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2.
Rev Med Suisse ; 16(686): 531-538, 2020 Mar 18.
Artigo em Francês | MEDLINE | ID: mdl-32186798

RESUMO

Peyronie's disease (PD) is a relatively unknown cause of sexual dysfunction. Symptoms may include the appearance of an erectile deformity, pain in the penis and erectile dysfunction (ED). The etiology is most often unclear, and medical treatments are limited, although improvement is always possible. However, surgical treatment remains the only option when the disease has stabilized and in the event of significant erectile and sexual disability.


Assuntos
Induração Peniana/fisiopatologia , Disfunção Erétil/complicações , Disfunção Erétil/fisiopatologia , Humanos , Masculino , Ereção Peniana , Induração Peniana/complicações , Pênis/fisiopatologia
4.
Urologe A ; 59(2): 209-218, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-32020240

RESUMO

The incidence of penile cancer in central Europe and North America is low, and patients often present at a late stage of the disease. The diagnosis can very often be made by visual examination of the primary tumor. Its morphology, size, and location as well as the inguinal lymph nodes are of clinical interest. The removal of (micro)metastatic lymph nodes is decisive for the prognosis. These cannot be diagnosed clinically or by imaging with sufficient reliability, which makes invasive lymph node staging necessary. Penile cancer can only be cured by surgery in patients with localized cancer and early stage regional lymph node metastasis. The primary tumor, including metastatic lymph nodes, must be completely excised as early as possible. If indicated, organ preservation must be performed with strict adherence of safety margins. Optimal lymph node management is crucial for long-term survival.


Assuntos
Excisão de Linfonodo/métodos , Linfonodos/patologia , Neoplasias Penianas/diagnóstico , Neoplasias Penianas/cirurgia , Intervalo Livre de Doença , Europa (Continente) , Humanos , Metástase Linfática/patologia , Metástase Linfática/prevenção & controle , Masculino , Estadiamento de Neoplasias , Neoplasias Penianas/mortalidade , Neoplasias Penianas/patologia , Pênis/patologia , Prognóstico , Reprodutibilidade dos Testes , Análise de Sobrevida
5.
Hinyokika Kiyo ; 66(1): 29-32, 2020 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-32028753

RESUMO

Approximately 400 cases of penile fracture have been reported in Japan, but the sexual function before and after treatment has not been evaluated. Here, we show 2 surgical procedures dealing with penile fractureand examinethechange s in sexual functions using IIEF-5. Case1 was in a 51 year old malewho underwent emergency surgery for a penile fracture. The IIEF-5 score was 17 points before surgery and 8 points 2 months after surgery. At 5 months post-surgery, the patient complained of mild pain and penile curvature while erect, still the IIEF-5 score showed an improvement to 12 points. Case 2 was in a 60 year old male who underwent emergency surgery for penile fracture. The IIEF-5 score was 21 points before surgery and 8 points 2 months after surgery. Erection and ejaculation became possible 6 months after surgery, and the IIEF-5 score showed an improvement to 21 points. After surgery, the IIEF-5 score declined and sexual function also declined temporarily, though both gradually improved. From a sexual functioning standpoint, surgical treatment would be preferable.


Assuntos
Doenças do Pênis , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Ereção Peniana , Pênis
6.
Urology ; 137: 183-189, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31926195

RESUMO

OBJECTIVE: To characterize the bulbospongiosus muscle (BSM) in patients with bulbar urethral strictures. MATERIALS AND METHODS: We studied 21 patients divided into 2 groups: Stricture Group (n = 14; mean age = 62.00 years) with bulbar stricture submitted to open urethroplasty; and Control Group (n = 7; mean age = 60.14 years) with penile strictures (hypospadias cripples, penile cancer and/or penile infection) who were submitted to perineal urethrostomy. Samples of the BSM were dissected and histologic sections were stained by histochemical and immunohistochemical techniques. Histomorphometric analyzes were performed on photomicrographs. Means were statistically compared using the unpaired Student t test and the Mann-Whitney test (P <.05). RESULTS: The etiology of bulbar urethral stricture was idiopathic in 2 cases (14.29%), post-TURP in 6 (42.86%), post open radical prostatectomy in 5 (35.71%) and post open prostatectomy in 1 case (7.14%). The average length of the stricture was 2.08 cm. The only parameter analyzed with significant difference between the groups was the vessels (significant difference between the control group: 5.11 ± 1.98% and stricture group: 3.57 ± 1.32%, P = .0460). The quantitative analysis of collagen (Control Group: 10.63 ± 5.37% and Stricture Group: 10.83 ± 4.55%, P = .9296); diameter of BSM muscle fibers (Control Group: 41.71 ± 14.63 µm and Stricture Group: 40.11 ± 8.59 µm, P = .76 and elastic system fibers (Control Group; 3.83 ± 1.54% and Stricture Group: 5.43 ± 2.90%, P = .2601) showed no significant difference. CONCLUSIONS: Histologic analysis showed a significant decrease of the BSM vessels in urethral stricture, without changes in elastic fibers, collagen, nerves, and muscle fiber diameter. These findings show that the bulbar urethral stricture causes minimal alterations in the structure of the BSM.


Assuntos
Doenças do Pênis , Pênis , Complicações Pós-Operatórias , Uretra , Estreitamento Uretral , Procedimentos Cirúrgicos Urológicos , Pesos e Medidas Corporais/métodos , Brasil , Constrição Patológica , Correlação de Dados , Técnicas de Imagem por Elasticidade/métodos , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Doenças do Pênis/diagnóstico , Doenças do Pênis/etiologia , Pênis/patologia , Pênis/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/patologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Uretra/irrigação sanguínea , Uretra/inervação , Uretra/patologia , Uretra/cirurgia , Estreitamento Uretral/diagnóstico , Estreitamento Uretral/epidemiologia , Estreitamento Uretral/etiologia , Estreitamento Uretral/patologia , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Procedimentos Cirúrgicos Urológicos/métodos
7.
Cell Prolif ; 53(2): e12756, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31943490

RESUMO

OBJECTIVES: To evaluate the rapid repair potential of adipose-derived stem cells (ADSCs) co-overexpressing VEGF and GDNF on bilateral cavernous nerve injury (BCNI) in rat models. Progressive fibrosis of the penis that occurs shortly after BCNI is a key cause of clinical treatment difficulty of erectile dysfunction (ED). Traditional medications are ineffective for ED caused by BCNI. ADSCs have shown therapeutic effects in animal models, but disappointing in clinical treatment suggests that we should explore optimal treatment of it. MATERIALS AND METHODS: We extracted ADSCs from rat epididymis. Lentiviral transfection was verified by western blot and immunofluorescence. Thirty-six SD rats (10 weeks old) were randomly divided into six groups (n = 6 per group): sham surgery, and remaining five BCNI groups transplanted PBS or ADSCs which were genetically modified by vehicle, VEGF (ADSC-V), GDNF (ADSC-G), or VEGF&GDNF (ADSC-G&V) around major pelvic ganglion (MPG). We investigated the therapeutic effects of BCNI rat model which is characterized by ED, penile tissue fibrosis and hypoxia, and lack of nitrogen nerves or vascular atrophy. RESULTS: Erectile function was almost recovered after 2 weeks of transplantation of ADSC-G&V, promoted cavernous nerve repair, prevented penile fibrosis and preserving the vascular endothelium, which was significant differences amongst ADSC-V or ADSC-G. Moreover, GM-ADSCs were detected in MPG and penis, indicating that their participation in repair of target organs and transverse nerves. CONCLUSIONS: These promising data indicate that ADSCs co-overexpressed VEGF and GDNF-induced synergistic effects, make it a potential tool for recovering of erectile function speedily after BCNI.


Assuntos
Adipócitos/metabolismo , Tecido Adiposo/metabolismo , Disfunção Erétil/metabolismo , Fator Neurotrófico Derivado de Linhagem de Célula Glial/metabolismo , Neurogênese/fisiologia , Células-Tronco/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo , Animais , Células Cultivadas , Modelos Animais de Doenças , Humanos , Masculino , Ereção Peniana/fisiologia , Pênis/metabolismo , Ratos , Ratos Sprague-Dawley , Transplante de Células-Tronco
10.
Urology ; 136: e5-e6, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31726183

RESUMO

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


Assuntos
Fístula Cutânea/diagnóstico por imagem , Cistografia , Pênis/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Cirurgia de Readequação Sexual/métodos , Doenças Uretrais/diagnóstico por imagem , Fístula Urinária/diagnóstico por imagem , Vagina/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
11.
Urology ; 136: 218-224, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31765653

RESUMO

OBJECTIVE: To understand the extent to which pediatricians are providing advice on care of the uncircumcised penis and the advice they are providing. We hypothesized that pediatric residents lack preparedness to offer parents advice on caring for the uncircumcised penis and as such are unlikely to offer such advice. METHODS: An IRB approved, anonymous survey was administered to 244 pediatric residents in 5 urban training programs (Appendix). Descriptive statistics were used for clinical and demographic data and Fisher's exact and Kruskal-Wallis tests were used for comparative analysis. RESULTS: Eighty-three residents completed the survey for a response rate of 34%. Less than half (45%) of the residents surveyed were likely, or extremely likely to voluntarily offer advice to parents on care of the uncircumcised penis. On a scale of 0-100, the median confidence level in offering advice was 48 (interquartile range [IQR] 30-52). Forty-nine percent of residents reported never being taught care of the uncircumcised penis. Of those who received education, 72% reported learning informally from a senior resident or attending and only 9% learned from a formal lecture. Pediatric residents varied greatly on advice given to parents in regards to the frequency of retraction and 40% offered no advice. CONCLUSION: This study demonstrates that pediatric residents currently lack confidence in providing parents advice on preputial care and are unlikely to offer such advice. When offered, the advice given is highly variable. This study emphasizes the need for improved education of pediatric residents.


Assuntos
Cuidado da Criança , Aconselhamento Diretivo , Internato e Residência , Pais , Pediatria/educação , Pênis , Pré-Escolar , Circuncisão Masculina , Aconselhamento Diretivo/métodos , Aconselhamento Diretivo/normas , Aconselhamento Diretivo/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino
12.
Urology ; 136: 158-161, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31790784

RESUMO

OBJECTIVE: To describe the technique of robotic remnant vaginectomy/excision of urethral diverticulum in transmen and report postoperative outcomes. MATERIALS AND METHODS: Between 2015 and 2018, 4 patients underwent robotic remnant vaginectomy/excision of urethral diverticulum for relief of urinary symptoms. Patients were of mean age 36 ± 10.1 years (range 26-50) at time of vaginal remnant excision, and were 26 ± 9.1 months (range 20-39) post-op following their primary vaginectomy and radial forearm free flap (n = 3) or anterolateral thigh (n = 1) phalloplasty. All had multiple urologic complications after primary phalloplasty, most commonly urinary retention (n = 4), urethral stricture (n = 3), fistula (n = 3), dribbling (n = 2), and obstruction (n = 2). Indication for revision was obstruction and retention (n =3 ) and/or dribbling (n = 2). In each case, the robotic transabdominal dissection freed remnant vaginal tissue from the adjacent bladder and rectum without injury to these structures. Concurrent first- or second-stage urethroplasty was performed in all cases at a more distal portion of the urethra using buccal mucosa, vaginal, or skin grafts. Intraoperative cystoscopy was used in each case to confirm complete resection and closure of the diverticulum. RESULTS: At mean follow-up of 294 ± 125.6 days (range 106-412), no patients had persistence or recurrence of vaginal cavity/urethral diverticulum on cystoscopic follow-up. Of 3 patients who wished to ultimately stand to void, 2 were able to do so at follow-up. CONCLUSION: Robotic transabdominal approach to remnant vaginectomy/excision of urethral diverticulum allows for excision without opening the perineal closure for management of symptomatic remnant/diverticulum in transgender men after vaginectomy.


Assuntos
Divertículo/cirurgia , Pênis/cirurgia , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Robóticos , Cirurgia de Readequação Sexual/métodos , Doenças Uretrais/cirurgia , Transtornos Urinários/cirurgia , Vagina/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
Ann R Coll Surg Engl ; 102(2): e36-e38, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31530167

RESUMO

Penile calciphylaxis or calcific uremic arteriolopathy is a rare urological condition often associated with patients undergoing renal dialysis for end-stage renal disease. The majority of cases are associated with systemic calciphylaxis. The pathophysiology, diagnosis and management of penile calciphylaxis as an individual entity has brought little attention. The rates of comorbidity and mortality of these patients are often particularly high. Early diagnosis and a multidisciplinary approach are therefore essential. We report a case of penile calciphylaxis in a 59-year-old man with end-stage renal failure on haemodialysis who was successfully managed conservatively.


Assuntos
Angioplastia/métodos , Calciofilaxia/terapia , Tratamento Conservador/métodos , Doenças do Pênis/terapia , Inibidores da Agregação de Plaquetas/uso terapêutico , Bandagens , Calciofilaxia/diagnóstico , Calciofilaxia/etiologia , Artéria Femoral/cirurgia , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Doenças do Pênis/diagnóstico , Doenças do Pênis/etiologia , Pênis/irrigação sanguínea , Pênis/patologia , Diálise Renal/efeitos adversos , Resultado do Tratamento
14.
Urology ; 135: 133-135, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31586472

RESUMO

Malignant peripheral nerve sheath tumors (MPNSTs) are soft tissue sarcomas that arise from peripheral nerve fibers and primarily occur in the setting of neurofibromatosis (NF1). MPNST arising from the penis is very rare and may require mutilating surgery to achieve surgical cure. We previously reported a case of MPNST involving the penis in a 14-month-old boy treated with neoadjuvant chemotherapy, total penectomy, and adjuvant radiation. Here we report intermediate follow-up of the same patient, describe his subsequent genitourinary reconstruction, and discuss management dilemmas that arise following treatment of penile MPNST.


Assuntos
Assistência ao Convalescente/métodos , Neoplasias da Bainha Neural/terapia , Neoplasias Penianas/terapia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Criança , Humanos , Masculino , Terapia Neoadjuvante , Neoplasias da Bainha Neural/patologia , Neoplasias Penianas/patologia , Pênis/patologia , Pênis/cirurgia , Escroto/cirurgia , Resultado do Tratamento , Uretra/cirurgia
15.
Urology ; 135: 11-19, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605681

RESUMO

OBJECTIVE: To elucidate current understanding on the pathophysiological mechanism of genital lichen sclerosus (LS), urologic manifestations, and treatment options. MATERIALS AND METHODS: The Medline/PubMed and Embase databases were systematically reviewed for publications pertaining to LS. After applying inclusion and exclusion criteria, references were assessed for relevance to the pathophysiology, presentation, and treatment of LS by title and abstract review by 2 independent reviewers, yielding 186 articles for assessment. RESULTS: The contemporary understanding of the epidemiology and histology of LS is reviewed herein. Additionally, we explore in detail the 3 hypotheses regarding the pathophysiological mechanism contributing to disease presentation: infectious etiology, primary immune dysregulation, and the isotraumatopic response. We summarize the available biological evidence supporting each hypothesis. This discussion provides context for understanding LS morbidity and may spur new avenues of research. For the clinician, we review the clinical presentation of disease, including the risk of progression to squamous cell carcinoma. The current medical and surgical treatment options are also detailed. CONCLUSION: LS remains a potentially insidious disease which may lead to debilitating urinary and sexual dysfunction. Cross disciplinary research should aim for earlier detection, as well as more effective and durable treatment. The exact cause of LS remains unknown.


Assuntos
Balanite Xerótica Obliterante/diagnóstico , Líquen Escleroso e Atrófico/diagnóstico , Líquen Escleroso Vulvar/diagnóstico , Administração Tópica , Balanite Xerótica Obliterante/epidemiologia , Balanite Xerótica Obliterante/terapia , Biópsia , Circuncisão Masculina , Diagnóstico Diferencial , Progressão da Doença , Feminino , Glucocorticoides/uso terapêutico , Humanos , Líquen Escleroso e Atrófico/epidemiologia , Líquen Escleroso e Atrófico/terapia , Masculino , Pênis/patologia , Pênis/cirurgia , Prevalência , Resultado do Tratamento , Vulva/patologia , Líquen Escleroso Vulvar/tratamento farmacológico , Líquen Escleroso Vulvar/epidemiologia
16.
Urology ; 135: 66-70, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31541647

RESUMO

OBJECTIVE: To define age-specific normal Color Doppler Duplex Ultrasound (CDDU) parameters based on a large institutional database of men referred for vascular erectile testing, but found to have normal and sustained rigidity following penile injection of alprostadil. METHODS: A retrospective review of patients who underwent CDDU from January 1, 2005 to December 31, 2014 was conducted. The indications for CDDU assessments included complaint of erectile dysfunction refractory to PDE-5 inhibitors, new-onset penile curvature, or secondary consultation for erectile dysfunction. Pearson correlation test was used to evaluate the association between ordinal age groups with peak systolic velocity (PSV) and resistive index (RI) measurements to determine the effect of age on erectile response. RESULTS: A total of 2043 patients underwent CDDU from January 1, 2005 to December 31, 2014. 259 patients (12.7%) with a mean age 53.7 and a mean BMI of 27.2 were noted to have normal erectile rigidity and normal Doppler parameters (PSV >35 cm/s, RI >0.90). Prolonged erection, defined by need to inject phenylephrine reversal agent at 1-2 hours, occurred in 93% of patients. When age was categorized by decade, a negative correlation coefficient was obtained for previsual sexual stimulation PSV (-0.09, P = .164) and postvisual sexual stimulation PSV (-0.23, P = .005). CONCLUSION: In men with normal vascular erections there appears to be a significant, age-related decline in postvisual sexual stimulation PSV without compromise to cavernous venous occlusion as measured by RI. We have used Doppler parameters in patients without vascular ED to define age-specific normalcy.


Assuntos
Envelhecimento/fisiologia , Disfunção Erétil/diagnóstico , Ereção Peniana/fisiologia , Pênis/diagnóstico por imagem , Ultrassonografia Doppler em Cores , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Disfunção Erétil/tratamento farmacológico , Disfunção Erétil/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Ereção Peniana/efeitos dos fármacos , Pênis/irrigação sanguínea , Pênis/fisiologia , Fenilefrina/administração & dosagem , Fenilefrina/antagonistas & inibidores , Inibidores da Fosfodiesterase 5/farmacologia , Inibidores da Fosfodiesterase 5/uso terapêutico , Estudos Retrospectivos , Falha de Tratamento , Agentes Urológicos/uso terapêutico , Adulto Jovem
17.
Urology ; 135: 146-153, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31626854

RESUMO

OBJECTIVE: To evaluate the magnetic resonance imaging (MRI) findings of traumatic bulbar stricture and to evaluate their ability to estimate repair complexity. METHODS: Eighty-nine men with traumatic bulbar stricture who underwent urethrography and MRI at least 3 months postinjury and subsequent excision and primary anastomosis were retrospectively analyzed. The associations of MRI findings, including continuity of the tunica albuginea of the corpus spongiosum, periurethral fistula, spongiofibrosis length (SFL), and distal and proximal bulbar urethral length from the stricture, with urethrography and operative parameters were evaluated. RESULTS: Mean SFL was significantly longer than mean stricture length on urethrography (14.9 vs 7.9 mm, P <.0001). Periurethral fistula was found in 18 (20.2%) patients on MRI but not in 10 (55.6%) of them on urethrography. The corpus spongiosum was disrupted in 40 patients (55.1%) on MRI. On multivariate linear regression, SFL (standard coefficient, 0.25; t value, 2.31; P = .02) predicted operation time, while SFL (standard coefficient, 0.22; t value, 2.04; P = .04) and proximal bulbar urethral length (standard coefficient, -0.25; t value, -2.11; P = .04) independently predicted blood loss. Corporal splitting to reduce anastomotic tension and/or increase visualization during repair was needed in 33 patients (37.1%). Stricture length on urethrography (odds ratio [OR], 1.22; 95% confidence interval, 1.04-1.42; P = .006) and corpus spongiosum disruption (odds ratio, 5.51; 95% confidence interval, 1.57-19.34, P = .005) were independent predictors for the need of corporal splitting. CONCLUSION: In contrast to urethrography findings, MRI findings help predict traumatic bulbar stricture repair complexity.


Assuntos
Planejamento de Assistência ao Paciente , Doenças do Pênis/complicações , Pênis/lesões , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto , Estudos de Viabilidade , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças do Pênis/cirurgia , Pênis/diagnóstico por imagem , Período Pré-Operatório , Estudos Retrospectivos , Resultado do Tratamento , Uretra/diagnóstico por imagem , Estreitamento Uretral/diagnóstico por imagem , Estreitamento Uretral/etiologia
18.
Urology ; 136: 231-237, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31730942

RESUMO

OBJECTIVE: To describe the use of additional tissue recruited for coverage after penile lengthening in male exstrophy-epispadias complex patients using either local skin from tissue expansion (TE) or extragenital skin with a skin graft (SG) and report their respective outcomes. METHODS: An institutionally approved database of exstrophy-epispadias complex patients was retrospectively reviewed for male patients who received penile reconstruction. This included a penile lengthening procedure and the subsequent use of TE and/or a full thickness skin graft to provide cutaneous coverage of gained corporal length. RESULTS: A total of 50 patients (mean age 18.1 years) underwent penile reconstruction. TE was used in 27 patients, SG in 19, and 4 received a combination of TE and SG. The mean number of previous penile operations was 2.7 for patients that received TE and 3.1 for SG. A successful outcome from primary reconstruction was achieved in 35 patients (70%) and overall successful reconstruction was achieved by 48 patients (96%). CONCLUSION: TE and SG are useful techniques in providing soft tissue coverage following penile lengthening. TE is the preferred technique for primary reconstruction in a lengthening procedure. When genital skin is not expandable or coverage from TE is insufficient after lengthening, extragenital skin (SG) is recruited.


Assuntos
Extrofia Vesical/cirurgia , Epispadia/cirurgia , Pênis/cirurgia , Transplante de Pele , Expansão de Tecido , Adolescente , Adulto , Criança , Humanos , Masculino , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto Jovem
20.
Radiol Med ; 125(3): 288-295, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31823294

RESUMO

PURPOSE: High-flow priapism is an incomplete and painless persistent erection caused by trauma. Its diagnosis is performed thanks to clinic and imaging evaluation with detection of fistula/pseudoaneurysm in the cavernous tissue. This paper aims to retrospectively assess the efficacy and safety of superselective arterial embolization in patients with high-flow priapism. MATERIALS AND METHODS: From January 2008 to March 2017, nine patients with high-flow priapism have been treated in a single center with embolization. The main etiology was trauma in eight subjects. The patients were evaluated with laboratory examinations and clinical and imaging findings (color Doppler ultrasonography and angiography). The mean follow-up time after embolization was 24 months. RESULTS: Eleven procedures were performed in nine patients: two of them required a second treatment session because of recurrence after 1-2 weeks. Embolic agents were microcoils, microparticles (300-500 µm) and Spongostan. Restoration of erectile function was monitored by clinical and color Doppler evaluation during follow-up. CONCLUSIONS: Superselective embolization should be the procedure of choice in patients affected by high-flow priapism; this technique appears to be successful in preserving erectile function. The choice of the embolic agent is crucial, and it should be tailored for each patient.


Assuntos
Embolização Terapêutica/métodos , Pênis/irrigação sanguínea , Priapismo/terapia , Adolescente , Adulto , Angiografia , Criança , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Ereção Peniana , Pênis/lesões , Priapismo/diagnóstico por imagem , Priapismo/etiologia , Recidiva , Fluxo Sanguíneo Regional , Retratamento , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Adulto Jovem
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