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1.
BMC Surg ; 21(1): 179, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33810794

RESUMO

BACKGROUND: Postoperative rectourethral fistula (RUF) in patients with congenital anorectal malformation (ARM) remains a challenge for paediatric surgeons, among them persistent fistula is the most common. Various techniques have been proposed, only a few reports based on different causes are available, and there is no consensus so far. This study is to evaluate the application, advantages and limitations of transanal fistulectomy approach in repairing persistent RUF in ARM patients. METHODS: From January 2007 to July 2019, 78 ARM patients who received revisional surgery for RUF were reviewed, 34 persistent fistulas were identified. Examination under anaesthesia included patients with fistulas that were located within 3 cm from the anus verge, good appearance of the anus and sphincter function, and no urethral and rectoanal obstruction. Three patients were excluded because of complex urologic pathologic defects. In total, thirty-one patients underwent transanal fistulectomy to repair RUF. RESULTS: All cases were approached with transanal incision and fistulectomy to repair RUF. The average operative time was 91 ± 35 min. At a minimum six-month follow-up, 29 patients healed after the first attempt, the success closure rate was 93.5%. Two patients received redo transanal fistulectomy and healed. Two patients had postoperative complications: one patient had urethral stenosis and it was managed by dilation; one patient had urethral diverticulum but it did not require revisional surgery. No patient in this study was incontinent because of the surgery. CONCLUSIONS: Transanal fistulectomy provides a simple, straightforward, and safe approach to repair persistent RUF in ARM patients, especially in those with a low-lying fistula, good anus appearance and sphincter function without obstruction in the rectum or urethra. TRIAL REGISTRATION: Retrospectively registered.


Assuntos
Malformações Anorretais/cirurgia , Fístula Retal/cirurgia , Doenças Uretrais/cirurgia , Fístula Urinária/cirurgia , Criança , Humanos , Masculino , Resultado do Tratamento , Uretra/cirurgia , Doenças Uretrais/etiologia , Fístula Urinária/etiologia
2.
Urologiia ; (1): 13-20, 2021 Mar.
Artigo em Russo | MEDLINE | ID: mdl-33818929

RESUMO

AIM: Studies on non-obstetric urogenital fistula provide limited information on predictive factors. The aim of our study was to specify and to analyze the predictors for long-term anatomical and functional results in women with non-obstetric urogenital fistula. MATERIALS AND METHODS: A cross-section study of surgical repair for non-obstetric urogenital fistula repairs was carried out. From 2012 to 2018, a total of 446 patients with urogenital fistulas were treated in two tertiary centers. Patients with vesicovaginal and urethrovaginal fistulas with at least 12 months of follow-up were identified and contacted by phone and/or examined in the clinic. Anatomical outcome was assessed by resolution of symptoms and/or results of clinical examination. Urinary distress inventory (UDI-6) was used for the measurement of functional outcomes. The nomogram is based on a multiple regression equation, the solution of which is performed using a computer. The nomogram is presented as a set of scales, each of which corresponds to a certain variable. The baseline parameter is assigned certain points, depending on its value, then the sum of all parameters is calculated. As a result, it is possible to determine the risk using a couple or three scales. RESULTS: Overall, 169 patients were studied (mean age of 49.2, mean follow-up of 34 months). The most common cause of fistulas included hysterectomy (69.4%), followed by pelvic radiotherapy (18.9%). Only 64% of cases were primary fistula. Closure rate was 90.7% (98/108). Anatomical success depended on the surgical approach. For transvesical procedure, success rate was 89.4% (42/47), compared to 84% (89/106) and 87.5% (14/16), respectively for transvaginal and transabdominal success rate. According to Clavien-Dindo, complications were grade 1 (11.8%) and grade 2 (4.7%). As UDI-6 showed, the most common symptoms were frequency (62%), urgency (50%), incontinence (73%), pain (55%) and voiding symptoms (27%). Fistula size > 3.0 cm, pelvic radiation, and previous vaginal surgeries were associated with a higher risk of failure or more severe lower urinary tract symptoms. A high number of re-do cases and complex fistulas could be a limitation of this study. Factors for successful non-obstetric urogenital fistula closure were fistula size less than 3.0 cm, absence of pelvic radiation, and previous vaginal surgeries. CONCLUSION: According to our results, only fistula size > 3 cm, previous vaginal procedures and pelvis irradiation were unfavorable predictors for anatomic success of fistula repair. In addition, our results allow to determine the predictors for successful repair and risk of recurrence lower urinary tract symptoms postoperatively.


Assuntos
Doenças Uretrais , Fístula Urinária , Fístula Vesicovaginal , Pré-Escolar , Feminino , Humanos , Nomogramas , Resultado do Tratamento , Fístula Urinária/diagnóstico , Fístula Urinária/cirurgia , Fístula Vesicovaginal/diagnóstico , Fístula Vesicovaginal/cirurgia
3.
Urol Clin North Am ; 48(1): 103-112, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218584

RESUMO

Lower urinary tract reconstruction has traditionally been approached in an open fashion but select complications or disease processes may be suitable for robotic reconstruction, including bladder neck contractures, proximal urethral strictures, and genitourinary fistulas. Here, the authors discuss the novel techniques used and the feasibility of robotic reconstruction for these conditions. The robotic approach is relatively novel, and more data and studies will be required to make definitive statements regarding success rate and complications from the procedure. Preliminary data suggest that the robotic approach may offer comparable success compared with open techniques.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Uretra/cirurgia , Doenças Uretrais/cirurgia , Doenças da Bexiga Urinária/cirurgia , Bexiga Urinária/cirurgia , Humanos , Obstrução Uretral/cirurgia , Fístula Urinária/cirurgia
4.
Arch Esp Urol ; 73(9): 852-856, 2020 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33144540

RESUMO

OBJECTIVE: The recto-vesical fistula (FRV) that follows a radical prostatectomy is an unusual complication and involves a difficult management. A wide variety of surgical aggressive repair techniques are described in literature, including end-colostomy. Furthermore, non-invasive procedures are barely documented. We present 2 cases with an early diagnosis of postoperative FRV resolved with minimally invasive treatment, with the aim to place theset echniques in the therapeutic range. MATERIAL AND METHODS: In both two cases, the diagnosis of VRF was clinical and radiological. First symptoms occurred heterogeneously since one of the fistulas was secondary to rectal perforation and second was evident after removing the bladder catheter in a uneventful postoperative period. Exploration techniques showed low diameter fistulous orifices in both cases. The conservative treatment consisted in the use of transrectal endoscopic approach and minimally invasive techniques for the closure of the fistulous orifice and a prolonged use of the bladder catheter. RESULTS: The two patients were followed up at least 36 months, confirming the resolution of the recto-vesical fistula by cystography and CT. During the follow-up, no patient has required symptomatic treatment or other specific care up to date. CONCLUSIONS: The conservative treatment of the VRF constitutes a non-aggressive alternative to the series of complex surgeries currently used to repair this iatrogenic pathology. The endoscopic closure of iatrogenic fistulas should be claimed as a therapeutic opportunity, although, more experience is needed to state this treatment as a gold standard technique.


Assuntos
Fístula Retal , Fístula da Bexiga Urinária , Fístula Urinária , Humanos , Masculino , Próstata , Prostatectomia , Fístula Retal/etiologia , Fístula Retal/cirurgia , Reto , Fístula da Bexiga Urinária/etiologia , Fístula da Bexiga Urinária/cirurgia , Fístula Urinária/etiologia , Fístula Urinária/cirurgia
5.
Actas urol. esp ; 44(9): 630-636, nov. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-198087

RESUMO

INTRODUCCIÓN: El cáncer de próstata (CP) es el segundo cáncer más frecuente del mundo y en los varones. Se estima que la incidencia crezca a 1,7 millones de casos nuevos y 499.000 nuevas muertes en 2030. El tratamiento del cáncer de próstata organoconfinado (CPOC) puede afectar a un individuo tanto física como mentalmente, así como sus relaciones cercanas y su trabajo o vocación, lo cual condiciona la calidad de vida (CV) relacionada con la salud. OBJETIVO: Conocer el impacto en la CV atribuible al tratamiento del CPOC. MATERIALES Y MÉTODOS: Es un estudio observacional multicéntrico de carácter prospectivo de 406 pacientes con CPOC tratados desde enero del año 2015 hasta junio del 2018. La muestra se dividió en cuatro grupos de estudio (GA, GB, GC y GD), correspondientes a los distintos métodos de abordaje quirúrgico: prostatectomía radical (PR), radioterapia externa (RTE), braquiterapia (BT) y diferente a monoterapia con alguno de los otros, respectivamente. RESULTADOS: La edad en el GC fue inferior, la media del antígeno prostático específico (PSA, prostatic specific antigen) de todos los pacientes fue 8,13 ng/ml, el grupo de mayor media de PSA fue el GB con 10,43 ng/dL, la media del estadio tumoral (TNM,) fue 3,82, la CV postratamiento en GD fue inferior respecto a los demás grupos. CONCLUSIÓN: El tratamiento del CPOC afecta la CV La monoterapia curativa, concretamente la PR y la BT, afectan menos a la CV que la radioterapia externa u otras alternativas terapéuticas. La incontinencia urinaria y las fístulas secundarias al tratamiento del CPOC son las que producen más deterioro en la CV. El cuestionario SF 36 validado internacionalmente es una medida transversal de la CV, útil para comparar el impacto de los tratamientos del CPOC


INTRODUCTION: Prostate cancer (PCa) is the second most common male cancer in the world. Its incidence is estimated to grow to 1.7 million new cases and 499,000 new deaths by 2030. Treatment of OCPC can affect patients physically and mentally, as well as their close relationships and their job or career, which conditions health-related quality of life (QoL). OBJECTIVE: Evaluate the impact on QoL attributable to the treatment for Organ Confined Prostate Cancer (OCPC). MATERIALS AND METHODS: Prospective multicenter observational study of 406 patients with OCPC treated from January 2015 to June 2018. The sample was divided into four study groups, according to the type of treatment: radical prostatectomy (RP) (GA), external radiotherapy (ERT) (GB), brachytherapy (BT) (GC) and other treatments different from monotherapy with RP, ERT or BT (GD). RESULTS: The age in GC was lower, the mean Prostate Specific Antigen (PSA) of all patients was 8.13 ng/ml, the group with the highest mean PSA was GB with a mean of 10.43 ng/dL, the mean Tumor Stage (TNM) was 3.82, and GD had the lowest post treatment quality of life. CONCLUSION: OCPC treatment affects QoL. Curative monotherapies, specifically RP and BT, have less effect on QoL than external radiotherapy or other therapeutic alternatives. Urinary incontinence and fistulas secondary to OCPC have the highest impact on QOL impairment. The internationally validated SF 36 questionnaire is a useful cross-sectional measure of QOL to compare the impact of OCPC treatment modalities


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Qualidade de Vida , Neoplasias da Próstata/fisiopatologia , Neoplasias da Próstata/terapia , Neoplasias da Próstata/complicações , Inquéritos e Questionários , Análise de Variância , Estatísticas não Paramétricas , Resultado do Tratamento , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/fisiopatologia , Fístula da Bexiga Urinária/etiologia , Fístula da Bexiga Urinária/fisiopatologia , Fístula Retal/etiologia , Fístula Retal/fisiopatologia , Fístula Urinária/etiologia , Fístula Urinária/fisiopatologia , Fatores de Risco , Prostatectomia/efeitos adversos
8.
Hinyokika Kiyo ; 66(9): 319-321, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-32988170

RESUMO

A 66-year-old male with bladder cancer underwent radical cystectomy and ileal conduit construction. The pathological diagnosis was urothelial carcinoma with squamous differentiation (pT3b). Computed tomography (CT) 18 months postoperatively revealed a right external iliac lymph node metastasis. He was treated with systemic chemotherapy after placement of bilateral ureteral stents, but CT following chemotherapy revealed an increase in the size of the metastasis, and the patient was diagnosed with progressive disease. Radiotherapy to the metastasis was selected as local therapy, but the patient was at risk of an uretero-arterial fistula because the right external iliac artery and the right ureter adjacent to the metastasis were involved in the irradiated field. The right external iliac lymph node metastasis was irradiated with a dose of 50 Gy after stent grafting for the right external iliac artery to prevent an ureteroarterial fistula. He had no adverse events, including hematuria after radiotherapy, but died of cancer cachexia 12 months after radiotherapy.


Assuntos
Ureter , Doenças Ureterais , Neoplasias da Bexiga Urinária/radioterapia , Fístula Urinária/etiologia , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/etiologia , Idoso , Humanos , Masculino , Stents
10.
Prog Urol ; 30(3): 155-161, 2020 Mar.
Artigo em Francês | MEDLINE | ID: mdl-32122748

RESUMO

INTRODUCTION: Urinary complications after kidney transplantation are common and can compromise renal function. While they are mainly attributed to ischemic lesions of the ureter, there is no existing method to evaluate its vascularization during surgery. The aim of the study was to evaluate if indocyanine green, revealed by infra-red light andused to visualize tissue perfusion, could provide an appreciation of the ureter's vascularization during kidney transplantation. METHODS: This feasibility study was conducted over one month, on eleven consecutive kidney transplants. During transplantation, an injection of indocyanine green enabled the surgeon to visualize in real time with an infra-red camera the ureter fluorescence. Its intensity was reported on a qualitative and semi-quantitative scale. Occurrence of urinary complications such as stenosis or ureteral fistula were collected during 6 months. RESULTS: In all of the 11 cases (100%), the last centimeters of the ureters were not fluorescent. Three (27%) ureters were poorly or partiallly fluorescent. Out of these three cases, only one case of urinary fistula occurred, followed by ureteric stenosis. In the series, two fistulas (18%) and two ureteric stenoses (18%) occurred. No side effects were observed. The low number of events did not allow statistical analysis. CONCLUSION: Infra-red fluorescence of indocyanine green could be a simple and innovative way to appreciate the transplant's ureteric vascularization during kidney transplantation. It could help surgeons to identify the level of ureter section and to decide the anastomosis technique, in order to limit urinary complications. LEVEL OF EVIDENCE: 3.


Assuntos
Transplante de Rim , Ureter/diagnóstico por imagem , Fístula Urinária/diagnóstico por imagem , Doenças Urológicas/diagnóstico por imagem , Adulto , Idoso , Estudos de Viabilidade , Feminino , Fluorescência , Corantes Fluorescentes , Humanos , Verde de Indocianina , Masculino , Pessoa de Meia-Idade , Doenças Ureterais/diagnóstico por imagem , Doenças Ureterais/etiologia , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/etiologia , Fístula Urinária/etiologia , Doenças Urológicas/etiologia
11.
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
12.
BMJ Case Rep ; 13(1)2020 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-31907214

RESUMO

We report a case of iatrogenic rectourethral fistula (RUF) in an elderly man with benign prostatic enlargement and acute urinary retention, following a transurethral resection of prostate (TURP). This patient presented a unique challenge of tackling the RUF in the presence of a large residual prostate gland and urinary tract infection. RUF was repaired only after getting the access to the fistula following transvesical prostatectomy. Follow-up imaging showed well-healed repair of RUF. Transvesical prostatectomy is a useful adjunctive procedure in repair of RUF when associated with a large prostate. This case also highlights the importance of technique selection while planning for surgery on large prostate glands. TURP is not the preferred first modality of choice for larger glands as noted in this case.


Assuntos
Complicações Pós-Operatórias/cirurgia , Hiperplasia Prostática/cirurgia , Fístula Retal/cirurgia , Ressecção Transuretral da Próstata/efeitos adversos , Fístula Urinária/cirurgia , Idoso , Humanos , Doença Iatrogênica , Masculino , Hiperplasia Prostática/diagnóstico por imagem , Fístula Retal/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Fístula Urinária/diagnóstico por imagem
13.
Updates Surg ; 72(1): 205-211, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31927754

RESUMO

Recto-vaginal (RVF) and recto-urethral (RUF) fistulas are infrequent but disabling conditions that severely affect patients' quality of life. Considering the high recurrence rate after conservative approaches, the best surgical treatment is still challenging. The aim of this study was to evaluate the outcome of graciloplasty to treat patients with complex RVF or RUF, and to investigate its effect on the quality of life. Fourteen patients with RVF and RUF who underwent graciloplasty between 2003 and 2017 were retrospectively enrolled. The main outcome was the healing rate of fistulas. Postoperative patients satisfaction was evaluated administering the Clinical Patient Grading Assessment Scale (CPGAS), SF-36 questionnaires and Changes in Sexual Functioning (CSF) questionnaires. The Wexner score was calculated in case of preoperative faecal incontinence. RVF and RUF were iatrogenic in 11 patients and due to Crohn's disease in 3 cases. After 1 year of follow-up (IQR 10-14 months), the success rate of the procedure was 78%. Out of three patients with RVF due to Crohn's disease, two healed after the procedure. Six months after surgery, all eight SF-36 domains significantly improved except for "body pain"; CSF score significantly increased from 35.5 (IQR 31-38.7) to 44 (IQR 37.7-48.5); CPGAS score improved from a median value of 0 (IQR 0-0) to 4 (IQR 3.2-4). The Wexner score was calculated only in 5 patients with preoperative faecal incontinence and it significantly decreased from a median value of 12 (IQR 11-14) to 5 (IQR 4-5). Graciloplasty could be considered as a first option treatment for complex or recurrent RVF and RUF. It shows a good healing rate even in case of unfavourable factors like Crohn's disease.


Assuntos
Fístula/fisiopatologia , Fístula/cirurgia , Qualidade de Vida , Recuperação de Função Fisiológica , Doenças Retais/fisiopatologia , Doenças Retais/cirurgia , Doenças Uretrais/fisiopatologia , Doenças Uretrais/cirurgia , Fístula Urinária/fisiopatologia , Fístula Urinária/cirurgia , Procedimentos Cirúrgicos Urogenitais/métodos , Doenças Vaginais/fisiopatologia , Doenças Vaginais/cirurgia , Feminino , Humanos , Masculino , Satisfação do Paciente , Inquéritos e Questionários , Resultado do Tratamento
14.
BJOG ; 127(7): 897-904, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31961472

RESUMO

OBJECTIVE: To describe and compare baseline renal anatomy and renal function in patients with obstetric fistulas, and to evaluate whether preoperative renal testing and imaging may aid with operative decision making. DESIGN: A prospective cohort study. SETTING: Fistula Care Centre in Malawi. POPULATION: Women with an obstetric fistula. METHODS: Baseline creatinine testing and renal ultrasounds were performed. Surgeons completed a short questionnaire on the usefulness of creatinine and renal ultrasound on operative decision making. MAIN OUTCOME MEASURES: Baseline creatinine and renal ultrasound findings. RESULTS: Four surgeons performed operations on 85 patients. The mean creatinine in patients with vesicovaginal fistulas (VVF) was 0.60 ng/ml versus patients with uretero-vaginal fistulas (UVF) (0.79 ng/ml, P = 0.012). When a grade 3 or more hydronephrosis is absent on renal ultrasound, the negative predictive value of the presence of UVF is 93.3% (95% confidence interval [CI] 88.6-96.2) with a specificity of 97.2% (95% CI 90.3-99.6). In cases of UVF, surgeons found the renal ultrasound results useful or very useful 87.5% of the time, and the creatinine useful or very useful 75% of the time. CONCLUSION: In this pilot study, most patients with obstetric fistulas presented with a normal creatinine. In the absence of a grade 3 hydronephrosis or above on renal ultrasound, the probability of not having a UVF is 93.3%. Surgeons should consider performing preoperative renal ultrasound testing in all patients with an obstetric fistula, particularly in women with a prior laparotomy, as this population has risk factors for ureterovaginal fistula. TWEETABLE ABSTRACT: Most patients with obstetric fistulas have normal renal function. Preoperative renal ultrasounds should be performed.


Assuntos
Rim/diagnóstico por imagem , Complicações do Trabalho de Parto , Fístula Urinária , Fístula Vesicovaginal , Adulto , Feminino , Humanos , Testes de Função Renal/métodos , Malaui/epidemiologia , Complicações do Trabalho de Parto/diagnóstico , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Gravidez , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/normas , Estudos Prospectivos , Melhoria de Qualidade , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/métodos , Ultrassonografia/métodos , Fístula Urinária/diagnóstico , Fístula Urinária/epidemiologia , Fístula Urinária/etiologia , Fístula Urinária/cirurgia , Fístula Vesicovaginal/epidemiologia , Fístula Vesicovaginal/etiologia , Fístula Vesicovaginal/cirurgia
16.
Urology ; 136: e5-e6, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31726183

RESUMO

As gender-affirming genital surgery for transgender men becomes more common, general urologists may be confronted with unfamiliar anatomy and complications. We describe the use of voiding cystourethrogram and retrograde urethrogram in a transgender man in demonstrating the anatomy of the urethra, urethrocutaneous fistula, and a vaginal remnant after phalloplasty.


Assuntos
Fístula Cutânea/diagnóstico por imagem , Cistografia , Pênis/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Cirurgia de Readequação Sexual/métodos , Doenças Uretrais/diagnóstico por imagem , Fístula Urinária/diagnóstico por imagem , Vagina/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
17.
Urology ; 137: 152-156, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31883881

RESUMO

OBJECTIVE: To evaluate the efficacy and safety of supracostal percutaneous nephrolithotomy (PCNL) through the 11th intercostal space and compare it with subcostal PCNL in children with renal calculi. MATERIALS AND METHODS: Children with renal calculi who underwent PCNL between January 2010 and December 2017 were divided into 2 groups: supracostal PCNL (group 1) and subcostal PCNL (group 2). Stone location, stone burden, location of the access points, operative time, postoperative visual pain score, success rate, hospital stay, and complications according to the modified Clavien classification were compared. Comparison of medians was done using Mann Whitney U test and the means were compared using t test. RESULTS: Group 1 had 50 patients while group 2 had 60 patients. The stone-free rate was 84.0% and 85.0% in groups 1 and 2, respectively after 1 session of PCNL (P = .885). After auxiliary procedures, it increased to 96.0% and 96.6%, respectively (P = .852). The mean fall in hematocrit was 0.9% in group 1 and 1.5% in group 2 (P = .11) whereas the median pain score was 4 in group 1 and 3 in group 2 (P = .37). In all, 54 complications were recorded the commonest among which were grade I (81.5%). Twenty-nine complications were observed in group 1 while 25 complications were observed in group 2 (P = .088). One patient developed nephropleural fistula while another patient developed hydropneumothorax. Both belonged to group 1. CONCLUSION: Supracostal access for PCNL is an effective and safe alternative to subcostal access for children with renal calculi in terms of stone-free rate and complications.


Assuntos
Hidropneumotórax , Cálculos Renais , Nefrolitotomia Percutânea , Complicações Pós-Operatórias/diagnóstico , Fístula Urinária , Criança , Feminino , Humanos , Hidropneumotórax/diagnóstico , Hidropneumotórax/etiologia , Índia/epidemiologia , Cálculos Renais/diagnóstico , Cálculos Renais/epidemiologia , Cálculos Renais/cirurgia , Tempo de Internação/estatística & dados numéricos , Masculino , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/métodos , Duração da Cirurgia , Resultado do Tratamento , Fístula Urinária/diagnóstico , Fístula Urinária/etiologia
18.
J Laparoendosc Adv Surg Tech A ; 30(3): 350-354, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30277838

RESUMO

Aim: This study aimed to compare the surgical outcomes of patients with the intermediate-type imperforate anus who underwent laparoscopically assisted anorectoplasty (LAARP; L group) with those of patients who underwent sacroperineal anorectoplasty (S group). Materials and Methods: The medical records of patients with intermediate-type imperforate anus at a single institution between April 1983 and April 2017 were retrospectively reviewed. Fecal continence was evaluated using the clinical assessment score for fecal continence developed by the Japanese Study Group of Anorectal Anomalies (maximum score, 8). Results: Twelve cases (rectobulbar urethral fistula, 7; anal agenesis without fistula, 4; and rectovaginal fistula, 1) were included in the L group versus 14 cases (rectobulbar urethral fistula, 11, and anal agenesis without fistula, 3) in the S group. Age and body weight at the time of surgery and rate of associated anomalies did not differ significantly between the two groups. The total scores for fecal continence 3, 5, and 7 years after anorectoplasty were 4, 5, and 4 points in the L group and 4, 5, and 6 points in the S group, respectively, showing no significant intergroup differences. Mucosal prolapse occurred in 50% of the L group and 29% of the S group (P = .42), but failed rectocutaneous anastomosis and anal stenosis were not identified in either group. Conclusions: Postoperative fecal continence and the incidence of complications after LAARP were comparable with those after sacroperineal anorectoplasty in patients with intermediate-type imperforate anus.


Assuntos
Malformações Anorretais/cirurgia , Anus Imperfurado/cirurgia , Laparoscopia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fístula Retovaginal/cirurgia , Doenças Uretrais/cirurgia , Fístula Urinária/cirurgia , Canal Anal/cirurgia , Anastomose Cirúrgica , Peso Corporal , Incontinência Fecal/epidemiologia , Feminino , Humanos , Lactente , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos
19.
J Invest Surg ; 33(2): 164-171, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30380353

RESUMO

Objective: The aim of this study was to identify a theoretical support for the prevention of urethral fistula following hypospadias repair, by comparing the preputial wound healing process in Sprague-Dawley (SD) rats with and without hypospadias induced by flutamide. Methods: Fifteen pregnant SD rats were randomly divided into three groups. These rats in one group received the androgen receptor antagonist flutamide (25 mg/kg/day) from gestation days 11-17, to establish a rat model of hypospadias for further study of the molecular mechanisms of the hypospadias etiology. The pregnant rats in the control groups were not administered flutamide. The pups from the control and experiment groups underwent an incision on the dorsal prepuce on postnatal day 25 and were sacrificed on postoperative days 3, 7, and 14 to collect penis samples. The penis morphology was examined in all groups. Subsequently, transforming growth factor ß1 (TGF-ß1), α-smooth muscle actin (α-SMactin), and signal transducers and activators of the transcription 3 (STAT3) expression levels in the different groups were measured at the indicated time points postoperatively using qRT-PCR and Western blot. Results: There was less regeneration of the subcutaneous tissue in hypospadias rats than in the sham-operated group (P < 0.05) on postoperative day 3. No differences were found in the regeneration of the subcutaneous tissue between these groups on postoperative days 7 or 14. Additionally, there were no differences in the epithelial cell regeneration between the control and the hypospadias groups at any postoperative timepoint. Moreover, the expression levels of TGF-ß1, α-SMactin, and STAT3 were all significantly lower in hypospadias group than that in the sham-operated group (P < 0.05). Conclusion: The results from the present work suggest that preputial wound healing is retarded in rats with hypospadias induced by flutamide and that this retardation might result from multi-gene regulation.


Assuntos
Hipospadia/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Doenças Uretrais/prevenção & controle , Fístula Urinária/prevenção & controle , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Antagonistas de Androgênios/toxicidade , Animais , Animais Recém-Nascidos , Modelos Animais de Doenças , Feminino , Flutamida/toxicidade , Regulação da Expressão Gênica/efeitos dos fármacos , Humanos , Hipospadia/etiologia , Masculino , Pênis/anormalidades , Pênis/cirurgia , Complicações Pós-Operatórias/etiologia , Gravidez , Ratos , Ratos Sprague-Dawley , Uretra/anormalidades , Uretra/cirurgia , Doenças Uretrais/etiologia , Fístula Urinária/etiologia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Cicatrização/efeitos dos fármacos , Cicatrização/genética
20.
BMC Urol ; 19(1): 131, 2019 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-31823766

RESUMO

BACKGROUND: The presence of urinary fistula after ileal conduit urinary diversion is a challenging complication, and this study investigated the role of the intra-conduit negative pressure system (NPS) in the presence of urinary fistula following ileal conduit (IC) urinary diversion as a conservative treatment. METHODS: Using the intra-conduit NPS, a minor drainage tube was placed within a silicon tube to suck urine from the conduit with consistent negative pressure. Patients with urinary fistula following IC from August 2012 to July 2017 were recorded, and the clinical characteristics and outcome were retrospectively analyzed. RESULTS: The intra-conduit NPS was used as a primarily conservative treatment for 13 patients who suffered from urinary fistula and presented with a large amount of abdominal/pelvic drainage without other significant morbidities. The median age was 60 years old (42-74 years), and 7patients were male. The median duration between the IC operation and the presence of urinary fistula was 15 days (2-28 days), and elevated creatinine levels were detected in the abdominal/pelvic drainage with a median level of 2114 µmol/L (636-388 µmol/L). A significant decrease in abdominal/pelvic drainage was identified in 12 patients. The median time that the NPS was used was 9 days (7-11 days). The other patient did not show any improvements after 2 days of observation and then underwent open surgery. With ureteral stenting, 2 abdominal drainage tubes and the intra-conduit NPS were placed during operation, no urine leakage was observed in the abdominal/pelvic field, and the patient was cured in 9 days. With a median follow-up of 22 months, no fistula recurrence or hydronephrosis was detected. CONCLUSION: The intra-conduit negative pressure system is a feasible and promising way to cure urinary fistula following ileal conduit urinary diversion. Because this procedure is a mini-invasive and simple approach, it might represent an alternative in selected patients.


Assuntos
Tratamento Conservador/métodos , Drenagem/métodos , Complicações Pós-Operatórias/terapia , Derivação Urinária/efeitos adversos , Fístula Urinária/terapia , Adulto , Idoso , Anastomose Cirúrgica/métodos , Creatinina/sangue , Drenagem/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Estudos Retrospectivos , Stents , Fístula Urinária/sangue
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