Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 9.428
Filtrar
2.
BMC Surg ; 21(1): 116, 2021 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-33676485

RESUMO

BACKGROUND: The first wave of the COVID-19 pandemic in March 2020 forced our healthcare system in the Bronx, New York to cancel nearly all scheduled surgeries. We developed a framework for prioritizing postponed urologic surgeries that was utilized once cases were permitted to be rescheduled. As many parts of our country experience first and second waves of this pandemic, our framework may serve as a resource for other centers experiencing restrictions on the scheduling of elective urologic surgeries. METHODS: As the COVID-19 pandemic started and peaked in New York, almost all of our scheduled urologic surgeries were cancelled. Each Urologist was asked to rank his/her cancelled surgeries by priority (Level 1-least urgent; Level 2-moderately urgent; Level 3-most urgent). A committee of Urologists assigned a subclass to Level 3 and 2 cases (3a-least urgent; 3b-moderately urgent; 3c-most urgent; 2a-lower priority; 2b-higher priority). The committee then reviewed cases by urgency to derive a final priority ranking. RESULTS: A total of 478 total urologic surgeries were canceled and categorized: 250 Level 1, 130 Level 2, 98 Level 3 (73 adult, 25 pediatric). Level 3c involved renal cell carcinoma ≥ T2b, high-grade bladder urothelial carcinoma, adrenal mass/cancer > 6 cm, testicular cancer requiring radical orchiectomy, and penile cancer. Level 3b involved T2a renal masses requiring nephrectomy, while high-risk prostate cancer and symptomatic nephrolithiasis were classified as 3a. Level 2 included testicular cancer requiring retroperitoneal lymph node dissection and complicated benign prostatic hyperplasia. Surgeries for urologic reconstruction, non-complicated nephrolithiasis, erectile dysfunction, and urinary incontinence were considered Level 1. CONCLUSIONS: Our disease-specific approach to surgical rescheduling offers appropriate guidance for triaging urologic surgeries. Our system can provide guidance to other institutions as COVID-19 cases surge in different regions and with the growing second wave.


Assuntos
Triagem , Procedimentos Cirúrgicos Urológicos , Adulto , Criança , Feminino , Humanos , Masculino , Cidade de Nova Iorque/epidemiologia , Triagem/métodos
3.
Actas urol. esp ; 45(1): 0-0, ene.-feb. 2021. tab, mapas, graf
Artigo em Espanhol | IBECS | ID: ibc-194903

RESUMO

OBJETIVO: La pandemia de la COVID-19 ha alterado sustancialmente las actividades de formación de los residentes. Si bien recientemente se han implementado nuevos programas de aprendizaje virtual, aún debe investigarse su utilidad desde la perspectiva de los aprendices de urología. MÉTODOS: Encuesta online transversal de 30 ítems, distribuida a través de Twitter, entre el 4 y el 18 de abril de 2020, con el objetivo de evaluar la perspectiva de los residentes de urología sobre las modalidades (videos pregrabados, seminarios web, podcasts y redes sociales [RRSS]) y contenidos (lecciones frontales, discusiones de casos clínicos, actualizaciones sobre guías y ensayos clínicos, videos quirúrgicos, clubes de revistas y seminarios sobre liderazgo y habilidades no técnicas) del aprendizaje inteligente (Smart learning). RESULTADOS: En total, 501 residentes de urología de 58 países completaron la encuesta. De estos, 78,4, 78,2, 56,9 y 51,9% consideraron los videos pregrabados, seminarios web interactivos, podcasts y RRSS, respectivamente, como modalidades de aprendizaje inteligente muy útiles. Los contenidos considerados como muy útiles por la mayor proporción de residentes fueron las actualizaciones de guías clínicas (84,8%) y videos quirúrgicos (81,0%). Además, más de la mitad de los residentes consideraron los seminarios de liderazgo y los de habilidades no técnicas (58,9 y 56,5%, respectivamente) como contenidos útiles para el aprendizaje inteligente. Las tres combinaciones preferidas de modalidad y contenido de aprendizaje inteligente fueron: videos quirúrgicos pregrabados, seminarios web interactivos sobre casos clínicos y videos pregrabados sobre guías. CONCLUSIÓN: Nuestro estudio proporciona la primera «visión global» de las modalidades y contenidos de aprendizaje inteligente que deben priorizarse con el objetivo de optimizar la educación virtual en urología. Aunque este estudio se llevó a cabo durante la pandemia de la COVID-19, nuestros hallazgos podrían tener un impacto aún mayor en el futuro


PURPOSE: The COVID-19 outbreak has substantially altered residents' training activities. While several new virtual learning programs have been recently implemented, the perspective of urology trainees regarding their usefulness still needs to be investigated. METHODS: A cross-sectional, 30-item, web-based Survey was conducted through Twitter from April 4th, 2020 to April 18th, 2020, aiming to evaluate the urology residents' perspective on smart learning (SL) modalities (pre-recorded videos, webinars, podcasts, and social media [SoMe]), and contents (frontal lessons, clinical case discussions, updates on Guidelines and on clinical trials, surgical videos, Journal Clubs, and seminars on leadership and non-technical skills). RESULTS: Overall, 501 urology residents from 58 countries completed the survey. Of these, 78.4, 78.2, 56.9 and 51.9% of them considered pre-recorded videos, interactive webinars, podcasts and SoMe highly useful modalities of smart learning, respectively. The contents considered as highly useful by the greatest proportion of residents were updates on guidelines (84.8%) and surgical videos (81.0%). In addition, 58.9 and 56.5% of responders deemed seminars on leadership and on non-technical skills highly useful smart learning contents. The three preferred combinations of smart learning modality and content were: pre-recorded surgical videos, interactive webinars on clinical cases, and pre-recorded videos on guidelines. CONCLUSION: Our study provides the first global «big picture» of the smart learning modalities and contents that should be prioritized to optimize virtual Urology education. While this survey was conducted during the COVID-19 outbreak, our findings might have even more impact in the future


Assuntos
Humanos , Masculino , Educação em Saúde/métodos , Infecções por Coronavirus , Urologia/educação , Internato e Residência/estatística & dados numéricos , Educação a Distância , Pandemias , Pneumonia Viral , Internato e Residência/normas , Inquéritos e Questionários , Telemedicina , Procedimentos Cirúrgicos Urológicos/educação
5.
Int Braz J Urol ; 47(3): 551-557, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33621003

RESUMO

PURPOSE: False-negative urodynamic findings may mislead or prevent planned treatments due to unmatched findings with the clinical presentation. We hypothesized that the absence of urodynamic demonstration of SUI or OAB on urodynamics would interfere with clinical outcomes. MATERIALS AND METHODS: We prospectively studied 124 women with (94) or without (30) demonstrable SUI after sling operations. Similarly, 64 women with OAB syndrome with (38) or without (26) demonstrable DO were also compared after treatment with anticholinergic agents. Patients were assessed with the UDI-6 and IIQ-7 questionnaires 3 and 6 months after treatment. RESULTS: Only 76% of SUI patients demonstrated urine leakage during urodynamics. The UDI-6 score was higher in the demonstrable-SUI and demonstrable-DO groups, while the IIQ-7 score was comparable within the incontinence or urgency/frequency groups. Demonstrable and non-demonstrable SUI-operated patients showed similar outcomes. Patients with urgency syndromes with or without demonstrable DO had a similar rate of improvement with anticholinergic therapy. CONCLUSIONS: Women with clinical complaints of SUI objectively demonstrated on urodynamics presented the same subjective clinical outcome as those with SUI lacking objective demonstration when measured by the UDI-6 and IIQ-7 questionnaires. Similarly, patients with OAB syndrome with or without demonstrable DO had similar clinical improvement when treated with anticholinergics and measured using the same questionnaires.


Assuntos
Incontinência Urinária por Estresse , Incontinência Urinária , Feminino , Humanos , Síndrome , Resultado do Tratamento , Incontinência Urinária por Estresse/tratamento farmacológico , Urodinâmica , Procedimentos Cirúrgicos Urológicos
6.
Int Braz J Urol ; 47(3): 584-593, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33621007

RESUMO

INTRODUCTION: The aim of the present prospective-randomized study was to compare perioperative outcomes and complications of bipolar and monopolar TURBT for lateral wall-located non-muscle invasive bladder cancers (NMIBC) under obturator nerve block (ONB). PATIENTS AND METHODS: 80 patients who underwent TURBT for lateral wall-located primary bladder tumors under ONB from March, 2016 to November, 2019 were included in the present study. The patients were randomized equally into two groups; monopolar TUR (M-TURBT) and bipolar TUR (B-TURBT). The primary and secondary outcomes were safety (obturator jerk and bladder perforation) and efficacy (complete tumor resection and sampling of the deep muscle tissue). RESULTS: Obturator jerk was detected in 2 patients (5%) in M-TURBT while obturator jerk was not observed during B-TURBT (p=0.494). Bladder perforation was not observed in both groups. All of the patients underwent complete tumor resection. There was no significant difference in muscle tissue sampling (67.5% vs. 72.5%, p=0.626) and thermal tissue damage rates (12.5% vs. 25%, p=0.201). The majority of complications were low-grade and the differences in Clavien grade 1-3 complications between groups were not statistically significant. CONCLUSION: In the treatment of lateral-wall located NMIBCs, either M-TURBT or B-TURBT can be safely and effectively performed by combining spinal anesthesia with ONB. Even so, it should be taken into consideration that low-grade postoperative hemorrhagic complications may occur in patients who undergo M-TURBT.


Assuntos
Neoplasias da Bexiga Urinária , Cistectomia , Humanos , Nervo Obturador , Estudos Prospectivos , Neoplasias da Bexiga Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos
8.
JAMA Netw Open ; 4(2): e2036315, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33533930

RESUMO

Importance: Adhesion-related complications (ARCs), including small-bowel obstruction, are common complications of intra-abdominal surgery. Statins, which have antifibrotic pleiotropic effects, inhibit adhesion formation in murine models but have not been assessed in humans. Objective: To assess whether statin use at the time of intra-abdominal surgery is associated with a reduction in ARCs. Design, Setting, and Participants: These 2 separate retrospective cohort studies (The Health Improvement Network [THIN] and Optum's Clinformatics Data Mart [Optum]) compared adults receiving statins with those not receiving statins at the time of intra-abdominal surgery. Individuals undergoing intra-abdominal surgery from January 1, 1996, to December 31, 2013, in the United Kingdom and from January 1, 2000, to December 31, 2016, in the US were included in the study. Those with obstructive events before surgery or a history of inflammatory bowel disease were excluded. Data analysis was performed from September 1, 2012, to November 24, 2020. Exposure: The primary exposure was statin use at the time of surgery. Main Outcomes and Measures: The primary outcome was ARCs, defined as small-bowel obstruction or need for adhesiolysis, occurring after surgery. Sensitivity analyses included statin use preceding but not concurrent with surgery, fibrate use, and angiotensin-converting enzyme inhibitor use. All analyses were adjusted for age, sex, and conditions associated with microvascular disease, such as hypertension, hyperlipidemia, obesity, and tobacco use; surgical approach and site; and diagnosis of a malignant tumor. Results: A total of 148 601 individuals met the inclusion criteria for THIN (mean [SD] age, 49.6 [17.7] years; 70.1% female) and 1 188 217 for Optum (mean [SD] age, 48.2 [16.4] years; 72.6% female). A total of 2060 participants (1.4%) experienced an ARC in THIN and 54 136 (4.6%) in Optum. Statin use at the time of surgery was associated with decreased risk of ARCs (THIN: adjusted hazard ratio [HR], 0.81; 95% CI, 0.71-0.92; Optum: adjusted HR, 0.92; 95% CI, 0.90-0.95). Similar associations were appreciated between statins and small-bowel obstruction (THIN: adjusted HR, 0.80; 95% CI, 0.70-0.92; Optum: adjusted HR, 0.88; 95% CI, 0.85-0.91). Conclusions and Relevance: This study's findings suggest that, among individuals in 2 separate cohorts undergoing intra-abdominal surgery, statin use may be associated with a reduced risk of postoperative ARCs. Statins may represent an inexpensive, well-tolerated pharmacologic option for preventing ARCs.


Assuntos
Abdome/cirurgia , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Obstrução Intestinal/epidemiologia , Intestino Delgado , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Operatórios , Aderências Teciduais/epidemiologia , Adulto , Idoso , Estudos de Coortes , Procedimentos Cirúrgicos do Sistema Digestório , Feminino , Procedimentos Cirúrgicos em Ginecologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Modelos de Riscos Proporcionais , Fatores de Proteção , Estudos Retrospectivos , Aderências Teciduais/cirurgia , Reino Unido/epidemiologia , Estados Unidos/epidemiologia , Procedimentos Cirúrgicos Urológicos , Procedimentos Cirúrgicos Vasculares
9.
Curr Urol Rep ; 22(4): 22, 2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33554322

RESUMO

PURPOSE: To provide a comprehensive review on the new da Vinci SP (single port) robotic surgical system. The published literature to date within urology and a description of the new system will be discussed. FINDINGS: There are currently no high-quality published studies with the SP robotic system. All studies are case series, many with 10 or fewer patients. However, all studies have found the SP system to be safe and feasible in performing most urological procedures. Renal and pelvic surgery using the SP robotic system is safe and feasible in the hands of expert robotic surgeons. Long-term, high-quality data is lacking. While the current high price and the learning curve will limit the SP systems' use in many health care systems, new updates and the release of robotic surgical systems from other developers may help drive down costs and encourage uptake.


Assuntos
Procedimentos Cirúrgicos Robóticos/instrumentação , Doenças Urológicas/cirurgia , Procedimentos Cirúrgicos Urológicos/instrumentação , Cistectomia/instrumentação , Cistectomia/métodos , Endoscopia , Humanos , Imageamento Tridimensional , Pelve Renal/cirurgia , Curva de Aprendizado , Nefrectomia/instrumentação , Nefrectomia/métodos , Prostatectomia/instrumentação , Prostatectomia/métodos , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Robóticos/economia , Procedimentos Cirúrgicos Robóticos/educação , Procedimentos Cirúrgicos Robóticos/tendências , Ureter/cirurgia , Bexiga Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/economia , Procedimentos Cirúrgicos Urológicos/educação , Procedimentos Cirúrgicos Urológicos/tendências
10.
Actas Urol Esp ; 45(3): 207-214, 2021 04.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33546905

RESUMO

INTRODUCTION: The suspension of most elective surgeries during COVID-19 pandemic caused the lengthening of urology surgical waiting lists. The objective of this study is to evaluate the impact of COVID-19 pandemic on urology surgical waiting list in a high-volume hospital. METHODS: An observational descriptive study was designed. All patients included in the urology surgical waiting list of our high-volume center on May 1st 2020 (46 days after the suspension of elective surgery) were analyzed. Baseline variables, priority on the waiting list, main urological disease, type of scheduled surgery, and waiting time were recorded. Other variables recorded were the presence of a urinary catheter, number of accesses to the emergency department, evidence of COVID-19 infection, number of deaths and their cause. The waiting time for each disease was compared with the time to surgery in 2019. RESULTS: A total of 350 patients were included. The mean (SD) time on the waiting list was 97.33 (55.47) days. Priority 1 patients, who normally should undergo surgery within 30 days, were on the waiting list for a mean (SD) time of 60.51 (20.14) days. They were mainly patients with ureteral lithiasis (25.6%), high-risk or muscle-invasive bladder cancer (20.9%) and high-risk prostate cancer (13.9%). The mean waiting time had already significantly exceeded the mean time to surgery in 2019 for radical cystectomy (p = 0.04) and URS (p = 0.003). CONCLUSIONS: The suspension of most elective surgeries due to COVID-19 had a significant impact on urology surgical waiting list of our high-volume center, especially in priority 1 group.


Assuntos
/epidemiologia , Pandemias , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Listas de Espera , Idoso , Análise de Variância , Cistectomia/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos , Feminino , Prioridades em Saúde , Hospitais com Alto Volume de Atendimentos , Humanos , Neoplasias Renais/epidemiologia , Masculino , Hiperplasia Prostática/epidemiologia , Neoplasias da Próstata/epidemiologia , Espanha/epidemiologia , Estatísticas não Paramétricas , Fatores de Tempo , Cálculos Ureterais/epidemiologia , Neoplasias da Bexiga Urinária/epidemiologia , Suspensão de Tratamento/estatística & dados numéricos
11.
Ann R Coll Surg Engl ; 103(3): 173-179, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33557703

RESUMO

INTRODUCTION: With the emergence of the COVID-19 pandemic, all elective surgery was temporarily suspended in the UK, allowing for diversion of resource to manage the anticipated surge of critically unwell patients. Continuing to deliver time-critical surgical care is important to avoid excess morbidity and mortality from pathologies unrelated to COVID-19. We describe the implementation and short-term surgical outcomes from a system to deliver time-critical elective surgical care to patients during the COVID-19 pandemic. MATERIALS AND METHODS: A protocol for the prioritisation and safe delivery of time-critical surgery at a COVID-19 'clean' site was implemented at the Nuffield Health Exeter Hospital, an independent sector hospital in the southwest of England. Outcomes to 30 days postoperatively were recorded, including unplanned admissions after daycase surgery, readmissions and complications, as well as the incidence of perioperative COVID-19 infection in patients and staff. RESULTS: A total of 128 surgical procedures were performed during a 31-day period by a range of specialties including breast, plastics, urology, gynaecology, vascular and cardiology. There was one unplanned admission and and two readmissions. Six complications were identified, and all were Clavien-Dindo grade 1 or 2. All 128 patients had preoperative COVID-19 swabs, one of which was positive and the patient had their surgery delayed. Ten patients were tested for COVID-19 postoperatively, with none testing positive. CONCLUSION: This study has demonstrated the implementation of a safe system for delivery of time-critical elective surgical care at a COVID-19 clean site. Other healthcare providers may benefit from implementation of similar methodology as hospitals plan to restart elective surgery.


Assuntos
Procedimentos Cirúrgicos Eletivos/métodos , Neoplasias/cirurgia , Procedimentos Cirúrgicos Operatórios/métodos , Tempo para o Tratamento , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios/métodos , Derivação Arteriovenosa Cirúrgica , Cateterismo Cardíaco , Assistência à Saúde/organização & administração , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Histerectomia , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Reino Unido/epidemiologia , Procedimentos Cirúrgicos Urológicos , Adulto Jovem
12.
Urologia ; 88(1): 3-8, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33632087

RESUMO

INTRODUCTION: Coronavirus disease 2019 (COVID-19) pandemic has dramatically hit all Europe and Northern Italy in particular. The reallocation of medical resources has caused a sharp reduction in the activity of many medical disciplines, including urology. The restricted availability of resources is expected to cause a delay in the treatment of urological cancers and to negatively influence the clinical history of many cancer patients. In this study, we describe COVID-19 impact on uro-oncological management in Piedmont/Valle d'Aosta, estimating its future impact. METHODS: We performed an online survey in 12 urological centers, belonging to the Oncological Network of Piedmont/Valle d'Aosta, to estimate the impact of COVID-19 emergency on their practice. On this basis, we then estimated the medical working capacity needed to absorb all postponed uro-oncological procedures. RESULTS: Most centers (77%) declared to be "much"/"very much" affected by COVID-19 emergency. If uro-oncological consultations for newly diagnosed cancers were often maintained, follow-up consultations were more than halved or even suspended in around two out of three centers. In-office and day-hospital procedures were generally only mildly reduced, whereas major uro-oncological procedures were more than halved or even suspended in 60% of centers. To clear waiting list backlog, the urological working capacity should dramatically increase in the next months; delays greater than 1 month are expected for more than 50% of uro-oncological procedures. CONCLUSIONS: COVID-19 emergency has dramatically slowed down uro-oncological activity in Piedmont and Valle d'Aosta. Ideally, uro-oncological patients should be referred to COVID-19-free tertiary urological centers to ensure a timely management.


Assuntos
/epidemiologia , Continuidade da Assistência ao Paciente , Acesso aos Serviços de Saúde , Oncologia/estatística & dados numéricos , Pandemias , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Urologia/estatística & dados numéricos , Agendamento de Consultas , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Itália/epidemiologia , Neoplasias Renais/epidemiologia , Neoplasias Renais/cirurgia , Masculino , Oncologia/organização & administração , Utilização de Procedimentos e Técnicas , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/cirurgia , Neoplasias da Bexiga Urinária/epidemiologia , Neoplasias da Bexiga Urinária/cirurgia , Neoplasias Urológicas/epidemiologia , Neoplasias Urológicas/cirurgia , Urologia/organização & administração
13.
Curr Urol Rep ; 22(3): 15, 2021 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-33534013

RESUMO

PURPOSE OF REVIEW: Patients with congenital urologic conditions present unique challenges as adults. Herein, we review the literature relevant to the adult reconstructive urologist confronted with complex surgical concerns affecting their patients with a history of hypospadias, spina bifida, and other syndromes affecting the genitourinary tract. RECENT FINDINGS: Urethral stricture disease related to hypospadias is complex, but successful urethroplasty and penile curvature correction can be achieved with an anatomically minded approach. Multiple urinary diversion techniques can be considered in a patient-centered approach to bladder management in the adult spina bifida patient, but complications are common and revision surgeries are frequently required. Strong evidence is lacking for most surgical techniques in this population, but experiences reported by pediatric and adult urologists with genitourinary reconstruction training can help foster consensus in decision-making. Urologists trained in genitourinary reconstruction may be uniquely positioned to care for the transitional urology patient as they enter adolescence and adulthood.


Assuntos
Papel do Médico , Procedimentos Cirúrgicos Reconstrutivos , Disrafismo Espinal/complicações , Transição para Assistência do Adulto , Anormalidades Urogenitais/cirurgia , Procedimentos Cirúrgicos Urológicos , Adolescente , Adulto , Criança , Feminino , Humanos , Hipospadia/cirurgia , Masculino , Reoperação , Estreitamento Uretral/etiologia , Estreitamento Uretral/cirurgia , Sistema Urinário/cirurgia , Anormalidades Urogenitais/terapia , Doenças Urológicas/etiologia , Doenças Urológicas/cirurgia , Urologistas
14.
Acta Cir Bras ; 35(12): e351208, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33503221

RESUMO

PURPOSE: To describe the anatomy of the swine urinary system using computed tomography and to discuss the role of this animal as an experimental model for urological procedures. METHODS: Three male Landrace pigs underwent computed tomography and the anatomy of the urinary system and renal circulation was analyzed and described. RESULTS: In all animals, 2 kidneys, 2 ureters and one bladder were identified. Each kidney presented a single renal artery vascularization, with a mean diameter on the right of 4.45 and 5.31 mm on the left (p < 0.0001) and single renal vein drainage, with a mean diameter on the right of 5.78 and 5.82 mm on the left (p = 0.0336). The average renal length was 9.85 cm on the right and 10.30 cm on the left (p < 0.0001). The average renal volume was 113.70 cm3 on the right and 109.70 cm3 on the left (p < 0.0001). The average length of the ureter was 19.78 cm on the right and 22.08 cm on the left (p < 0.0001). The average bladder volume was 423.70 cm3. CONCLUSIONS: The data obtained show similarities with human anatomy, suggesting the viability of the swine model for planning preclinical trials, basic research, refinement in experimental surgery and surgical training for urological procedures.


Assuntos
Ureter , Animais , Rim/diagnóstico por imagem , Rim/cirurgia , Artéria Renal , Suínos , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos
15.
J Am Vet Med Assoc ; 258(2): 186-191, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33405984

RESUMO

CASE DESCRIPTION: As a result of vehicular trauma, a 3-year-old neutered male domestic shorthair cat sustained luxation of the sacrocaudal joint and a urethral tear. CLINICAL FINDINGS: Retrograde contrast urethrocystography revealed a urethral tear at the level of the ischiatic tuberosity. Conservative treatment for 7 days with a urethral catheter was unsuccessful. TREATMENT AND OUTCOME: An approach for a perineal urethrostomy was performed and revealed a large urethral tear (4 mm in length in a craniocaudal orientation and encompassing approx 50% of the urethral circumference) proximal to the bulbourethral glands. Urethroplasty was performed with a graft of a rectangular section of single-layer porcine small intestinal submucosa. Perineal urethrostomy was then completed routinely, and a urethral catheter was left in place for 5 days. Two days after removal of the urethral catheter, stranguria was noted. Retrograde contrast urethrocystography revealed a urethral stricture. Balloon dilation of the urethral stricture was performed, and the cat's stranguria improved. Ten weeks following balloon dilation, the cat developed hematuria, and a urinary tract infection and urethral stricture were diagnosed. Balloon dilation was repeated with instillation of triamcinolone solution at the stricture site. Eighteen months later (approx 21 months after the initial surgery), the cat was urinating normally. CLINICAL RELEVANCE: The outcome for the cat of this report indicated that porcine small intestinal submucosa may be used to successfully augment urethroplasty for treatment of traumatic urethral tears in cats. Urethral balloon dilation with triamcinolone instillation may be used to treat postoperative urethral strictures.


Assuntos
Doenças do Gato , Doenças dos Suínos , Estreitamento Uretral , Animais , Doenças do Gato/cirurgia , Cateterismo/veterinária , Gatos , Dilatação/veterinária , Masculino , Suínos , Resultado do Tratamento , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Estreitamento Uretral/veterinária , Procedimentos Cirúrgicos Urológicos/veterinária
16.
Urology ; 149: 40-45, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33482129

RESUMO

OBJECTIVE: To assess the impact of the COVID-19 pandemic on the rate of same-day discharge (SDD) after robotic surgery METHODS: We reviewed our robotic surgeries during COVID-19 restrictions on surgery in Ohio between March 17 and June 5, 2020 and compared them with robotic procedures before COVID-19 and after restrictions were lifted. We followed our formerly described protocol in use since 2016 offering the option of SDD to all robotic urologic surgery patients, regardless of procedure type or patient-specific factors. RESULTS: During COVID-19 restrictions (COV), 89 robotic surgeries were performed and compared with 1667 of the same procedures performed previously (pre-COV) and 42 during the following month (post-COV). Among COV patients 98% (87/89 patients) opted for same-day discharge after surgery versus 52% in the historical pre-COV group (P < .00001). Post-COV, the higher rate of SDD was maintained at 98% (41/42 patients). There were no differences in 30-day complications or readmissions between SDD and overnight patients with only 2 COV (2%) and no post-COV 30-day readmissions. CONCLUSION: SDD after robotic surgery was safely applied during the COVID-19 crisis without increasing complications or readmissions. SDD may allow continuation of robotic surgery despite limited hospital beds and when minimizing hospital stay is important to protect postoperative patients from infection. Our experience suggests that patient attitude is a major factor in SDD after robotic surgery since the proportion of patients opting for SDD was much higher during COV and continued post-COV. Consideration of SDD long-term may be warranted for cost savings even in the absence of a crisis.


Assuntos
/prevenção & controle , Alta do Paciente/estatística & dados numéricos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Neoplasias Urológicas/cirurgia , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , /virologia , Feminino , Humanos , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Ohio/epidemiologia , Pandemias/prevenção & controle , Alta do Paciente/normas , Readmissão do Paciente/estatística & dados numéricos , Seleção de Pacientes , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Procedimentos Cirúrgicos Robóticos/normas , Índice de Gravidade de Doença , Fatores de Tempo , Neoplasias Urológicas/diagnóstico , Procedimentos Cirúrgicos Urológicos/normas , Adulto Jovem
17.
BMC Surg ; 21(1): 43, 2021 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-33468126

RESUMO

BACKGROUND: The prolapse of a ruptured and extruded bladder after vaginal hysterectomy is rare in clinical practice. We report the case of a significant mass that prolapsed from the vagina after a vaginal hysterectomy in a multiparous postmenopausal woman. CASE PRESENTATION: A 67-year old multiparous postmenopausal Chinese woman was found to have a significant mass extruding from the vagina after a vaginal hysterectomy. The mass was a ruptured and everted bladder, and the diagnosis was confirmed after physical and imaging examinations and urethral catheterization. The patient underwent an emergency operation for mass reduction, bladder repair, and partial colpocleisis under general anesthesia. She recovered without prolapse or urinary drainage complications after 35 months of follow-up. CONCLUSIONS: The present case serves as a guide for the management of patients with pelvic organ prolapse. The condition of patients should be carefully evaluated before surgery, and individualized operation should be performed. Careful postoperative follow-up is crucial for the timely exclusion of complications, especially in elderly patients with persistently increased abdominal pressure.


Assuntos
Cistostomia , Histerectomia Vaginal/efeitos adversos , Prolapso de Órgão Pélvico/cirurgia , Bexiga Urinária/cirurgia , Incontinência Urinária/etiologia , Idoso , Feminino , Humanos , Pós-Menopausa , Resultado do Tratamento , Bexiga Urinária/diagnóstico por imagem , Cateterismo Urinário , Procedimentos Cirúrgicos Urológicos , Vagina/cirurgia
18.
Urologe A ; 60(2): 178-185, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33443722

RESUMO

The following article summarizes the current evidence including postoperative success rates and complications for various surgical options in the treatment of urinary incontinence. Due to different inclusion criteria and inconsistent definitions of study endpoints, the analysis of available studies is difficult. Thus, comparative studies with new devices for established treatment options should be planned. Structured processes used in certified continence centers improve the quality of care. Furthermore by documenting relevant complications, comparisons of treatment results thus become possible and provide evidence for the use of different surgical options in the treatment of urinary incontinence.


Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse , Incontinência Urinária , Seguimentos , Humanos , Resultado do Tratamento , Incontinência Urinária/diagnóstico , Incontinência Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos
19.
Urol J ; 17(6): 560-561, 2021 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-33432567

RESUMO

In this correspondence the authors try to show that guidelines and recommendations including what was published by EAU rapid reaction group must be further updated and tailored according to different epidemiologic data in different countries. The authors assign the countries worldwide in three categories. First category comprises countries that experience the secondary surges smoother than the first one. The second category include countries with stronger or -merging and rising-secondary surges and the third category encompasses countries with successful initial response and secondary stronger but still more controllable surges. Authors proclaim that after passing the first baffling impact we find out that postponement strategies preached in many of these scout treatises are no more suitable at least for the countries delineated in the second category and can culminate in performance of procedures in worse. The authors proffer Iranian Urology Association COVID-19 Taskforce Pamphlet(IUA-CTP) as a paragonic document mentioning it's the time we must recognise the wide variability of the situation in different regions and any advisory position must consider this huge variance in epidemiologic profile.


Assuntos
/epidemiologia , Procedimentos Cirúrgicos Urológicos/normas , Agendamento de Consultas , Procedimentos Cirúrgicos Eletivos/normas , Humanos , Irã (Geográfico)/epidemiologia , Guias de Prática Clínica como Assunto
20.
Neurourol Urodyn ; 40(2): 695-704, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33492706

RESUMO

AIMS: To investigate the impact of COVID-19 pandemic on health-care provision to patients suffering from pelvic floor dysfunctions in Italy. METHODS: A retrospective web-based interdisciplinary survey was mailed by the Italian Society of Urodynamics to members involved in pelvic floor dysfunctions management from June 22, 2020 to July 17, 2020. The 84-item questionnaire investigated the period March-June 2020 (first epidemic wave) and showed high content validity. The primary outcome was the mean rate of cancellation for health-care services. Secondary outcomes included estimation of the accumulated surgeries backload until return to baseline activity and of the recovery pattern, using linear regression and scenario-based forecasting. RESULTS: A total of 85 participants provided complete responses. Respondents were mostly urologists (47%), followed by gynecologists (29.5%) and physiatrists (17.6%). On average, 78.4% of outpatient services and 82.7% of functional surgeries were canceled, without significant differences by geographical distribution. An impact on patients' quality of life was anticipated by most of the respondents (87%) and 48.2% also reported potentially serious health risks for patients. Thirty-three percent of the respondents reported the use of telemedicine. If the nation-wide surgical activity increases by 20% postpandemic, it would take 37 months to clear the backlog of functional surgeries. We acknowledge the inherent limitations of the survey methodology and retrospective design. CONCLUSIONS: Access to care for patients suffering from pelvic floor dysfunctions has been dramatically affected by the COVID-19 outbreak. The indirect effects of this unprecedented disruption on pelvic floor dysfunctions care may last for several months.


Assuntos
Assistência à Saúde , Procedimentos Cirúrgicos Eletivos , Distúrbios do Assoalho Pélvico/terapia , Tempo para o Tratamento , Adulto , Assistência Ambulatorial , Feminino , Procedimentos Cirúrgicos em Ginecologia , Ginecologia , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Pandemias , Diafragma da Pelve , Prolapso de Órgão Pélvico/cirurgia , Fisiatras , Hiperplasia Prostática/cirurgia , Qualidade de Vida , Doenças Retais/cirurgia , Estudos Retrospectivos , Inquéritos e Questionários , Telemedicina , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos , Urologistas , Carga de Trabalho
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...