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1.
Surg Clin North Am ; 100(2): 361-378, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32169184

RESUMO

Urologists have always been leaders in advancing surgical technology and were the first to utilize modern robotic surgery for robotic-assisted laparoscopic radical proctectomy. Surgeon ergonomics, instrument precision, operative time, and postoperative recovery were all objectively improved. In urology, robotic surgery is now used for all intra-abdominal, retroperitoneal, and pelvic procedures and has been expanded to renal transplants and pediatric use. Modern robotic surgery has become an essential part of treating complex urologic disease in the developed world. Urologists continue to lead the way with the latest robotic surgical systems, including the newly approved single port systems.


Assuntos
Procedimentos Cirúrgicos Robóticos/métodos , Doenças Urológicas/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Cistectomia/métodos , Humanos , Laparoscopia/métodos , Nefrectomia/métodos , Prostatectomia/métodos
2.
Urology ; 137: 183-189, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31926195

RESUMO

OBJECTIVE: To characterize the bulbospongiosus muscle (BSM) in patients with bulbar urethral strictures. MATERIALS AND METHODS: We studied 21 patients divided into 2 groups: Stricture Group (n = 14; mean age = 62.00 years) with bulbar stricture submitted to open urethroplasty; and Control Group (n = 7; mean age = 60.14 years) with penile strictures (hypospadias cripples, penile cancer and/or penile infection) who were submitted to perineal urethrostomy. Samples of the BSM were dissected and histologic sections were stained by histochemical and immunohistochemical techniques. Histomorphometric analyzes were performed on photomicrographs. Means were statistically compared using the unpaired Student t test and the Mann-Whitney test (P <.05). RESULTS: The etiology of bulbar urethral stricture was idiopathic in 2 cases (14.29%), post-TURP in 6 (42.86%), post open radical prostatectomy in 5 (35.71%) and post open prostatectomy in 1 case (7.14%). The average length of the stricture was 2.08 cm. The only parameter analyzed with significant difference between the groups was the vessels (significant difference between the control group: 5.11 ± 1.98% and stricture group: 3.57 ± 1.32%, P = .0460). The quantitative analysis of collagen (Control Group: 10.63 ± 5.37% and Stricture Group: 10.83 ± 4.55%, P = .9296); diameter of BSM muscle fibers (Control Group: 41.71 ± 14.63 µm and Stricture Group: 40.11 ± 8.59 µm, P = .76 and elastic system fibers (Control Group; 3.83 ± 1.54% and Stricture Group: 5.43 ± 2.90%, P = .2601) showed no significant difference. CONCLUSIONS: Histologic analysis showed a significant decrease of the BSM vessels in urethral stricture, without changes in elastic fibers, collagen, nerves, and muscle fiber diameter. These findings show that the bulbar urethral stricture causes minimal alterations in the structure of the BSM.


Assuntos
Doenças do Pênis , Pênis , Complicações Pós-Operatórias , Uretra , Estreitamento Uretral , Procedimentos Cirúrgicos Urológicos , Pesos e Medidas Corporais/métodos , Brasil , Constrição Patológica , Correlação de Dados , Técnicas de Imagem por Elasticidade/métodos , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Doenças do Pênis/diagnóstico , Doenças do Pênis/etiologia , Pênis/patologia , Pênis/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/patologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Uretra/irrigação sanguínea , Uretra/inervação , Uretra/patologia , Uretra/cirurgia , Estreitamento Uretral/diagnóstico , Estreitamento Uretral/epidemiologia , Estreitamento Uretral/etiologia , Estreitamento Uretral/patologia , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Procedimentos Cirúrgicos Urológicos/métodos
3.
Urology ; 136: 88-94, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31794815

RESUMO

OBJECTIVE: To determine whether the presence of detrusor overactivity (DO) is associated with the 12-week and 12-month clinical outcomes of selective bladder denervation (SBD) in women with refractory overactive bladder (OAB). METHODS: Prospective single institutional study of refractory OAB females who underwent a urodynamic study and were categorized according to DO status (DO- vs DO+) prior to receiving SBD. RESULTS: Among the 23 patients, 10 were DO- and 13 were DO+. Both groups reported improvement at 12 weeks on the 24-hour pad weight test, in urgency urinary incontinence (UUI) and urgency. At 12 months, both groups still reported improvement in urgency, but only the DO- group reported reduction on the pad weight test and only the DO+ group maintained improvement in the UUI rate. Clinical success (≥50% reduction in UUI) was achieved by all DO- and by 69% of DO+ patients at 12 weeks, and by 60% of DO- and 92% of DO+ patients at 12 months. Treatment benefit (Treatment Benefit Scale ≤2) was reported in 90% of DO- and 85% of DO+ patients at 12 weeks, and in 60% of DO- and 85% of DO+ patients at 12 months. When directly comparing both group outcomes, the only significant difference was the greater reduction of UUI in the DO- group at 12 weeks (-9.0 vs -6.5; P = .045). CONCLUSION: Refractory OAB females appear to be effectively treated by SBD regardless of baseline DO status. DO status does not seem to be associated with the 12-week and 12-month outcomes of SBD.


Assuntos
Denervação/métodos , Bexiga Urinária Hiperativa/complicações , Bexiga Urinária/inervação , Bexiga Urinária/fisiopatologia , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos/métodos
4.
Urology ; 137: 146-151, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31887351

RESUMO

OBJECTIVE: To explore a series of classic bladder exstrophy (CBE) cases referred to the authors' institution where primary closure with penile disassembly epispadias repair was complicated by penile injury. The penile disassembly technique is frequently combined with bladder closure in patients with CBE undergoing the complete primary repair of exstrophy (CPRE). Penile disassembly has been posited as a risk for penile injury by ischemic mechanisms. METHODS: A prospectively-maintained institutional database of 1337 exstrophy-epispadias complex patients was reviewed for CPRE cases referred to the authors' institution, and those with injury to the penis were identified. The location, extent of injury, and subsequent management is reported. RESULTS: One hundred and thirteen male CBE patients were referred after prior CPRE. Twenty-six (20%) were identified with penile loss and reviewed. Eighty-one percent were closed in the neonatal period, and 54% had a pelvic osteotomy. Median follow-up time was 9.9 years (range 0.6-21.3). Of 26 patients with penile loss, 77% had unilateral loss and in 23% had bilateral loss involving the glans and/or one or both corpora cavernosa. Three patients were successfully managed with myocutaneous neophalloplasty. CONCLUSION: Complete penile disassembly during bladder exstrophy closure may lead to penile injury. This major complication questions the continued application of complete penile disassembly in the reconstruction of bladder exstrophy.


Assuntos
Extrofia Vesical/cirurgia , Epispadia/cirurgia , Complicações Intraoperatórias , Doenças do Pênis , Pênis , Procedimentos Cirúrgicos Urológicos , Atrofia , Criança , Humanos , Recém-Nascido , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/cirurgia , Masculino , Doenças do Pênis/diagnóstico , Doenças do Pênis/etiologia , Doenças do Pênis/cirurgia , Pênis/irrigação sanguínea , Pênis/lesões , Pênis/patologia , Pênis/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reoperação/métodos , Fatores de Risco , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Procedimentos Cirúrgicos Urológicos/métodos , Adulto Jovem
5.
J Urol ; 203(1): 200-205, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31437120

RESUMO

PURPOSE: We investigated surgical approaches to urinary incontinence and long-term continence outcomes after successful bladder reconstruction in a heterogeneous patient population with classic bladder exstrophy. We hypothesized that while most patients will achieve urinary continence after surgery, only a select group will void volitionally per urethra. MATERIALS AND METHODS: An institutional database of 1,323 patients with exstrophy-epispadias complex was reviewed for patients with classic bladder exstrophy who underwent successful bladder closure and a subsequent continence procedure between 1975 and 2017. Procedures included bladder neck reconstruction, bladder neck reconstruction with augmentation cystoplasty or continent catheterizable stoma, and bladder neck closure with continent catheterizable stoma. Cloacal exstrophy, epispadias and variant exstrophy cases were excluded from analysis. Continence at last followup was defined as a dry interval of 3 or more hours without nighttime leakage. Those patients with more than 3 months of followup were assessed. RESULTS: Overall 432 patients underwent successful bladder closure (primary 71.5%, repeat 28.5%) and a urinary continence procedure. At last followup 162 (37%) underwent bladder neck reconstruction, 76 (18%) underwent bladder neck reconstruction with augmentation cystoplasty or continent catheterizable stoma, 173 (40%) underwent bladder neck closure with continent catheterizable stoma and 18 underwent other procedures. Median followup from the first continence procedure was 7.2 years (IQR 2.3-13.7). Continence was assessed in 350 patients. After isolated bladder neck reconstruction 91 of 142 patients were continent (64%, 95% CI 56-72). After bladder neck closure with continent catheterizable stoma 124 of 133 patients evaluated were continent (93%, 95% CI 87-97). CONCLUSIONS: Most patients with classic bladder exstrophy require multiple reconstructive procedures to achieve continence. Only about 25% of patients are expected to void normally per urethra without reliance on catheterization or urinary diversion.


Assuntos
Extrofia Vesical/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Incontinência Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino
6.
Actas urol. esp ; 43(10): 521-525, dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185257

RESUMO

Objetivos: El objetivo de este estudio fue evaluar el rol de la aplicación de fluoroscopia en pacientes intervenidos mediante cirugía retrógrada intrarrenal y su efecto sobre los resultados quirúrgicos. Material y métodos: Los pacientes que ingresaron en nuestro centro con diagnóstico de cálculos renales se dividieron en 2 grupos. En el grupo 1 se utilizó fluoroscopia de rutina en todos los casos (n: 58). En el grupo 2 se ejecutó el mismo procedimiento sin fluoroscopia (n: 67). Posteriormente se compararon los resultados de los 2 grupos. Resultados: No hubo diferencias estadísticamente significativas entre los 2 grupos en términos de tiempo quirúrgico, tasa libre de cálculos, complicaciones, necesidad de analgésicos, requerimiento de nuevo tratamiento y escala visual analógica. Conclusión: El uso de fluoroscopia no altera la frecuencia de complicaciones ni la tasa libre de cálculos. Creemos que el uso de fluoroscopia no es indispensable en los casos en los que se consigue acceso a la pelvis renal (especialmente en procedimientos de ureteroscopia semirrígida) y que su uso debe ser limitado para evitar un aumento innecesario de exposición a la radiación


Objectives: The aim of this study was to evaluate the role of the use of fluoroscopy in patients undergoing retrograde intrarenal surgery and the effect on surgical outcomes. Material and methods: The patients who were admitted to our center with the diagnosis of kidney stones were divided into 2 groups. In group 1, routine fluoroscopy was used in all cases (n: 58). In group 2, the same procedure was performed without fluoroscopy (n: 67) and the results of the 2 groups were compared. Results: There were no statistically significant differences between the 2 groups in terms of operation time, stone-free rate, complication rate, need for analgesic and re-treatment requirement and Visual Analogic Scale score. Conclusion: The use of fluoroscopy does not alter the complication frequency and stone-free rate. We think that the use of fluoroscopy is not mandatory in cases in which renal pelvis access is achieved especially with semirigid ureteroscopy and that unnecessary fluoroscopy increases radiation exposure


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Fluoroscopia , Cálculos Renais/cirurgia , Avaliação de Resultado de Intervenções Terapêuticas , Nefrostomia Percutânea/métodos , Escala Visual Analógica , Ureteroscopia , Complicações Intraoperatórias , Procedimentos Cirúrgicos Urológicos/métodos
7.
Actas urol. esp ; 43(10): 526-535, dic. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-185258

RESUMO

Contexto y objetivo: La incontinencia urinaria es el efecto secundario con mayor impacto en la calidad de vida después de la prostatectomía radical. El objetivo de nuestro artículo es revisar la evidencia científica actual sobre las variaciones quirúrgicas descritas para preservar la continencia urinaria después de la prostatectomía radical. Adquisición de la evidencia: Se realizó una revisión sistemática de la literatura en PubMed, Cochrane y ScienceDirect según los criterios PRISMA (Preferred reporting items for systematic reviews and meta-analyses), utilizando los términos: urinary continence, urinary incontinence, urinary leakage, radical prostatectomy, open radical prostatectomy, laparoscopic prostatectomy, robot assisted laparoscopic prostatectomy, robotic prostatectomy y los criterios de selección PICO. Se identificaron 1.603 referencias de las que se seleccionaron 27 publicaciones que cumplieron los criterios de inclusión, 6 fueron ensayos clínicos aleatorizados y 4 metaanálisis. Síntesis de la evidencia: Las técnicas más empleadas para alcanzar una continencia urinaria precoz son la preservación del cuello vesical, de las bandeletas neurovasculares y la reconstrucción del rabdoesfínter, siendo esta la técnica con mayor evidencia, ya que existen 3 ensayos clínicos aleatorizados. Pese que algunas variaciones técnicas han conseguido mejorías en los resultados funcionales, la ausencia de consenso en la definición de incontinencia urinaria y la manera de evaluarla no permiten elaborar recomendaciones técnicas basadas en evidencia científica de calidad. Conclusiones: La reconstrucción del rabdoesfínter es la única técnica que ha demostrado mejoría en la recuperación precoz de la continencia urinaria tras la prostatectomía radical. La evidencia científica actual es heterogénea y limitada, por lo que son necesarios estudios aleatorizados bien diseñados para evaluar las modificaciones técnicas


Background and objective: Urinary incontinence is the adverse effect with more impact on patients’ quality of life after undergoing radical prostatectomy. The objective of this study is to review the present evidence that describes the variations on surgical techniques which aim to preserve urinary continence after radical prostatectomy. Evidence acquisition: We searched the literature on PubMed, Cochrane, and ScienceDirect according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement, using the PICO review protocol. The search terms were urinary continence, urinary incontinence, urinary leakage, radical prostatectomy, open radical prostatectomy, laparoscopic prostatectomy, robot-assisted laparoscopic prostatectomy, robotic prostatectomy. We identified 1,603 registers, and 27 articles were reviewed for meeting the inclusion criteria. Six of them are randomized clinical trials and 4 of them, meta-analysis. Evidence synthesis: The surgical techniques more frequently used to achieve early urinary continence are bladder neck and neurovascular bundles preservation, as well as the reconstruction of the rhabdosphincter. The latter has been presented in three randomized clinical trials. Even though some approaches have obtained improved functional outcomes, the lack of consensus on the definition of urinary incontinence and its measurement methods have not advocated for the creation of technical recommendations based on scientific evidence. Conclusions: The reconstruction of the rhabdosphincter is the only technique that has shown improved functional results through randomized trials. The current evidence is limited and heterogenous, and more studies with consistent criteria are needed in order to establish a standard surgical technique


Assuntos
Humanos , Masculino , Prostatectomia/métodos , Prostatectomia/reabilitação , Incontinência Urinária/reabilitação , Qualidade de Vida , Medicina Baseada em Evidências , Incontinência Urinária/complicações , Robótica , Uretra/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos
8.
Actas urol. esp ; 43(10): 543-550, dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185260

RESUMO

Objetivos: Comparar los resultados oncológicos de dos técnicas quirúrgicas abiertas y dos endoscópicas para el manejo del uréter distal durante nefroureterectomía laparoscópica (NUL). Material y métodos: Revisión retrospectiva de 152 pacientes sometidos a NUL por tumor del tramo urinario superior entre 2007 y 2014. Se analizó el potencial impacto de distintas técnicas de desinserción abierta (extravesical vs. intravesical) y endoscópica (resección meato con evacuación de fragmentos vs. rodete perimeático) sobre el desarrollo de recidiva vesical, extraurotelial y supervivencia cáncer-específica (SCE). Resultados: Un total de 152 pacientes con edad media de 69,9 años (±10,1) fueron sometidos a NUL. Se reportaron 62 pTa-T1 (41%), 35 pT2 (23%) y 55 pT3-4 (36%). Treinta y dos fueron bajo grado (21,1%) y 120 alto grado (78,9%). Se realizó desinserción endoscópica en 89 casos (58,5%), 32 con resección (36%) y 57 con rodete (64%), y abierta en 63 (41,5%), 42 intravesical (66,7%) y 21 extravesical (33,3%). Con mediana de seguimiento de 32 meses (3-120), 38 pacientes (25%) desarrollaron recidiva vesical, 42 extraurotelial (27,6%) y 34 murieron por tumor (22,4%). En el análisis univariante, el tipo de técnica endoscópica no se relacionó con recidiva vesical (p = 0,961), extraurotelial (p = 0,955) ni SCE (p = 0,802). El abordaje abierto extravesical no se relacionó con recidiva vesical (p = 0,12) pero sí con aumento de recidiva extraurotelial (p = 0,045) y menor SCE (p = 0,034) respecto al intravesical. Conclusiones: El subtipo de desinserción endoscópica no influye en los resultados de la NUL. La desinserción abierta extravesical es una técnica más compleja que la intravesical y podría empeorar los resultados oncológicos


Objectives: To compare the oncological outcomes between two open surgical techniques and two endoscopic approaches for the management of the distal ureter during laparoscopic radical nephroureterectomy (LRNU). Material and methods: Retrospective review of 152 patients submitted to LRNU for the management of upper urinary tract tumors between 2007-2014. We analyzed the potential impact of two different open surgical (extravesical vs intravesical) and two endoscopic (resection of ureteral orifice and fragment removal vs endoscopic bladder cuff) techniques on the development of bladder recurrence, distant/local recurrence and cancer-specific survival (CSS). Results: A total of 152 patients with a mean age of 69.9 years (±10.1) underwent LRNU. We reported 62 pTa-T1 (41%), 35 pT2 (23%) and 55 pT3-4 (36%). Thirty-two were low grade (21.1%) and 120 high grade (78.9%). An endoscopic approach was performed in 89 cases (58.5%), 32 with resection (36%) and 57 with bladder cuff (64%), and open approach in 63 (41.5%), 42 intravesical (66.7%) and 21 extravesical (33.3%). Within a median follow-up of 32 months (3-120), 38 patients (25%) developed bladder recurrence, 42 distant/local recurrence (27.6%) and 34 died of tumor (22.4%). In the univariate analysis, the type of endoscopic technique was not related to bladder recurrence (P = .961), distant/local recurrence (P = .955) nor CSS (P = .802). The open extravesical approach was not related to bladder recurrence (P = .12) but increased distant/local recurrence (P = .045) and decreased CSS (P = .034) compared to intravesical approach. Conclusions: LRNU outcomes are not dependant on the type of endoscopic approach performed. The open extravesical approach is a more difficult technique and could worsen the oncological outcomes when compared to the intravesical


Assuntos
Humanos , Masculino , Feminino , Idoso , Procedimentos Cirúrgicos Urológicos/métodos , Nefroureterectomia/métodos , Neoplasias Ureterais/cirurgia , Ureter/cirurgia , Estudos Retrospectivos , Excisão de Linfonodo/métodos , Cistoscopia , Análise Multivariada
9.
Zhonghua Wai Ke Za Zhi ; 57(11): 853-859, 2019 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-31694135

RESUMO

Objective: To establish experimental porcine model of reconstruction the neobladder by ileal seromuscular with transplantation of autologous peritoneum. Methods: This was an animal experiment carried out from January to April 2018 at animal center of Guizhou Medical University. Randomly 6 experimental female porcines were chosen, and their body weight was 28 to 33 kg. By intravenous anesthesia, the transplantation of autologous peritoneum for bladder reconstruction operation was carried out by transplanting the peritoneum onto an ileum segment which mucosa and submucosa had been removed. These flaps were used to mend and reconstruct the neobladder by suturing with edge of the detective bladder. After removal of ureteral catheters and balloon catheter at day 5 and day 7 respectively, voiding behavior was monitored, and animals were euthanized at week 12 for routine pathology, immunohistochemistry, and electron microscopic examinations. Results: Six porcines underwent reconstruction, but no one lost to complications such as peritonitis, ileus and urinary fistula. Voiding behavior was normal, and urine was clear in all animals after removal of catheters. At autopsy, reconstructed bladders were healthy. Pathological examination showed the part of reconstruction had been covered by continuous urothelium while the peritoneum disappeared and showed no ileal mucosa regrowth and residual. Scanning electron microscope showed that the transitional cells of neobladder were complete and orderly, and urothelium around suture border was continuous and no malposition. Conclusion: In this experimental porcine model, reconstruction bladder by autologous peritoneum and ileal seromuscular flaps is an ideal approach.


Assuntos
Íleo/transplante , Peritônio/transplante , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Procedimentos Cirúrgicos Urológicos/métodos , Animais , Cistectomia , Feminino , Modelos Animais , Distribuição Aleatória , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos , Suínos , Transplante Autólogo
10.
Surg Technol Int ; 35: 189-198, 2019 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-31687782

RESUMO

The present review aims to analyze the current information available on the pathophysiology, clinical presentation and treatment of vesico-vaginal fistulas (VVF), with particular focus on the safety and efficacy of minimally invasive surgical (MIS) techniques. Through the use of the PubMed and Google Scholar databases, we conducted a literature review of all available studies related to MIS treatment of VVF, focusing on laparoscopic techniques. After abstracts were read to identify pertinent studies, full manuscripts were reviewed by two authors according to the aim of the review. Vesico-vaginal fistula is defined as an abnormal passage that connects the bladder to the vagina and affects over 3 million women worldwide. It can be classified according to its complexity (simple or complex) and mechanism (obstetric-related or iatrogenic). Laparoscopic treatment of VVF started in 1994 and is currently the gold-standard approach for this pathology. No differences in terms of efficacy or safety have been reported between MIS (laparoscopy, robotic-assisted laparoscopy and laparoscopic single-site) using extra-vesical and trans-vesical approaches, with success rates of 80% to 100%, and low rates of conversion (1.9%), recurrence (less than 1%) and intra- or post-operative complications (3%). Surgical principles for fistula repair, described independently by Angioli and Couvelaire, must always be followed. A bladder fill and integrity test with at least 300 mL should be performed before ending surgery, since this increases the success rate by about 6%. Other interventions such as flap interposition, number of layers in closure and expectant management (spontaneous closure with a Foley catheter alone) remain controversial. To date, no differences have been seen among the laparoscopic surgical techniques. The lack of prospective evaluations has hindered a better understanding of the natural history of the disease and the development of evidence-based recommendations regarding diagnosis, management and follow-up. Since no differences were found compared to a trans-vesical approach, extra-vesical repair is recommended to avoid bladder bi-valving.


Assuntos
Laparoscopia , Procedimentos Cirúrgicos Minimamente Invasivos , Procedimentos Cirúrgicos Urológicos , Fístula Vesicovaginal , Feminino , Humanos , Estudos Prospectivos , Procedimentos Cirúrgicos Urológicos/métodos , Fístula Vesicovaginal/cirurgia
11.
Curr Urol Rep ; 20(12): 81, 2019 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-31782033

RESUMO

PURPOSE OF REVIEW: Postgraduate medical training has evolved considerably from an emphasis on hands-on, autonomous learning to a paradigm where simulation technologies are used to introduce and augment certain skill sets. This review is intended to provide an update on surgical simulators and tools for urological trainee education. RECENT FINDINGS: We provide an overview of simulation platforms for robotics, endoscopy, and laparoscopic practice and training. In general, these simulators provide face, content, and construct validity. Various educational and evaluation tools have been adopted. Simulation platforms have been developed for technical and non-technical surgical skills, educational bootcamps, and tools for evaluation and feedback. While trainees find the opportunity to practice their skills beneficial, there may be difficulty with access due to cost and availability. Additionally, there is a need for more objective metrics demonstrating improvement in skill or patient outcome.


Assuntos
Simulação por Computador , Treinamento por Simulação , Procedimentos Cirúrgicos Urológicos/educação , Urologia/educação , Realidade Aumentada , Cadáver , Competência Clínica , Avaliação Educacional , Endoscopia/educação , Humanos , Imagem Tridimensional , Internato e Residência , Laparoscopia/educação , Aplicativos Móveis , Impressão Tridimensional , Procedimentos Cirúrgicos Robóticos/educação , Smartphone , Cirurgia Assistida por Computador/educação , Visitas com Preceptor , Procedimentos Cirúrgicos Urológicos/métodos
12.
Actas urol. esp ; 43(9): 455-466, nov. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-185246

RESUMO

Introducción: Con el avance de la cirugía laparoscópica y robótica, la profilaxis tromboembólica en los procedimientos urológicos se han basado clásicamente en la experiencia de otras especialidades quirúrgicas. En este trabajo se realiza un análisis de la actualidad de las recomendaciones, basado en un estudio pormenorizado de las guías clínicas europeas y en la bibliografía, aplicando las recomendaciones de tromboprofilaxis a la práctica urológica diaria. Objetivos: Elaborar unas recomendaciones generales aplicables a los pacientes quirúrgicos en urología, evitando la aparición de eventos tromboembólicos en el periodo perioperatorio. Optimizar la medicación y el ajuste en pacientes crónicos y conocer qué pacientes son candidatos a terapias puente. Material y métodos: Se ha realizado una revisión de la literatura disponible y de las guías clínicas europeas. Se analizan los artículos de consenso más recientes realizando una revisión de la bibliografía disponible y los estudios y revisiones en los que se basan las guías europeas de tromboprofilaxis en urología. Resultados: La profilaxis tromboembólica se debe emplear en aquellas cirugías que requieran abordajes abdominales, encamamiento prolongado o enfermedades oncológicas. Las terapias puente con heparinas de bajo peso molecular deben ser reducidas. Los pacientes en tratamiento crónico se pueden beneficiar de terapias puente en casos concretos. Conclusiones: El empleo de heparinas, tan habitual en la práctica clínica, puede ser excesivo según las guías actuales. La aparición de nuevos fármacos anticoagulantes, los cuales poseen antagonistas directos, permiten la reducción de los tiempos de reintroducción de la medicación crónica y un control más eficaz del sangrado


Introduction: With the advanced laparoscopic and robotic surgery, thromboembolic prophylaxis in urologic procedures has traditionally been based on the experience of other surgical specialties. This paper aims to analyze the current recommendations, through a detailed study of the European clinical guidelines and bibliography, applying the recommendations of thromboprophylaxis to the daily urological practice. Objectives: To elaborate general recommendations to surgical patients in Urology, avoiding the risk of perioperative thromboembolic events. Optimize medication in chronic patients and accurately classify who are eligible for bridge therapy. Material and methods: A review of the available literature and the European clinical guidelines was carried out. We analyzed the most recent consensus articles by studying the available bibliography, trials and reviews on which the European guidelines for thromboprophylaxis in urology are based. Results: Thromboembolic prophylaxis should be targeted towards surgeries that require abdominal approaches, prolonged bed rest or oncological pathologies. Bridge therapies with low molecular weight heparins should be limited. Patients undergoing treatment for chronic conditions can benefit from bridge therapies in specific cases


Assuntos
Humanos , Masculino , Feminino , Tromboembolia/prevenção & controle , Tromboembolia/cirurgia , Profilaxia Pré-Exposição , Procedimentos Cirúrgicos Urológicos/métodos , Período Perioperatório , Heparina/administração & dosagem , Indicadores Básicos de Saúde , Inibidores da Agregação de Plaquetas/administração & dosagem , Anticoagulantes/administração & dosagem , Antibioticoprofilaxia
13.
Pan Afr Med J ; 33: 184, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31565144

RESUMO

We here report a case of bladder urothelial carcinoma, a rare tumor in subjects less than 40 years, as well as our therapeutic experience. The study involved a 37-year old patient with a history of urinary tract infection and of staying at a riparian area (bilharzia) presenting with hypogastralgia and total macroscopic hematuria. Clinical and paraclinical assessment showed voluminous bladder mass suggesting infiltrative tumor without local or distant lymph node or organic involvement. Surgical management was based on resection of bladder tumor and biopsy followed by total cystectomy with substitutive ileal enterocystoplasty. The postoperative course was uneventful. The patient also underwent adjuvant chemotherapy and vitamin B-12 therapy. Clinical and paraclinical assessment, performed after 6 and 12 months, showed no recurrence.


Assuntos
Carcinoma de Células de Transição/cirurgia , Cistectomia/métodos , Neoplasias da Bexiga Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Adulto , Carcinoma de Células de Transição/diagnóstico , Carcinoma de Células de Transição/patologia , Quimioterapia Adjuvante/métodos , Seguimentos , Humanos , Íleo/cirurgia , Masculino , Recidiva Local de Neoplasia , Resultado do Tratamento , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/patologia , Vitamina B 12/administração & dosagem
14.
Ann Saudi Med ; 39(5): 302-308, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31580693

RESUMO

BACKGROUND: Laryngeal masks are increasingly used in place of endotracheal intubation or face masks for maintaining the airway during surgery. OBJECTIVES: Compare the insertion time and other features of the Baska and I-gel masks in patients undergoing general anesthesia for urological surgery. DESIGN: Randomized-controlled, single-blind study. SETTINGS: Urology surgical operating rooms of a tertiary care hospital. SUBJECTS AND METHODS: We enrolled concomitant patients whose surgery was expected to last less than two hours. Following premedication and adequate relaxation, subjects were randomly allocated to the I-gel mask or the Baska mask. Computer-generated random numbers were used for randomization with sealed opaque envelopes for allocation concealment. MAIN OUTCOME MEASURES: The primary outcome measure of the study was the time required for laryngeal mask airway (LMA) insertion. Also, the number of device placement attempts, the number of postoperative signs and symptoms (cough, breath holding, laryngeal spasm, lip trauma, blood on the mask), and laryngopharyngeal morbidity scores at 1 and 24 hours postoperatively. SAMPLE SIZE: 211 met inclusion criteria, 200 participants completed the study. RESULTS: Compared to I-gel, the Baska mask required a longer time for insertion, and its airway pressure was higher. The median (minimum-maximum) duration of LMA insertion in the Baska and I-gel groups was 14 (6-25) and 7 (5-12) seconds, respectively (z=-10.934; P<.001). The mean (SD) airway pressures were significantly different between the two groups (15.8 [1.9] and 14.9 [1.7] cm/H2O for Baska and I-gel, respectively; t=3.668; P<.001). Seal pressure was not significantly different between the groups (0.08 [0.2] vs. 0.07 [0.2] cm/H2O in the Baska and I-gel groups, respectively, (t=1.35; P=.194). CONCLUSIONS: The Baska and I-gel masks are similar in most respects. Both have reasonably acceptable insertion times and can be used for selected surgical procedures. LIMITATIONS: The requirement for more vigorous training is a limitation of the Baska mask. Results could differ with patients younger than 18 years of age or obese patients. CONFLICT OF INTEREST: None. CLINICAL TRIAL REGISTRY: Not registered.


Assuntos
Manuseio das Vias Aéreas/métodos , Anestesia Geral/métodos , Intubação Intratraqueal/métodos , Máscaras Laríngeas , Adulto , Manuseio das Vias Aéreas/instrumentação , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Fatores de Tempo , Procedimentos Cirúrgicos Urológicos/métodos
15.
Arch Ital Urol Androl ; 91(3)2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31577109

RESUMO

Ureteral realignment using a ureteral stent can be an alternative treatment in cases of complete ureteral transection and may avoid the need for reconstructive surgery. The combined access can help the passage of the guidewire through the injured area and the threading of the urinary system of the patient. We present a case of a 38-year-old man with multiples abdominal surgeries, who underwent a complete ureteral section treated with ureteral realignment with combined access. The subsequent evolution was favourable, with resolution of the ureteral injury at the acute time, and without the presence of long-term obstruction. Although we must accept that the standard treatment of the complete ureteral transection is reconstruction and anastomosis, in cases such as the one prsented, with multiple abdominal surgeries and whenever it is technically feasible, ureteral realignment may be a treatment option.


Assuntos
Ureter/lesões , Ureter/cirurgia , Adulto , Humanos , Masculino , Procedimentos Cirúrgicos Urológicos/métodos
16.
BMC Surg ; 19(1): 150, 2019 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-31646995

RESUMO

BACKGROUND: Pyelo-ureteral junction syndrome (PUJS) is a frequent congenital malformation. We report the surgical management of PUJS by pyeloplasty according to Anderson-Hyne-Kuss's procedure at the Zinder National Hospital.. METHODS: This was a retrospective study from January 2013 to December 2016 (4 years), including patients who have undergone surgery for PUJS. RESULTS: Twelve (12) cases of PUJS had a surgery among which 66.7% were men with an average age of 32.5 ± 7.6 years. The clinical symptomatology was lumbar pain or renal colic in 92.3% of cases. This pain had evolved for more than 2 years for 58.3% of the cases. Ultrasound coupled with intravenous urography or CT-scan was performed to confirm the diagnosis of PUJS in 58.3 and 41.7% of cases. The average serum creatinine level at admission was 181.25 ± 67.3 µmol/L [Lab reference range: 53-97 µmol/L]. The Anderson-Hynes non dismembered pyeloplasty is used for all the patients. The release of a crossing lower pole vessel was performed in 25%, pyelolithotomy in 16.7%. The average surgery time was 118.3 ± 20.7 min. The average hospital length of stay was 10.8 ± 3 days. Immediate postoperative complications were recorded in 33.3% (n = 4). Postoperative outcomes were considered good by disappearance of clinical, biological and radiological signs. CONCLUSION: The Anderson-Hynes non dismembered pyeloplasty gives good results and provides a successful alternative in an environment where laparoscopy and robotic surgery are not developed.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Obstrução Ureteral/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Adulto , Feminino , Humanos , Rim/cirurgia , Masculino , Pessoa de Meia-Idade , Níger , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Síndrome , Tomografia Computadorizada por Raios X , Adulto Jovem
17.
Int Braz J Urol ; 45(5): 965-973, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31626519

RESUMO

OBJECTIVE: We aimed to evaluate the results of laparoscopic pyeloplasty with concomitant pyelolithotomy and compare results with a cohort of patients undergoing laparoscopic pyeloplasty without pyelolithotomy. MATERIALS AND METHODS: We retrospectively reviewed records of 43 patients undergoing transperitoneal laparoscopic Anderson-Hynes dismembered pyeloplasty between December 2012 and July 2018 at our department. Eighteen patients (42%) underwent laparoscopic pyeloplasty with concomitant pyelolithotomy. The results of patients with renal stones were compared with 25 matched patients undergoing laparoscopic pyeloplasty without concomitant renal stones. Demographic data, operative and stone parameters were compared between the groups. RESULTS: The groups were similar regarding to demographic characteristics. All operations were completed laparoscopically with no conversions to open surgery. In 3 cases without renal stones and 15 cases with renal stones, transposition of the ureter due to crossing vessels was performed. The mean stone size was 13±5.24 mm, and the median number of stones was 1 (1-18). The success of laparoscopic pyeloplasty with and without pyelolithotomy was 93.3% and 92.9%, respectively, as confirmed by negative diuretic renogram at postoperative 3rd months. Overall stone-free rate after laparoscopic pyelolithotomy was 93.3%. Mean operative time was 222.6765.71 minutes vs. 219.11±75.63 minutes for the pyeloplasty with concomitant pyelolithotomy vs. pyeloplasty, respectively (p=0.88). CONCLUSIONS: Laparoscopic pyeloplasty with concomitant pyelolithotomy is a safe and effective intervention with associated good cosmetic results and high stone-free rates without significant increase in operative time or complications.


Assuntos
Pelve Renal/cirurgia , Laparoscopia/métodos , Nefrolitíase/cirurgia , Nefrotomia/métodos , Obstrução Ureteral/cirurgia , Adolescente , Adulto , Criança , Feminino , Humanos , Hidronefrose/cirurgia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Nefrolitíase/patologia , Duração da Cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Estatísticas não Paramétricas , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos/métodos , Adulto Jovem
18.
Int Braz J Urol ; 45(5): 981-988, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31626521

RESUMO

OBJECTIVES: To compare and assess various outcomes and success of buccal mucosal graft urethroplasty (BMGU) in patients with CKD versus patients having normal renal function. MATERIAL AND METHODS: This was a retrospective, single centre study, during period 2013 to 2017. Patients were grouped into two groups. Group 1 had patients with estimated Glomerular Filtration Rate (eGFR)>60mL/min/1.73m2 while group 2 had patients with eGFR <60mL/min/1.73m2. eGFR was calculated according to the MDRD equation. The two groups were compared with regard to various outcomes like length, location of stricture, technique of graft placement, intra-operative blood loss (haemoglobin drop), duration of hospital stay, post-operative complications and recurrence. RESULTS: A total of 223 patients were included in study with group 1 had 130 patients and group 2 had 93 patients. Mean age of patients with CKD were higher (47.49 years versus 29.13 years). The mean follow-up period was comparable between both groups (23.29 months and 22.54 months respectively). Patients with CKD had more post-operative Clavien Grade 2 or higher complications (p=0.01) and a greater recurrence rates (p<0.001) than in non-CKD patients. On multivariate analysis, age and CKD status was significant predictor of urethroplasty success (p=0.004) (OR= 14.98 (1.952-114.94, 95% CI). CONCLUSIONS: CKD patients are more prone to post-operative complications in terms of wound infection, graft uptake and graft failure and higher recurrence rates following BMGU.


Assuntos
Mucosa Bucal/transplante , Insuficiência Renal Crônica/fisiopatologia , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Adolescente , Adulto , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/etiologia , Recidiva , Insuficiência Renal Crônica/complicações , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Adulto Jovem
19.
Arch Esp Urol ; 72(8): 867-881, 2019 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31579046

RESUMO

OBJECTIVE: To provide an overview of the meaning and types of virtual reality (VR) system, its current applications in the field of urology and future implications. SYNTHESIS OF THE EVIDENCE: The concept of VR involves the generation of computer environments with which a user can interact directly. Urology technologies and surgical practices are constantly evolving and RV simulation has become an important complement in urologist training curricula, taking into account not only simulations in surgical techniques, but also in non-surgical techniques such as communication and decision making. VR approaches for image-guided surgery have demonstrated potential in the field of urology by supporting guidance for various disorders. An increasing number of pre and intraoperative imaging modalities have been used to create detailed surgical route maps. The tracing of these surgical roadmaps with the surgical vision of real life has been produced in different ways (electromagnetic, acoustic, optical ...), recommending the combination of several approaches to provide a superior result. One of the disadvantages of navigation systems is soft tissue deformations, requiring confirmatory images. Although early studies report that navigation surgeries provide results equal to or greater than conventional approaches, most of the work has been done in relatively small groups of patients, thus requiring studies with larger sample sizes. CONCLUSIONS: The development of VR offers urologists many opportunities, with surgical simulation being one of its most important applications today. Likewise, the first clinical studies have demonstrated the potential of augmented reality (2D and 3D models) to improve surgical accuracy, describing different navigation systems for different urological surgical interventions.


Assuntos
Cirurgia Assistida por Computador , Procedimentos Cirúrgicos Urológicos , Urologia , Realidade Virtual , Humanos , Procedimentos Cirúrgicos Urológicos/métodos , Urologia/tendências , Interface Usuário-Computador
20.
JAMA ; 322(11): 1066-1076, 2019 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-31529007

RESUMO

Importance: Mixed urinary incontinence, including both stress and urgency incontinence, has adverse effects on a woman's quality of life. Studies evaluating treatments to simultaneously improve both components are lacking. Objective: To determine whether combining behavioral and pelvic floor muscle therapy with midurethral sling is more effective than sling alone for improving mixed urinary incontinence symptoms. Design, Setting, and Participants: Randomized clinical trial involving women 21 years or older with moderate or severe stress and urgency urinary incontinence symptoms for at least 3 months, and at least 1 stress and 1 urgency incontinence episode on a 3-day bladder diary. The trial was conducted across 9 sites in the United States, enrollment between October 2013 and April 2016; final follow-up October 2017. Interventions: Behavioral and pelvic floor muscle therapy (included 1 preoperative and 5 postoperative sessions through 6 months) combined with midurethral sling (n = 209) vs sling alone (n = 207). Main Outcomes and Measures: The primary outcome was change between baseline and 12 months in mixed incontinence symptoms measured by the Urogenital Distress Inventory (UDI) long form; range, 0 to 300 points; minimal clinically important difference, 35 points, with higher scores indicating worse symptoms. Results: Among 480 women randomized (mean [SD] age, 54.0 years [10.7]), 464 were eligible and 416 (86.7%) had postbaseline outcome data and were included in primary analyses. The UDI score in the combined group significantly decreased from 178.0 points at baseline to 30.7 points at 12 months, adjusted mean change -128.1 points (95% CI, -146.5 to -109.8). The UDI score in the sling-only group significantly decreased from 176.8 to 34.5 points, adjusted mean change -114.7 points (95% CI, -133.3 to -96.2). The model-estimated between-group difference (-13.4 points; 95% CI, -25.9 to -1.0; P = .04) did not meet the minimal clinically important difference threshold. Related and unrelated serious adverse events occurred in 10.2% of the participants (8.7% combined and 11.8% sling only). Conclusions and Relevance: Among women with mixed urinary incontinence, behavioral and pelvic floor muscle therapy combined with midurethral sling surgery compared with surgery alone resulted in a small statistically significant difference in urinary incontinence symptoms at 12 months that did not meet the prespecified threshold for clinical importance. Trial Registration: ClinicalTrials.gov Identifier: NCT01959347.


Assuntos
Terapia por Exercício , Slings Suburetrais , Incontinência Urinária/cirurgia , Incontinência Urinária/terapia , Adulto , Terapia Combinada , Terapia por Exercício/métodos , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Diafragma da Pelve , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos/métodos
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