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1.
Curr Urol Rep ; 22(4): 19, 2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33554283

RESUMO

PURPOSE OF THE REVIEW: The goal of this paper was to evaluate the impact on erectile and ejaculatory function after anterior and posterior urethroplasty. RECENT FINDINGS: With a rise in the use of urethroplasty, its impact on sexual function has come into question. For anterior urethroplasties, some degree of erectile dysfunction is common, but this tends to be transient, with most patients having a resolution of any de novo dysfunction by 12 months. Patients with posterior urethral strictures have a very high rate of erectile dysfunction prior to surgery and may show improvement after urethroplasty. Ejaculatory function tends to improve in patients due to alleviation of obstruction while some patients notice degradation in force of ejaculation. While urethroplasty has a minimal permanent effect on sexual function for most patients, there are some patients who notice improvement and others worsening. Patients should be counseled on these risks prior to urethroplasty.


Assuntos
Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Psicogênicas/etiologia , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Ejaculação/fisiologia , Disfunção Erétil/etiologia , Disfunção Erétil/fisiopatologia , Disfunção Erétil/psicologia , Humanos , Masculino , Pênis/irrigação sanguínea , Pênis/inervação , Pênis/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Risco , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Fisiológicas/psicologia , Disfunções Sexuais Psicogênicas/fisiopatologia , Disfunções Sexuais Psicogênicas/psicologia , Uretra/inervação , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
2.
Ulus Travma Acil Cerrahi Derg ; 27(1): 139-145, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33394478

RESUMO

BACKGROUND: To compare the effectiveness of spinal anesthesia (SA) and the combination of intraurethral topical instillation of 2% lidocaine + intraurethral local visual injection anesthesia (T + LIA) for visual internal urethrotomy (VIU) in the treatment of traumatic posterior urethral strictures and prostatic urethral stenoses. METHODS: In this study, the results of 178 patients who underwent visual internal urethrotomy for posterior urethral strictures and prostatic urethral stenoses secondary to trauma in our clinic between October 2018 and January 2020 were analyzed retrospectively. Patients were divided into two groups as combined T + LIA (n=146, 82.08%) group and SA (n=32, 17.97%) group according to the type of anesthesia used. The preoperative clinical data and postoperative results of the patients were analyzed and compared between the groups. RESULTS: The mean age of the patients was 67.99±10.87 years and the mean follow-up was 5.32±3.27 months. The median age of the patients in the T + LIA group was significantly higher than that of the patients in the SA group (p=0.033). There was no statistically significant difference between the groups regarding preoperative Q-max value (p=0.931). Similarly, the rate of postoperative improvement in the Q-max values of the patients was similar between the groups (p=0.572). The presence of postoperative complications and recurrence rates were similar between the groups (p=0.879 and p=0.904, respectively). CONCLUSION: Compared to spinal anesthesia, T + LIA anesthesia is a safe and effective technique for visual internal urethrotomy in treating traumatic posterior urethral strictures and prostatic urethral stenoses, with a high rate of success and acceptable rate of complications.


Assuntos
Anestésicos Locais , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos , Idoso , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Próstata/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Uretra/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Procedimentos Cirúrgicos Urológicos Masculinos/estatística & dados numéricos
3.
Tech Vasc Interv Radiol ; 23(3): 100693, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33308525

RESUMO

Many interventions to treat men with benign prostatic hyperplasia (BPH) associated lower urinary tract symptoms (LUTS) are associated with sexual side effects or complications, such as hematospermia, erectile dysfunction, or ejaculatory dysfunction. As loss of sexual function can significantly impact quality of life, an optimal treatment for BPH associated LUTS would be one without any sexual dysfunction side effects. Prostatic artery embolization is a minimally invasive treatment for men with BPH associated LUTS. The aim of this paper is to review the effects of prostatic artery embolization on sexual function and compare the sexual side effect profile to the other available BPH procedures.


Assuntos
Embolização Terapêutica/efeitos adversos , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Radiografia Intervencionista/efeitos adversos , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Psicogênicas/etiologia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/fisiopatologia , Medição de Risco , Fatores de Risco , Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Psicogênicas/diagnóstico , Disfunções Sexuais Psicogênicas/psicologia , Resultado do Tratamento
4.
Tech Vasc Interv Radiol ; 23(3): 100687, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33308528

RESUMO

As prostatic artery embolization is assuming an increasingly important role in the management of benign prostatic hyperplasia, it is important for the practicing interventional radiologist to have a deep understanding of all aspects of the disease process and the available treatment options. This paper provides a comprehensive overview of the pathophysiology, diagnosis and management options for benign prostatic hyperplasia with an emphasis on the surgical and medical treatments.


Assuntos
Embolização Terapêutica , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Radiografia Intervencionista , Procedimentos Cirúrgicos Urológicos Masculinos , Agentes Urológicos/uso terapêutico , Embolização Terapêutica/efeitos adversos , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/terapia , Radiografia Intervencionista/efeitos adversos , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Agentes Urológicos/efeitos adversos
5.
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
6.
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
7.
J Urol ; 204(6): 1270-1274, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32718203

RESUMO

PURPOSE: Our primary objective was to determine the incidence of extravasation on imaging at the time of catheter removal after ventral onlay buccal mucosal graft urethroplasty. MATERIALS AND METHODS: This is a single center retrospective cohort study of patients who underwent ventral onlay buccal mucosal graft bulbar urethroplasty from 2007 to 2017. Patients with imaging at the time of catheter removal were included. Urethroplasty success was defined as the ability to pass a 17Fr cystoscope at the time of followup cystoscopy. RESULTS: A total of 229 patients met the inclusion criteria, including 110 with a ventral onlay buccal mucosal graft and 119 with an augmented anastomotic urethroplasty with a mean stricture length of 4.4 cm. Imaging consisted of a voiding cystourethrogram in 210 and retrograde urethrogram in 19 patients at a median of 21.7 days after surgery. The incidence of extravasation was 3.1% (7/229). Of patients who had a documented followup cystoscopy (60%, 137/229), those with extravasation on imaging had a worse urethroplasty success rate (60%, 3/5) compared to those who did not (94%, 117/130) (p=0.047). On multivariate analysis those who had 5 or more endoscopic interventions were 9.6 times more likely to demonstrate extravasation (OR 9.6, p=0.0080). CONCLUSIONS: The incidence of radiological extravasation after ventral onlay using a single buccal mucosal graft, with or without augmented anastomotic urethroplasty, is 3.1%. Given this low rate it is reasonable to omit routine imaging at the time of Foley removal in this population. It appears that extravasation may be associated with a worse cystoscopic patency rate but does not lead to more complications.


Assuntos
Cistoscopia/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Cuidados Pós-Operatórios/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Adulto , Cistoscopia/estatística & dados numéricos , Extravasamento de Materiais Terapêuticos e Diagnósticos/diagnóstico , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/transplante , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/estatística & dados numéricos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Uretra/diagnóstico por imagem , Uretra/cirurgia , Estreitamento Uretral/patologia , Cateterismo Urinário/instrumentação , Procedimentos Cirúrgicos Urológicos Masculinos/instrumentação
8.
J Urol ; 204(6): 1341-1348, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32718276

RESUMO

PURPOSE: Surgery is the first line treatment for congenital concealed penis but penile retraction is inevitable in some cases. We investigate the anatomical and histological characteristics of penile fasciae and describe a new technique for the correction of concealed penis. MATERIALS AND METHODS: The anatomical structures of penile fasciae were observed in 10 adult cadaveric penises. Penile tissue samples were stained with hematoxylin-eosin, Masson's trichrome and Weigert's resorcin-fuchsin, respectively. From January 2017 to May 2019, 78 patients with congenital concealed penis were treated with the new surgical technique. Median patient age was 14 years (range 8 to 18). RESULTS: Dartos fascia had sublayers. The superficial layer was a well vascularized tissue composed of nonpolar collagen fibers intermixed with nerves and vessels. The deep layer was composed of a transverse arrangement of collagen fibers and elastic fibers, and there were fewer venules and nerve fibers. Based on this finding we performed anatomical resection of the deep layer of dartos fascia to correct concealed penis. During the operation dartos fascia was separated into 2 layers and a complete circular resection of the deep layer was made at the base of the penis. Mean followup was 14 months. All patients and their parents were satisfied with the outcomes. None of the patients underwent postoperative penile retraction. CONCLUSIONS: The anatomical resection of the deep layer of dartos fascia for correcting concealed penis is technically easy, safe and effective. It provides a good cosmetic appearance and functional outcomes.


Assuntos
Fáscia/patologia , Fasciotomia/métodos , Doenças dos Genitais Masculinos/cirurgia , Pênis/anormalidades , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adolescente , Adulto , Cadáver , Criança , Fasciotomia/efeitos adversos , Estudos de Viabilidade , Seguimentos , Doenças dos Genitais Masculinos/congênito , Doenças dos Genitais Masculinos/patologia , Humanos , Masculino , Pênis/patologia , Pênis/cirurgia , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
9.
J Urol ; 204(6): 1326-1332, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32614254

RESUMO

PURPOSE: We sought to determine the number of cases to achieve competency and proficiency in tubularized incised plate technique for distal hypospadias repair using cumulative sum analysis. MATERIALS AND METHODS: From 2001 to 2015 we reviewed all distal tubularized incised plate repairs performed by a single surgeon since independent practice. Data for 450 consecutive cases included age, meatal location, presence of curvature, operative time, occurrence of complications and followup duration. A cumulative sum analysis cohort chart was used to determine trends in complication rate and operative time during the evaluation period. In order to account for surgical experience with time, the highest peak, plateau, and down trends in operative time and complication rate were identified on the plot and set as the transition points between learning (phase 1), competence (phase 2) and proficiency (phase 3). RESULTS: Based on the cumulative sum analysis learning curve, the competence phase with plateau of operative time and complication rate commences beyond the 127th case, and the proficiency phase with notable decline in operative time and complication rate was noted beyond the 234th case. When comparing case characteristics and surgical outcomes between phases and learning curve, the proficiency phase involved younger patients and more severe degree of distal hypospadias being repaired using the tubularized incised plate approach with fewer complications related to meatal stenosis and fewer cosmetic complications. CONCLUSIONS: In our study competency in distal hypospadias tubularized incised plate repair was reached beyond the 127th case, while proficiency was attained beyond the 234th case.


Assuntos
Hipospadia/cirurgia , Curva de Aprendizado , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Procedimentos Cirúrgicos Urológicos Masculinos/estatística & dados numéricos , Competência Clínica , Seguimentos , Humanos , Lactente , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/educação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Cirurgiões/educação , Resultado do Tratamento , Uretra/anormalidades , Uretra/cirurgia , Estreitamento Uretral/epidemiologia , Estreitamento Uretral/etiologia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/educação , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
10.
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
11.
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
12.
Urol J ; 17(1): 68-72, 2020 01 26.
Artigo em Inglês | MEDLINE | ID: mdl-31984473

RESUMO

PURPOSE: The most common option for the management of urethral stricture (US) is direct visual internal urethrotomy (DVIU), because it is an easy and minimally invasive technique but the low success and high recurrence rates of this technique make urologists research for different types of therapeutic alternatives in stricture treatment. In this study we aimed to compare the internal urethrotomy with amplatz dilation for the treatment of male US. MATERIALS AND METHODS: A total of sixty patients, who have been operated due to urethral stricture were enrolled into this study. Group 1 was treated with amplatz renal dilators and the group 2 was treated with cold knife urethrotomy. All patients were evaluated for Qmax preoperatively and at the first, 3rd, 9th and 12th months postoperatively. RESULTS: In the 3 month uroflowmetry results, mean Q max values were 15.6±2 ml/sec in amplatz group and 15.5±1.6 ml/sec in DVIU group. There was no statisticaly difference between the two groups. However the Q max values in the postoperative 9 and 12 months were significantly decreased in the DVIU group. In the DVIU group 9 recurrences (36%) appeared and 2 of these reccurrences were in the first 3 months, whereas in the amplatz group no recurrences appeared in the first 3 months. The urethral stricture recurrence rate up to the 12 month follow up was statistically significant for group 1 when it is compared with group 2. Conclusions: In our experience, amplatz dilation is a good option as the initial treatment for urethral stricture.


Assuntos
Dilatação , Estreitamento Uretral/terapia , Procedimentos Cirúrgicos Urológicos Masculinos , Idoso , Dilatação/efeitos adversos , Dilatação/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Estreitamento Uretral/fisiopatologia , Urodinâmica , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
13.
Andrologia ; 52(1): e13493, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31762050

RESUMO

A careful history and evaluation of men with chronic orchialgia elucidates the aetiology in some men to be a hyperactive cremaster muscle reflex with testicular retraction as the cause. The objective is to evaluate outcomes in men who underwent microsurgical subinguinal cremaster muscle release (MSCMR) with a retrospective chart review between September 2011 and April 2019. Nineteen men with hyperactive cremaster muscle reflex in 25 spermatic cord units underwent MSCMR, six bilateral and thirteen unilateral. Candidacy for MSCMR included answering yes to the question: "at times of testicular pain, does the testicle retract up in the groin to the extent that you have to milk it back down to the scrotum?", normal digital rectal examinations, negative urinalyses, negative scrotal Doppler ultrasounds, vigorous retraction of testis with Valsalva on examination and pain without an anatomic or pathologically identifiable aetiology except testicular retraction. Of the men who underwent MSCMR, 100% (25/25) of spermatic cord units had resolution of testicular retraction and 92% (23/25) of spermatic cord units had complete resolution of orchialgia. There was one complication, a small scrotal hematoma which resolved. MSCMR is an effective option for men with orchialgia secondary to testicular retraction due to a hyperactive cremaster muscle reflex.


Assuntos
Músculos Abdominais/cirurgia , Dor Crônica/cirurgia , Microcirurgia/métodos , Doenças Testiculares/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Músculos Abdominais/inervação , Adulto , Dor Crônica/diagnóstico , Dor Crônica/etiologia , Hematoma/etiologia , Humanos , Masculino , Microcirurgia/efeitos adversos , Pessoa de Meia-Idade , Medição da Dor , Hemorragia Pós-Operatória/etiologia , Reflexo Anormal , Estudos Retrospectivos , Cordão Espermático/inervação , Cordão Espermático/cirurgia , Doenças Testiculares/diagnóstico , Doenças Testiculares/etiologia , Testículo , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
14.
Minerva Urol Nefrol ; 72(1): 22-29, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31619035

RESUMO

INTRODUCTION: In the past years several reviews have analysed different aspects of surgical techniques for patients with LUTS due to BPE however none of them have concentrated on large prostates treatment exclusively. Moreover, none of the reviews have focused on level 1 evidence which is essential to avoid bias and wrong conclusions. With this knowledge in mind, aim of the present review is to analyze the available randomized clinical trials assessing the management of patients with big prostates (>80 cc). EVIDENCE ACQUISITION: A systematic review of the literature using the Medline, Scopus and Web of Science databases for relevant articles published until January 2019 was performed using both the Medical Subjects Heading and free test protocols. The search was conducted by combining the following terms: "Enucleation," "Prostate," "Benign Prostatic Hyperplasia," "Holmium," "laser," "adenomectomy," "Randomized clinical trial," "Big" "large" "prostate," ">80," "≥80," "transurethral resection of prostate," "Thulium," "Diode," "laparoscopy," "robotic," "Plasmakinetic," "green light" "532 nm" "YAG" "Lower Urinary tract symptoms". Only randomized clinical trials were included in the analysis. EVIDENCE SYNTHESIS: Overall 9 RCTs were retrieved with most of them reporting data at 1 year. The present trials compared enucleation, vaporization and open techniques between each other. In terms of perioperative outcomes all the techniques had similar operative times and resected weight however catheterization time and hospital stay were better in endoscopic techniques when compared to open surgery. In terms of functional outcomes (IPSS, QMAX and PVR) none of the techniques was proven superior to the other. When considering complications open procedures carried a higher risk of transfusions while no technique was proven superior to the others in terms of transient urge urinary incontinence, bladder neck contracture and reintervention. Only one trial was retrieved reporting five years data confirming the safety, efficacy and durability of simple prostatectomy SP and holmium laser enucleation of the prostate at five years. CONCLUSIONS: According to our review no technique may be considered better than the other when treating large adenomas. Studies are still lacking to prove long term efficacy and future studies should clarify the role of prostatic artery embolization and minimally invasive simple prostatectomy in the management of prostates larger than 80 mL.


Assuntos
Hiperplasia Prostática/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Humanos , Masculino , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/patologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
15.
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
16.
J Invest Surg ; 33(1): 40-48, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30339469

RESUMO

Background: The goal of this meta-analysis and systematic review is to evaluate the overall effect and safety of microsurgery versus laparoscopic surgery in the treatment of varicocele according to qualified randomized controlled trials (RCTs). Methods: The following electronic databases were searched including PubMed, Cochrane, Embase to identify the qualified studies and publications that were associated with this meta-analysis updated to February 2018 based on index words. The qualified studies only included RCTs. We analyzed the main outcomes through mean difference (MD) and relative risk (RR) along with 95% confidence interval (95% CI). Results: Totally, the current meta-analysis included 23 studies with 1178 patients in the group with microsurgery and 1069 patients in the group with laparoscopic surgery. The results indicated that compared with the laparoscopic surgery group, the microsurgery group could significantly decrease the complication rate (RR: 0.40, 95% CI: 0.21-0.75), as well as the hospital stay (WMD: -0.53, 95% CI: -0.85 to -0.21), increase the sperm concentration after the surgery (WMD: 3.00, 95% CI: 1.23-4.76), and decrease the recurrence rate (RR: 0.35, 95% CI: 0.22-0.55). Besides, there was no significant difference of operation time (SMD: 1.61, 95% CI: 0.71-2.51) and sperm motility (WMD: 2.38, 95% CI: 0.39-4.37) between the two groups. Conclusion: The results demonstrated microsurgery would significantly decrease the complication, hospital stay, and recurrence rate and increase the sperm concentration when compared with laparoscopic surgery. In conclusion, microsurgery is prone to be a better alternative therapy for the treatment of varicocele than laparoscopic surgery.


Assuntos
Infertilidade Masculina/cirurgia , Laparoscopia/efeitos adversos , Microcirurgia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Varicocele/cirurgia , Humanos , Infertilidade Masculina/etiologia , Laparoscopia/métodos , Tempo de Internação , Masculino , Microcirurgia/métodos , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Contagem de Espermatozoides , Motilidade Espermática , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Varicocele/complicações
17.
J Invest Surg ; 33(2): 164-171, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30380353

RESUMO

Objective: The aim of this study was to identify a theoretical support for the prevention of urethral fistula following hypospadias repair, by comparing the preputial wound healing process in Sprague-Dawley (SD) rats with and without hypospadias induced by flutamide. Methods: Fifteen pregnant SD rats were randomly divided into three groups. These rats in one group received the androgen receptor antagonist flutamide (25 mg/kg/day) from gestation days 11-17, to establish a rat model of hypospadias for further study of the molecular mechanisms of the hypospadias etiology. The pregnant rats in the control groups were not administered flutamide. The pups from the control and experiment groups underwent an incision on the dorsal prepuce on postnatal day 25 and were sacrificed on postoperative days 3, 7, and 14 to collect penis samples. The penis morphology was examined in all groups. Subsequently, transforming growth factor ß1 (TGF-ß1), α-smooth muscle actin (α-SMactin), and signal transducers and activators of the transcription 3 (STAT3) expression levels in the different groups were measured at the indicated time points postoperatively using qRT-PCR and Western blot. Results: There was less regeneration of the subcutaneous tissue in hypospadias rats than in the sham-operated group (P < 0.05) on postoperative day 3. No differences were found in the regeneration of the subcutaneous tissue between these groups on postoperative days 7 or 14. Additionally, there were no differences in the epithelial cell regeneration between the control and the hypospadias groups at any postoperative timepoint. Moreover, the expression levels of TGF-ß1, α-SMactin, and STAT3 were all significantly lower in hypospadias group than that in the sham-operated group (P < 0.05). Conclusion: The results from the present work suggest that preputial wound healing is retarded in rats with hypospadias induced by flutamide and that this retardation might result from multi-gene regulation.


Assuntos
Hipospadia/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Doenças Uretrais/prevenção & controle , Fístula Urinária/prevenção & controle , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Antagonistas de Androgênios/toxicidade , Animais , Animais Recém-Nascidos , Modelos Animais de Doenças , Feminino , Flutamida/toxicidade , Regulação da Expressão Gênica/efeitos dos fármacos , Humanos , Hipospadia/etiologia , Masculino , Pênis/anormalidades , Pênis/cirurgia , Complicações Pós-Operatórias/etiologia , Gravidez , Ratos , Ratos Sprague-Dawley , Uretra/anormalidades , Uretra/cirurgia , Doenças Uretrais/etiologia , Fístula Urinária/etiologia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Cicatrização/efeitos dos fármacos , Cicatrização/genética
18.
Adv Clin Exp Med ; 29(12): 1487-1490, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33389839

RESUMO

BACKGROUND: Distal penile hypospadias account for about 70% of all cases of hypospadias. There is a variety of operative techniques that could be performed when foreskin reconstruction is an option. The urethral stent is left in the urethra to prevent complications. OBJECTIVES: To determine whether the duration of stenting influences the healing of foreskin after distal hypospadias repair. MATERIAL AND METHODS: Data from 2 institutions was retrospectively analyzed. Inclusion criteria were as follows: 1) a modified meatal advancement glanuloplasty without tubularization of the urethral plate, 2) foreskin reconstruction and 3) follow-up - 12 months. All other types of reconstruction and re-do procedures were excluded. The period of urethral stenting was determined intraoperatively depending on the surgeon's preferences. Mean age at operation was 23.3 months. The cohort was divided into 3 groups. In Group I (G-I), no catheter was left or it was removed the next day after surgery. In Group II, the catheter was left for more than 5 days. In those 2 groups, the surgery was done by different surgeons. Group III consisted of 35 patients who had a stent for <2 days, and the procedure was performed by the same surgeon. The χ2 with Yates's correction and Pearson's χ2 tests were used for the statistical analysis. RESULTS: Overall, 11 patients had foreskin dehiscence and needed re-do surgery. None of the patients required operation because of foreskin stenosis. Complications occurred in 3 out of 33 patients (9%) in Group I, 2 out of 27 in Group II (7.4%) and 6 out of 35 in Group III (17%). There was no statistically significant difference between Groups I and II (p = 0.8144), nor between Groups I and III (p = 0.5344). In the non-parametric Pearson's χ2 test, no significant difference was found in such grouped data (p = 0.4239). CONCLUSIONS: Prolonged urethral stenting does not reduce the risk of a re-do foreskin surgery after hypospadias repair.


Assuntos
Hipospadia , Procedimentos Cirúrgicos Reconstrutivos , Pré-Escolar , Seguimentos , Prepúcio do Pênis/cirurgia , Humanos , Hipospadia/cirurgia , Lactente , Masculino , Estudos Retrospectivos , Stents , Resultado do Tratamento , Uretra/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
19.
J Pediatr Urol ; 15(6): 634.e1-634.e6, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31685390

RESUMO

BACKGROUND: Urethrocutaneous fistula UCF is the most common complication following surgical repair of hypospadias. Currently, the surgical technique mostly used to prevent recurrence employs preputial dartos or testicular tunica vaginalis flaps as a urethral covering. However, autologous tissues are limited in patients with multiple surgeries, and the use of biomaterials as a urethral coverage may represent a good alternative. OBJECTIVE: The goal of the present study is to assess the results and complications of recurrent UCF correction using a dermal bovine regeneration sheet as a urethral covering. MATERIALS AND METHOD: From May 2016 to January 2019, all patients with recurrent UCF of the authors center were repaired using this technique. The inclusion criteria were patients who had undergone one or more unsuccessful UCF repair surgeries and the absence of preputial tissue. The informed consent has been signed by all the patients. Patients were examined in outpatient consultations where their urinary stream was evaluated and a physical examination of the penis was conducted. RESULTS: A total of 12 patients and 13 UCFs were included in the study. The median follow-up was 18 months, (range: 4-26), and only two patients (15%) developed a recurrence of UCF. No complications were observed in the remaining patients (85%) during their evolution. No patient developed a fibrosis increase or loss of elasticity of the tissues in contact with the dermal matrix. CONCLUSION: The use of an Integra® sheet as a urethral covering during urethral fistula surgery appears to be a safe, effective, and easily reproducible option. However, prospective studies with larger numbers of patients should be performed to corroborate these results.


Assuntos
Sulfatos de Condroitina , Colágeno , Fístula Cutânea/etiologia , Prepúcio do Pênis/fisiologia , Hipospadia/cirurgia , Regeneração/fisiologia , Fístula Urinária/etiologia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Adolescente , Criança , Pré-Escolar , Fístula Cutânea/diagnóstico , Seguimentos , Humanos , Masculino , Complicações Pós-Operatórias , Estudos Prospectivos , Recidiva , Reoperação , Pele Artificial , Uretra/cirurgia , Fístula Urinária/diagnóstico
20.
Urol Int ; 103(4): 454-458, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31614357

RESUMO

BACKGROUND: Dorsal or ventral single layer repair can be impractical when there is an inadequate strip of urethra. Staged urethroplasty and non-transecting bilayer substitution urethroplasty are the other alternatives. OBJECTIVES: To assess the safety and outcome of non-transecting dorsal onlay and ventral inlay buccal mucosal substitution urethroplasty technique. METHOD: Between January 2014 and December 2018, 21 patients underwent non-transecting, double-layer, buccal mucosal urethroplasty for inflammatory bulbar urethral strictures. Four weeks after surgery, foley catheters were removed and voiding trial was given. Clinical examination and uroflowmetry (UFM) were done at 1, 3, and 6 months after surgery. Annual follow-up with flow rate and post-void residual assessment were also recorded. Failure was defined as a condition when there was flow rate deterioration (<15 mL/s) or when there is stricture recurrence (<20 Fr). RESULTS: The mean age was 49.5 years. There was no significant difference in comorbidities among the patients. The mean duration of operative time was 259 min. The mean blood loss was 190 mL. The follow-up duration ranged from 12 to 66 months. The average length of stricture was 3.9 cm. The mean diameter of stricture segment was 1.96 mm. Comparison of UFM trend during follow-up was statistically significant (p = 0.05). One patient had Clavien-dindo grade 1, while 2 patients had grade 3b complications. Two patients had soft anastomotic site stricture and were treated successfully with endoscopic internal urethrotomy. The success rate was 90.47%. CONCLUSIONS: Non-transecting bilayer substitution urethroplasty is safe and has better short-term outcome in case of obliterative inflammatory urethral strictures.


Assuntos
Mucosa Bucal/transplante , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
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