients using available preputial skin along with lingual mucosa with good outcomes.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Estruturas Criadas Cirurgicamente , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adolescente , Adulto , Circuncisão Masculina , Seguimentos , Humanos , Masculino , Mucosa Bucal/transplante , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Estudos Retrospectivos , Índice de Gravidade de Doença , Retalhos Cirúrgicos , Estruturas Criadas Cirurgicamente/efeitos adversos , Língua , Urodinâmica , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
6.
J Gastrointest Surg ; 22(6): 1104-1111, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29520647

RESUMO

BACKGROUND: Colonic interposition is a second-line option after oesophagectomy when a gastric neo-oesophagus is not viable. There is no consensus on the optimum anatomical colonic conduit (right or left), or route of placement (posterior mediastinal, retrosternal or subcutaneous). The aim of this review was to determine the optimum site and route of neo-oesophageal conduit after adult oesophagectomy. METHODS: PubMed, MEDLINE, and the Cochrane Library (January 1985 to January 2017) were systematically searched for studies which reported outcomes following colonic interposition in adults. The outcome measures were overall morbidity and mortality. RESULTS: Twenty-seven observational studies involving 1849 patients [1177 males; median age (range) 60.5 (18-84) years] undergoing colonic interposition for malignant (n = 697) and benign (n = 1152) pathology were analysed. Overall pooled morbidity of left vs. right colonic conduit was 15.7% [95% CI (11.93-19.46), p < 0.001] and 18.7% [95% CI (15.58-21.82), p < 0.001] respectively. Overall pooled mortality of left vs. right colonic conduit was 6.5% [95% CI (4.55-8.51), p < 0.001] and 10.1% [95% CI (7.35-12.82), p < 0.001] respectively. Retrosternal route placement was associated with the lowest overall pooled morbidity and mortality of 9.2% [95% CI (6.48-11.99), p < 0.001] and 4.8% [95% CI (3.74-5.89), p < 0.001] respectively. CONCLUSION: Left colonic conduits placed retrosternally were safest.


Assuntos
Colo/transplante , Neoplasias Esofágicas/cirurgia , Esofagectomia , Esôfago/cirurgia , Estruturas Criadas Cirurgicamente , Humanos , Estruturas Criadas Cirurgicamente/efeitos adversos , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos , Resultado do Tratamento
8.
Dis Esophagus ; 30(12): 1-11, 2017 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-28881882

RESUMO

It is generally recognized that in patients with an intact stomach diagnosed with esophageal cancer, gastric tubulization and pull-up shall always be the preferred technique for reconstruction after an esophageal resection. However, in cases with extensive gastroesophageal junction (GEJ) cancer with aboral spread and after previous gastric surgery, alternative methods for reconstruction have to be pursued. Moreover, in benign cases as well as in those with early neoplastic lesions of the esophagus and the GEJ that are associated with long survival, it is basically unclear which conduit should be recommended. The aim of this study is to determine the long-term functional outcomes of different conduits used for esophageal replacement, based on a comprehensive literature review. Eligible were all clinical studies reporting outcomes after esophagectomy, which contained information on at least three years of follow-up after the operation in patients who were older than 18 years of age at the time of the operation. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic web-based search using MEDLINE, the Cochrane Library, and EMBASE databases was performed, reviewing medical literature published between January 2006 and December 2015. The scientific quality of the data was generally low, which allowed us to incorporate only 16 full text articles for the final analyses. After a gastric pull-up, the proportion of patients who suffered from dysphagia varied substantially but seemed to decrease over time with a mild dysphagia remaining during long-term follow-up. When reflux-related symptoms and complications were addressed, roughly two third of patients experienced mild to moderate reflux symptoms a long time after the resection. Following an isoperistaltic colonic graft, the functional long-term outcomes regarding swallowing difficulties were sparsely reported, while three studies reported reflux/regurgitation symptoms in the range of 5% to 16%, one of which reported the symptom severity as being mild. Only one report was available after the use of a long jejunal segment, which contained only six patients, who scored the severity of dysphagia and reflux as mild. Very few if any data were available on a structured assessment of dumping and disturbed bowel functions. Few high-quality data are available on the long-term functional outcomes after esophageal replacement irrespective of the use of a gastric tube, the right or left colon or a long jejunal segment. No firm conclusions regarding the advantages of one graft over the other can presently be drawn.


Assuntos
Colo/transplante , Transtornos de Deglutição/etiologia , Esofagectomia , Esofagoplastia/métodos , Complicações Pós-Operatórias/etiologia , Estômago/cirurgia , Transtornos de Deglutição/fisiopatologia , Síndrome de Esvaziamento Rápido/etiologia , Esofagoplastia/efeitos adversos , Esvaziamento Gástrico , Humanos , Jejuno/transplante , Refluxo Laringofaríngeo/etiologia , Complicações Pós-Operatórias/fisiopatologia , Estruturas Criadas Cirurgicamente/efeitos adversos , Estruturas Criadas Cirurgicamente/fisiologia , Fatores de Tempo
9.
Curr Opin Obstet Gynecol ; 29(5): 316-321, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28696998

RESUMO

PURPOSE OF REVIEW: Indications for vaginoplasty include congenital conditions such as adrenal hyperplasia, cloacal malformations, and Müllerian agenesis, acquired conditions including stenosis from radiation or surgical resection for malignancy, and gender affirmation. All vaginoplasty techniques carry significant risk of both immediate and long-term complications. RECENT FINDINGS: The purpose of this study is to provide a review of the evaluation and management of the neovagina, addressing management of human papilloma virus infections and complications including stenosis, fistula, prolapse, and neovaginal colitis. SUMMARY: Gynecologists who care for patients who have had a vaginoplasty need to understand the importance of long-term follow up and care, including evaluation and management of complications.


Assuntos
Hemorragia/terapia , Complicações Pós-Operatórias/terapia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Estruturas Criadas Cirurgicamente/efeitos adversos , Vagina/cirurgia , Doenças Vaginais/terapia , Animais , Constrição Patológica/terapia , Dilatação , Feminino , Hemorragia/etiologia , Humanos , Infecções por Papillomavirus/prevenção & controle , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/etiologia , Estruturas Criadas Cirurgicamente/patologia , Bexiga Urinária Hiperativa/terapia , Infecções Urinárias/etiologia , Prolapso Uterino/terapia , Doenças Vaginais/etiologia
10.
Ann Thorac Surg ; 103(4): e361-e363, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28359499

RESUMO

Occasionally, enteric conduits are unavailable or impractical for esophageal replacement. Cutaneous tubes are rarely employed alternatives that remain useful in specific circumstances. We present the case of a patient with a long standing skin tube complicated by malignancy that was replaced with a new skin tube.


Assuntos
Carcinoma de Células Escamosas/etiologia , Carcinoma de Células Escamosas/cirurgia , Esofagoplastia/efeitos adversos , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/cirurgia , Estruturas Criadas Cirurgicamente/efeitos adversos , Idoso , Carcinoma de Células Escamosas/diagnóstico , Esofagostomia , Humanos , Masculino , Neoplasias Cutâneas/diagnóstico
12.
Dig Surg ; 34(6): 483-488, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28183095

RESUMO

BACKGROUND: Intrathoracic herniation of gastric tube (IHGT) pull-up via the retrosternal route is a rare complication following esophagectomy, which is caused due to an injury in the parietal pleura during a blunt dissection of the retrosternal space. However, little is known regarding the clinical impact of IHGT pull-up via the retrosternal route. PATIENTS AND METHODS: Clinical data of 231 patients receiving gastric tube reconstruction via the retrosternal route following esophagectomy were collected from medical charts. RESULTS: Of the 231 patients, 19 (8%) developed IHGT. Vocal cord palsy, particularly with delayed onset, developed at a significantly high frequency in the group of patients with IHGT. There were no significant differences in the frequency of other surgical complications. CONCLUSION: This is the first report to examine the clinical impact of IHGT pull-up via the retrosternal route. Vocal cord palsy, particularly with delayed onset, developed in the group of patients with IHGT. Therefore, when reconstruction is performed via the retrosternal route, it is very important that blunt and blind dissection of the retrosternal space be performed with extreme care to prevent pleural injury.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Esofagoplastia/efeitos adversos , Hérnia/etiologia , Gastropatias/etiologia , Estômago/cirurgia , Estruturas Criadas Cirurgicamente/efeitos adversos , Paralisia das Pregas Vocais/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Esofagoplastia/métodos , Feminino , Hérnia/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Gastropatias/diagnóstico por imagem , Cavidade Torácica
13.
Int Urol Nephrol ; 49(1): 49-53, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27785747

RESUMO

PURPOSE: To evaluate the necessity of chronic alkali therapy in non-complicated orthotopic ileal neobladders with normal renal function. MATERIALS AND METHODS: This is a prospective study that included 200 male patients who underwent radical cystectomy and ileal W neobladder for invasive bladder carcinoma between January 1993 and December 2013. The studied patients included 100 consecutive patients who were maintained on regular alkali therapy since surgery and 100 consecutive patients who stopped the use of alkali treatment after initial 3 months postoperative with minimum postoperative observation time of 1 year. All patients had satisfactory function of the reservoirs with normal upper tract. The patients were subjected to blood analysis for creatnine, electrolytes, pH and bicarbonate and urine chemical analysis. The study also included 40 healthy male age-matched volunteers who served as a control group. RESULTS: Both groups were comparable as regard age, BMI, follow-up period and surgical technique. There were no significant differences between both groups as regard serum creatnine, electrolytes blood pH and bicarbonate and the mean values were within normal range; however, the neobladder patients are still toward the acidotic side in comparison to healthy volunteers. Also there were no significant differences between both groups of patients as regard urine pH and excretion of electrolytes, calcium, phosphorus and creatnine. CONCLUSION: Patients with non-complicated ileal neobladders with normal upper tract who were not maintained on alkali prophylaxis for long period have a compensated acid base status. Therefore, the prolonged alkali prophylaxis is not mandatory.


Assuntos
Acidose/prevenção & controle , Carcinoma/cirurgia , Bicarbonato de Sódio/administração & dosagem , Estruturas Criadas Cirurgicamente/efeitos adversos , Neoplasias da Bexiga Urinária/cirurgia , Bexiga Urinária/cirurgia , Derivação Urinária/efeitos adversos , Acidose/sangue , Acidose/etiologia , Idoso , Cistectomia , Seguimentos , Humanos , Concentração de Íons de Hidrogênio , Íleo/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Bicarbonato de Sódio/sangue , Urinálise
14.
Medicine (Baltimore) ; 95(36): e4838, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27603401

RESUMO

Ileal conduit and neobladder urinary diversions are frequently performed after radical cystectomy. However, complications after radical cystectomy may be different according to the type of urinary diversion. Acute kidney injury (AKI) is a common complication after surgery and increases costs, morbidity, and mortality of hospitalized patients. This study was performed to compare the incidence of postoperative AKI between ileal conduit and neobladder urinary diversions after radical cystectomy.All consecutive patients who underwent radical cystectomy in 2004 to 2014 in a single tertiary care center were identified. The patients were divided into the ileal conduit and ileal neobladder groups. Preoperative variables, including demographics, cancer-related data and laboratory values, as well as intraoperative data and postoperative outcomes, including AKI, intensive care unit admission rate, and the duration of hospital stay, were evaluated between the groups. Postoperative AKI was defined according to the Kidney Disease: Improving Global Outcome criteria. Propensity score matching analysis was performed to reduce the influence of possible confounding variables and adjust for intergroup differences.After performing 1:1 propensity score matching, the ileal conduit and ileal neobladder groups each included 101 patients. The overall incidence of AKI after radical cystectomy was 30.7% (62 out of 202) and the incidences did not significantly differ between the groups (27 [26.7%], ileal conduit group vs 35 [34.7%], ileal neobladder group, P = 0.268). Intraoperative data, intensive care unit admission rate, and the duration of hospital stay were not significantly different between the groups.Postoperative AKI did not significantly differ between ileal conduit and neobladder urinary diversions after radical cystectomy. This finding provides additional information useful for appropriate selection of the urinary diversion type in conjunction with radical cystectomy.


Assuntos
Lesão Renal Aguda/etiologia , Cistectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Estruturas Criadas Cirurgicamente/efeitos adversos , Bexiga Urinária/cirurgia , Derivação Urinária/efeitos adversos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos
15.
Klin Monbl Augenheilkd ; 233(6): 722-6, 2016 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-27315293

RESUMO

BACKGROUND AND PURPOSE: Implantation of intracorneal ring segments (ICRS) using a femtosecond laser is a minimally invasive procedure which represents a reliable option to widen the spectrum of the stage-related therapy of keratoconus in patients with contact lens intolerance, or with post-LASIK-keratectasia or pellucide marginale degeneration (PMD). METHODS: From August 2011 to September 2015, 84 eyes of 69 patients were implanted with ICRS. 74 eyes were implanted with INTACS-SK (Intacs, Addition Technology, Inc.), and 10 eyes were implanted with KeraRing SI6 (Mediaphacos Ltda.). The indication is taken in the presence of a clear central cornea and the patients had to fulfill the corneal diagnostic tests required for implantation. Tunnel creation should nowadays only be carried out by femtosecond laser, in order to avoid intra- and postoperative complications. RESULTS: Three months after surgery, the INTACS-SK group showed an increase in uncorrected distance visual acuity (logMAR) from 0.99 ± 0.35 to 0.29 ± 0.17. The KeraRing SI6 group showed an increase in uncorrected distance visual acuity (logMAR) from 0.93 ± 0.4 to 0.41 ± 0.34. The keratometric values were reduced in both groups. CONCLUSION: Uncorrected and corrected distance visual acuity can be improved by implantation of the ICRS. Progression of ectasia seems to be retarded. Consistent follow-up visits at close intervals are necessary to identify complications at an early stage. However, larger case series and a longer postoperative observation period are required. Complications after ICRS implantation are rare, due to strict patient selection and modern surgical techniques.


Assuntos
Transplante de Córnea/efeitos adversos , Transplante de Córnea/métodos , Ceratocone/diagnóstico , Ceratocone/cirurgia , Próteses e Implantes , Transtornos da Visão/prevenção & controle , Medicina Baseada em Evidências , Feminino , Humanos , Ceratocone/complicações , Masculino , Pessoa de Meia-Idade , Implantação de Prótese/efeitos adversos , Implantação de Prótese/métodos , Estruturas Criadas Cirurgicamente/efeitos adversos , Resultado do Tratamento , Transtornos da Visão/diagnóstico , Transtornos da Visão/etiologia , Acuidade Visual
16.
Eur Urol ; 69(2): 247-53, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26164417

RESUMO

BACKGROUND: Intracorporeal orthotopic neobladder (iONB) creation following robotic radical cystectomy is an emerging procedure and robust functional data are required. OBJECTIVE: To evaluate urodynamic features of iONB and bladder cancer-specific and general health-related quality-of-life (HRQOL) outcomes. DESIGN, SETTING, AND PARTICIPANTS: We retrospectively assessed 28 men who underwent iONB creation (January 2012 to October 2013) and compared results to a previously characterized cohort of 79 of open ONB procedures. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: iONB pressure-volume properties were characterized using multichannel urodynamics (UDS). The Bladder Cancer Index (BCI) questionnaire, modified with mucus- and pad-related questions, and the Short Form Health Survey (SF-36) were used to evaluate urinary function and HRQOL. ONB cohorts were compared for functional outcomes and BCI score. Multivariable linear regression was used to assess predictors of BCI score. RESULTS AND LIMITATIONS: The median follow-up was 9.4 mo for the iONB and 62.1 mo for the open ONB group (p<0.0001); ≥2-yr follow-up had been completed for one (4%) patient in the iONB group compared to 75 (95%) patients in the open ONB group (p<0.0001). In UDS tests, the iONB group had minimal postvoid residual volume, normal compliance, and a mean capacity of 514 cm(3) (range 339-1001). BCI mean scores for urinary function (p=0.58) and urinary bother (p=0.31) were comparable between the groups. The surgical approach was not associated with the BCI score on multivariable analysis. Rates of 24-h pad use were comparable between iONB and open ONB groups (pad-free 17% vs. 19%; ≤2 pads 84% vs. 79%), as reflected by total pad usage (p=0.1); pad size and daytime wetness were worse in the iONB group. The clean intermittent catheterization rate was 10.7% in the iONB and 6.3% in the open ONB group. Limitations include the retrospective comparison, small number of patients and short follow-up for the iONB group. CONCLUSIONS: iONB had adequate UDS characteristics and comparable bladder cancer-specific HRQOL scores to open ONB. However, pad size and daytime wetness were worse for iONB, albeit over significantly shorter follow-up. PATIENT SUMMARY: We demonstrate that the volumetric and pressure characteristics are acceptable for a neobladder created using an entirely robot-assisted laparoscopic technique after bladder removal for cancer. Urinary function and quality-of-life outcomes related to the robotic technique were compared to those for neobladders created via an open surgical technique. We found that urinary function and bother indices were comparable; however, the robotic group required larger incontinence pads that were wetter during the daytime. This may be explained by the significantly shorter duration of recovery after surgery in the robotic group.


Assuntos
Procedimentos Cirúrgicos Robóticos , Estruturas Criadas Cirurgicamente/patologia , Estruturas Criadas Cirurgicamente/fisiologia , Neoplasias da Bexiga Urinária/cirurgia , Bexiga Urinária/patologia , Bexiga Urinária/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Complacência (Medida de Distensibilidade) , Cistectomia , Humanos , Tampões Absorventes para a Incontinência Urinária , Cateterismo Uretral Intermitente , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Qualidade de Vida , Estudos Retrospectivos , Estruturas Criadas Cirurgicamente/efeitos adversos , Bexiga Urinária/cirurgia , Incontinência Urinária/etiologia , Micção , Urodinâmica
17.
Int Urogynecol J ; 27(2): 315-6, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26179551

RESUMO

Surgical creation of a neovagina using the sigmoid was one of the main techniques used in patients with Mayer-Rokinatsky-Küster-Hauser syndrome. Nowadays, this surgery is not common as a result of the high frequency of complications and adverse outcomes, one of which is sigmoid neovagina prolapse. There are no standards of treatment because of the rarity of these clinical events; therefore, any medical case is important. We present a case report of a 72-year-old patient with prolapse of the sigmoid stump. Perscrutation of this example allows us to conclude that laparoscopic sacrocolpopexy is the optimal operation for patients with apical prolapse and a history of sigmoidal colpopoiesis owing to its high level of safety and excellent outcomes.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Estruturas Criadas Cirurgicamente/efeitos adversos , Vagina/cirurgia , Transtornos 46, XX do Desenvolvimento Sexual/cirurgia , Idoso , Colo Sigmoide/transplante , Anormalidades Congênitas/cirurgia , Feminino , Humanos , Laparoscopia , Ductos Paramesonéfricos/anormalidades , Ductos Paramesonéfricos/cirurgia , Prolapso de Órgão Pélvico/etiologia
18.
Eur Urol ; 69(4): 704-709, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26463317

RESUMO

BACKGROUND: Robotic assisted radical cystectomy (RARC) is increasingly being adopted, but intracorporeal neobladder formation remains a challenging procedure limited to selected centers. Common challenges with intracorporeal neobladder formation relate to fashioning a tension-free urethro-ileal anastomosis. In this paper, we describe a series of maneuvers to overcome these challenges that we believe will be of great utility to surgeons performing intracorporeal neobladder. OBJECTIVE: To describe maneuvers to overcome challenges during intracorporeal urethro-ileal anastomosis formation and to report postoperative outcomes for patients in whom these maneuvers were used. DESIGN, SETTING, AND PARTICIPANTS: A retrospective review of medical records of patients who underwent RARC with intracorporeal neobladder performed by one surgeon (G.-P.H.) at our tertiary center from January 2012 to February 2015 in which at least one additional maneuver was required beyond preservation of urethral length, removal of the sigmoid colon from the pelvis, and careful ileal loop selection. The primary end point was 90-d complications. Follow-up ranged from 6 to 36 mo, and 16 patients had at least 1-yr follow-up. SURGICAL PROCEDURE: RARC with intracorporeal neobladder formation. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSES: Clinical and operative data collected from a prospectively maintained, institutional review board-approved database. Maneuvers used during intracorporeal urethro-ileal anastomosis were recorded. Descriptive statistics were used to evaluate postoperative outcomes. RESULTS AND LIMITATIONS: Nineteen patients met the inclusion criteria. Mean operative time was 486 min (standard deviation: 112 min) with median hospitalization of 7 d (interquartile range: 7-9 d). Seven patients (36.8%) experienced a complication, with one (5.3%) major complication thought to be unrelated to surgery. No open conversions were required. There was no 90-d mortality. CONCLUSIONS: Our stepwise approach can help overcome challenges of urethro-ileal anastomosis during intracorporeal neobladder formation. PATIENT SUMMARY: When performing intracorporeal neobladder formation, challenges are often encountered in fashioning the urethro-ileal anastomosis. We describe a series of maneuvers that, when used in a stepwise manner, help overcome these challenges.


Assuntos
Cistectomia/métodos , Íleo/cirurgia , Procedimentos Cirúrgicos Robóticos , Estruturas Criadas Cirurgicamente , Uretra/cirurgia , Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Adulto , Idoso , Anastomose Cirúrgica , Cistectomia/efeitos adversos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Ohio , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Estruturas Criadas Cirurgicamente/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Derivação Urinária/efeitos adversos
19.
Can J Urol ; 22(6): 8112-4, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26688144

RESUMO

Orthotopic ileal neobladder has been frequently performed as urinary diversion after cystectomy over the last decades. We report an unusual complication of very large calculi in a Studer ileal neobladder. Due to its size, open cystolithotomy was performed.


Assuntos
Estruturas Criadas Cirurgicamente/efeitos adversos , Cálculos da Bexiga Urinária/cirurgia , Bexiga Urinária/cirurgia , Cistectomia , Humanos , Masculino , Pessoa de Meia-Idade , Cálculos da Bexiga Urinária/etiologia
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