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1.
J Urol ; 203(4): 826-831, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31821098

RESUMO

PURPOSE: We studied the effect of oxybutynin on bladder and upper urinary tract outcomes in infants following posterior urethral valve ablation. MATERIALS AND METHODS: Patients younger than 12 months old who had undergone primary endoscopic valve ablation for posterior urethral valves were screened for eligibility. Patients who had undergone urinary diversion or had other conditions that could affect lower urinary tract function were excluded. Study patients were randomized to either oxybutynin (0.2 mg/kg 3 times daily) until toilet training or active observation. The study end points were serum creatinine, estimated glomerular filtration rate, hydronephrosis improvement, vesicoureteral reflux resolution, febrile urinary tract infection and toilet training. RESULTS: A total of 49 infants (24 receiving oxybutynin and 25 undergoing observation) were enrolled between December 2013 and September 2015 and completed at least 1 year of followup. Oxybutynin was discontinued before toilet training in 5 patients due to facial flushing in 2, bladder and upper tract dilatation in 2, and cognitive changes in 1. After a median followup of 44.2 months (range 12 to 57.6) median serum creatinine and estimated glomerular filtration rate were not significantly different between the groups (p=0.823 and p=0.722, respectively). Renal units in the oxybutynin group had a greater likelihood of hydronephrosis improvement (61.9% vs 34.8%, p=0.011) and resolution of vesicoureteral reflux (62.5% vs 25%, p=0.023). Febrile urinary tract infection (29.2% vs 40%, p=0.404), completion of toilet training (70.8% vs 76%, p=0.748) and age at toilet training (p=0.247) did not differ significantly between the oxybutynin and observation groups. CONCLUSIONS: Oxybutynin enhances hydronephrosis improvement and vesicoureteral reflux resolution following primary endoscopic valve ablation in infants but periodic monitoring is warranted.


Assuntos
Hidronefrose/terapia , Ácidos Mandélicos/administração & dosagem , Uretra/anormalidades , Obstrução Uretral/cirurgia , Agentes Urológicos/administração & dosagem , Refluxo Vesicoureteral/terapia , Creatinina/sangue , Seguimentos , Taxa de Filtração Glomerular/fisiologia , Humanos , Hidronefrose/etiologia , Hidronefrose/fisiopatologia , Lactente , Recém-Nascido , Rim/efeitos dos fármacos , Rim/fisiopatologia , Masculino , Resultado do Tratamento , Obstrução Uretral/etiologia , Obstrução Uretral/fisiopatologia , Refluxo Vesicoureteral/etiologia , Refluxo Vesicoureteral/fisiopatologia
2.
BMC Urol ; 19(1): 82, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481034

RESUMO

BACKGROUND: We aimed to investigate the prevalence, relative risk factors, and the impact on the health-related quality of life (HRQoL) of benign prostatic obstruction (BPO) with coexisting overactive bladder (OAB) in men aged over 50 and living in Shanghai Pudong New Area. METHODS: Using a multi-stage sampling and descriptive epidemiological method, 1632 men were selected from among the general population. Participants completed an evaluation of lower urinary tracts symptoms (LUTS), including international prostate symptom score (IPSS) and quality of life (QoL) questionnaires. Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5) questionnaire. In addition, the Overactive Bladder Symptom Score (OABSS) and King's health questionnaire (KHQ) were used to assess the impact of BPO with coexisting OAB on the HRQoL. Maximum flow rate (Qmax), postvoid residual urine volume (PVR) and prostate-specific antigen (PSA) were also recorded. RESULTS: A total of 1476 men with complete data were analyzed. The overall prevalence of BPO with coexisting OAB was 39.6%. Age and prostate volume were associated risk factors for BPO with coexisting OAB. In addition, BPO with coexisting OAB negatively impacted the HRQoL, with increased IPSS, QoL, OABSS, and KHQ scores and decreased IIEF-5 scores compared to that in patients with BPO without OAB. CONCLUSIONS: Qmax, PVR and serum PSA did not predict whether the patients had a combined BPO + OAB or not. The prostate volume and age were associated risk factors for BPO with coexisting OAB. BPO is a progressive disease and may be one of the risk factors for OAB.


Assuntos
Hiperplasia Prostática/complicações , Qualidade de Vida , Obstrução Uretral/epidemiologia , Obstrução Uretral/etiologia , Bexiga Urinária Hiperativa/complicações , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Estudos Transversais , Autoavaliação Diagnóstica , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco
3.
BMJ Case Rep ; 12(7)2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31340946

RESUMO

We present a rare case of association of anterior rectal duplication and posterior urethral valve (PUV). A term neonate with no antenatal concerns was admitted with urosepsis and acute renal injury at 18 days of age. History revealed a poor urinary stream and dribbling. After resuscitation and stabilisation, renal tract ultrasound and micturating cysto-urethrogram were performed. Cystourethroscopy showed PUV and a mass indenting the bladder posteriorly. MRI confirmed the presence of a cystic lesion anterior to the rectum suspicious of rectal duplication. Laparoscopic-assisted excision of the anterior rectal duplication cyst was then performed. The infant recovered uneventfully. Creatinine normalised postoperatively and has been stable at follow-up.


Assuntos
Anormalidades Múltiplas/diagnóstico por imagem , Malformações Anorretais/diagnóstico por imagem , Laparoscopia/métodos , Reto/anormalidades , Uretra/anormalidades , Obstrução Uretral/diagnóstico por imagem , Anormalidades Múltiplas/cirurgia , Malformações Anorretais/cirurgia , Cistoscopia/métodos , Seguimentos , Humanos , Recém-Nascido , Imagem por Ressonância Magnética/métodos , Masculino , Doenças Raras , Reto/cirurgia , Medição de Risco , Resultado do Tratamento , Uretra/cirurgia , Obstrução Uretral/etiologia , Obstrução Uretral/cirurgia , Infecções Urinárias/diagnóstico , Infecções Urinárias/etiologia
4.
World J Urol ; 37(6): 1023-1027, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31037402

RESUMO

PURPOSE: When medications fail to satisfactorily treat bothersome lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO), procedural treatments are indicated. There is much interest in minimally invasive office-based treatments which can be performed under local anesthesia, allow fast recovery and have minimal morbidity. The purpose of this article is to review recent literature regarding safety and efficacy of office-based minimally invasive therapies for BPO. METHODS: A literature search using PUBMED and Medline was performed regarding minimally invasive office-based treatments for BPO, including the prostatic urethral lift (Urolift), water vapor therapy (Rezum) and stents. Literature published within the last 5 years were reviewed. RESULTS: The prostatic urethral lift (Urolift) is a safe and efficacious treatment for LUTS-BPO whilst also preserving sexual function. Rezum appears to be a safe and effective treatment in Phase 2 trials. Memokath prostatic stents do not appear to be a durable treatment; Allium prostatic stents warrant further investigation prior to recommendation. CONCLUSIONS: The prostatic urethral lift (Urolift) is a safe and effective treatment for LUTS-BPO whilst preserving sexual function. Rezum also appears to be a safe and effective treatment in small RCTs comparing performance with TURP. Memokath prostatic stents do not appear to have treatment durability. Further studies would be warranted to determine whether Allium prostatic stents are safe effective treatments for LUTS-BPO.


Assuntos
Sintomas do Trato Urinário Inferior/terapia , Hiperplasia Prostática/terapia , Obstrução Uretral/terapia , Humanos , Sintomas do Trato Urinário Inferior/complicações , Masculino , Visita a Consultório Médico , Hiperplasia Prostática/complicações , Obstrução Uretral/etiologia
5.
Urology ; 129: e6, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30935937

RESUMO

Urethral obstruction due to retained bullets migrating into the genitourinary system has rarely been reported. The literature describes 2 main methods of retained bullet removal from the genitourinary system: (1) spontaneous expulsion during voiding and (2) manual extraction due to urethral obstruction causing acute urinary retention. We present a case in which a 21-year-old man presented with acute urinary retention 3 years after suffering a gunshot wound to the abdomen. A retained bullet eroded through the bladder wall, migrated through the bladder and urethra, and eventually became lodged in the external urethral meatus, causing obstruction and urinary retention.


Assuntos
Migração de Corpo Estranho/complicações , Uretra/lesões , Obstrução Uretral/etiologia , Retenção Urinária/etiologia , Ferimentos por Arma de Fogo/complicações , Doença Aguda , Humanos , Masculino , Fatores de Tempo , Adulto Jovem
6.
Artigo em Alemão | MEDLINE | ID: mdl-30999351

RESUMO

The diagnosis of obstructive urolithiasis in small ruminants frequently results in a multitude of decisions that have to be made by the consulted practitioner. Factors that influence the decision for therapy (or euthanasia) are the type of the animal's use, economic aspects and specific options of the veterinarian practice as well as emotional aspects depending on the owners of small ruminants kept as companion animals. The present article aims to present the currently available methods of therapy to facilitate a decision by the practicing veterinarian based on the present state of the science. Naturally, the individual method of choice may differ from the scientific point of view depending on the practitioner's evaluation.


Assuntos
Doenças das Cabras/terapia , Doenças dos Ovinos/terapia , Urolitíase/veterinária , Amputação/veterinária , Animais , Cistotomia/veterinária , Cabras , Litotripsia/métodos , Litotripsia/veterinária , Litotripsia a Laser/veterinária , Masculino , Pênis/cirurgia , Ovinos , Cirurgia Plástica/veterinária , Uretra/cirurgia , Obstrução Uretral/etiologia , Obstrução Uretral/terapia , Obstrução Uretral/veterinária , Bexiga Urinária/cirurgia , Cateterismo Urinário/instrumentação , Cateterismo Urinário/métodos , Cateterismo Urinário/veterinária , Urolitíase/complicações , Urolitíase/terapia
7.
Prog Urol ; 29(5): 288-292, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30962142

RESUMO

AIM: To assess the feasibility of voiding urethrocystoscopy (VUC) in males and describe the characteristics of dynamic movements of the prostatic lobes during micturition. MATERIAL AND METHODS: Patients scheduled for benign prostatic obstruction relief in a tertiary reference center were included in this prospective evaluation. During urethrocystoscopy with a small diameter flexible endoscope, the bladder was filled until desire to void. The patient was asked to void with endoscope in place facing the veru montanum. Movements of the prostatic lobes during micturition were characterized, video-recorded, and categorized based on the dynamics of the lateral lobes, the posterior lobe and the bladder neck. RESULTS: In all, 192 evaluations were conducted. In 161 cases (84%), the patient was able to void. Among these patients, 126 cases were stated as "closed" (coalescent), without opening of the initial part of the urethra and the bladder neck. In 38 cases, there was no opening of the lateral lobes (type 1A), and in 47 cases a partial opening of the distal parts of the lateral lobes was seen (type 1B). In 31 cases, a fixed posterior bladder neck was seen (type 2A) and in 10 cases a mobile median lobe, with a rolling ball effect, was seen (type 2B). In 25 cases, the lumen was completely open and equivocal in 10 cases. CONCLUSIONS: This study demonstrates the feasibility of VUC and describes for the first time the dynamics of prostatic lobes during micturition. This evaluation may lead to a new approach for understanding the mechanical aspects of benign prostatic obstruction. LEVEL OF EVIDENCE: 3.


Assuntos
Cistoscopia/métodos , Hiperplasia Prostática/diagnóstico , Obstrução Uretral/diagnóstico , Obstrução do Colo da Bexiga Urinária/diagnóstico , Micção/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estudos de Viabilidade , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão/fisiologia , Próstata/diagnóstico por imagem , Próstata/patologia , Hiperplasia Prostática/complicações , Obstrução Uretral/etiologia , Obstrução do Colo da Bexiga Urinária/etiologia , Urodinâmica/fisiologia
9.
Vet Surg ; 48(3): 315-320, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30693545

RESUMO

OBJECTIVE: To report the clinical findings, outcome, and complications associated with urethrotomy performed in combination with or after temporary tube cystostomy for treatment of obstructive urolithiasis in male goats. STUDY DESIGN: Retrospective case series. SAMPLE POPULATION: Castrated male goats (n = 15). METHODS: The medical records of male goats admitted for obstructive urolithiasis were reviewed. Goats that underwent aurethrotomy performed in combination with or after a temporary tube cystostomy were included in the study population. Follow-up information was obtained through hospital records and telephone communication. RESULTS: Thirteen of 15 goats were discharged from the hospital a median of 13 days (range, 7-25) after urethrotomy. Complications related to the urinary system occurred in 5 goats and included recurrent obstruction, urination from open urethrotomy, uroabdomen and intra-abdominal adhesions after removal of the Foley catheter, and incisional infection. Five of 7 goats with long-term follow-up (2-24 months after surgery) were healthy, with normal urinary function. The remaining 2 goats returned to the hospital with signs of reobstruction that were attributed to uroliths at necropsy in 1 goat. CONCLUSION: Goats treated with urethrotomy for persistent urethral obstruction after temporary tube cystostomy generally survived the procedure. Normal long-term urinary function was obtained in some goats, although recurrence was the most common complication. CLINICAL SIGNIFICANCE: Urethrotomy is a surgical option for male goats with persistent urethral obstruction due to urethral calculi after temporary tube cystostomy.


Assuntos
Cistostomia/veterinária , Doenças das Cabras/cirurgia , Obstrução Uretral/veterinária , Animais , Cabras , Masculino , Estudos Retrospectivos , Uretra/cirurgia , Obstrução Uretral/etiologia , Obstrução Uretral/cirurgia , Cálculos Urinários/complicações , Cálculos Urinários/veterinária , Urolitíase/cirurgia
10.
World J Urol ; 37(7): 1369-1375, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30288598

RESUMO

PURPOSE: Aquablation of the prostate using the AquaBeam™ system promises equivalent functional outcomes, reduced learning curve, and improved sexual function compared to transurethral prostate resection as shown in prospective randomized trials. This prospective cohort study aims to evaluate if published results can be transferred into the clinical routine in a non-selected patient collective. METHODS: This study includes all patients treated between September 2017 and June 2018 with Aquablation of the prostate. Patients have been evaluated prospectively for the perioperative course and early follow-up. Besides voiding parameter and symptom score, TRUS-volume change, ejaculatory function, and adverse events have been recorded. RESULTS: 118 consecutive patients have been treated in the given time. Aquablation could be carried out successfully in all patients. IPSS, QoL, Qmax, and PVR improved significantly after the procedure and continued to improve during 3-month follow-up. Mean OR time was 20 min, TRUS volume decreased by 65%, and 73% of the patients retained antegrade ejaculation. Thirteen adverse events (> Clavien-Dindo I) occurred in 10 patients. CONCLUSION: The surgical ablation of the prostate using Aquablation achieved significant and immediate improvement of functional voiding parameters Qmax and PVR as well as symptomatic improvement of IPSS and QoL. Aquablation seems to be safe and effective with a low perioperative complication profile even in a non-selected group of patients.


Assuntos
Técnicas de Ablação/métodos , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Obstrução Uretral/cirurgia , Água , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Hiperplasia Prostática/complicações , Disfunções Sexuais Fisiológicas/epidemiologia , Resultado do Tratamento , Obstrução Uretral/etiologia
11.
World J Urol ; 37(7): 1353-1360, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30283994

RESUMO

INTRODUCTION: Successful outcomes have been reported for the treatment of lower urinary tract symptoms (LUTS) with the prostatic urethral lift (PUL) in a number of clinical investigations. Our aim was to investigate PUL outcomes in patients treated in a day-to-day clinical setting without the rigid exclusion criteria of clinical studies. MATERIALS AND METHODS: We investigated the outcome of the PUL procedure at five German departments during the initial period when PUL was approved for the clinic (10/2012-06/2014). All candidates for transurethral resection of the prostate (TURP) received PUL information and were given the choice of procedures. The only exclusion criterion was an obstructive median lobe. No patients were excluded because of high post-void residual volume (PVR), prostate size, retention history or LUTS oral therapy. Maximum urinary flow (Qmax), PVR, International Prostate Symptom Score (IPSS) and Quality of Life (QOL) were assessed at baseline, 1, 6, 12, and 24 months after surgery. RESULTS: Of 212 TURP candidates, 86 choose PUL. A mean of 3.8 (2-7) UroLift implants were implanted in patients of 38-85 years with a prostate size of 17-111 ml over 57 (42-90) min under general or local anesthesia. Thirty-eight (38.4%) patients had severe BPH obstruction and would have been denied PUL utilizing previously reported study criteria. Within 1 month 74 (86%) reported substantial symptom relief with significant improvements in Qmax, PVR, IPSS, and QOL (p < 0.001) that was maintained within the follow-up. Sexual function including ejaculation was unchanged or improved. No Clavien-Dindo Grad ≥ 2 was reported postoperatively. Eleven (12.8%) patients were retreated over 2 years. Twelve (86%) of 14 patients presenting with chronic urinary retention were catheter free at last follow-up. CONCLUSION: PUL is a promising surgical technique that may alleviate LUTS, even in patients with severe obstruction.


Assuntos
Sintomas do Trato Urinário Inferior/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Hiperplasia Prostática/cirurgia , Implantação de Prótese , Obstrução Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos , Adulto , Idoso , Idoso de 80 Anos ou mais , Alemanha , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Hiperplasia Prostática/complicações , Qualidade de Vida , Índice de Gravidade de Doença , Ressecção Transuretral da Próstata , Obstrução Uretral/etiologia
12.
World J Urol ; 37(7): 1315-1320, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30350017

RESUMO

OBJECTIVE: This study sought to compare the incidental prostate cancer (iPCa) detection rate between pathological specimens from green laser enucleation of the prostate (GreenLEP) and open simple prostatectomy (OSP). MATERIALS AND METHODS: In two institutions, the charts of all consecutive patients who underwent OSP between January 2005 and December 2010 were retrospectively reviewed, and the data of all consecutive patients who underwent GreenLEP with tissue morcellation between July 2013 and January 2018 were also collected. Preoperative demographics and pathological findings were recorded. iPCa detection rate was retrospectively compared between the GreenLEP and OSP groups in a propensity score model, including all predetermined variables: Age, preoperative PSA level and prostate volume. RESULTS: Of 738 patients, 402 were included in the propensity-score matching analysis, and they were equally distributed among groups. The overall iPCa detection rates were similar in both groups (9.9% vs. 8.5%; p = 0.73), and there were no statistically significant differences in terms of tumour stage, Gleason score or the rate of clinically significant iPCa, although the number of cassettes analysed was significantly higher in the morcellation group than in the OSP group. No predictive factors for iPCa were identified. CONCLUSIONS: The results of the present study suggest that the mechanical morcellation of large glands had no influence on iPCa detection. Compared with a specimen from standard OSP, a large morcellated tissue sample allows adequate pathological evaluation and does not alter a pathologist's ability to detect iPCa.


Assuntos
Achados Incidentais , Morcelação/métodos , Prostatectomia/métodos , Hiperplasia Prostática/cirurgia , Neoplasias da Próstata/patologia , Ressecção Transuretral da Próstata/métodos , Obstrução Uretral/cirurgia , Idoso , Humanos , Terapia a Laser , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Hiperplasia Prostática/complicações , Neoplasias da Próstata/diagnóstico , Obstrução Uretral/etiologia
13.
Int Urogynecol J ; 30(5): 761-766, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30083942

RESUMO

INTRODUCTION AND HYPOTHESIS: The suburethral sling procedure has been widely used as the first-line treatment for stress urinary incontinence (SUI) in women. Although the success rate is high, difficult urination and urine retention can occur in a small portion of patients. A transvaginal sling incision can solve this problem but recurrent SUI may occur. This study investigated the long-term outcomes of women who underwent the pubovaginal sling (PVS) procedure and subsequent transvaginal sling incision for urethral obstruction. METHODS: We retrospectively reviewed the voiding conditions of women who underwent transvaginal sling incision owing to bladder outlet obstruction after the PVS procedure over the past two decades. Urodynamic study was performed before and after each operation. The patients' Global Impression of Improvement (PGI-I) and quality of life index (QoL-I) due to urinary symptoms were used for outcome evaluation. RESULTS: Among 405 women who underwent PVS procedure, 14 (3.5%) underwent subsequent transvaginal sling incision. The main symptoms were severe dysuria, followed by urinary retention or severe wound discomfort. The average interval between the two operations was 147.6 ± 353.6 days (range 3~1,344). The mean follow-up time after sling incision was 91.1 ± 50.7 months. At follow-up, 12 patients (85.7%) could maintain urinary continence whereas 2 had urgency incontinence. Ten patients (71.4%) were satisfied with their quality of life postoperatively. CONCLUSIONS: Transvaginal sling incision is effective for urethral obstruction after PVS procedure. Voiding dysfunction after PVS could be resolved via sling incision. Most patients could maintain urinary continence and reported good satisfaction.


Assuntos
Slings Suburetrais/efeitos adversos , Obstrução Uretral/cirurgia , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Telas Cirúrgicas/efeitos adversos , Resultado do Tratamento , Obstrução Uretral/etiologia , Retenção Urinária/etiologia , Retenção Urinária/cirurgia
15.
Rev Int Androl ; 16(4): 143-146, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30286868

RESUMO

INTRODUCTION: Our aim was to evaluate and share our urethrocutaneus fistula repair results in adult patients who had been operated for hypospadias in their childhood. MATERIAL AND METHODS: The data of totally 48 patients who had been treated for urethrocutaneous fistula after hypospadias surgery in our department from May 2008 to January 2015 analyzed retrospectively. Patients' age at fistula repair, age at first hypospadias surgery, fistula size, localization and number, distal urethral obstruction status and surgical outcomes of fistula repairs were recorded. All patients were controlled three months after the repair for surgical outcomes. RESULTS: Fistula repair performed in 45 patients. Mean age was 21.46 (20-26). Nineteen patients (42.2%) underwent first hypospadias surgery under the age of 7 years; 8 patients (17.7%) between 7 and 15 years, 18 patients between 15 and 20 years. Tubularized incised plate urethroplasty (TIPU) was performed in 40 patients (88.9%), extragenital tissue was used in 5 patients (11.1%). Twenty two patients (48.9%) had 1 or 2 operations, 17 patients (37.8%) had 3-5 operations and 6 patients (13.3%) had 6 or more operations. Thirteen (28.9%) coronal, 24 (53.3%) subcoronal, 6 (13.3%) penile and 2 (4.4%) penoscrotal fistulas were observed. While a single fistula was observed in 35 patients, multiple fistulas were seen in 10 patients. A fistula diameter les than 5mm was detected in 37 patients, and larger than 5mm in 8 patients. Fistula recurrence was observed in 3 patients at follow-up examinations carried out at 3 months postoperatively. The number of operations was more than 5, the fistula diameter was larger than 5mm and the fistulas were coronal in all three recurrent fistulas. CONCLUSION: According to our results fistula size, previous surgery and well-vascularised, one or two layer tissue were the important factors in the success of fistula repair after hypospadias surgery.


Assuntos
Fístula Cutânea/cirurgia , Hipospadia/cirurgia , Complicações Pós-Operatórias/cirurgia , Fístula Urinária/cirurgia , Adulto , Fístula Cutânea/etiologia , Seguimentos , Humanos , Masculino , Complicações Pós-Operatórias/patologia , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Obstrução Uretral/etiologia , Obstrução Uretral/cirurgia , Fístula Urinária/etiologia , Adulto Jovem
17.
BMJ Case Rep ; 20182018 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-30249735

RESUMO

Posterior urethral valve and foreign body are among the important causes of male urethral obstruction. Although one is congenital and the other is acquired, both entities are rare in children with only a few reported cases. Because of myriad of symptoms associated with both conditions, a conclusive diagnosis requires both physical examination and radiological imaging. We report a first of its kind association of posterior urethral valve with foreign body in the posterior urethra in a 6-year-old male child which was eventually managed by endoscopic intervention.


Assuntos
Corpos Estranhos/diagnóstico , Uretra/anormalidades , Obstrução Uretral/etiologia , Criança , Corpos Estranhos/complicações , Humanos , Masculino
18.
Prenat Diagn ; 38(12): 964-970, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30207389

RESUMO

OBJECTIVE: Because the literature on the predictive value of fetal urinalysis is controversial in fetuses with lower urinary tract obstruction, we determined the best model of fetal urine biochemical markers correlated with long-term postnatal renal function based on glomerular filtration rate (GFR). METHOD: This retrospective study concerned 89 fetuses with lower urinary tract obstruction and their renal function after 10 years of age. We correlated fetal urine biochemical markers (total protein, ß2-microglobulin, sodium, chloride, glucose, calcium, and phosphorus) with GFR at 10 to 30 years of age in 89 patients with posterior urethral valves. We defined five stages of chronic kidney disease (CKD). RESULTS: Of the 89 patients, 18 (20%) are 20 years old or over. Postnatal renal function was good in 67.4% (GFR > 60 mL/min/1.73 m2 ) and poor in 17% (GFR < 30 mL/min/1.73 m2 ). All fetal urine markers differed between CKD stage 1 + 2 and CKD stage 4 + 5 (P < 0.001). ß2-microblobulin showed an 87% sensitivity for a 72% specificity. A combination of ß2-microglobulin and chloride gave the best results (93% sensitivity and 71% specificity) versus amniotic fluid volume (80% sensitivity and 73% specificity). CONCLUSION: Fetal urine biochemistry predicts long-term (10-30 years) postnatal renal function.


Assuntos
Doenças Fetais/urina , Insuficiência Renal Crônica/fisiopatologia , Insuficiência Renal Crônica/urina , Obstrução Uretral/urina , Microglobulina beta-2/urina , Biomarcadores/urina , Criança , Cloretos/urina , Feminino , Doenças Fetais/diagnóstico por imagem , Doenças Fetais/etiologia , Taxa de Filtração Glomerular , Humanos , Masculino , Oligo-Hidrâmnio/diagnóstico por imagem , Oligo-Hidrâmnio/etiologia , Valor Preditivo dos Testes , Gravidez , Prognóstico , Insuficiência Renal Crônica/congênito , Insuficiência Renal Crônica/etiologia , Estudos Retrospectivos , Obstrução Uretral/congênito , Obstrução Uretral/diagnóstico por imagem , Obstrução Uretral/etiologia , Urinálise
19.
Prog Urol ; 28(15): 813-820, 2018 Nov.
Artigo em Francês | MEDLINE | ID: mdl-30262261

RESUMO

OBJECTIVE: Our objective was to evaluate bladder outlet obstruction (BOO) consequences on the detrusor activity, to analyze the impact of medical and surgical treatments, and to study the reasons for recurrence of urinary symptoms after surgical treatment. METHOD: A non-systematic review of the scientific literature was conducted from the PubMed database to retrieve the most relevant scientific publications between 2000 and July 2018 with the keywords: BPH, bladder obstruction, bladder instability, surgery, and reoperation. A first research was crossed with the results of the reviews of literature already published and was enriched by the contributions of the various authors. A synthesis has been proposed. RESULTS: The consequences of bladder outlet obstruction (BOO) on the detrusor may be detrusor overactivity (DOA) or detrusor hypocontractility. DOA is found in about 50% of patients at the time of their surgery and its evolution is most often favorable after surgical treatment (resolved or reduced in 2/3 of cases). Bladder hypocontractility is responsible for acute or chronic urinary retention. It can be the cause for poor postoperative micturition recovery requiring self-catheterization which the patient must have been informed before surgical treatment. Surgery reduces urinary symptoms with a low but significant surgical revision rate (10 to 30% depending on the surgical technique). The less efficient technique with regard to surgical revision rates are prostatic radiofrequency or cervico-prostatic incision, followed by laser vaporization techniques, TURP and adenomectomy (surgical or endoscopic). Adenomectomy is the surgical technique that has the lowest recurrence rate. The identified risk factors for surgical revision are the surgeon's experience, the power of the laser (in case of photovaporization), the surgical technique employed, the length of operative time, the low or excessive volume of the prostate, the significant pre-operative post-void residual volume, and the slight decrease of postoperative PSA level. Prior to any surgical revision for recurrence of urinary symptoms, the assessment should include the review of previous surgical report, the evaluation of the resected prostatic volume and the residual prostatic volume, the IPSS score, the calendar of micturition, the urethrocystoscopy and the urodynamic assessment. CONCLUSION: BOO can lead to bladder dysfunction such as DOA or detrusor hypocontractility. Resolution of BOO by a suitable surgical treatment allows, in the majority of the cases, to resolve bladder dysfunctioning. In case of failure, the assessment must be complete to define the causes and to find the most suitable solution.


Assuntos
Prostatectomia , Hiperplasia Prostática/cirurgia , Bexiga Urinária/fisiologia , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/terapia , Masculino , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Hiperplasia Prostática/complicações , Hiperplasia Prostática/patologia , Hiperplasia Prostática/fisiopatologia , Recidiva , Reoperação/métodos , Obstrução Uretral/etiologia , Obstrução Uretral/fisiopatologia , Obstrução Uretral/cirurgia , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/fisiopatologia , Obstrução do Colo da Bexiga Urinária/cirurgia , Urodinâmica/fisiologia
20.
Medicine (Baltimore) ; 97(23): e11033, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29879071

RESUMO

We investigated long-term functional changes in the kidney and bladder of patients with posterior urethral valve (PUV) who underwent fetal intervention or postnatal surgery.We retrospectively reviewed the medical records of 28 consecutive patients treated for PUV at our institution. Detailed data on medical and surgical histories, particularly on pre- and postnatal treatment modality, including fetal vesicoamniotic shunt, endoscopic valve ablation, and vesicostomy, were collected and analyzed. Long-term renal function was evaluated based on serum levels of creatinine (sCr), estimated glomerular filtration rate (eGFR), and renal scans. Voiding function was evaluated in urodynamic tests.Vesicoamniotic shunting was performed in 12 (42.8%) patients. Although the mean initial sCr was significantly higher in patients in whom a fetal shunt was placed than in others (2.04 vs 1.17 mg/L, P = .038), the sCr at long-term follow-up was not significantly different between them (0.64 vs 0.40 mg/L, P = .186). The mean maximum detrusor pressure was significantly lower in patients with a fetal shunt than in others (37.7 vs 73.0 cm H2O, P = .019). Postnatal vesicostomy was performed in 14 patients, and primary valve ablation was performed in 13 patients. The mean initial sCr was higher in patients in the vesicostomy group than in the primary valve ablation group (2.08 vs 0.86 mg/L, P = .014). However, no significant differences were found in sCr (0.9 vs 0.3 mg/L, P = .252) or GFR (59.1 vs 68.5 mL/min/1.73 m, P = .338) at long-term follow-up. Bladder capacity was greater and residual urine volume was less in the vesicostomy group than in the primary valve ablation group, but without statistical significance.Vesicostomy is more beneficial in the recovery of renal function and is not inferior in terms of bladder function, even in patients with severe PUV disorder. It is a reliable surgical option that can spare renal function and guarantee adequate bladder function in the long term.


Assuntos
Rim/fisiopatologia , Uretra/anormalidades , Estreitamento Uretral/complicações , Bexiga Urinária/fisiopatologia , Creatinina/sangue , Cistostomia/métodos , Terapias Fetais/métodos , Idade Gestacional , Taxa de Filtração Glomerular/fisiologia , Humanos , Testes de Função Renal/métodos , Masculino , Diagnóstico Pré-Natal/métodos , Estudos Retrospectivos , Uretra/patologia , Uretra/cirurgia , Obstrução Uretral/epidemiologia , Obstrução Uretral/etiologia , Estreitamento Uretral/epidemiologia , Estreitamento Uretral/cirurgia
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