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1.
Urologe A ; 59(1): 65-71, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31741004

RESUMO

Due to a safety alert issued by the US Food and Drug Administration (FDA) in 2011 for transvaginal mesh implants to treat female prolapse as a result of numerous reports of complications such as infection, chronic pain, dyspareunia, vaginal erosion, shrinkage and erosion into other organs nearly all industrial products have been withdrawn from the market in the meantime. The United Kingdom, Australia, and New Zealand extended warnings and prohibitions even on the implantation of midurethral slings (TVT, TOT). In view of these current international controversies regarding the use of implanted materials for the treatment of stress incontinence and prolapse and the lack of clear guidelines for the use of biomaterials, the opinion of the Working Group on Urological Functional Diagnostics and Female Urology should provide clarity. The Opinion is based on the SCENIHR Report of the "European Commission's Scientific Committee on Emerging and Newly Identified Health Risks", the "Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence" and in compliance with relevant EAU and national guidelines and the opinion of the Association for Urogynaecology and Plastic Pelvic Floor Reconstruction (AGUB eV). In addition, recommendations are given for the future handling of implants of slings and meshes for the treatment of stress incontinence and prolapse from a urologic viewpoint.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Slings Suburetrais/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos/instrumentação , Feminino , Alemanha , Humanos
2.
Urologe A ; 58(11): 1304-1312, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31506761

RESUMO

The increase of medical knowledge and technical innovations together with the demographic change represent a challenge for the new conception of guidelines and clinical studies. The present S2k guidelines, which are exclusively concerned with kidney and ureteral stones, should support the treatment of urolithiasis in hospitals and private practices and provide information on urolithiasis for patients. Increasing interdisciplinary collaboration in stone treatment is also demonstrated in the number of professional and working groups participating in the update of the new guidelines. The present S2k guidelines emerged from a consensus process and demonstrate the current recommendations in step with actual practice. They provide decision-making guidance for diagnostics, treatment and metaphylactic measures based on expert opinions and available published fundamental evidence from the literature.


Assuntos
Litotripsia/normas , Guias de Prática Clínica como Assunto , Ureteroscopia/normas , Urolitíase/cirurgia , Procedimentos Cirúrgicos Urológicos/normas , Urologia/normas , Tratamento por Ondas de Choque Extracorpóreas , Humanos , Cálculos Renais , Nefrolitotomia Percutânea , Resultado do Tratamento , Cálculos Ureterais , Urolitíase/diagnóstico , Urolitíase/prevenção & controle , Procedimentos Cirúrgicos Urológicos/instrumentação
3.
Medicine (Baltimore) ; 98(31): e16223, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374003

RESUMO

Intravesical instillation of Bacille Calmette-Guèrin (BCG) is the standard adjuvant treatment for high-risk non muscle invasive bladder cancer (NMIBC). Since its mechanism of action is supposed to be linked to the immune system efficiency and senescence could negatively affect this efficiency, BCG efficacy in the elderly has been questioned. This study aimed to assess the impact of age on BCG efficacy and safety in patients with high-grade T1 bladder cancer (BC).Among 123 patients with high-grade T1 BCG scheduled for BCG treatment, 82 were <75 year-old (group A) and 41 were ≥75 year-old (group B). Follow-up: urine cytology and cystoscopy every 3 months for the first 2 years, every 6 months for the third year, and then yearly. Tumor recurrence was defined as pathological evidence of disease at the bladder biopsy; tumor progression was defined as pathological shift to muscle invasive disease at the bladder biopsy or the imaging techniques showing recurrent BC and distant metastasis likely related to it.The median follow-up was 65 months (range 11-152). Recurrence occurred in 35 patients, 19 (23.2%) in the group A and 16 (39%) in the group B. Progression occurred in 18 patients, 12 (14.6%) in the group A and 6 (14.6%) in the group B. Recurrence free rate was similar in both groups up to 2 years. The 5 years progression rate was almost the same in both groups A and B (85.9% vs 84.7%), whereas the 5 years cancer-specific survival (CSS) was 92.6% in the group A and 85.4% in the group B. Of the 18 patients with progression, 11 underwent cystectomy; 12 patients died because of their BC. Kaplan-Meier plots pointed out no difference in recurrence-free, progression-free, and CSS between the 2 groups. Adverse events were similar in the 2 groups. Only 4 (3.3%) patients, 2 (2.4%) in the group A and 2 (4.8%) in the group B, experienced mild adverse reactions compatible with treatment.Elderly patients with high-grade T1 BC are not poorer candidates to BCG treatment, as they had similar benefit and adverse reactions than those aging ≥75 years.


Assuntos
Fatores Etários , Neoplasias da Bexiga Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/instrumentação , Administração Intravesical , Idoso , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Estatísticas não Paramétricas , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos/métodos
4.
BMC Urol ; 19(1): 80, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31464587

RESUMO

BACKGROUND: The aim of this study was to examine ureteral stricture rate after the use of UAS in an unstented ureter and compare complications of smaller vs. larger-caliber UAS. METHODS: We conducted a retrospective analysis of consecutive RIRS for renal stones, with the use of UAS in unstented ureters. We excluded cases with previous ureteroscopies, who carried ureteral stent or nephrostomy, had impacted stones, underwent radiation treatment, or had urinary tract malignancies. The primary outcome was formation of ureteral strictures diagnosed by hydronephrosis in ultrasound test and late secretion in dynamic renal scan. Secondary outcome was stone-free-rate (SFR) and complications. In addition, we compared safety and efficacy of smaller (9.5/11.5Fr) vs. larger-caliber (12/14Fr) UAS. RESULTS: The cohort included 165 patients with a median follow-up time of 115 days. There was no case of ureteral stricture formation after the use us UAS, despite using a larger-caliber UAS in nearly half the cases. Larger-caliber UAS was not associated with more complications compared to the smaller-caliber one (p = 0.780). SFR was non-significantly higher in the larger-caliber UAS group (p = 0.056), despite having a larger stone burden, and only stone number was associated with SFR (p = 0.003). CONCLUSIONS: These data suggest that the use of UAS during RIRS in an unstented ureter is safe and does not involve ureteral stricture formation after one procedure. Furthermore, the use of wider sheaths was not found to be associated with higher complications rate.


Assuntos
Cálculos Renais/cirurgia , Complicações Pós-Operatórias/etiologia , Obstrução Ureteral/etiologia , Procedimentos Cirúrgicos Urológicos/instrumentação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Constrição Patológica , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/patologia , Estudos Retrospectivos , Ureter , Obstrução Ureteral/epidemiologia , Obstrução Ureteral/patologia , Adulto Jovem
5.
J Vet Intern Med ; 33(5): 2124-2132, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31386229

RESUMO

BACKGROUND: Subcutaneous ureteral bypass (SUB) device placement is an increasingly popular treatment option for decompression of ureteral obstruction in cats. Mineralization occlusion of the device occurs in a minority of cases but is the most common complication. OBJECTIVE: To evaluate a 2% tetrasodium ethylenediaminetetraacetic acid (tEDTA) solution for treatment of mineralization occlusion in cats with SUBs. ANIMALS: Six client-owned cats (8 obstructed devices). METHODS: Case series. Each cat was found to have device occlusion based on a combination of ultrasound examination, SUB irrigation, and failure to identify another cause of device obstruction. Each SUB was drained, irrigated using sterile saline, and infused with 1-2 mL of 2% tEDTA solution. Success was defined as normalization of flow during subsequent ultrasound visualization while irrigating. The volume and frequency of tEDTA instillations, time to achieve device patency, follow-up biochemical and ultrasound findings, and future reobstruction events were recorded. RESULTS: Resolution of mineralization was documented in all 8 SUBs. Reobstruction events occurred in 2 cats, all of which resolved after additional tEDTA infusions, but 1 cat ultimately required device exchange at 356 days from the first tEDTA infusion. In 1 cat, a single infusion was prematurely discontinued because of persistent pelvic dilatation after 1.25 mL of tEDTA had been instilled. No complications were observed. CONCLUSIONS AND CLINICAL IMPORTANCE: Tetrasodium EDTA infusions can be safely considered as a treatment option for mineralized SUB devices in cats. This solution was easily infused, well tolerated, and avoided the need for SUB device exchange in the majority of cats in which it was used.


Assuntos
Doenças do Gato/terapia , Ácido Edético/administração & dosagem , Stents/veterinária , Procedimentos Cirúrgicos Urológicos/veterinária , Animais , Quelantes de Cálcio/administração & dosagem , Doenças do Gato/diagnóstico por imagem , Gatos , Feminino , Masculino , Ultrassonografia/veterinária , Obstrução Ureteral/terapia , Obstrução Ureteral/veterinária , Procedimentos Cirúrgicos Urológicos/instrumentação
6.
Arch Ital Urol Androl ; 91(2)2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31266279

RESUMO

OBJECTIVE: To determine if there is a difference between postoperative urinary infection rates after retrograde intra-renal surgery (RIRS) when ureteral access sheath (UAS) was used or not used. MATERIALS AND METHODS: We retrospectively analyzed the medical records of all patients who underwent RIRS at our institution between January 2016 and October 2018. RESULTS: 129 patients were included in the study. The mean age of the patients was 48.8 ± 12.1 years; 94 patients were male and 35 were female. The mean stone size (largest diameter), stone attenuation and stone volume were 15.3 ± 5.8 mm, 1038 ± 368 HU and 1098 ± 1031 mm3, respectively. Out of 129 patients, 81 were treated by using UAS (Group 1) and 48 were treated without use of UAS (Group 2). There was no statistically significant difference between the two groups in terms of post-operative infection (p = 0.608). However, the operative time of patients with post-operative infection was statistically higher than the other patients; 88.35 ± 22.5 min versus 59.37 ± 22.1 min (p = 0.017). In multivariate regression analysis, operation time (p = 0.02, r = 1.07) was found to be the sole predictor of post-operative infection. CONCLUSIONS: Using UAS during RIRS might reduce the intrarenal pressure and also has several advantages. However not prolonging the operation time too much could be of higher importance than UAS use in terms of preventing post-operative infection after RIRS.


Assuntos
Cálculos Renais/cirurgia , Complicações Pós-Operatórias/epidemiologia , Infecções Urinárias/epidemiologia , Procedimentos Cirúrgicos Urológicos/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Ureter , Procedimentos Cirúrgicos Urológicos/instrumentação
8.
Urology ; 131: 71-76, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31229514

RESUMO

OBJECTIVE: To investigate trends in stress urinary incontinence (SUI) surgery before and after the 2011 Foods and Drug Administration notification and the 2014 (American Urogynecologic Society [AUGS]/Society for Urodynamics Female Pelvic Medicine and Urogenital Reconstruction [SUFU]) position statement. METHODS: A retrospective chart review was performed to identify patients presenting for evaluation of SUI by 2 Female Pelvic Medicine and Reconstructive Surgery specialists between June 1, 2010 and May 31, 2017. Rates of surgical treatment modality (synthetic midurethral slings [MUS] versus autologous fascial pubovaginal sling versus bulking agents) were analyzed at 6-month intervals. RESULTS: Over fourteen 6-month intervals, the number of new patients presenting for evaluation of SUI increased consistently. There was a decrease in the proportion of new patients who underwent antiincontinence surgical procedures, specifically MUS, between December 2011 and December 2013. After the integration of the 2014 AUGS/SUFU position statement in patient counseling, this trend reverted and we noted a sustained increase in the proportion of patients electing surgical management. This paralleled an increase in new patient visits for SUI and MUS. The number autologous fascial pubovaginal sling remained stable throughout the study period. Conversely, MUS composed the highest proportion of procedures performed, accounting for 60 %-87.2% off all antiincontinence procedures. CONCLUSION: After the Foods and Drug Administration Public Health Notification in 2011, we observed a decline in the number of new patients presenting with SUI electing surgical management, specifically MUS. However, after the AUGS/SUFU position statement publication and integration into counseling, we observed a reversal in the previous year's trends, noting a resurgence of MUS utilization.


Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Feminino , Ginecologia , Humanos , Guias de Prática Clínica como Assunto , Desenho de Prótese , Estudos Retrospectivos , Sociedades Médicas , Centros de Atenção Terciária , Estados Unidos , Procedimentos Cirúrgicos Urológicos/instrumentação , Procedimentos Cirúrgicos Urológicos/normas , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Procedimentos Cirúrgicos Urológicos/tendências , Urologia
9.
BMJ ; 365: l1842, 2019 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-31167796

RESUMO

OBJECTIVES: To compare the effectiveness and safety of surgical interventions for women with stress urinary incontinence. DESIGN: Systematic review and network meta-analysis. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials evaluating surgical interventions for the treatment of stress urinary incontinence in women. METHODS: Identification of relevant randomised controlled trials from Cochrane reviews and the Cochrane Incontinence Specialised Register (searched May 2017), which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Medline In-Process, Medline Epub Ahead of Print, CINAHL, ClinicalTrials.gov, and WHO ICTRP. The reference lists of relevant articles were also searched. Primary outcomes were "cure" and "improvement" at 12 months, analysed by means of network meta-analyses, with results presented as the surface under the cumulative ranking curve (SUCRA). Adverse events were analysed using pairwise meta-analyses. Risk of bias was assessed using the Cochrane risk of bias tool. The quality of evidence for network meta-analysis was assessed using the GRADE approach. RESULTS: 175 randomised controlled trials assessing a total of 21 598 women were included. Most studies had high or unclear risk across all risk of bias domains. Network meta-analyses were based on data from 105 trials that reported cure and 120 trials that reported improvement of incontinence symptoms. Results showed that the interventions with highest cure rates were traditional sling, retropubic midurethral sling (MUS), open colposuspension, and transobturator MUS, with rankings of 89.4%, 89.1%, 76.7%, and 64.1%, respectively. Compared with retropubic MUS, the odds ratio of cure for traditional sling was 1.06 (95% credible interval 0.62 to 1.85), for open colposuspension was 0.85 (0.54 to 1.33), and for transobtrurator MUS was 0.74 (0.59 to 0.92). Women were also more likely to experience an improvement in their incontinence symptoms after receiving retropubic MUS or transobturator MUS compared with other surgical procedures. In particular, compared with retropubic MUS, the odds ratio of improvement for transobturator MUS was 0.76 (95% credible interval 0.59 to 0.98), for traditional sling was 0.69 (0.39 to 1.26), and for open colposuspension was 0.65 (0.41 to 1.02). Quality of evidence was moderate for retropubic MUS versus transobturator MUS and low or very low for retropubic MUS versus the other two interventions. Data on adverse events were available mainly for mesh procedures, indicating a higher rate of repeat surgery and groin pain but a lower rate of suprapubic pain, vascular complications, bladder or urethral perforation, and voiding difficulties after transobturator MUS compared with retropubic MUS. Data on adverse events for non-MUS procedures were sparse and showed wide confidence intervals. Long term data were limited. CONCLUSIONS: Retropubic MUS, transobturator MUS, traditional sling, and open colposuspension are more effective than other procedures for stress urinary incontinence in the short to medium term. Data on long term effectiveness and adverse events are, however, limited, especially around the comparative adverse events profiles of MUS and non-MUS procedures. A better understanding of complications after surgery for stress urinary incontinence is imperative. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016049339.


Assuntos
Meta-Análise em Rede , Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos , Feminino , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Incontinência Urinária por Estresse/fisiopatologia , Procedimentos Cirúrgicos Urológicos/instrumentação , Procedimentos Cirúrgicos Urológicos/métodos
10.
J Infect Chemother ; 25(7): 567-570, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31005565

RESUMO

We performed a questionnaire-based, retrospective, nationwide survey on perioperative management and antimicrobial prophylaxis for mid-urethral sling surgery for stress urinary incontinence in Japan to realize the clinical practice and risk factors for SSI. Records of women receiving transobturator tape (TOT) and tension-free vaginal tape (TVT) surgeries from 2010 to 2012 were obtained from hospitals belonging to the Japanese Society of Pelvic Organ Prolapse Surgery. The questionnaire addressed hospital volume, perioperative management, and SSI. Risk factors for SSI were investigated by comparing cases with and without SSI. The data from 97 hospitals and a total 1627 TOT and 1045 TVT surgeries were analyzed. Mean case volumes of TOT and TVT surgeries were 7.3 ± 14.9 and 7.1 ± 17.8 cases per year, respectively. Preoperative hair removal, bowel preparation, and urine culture were routinely performed at 44 (45.3%), 31 (32.0%), and 22 (22.7%) hospitals, respectively. First-generation (51.5%) or second-generation (34.0%) cephalosporin was mostly used for antimicrobial prophylaxis. SSI was reported only in 6 patients (0.22%) and none of them developed abscesses. None of the factors we could evaluate from the questionnaire were found to be significantly associated with SSI. SSI after mid-urethral slings rarely occurred in Japan (0.22%) and no parameters about perioperative managements significantly increased SSI. However, further studies with more detail information of each patient and operation are required to confirm their appropriate perioperative managements for mid-urethral slings.


Assuntos
Assistência Perioperatória/estatística & dados numéricos , Slings Suburetrais/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/estatística & dados numéricos , Monitoramento Epidemiológico , Feminino , Hospitais/estatística & dados numéricos , Humanos , Japão/epidemiologia , Assistência Perioperatória/métodos , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Inquéritos e Questionários/estatística & dados numéricos , Procedimentos Cirúrgicos Urológicos/instrumentação
11.
Int Braz J Urol ; 45(3): 617-620, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30676306

RESUMO

OBJECTIVE: Pyeloplasty is considered the gold standard treatment for ureteropelvic junction obstruction (UPJO). However, the failure rate of pyeloplasty is as high as 10% and repeat pyeloplasty is more difficult. This study aimed to evaluate the efficacy of balloon dilatation for failed pyeloplasty in children. MATERIALS AND METHODS: Between 2011 and 2017, 15 patients, aged 6 months to 14 years, were treated with balloon dilation for restenosis of UPJO after a failed pyeloplasty. Ultrasound and intravenous urography were used to evaluate the primary outcome. Success was defined as the relief of symptoms and improvement of hydronephrosis, which was identified by ultrasound at the last follow-up. RESULTS: All patients successfully completed the operation, 13 patients by retrograde approach and 2 patients by antegrade approach. Thirteen patients were followed for a median of 15 (4 to 57) months and 2 patients were lost to follow-up. Resolution of the hydronephrosis was observed in 5 cases. The anteroposterior diameter (APD) of the pelvis decreased by an average of 12.4 ± 14.4mm. Eight patients needed another surgery. The average postoperative hospital stay was 1.78 ± 1.4 days. Two patients experienced fever after balloon dilation. No other complications were found. CONCLUSIONS: Balloon dilatation surgery is safe for children, but it is not recommended for failed pyeloplasty in that group of patients, owing to the low success rate.


Assuntos
Pelve Renal/cirurgia , Obstrução Ureteral/cirurgia , Cateterismo Urinário/métodos , Procedimentos Cirúrgicos Urológicos/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Hidronefrose/cirurgia , Lactente , Pelve Renal/diagnóstico por imagem , Masculino , Reprodutibilidade dos Testes , Resultado do Tratamento , Ultrassonografia/métodos , Obstrução Ureteral/diagnóstico por imagem , Cateterismo Urinário/instrumentação , Urografia/métodos , Procedimentos Cirúrgicos Urológicos/instrumentação
12.
Int Braz J Urol ; 45(1): 179-182, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30648825

RESUMO

INTRODUCTION: Double-J stent insertion during laparoscopic pyeloplasty is a difficult and time-consuming process and several techniques were defined to perform a double-J stent with an antegrade approach. In this study we present the technique (PICA) of antegrade double-J placement during laparoscopic pyeloplasty by using 14 gauge intravenous cannula. Surgical technique: After we complete the suturing of the posterior wall of the anastomosis during laparoscopic pyeloplasty, we first puncture the abdominal wall with a 14-gauge "intravenous cannula" from a location that provides most suitable angle for inserting the double-J stent into the ureter. We remove the metal needle of the cannula, and the sheath which has an inner diameter of 5.2F remains over the abdominal wall. The double J stent is then advanced from inside the cannula sheath to the intraperitoneal area; under laparoscopic imaging the stent is gently grasped at its distal end using an atraumatic laparoscopic forceps to insert it into the ureter. The stent is then pulled down to its proximal end, and after the guidewire is removed, the proximal end of the double-J stent is placed inside the renal pelvis with an atraumatic forceps. With this technique we can apply the double-J stent in just one step. Additionaly we can use a 14-gauge IV cannula sheath as a trocar when needed during laparoscopic pyeloplasty to retract an organ or reveal an anastomosis line. COMMENTS: Our new technique of antegrade double-J placement during laparoscopic pyeloplasty by 14 gauge intravenous cannula sheath, is very easy and quick to perform.


Assuntos
Cânula , Laparoscopia/métodos , Stents , Procedimentos Cirúrgicos Urológicos/métodos , Humanos , Procedimentos Cirúrgicos Urológicos/instrumentação
13.
Vet Surg ; 48(1): 29-34, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30376185

RESUMO

OBJECTIVE: To evaluate the long-term efficacy of the transobturator vaginal tape inside out (TVT-O) in female dogs with urethral sphincter mechanism incompetence (USMI). STUDY DESIGN: Retrospective study. ANIMALS: Incontinent spayed female dogs (n = 12). METHODS: TVT-O tape was inserted in 12 incontinent bitches diagnosed with USMI. Follow-up information was evaluated by a telephone questionnaire, and a continence score was attributed. RESULTS: One year after surgery, 7 of 12 (58%) dogs were completely continent. Two dogs were removed from the long-term analysis (1 dead and 1 lost). At a median follow-up time of 85 months (range, 28-95), 4 of 10 dogs were completely continent without medical treatment. Incontinence recurred in 6 dogs at a median time of 2 months after surgery (range 1-20). Among these 6 dogs, 4 regained continence, and 2 had sporadic episodes of incontinence with additional medical treatment. No postoperative complications were encountered. CONCLUSION: TVT-O alone was successful in maintaining long-term continence in 40% of the dogs. Additional postoperative medical treatment was effective in restoring continence in another 40% of the dogs. CLINICAL SIGNIFICANCE: TVT-O provides an alternative treatment of USMI in female dogs that is safe and less invasive than standard surgical techniques.


Assuntos
Doenças do Cão/cirurgia , Complicações Pós-Operatórias/veterinária , Slings Suburetrais/veterinária , Doenças Uretrais/veterinária , Incontinência Urinária/veterinária , Procedimentos Cirúrgicos Urológicos/veterinária , Animais , Doenças do Cão/fisiopatologia , Cães , Feminino , Slings Suburetrais/estatística & dados numéricos , Resultado do Tratamento , Uretra/fisiopatologia , Uretra/cirurgia , Doenças Uretrais/cirurgia , Incontinência Urinária/cirurgia , Urodinâmica , Procedimentos Cirúrgicos Urológicos/instrumentação , Procedimentos Cirúrgicos Urológicos/métodos
14.
Urol Int ; 102(2): 194-198, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30368512

RESUMO

OBJECTIVE: We validated the Chinese version of the Ureteral Stent Symptoms Questionnaire (USSQ) in patients with an indwelling ureteric stent. PATIENTS AND METHODS: The English version of the USSQ was translated into Chinese using a multi-step process by 3 urologists and 2 independent translators. The Chinese version was validated by asking 50 patients with temporary unilateral ureteral stent to complete the questionnaire at weeks 1 and 4 after stent placement. Thirty healthy individuals without a ureteral stent were also asked to complete the Chinese USSQ once. The psychometric properties of the questionnaire were analyzed. RESULTS: After revision of the initial 2 drafts after translation, back translation, and pilot testing, a final draft was developed that underwent field testing. Psychometric analyses revealed satisfactory internal consistencies and test-retest reliability for all domains except for sexual matters. Most USSQ domains showed moderate correlations with each other. It demonstrated satisfactory discriminant validity (sensitivity to change, p < 0.05) and test-retest reliability. Analysis of the domains of the sexual matters was limited because of the small proportion of the study population for whom it was applicable. CONCLUSION: The Chinese version of the USSQ is a reliable and valid instrument to evaluate symptoms and health-related quality of life in Chinese patients with ureteric stents.


Assuntos
Complicações Pós-Operatórias/diagnóstico , Qualidade de Vida , Stents , Inquéritos e Questionários , Tradução , Ureter/cirurgia , Procedimentos Cirúrgicos Urológicos/instrumentação , Adulto , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Valor Preditivo dos Testes , Psicometria , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos/efeitos adversos
15.
Eur Urol ; 75(4): 684-691, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30522914

RESUMO

We report the first clinical investigation for surgical procedures performed using the da Vinci SP robotic surgical platform (Intuitive Surgical, Sunnyvale, CA, USA) during the first 10 days (September 28-October 12, 2018) after the system was installed at our institution. The aim of the study was to determine the feasibility and safety of major urologic procedures, measured as the rate of conversions and the incidence of perioperative complications. Secondary aims of the study consisted of key perioperative surgical outcomes, including operative time, blood loss, and length of stay. Pathology data were reported. Data collection was performed under institutional review board approval (IRB 13-780). A total of nine patients were treated (3 robot-assisted radical prostatectomies, 3 transperitoneal robot-assisted partial nephrectomies, 1 simple cystectomy with intracorporeal ileal conduit urinary diversion, 2 ureteral reimplantations). No intraoperative complications occurred. In six cases the surgeries were performed according to a pure single-site approach. The mean operative time was slightly longer than that reported for the corresponding multiarm robotic procedures in the literature, which can easily be explained by the expected learning curve. One minor and one major complication occurred. A learning curve exists when embarking with this surgery. Further investigations are awaited.


Assuntos
Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Urológicos/instrumentação , Idoso , Competência Clínica , Estudos de Viabilidade , Feminino , Humanos , Incidência , Curva de Aprendizado , Masculino , Pessoa de Meia-Idade , Ohio/epidemiologia , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Cirurgiões , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos/efeitos adversos
16.
Int Urol Nephrol ; 51(2): 207-213, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30536191

RESUMO

PURPOSE: The purpose of the study was to evaluate the efficacy and safety of a patented perfusion and suctioning platform and ureteral access sheath in the treatment of large ureteral stones (≥ 1.5 cm) below L4 level. METHODS: We recruited 122 patients with large ureteral stones below L4 level at our hospital from December 2014 to June 2017. The patients were randomly divided into the study and control groups. Multiple operative and perioperative parameters were compared between the two groups. RESULTS: The study group had shorter operation time, less cases of postoperative fever, lower serum levels of PCT, IL-6 and BET within 24 h after surgery, as well as less number of cases receiving secondary surgery than the control group. Moreover, the former had a significantly higher stone clearance rate than the latter (P < 0.05; t-test or χ2 test). CONCLUSIONS: The patented perfusion and suctioning platform and ureteral access sheath are safe and effective in treating large ureteral stones (≥ 1.5 cm) below L4 level.


Assuntos
Febre , Perfusão , Complicações Pós-Operatórias/diagnóstico , Sucção , Ureter , Ureteroscopia , Infecções Urinárias , Procedimentos Cirúrgicos Urológicos , Adulto , Feminino , Febre/diagnóstico , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Perfusão/efeitos adversos , Perfusão/instrumentação , Perfusão/métodos , Sucção/efeitos adversos , Sucção/instrumentação , Sucção/métodos , Resultado do Tratamento , Ureter/diagnóstico por imagem , Ureter/cirurgia , Cálculos Ureterais/diagnóstico , Cálculos Ureterais/fisiopatologia , Cálculos Ureterais/cirurgia , Ureteroscopia/efeitos adversos , Ureteroscopia/métodos , Infecções Urinárias/diagnóstico , Infecções Urinárias/etiologia , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Procedimentos Cirúrgicos Urológicos/instrumentação , Procedimentos Cirúrgicos Urológicos/métodos
17.
Int Urogynecol J ; 30(1): 163-165, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30220023

RESUMO

INTRODUCTION AND HYPOTHESIS: We present a video demonstrating technical considerations and tips for cystoscopic placement of external, lighted, and internal ureteral stents. METHODS: Cystoscopic ureteral stent placement is useful in cases where difficult pelvic periureter dissection is expected or encountered. In this video, we review cystoscopy basics, our approach to various types of retrograde stent placement, and performing retrograde pyelograms. Traditional external ureteral stent and lighted stent placement for prophylactic purposes are discussed, with attention to understanding stent markings, appropriate resistance, and steps for externalization. Internal, double-J ureteral stent placement with the use of fluoroscopy is initiated with placement of a guidewire. An open-ended ureteral catheter is advanced over the wire in the pelvic portion of the ureter, and a retrograde pyelogram is performed. The wire is reintroduced and the stent advanced to the renal pelvis under fluoroscopy. The proximal curl is confirmed to be in the appropriate position with fluoroscopy. The string attached to the stent is then cut and removed, the guidewire is removed, and the stent is deployed with the distal curl in the bladder. CONCLUSIONS: This video reviews key steps for cystoscopic ureteral stent placement in a prophylactic setting, cases of challenging anatomy, or ureteral injury.


Assuntos
Cistoscopia/métodos , Procedimentos Cirúrgicos em Ginecologia/métodos , Stents , Ureter , Procedimentos Cirúrgicos Urológicos/métodos , Feminino , Humanos , Procedimentos Cirúrgicos Urológicos/instrumentação
18.
Int Urol Nephrol ; 51(2): 247-252, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30478813

RESUMO

INTRODUCTION: Currently, polypropylene materials are used widely for the treatment of various urogynecologic disorders. This type of treatment can be complicated, although rarely, with erosions of the polypropylene implants into the bladder or the urethra. There is no established treatment for such complications. We present our experience in transvesical laparoendoscopic single-site surgery (T-LESS) removal of eroded materials, and a review of the literature in this field. MATERIALS AND METHODS: From June 2015 to May 2017 eight females, with an average age of 66.5 years (range 55-80 years), were referred to our Center because of the erosion of polypropylene material in the bladder, after anti-incontinence or pelvic organ prolapse treatment. Patients were diagnosed with ultrasound and cystoscopy. Seven bladder erosions and one bladder and urethral penetration were found. Patients were qualified for removal with the T-LESS approach. The Tri-Port + disposable set and standard laparoscopic instruments were used. The eroded materials were dissected and cut away, and the defects of the bladder wall were closed with barbed sutures. The peri-operative efficacy and safety of the method were assessed, and the patients were scheduled for follow-up visits at 6 weeks and every 3 months thereafter. The patients were offered a cystoscopic exam during the 7-10 month period after the operation. RESULTS: The procedures were completed successfully in all patients. No blood loss or complications were observed. The mean operative time was 54.5 min, and the average hospital stay was 30 h. During a follow-up at 11 months, all patients were cured, except for one who presented urethral erosion. CONCLUSIONS: The T-LESS technique for removal of eroded meshes is a safe and effective method. The precise access to the bladder minimizes morbidity, and suturing the bladder wall defects may reduce the risk of recurrence.


Assuntos
Cistoscopia/métodos , Remoção de Dispositivo/métodos , Laparoscopia/métodos , Complicações Pós-Operatórias/cirurgia , Slings Suburetrais/efeitos adversos , Procedimentos Cirúrgicos Urológicos , Idoso , Falha de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Prolapso de Órgão Pélvico/cirurgia , Polipropilenos/farmacologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Uretra/patologia , Uretra/cirurgia , Bexiga Urinária/patologia , Bexiga Urinária/cirurgia , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Procedimentos Cirúrgicos Urológicos/instrumentação , Procedimentos Cirúrgicos Urológicos/métodos
19.
J Am Vet Med Assoc ; 253(10): 1309-1327, 2018 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-30398425

RESUMO

OBJECTIVE To determine outcomes of subcutaneous ureteral bypass (SUB) device placement for treatment of benign ureteral obstruction in cats. DESIGN Retrospective case series. ANIMALS 134 cats with SUB devices placed in 174 obstructed ureters during 144 hospitalizations. PROCEDURES Medical records of cats that underwent SUB device placement for treatment of benign ureteral obstruction between 2009 and 2015 were reviewed. The SUB device was placed by use of fluoroscopic and surgical methods. Signalment, history, diagnostic imaging results, postprocedural results, duration of hospitalization, complications, and short- and long-term outcomes were recorded. RESULTS Ureteral obstructions were caused by ureterolithiasis (114/174 [65.5%]), stricture (28/174 [16.1%]), both ureterolithiasis and stricture (29/174 [16.7%]), or pyonephrosis (1/174 [0.6%]); in 2 (1.1%) cats, the cause was not recorded. Fifty-two of the 134 (39%) cats had bilateral ureteral obstruction. At admission, 127 (95%) cats were azotemic. Median serum creatinine concentrations at admission and 3 months after SUB device placement were 6.6 and 2.6 mg/dL, respectively. Median renal pelvis diameters before and after the procedure were 9.2 and 1.5 mm, respectively. Postsurgical complications included device occlusion with blood clots (14/172 [8.1%]), device leakage (6/172 [3.5%]), and kinking of the device tubing (8/174 [4.6%]). Cats survived to hospital discharge after 135 of the 144 (94%) hospital admissions. The most common long-term complication was catheter mineralization (40/165 [24.2%]), which was documented a median of 463 days after device placement. A high postoperative serum ionized calcium concentration was significantly associated with SUB device occlusion. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that SUB device placement may be a viable option for treatment of cats with benign ureteral obstruction.


Assuntos
Doenças do Gato/cirurgia , Equipamentos e Provisões/veterinária , Obstrução Ureteral/veterinária , Animais , Gatos , Feminino , Masculino , Estudos Retrospectivos , Stents/veterinária , Obstrução Ureteral/cirurgia , Ureterolitíase/veterinária , Procedimentos Cirúrgicos Urológicos/instrumentação , Procedimentos Cirúrgicos Urológicos/métodos , Procedimentos Cirúrgicos Urológicos/veterinária
20.
Urology ; 122: 70-75, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30170088

RESUMO

OBJECTIVE: To explore patient migration patterns in patients requiring repeat surgery after Pelvic Organ Prolapse (POP) repair as there is a limited understanding of care seeking patterns for repeat surgery after POP repair. We hypothesized that undergoing repeat surgery for a prolapse mesh complication would be associated with an increased incidence of migration to a new facility for care compared to those undergoing repeat surgery for recurrent POP. METHODS: In this retrospective population based study, all females who underwent an index POP repair procedure (with or without mesh) at nonfederal facilities who subsequently underwent a repeat surgery (recurrent prolapse repair or mesh complication) were identified from the Office of Statewide Health Planning and Development for the state of California (2005-2011). The location of index repair and repeat surgery were identified and factors associated with migration were explored. RESULTS: Of the 3,930 women who underwent repeat surgery for either POP recurrence or a mesh complication, 1,331 (33.9%) had surgery at a new facility. Multivariate analysis revealed that mesh complications (odds ratio [OR] 1.28, P = 0.004) or native tissue same compartment recurrence (OR 1.19, P = 0.02) were both associated with increased odds of undergoing surgery at a new facility. Having surgery in a county with multiple centers increased the odds of migration to a new facility for care (OR = 1.33, P < 0.001), unless the initial repair was at a high volume institution (OR = 0.32, P < 0.001). Overall across indications, women changing locations for their second surgery tended to migrate toward select centers in urban areas. CONCLUSION: Women who undergo repeat surgery after POP repair have similar patterns of migration to a new facility irrespective of the indication for surgery.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Prolapso de Órgão Pélvico/cirurgia , Reoperação/estatística & dados numéricos , Telas Cirúrgicas/efeitos adversos , Procedimentos Cirúrgicos Urológicos/efeitos adversos , California , Feminino , Humanos , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/epidemiologia , Prevalência , Recidiva , Estudos Retrospectivos , Slings Suburetrais/efeitos adversos , Falha de Tratamento , Procedimentos Cirúrgicos Urológicos/instrumentação , Procedimentos Cirúrgicos Urológicos/métodos
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