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1.
J Am Vet Med Assoc ; 258(7): 740-747, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33754813

RESUMO

CASE DESCRIPTION: An 8-month-old 41.2-kg (90.6-lb) sexually intact male Dogue de Bordeaux with urinary incontinence and signs of nausea was referred for further evaluation and treatment of bilateral hydronephrosis, hydroureter, and ectopic ureters. CLINICAL FINDINGS: Clinicopathologic analyses revealed urine specific gravity and serum concentrations of urea nitrogen and creatinine within reference limits. Abdominal ultrasonography and CT revealed unilateral abdominal cryptorchidism, ureters that bilaterally passed dorsal to and appeared compressed by the external iliac arteries (retroiliac ureters), and bilateral hydronephrosis, hydroureter, and ectopic ureters. On CT, minimal uptake of contrast medium by the right kidney indicated either a lack of renal function or ureteral obstruction. TREATMENT AND OUTCOME: The dog underwent exploratory laparotomy, right ureteronephrectomy, left neoureterocystostomy, bilateral castration, and incisional gastropexy without complication and was discharged 2 days postoperatively. Eleven days after surgery, the dog had improved but continued urinary incontinence, improved left hydronephrosis and hydroureter, and serum concentrations of urea nitrogen and creatinine within reference limits. At 24 months after surgery, the dog was reportedly clinically normal, other than having persistent urinary incontinence. CLINICAL RELEVANCE: To our knowledge, this was the first report of a dog with retroiliac ureters and compression-induced ureteral obstruction with secondary hydroureter and hydronephrosis. Retroiliac ureters should be considered as a differential diagnosis in young dogs with ureteral obstruction. Our findings indicated that a good outcome was possible for a dog with retroiliac ureters treated surgically; however, the presence of additional congenital anomalies should be considered and may alter the prognosis in dogs with retroiliac ureters.


Assuntos
Doenças do Cão , Hidronefrose , Ureter , Obstrução Ureteral , Incontinência Urinária , Animais , Doenças do Cão/cirurgia , Cães , Hidronefrose/etiologia , Hidronefrose/cirurgia , Hidronefrose/veterinária , Masculino , Ureter/cirurgia , Obstrução Ureteral/veterinária , Incontinência Urinária/etiologia , Incontinência Urinária/cirurgia , Incontinência Urinária/veterinária
3.
Urologe A ; 60(2): 178-185, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33443722

RESUMO

The following article summarizes the current evidence including postoperative success rates and complications for various surgical options in the treatment of urinary incontinence. Due to different inclusion criteria and inconsistent definitions of study endpoints, the analysis of available studies is difficult. Thus, comparative studies with new devices for established treatment options should be planned. Structured processes used in certified continence centers improve the quality of care. Furthermore by documenting relevant complications, comparisons of treatment results thus become possible and provide evidence for the use of different surgical options in the treatment of urinary incontinence.


Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse , Incontinência Urinária , Seguimentos , Humanos , Resultado do Tratamento , Incontinência Urinária/diagnóstico , Incontinência Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos
4.
Zhonghua Nan Ke Xue ; 26(4): 316-320, 2020 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-33351297

RESUMO

Objective: To explore the safety of modified sandwich urethral reconstruction (MSUR) in laparoscopic radical prostatectomy (LRP) and its effect on the early recovery of urinary continence. METHODS: We retrospectively analyzed the clinical data on 20 patients treated by LRP with MSUR (the MSUR group) and another 21 cases of LRP without MSUR (the conventional control group) from January 2018 to September 2019. We compared the two groups of patients in the general data, anastomosis time, operation time and urinary continence recovery. RESULTS: There were no statistically significant differences between the two groups of patients in the age, body mass index, Gleason scores, prostate volume and baseline PSA level (P > 0.05) or in operation time, intraoperative blood loss, drainage tube indwelling time, postoperative feeding time and postoperative hospital stay (P > 0.05). Anastomotic stenosis occurred in 1 case in the MSUR group postoperatively, which was cured after regular urethral dilation, and anastomotic fistula developed in 1 case in the control group, which was healed after 5 days of prolonged catheterization. The recovery rate of urinary continence at 12 weeks after catheter removal was significantly higher in the MSUR than in the control group (80.0% vs 47.6%, P < 0.05). CONCLUSIONS: Modified sandwich urethral reconstruction in LRP is a safe, effective and feasible surgical strategy, which can significantly improve postoperative urinary continence recovery of the patient.


Assuntos
Laparoscopia , Prostatectomia , Neoplasias da Próstata , Procedimentos Cirúrgicos Reconstrutivos/métodos , Uretra/cirurgia , Incontinência Urinária/cirurgia , Humanos , Masculino , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos
5.
Arch Esp Urol ; 73(8): 709-723, 2020 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-33025916

RESUMO

OBJECTIVE:  LASER (Light Amplification by Stimulated Emission of Radiation) technology consists of the emission of a high-energy light beam. In medicine, it is used to cut, coagulate, fragment and evaporate biological or synthetic tissues. In the field of Functional Urology and Urogynecology its use has been widely explored. This article tries to give an overview of its applications in this subspecialty. MATERIAL AND METHOD: A non-systematic free search was performed in Pubmed, Embase and Google Scholar,combining the terms "laser", "laser technology", "interstitial cystitis", "trigonitis", "urinary tract infections","mesh", "mesh complications", "microbiome", "menopause genitourinary syndrome", "vulvovaginal atrophy", "urinary incontinence", "pelvic organ prolapse", "lichensclerosus", "complications" and "vaginal laxity". All relevant studies were retrieved in full text, in order to prepare a summary of each of the pathologies in which laser therapy has been used in Functional Urology and Urogynecology over time. RESULTS: There are different types of lasers and different application modalities to treat a wide variety of functional pathologies, including interstitial cystitis, trigonitis, mesh complications, urinary incontinence or pelvic organ prolapse. In some of them its use has been abandoned, despite the fact that, theoretically, they offer advantages over other therapies, such as in the case of interstitial cystitis. In others there is still not enough evidence in terms of safety and efficacy to be an alternativeto other conventional treatments. CONCLUSIONS: Although laser therapy offers certain advantages over other treatments, its use has not been generalized in the subspecialty of Functional Urology and Urogynecology. More evidence is needed to demonstrate its efficacy and safety.


Assuntos
Terapia a Laser , Lasers de Estado Sólido , Prolapso de Órgão Pélvico , Incontinência Urinária , Urologia , Feminino , Humanos , Prolapso de Órgão Pélvico/cirurgia , Incontinência Urinária/cirurgia
9.
BJOG ; 127(11): 1338-1346, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32333820

RESUMO

BACKGROUND: Laser therapy is now being proposed for the treatment of pelvic organ prolapse (POP) and urinary incontinence (UI). OBJECTIVES: To systematically review the available literature on laser therapy for POP and UI. SEARCH STRATEGY: PubMed, Web Of Science and Embase were searched for relevant articles, using a three-concept (POP, UI, laser therapy) search engine composed as (concept 1 OR concept 2) AND concept 3. SELECTION CRITERIA: Only full-text clinical studies in English. DATA COLLECTION AND ANALYSIS: Data on patient characteristics, laser setting, treatment outcome and adverse events were independently collected by two researchers. There was a lack of methodological uniformity so meta-analysis was not possible and the results are presented narratively. MAIN RESULTS: Thirty-one studies recruiting 1530 adult women met the inclusion criteria. All studies showed significant improvement either on UI, POP or both; however the heterogeneity of laser settings, application and outcome measures was huge. Only one study was a randomised controlled trial, two studies were controlled cohort studies. All three were on UI and used standardised validated tools. The risk of bias in the randomised controlled trial was low on all seven domains; the controlled studies had a serious risk of bias. No major adverse events were reported, mild pain and burning sensation were the most commonly described adverse events. CONCLUSIONS: All studies on vaginal and/or urethral laser application for POP and UI report improvement, but the quality of studies needs to be improved. TWEETABLE ABSTRACT: There is weak evidence that laser therapy is effective for urinary incontinence and pelvic organ prolapse #LASER#UI#POP.


Assuntos
Lasers de Gás/uso terapêutico , Lasers de Estado Sólido/uso terapêutico , Prolapso de Órgão Pélvico/cirurgia , Incontinência Urinária/cirurgia , Feminino , Humanos , Lasers de Gás/efeitos adversos , Lasers de Estado Sólido/efeitos adversos , Projetos de Pesquisa/normas , Resultado do Tratamento
10.
BJOG ; 127(8): 1002-1013, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32141709

RESUMO

OBJECTIVE: To compare standard (native tissue) repair with synthetic mesh inlays or mesh kits. DESIGN: Randomised controlled trial. SETTING: Thirty-three UK hospitals. POPULATION: Women having surgery for recurrent prolapse. METHODS: Women recruited using remote randomisation. MAIN OUTCOME MEASURES: Prolapse symptoms, condition-specific quality-of-life and serious adverse effects. RESULTS: A Mean Pelvic Organ Prolapse Symptom Score at 1 year was similar for each comparison (standard 6.6 versus mesh inlay 6.1, mean difference [MD] -0.41, 95% CI -2.92 to 2.11: standard 6.6 versus mesh kit 5.9, MD -1.21 , 95% CI -4.13 to 1.72) but the confidence intervals did not exclude a minimally important clinical difference. There was no evidence of difference in any other outcome measure at 1 or 2 years. Serious adverse events, excluding mesh exposure, were similar at 1 year (standard 7/55 [13%] versus mesh inlay 5/52 [10%], risk ratio [RR] 1.05 [0.66-1.68]: standard 3/25 [12%] versus mesh kit 3/46 [7%], RR 0.49 [0.11-2.16]). Cumulative mesh exposure rates over 2 years were 7/52 (13%) in the mesh inlay arm, of whom four women required surgical revision; and 4/46 in the mesh kit arm (9%), of whom two required surgical revision. CONCLUSIONS: We did not find evidence of a difference in terms of prolapse symptoms from the use of mesh inlays or mesh kits in women undergoing repeat prolapse surgery. Although the sample size was too small to be conclusive, the results provide a substantive contribution to future meta-analysis. TWEETABLE ABSTRACT: There is not enough evidence to support use of synthetic mesh inlay or mesh kits for repeat prolapse surgery.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Satisfação do Paciente/estatística & dados numéricos , Prolapso de Órgão Pélvico/cirurgia , Telas Cirúrgicas , Incontinência Urinária/cirurgia , Prolapso Uterino/cirurgia , Adulto , Coito , Feminino , Seguimentos , Procedimentos Cirúrgicos em Ginecologia/instrumentação , Humanos , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/fisiopatologia , Prolapso de Órgão Pélvico/psicologia , Qualidade de Vida , Reoperação/estatística & dados numéricos , Resultado do Tratamento , Incontinência Urinária/fisiopatologia , Incontinência Urinária/psicologia , Prolapso Uterino/fisiopatologia , Prolapso Uterino/psicologia
12.
Cochrane Database Syst Rev ; 1: CD001754, 2020 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-31990055

RESUMO

BACKGROUND: Stress urinary incontinence constitutes a significant health and economic burden to society. Traditional suburethral slings are surgical operations used to treat women with symptoms of stress urinary incontinence. OBJECTIVES: To assess the effectiveness of traditional suburethral sling procedures for treating stress urinary incontinence in women; and summarise the principal findings of relevant economic evaluations. SEARCH METHODS: We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), as well as MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP); we handsearched journals and conference proceedings (searched 27 February 2017) and the reference lists of relevant articles. On 23 January 2019, we updated this search; as a result, several additional reports of studies are awaiting classification. SELECTION CRITERIA: Randomised or quasi-randomised trials that assessed traditional suburethral slings for treating stress or mixed urinary incontinence. DATA COLLECTION AND ANALYSIS: At least two review authors independently extracted data from included trials and assessed risk of bias. When appropriate, a summary statistic was calculated: risk ratio (RR) for dichotomous data, odds ratio (OR) for continence and cure rates that were expected to be high, and mean difference (MD) for continuous data. We adopted the GRADE approach to assess the quality of evidence. MAIN RESULTS: A total of 34 trials involving 3244 women were included. Traditional slings were compared with 10 other treatments and with each other. We did not identify any trials comparing suburethral slings with no treatment or sham treatment, conservative management, anterior repair, or laparoscopic retropubic colposuspension. Most trials did not distinguish between women having surgery for primary or recurrent incontinence. One trial compared traditional slings with bladder neck needle suspension, and another trial compared traditional slings with single-incision slings. Both trials were too small to be informative. Traditional suburethral sling operation versus drugs One small trial compared traditional suburethral sling operations with oxybutynin to treat women with mixed urinary incontinence. This trial did not report any of our GRADE-specific outcomes. It is uncertain whether surgery compared with oxybutynin leads to more women being dry (83% vs 0%; OR 195.89, 95% confidence interval (CI) 9.91 to 3871.03) or having less urgency urinary incontinence (13% vs 43%; RR 0.29, 95% CI 0.09 to 0.94) because the quality of this evidence is very low. Traditional suburethral sling versus injectables One small trial compared traditional slings with suburethral injectable treatment. The impact of surgery versus injectables is uncertain in terms of the number of continent women (100% were dry with a traditional sling versus 71% with the injectable after the first year; OR 11.57, 95% CI 0.56 to 239.74), the need for repeat surgery for urinary incontinence (RR 0.52, 95% CI 0.05 to 5.36) or the occurrence of perioperative complications (RR 1.57, 95% CI 0.29 to 8.49), as the quality of evidence is very low. Traditional suburethral sling versus open abdominal retropubic colposuspension Eight trials compared slings with open abdominal retropubic colposuspension. Moderate-quality evidence shows that the traditional suburethral sling probably leads to more continent women in the medium term (one to five years) (69% vs 59% after colposuspension: OR 1.70, 95% CI 1.22 to 2.37). High-quality evidence shows that women were less likely to need repeat continence surgery after a traditional sling operation than after colposuspension (RR 0.15, 95% CI 0.05 to 0.42). We found no evidence of a difference in perioperative complications between the two groups, but the CI was very wide and the quality of evidence was very low (RR 1.24, 95% CI 0.83 to 1.86). Traditional suburethral sling operation versus mid-urethral slings Fourteen trials compared traditional sling operations and mid-urethral sling operations. Depending on judgements about what constitutes a clinically important difference between interventions with regard to continence, traditional suburethral slings are probably no better, and may be less effective, than mid-urethral slings in terms of number of women continent in the medium term (one to five years) (67% vs 74%; OR 0.67, 95% CI 0.44 to 1.02; n = 458; moderate-quality evidence). One trial reported more continent women with the traditional sling after 10 years (51% vs 32%: OR 2.22, 95% CI 1.07 to 4.61). Mid-urethral slings may be associated with fewer perioperative complications (RR 1.74, 95% CI 1.16 to 2.60; low-quality evidence). One type of traditional sling operation versus another type of traditional sling operation Nine trials compared one type of traditional sling operation with another. The different types of traditional slings, along with the number of different materials used, mean that trial results could not be pooled due to clinical heterogeneity. Complications were reported by two trials - one comparing non-absorbable Goretex with a rectus fascia sling, and the second comparing Pelvicol with a rectus fascial sling. The impact was uncertain due to the very low quality of evidence. AUTHORS' CONCLUSIONS: Low-quality evidence suggests that women may be more likely to be continent in the medium term (one to five years) after a traditional suburethral sling operation than after colposuspension. It is very uncertain whether there is a difference in urinary incontinence after a traditional suburethral sling compared with a mid-urethral sling in the medium term. However, these findings should be interpreted with caution, as long-term follow-up data were not available from most trials. Long-term follow-up of randomised controlled trials (RCTs) comparing traditional slings with colposuspension and mid-urethral slings is essential. Evidence is insufficient to suggest whether traditional suburethral slings may be better or worse than other management techniques. This review is confined to RCTs and therefore may not identify all of the adverse effects that may be associated with these procedures. A brief economic commentary (BEC) identified three eligible economic evaluations, which are not directly comparable due to differences in methods, time horizons, and settings. End users of this review will need to assess the extent to which methods and results of identified economic evaluations may be applicable (or transferable) to their own setting.


Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Incontinência Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Feminino , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Procedimentos Cirúrgicos Urológicos/economia
13.
PLoS One ; 15(1): e0227744, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31929596

RESUMO

PURPOSE: To evaluate early recovery of urinary continence after robot-assisted radical prostatectomy (RARP) with urethral realignment using bladder neck preservation (BNP) and maximal urethral length preservation (MULP). METHODS: Patients who underwent RARP between 2014 and 2017 owing to prostate cancer with a Gleason score ≤ 7 (3+4), ≤ cT2c stage, and prostate-specific antigen level < 20 ng/ml were investigated. Patients with tumors of the bladder neck or apex on magnetic resonance imaging were excluded. A total of 266 patients underwent the operation using the standard method between 2014 and 2015 (group 1), while 305 patients underwent urethral realignment between 2016 and 2017 (group 2). Continence was defined as wearing no pad or one security pad. RESULTS: The continence rates immediately after Foley catheter removal, at 2 weeks, and at 1, 3, 6, and 12 months after operation in group 2 were 46.9%, 63.0%, 73.4%, 90.1%, 94.8%, and 98.7%, respectively. The continence rate at 1 month in group 2 was significantly higher than that in group 1 (65.4% versus 73.4%, p = 0.037). The multivariate regression analysis showed that age and surgical method were factors affecting early continence recovery. The positive surgical margin rates were 18.0% and 14.8% in groups 1 and 2, respectively (p = 0.288). Biochemical recurrence occurred in 14.7% and 8.2% in groups 1 and 2, respectively (p = 0.015). CONCLUSION: Urethral realignment using BNP and MULP resulted in rapid continence recovery and good oncological results after RARP in young patients with a Gleason score ≤ 7 and organ-confined disease.


Assuntos
Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Incontinência Urinária/cirurgia , Fatores Etários , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Próstata/cirurgia , Prostatectomia/efeitos adversos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Resultado do Tratamento , Uretra/cirurgia , Incontinência Urinária/etiologia
14.
Neurourol Urodyn ; 39(2): 771-777, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31951678

RESUMO

AIM: The objective of this study was to report the long-term outcomes and complications of patients with multiple sclerosis (MS) who underwent noncontinent urinary diversion to treat lower urinary tract symptoms (LUTS). MATERIAL AND METHODS: A retrospective study included all adult patients with MS who underwent an ileal conduit urinary diversion between 2000 and 2015. Early postoperative complications were reported as well as long-term complications, reoperation rates, and renal function. RESULTS: Overall, 91 patients were included. The surgery was indicated for refractory urinary incontinence (n = 73), renal failure (n = 8), major perineal skin ulcer due to urinary incontinence (n = 6), and recurrent urinary tract infections (n = 4). The median follow-up was 50 months (range, 3-158 months). A significant reduction (P < .05) of postoperative nonobstructive pyelonephritis rate was observed. There was no significant difference between preoperative and postoperative renal function (P = .32). Early postoperative complications were reported in 24 patients (26%): 4 Clavien I, 6 Clavien II, 9 Clavien III, 4 Clavien IV, and 1 Clavien V. Nine patients required reoperation for these complications (9.9%). Late complications were reported in 28 patients (30.8%): 8 ureteral anastomosis stenosis, 2 stoma stenosis, 2 incisional hernias, 6 kidney or ureteral lithiasis, and 10 pyelonephritis. Among them, 15 patients (16.5%) required reoperation for late complications. CONCLUSION: Noncontinent urinary diversion using ileal conduit appears to be an effective end-stage solution in MS patients. The perioperative morbidity rate of 26% and the late complication rate of 31% should be considered to better inform patients before the surgery.


Assuntos
Sintomas do Trato Urinário Inferior/cirurgia , Esclerose Múltipla/complicações , Complicações Pós-Operatórias/epidemiologia , Derivação Urinária , Incontinência Urinária/cirurgia , Infecções Urinárias/cirurgia , Adulto , Idoso , Anastomose Cirúrgica , Constrição Patológica , Feminino , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Pielonefrite/epidemiologia , Insuficiência Renal , Reoperação , Estudos Retrospectivos , Ureter/cirurgia , Incontinência Urinária/etiologia , Infecções Urinárias/etiologia
15.
Neurourol Urodyn ; 39(2): 738-743, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31899822

RESUMO

AIMS: The aim is to assess whether subjects with diabetes mellitus (DM) have greater urinary retention and increased post-void residual volume (PVR) following mid-urethral sling (MUS) surgery. METHODS: This multi-center retrospective study included patients who underwent MUS (2012-2016). Baseline data included demographics, comorbidities, urinary symptoms, urodynamics data, PVR, and responses to validated questionnaires (UDI6 and IIQ7). Intraoperative data, postoperative voiding trial results, postop questionnaires, and complications were also noted. Patients with and without DM were compared. Significance was defined as P < .05. RESULTS: A total of 605 MUS were included, 538(89%) without DM and 67(11%) with DM, of which 69% were transobturator and 31% retropubic. No differences were seen in urinary retention and passing void trial(79% DM vs 81% non-DM; P = .72). Mean PVR at discharge was similar between groups (136 mL DM vs 139 mL non-DM; P = .922). There were no differences between groups in UDI6 and IIQ7 sum scores at baseline and 1 month. DM subjects reported more bother at baseline on certain UDI-6 and IIQ-7 items including frequent urination, leakage related to urgency, and feeling frustrated. At 3 months postop, all subjects demonstrated improvement in scores. Interestingly, patients with DM reported worse quality of life on the IIQ7 sum. CONCLUSIONS: Among subjects with well-controlled diabetes and more comorbidities who underwent MUS there were few differences in postoperative voiding dysfunction or PVR compared to nondiabetic women. DM patients were more bothered at baseline by urge-related symptoms. Quality of life following sling surgery appears to be worse in patients with DM at 3 months based on IIQ7. This data suggests that diabetic women with lower HbA1C can be counseled similarly to these complication rates and voiding dysfunction after MUS.


Assuntos
Complicações do Diabetes , Slings Suburetrais , Incontinência Urinária/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Humanos , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do Tratamento , Bexiga Urinária/fisiopatologia , Incontinência Urinária/fisiopatologia , Urodinâmica , Procedimentos Cirúrgicos Urológicos
16.
Asian J Androl ; 22(1): 39-44, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31793445

RESUMO

Penile prosthesis implant (PPI) remains an effective and safe treatment option for men with erectile dysfunction (ED). However, PPI surgery can be associated with a higher risk of complications in certain populations. This article provides a critical review of relevant publications pertaining to PPI in men with diabetes, significant corporal fibrosis, spinal cord injury, concurrent continence surgery, and complex salvage cases. The discussion of each category of special populations includes a brief review of the surgical challenges and a practical action-based set of recommendations. While specific patient populations posed considerable challenges in PPI surgery, strict pre- and postoperative management coupled with safe surgical practice is a prerequisite to achieving excellent clinical outcomes and high patient satisfaction rate.


Assuntos
Disfunção Erétil/cirurgia , Implante Peniano , Induração Peniana/cirurgia , Priapismo/cirurgia , Infecções Relacionadas à Prótese/prevenção & controle , Traumatismos da Medula Espinal/complicações , Infecção da Ferida Cirúrgica/prevenção & controle , Incontinência Urinária/cirurgia , Complicações do Diabetes , Diabetes Mellitus , Disfunção Erétil/complicações , Humanos , Masculino , Induração Peniana/complicações , Prótese de Pênis , Priapismo/complicações , Infecções Relacionadas à Prótese/epidemiologia , Terapia de Salvação , Slings Suburetrais , Infecção da Ferida Cirúrgica/epidemiologia , Incontinência Urinária/complicações , Esfíncter Urinário Artificial
17.
Urology ; 137: 206-207, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31790786

RESUMO

OBJECTIVE: Robot-assisted laparoscopic (RAL) techniques for the management of neurogenic bladder involves complex procedures using lower urinary tract and bowel. When medical therapy fails, surgery aims to preserve upper tract function and social continence.1 Traditionally, the procedure was performed in an open approach, but newer minimally-invasive techniques offer improved cosmesis, reduced pain and length of stay.2 A series of 38 cases showed the feasibility and safety of this approach.3 Here, we describe a RAL bladder neck reconstruction with appendicovesicostomy in a 7-year-old with neurogenic bladder (Fig. 1). METHODS: The patient was placed in a lithotomy position followed by double-J and Foley catheter placement. With an open Hasson technique, a 12-mm, two 8-mm, and a 5-mm port were positioned. The bladder is prefilled with saline (80 mL) and a cystotomy is performed. The tubularization is completed in 2 layers achieving a 3-cm tunnel (Figs. 2-3). The appendix is implanted in the posterior wall of the bladder with a submucosal tunnel. Ultimately, 2 suprapubic tubes are placed and the bladder is closed in a single layer. RESULTS: No complications reported, operative time was 5 hours and estimated blood loss was 50 mL. At 1-month follow-up, double-J stents were removed and the patient reported catheterizing well with good continence and well-healed incisions. CONCLUSION: Robotic continence procedures have demonstrated to be a safe and effective alternative. Here, we presented a satisfactory outcome using RAL bladder neck reconstruction with appendicovesicostomy in a 7 years old with persistent incontinence, despite untethering and maximal anticholinergic therapy.


Assuntos
Laparoscopia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Bexiga Urinaria Neurogênica , Derivação Urinária/métodos , Procedimentos Cirúrgicos Urológicos/métodos , Criança , Humanos , Masculino , Duração da Cirurgia , Resultado do Tratamento , Bexiga Urinária/cirurgia , Bexiga Urinaria Neurogênica/complicações , Bexiga Urinaria Neurogênica/cirurgia , Incontinência Urinária/etiologia , Incontinência Urinária/cirurgia
18.
Neurourol Urodyn ; 39(2): 665-673, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31782980

RESUMO

AIMS: The aim was to assess complications of urinary incontinence (UI) for women who had a hospital contact within 30 days and to evaluate the conventional method of classifying complications vs grading complications into the Clavien-Dindo classification (CDC) system. METHODS: A historical cohort study based on a nationwide population of women who had hospital contact within 30 days of surgical treatment for UI during a 5-year period. RESULTS: There were 874 (16.2%) hospital contacts to the Department of Obstetrics and Gynecology, among 5393 procedures. For retropubic midurethral sling (RPMUS) and transobturator midurethral sling (TOMUS), the most common reasons for hospital contacts were voiding dysfunction, self-reported pain within 14 days and acute cystitis and for urethral injection therapy (UIT) persisting UI, acute cystitis, and voiding dysfunction. Voiding dysfunction requiring surgery, use of catheter or both, occurred more frequently in women who had RPMUS as compared with TOMUS (30.5% vs 21.7%; P = .01). Women, who received RPMUS and TOMUS, had surgical complications classified as up to CD IIIb, whereas women who had UIT were classified as up to CD II. CONCLUSIONS: Sixteen percent of the women had a hospital contact within 30 days. A more obstructive character of RPMUS than for TOMUS was indicated, as more women with voiding dysfunction required surgery or catheter following RPMUS. The CDC system in its current form does not improve the overall characterization of complications in terms of type and severity following synthetic midurethral sling and UIT treatment.


Assuntos
Complicações Pós-Operatórias/etiologia , Slings Suburetrais/efeitos adversos , Incontinência Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Adulto , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Urológicos/métodos
19.
BJU Int ; 125(3): 467-475, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31755624

RESUMO

OBJECTIVES: To consider the provision of post-radical prostatectomy (RP) continence surgery in England. MATERIALS AND METHODS: Patients with an Office of Population Census and Surveys Classification of Interventions and Procedures, version 4 code for an artificial urinary sphincter (AUS) or male sling between 1 January 2010 and 31 March 2018 were searched for within the Hospital Episode Statistics (HES) dataset. Those without previous RP were excluded. Multivariable logistic regressions for repeat AUS and sling procedures were built in stata. Further descriptive analysis of provision of procedures was performed. RESULTS: A total of 1414 patients had received index AUS, 10.3% of whom had undergone prior radiotherapy; their median follow-up was 3.55 years. The sling cohort contained 816 patients; 6.7% of these had received prior radiotherapy and the median follow-up was 3.23 years. Whilst the number of AUS devices implanted had increased each year, male slings peaked in 2014/2015. AUS redo/removal was performed in 11.2% of patients. Patients in low-volume centres were more likely to require redo/removal (odds ratio [OR] 2.23 95% confidence interval [CI] 1.02-4.86; P = 0.045). A total of 12.0% patients with a sling progressed to AUS implantation and 1.3% had a second sling. Patients with previous radiotherapy were more likely to require a second operation (OR 2.03 95% CI 1.01-4.06; P = 0.046). Emergency re-admissions within 30 days of index operation were 3.9% and 3.6% fewer in high-volume centres, for AUS and slings respectively. The median time to initial continence surgery from RP was 2.8 years. Increased time from RP conferred no reduced risk of redo surgery for either procedure. CONCLUSION: There is a volume effect for outcomes of AUS procedures, suggesting that they should only be performed in high-volume centres. Given the known impact of incontinence on quality of life, patients should be referred sooner for post-prostatectomy continence surgery.


Assuntos
Complicações Pós-Operatórias/cirurgia , Prostatectomia , Slings Suburetrais , Incontinência Urinária/cirurgia , Esfíncter Urinário Artificial , Adulto , Idoso , Idoso de 80 Anos ou mais , Inglaterra , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
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