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1.
Urology ; 135: 159-164, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31626858

RESUMO

OBJECTIVE: To describe a minimal-incision modified fenestration technique (MIMFeT) for symptomatic hydroceles utilizing local anesthesia. METHODS: A database was maintained for men undergoing in-office MIMFeT for symptomatic hydroceles between June 2015 and August 2018. Following local anesthesia, the hydrocele was sequentially everted through a small upper hemiscrotal incision, excised, and oversewn without delivering the testicle through the wound. Patient demographics and clinical outcomes were subsequently reviewed. RESULTS: A total of 54 men (median age 67) underwent MIMFeT under local anesthesia for symptomatic hydrocele. Median estimated hydrocele size was 250 mL (IQR 150;500). Medical comorbidities included coronary artery disease (12%), hypertension (43%), diabetes (13%), and current antiplatelet or anticoagulant (44%) use. Six patients (11%) were deemed unsafe for monitored or general anesthesia. About 48 patients had follow-up data available (median 9 months; IQR 2-18). Mild recurrent scrotal swelling occurred in 4 patients (8%) and 9/48 (18%) experienced postoperative complications including hematoma (n = 2), prolonged pain (n = 3), wound infection (n = 2), and partial incisional separation (n = 2). No patient required repeat hydrocelectomy. CONCLUSION: Our early results suggest that the MIMFeT for management of symptomatic hydroceles can be safely performed in the office setting under local anesthesia, including in those patients who are determined to be unsafe for monitored and general anesthesia.


Assuntos
Anestesia Local , Complicações Pós-Operatórias/epidemiologia , Escroto/cirurgia , Hidrocele Testicular/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Idoso , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Recidiva , Técnicas de Sutura , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
3.
Minerva Urol Nefrol ; 71(5): 427-434, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31487977

RESUMO

INTRODUCTION: Despite the high rate of resolution, ejaculatory dysfunction still is the most common side effect related to surgical treatment of bladder outlet obstruction (BOO). The aim of the present systematic review was to compare several technological treatment modalities for the management of lower urinary tract symptoms/BOO in terms of functional and sexual outcomes. EVIDENCE ACQUISITION: All English language randomized controlled trials assessing the impact of different endoscopic treatments for BOO were evaluated. We followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement to evaluate PubMed®, Scopus®, and Web of Science™ databases (up to June 2019). EVIDENCE SYNTHESIS: Our electronic search identified a total of 2221 papers in PubMed, Scopus, and Web of Science. Of these, 142 publications were identified for detailed review, which yielded 21 included in the present systematic review. All groups appeared similar with regards to preoperative IPSS/AUA Score, Qmax, and prostate volume (cc). Patients undergoing endoscopic treatments using ThuLEP, Greenlight or Prostate Artery Embolization techniques had lower-but not statistically significant- relative risk (RR) of retrograde ejaculation compared with conventional transurethral resection of the prostate (TURP) (RR: 0.90; P=0.35; RR: 0.71; P=0.1; RR0.73; P=0.11). Efficacy of those techniques was equal to TURP. CONCLUSIONS: Data reporting anterograde ejaculation preservation after endoscopic treatment in patients with benign prostatic enlargement are sparse and heterogeneous. Pooled analyses suggest that new technological alternatives to conventional TURP might improve sexual outcomes, especially for non-ablative treatments.


Assuntos
Ejaculação , Complicações Pós-Operatórias/terapia , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/terapia , Obstrução do Colo da Bexiga Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
Pediatr Surg Int ; 35(11): 1301-1308, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31372729

RESUMO

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


Assuntos
Fístula Cutânea/etiologia , Hipospadia/cirurgia , Estreitamento Uretral/etiologia , Fístula Urinária/etiologia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Humanos , Masculino , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
5.
Andrologia ; 51(9): e13351, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31264245

RESUMO

Until now, no reliable method is recognised in treating buried penis. This study explored a new method of penile length augmentation using acellular dermal matrix filler in infrapubic space combined with liposuction and penile suspensory release. Patients with "small-sized penis" received penile length augmentation procedure including suprapubic liposuction, penile suspensory ligament release and insertion of folded acellular dermal matrix between corpora cavernosa and pubis symphysis. Their penile length from tip to skin was measured pre-operatively and post-operatively. The post-operative complications and patients' satisfaction were also recorded. Fifteen adult male patients were included with the mean age of 33.2 ± 4.6 years old and BMI of 28.9 ± 5.3 kg/m2 . The average amount of liposuction was 430 ± 90.0 ml. The average penile length measured pre-operatively and post-operatively (on table and 3 months afterwards) was 3.0 ± 1.3 cm, 7.3 ± 2.1 cm and 5.4 ± 1.8 cm. The penile length has significantly increased by 4.3 ± 1.6 cm (on table) and 2.4 ± 0.8 cm (3 months post-operatively; p < 0.05). The post-operative complications included oedema of penis, ecchymosis of lower abdomen and poor wound healing. No patient was dissatisfied with the appearance and function. The new method using acellular dermal matrix combined with liposuction and penile suspensory ligament release is safe and effective. The method could be applied to selected patients with buried penis.


Assuntos
Derme Acelular , Preenchedores Dérmicos/uso terapêutico , Lipectomia/métodos , Doenças do Pênis/cirurgia , Pênis/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto , Estudos de Viabilidade , Humanos , Ligamentos/cirurgia , Lipectomia/efeitos adversos , Masculino , Obesidade/complicações , Obesidade/terapia , Tamanho do Órgão , Satisfação do Paciente , Seleção de Pacientes , Doenças do Pênis/etiologia , Doenças do Pênis/patologia , Pênis/patologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
6.
J Pediatr Surg ; 54(10): 2125-2129, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31079867

RESUMO

BACKGROUND: There are only a few publications in the medical literature reporting on complication rates in proximal hypospadias surgery, particularly with regard to long-term follow-up. METHODS: Over a 17.5-year period, we operated 100 patients with penoscrotal, scrotal and perineal hypospadias. Sixty-four had a single-stage repair, including 15 who received a buccal mucosa inlay "Snodgraft" repair. Thirty-six had a two-stage Bracka repair of which 19 received buccal or lower lip grafts and 17 had preputial grafts. Overall, 34 patients received buccal grafts. The median follow-up was eight years (range 1-16 years). Three patients were operated for residual chordee years later. RESULTS: Urethral fistulae occurred in a total of 26/100 (26.0%) cases, meatal stenosis in 16/100 (16.0%), wound breakdown in six (6.0%) and graft failure in one (1.0%). The fistula rate after the single-stage approach was 15/64 (23.4%), whereas it was 11/36 (30.6%) following two-stage repair (P = 0.4811). CONCLUSIONS: Proximal hypospadias remains a challenging condition to treat. It is possible to perform a single-stage repair in 64.0% of cases. This brings down the median number of operations to only two. Lower lip grafts were used in 34.0% but are now used in redo-surgeries only. Our fistula rate was 26.0% but has decreased significantly in recent years. LEVEL OF EVIDENCE: Level III.


Assuntos
Hipospadia/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Criança , Pré-Escolar , Prepúcio do Pênis/cirurgia , Humanos , Lactente , Masculino , Mucosa Bucal/transplante , Complicações Pós-Operatórias , Estudos Prospectivos , Escroto/cirurgia , Deiscência da Ferida Operatória , Resultado do Tratamento , Uretra/cirurgia , Doenças Uretrais/etiologia , Doenças Uretrais/cirurgia , Estreitamento Uretral/etiologia , Estreitamento Uretral/cirurgia , Fístula Urinária/etiologia , Fístula Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
7.
Curr Urol Rep ; 20(6): 31, 2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31041616

RESUMO

PURPOSE OF REVIEW: Gender-affirming surgery has become a more common procedure in the last 5 years. Feminizing genitoplasty typically involves inversion of penile skin as a neovagina, urethral shortening, and glans reduction to create a neoclitoris. Masculinizing genitoplasty is more complex, typically is performed in multiple stages, and has more inherent urologic risks. RECENT FINDINGS: The most common urologic complications involve voiding dysfunction, specifically meatal stenosis or fistula to the urinary tract. Urethral stricture, fistula, urinary retention, and voiding dysfunction are very common and require early recognition and intervention. This includes placement of catheter drainage, if necessary with the appropriate urologic instrumentation. Genital risks relating to phallus health are rare, but risks associated with placement of penile prosthesis for sexual function are common and require immediate attention. Urological complications after gender-affirming surgery are common, and the general urologist and urogynecologist should be able to identify and treat problems in this population after review of this chapter.


Assuntos
Transtornos do Desenvolvimento Sexual/cirurgia , Pênis/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Uretra/cirurgia , Estreitamento Uretral/etiologia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Humanos , Masculino , Prótese de Pênis , Reoperação , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
8.
Andrologia ; 51(7): e13293, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30995701

RESUMO

In the present study, we compared the retroperitoneal high ligation with subinguinal varicocelectomy on the treatment of painful varicocele. A total of 90 patients who underwent retroperitoneal high ligation (n = 45) and subinguinal varicocelectomy (n = 45) for painful varicocele were included in this prospective study. Varicocele in all patients was diagnosed with by physical examination and coloured Doppler ultrasonography. All the patients underwent a conservative treatment for pain for 4 weeks. Patient ages, varicocele grades, preoperative pain scores, postoperative pain scores at 6 months, duration of surgeries, complications and recurrences were recorded. Complete success rate for chronic scrotal pain was found to be 80% in retroperitoneal varicocelectomy group and 71% in subinguinal varicocelectomy group. Partial success rate was 11% for retroperitoneal varicocelectomy group and 18% for subinguinal ligation group. There was no significant difference between two groups in terms of pain and complications. However, the operation time was significantly lower in the Palomo group. Although microsurgical subinguinal varicocelectomy is the current approach for the treatment of varicocele, retroperitoneal high ligation can achieve the same pain resolution with shorter operative duration compared to loupe-assisted subinguinal varicocelectomy.


Assuntos
Dor Crônica/terapia , Microcirurgia/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Varicocele/cirurgia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Adolescente , Adulto , Dor Crônica/diagnóstico , Dor Crônica/etiologia , Humanos , Ligadura/efeitos adversos , Ligadura/métodos , Masculino , Microcirurgia/métodos , Duração da Cirurgia , Medição da Dor , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Recidiva , Espaço Retroperitoneal , Estudos Retrospectivos , Escroto/irrigação sanguínea , Escroto/diagnóstico por imagem , Escroto/cirurgia , Resultado do Tratamento , Ultrassonografia Doppler , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Varicocele/complicações , Varicocele/diagnóstico por imagem , Procedimentos Cirúrgicos Vasculares/métodos , Adulto Jovem
9.
Andrologia ; 51(5): e13256, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30820998

RESUMO

After varicocelectomy, complications such as hydrocele, testicular atrophy and recurrence can be seen. Our case was a 29-year-old male patient who had a fistula mouth laterally on the left scrotum. In the examination and scrotal ultrasonography (USG), a foreign body was detected under the skin. The patient had a history of varicocelectomy, suggesting suture reaction. Our case is interesting because it is the first reported suture granuloma case after varicocelectomy.


Assuntos
Granuloma de Corpo Estranho/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Suturas/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Adulto , Granuloma de Corpo Estranho/etiologia , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Escroto/irrigação sanguínea , Escroto/diagnóstico por imagem , Escroto/cirurgia , Ultrassonografia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Varicocele/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos
10.
Urologia ; 86(1): 23-26, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30890103

RESUMO

OBJECTIVE:: Varicocele is the most commonly curable cause of infertility in men. Varicocele is found in 15% of the total male population, 35% of men with primary infertility, and 75%-81% of men with secondary infertility. Generally, patients seek microscopic surgery via surfing the Internet, which is not an available option in all medical centers. The purpose of this study was to determine the success rate and complications of conventional varicocelectomy and to compare it with that of the microscopic method. METHODS:: In this descriptive cross-sectional study, 88 patients with varicocele who underwent non-microscopic varicocele surgery in the 15th Khordad Hospital during 2013-2015 were evaluated by the census method. RESULTS:: The mean age of patients with varicocele was 27.30 years; 52 patients underwent bilateral varicocelectomy and 36 left varicocelectomy. Surgical complications of non-microscopic varicocelectomy in the studied patients included bleeding and hydrocele formation both in 0.7% and recurrence in 2.8%. Testicular atrophy was not observed in any case. CONCLUSION:: The incidence of recurrence, hydrocele formation, atrophy, and bleeding in non-microscopic varicocelectomy, if done in accordance with its principles, is not more than the microscopic approach and therefore it could be recommended as a safe surgical treatment in centers where microscopic surgery is not available.


Assuntos
Microcirurgia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Varicocele/cirurgia , Adolescente , Adulto , Criança , Estudos Transversais , Humanos , Masculino , Pessoa de Meia-Idade , Indução de Remissão , Adulto Jovem
11.
Fertil Steril ; 111(3): 415-419, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30827515

RESUMO

The impact of clinical varicoceles on semen parameters and male infertility has long been established. In the era of assisted reproduction, clinical discussion has questioned the role of varicocelectomy, offering the potential to bypass, rather than treat, varicocele-associated male infertility. However, current literature supports improved semen parameters and reproductive outcomes following repair. This article presents the stepwise operative approaches to microsurgical varicocelectomy and discusses the recent publications on outcomes.


Assuntos
Infertilidade Masculina/cirurgia , Microcirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Varicocele/cirurgia , Fertilidade , Humanos , Infertilidade Masculina/diagnóstico , Infertilidade Masculina/etiologia , Infertilidade Masculina/fisiopatologia , Ligadura , Masculino , Microcirurgia/efeitos adversos , Fatores de Risco , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Varicocele/complicações , Varicocele/diagnóstico , Varicocele/fisiopatologia
12.
Fertil Steril ; 111(3): 420-426, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30827516

RESUMO

Infertility due to nonobstructive azoospermia is treatable with the use of testicular sperm extraction and IVF. The optimal approach for sperm retrieval is microdissection testicular sperm extraction (mTESE). This systematic review summarizes and evaluates the literature pertaining to patient optimization before mTESE, mTESE technique, and post-mTESE testicular tissue processing. Preoperative patient optimization has been assessed in terms of adjuvant hormone therapy and varicocele repair. Limited data are available for adjuvant medical therapy, and although also limited, data for varicocele repair support increased sperm retrieval, pregnancy, and return of sperm to the ejaculate. Post-mTESE tissue processing has few comparative studies; however, most studies support the combination of mechanical mincing and use of type 4 collagenase for tissue disintegration along with pentoxifylline to assist in identifying motile and viable spermatozoa for intracytoplasmic sperm injection.


Assuntos
Azoospermia/cirurgia , Infertilidade Masculina/cirurgia , Microdissecção , Recuperação Espermática , Espermatogênese , Testículo/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Azoospermia/complicações , Azoospermia/diagnóstico , Azoospermia/fisiopatologia , Fertilidade , Humanos , Infertilidade Masculina/diagnóstico , Infertilidade Masculina/etiologia , Infertilidade Masculina/fisiopatologia , Masculino , Microdissecção/efeitos adversos , Fatores de Risco , Injeções de Esperma Intracitoplásmicas , Recuperação Espermática/efeitos adversos , Testículo/fisiopatologia , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
13.
Fertil Steril ; 111(3): 427-443, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30827517

RESUMO

Ejaculatory duct obstruction is an uncommon but surgically correctable cause of male infertility. With the advent and increased use of high-resolution transrectal ultrasonography, anomalies of the ejaculatory ducts related to infertility have been well documented. Although there are no pathognomonic findings associated with ejaculatory duct obstruction, the diagnosis should be suspected in an infertile male with oligospermia or azoospermia with low ejaculate volume, normal secondary sex characteristics, testes, and hormonal profile, and dilated seminal vesicles, midline cyst, or calcifications on transrectal ultrasound (TRUS). Although additional larger prospective and comparative studies are needed, it appears that TRUS with aspiration is the most effective method for diagnosis. While intrusive, it is less invasive than vasography. The most robust and published evidence for treatment involves transurethral resection of ejaculatory duct (TURED). More recent experience with antegrade endoscopic approaches are promising and may also be considered. An alternative to surgeries for reversal of obstruction is sperm retrieval for in vitro fertilization/intracytoplasmic sperm injection. A thorough discussion of all alternatives, including risks and benefits, should be held with couples facing this uncommon condition to allow them to make informed decisions regarding management.


Assuntos
Azoospermia/cirurgia , Ductos Ejaculatórios/cirurgia , Endoscopia , Infertilidade Masculina/cirurgia , Recuperação Espermática , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Azoospermia/complicações , Azoospermia/diagnóstico por imagem , Azoospermia/fisiopatologia , Ductos Ejaculatórios/diagnóstico por imagem , Ductos Ejaculatórios/fisiopatologia , Endoscopia/efeitos adversos , Fertilidade , Humanos , Infertilidade Masculina/diagnóstico , Infertilidade Masculina/etiologia , Infertilidade Masculina/fisiopatologia , Masculino , Fatores de Risco , Injeções de Esperma Intracitoplásmicas , Recuperação Espermática/efeitos adversos , Resultado do Tratamento , Ultrassonografia de Intervenção , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
14.
Fertil Steril ; 111(3): 413-414, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30722940

RESUMO

Surgical treatments offer effective solutions for many couples experiencing male factor infertility. This Views and Reviews collection of articles offers a state-of-the-art overview of the surgical procedures commonly used to treat impaired male reproductive health.


Assuntos
Infertilidade Masculina/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Fertilidade , Humanos , Infertilidade Masculina/diagnóstico , Infertilidade Masculina/etiologia , Infertilidade Masculina/fisiopatologia , Masculino , Saúde do Homem , Saúde Reprodutiva , Fatores de Risco , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
15.
World J Urol ; 37(4): 661-666, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30810832

RESUMO

PURPOSE: Evaluate the main etiologies and clinical characteristics of male urethral stricture disease (USD) in Brazil. METHODS: This multicentric study was performed using retrospective data collected from six Brazilian referral centers of urethral reconstruction. The database comprised data from 899 patients with USD who had undergone surgical treatment from 2008 to 2018. Age, stricture site and primary stricture etiology were identified for each patient. RESULTS: The mean age was 52.13 ± 16.9 years. The most common etiology was iatrogenic (43.4%), followed by idiopathic (21.7%), trauma (21.5%) and inflammatory (13.7%). Of the iatrogenic causes, 59% were secondary to urethral instrumentation (60% by urethral catheterization and 40% by transurethral procedures), 24.8% by other procedures (prostatectomy, radiotherapy, postectomy) and 16.2% by failed hypospadia repairs. Pelvic fracture urethral distraction injuries were responsible for most of the trauma-related strictures (62.7%). When stratified by age, the most common stricture etiology was trauma in the 0-39 years old group (42.8%), idiopathic in the 40-59 years old group (32.4%) and iatrogenic in patients over 60 years old (68%). In regard to the stricture site, 80% presented with an anterior urethral stricture and 20% with a posterior stenosis. In the anterior stenosis group, the most common stricture site was bulbar (39.5%). CONCLUSION: In Brazil, as in many developed countries, the most common cause of urethral stricture diseases is iatrogenic, especially urethral catheterization. These findings emphasize the need of a careful urethral manipulation and a better training of healthcare professionals. Trauma is still responsible for a great proportion of strictures and inflammatory etiologies are now less frequently observed.


Assuntos
Países em Desenvolvimento , Doença Iatrogênica/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Estreitamento Uretral/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Fraturas Ósseas/complicações , Humanos , Hipospadia/cirurgia , Líquen Escleroso e Atrófico/complicações , Líquen Escleroso e Atrófico/epidemiologia , Masculino , Pessoa de Meia-Idade , Ossos Pélvicos/lesões , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Estreitamento Uretral/etiologia , Uretrite/complicações , Uretrite/epidemiologia , Cateterismo Urinário/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Adulto Jovem
16.
Int Urol Nephrol ; 51(4): 579-583, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30796727

RESUMO

PURPOSE: To report current results of complete penile disassembly technique in epispadias repair. METHODS: In ten years, we have preformed 31 complete penile disassembly for proximal epispadias repair. Twenty-four patients had epispadias after primary repair of bladder exstrophy and 7 isolated penopubic epispadias. The age of the patients ranged from 10 months to 6 years (median 3 years). RESULTS: The shortening of urethral plate was found in 30 patients (97% of cases), and this shortening varied between 6 and 16 mm. However, in one patient we found a lengthening of the urethral plate of 8 mm. The narrowing of urethral plate was found in all patients, and this narrowing varied between 30 and 50% of the width of the plate. Postoperative complications encountered in our patients were dominated by fistulas and dehiscence, particularly in patients who had bladder exstrophy-epispadias complex. After dehiscence and fistulas repair, the cosmetic results were satisfying in 25 patients (80.5% of cases) with conical glans and meatus in orthotopic position without any necrosis of the glans. However, the urinary continence ≥ 1 h was observed in 6 patients (19% of cases) and only 3 patients (9.7% of cases) had a urinary continence ≥ 3 h. The mean follow-up was 61 months. CONCLUSIONS: The complete penile disassembly remains one of the best techniques for epispadias repair. However, we noticed a reappearance of the dorsal curvature of the penis in a large number of patients treated for isolated epispadias and the impact of this technique on urinary incontinence remains uncertain.


Assuntos
Epispadia/cirurgia , Pênis/cirurgia , Uretra/cirurgia , Fístula Urinária/etiologia , Anormalidades Múltiplas/cirurgia , Extrofia Vesical/cirurgia , Criança , Pré-Escolar , Epispadia/complicações , Humanos , Lactente , Masculino , Pênis/anormalidades , Deiscência da Ferida Operatória/etiologia , Uretra/anormalidades , Incontinência Urinária/etiologia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
17.
J Urol ; 201(3): 563-572, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30240692

RESUMO

PURPOSE: We sought to characterize a standardized postoperative radiographic and functional voiding trial, and determine its impact on outcomes after substitution urethroplasty. MATERIALS AND METHODS: This is an observational, monocenter study of men who underwent 1-stage ventral onlay buccal mucosal graft urethroplasty for bulbar urethral stricture between January 2009 and December 2016. Patients were stratified by voiding trial success vs failure, including radiographic (extravasation or residual narrowness) and functional (post-void residual volume greater than 100 ml) failure, 21 days postoperatively. End points were voiding trial failure and recurrence-free survival. Regression models were created to determine risk factors of voiding trial failure and evaluate the impact of voiding trial failure on recurrence. RESULTS: The voiding trial succeeded and failed in 437 (85.2%) and 76 (14.8%), respectively, of 513 men. Of the latter men 54 (71.1%) showed evidence of extravasation and 22 (28.9%) had residual narrowness or functional failure. On multivariable logistic regression analyses no preoperative predictor of voiding trial failure was found (all p >0.05). At a median followup of 32 months Kaplan-Meier analyses (log rank test p = 0.033) and multivariable Cox regression analyses (HR 1.86, p = 0.037) revealed an association of voiding trial failure and stricture recurrence. When further stratifying voiding trial failure, residual narrowness or functional failure (HR 4.60, p <0.001) but not extravasation (HR 1.08, p = 0.9) was a risk factor for recurrence. Limitations include the retrospective assessment of investigated end points. CONCLUSIONS: Residual narrowness or functional failure at an early voiding trial after buccal mucosal graft urethroplasty may predict stricture recurrence. Identifying intraoperative complexity factors predicting initial voiding trial failure might be a key to identifying those individuals with early recurrence.


Assuntos
Mucosa Bucal/transplante , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Transtornos Urinários/diagnóstico , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Humanos , Masculino , Período Pós-Operatório , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recidiva , Uretra/diagnóstico por imagem , Uretra/patologia , Estreitamento Uretral/complicações , Estreitamento Uretral/diagnóstico por imagem , Transtornos Urinários/etiologia
18.
Eur Urol ; 75(3): 448-461, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30316583

RESUMO

CONTEXT: The benefits and harms of intervention (surgical or radiological) versus observation in children and adolescents with varicocele are controversial. OBJECTIVE: To systematically evaluate the evidence regarding the short- and long-term outcomes of varicocele treatment in children and adolescents. EVIDENCE ACQUISITION: A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. A priori protocol was registered to PROSPERO (CRD42018084871), and a literature search was performed for all relevant publications published from January 1980 until June 2017. Randomized controlled trials (RCTs), nonrandomized comparative studies (NRSs), and single-arm case series including a minimum of 50 participants were eligible for inclusion. EVIDENCE SYNTHESIS: Of 1550 articles identified, 98 articles including 16 130 patients (7-21 yr old) were eligible for inclusion (12 RCTs, 47 NRSs, and 39 case series). Varicocele treatment improved testicular volume (mean difference 1.52ml, 95% confidence interval [CI] 0.73-2.31) and increased total sperm concentration (mean difference 25.54, 95% CI 12.84-38.25) when compared with observation. Open surgery and laparoscopy may have similar treatment success. A significant decrease in hydrocele formation was observed in lymphatic sparing versus non-lymphatic sparing surgery (p=0.02). Our findings are limited by the heterogeneity of the published data, and a lack of long-term outcomes demonstrating sperm parameters and paternity rates. CONCLUSIONS: Moderate evidence exists on the benefits of varicocele treatment in children and adolescents in terms of testicular volume and sperm concentration. Current evidence does not demonstrate superiority of any of the surgical/interventional techniques regarding treatment success. Long-term outcomes including paternity and fertility still remain unknown. PATIENT SUMMARY: In this paper, we review benefits and harms of varicocele treatment in children and adolescents. We found moderate evidence that varicocele treatment results in improvement of testicular volume and sperm concentration. Lymphatic sparing surgery decreases hydrocele formation. Paternity and fertility outcomes are not clear.


Assuntos
Laparoscopia , Cordão Espermático/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Varicocele/cirurgia , Adolescente , Idade de Início , Criança , Embolização Terapêutica , Medicina Baseada em Evidências , Fertilidade , Humanos , Laparoscopia/efeitos adversos , Masculino , Fatores de Risco , Contagem de Espermatozoides , Cordão Espermático/fisiopatologia , Cordão Espermático/efeitos da radiação , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Varicocele/epidemiologia , Varicocele/fisiopatologia , Varicocele/radioterapia , Adulto Jovem
19.
Urology ; 123: 247-251, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30312674

RESUMO

OBJECTIVE: To demonstrate the safety and feasibility of outpatient surgical management for patients with acquired buried penis (ABP). METHODS: We conducted an Institutional Review Board approved review of patients who underwent surgical repair of ABP at a single institution from September 2014 to August 2017. Patient characteristics, operative details, and 30- and 90-day complications were assessed. RESULTS: Sixteen patients underwent surgical repair of ABP at the University of Kentucky during the study period. Mean age was 54 years (range 44-62). Median body mass index (BMI) was 47.7 (range 25.5-53.3). Patients largely underwent penile liberation, escutcheonectomy, and split thickness skin grafting. Concurrent scrotoplasty and urethroplasty were performed in select cases. The majority of patients 10/16 (62.5%) were discharged on the same day of surgery, while the remaining 6/16 (37.5%) were outpatient extended stay-and were discharged on postoperative day 1. The 30- and 90-day complications were 19% and 25% respectively, all were Clavien II. Split thickness skin graft take was 100%, and technical success was achieved in all patients. Patients with complications had higher BMIs, higher rates of diabetes, and higher rates of tobacco use, though only BMI reached statistical significance (P = .0150, P = .5846, and P = .0632) respectively. CONCLUSION: Multi component repair of adult ABP can be safely done on an outpatient basis without need for routine inpatient admission and complex algorithms. The most common complication is surgical site infection, which arose in the first 30 days postoperatively. Higher BMI was a significant risk factor for complications.


Assuntos
Doenças do Pênis/cirurgia , Adulto , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Estudos de Viabilidade , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Doenças do Pênis/etiologia , Estudos Retrospectivos , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
20.
Am J Ther ; 26(3): e314-e320, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-28767453

RESUMO

BACKGROUND: There are scant data reporting postoperative ultrasonographically measured bladder volumes in children undergoing penile surgery. STUDY QUESTION: We studied the effect of various anesthesia techniques on return of micturition after penile surgery in children, using ultrasonographically measured bladder volumes. DATA SOURCES: Ultrasonographically measured postvoiding residual bladder volumes indexed to age-appropriate capacity, and time elapsed between the end of surgery and spontaneous voiding after pediatric circumcision, distal hypospadias repair, or repair of urethrocutaneous fistula, were studied. STUDY DESIGN: Children between 4 months and 12 years were randomized to caudal block, intravenous (IV) fentanyl or penile block, in association with inhaled general anesthesia. Bladder volumes were measured before surgery and immediately after voiding for the first time. Time to first postsurgery void was also recorded. RESULTS: Thirty-one children completed all assessments; 12 underwent caudal block, 9 IV fentanyl anesthesia, and 7 were given penile block. The mean first postvoid bladder residual volumes were highest in the caudal and lowest in the penile block children (27.5 vs. 17.3 mL, P = 0.003). The time elapsing between the end of surgery and first voiding was the longest in the fentanyl group compared with caudal and penile blocks (232, 178, 150 minutes, respectively, P = 0.02). CONCLUSIONS: None of the anesthetic techniques provoked postoperative urinary retention after minor penile surgery in children. The penile block appears superior to caudal block or to IV fentanyl-based anesthesia with regard to postoperative recovery of normal micturition.


Assuntos
Anestesia Intravenosa/efeitos adversos , Bloqueio Nervoso/efeitos adversos , Complicações Pós-Operatórias/diagnóstico por imagem , Retenção Urinária/diagnóstico por imagem , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Adolescente , Anestesia Intravenosa/métodos , Criança , Pré-Escolar , Fentanila/administração & dosagem , Humanos , Lactente , Masculino , Bloqueio Nervoso/métodos , Pênis/cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Ultrassonografia , Bexiga Urinária/diagnóstico por imagem , Retenção Urinária/etiologia
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