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3.
Curr Urol Rep ; 20(8): 45, 2019 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-31218458

RESUMO

PURPOSE OF REVIEW: To provide an economic context within which to consider treatment options for benign prostatic hyperplasia (BPH). To this end, this review provides a comparison of the costs of combination medical therapy, operative treatment, and office-based therapies for BPH from a payer perspective. RECENT FINDINGS: Analysis of Medicare charges from the authors' institution, as well as local retail costs of medication, demonstrated a wide range in costs of commonly used BPH treatments. In this study, interventions for BPH reached cost equivalence with combination medical therapy within 6 months to 8 years. A myriad of options for managing men with symptomatic BPH exist. It is prudent not only to consider surgeon preference and patient-specific factors when selecting a treatment but also to understand the economic impact different BPH therapies confer.


Assuntos
Hiperplasia Prostática/economia , Hiperplasia Prostática/terapia , Terapia Combinada/economia , Custos e Análise de Custo , Humanos , Masculino , Medicare/economia , Estados Unidos , Procedimentos Cirúrgicos Urológicos Masculinos/economia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Agentes Urológicos/economia , Agentes Urológicos/uso terapêutico
5.
J Urol ; 202(3): 592-598, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31059668

RESUMO

PURPOSE: Male lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is common in men and can have negative effects on quality of life (QoL). It is the hope that this Guideline becomes a reference for effective evidence-based surgical management of LUTS/BPH. MATERIALS AND METHODS: The evidence team searched Ovid MEDLINE, the Cochrane Library, and the Agency for Healthcare Research and Quality database to identify studies indexed between January 2007-September 2017. Following initial publication, this guideline was amended in 2019 and reflects relevant literature published through January 2019. When sufficient evidence existed, the body of evidence was assigned 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, additional information is provided as Clinical Principles and Expert Opinions (table 1 in supplementary unabridged guideline, https://www.jurology.com). RESULTS: This Guideline provides evidence-based recommendations regarding management of LUTS/BPH utilizing surgery and minimally invasive surgical therapies (MIST). Additional statements are made regarding diagnostic and pre-operative tests. Clinical statements are made in comparison to what is generally accepted as the gold standard (i.e. transurethral resection of the prostate [TURP] monopolar and/or bipolar). This guideline is designed to be used in conjunction with the associated treatment algorithm (see figure).[Figure: see text]Conclusions:The prevalence and the severity of LUTS increases as men age and is an important diagnosis in the healthcare of patients and the welfare of society. This document will undergo updating as knowledge regarding treatments and future surgical options continues to expand.


Assuntos
Sintomas do Trato Urinário Inferior/cirurgia , Hiperplasia Prostática/complicações , Sociedades Médicas/normas , Procedimentos Cirúrgicos Urológicos Masculinos/normas , Urologia/normas , Idoso , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/normas , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/psicologia , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/normas , Próstata/cirurgia , Hiperplasia Prostática/cirurgia , Qualidade de Vida , Estados Unidos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Urologia/métodos
6.
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
7.
Pediatr Surg Int ; 35(7): 823-827, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31049665

RESUMO

PURPOSE: To evaluate the intermediate outcomes of our institution's experience with staged TPIF urethroplasty for proximal hypospadias repair. METHODS: We retrospectively evaluated the medical records of patients who underwent repair of proximal hypospadias using staged TPIF urethroplasty at our hospital from 2011 to 2017. RESULTS: One hundred and two patients were included in the present study. The mean follow-up was 52.4 months (range 13-74 months). The mean age at the time of the first surgery was 13.5 months (range 11-65 months). There were two main types of initial complications including meatal stenosis in four (3.9%) and urethrocutaneous fistula in three (2.9%) patients after the first stage. Surgical complications were seen in 15 patients after second stage, including urethrocutaneous fistulas in 8 (7.8%), urethral strictures in 5 (4.9%), urethral diverticula in 2 (1.9%). Overall complication rates after second stage were 14.7%. The incidence of fistulas was lower in patients who underwent repair with a tunica vaginalis flap (1/29, 3.4%) than with the dartos fascia (7/73, 9.6%; p = 0.435). CONCLUSIONS: Our results show that staged TPIF urethroplasty is a viable and durable technique for primary severe proximal hypospadias. This procedure was associated with a 14.7% complication rate in the present study. Staged TPIF urethroplasty can reduce the incidence of urethral strictures and diverticula associated with the second stage.


Assuntos
Prepúcio do Pênis/cirurgia , Hipospadia/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos , Uretra/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Pré-Escolar , Seguimentos , Humanos , Lactente , Masculino , Estudos Retrospectivos , Resultado do Tratamento
9.
Urologe A ; 58(6): 651-657, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31098652

RESUMO

Defects in ureteral continuity and function can originate from various etiologies such as stricture, radiotherapy, tuberculosis, tumor, trauma or perforation due to iatrogenic injury. The surgical options for the management of ureteral defects are complex and depend on the location of the defect. The aim of the surgical management of ureteral stricture is the reconstruction of an anti-refluxive and nonobstructive flow of urine to preserve kidney function. There are numerous possibilities for the reconstruction of ureteral defects ranging from ureteroneocystostomy with or without psoas-hitch- or Boari-flap to ileal ureteral replacement. Nearly all these techniques can either be done in open surgery or in a laparoscopically or robotic-assisted manner. The technique of robotic-assisted reconstruction of ureteral defects is challenging but offers a great opportunity. The aim of this article is to provide an overview of current surgical procedures in ureteric reconstruction.


Assuntos
Cistostomia/métodos , Íleo/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reimplante/métodos , Retalhos Cirúrgicos , Ureter/cirurgia , Obstrução Ureteral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Feminino , Humanos , Laparoscopia , Estudos Retrospectivos , Resultado do Tratamento , Ureter/anormalidades , Ureter/lesões , Obstrução Ureteral/etiologia
10.
Arch Ital Urol Androl ; 91(1): 25-29, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-30932426

RESUMO

OBJECTIVE: The purpose of this study was to provide a detailed analysis of surgical and functional outcomes after correction of acquired buried penis in the adult. MATERIALS AND METHODS: From 2006 to 2016, we retrospectively reviewed 47 patients undergoing surgical treatment for the correction of buried penis. Functional and surgical outcomes, as well as patients' satisfaction were the main endpoints. RESULTS: The most common complains at presentation were recurrent uro-genital infections, sexual dysfunction, voiding dysfunction and Lichen Sclerosus (LS). Surgical management steps included: circumcision (27.66%), scrotoplasty (19.14%), V-Y skin plasty (4.25%), split thickness skin graft (STSG) 12.76%, full thickness skin graft (FTSG) 36.17%, suprapubic fat pad excision (57.44%), abdominoplasty (25.53%), division of the suspensory ligament (36.17%). Postoperative complications were recorded in 15% of patients. Vaginal penetration and erectile function ended up being more effective in 97.87% (46/47) and 42.55% (20/47) of patients. Improvement in penile erogenous sensation was in 6.38% (3/47). Aesthetic appearance of genitalia fully satisfied 36.17% of patients (17/47). Overall patients' satisfaction rate resulted 76.59% (36/47). CONCLUSION: Management of adult acquired buried penis still remains a challenging task to achieve, however excellent cosmetic results can be obtained by surgical reconstruction.


Assuntos
Satisfação do Paciente , Pênis/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto , Idoso , Circuncisão Masculina/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Pênis/anormalidades , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Escroto/cirurgia , Transplante de Pele/métodos , Resultado do Tratamento
11.
BMJ Case Rep ; 12(3)2019 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-30936333

RESUMO

We present a case of intractable acute ischaemic priapism occurring secondary to newly commenced olanzapine. It demonstrates rapid intervention in a stepwise approach aiming to restore penile flaccidity in order to prevent chronic damage to the corpora cavernosa. After an unsuccessful conservative approach, our patient underwent two formal distal penile shunt procedures with no effective penile detumescence. Subsequently, bilateral proximal penile shunts were performed comprising a right corpus cavernosum to corpus spongiosum anastomosis and a left saphenous vein to left corpus cavernosum anastomosis. The patient remained an inpatient for observation, and detumescence was gradually achieved over several days after this procedure. However, follow-up revealed erectile dysfunction, and it was explained to the patient that he was unlikely to achieve further erections and that a penile implant was the only realistic option.


Assuntos
Antipsicóticos/efeitos adversos , Olanzapina/efeitos adversos , Pênis/cirurgia , Priapismo/induzido quimicamente , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto , Antipsicóticos/administração & dosagem , Humanos , Masculino , Olanzapina/administração & dosagem , Pênis/irrigação sanguínea , Pênis/efeitos dos fármacos , Priapismo/fisiopatologia , Priapismo/cirurgia , Prisioneiros , Resultado do Tratamento
12.
Curr Urol Rep ; 20(6): 30, 2019 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-31020487

RESUMO

PURPOSE OF REVIEW: Fossa navicularis strictures represent a surgically challenging disease process that requires detailed preoperative planning and an understanding of each patient's goals in order to achieve a satisfactory long-term outcome. This review summarizes the various approaches used in the management of fossa navicularis strictures over the past several decades. RECENT FINDINGS: In addition to existing evidence to support open flap- and graft-based reconstruction, recent studies suggest a potential role for limited open repair via a transurethral approach. Open repair of fossa navicularis strictures has become the standard of care with high success rates using local skin flaps or tissue grafts. There remains a very limited role for minimally invasive techniques in definitive management of this disease.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/história , Estreitamento Uretral/história , Procedimentos Cirúrgicos Urológicos Masculinos/história , História do Século XXI , Humanos , Masculino , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
13.
J Urol ; 201(6): 1164-1170, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30864909

RESUMO

PURPOSE: We report multi-institutional outcomes in patients who underwent urethroplasty with a rectal mucosa graft. MATERIALS AND METHODS: We used the TURNS (Trauma and Urologic Reconstructive Network of Surgeons) database to identify patients who underwent urethral reconstruction with transanal harvest of a rectal mucosa graft. We reviewed preoperative demographics, stricture etiology, previous management and patient outcomes. RESULTS: We identified 13 patients from April 2013 to June 2017. Median age at surgery was 54 years. The stricture etiology was lichen sclerosus in 6 of 13 patients (46%), idiopathic in 2 (15%), hypospadias in 1 (7%), prior gender confirming surgery in 3 (23%) and rectourethral fistula after radiation for prostate cancer in 1 (7%). Prior procedures included failed urethroplasty with a buccal mucosa graft in 9 of 13 patients (69%), direct vision internal urethrotomy in 2 (15%) and none in 2 (15%). Median stricture length was 13 cm. Stricture location in the 9 cisgender patients was panurethral in 5 (56%), bulbopendulous in 2 (22%) and bulbar in 2 (22%). It was located at the junction of the fixed urethra extending into the neophallus in all 3 patients (100%) who underwent prior gender confirming surgery. Mean rectal mucosa graft length for urethroplasty was 10.6 cm (range 3 to 16). Repair types included dorsal or ventral onlay, or 2-stage repair. Stricture recurred at a median followup of 13.5 months in 2 of 13 patients (15%). Postoperative complications included glans dehiscence, urethrocutaneous fistula and compartment syndrome in 1 patient each (7%). No rectal or bowel related complications were reported. CONCLUSIONS: Urethral reconstruction with a transanal harvested rectal mucosa graft is a safe technique when a buccal mucosa graft is unavailable or not indicated.


Assuntos
Mucosa Intestinal/transplante , Coleta de Tecidos e Órgãos/métodos , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Reto , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
14.
BMC Urol ; 19(1): 18, 2019 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-30885184

RESUMO

BACKGROUND: To evaluate outcome of buccal mucosa graft urethroplasty (BMGU) for the treatment of urethral stricture disease, including a detailed analysis of success, morbidity and quality of life (QoL). METHODS: Between 12/05/2008 and 07/21/2010, 187 patients with urethral stricture disease, who were treated with BMGU at our University Medical Center, received a standardized questionnaire, evaluating postoperative success, morbidity and QoL. The primary endpoint was the success, i.e., stricture recurrence-free survival plus patients' satisfaction with surgery. Secondary endpoints included erectile function, voiding symptoms, pain and health-related QoL, which were assessed with a modified Urethral Stricture Surgery Patient Reported Outcome Measure (USS PROM), including the Erectile Function domain of the International Index of Erectile Function (IIEF-EF), Incontinence Questionnaire Male Lower Urinary Tract Symptoms Module (ICIQ-MLUTS) and EuroQol-5 dimensions (EQ-5D). RESULTS: In total, 83 patients (51.9%) completed the questionnaire. Bulbar, penile and panurethral strictures were found in 69 patients (83.1%), 13 patients (15.7%) and one patient (1.2%), respectively. The median length of the stricture was 5 cm (range: 1-16). At a median follow-up of 46 months (range: 36-54), 65 patients (78.3%) had no stricture recurrence and were satisfied with BMGU. Median scores for ICIQ-MLUTS, IIEF-EF and EQ-5D visual analogue scale were 6, 22 and 80, respectively. Based on USS PROM, postoperative improvement of QoL and satisfaction with BMGU was found in 67 patients (80.7%) and 68 patients (81.9%), respectively. CONCLUSIONS: In patients with urethral stricture disease, BMGU offers excellent success, morbidity and QoL.


Assuntos
Mucosa Bucal/transplante , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Centros de Atenção Terciária , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adolescente , Adulto , Idoso , Estudos de Coortes , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade , Estudos Prospectivos , Resultado do Tratamento , Estreitamento Uretral/diagnóstico , Adulto Jovem
15.
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
16.
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
17.
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
18.
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
19.
Urology ; 127: 124-126, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30822476

RESUMO

Inverted-Y ureteral duplication is one of the rarest anomalies of ureteral branching, which has been found to be more prevalent in females.2 Females commonly present with urinary incontinence often associated with distal limb ectopia to the bladder neck, uterus, or vagina.2 We present the case of a 7-year-old female with intermittent urinary incontinence who was found to have an inverted-Y ureteral duplication with perianal ectopia. We highlight the role of magnetic resonance urography in the evaluation of females with urinary incontinence and a normal renal/bladder ultrasound who are refractory to behavioral therapy.


Assuntos
Coristoma/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Ureter/anormalidades , Incontinência Urinária/etiologia , Urografia/métodos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Anormalidades Múltiplas/diagnóstico por imagem , Anormalidades Múltiplas/cirurgia , Criança , Coristoma/cirurgia , Feminino , Humanos , Doenças Raras , Medição de Risco , Índice de Gravidade de Doença , Ureter/diagnóstico por imagem , Ureter/cirurgia , Incontinência Urinária/fisiopatologia , Incontinência Urinária/terapia
20.
J Cancer Res Clin Oncol ; 145(4): 921-926, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30825028

RESUMO

PURPOSE: The European Association of Urology (EAU) guidelines for penile cancer (PC) are exclusively based on retrospective studies and have low grades of recommendation. The aim of this study was to assess the adherence to guidelines by investigating the management strategies for primary tumours and inguinal lymph nodes. METHODS: We retrospectively reviewed the clinical charts of 176 PC patients who underwent surgery in eight European centres from 2010 to 2016. The stage and grade were assessed according to the 2009 AJCC-UICC TNM classification system. To assess adherence rates, we compared theoretical and practical adherence to the EAU guidelines. RESULTS: Overall, 176 patients were enrolled. Partial amputation was the most frequent surgical approach (39%). 53.7% of tumours were stage Tis-T1b and the remaining 46.3% were stage T2-T4. Palpable lymph nodes were detected in 30.1% of patients and 45.1% underwent lymphadenectomy (LY). A sizeable group of tumours (43.2%) were N0. For primary treatment, adherence to the EAU guidelines was good (66%). In non-adherent cases, reasons for discrepancy were patient's choice (17%), surgeon's preference (36%), and other causes (47%). For LY, the guideline adherence was 70%, with either patient's or surgeon's choice or other causes accounting for discrepancy in 28, 20, and 52% of non-adherent cases, respectively. CONCLUSION: Adherence to the EAU guidelines for PC was quite high across the eight European centres involved in the study. This notwithstanding, strategies for further improvement should be developed and evenly adopted.


Assuntos
Fidelidade a Diretrizes , Neoplasias Penianas/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/normas , Idoso , Amputação/métodos , Amputação/normas , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Europa (Continente) , Humanos , Excisão de Linfonodo , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Penianas/patologia , Estudos Retrospectivos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
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