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1.
Rev Med Liege ; 75(11): 748-753, 2020 Nov.
Artigo em Francês | MEDLINE | ID: mdl-33155450

RESUMO

Stricture of the male urethra is a frequent and regularly iatrogenic pathology in industrialized countries. The urologist's surgical arsenal is wide and the choice of an operative technique is made at the end of an assessment where urethrocystography is the main radiological examination. The conditions to achieve the examination, its different stages, the normal aspects and anatomical variants as well as the limitations to its interpretation, should therefore be known by the urologist and the radiologist, in order to assess correctly this pathology.


Assuntos
Cavidade Abdominal , Estreitamento Uretral , Constrição Patológica , Humanos , Masculino , Resultado do Tratamento , Uretra/diagnóstico por imagem , Uretra/cirurgia , Estreitamento Uretral/diagnóstico por imagem , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos
2.
Urologiia ; (5): 73-77, 2020 Nov.
Artigo em Russo | MEDLINE | ID: mdl-33185351

RESUMO

AIM: Urethral stenosis is one of the serious complications after proximal hypospadias repair. A variety of techniques has been suggested for its correction, such as urethral dilation using bougies, endoscopic incisions and one- or two-staged urethroplasty with buccal mucosa. The aim of our study was to improve results of urethral stenosis correction in children after multiple proximal hypospadias repairs. MATERIALS AND METHODS: A total of 24 patients with urethral stenosis after proximal hypospadias repairs underwent treatment in the Department of Uroandrology of the Russian Childrens Clinical Hospital from 2015 to 2019. The age of the patients was from 3-17 years (average - 4.2) with penoscrotal form of hypospadias in 12, scrotal in 8, and perineal in 4 patients. All children previously underwent 2-8 hypospadias repairs. Patients were divided into 2 groups. In group I, 16 patients had urethral stenosis from the glans of the penis to the penoscrotal area, urethral diameter of 3-4 Ch and ventral penile curvature of 45-60o. These patients were treated with a two-staged urethroplasty, similar to Brackas technique. In group II, 8 patients with urethral stenosis in the penile shaft area, urethral diameter of 6 Ch, without penile curvature were included. They underwent to a one-stage urethroplasty with buccal mucosa graft, which was sutured on the dorsolateral aspect of the urethra, with a formation of the age-appropriate urethra (Dorsolateral Inlay). RESULTS: All patients in both groups had successful results with flow rate of 8-12 ml/sec. CONCLUSIONS: The correction of urethral stenosis in children after proximal hypospadias repairs can be performed using buccal mucosa. In cases of long urethral stenosis, urethral diameter of 3-4 Ch, penile curvature, and scarring of the penile skin, a two-staged urethroplasty is recommended. In patients with stenosis of the penile shaft, urethral diameter of 6 Ch and lack of penile curvature, a one-stage urethroplasty with buccal mucosa fixation on the dorsolateral aspect of the urethra (Dorsolateral Inlay) allows to achieve successful results.


Assuntos
Hipospadia , Procedimentos Cirúrgicos Reconstrutivos , Estreitamento Uretral , Criança , Humanos , Hipospadia/cirurgia , Lactente , Masculino , Pênis/cirurgia , Federação Russa , Resultado do Tratamento , Uretra/cirurgia , Estreitamento Uretral/etiologia , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
3.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(11): 1423-1428, 2020 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-33191701

RESUMO

Objective: To evaluate the effectiveness of pedicled skin flap of foreskin for phalloplasty and Sugita surgical method in the treatment of complete concealed penis. Methods: The clinical data of 46 children with complete concealed penis between January 2016 and January 2018 were analyzed retrospectively. Among which, 25 cases were treated with pedicled skin flap of foreskin for phalloplasty (group A) and 21 cases were treated with Sugita surgical method (group B) with an average age of 4.7 years (range, 2 years and 8 months to 11 years). At 3 months after operation, the concealed penis recovery was scored from three aspects of postoperative penis length (the difference of the penis length between at 3 months after operation and before operation), penis appearance, and skin appearance (the total score was 10). And the parents evaluation of satisfaction degree of penis exposure, penis appearance, and foreskin appearance after surgical correction was collected. Results: Eighteen cases (72.0%) in group A and 15 cases (71.4%) in group B were followed up with an average of 13 months (range, 3-36 months). The incisions healed well in both groups, and there was no flap dehiscence, infection, necrosis, and penile erectile dysfunction. The penile length of the two groups increased significantly at 3 months after operation ( P<0.05); there was no significant difference between the two groups in terms of penis length and increased length at 3 months after operation and score of increase penis length after operation ( P>0.05). No penile retraction occurred in the two groups. And there was no significant difference between the two groups in penis appearance score, but the penis appearance score, skin appearance score, and total score of group A were significantly better than those of group B ( P<0.05). At 3 months after operation, the satisfaction rate of penis exposure in group A and group B was 88.9% and 80.0%, respectively, with no significant difference ( χ 2=0.50, P=0.48); the satisfaction rate of penis appearance was 72.2% and 53.3%, and the satisfaction rate of foreskin appearance was 94.4% and 53.3%, respectively, and the differences were significant ( χ 2=5.13, P=0.03; χ 2=7.53, P=0.01). Conclusion: Both surgical methods are suitable for correction of complete concealed penis, and the penile length gets a satisfactory recovery. However, the lymphedema of the prepuce after Sugita surgical method is serious, which can easily lead to poor appearance of the penis after operation. In general, the effectiveness of pedicled skin flap of foreskin for phalloplasty is better than that of the Sugita surgical method.


Assuntos
Prepúcio do Pênis , Procedimentos Cirúrgicos Reconstrutivos , Criança , Prepúcio do Pênis/cirurgia , Humanos , Lactente , Masculino , Pênis/cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Urológicos Masculinos
4.
Urologiia ; (4): 27-35, 2020 Sep.
Artigo em Russo | MEDLINE | ID: mdl-32897011

RESUMO

INTRODUCTION: Reconstructive plastic surgery is the gold standard in the treatment of primary urethral strictures, but the effectiveness of these methods does not reach 100%. In cases of recurrent urethral strictures, the effectiveness of standard operations is lower than with primary strictures, which requires a search for methods to improve the results of surgical treatment. PURPOSE OF THE STUDY: To evaluate the structure of the intercellular matrix, the cellular composition and regenerative potential of a plasma enriched in platelets after performing urethroplasty on a biological model. MATERIALS AND METHODS: Experiment was carried out on male rabbits ("Burgundy" breed) weighting 3.0-4.5 kg (18 individuals). 18 animals were divided into two groups: an experimental one (contained 9 individuals) and a control one (contained 9 individuals). All animals in each group were subjected to end-to-end plastic surgery of the urethral bulbous region using standard procedures. In the control group 4 ml of 0.9% NaCl isotonic solution was injected along the perimeter of the suture into anastomotic zone of the spongy body. Autologous plasma was injected to the animals from the experimental group. Histopathological examination was made by using routine pathological assessment with hematoxylin-eosin staining. The study also assessed the distribution and orientation of collagen fibers with Van Gieson stain. In order to objectively detail inflammatory and regenerative changes an additional immunohistochemical analysis was performed for the following antibodie groups: CD79a, CD43, CD31 (PECAM1), MMP1, MMP9. Quantitative analysis of structural changes was carried out by counting B- and T-lymphocytes having a positive membrane reaction with CD79a and CD43, respectively, in 10 representative sites in view (HPF) with a lens aperture of 0.65 in the highest concentration areas ("hot spots"). The expression level of MMP1, MMP9 was estimated by counting positive cells in 10 representative sites in view with a lens aperture of 0.65 in the submucosal and muscle layers. The level of angiogenesis in micropreparations was evaluated by counting the number of vessels in 10 sites in view (objective aperture of 0.65), reliable endothelial visualization was performed using CD31 expression (PECAM1). RESULTS: In the analysis of histological material use of platelet-rich plasma in the suture zone helps to reduce the area of necrotic changes and the inflammation severity, accelerated migration of macrophage-histiocytic cells to the alteration site and increased blood supply due to enhanced angiogenesis. In experimental samples a higher expression of metalloproteinases (collagenases) types 1 and 9, decreased collagen production and the correct orientation of collagen fibers during repair processes were noticed. CONCLUSIONS: The use of platelet-rich plasma helps to accelerate the reparative processes in the spongy body after urethroplasty. Another important positive effect of platelet-rich plasma is an increase in the expression of metalloproteinases, which leads to a decrease in collagen production and the correct orientation of collagen fibers. This allows to reduce the amount of pathological fibro-scar tissue in the operation area.


Assuntos
Plasma Rico em Plaquetas , Estreitamento Uretral/cirurgia , Animais , Humanos , Masculino , Modelos Teóricos , Coelhos , Uretra , Procedimentos Cirúrgicos Urológicos Masculinos
5.
Medicine (Baltimore) ; 99(31): e21545, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756211

RESUMO

Traditional open surgery (OS) is usually necessary when testicular torsion (TT) cannot be excluded by scrotal ultrasound. Scrotoscopy has been used as a minimally invasive technique to diagnose or treat scrotal diseases, and it may also play a role in diagnosing TT.A retrospective analysis was performed for patients with TT to evaluate the consistency of scrotoscopy and OS in the diagnosis of TT. In the cases where preoperational Color Doppler ultrasonography was performed, scrotoscopy, open surgery, and confirmed TT were included for future analysis.A total of 43 patients were studied. Twisted testes were retained in 11 cases (25.59%), and the remaining 32 patients (74.41%) underwent orchiectomy. There were significant differences in the diagnostic value between the grading of scrotoscopy and ultrasound, as well as between ultrasound grading and blood supply grading (BSG) (both P < .05). However, no significant difference was observed between the grading of scrotoscopy and BSG in traditional OS (P > .05), but a high degree of consistency existed between scrotoscopy grading and BSG in traditional OS (Kappa = 0.733, P ≤ .001).Our limited data indicate that the diagnosis of testicular torsion by scrotoscopy is highly consistent with that of traditional surgical exploration. Therefore, further studies are necessary to confirm its application value in the future. Scrotoscopy may have potential application value for the patients whom testicular torsion are insufficiently diagnosed but cannot be excluded.


Assuntos
Endoscopia/métodos , Escroto/cirurgia , Torção do Cordão Espermático/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adolescente , Humanos , Masculino , Orquiectomia/efeitos adversos , Orquiectomia/métodos , Estudos Retrospectivos , Escroto/diagnóstico por imagem , Torção do Cordão Espermático/diagnóstico por imagem , Torção do Cordão Espermático/patologia , Ultrassonografia Doppler em Cores , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/instrumentação , Adulto Jovem
6.
Mymensingh Med J ; 29(3): 516-522, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32844788

RESUMO

The surgical procedures of post traumatic posterior urethral stricture and distraction defects range from the extremely simple to the extremely radical. In oral Mucosal Graft Augmented Anastomotic Urethroplasty (OMG AAU) the stricture segment is excised followed by partially re-anastomosis of the dorsal or ventral urethral wall then the reconstruction is completed by placement of oral mucosal graft into the remaining urethral defect. The aim of this study is to determine the impact and assess the effectiveness of this technique, discuss the procedure and outcome and to refine them where found lacking. A prospectively collected review of records was done from September 2010 to April 2019. A total 100 patients with post traumatic urethral stricture and distraction defect were treated by dorsal onlay oral mucosal graft augmented anastomotic urethroplasty by same surgeon in a single centre. All were followed up every 3 and 6 monthly for 1-2 years with uroflowmetry. Retrograde urethrogram/Micturating cysto-urethrogram (RGU/MCU) and cystoscopy were reserved for those who had complained of obstructive symptoms and uroflowmetry evidence of outflow obstruction. The etiology of trauma was road traffic accident (RTA) (69%), falling astride (28%) and traumatic catheterization (3%). Mean excised stricture length was 1.5cm (Range 1.0-2.2). The mean length of dorsal onlay considering excised stricture length and 1cm spatulations was 4.25cm (range 2.0-6.5). The successful recovery was observed in 94% cases. On conclusion the technique of OMG AAU is very easy to do, reliable and has high success rates. This is also the procedure of choice for long segment obliterative strictures. For post traumatic obliterative strictures and distraction defects we strongly recommend the procedure for successful and patient satisfactory outcome.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Estreitamento Uretral/cirurgia , Humanos , Masculino , Mucosa Bucal , Estudos Retrospectivos , Resultado do Tratamento , Uretra/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos
7.
J Urol ; 204(4): 799-804, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32698710

RESUMO

PURPOSE: The AUA Guideline panel provides evidence-based recommendations for the surgical management of male lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: The Panel amended the Guideline in 2020 to reflect additional literature published through September 2019. When sufficient evidence existed, the Panel assigned the body of evidence a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, the Panel provided additional information as Clinical Principles and Expert Opinions (See table 1[Table: see text]). RESULTS: Amendments to these Guidelines include: 1) an amended statement (Guideline 1) to include conducting a physical examination; 2) a new statement (Guideline 6) discussing concepts of treatment failure and retreatment; 3) an amended statement (Guideline 15) with updated supporting text for prostatic urethral lift (PUL); 4) an amended statement (Guideline 16) for PUL; 5) an amended statement (Guideline 17) with updated supporting text for transurethral microwave therapy (TUMT); 6) an amended statement (Guideline 18) with updated supporting text for water vapor thermal therapy; 7) updated supporting text for water vapor thermal therapy (Guideline 19); 8) an amended statement (Guideline 21) with updated supporting text for laser enucleation; 9) an amended statement (Guideline 22) with updated supporting text for Aquablation; and 10) an amended statement (Guideline 23) with updated supporting text for Prostate Artery Embolization (PAE). CONCLUSIONS: These evidence-based updates to the AUA Guidelines further inform the surgical management of LUTS/BPH.


Assuntos
Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/cirurgia , Hiperplasia Prostática/complicações , Árvores de Decisões , Humanos , Masculino , Procedimentos Cirúrgicos Urológicos Masculinos/normas
11.
J Urol ; 204(5): 989-995, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32501135

RESUMO

PURPOSE: Controversy exists regarding the optimal urethroplasty technique, particularly for long bulbar urethral strictures requiring buccal mucosal graft. We assessed the relative outcomes of augmented anastomotic urethroplasty vs dorsal onlay in the setting of bulbar urethroplasty using a dorsal buccal mucosal graft. MATERIALS AND METHODS: A retrospective review was performed on all patients who underwent bulbar urethroplasty with dorsal buccal mucosal graft between October 2003 and March 2019. Around 2011 institutional technique shifted from routinely performing transecting augmented anastomotic urethroplasty to nontransecting dorsal onlay. Anastomotic urethroplasty without buccal mucosal graft, ventral onlay, staged, flap and circumferential reconstructions were excluded. The primary outcome was stricture recurrence defined as less than 16Fr on cystoscopy. Secondary outcomes included 90-day complications and de novo erectile dysfunction at 6 months. RESULTS: Of the 836 patients who underwent bulbar urethroplasty during the study period 507 met inclusion criteria. Of these, 221 patients received an augmented anastomotic urethroplasty while 286 underwent dorsal onlay urethroplasty. Mean patient age and stricture length were 45.4±14.8 years and 4.4±1.5 cm, respectively. Overall success rate was 93.9% (476 of 507) with a mean followup of 78.9 months. On multivariate analysis augmented anastomotic urethroplasty (HR 4.8, p=0.002), increasing stricture length (HR 1.2, p=0.002) and iatrogenic strictures (HR 3.2, p=0.03) were independently associated with stricture recurrence, while comorbidity (p=0.06), prior endoscopic treatment (p=0.41), prior urethroplasty (p=0.89) and other etiologies were not. There was no difference between cohorts with respect to Clavien 2 or greater complications (3.6% vs 4.2%, p=0.74) or de novo erectile dysfunction (5.9% vs 5.6%, p=0.89). CONCLUSIONS: Augmented anastomotic urethroplasty is independently associated with stricture recurrence when compared to a pure dorsal onlay technique.


Assuntos
Mucosa Bucal/transplante , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Retalhos Cirúrgicos/efeitos adversos , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Adulto , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recidiva , Estudos Retrospectivos , Retalhos Cirúrgicos/transplante , Falha de Tratamento , Resultado do Tratamento , Uretra/patologia , Uretra/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
12.
J Urol ; 204(5): 1033-1038, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32516073

RESUMO

PURPOSE: Ischemic priapism is a urological emergency that requires prompt intervention to preserve erectile function. Characteristics that influence escalation to surgical intervention remain unclear. We identified factors and developed machine learning models to predict which men presenting with ischemic priapism will require shunting. MATERIALS AND METHODS: We identified men with ischemic priapism admitted to the emergency department of our large county hospital between January 2010 and June 2019. We collected patient demographics, etiology, duration of priapism prior to intervention, interventions attempted and escalation to shunting. Machine learning models were trained and tested using R to predict which patients require surgical shunting. RESULTS: A total of 334 encounters of ischemic priapism were identified. The majority resolved with intracavernosal phenylephrine injection and/or cavernous aspiration (78%). Shunting was required in 10% of men. Median duration of priapism before intervention was longer for men requiring shunting than for men who did not (48 vs 7 hours, p=0.030). Patients with sickle cell disease as the etiology were less likely to require shunting compared to all other etiologies (2.2% vs 15.2%, p=0.035). CONCLUSIONS: Men with longer duration of priapism before treatment more often underwent shunting. However, phenylephrine injection and aspiration remained effective for priapism lasting more than 36 hours. Having sickle cell disease as the etiology of priapism was protective against requiring shunting. We developed artificial intelligence models that performed with 87.2% accuracy and created an online probability calculator to determine which patients with ischemic priapism may require shunting.


Assuntos
Tratamento de Emergência/estatística & dados numéricos , Aprendizado de Máquina , Pênis/cirurgia , Priapismo/terapia , Procedimentos Cirúrgicos Urológicos Masculinos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Disfunção Erétil/etiologia , Disfunção Erétil/prevenção & controle , Humanos , Funções Verossimilhança , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Paracentese/estatística & dados numéricos , Ereção Peniana/efeitos dos fármacos , Ereção Peniana/fisiologia , Pênis/irrigação sanguínea , Pênis/efeitos dos fármacos , Pênis/fisiopatologia , Fenilefrina/administração & dosagem , Priapismo/etiologia , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
13.
J Ayub Med Coll Abbottabad ; 32(1): 99-103, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32468766

RESUMO

BACKGROUND: Urethral stricture disease has significant economic impact throughout world. The bulbar urethra is the commonest site for urethral strictures (Approx 50%) followed by penile urethra in most of the published literature. In developing countries trauma (road traffic accident and iatrogenic) is the leading cause of urethral stricture disease. Younger patients have usually idiopathic type as compare to old age group, which present more frequently with iatrogenic and trauma related urethral strictures. METHODS: This Qausi Experimental study was conducted from May2012-June2016 of duration at Liaquat National Hospital Karachi. All the patients diagnosed with short urethral strictures related to bulbar urethra were included in this study. All the patients underwent non transecting bulbar urethroplasty. All patients were assessed preoperatively, peri-operatively and postoperatively and on follow-up visits as; on 2nd, 8th and 24th week. All the data regarding outcome was recorded on the Performa and analyzed on SPSS V20. RESULTS: Total of 179patients were included, mean age was 38±SD15.3years (range 20- 65years). Anatomically bulbar urethra was affected in 52% of the cases followed by bulbopenile, bulbomembranous region. Etiologically idiopathic type was found in 40% cases, while trauma 21%, iatrogenic injury 26% and UTI 13% were also reasons. Stricture length was mean1.1±SD 1.4 cm (range 0.5-2.5cm). Preoperative Uroflowmetry revealed mean Qmax of 10.5±SD 5.3 ml/sec. Mean operative time was 35±SD 4.6 minutes, 7 patients had conversion to other procedures (3.91%), Postoperative complications were minimal. Mean follow up was 12±SD 21 months (range 6 months to 3 years). On initial follow up at 8th week and 24th week, Qmax was significantly improved. Only 3 patients required DVIU after the 24th week. Initial success rate after 24th week was 98.3% and eventually 100% at the long-term follow-up. CONCLUSIONS: non-transecting anastomotic bulbar urethroplasty (NTABU) is a new standard of care for the short bulbar urethral stricture up to 2.5cm. Idiopathic aetiology, iatrogenic and posttraumatic urethral strictures in selective patients can safely be operated with this technique.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Paquistão , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/estatística & dados numéricos , Adulto Jovem
14.
F1000Res ; 92020.
Artigo em Inglês | MEDLINE | ID: mdl-32419925

RESUMO

Urethral stricturing is a narrowing of the urethral lumen as a result of ischaemic spongiofibrosis. The main challenge of currently available treatment options is recurrence of the stricture. Recent advancements in the treatment of urethral strictures mainly came from the fields of regenerative medicine and tissue engineering. Research efforts have primarily focused on decreasing the recurrence of stricture after internal urethrotomy and constructing tissue-engineered urethral substitutes to improve clinical outcomes of urethroplasty surgeries. The aim of this article is to review the most recent advancements in the management of urethral stricture disease in men.


Assuntos
Estreitamento Uretral , Constrição Patológica , Humanos , Masculino , Recidiva , Uretra , Procedimentos Cirúrgicos Urológicos Masculinos
16.
Urologe A ; 59(5): 559-564, 2020 May.
Artigo em Alemão | MEDLINE | ID: mdl-32274542

RESUMO

With an incidence of 0.7-3% in male infants, undescended testicles is one of the most common congenital anomalies. In the first 6 months of life, the testicles may spontaneously descend in up to 70% of individuals. If the testicle is not in a scrotal position afterwards, fertility can gradually be reduced and the risk of a testicular tumor increases. Therefore, the current German guideline for undescended testis recommends that therapy should be take place between 6 and 12 months of life. After extensive information on the advantages and disadvantages, hormone therapy with the aim of a descensus or in those with bilateral anomaly with the aim of improving the germ cell pool can be offered. After the first year of life, hormone therapy is obsolete. Otherwise, surgical intervention is the treatment of choice. In the case of gliding or deep inguinal testis via scrotal or inguinal access, in the case of nonpalpable and sonographically undetectable testis, laparoscopy is carried out for diagnosis and simultaneous therapy. In the first postoperative year, adequate follow-up should be done to detect a re-ascensus and/or insufficient growth. Regular self-examinations from the age of 15 serve for the early detection of a testicular tumor that occurs only very rarely (approximately 0.003%).


Assuntos
Criptorquidismo/cirurgia , Orquidopexia/métodos , Guias de Prática Clínica como Assunto , Criptorquidismo/patologia , Alemanha , Humanos , Lactente , Laparoscopia , Masculino , Escroto , Testículo , Procedimentos Cirúrgicos Urológicos Masculinos
17.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(4): 505-508, 2020 Apr 15.
Artigo em Chinês | MEDLINE | ID: mdl-32291990

RESUMO

Objective: To investigate the effectiveness of concealed penis correction surgery based on the principle of midline symmetry. Methods: Between January 2016 and September 2018, 18 children with concealed penis were treated with correction surgery based on the principle of midline symmetry. All children were 3-12 years old, with an average age of 8.3 years. Physical examination showed that the penis was short; the penis body could not be exposed or be exposed too limited; the corpus cavernosum developed well. The pressure dressing was removed at 3 days after operation and the urethral tube was removed. The color of the glans, the swelling and congestion of penis and scrotum, and the blood supple of the prepuce flap were observed. Results: The operation time ranged from 47 to 54 minutes, with an average of 50 minutes. All children were followed up 3 months after operation. There was no hemorrhage and necrosis of the glans and no infection or ischemic necrosis of the flap. All patients had different degree of prepuce edema at 3 days after operation, 5 patients still had prepuce edema at 2 weeks, and the prepuce edema in all patients subsided at 3 months. All penises were exposed well after midline symmetric anastomosis with no bulky prepuce and scrotum. Conclusion: The correction surgery based on the principle of midline symmetry can be used to correct the appearance of the concealed penis effectively.


Assuntos
Pênis/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Procedimentos Cirúrgicos Urológicos Masculinos , Criança , Pré-Escolar , Prepúcio do Pênis , Humanos , Masculino , Escroto , Retalhos Cirúrgicos
18.
Am J Surg Pathol ; 44(8): 1112-1117, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32301753

RESUMO

Recently, the American Joint Committee on Cancer (AJCC) updated the staging system for penile squamous cell carcinoma. According to it, unlike its previous version, the involvement of urethra does not upstage the tumor; however, the involvement of corpora cavernosa (CC) does. The tumors involving CC are now staged pT3, whereas those involving corpora spongiosa (CS) are staged pT2, irrespective of the involvement of the urethra. In the current study, we sought to validate these recent modifications and in-process also attempted to improvise upon it. The histopathology slides were reviewed in 142 cases of penile squamous cell carcinoma. The histopathologic variables noted were tumor grade, anatomic level of invasion (CC/CS), lymphovascular invasion (LVI), and perineural invasion (PNI). Metastases to the lymph nodes were confirmed. Tumors were staged pT2/pT3 according to AJCC 8th edition and this staging system was further improvised by incorporating histopathologic variables similar to pT1 tumors in AJCC 8th edition. Accordingly, pT2 tumors invaded CS/CC without LVI or PNI and were not grade 3, whereas pT3 tumors invaded CS/CC, showed LVI and/or PNI, or were grade 3. Both the staging models were then correlated with nodal metastasis and disease-free survival. The new staging model (P=0.001) and not the AJCC pT2/pT3 stages (P=0.2) showed a statistically significant correlation with nodal metastasis. Similarly, only the proposed model significantly impacted disease-free survival (P=0.011). To conclude, we were unable to validate the prognostic difference between the pT2/pT3 stages according to AJCC 8th edition. The staging system can be improvised by incorporating histopathologic variables similar to pT1 tumors.


Assuntos
Carcinoma de Células Escamosas/secundário , Linfonodos/patologia , Estadiamento de Neoplasias/métodos , Neoplasias Penianas/patologia , Carcinoma de Células Escamosas/classificação , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/cirurgia , Intervalo Livre de Doença , Humanos , Excisão de Linfonodo , Linfonodos/cirurgia , Metástase Linfática , Masculino , Invasividade Neoplásica , Neoplasias Penianas/classificação , Neoplasias Penianas/mortalidade , Neoplasias Penianas/cirurgia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Procedimentos Cirúrgicos Urológicos Masculinos
19.
Arch Esp Urol ; 73(2): 89-95, 2020 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-32124838

RESUMO

OBJECTIVE: To present the evolution in the diagnosis and treatment of urethral stricture, after performing 300 surgical procedures over urethral meatus,penile and bulbar urethra along 20 years, contrasting two surgical periods: from 1997-2006 to 2007-2016. MATERIAL AND METHODS: A retrospective review of495 medical records between 1997-2016 was conducted.All the patients treated with urethroplasty were included and those who under went internal urethrotomy,stents or dilatations plus those with strictures due to prostate cancer treatment or orthotopic neobladder were excluded. RESULTS: 300 patients were selected: 100 patients within the first period (1997-2006) and 200 within the second (2007-2016). The median follow-up was 36 months (range 12-60). In relation to the surgical techniques, among the most employed, four are outstanding so their results can be compared in both periods:termino-terminal urethroplasty, penile flap urethroplasty and the buccal mucosa in penile or bulbar urethroplasty.Other techniques were incorporated during the second period. The best outcomes were provided by end' to endurethroplasty with 90 and 92% success. Over the second period, buccal mucosa indications were consolidated with an increase use from 16% to 56%. Were considered as successful those patients that did not need any endoscopic procedure and reporting excellent urinary flow without low urinary tract symptoms. CONCLUSIONS: A trend towards an increased usage of open surgery vs urethrotomy is observed. Buccal mucosa graft has been consolidated as a reconstructive technique. End-to end urethroplasty seems to provide the best functional outcomes.


Assuntos
Uretra , Estreitamento Uretral , Procedimentos Cirúrgicos Urológicos Masculinos , Feminino , Humanos , Masculino , Mucosa Bucal/transplante , Estudos Retrospectivos , Resultado do Tratamento
20.
Cir. plást. ibero-latinoam ; 46(1): 73-78, ene.-mar. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-190865

RESUMO

INTRODUCCIÓN Y OBJETIVO: El pene enterrado es un motivo de consulta frecuente en la práctica clínica pediátrica. En general, los cuerpos cavernosos y el glande son normales, pero el pene está enterrado por el exceso de grasa suprapúbica, sin fijación de los ángulos peno-púbicos. Presentamos nuestra serie de pacientes intervenidos mediante una alternativa al tratamiento quirúrgico clásico. MATERIAL Y MÉTODO: Descripción de técnica quirúrgica, modificada en los últimos 10 años, que incluye Z-plastia suprapúbica para obtener suficiente piel para cubrir la base del pene, lipectomía suprapúbica y sección del ligamento suspensorio del pene con fijación de ángulos penopúbicos. Estudio retrospectivo de pacientes con recopilación de datos sobre edad, complicaciones y resultado estético obtenido. RESULTADOS: Fueron intervenidos 16 pacientes con edad media de 9 años. La técnica quirúrgica modificada se aplicó a todos los pacientes, retirando vendaje y sonda vesical a las 24 horas de la cirugía en todos los casos. Las complicaciones a corto plazo fueron: pérdida parcial del colgajo de la Z-plastia en 2 pacientes que curó por segunda intención; edema significativo de la mucosa prepucial en 6 pacientes. El seguimiento medio fue superior a 5 años en todos los casos. A largo plazo, tanto los pacientes como los padres mostraron satisfacción con los resultados. CONCLUSIONES: El abordaje quirúrgico del pene enterrado no está estandarizado y es un tema cuestionado. En nuestra experiencia, la intervención quirúrgica con abordaje suprapúbico en los pacientes con hipertrofia de grasa púbica aporta mejor aspecto estético, con menos recidivas a largo plazo y clara mejoría psicológica de los pacientes


BACKGROUND AND OBJECTIVE: Buried penis is a frequent claim in pediatric outpatient clinic. Usually the cavernous bodies and the gland are normal but the penis is buried in the excess suprapubic fat, with no fixation of the peno-pubic angles. We present our series of patients treated with an alternative to the classic surgical treatment. METHODS: Our surgical technique has been modified in the last 10 years to include a suprapubic Z-plasty in order to get enough skin to cover the base of the penis, lipectomy with section of the suspensory ligament of the penis and fixation of the penopubic angles. We conduct a retrospective study of our patients, collecting data about age, complications and aesthetic results. RESULTS: Sixteen patients with a mean age of 9 years were operated. The modified surgical technique was applied to all patients; bandage and bladder catheter were removed after 24 hours in all cases. Short-term complications were partial los of the Z-plasty flap that cured by secondary intention in 2 patients and in 6 patients a significant edema of the preputial mucosa was observed. Mean follow-up was longer than 5 years in all cases. At the end of follow-up, both patients and parents were satisfied with the results. CONCLUSION: The gold-standard surgical technique for the buried penis is still controversial. In our experience, the suprapubic approach in patients with pubic fat hypertrophy, provides better aesthetic appearance with fewer long-term relapses and a clear psychological impact


Assuntos
Humanos , Masculino , Pré-Escolar , Criança , Adolescente , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Pênis/anormalidades , Pênis/cirurgia , Resultado do Tratamento , Estudos Retrospectivos , Seguimentos
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