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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.
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
3.
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
5.
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
7.
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
8.
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
9.
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
10.
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
11.
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
12.
J Pediatr Urol ; 15(6): 634.e1-634.e6, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31685390

RESUMO

BACKGROUND: Urethrocutaneous fistula UCF is the most common complication following surgical repair of hypospadias. Currently, the surgical technique mostly used to prevent recurrence employs preputial dartos or testicular tunica vaginalis flaps as a urethral covering. However, autologous tissues are limited in patients with multiple surgeries, and the use of biomaterials as a urethral coverage may represent a good alternative. OBJECTIVE: The goal of the present study is to assess the results and complications of recurrent UCF correction using a dermal bovine regeneration sheet as a urethral covering. MATERIALS AND METHOD: From May 2016 to January 2019, all patients with recurrent UCF of the authors center were repaired using this technique. The inclusion criteria were patients who had undergone one or more unsuccessful UCF repair surgeries and the absence of preputial tissue. The informed consent has been signed by all the patients. Patients were examined in outpatient consultations where their urinary stream was evaluated and a physical examination of the penis was conducted. RESULTS: A total of 12 patients and 13 UCFs were included in the study. The median follow-up was 18 months, (range: 4-26), and only two patients (15%) developed a recurrence of UCF. No complications were observed in the remaining patients (85%) during their evolution. No patient developed a fibrosis increase or loss of elasticity of the tissues in contact with the dermal matrix. CONCLUSION: The use of an Integra® sheet as a urethral covering during urethral fistula surgery appears to be a safe, effective, and easily reproducible option. However, prospective studies with larger numbers of patients should be performed to corroborate these results.


Assuntos
Sulfatos de Condroitina , Colágeno , Fístula Cutânea/etiologia , Prepúcio do Pênis/fisiologia , Hipospadia/cirurgia , Regeneração/fisiologia , Fístula Urinária/etiologia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Adolescente , Criança , Pré-Escolar , Fístula Cutânea/diagnóstico , Seguimentos , Humanos , Masculino , Complicações Pós-Operatórias , Estudos Prospectivos , Recidiva , Reoperação , Pele Artificial , Uretra/cirurgia , Fístula Urinária/diagnóstico
13.
Hinyokika Kiyo ; 65(8): 341-345, 2019 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-31501404

RESUMO

In daily medical practice, we occasionally encounter patients with a foreign body in the urinary bladder. However, the identification of such a foreign body in an adolescent and the occurrence of an urethrocutaneous fistula caused by the foreign body are extremely rare. Only two cases have been reported previously. Herein we present a case of a foreign body in the urinary bladder and an urethrocutaneous fistula in a young patient. A 14-year-old boy with fever, left scrotal pain and urinary incontinence was referred to our department. Intravenous pyelography and micturition cystourethrography findings revealed a vesical foreign body and an urethrocutaneous fistula. He mentioned that he had inserted two dozen magnets into the urethra for masturbation one year previously. As the foreign bodies were spherical small magnets, we performed transurethral surgery and successfully removed the magnets. His postoperative course was uneventful and he was discharged from our department on the seventh day after surgery. Three months following surgery, the fistula had closed spontaneously.


Assuntos
Fístula Cutânea , Corpos Estranhos , Fístula Urinária , Adolescente , Fístula Cutânea/etiologia , Humanos , Imãs/efeitos adversos , Masculino , Masturbação , Uretra , Bexiga Urinária , Fístula Urinária/etiologia
14.
Tech Coloproctol ; 23(10): 1003-1007, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31535239

RESUMO

BACKGROUND: Rectourethral fistula (RUF) is a rare but significant complication after radical prostatectomy. Many different approaches have been used, but none of them has become the standard of care. METHODS: We present our series of seven patients treated with a transanal rectal advancement flap plus the injection of mesenchymal stem cells, to facilitate the healing of the fistula. Mesenchymal cells were obtained by a new mechanical device known as LIPOGEMS®. We called this technique RAFAL (rectal advancement flap plus adipose lipofilling). In all patients the RUF was a complication of laparoscopic radical prostatectomy. Fistula size ranged from 0.3 to 0.5 cm (median 0.4 cm). RESULTS: After a median follow-up of 53 months (range 6-163 months), 2 out of 7 patients experienced RUF recurrence. In both cases recurrence was successfully treated by the York-Mason technique in one case and by redo RAFAL in the other. Success rate of RAFAL was 71% (5 of 7). The total success rate of primary RAFAL and redo- RAFAL was 85.7% (6 of 7). No short- or long-term complications were seen. CONCLUSIONS: In our patient population this new procedure was safe and effective.


Assuntos
Transplante de Células-Tronco Mesenquimais/métodos , Complicações Pós-Operatórias/cirurgia , Fístula Retal/cirurgia , Reto/cirurgia , Retalhos Cirúrgicos , Doenças Uretrais/cirurgia , Fístula Urinária/cirurgia , Idoso , Humanos , Masculino , Células-Tronco Mesenquimais , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Prostatectomia/efeitos adversos , Neoplasias da Próstata/cirurgia , Fístula Retal/etiologia , Resultado do Tratamento , Doenças Uretrais/etiologia , Fístula Urinária/etiologia
15.
J Vasc Interv Radiol ; 30(12): 1994-2001, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31530488

RESUMO

PURPOSE: To describe outcomes of transrenal embolization with vascular plugs and ethylene vinyl alcohol (EVOH) in a case series of patients with refractory urinary leak or fistula. MATERIALS AND METHODS: Fifteen ureteral occlusions performed over 53 months in 9 consecutive patients (56% female; mean age 61 y; range, 45-80 y) were reviewed retrospectively. The main indication was palliation for refractory fistula or leak in the setting of malignancy not responding to urine diversion by percutaneous nephrostomy tube or nephroureteral stent. Transrenal ureteral occlusion was performed using EVOH injected between vascular plugs placed distal and proximal to the leak or fistula. RESULTS: Technical success was 100%. Considerable reduction of urine leak or symptoms (clinical success) was achieved in 64% of ureters after mean follow-up of 105 days (range, 0-632 d). Complete ureteral occlusion on follow-up anterograde nephrostogram (imaging success) was achieved in 60% of ureters after mean follow-up of 139 days (range, 0-643 d). One patient with distal ureterovesical junction-perineal fistula had continued leak despite complete proximal occlusion of ureter owing to retrograde urine reflux from the bladder and was treated with endoscopic injection of intramural calcium hydroxyapatite to the ureteral segment distal to the fistula. Three ureters (33%) in 2 patients with vesicovaginal fistula had recanalization, requiring additional proximal embolization, yielding secondary success rates of 91% (clinical) and 90% (imaging) per ureter. One minor urinary tract infection and no major complications occurred. CONCLUSIONS: Transrenal anterograde ureteral occlusion using EVOH between vascular plugs could be considered a relatively safe and potentially valuable treatment option for refractory ureteral fistulae.


Assuntos
Embolização Terapêutica/instrumentação , Cuidados Paliativos , Polivinil/administração & dosagem , Ureter/fisiopatologia , Fístula Urinária/terapia , Incontinência Urinária/terapia , Idoso , Idoso de 80 Anos ou mais , Embolização Terapêutica/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polivinil/efeitos adversos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Ureter/diagnóstico por imagem , Fístula Urinária/diagnóstico por imagem , Fístula Urinária/etiologia , Fístula Urinária/fisiopatologia , Incontinência Urinária/diagnóstico por imagem , Incontinência Urinária/etiologia , Incontinência Urinária/fisiopatologia
16.
Radiographics ; 39(7): 2134-2145, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31560613

RESUMO

Thermal ablation of small renal masses is increasingly accepted as an alternative to partial nephrectomy, particularly in patients with multiple comorbidities. Many professional societies support this alternate treatment with updated guidelines. Before performing thermal ablation, it is important to stratify risk and assess technical feasibility by evaluating tumor imaging features such as size, location, and centrality. Routine postablation imaging with CT or MRI is necessary for assessment of residual or recurrent tumor, evidence of complications, or new renal masses outside the ablation zone. The normal spectrum and evolution of findings at CT and MRI include a halo appearance of the ablation zone, ablation zone contraction, and ablation zone calcifications. Tumor recurrence frequently manifests at CT or MRI as new nodular enhancement at the periphery of an expanding ablation zone, although it is normal for the ablation zone to enlarge within the first few months. Recognizing early tumor recurrence is important, as small renal masses are often easily treated with repeat ablations. Potential complications of thermal ablation include vascular injury, urine leak, ureteral stricture, nerve injury, and bowel perforation. The risk of these complications may be related to tumor size and location.©RSNA, 2019.


Assuntos
Carcinoma de Células Renais/diagnóstico por imagem , Ablação por Cateter , Neoplasias Renais/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Algoritmos , Falso Aneurisma/diagnóstico por imagem , Carcinoma de Células Renais/cirurgia , Ablação por Cateter/efeitos adversos , Doenças do Colo/diagnóstico por imagem , Doenças do Colo/etiologia , Feminino , Humanos , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/etiologia , Complicações Intraoperatórias/diagnóstico por imagem , Nefropatias/diagnóstico por imagem , Nefropatias/etiologia , Neoplasias Renais/cirurgia , Túbulos Renais Coletores/diagnóstico por imagem , Túbulos Renais Coletores/lesões , Masculino , Recidiva Local de Neoplasia/diagnóstico por imagem , Nefrectomia/métodos , Traumatismos dos Nervos Periféricos/diagnóstico por imagem , Traumatismos dos Nervos Periféricos/etiologia , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Hemorragia Pós-Operatória/diagnóstico por imagem , Cuidados Pré-Operatórios , Fístula Urinária/diagnóstico por imagem , Fístula Urinária/etiologia
17.
Vasc Endovascular Surg ; 53(8): 662-664, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31401941

RESUMO

One of the possible complications of chronic ureteral stenting is an artery-urinary tract fistula, although it is very rare. If it occurs, it is an emergency that needs surgery because of hemorrhage. We describe a case of an iliac-ileal conduit fistula, which is extremely rare, that was successfully treated by endovascular stent grafting.


Assuntos
Artéria Ilíaca , Derivação Urinária/efeitos adversos , Fístula Urinária/etiologia , Fístula Vascular/etiologia , Idoso , Procedimentos Endovasculares/instrumentação , Humanos , Artéria Ilíaca/diagnóstico por imagem , Masculino , Stents , Resultado do Tratamento , Derivação Urinária/instrumentação , Fístula Urinária/diagnóstico por imagem , Fístula Urinária/terapia , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/terapia
18.
Pediatr Surg Int ; 35(11): 1301-1308, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31372729

RESUMO

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


Assuntos
Fístula Cutânea/etiologia , Hipospadia/cirurgia , Estreitamento Uretral/etiologia , Fístula Urinária/etiologia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Humanos , Masculino , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
19.
J Vasc Interv Radiol ; 30(12): 2002-2008, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31420260

RESUMO

PURPOSE: To retrospectively evaluate the safety and efficacy of the percutaneous obliteration of urinary leakage after partial nephrectomy (PN) using coils and N-butyl-cyanoacrylate (NBCA). MATERIALS AND METHODS: Data of 10 consecutive patients who underwent percutaneous obliteration of urinary leakage after PN using coil and NBCA between February 2016 and May 2018 were retrospectively reviewed. A urinary fistulography was performed via the drainage catheter. If the fistulous tract was clearly visualized, super-selective embolization of the fistulous tract with coils and urinoma cavity sealing with NBCA was performed. In cases where the fistulous tract could not be clearly visualized, only urinoma cavity sealing was performed. Outcomes and complications were assessed by reviewing medical records and computed tomography (CT). RESULTS: In 7 (70%) patients who showed obvious urinary fistulous tract, coil embolization of the urinary fistulous tract, followed by sealing of the urinoma cavity with NBCA, was performed. Obliteration of the urinoma without coil embolization of the fistula tract was performed in 3 patients (30%) in whom a distinct fistulous tract could not be visualized. The median number of treatment sessions required to achieve clinical success was 1 (range, 1-5). Four patients underwent multiple repeated procedure with successful results. All patients showed gradual decrease in size or complete disappearance of urinoma on follow-up CT without evidence of urinary leakage during the follow-up period (mean, 44.6 weeks; range, 11-117 weeks). There were no procedure-related complications. CONCLUSIONS: Percutaneous obliteration of urinary leakage after PN using coils and NBCA is safe and effective.


Assuntos
Embolização Terapêutica/instrumentação , Embucrilato/administração & dosagem , Neoplasias Renais/cirurgia , Nefrectomia/efeitos adversos , Fístula Urinária/terapia , Incontinência Urinária/terapia , Urinoma/terapia , Adulto , Idoso , Embolização Terapêutica/efeitos adversos , Embucrilato/efeitos adversos , Feminino , Humanos , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Fístula Urinária/diagnóstico por imagem , Fístula Urinária/etiologia , Incontinência Urinária/diagnóstico por imagem , Incontinência Urinária/etiologia , Urinoma/diagnóstico por imagem , Urinoma/etiologia
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