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1.
Nat Rev Urol ; 17(3): 162-175, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32024995

RESUMO

Hypospadias is a congenital malformation resulting from the disruption of normal urethral formation with varying global prevalence. Hypospadias repair, especially that of proximal hypospadias (in which reconstruction of a long urethra is necessary), remains a surgical challenge despite more than two decades of surgical technique development and refinement. The lack of tissue substitutes with mechanical and biological properties similar to those of native urethra is a challenge for which the field of tissue engineering might offer promising solutions. However, the use of tissue-engineered constructs in preclinical studies is still hindered by complications such as strictures or fistulae, which have slowed progression to clinical application. Furthermore, the generation of uniform tubular constructs remains a challenge. Exciting advances in the application of nanotechnology and 3D bioprinting to urethral tissue engineering might present solutions to these issues.


Assuntos
Hipospadia/terapia , Engenharia Tecidual/métodos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Algoritmos , Animais , Ensaios Clínicos como Assunto , Humanos , Hipospadia/classificação , Masculino , Procedimentos Cirúrgicos Reconstrutivos , Transplante de Células-Tronco , Uretra/cirurgia
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.
Cir. pediátr ; 33(1): 36-42, ene. 2020. graf, ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-186136

RESUMO

Objetivos: Comunicar nuestra experiencia con la utilización de la urosonografía miccional seriada (UMS) para el diagnóstico y manejo de pacientes con válvulas de uretra posterior (VUP). Material y método: Estudio retrospectivo descriptivo en pacientes entre 0 a 14 años con sospecha de VUP en UMS realizada como primera prueba contrastada de la vía urinaria y con estudio cistoscópico posterior. Las variables se analizaron utilizando SPSSv22. Resultados: Fueron estudiados 18 pacientes (edad mediana de 6 meses). La mayoría de los pacientes (15) presentaban dilatación de la uretra posterior (diámetro medio de 9,56 mm) y diferencia entre uretra proximal y distal mayor de 2 mm. Trece casos tenían engrosamiento vesical y 9 RVU. Se diagnosticaron 15 casos de VUP, 1 caso de mucocele de uretra distal y 1 divertículo vesical que obstruía uretra. Se consiguió resección completa de las VUP en 10 pacientes (66,6%) en la primera cistoscopia. La UMS de control detectó un caso de resección incompleta por persistencia de dilatación de uretra posterior. Este caso y los 5 conocidos con resección incompleta se sometieron a una segunda cistoscopia y resección. El menor de los pacientes requirió una tercera resección y dilatación con balón de corte por estenosis residual. La creatinina media al diagnóstico fue 0,28 mg/dl. Conclusiones: La urosonografía miccional seriada (UMS) es una prueba complementaria útil en pacientes pediátricos con válvulas de uretra posterior. Su carácter dinámico y ventajas: ausencia de irradiación, seguridad y alta sensibilidad; la convierten en una prueba de imagen ideal para el diagnóstico y seguimiento de VUP


Objectives: Report our experience with the use of contrast-enhanced serial voiding urosonography (SVU) for posterior urethral valve (PUV) patient diagnosis and management. Materials and Methods: Descriptive retrospective study in 0- to 14-year-old patients with suspected PUV at SVU performed as a first contrast-enhanced urinary tract test with subsequent cystoscopic study. Variables were analyzed using SPSSv22. Results: 18 patients were studied (median age: 6 months). Most patients (15) presented posterior urethral dilatation (mean diameter: 9.56 mm) and a >2 mm gap between proximal and distal urethra. 13 cases had bladder thickening and 9 had VUR. 15 PUV cases, 1 case of distal urethral mucocele, and 1 case of bladder diverticulum obstructing the urethra were diagnosed. Complete PUV resection was performed in 10 patients (66.6%) at the first cystoscopy. The control SVU detected one case of recurrence due to persistence of posterior urethral dilatation. The recurrence case and the 5 incomplete resection cases were treated with a second cystoscopy and resection. The youngest patients required a third resection and cutting balloon dilatation due to residual stenosis. Mean creatinine levels at diagnosis were 0.28 mg/dl. Conclusions: Serial voiding urosonography (SVU) is a useful complementary test in pediatric patients with posterior urethral valve. Its dynamic nature and its advantages - absence of irradiation, safety, and high sens efitivity - make it an ideal imaging test for PUV diagnosis and follow-up


Assuntos
Humanos , Recém-Nascido , Lactente , Criança , Adolescente , Uretra/anormalidades , Uretra/cirurgia , Obstrução Uretral/diagnóstico por imagem , Uretra/diagnóstico por imagem , Estudos Retrospectivos , Cistografia/métodos , Transtornos Urinários/complicações , Análise Qualitativa
5.
Urology ; 135: 139-145, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31586471

RESUMO

OBJECTIVE: To examine the most cited literature in urethral reconstruction, review types of work published, and observe research trends. METHODS: The Web of Sciences Sci-Expanded Index was used to conduct a search for urethral reconstruction. References were assessed for relevance to urethral reconstruction by 2 independent reviewers and a final list of the top 100 articles ranked by citation count was obtained. For each article, citation count, publication date, corresponding author, origin institution, origin country, topic area, study design, level of evidence, and origin journal were collected. RESULTS: The mean citation count per publication was 108 (median = 94.5; range = 69-366, SD = 43) with a total of 10,874 citations for all papers since 1970. The top 100 articles were published between 1973 and 2011, came from 19 different countries and 16 different journals. Nearly half were case series and most studies were Level III evidence or lower. The United States was the largest contributor to the top 100 with 56 publications, followed by Italy (14), England (12), and Egypt (7). "Outcomes of surgical treatment for urethral stricture disease" was the most prevalent topic area comprising 55 articles in the top 100, with most articles including descriptions or outcomes of novel surgical techniques. CONCLUSION: In this study, we discovered that the most cited literature in the field of urethral reconstruction is singularly focused and lacking in high levels of evidence. The top 100 cited articles originate primarily from the United States, focus on short-term outcomes after surgical treatment for urethral stricture disease, and are predominantly case series.


Assuntos
Bibliometria , Procedimentos Cirúrgicos Reconstrutivos/métodos , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Humanos , Masculino , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Uretra/patologia , Estreitamento Uretral/patologia , Procedimentos Cirúrgicos Urológicos Masculinos/estatística & dados numéricos
6.
Urology ; 135: 133-135, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31586472

RESUMO

Malignant peripheral nerve sheath tumors (MPNSTs) are soft tissue sarcomas that arise from peripheral nerve fibers and primarily occur in the setting of neurofibromatosis (NF1). MPNST arising from the penis is very rare and may require mutilating surgery to achieve surgical cure. We previously reported a case of MPNST involving the penis in a 14-month-old boy treated with neoadjuvant chemotherapy, total penectomy, and adjuvant radiation. Here we report intermediate follow-up of the same patient, describe his subsequent genitourinary reconstruction, and discuss management dilemmas that arise following treatment of penile MPNST.


Assuntos
Assistência ao Convalescente/métodos , Neoplasias da Bainha Neural/terapia , Neoplasias Penianas/terapia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Criança , Humanos , Masculino , Terapia Neoadjuvante , Neoplasias da Bainha Neural/patologia , Neoplasias Penianas/patologia , Pênis/patologia , Pênis/cirurgia , Escroto/cirurgia , Resultado do Tratamento , Uretra/cirurgia
7.
Urology ; 136: 251-256, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31733272

RESUMO

OBJECTIVE: To compare the clinical courses of patients with straddle injuries to the bulbar urethra based on the initial management strategy for urinary drainage, mainly suprapubic tube placement (SPT) and primary realignment (PR), and to examine whether PR has a beneficial effect on subsequent urethroplasty with regards to surgical and patient-reported outcomes. METHODS: We reviewed the clinical courses of 126 patients with bulbar urethral stricture following straddle injuries who underwent delayed urethroplasty between August 2010 and April 2019. Patients were categorized as being initially treated with SPT (82 patients) or PR (44 patients). Stricture was considered complicated if preoperative urethrography or cystoscopy revealed iatrogenic scarring or a stricture away from the injury site. RESULTS: The percentage of patients who experienced delayed transurethral treatment at least once before referral was significantly higher in patients treated with PR than in those treated with SPT (25/44, 56.8% vs 16/82, 19.8%, P < .0001). Although there was no difference in stricture length in both cohorts, the fraction of patients with complicated stricture was significantly higher in patients treated with PR than in those treated with SPT (15/44, 34.1% vs 14/82, 17.1%, P = .003). There was no significant difference in the selected type of urethroplasty, operative time, blood loss, success rate, postoperative maximum urinary flow rate, voiding symptoms, or erectile function between the 2 groups. CONCLUSION: PR does not facilitate delayed urethroplasty and had no beneficial effect on urethroplasty outcome. PR might lead to delayed transurethral procedures, resulting in increased risk of complicated strictures.


Assuntos
Uretra/lesões , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Estreitamento Uretral/etiologia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Procedimentos Cirúrgicos Urológicos Masculinos/normas
8.
Urology ; 137: 205, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31883880

RESUMO

OBJECTIVE: Scrotal hypospadias still presents a challenge for reconstructive urologists. We present a novel and 1-stage technique of using a specially shaped buccal mucosa graft for simultaneous ventral tunica grafting and urethroplasty for severe hypospadias repair. METHODS: A 14-month old boy underwent repair of scrotal hypospadias with severe chordee. Penile straightening is achieved by division of short urethral plate combined with ventral grafting. Urethral reconstruction is done by combined buccal mucosa graft and longitudinal dorsal penile skin flap. Buccal mucosa graft is harvested and designed in a special "watch" shape, with the spherical part in the middle and 2 rectangular parts on both sides. The tunica albuginea is opened ventrally for penile straightening and grafted to the spherical part of the "watch-shaped" graft with "U-shape" stitches. The rectangular parts are fixed to the tip of the glans distally and native urethral meatus proximally creating new urethral plate. A longitudinal dorsal skin flap is harvested, button-holed ventrally and joined with the urethral plate. Penile skin reconstruction is performed using available penile skin. RESULTS: In period between July 2014 and December 2018, this technique is performed in 35 patients (aged from 10 to 22 months) with scrotal hypospadias. In the follow-up, ranged from 10 to 63 months (mean 29 months), satisfactory results were achieved in 30 boys (86%). Urethral fistula in 3 and meatal stenosis in 2 cases were successfully treated by minor revision and temporary meatal dilatation, respectively. Good result in curvature repair was obtained in all cases based on vacuum device checking and parents' reports. CONCLUSION: Repair of scrotal hypospadias associated with severe ventral curvature is usually done as a 2-stage procedure. A "watch" shaped buccal mucosa graft for simultaneous curvature correction and urethroplasty is a viable and reliable option for single stage repair of scrotal hypospadias with severe chordee.


Assuntos
Mucosa Bucal/transplante , Pênis , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Uretra , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Humanos , Hipospadia , Lactente , Masculino , Pênis/anormalidades , Pênis/cirurgia , Estudos Retrospectivos , Escroto/anormalidades , Escroto/cirurgia , Retalhos Cirúrgicos , Coleta de Tecidos e Órgãos/métodos , Uretra/anormalidades , Uretra/cirurgia
10.
Prensa méd. argent ; 105(11): 852-860, dic2019. fig, tab
Artigo em Inglês | LILACS, BINACIS | ID: biblio-1050073

RESUMO

Background: The Tubularized Incised Urethral Plate (TIP) urethroplasty is a widely accepted technique among urologists and heavily used in their centers. This technique was developed by Snodgrass in 1994 for repairing varied degrees of hypospadias. Aim: This paper aims at analyzing and evaluating our early experience and the outcomes of using TIP urethroplasty technique. Therefore, the results have to be assessed in a large series. Methods: In this prospective study, 95 patients with varying hypospadiac meatus levels who experienced the procedure of TIP. During the entire sampling period, patients had varying degrees of hypospadias ranging from glanular to penoscrotal (glanular 2, coronal/subcoronal 37, distal shaft 30, mid-shaft 10, proximal shaft 5 and penoscrotal 11). Results: The overall success rate of TIP procedure repair of hypospadias was 87.4%; whereas the overall reoperation rate was 12.6%. The highest percentage was for those with failed previous repair (secondary). The average duration of the procedure was 58.6±18.4 minutes. Nearly a third of the patients developed one or more postoperative major complication. The total rate of fistula was 12.6%, with "10.6% in primary distal, 15.9% in primary proximal and 20% in secondary repair". Sixteen cases had a mild degree of "meatal stenosis" (16.8%), but all were managed by simple dilatation at the office or at home using 8 F feedingtube. Conclusion: The outcomes demonstrated that the TIP procedure is a quick, safe and reliable technique. Additionally, it can provide excellent cosmoses and function with few complications and acceptable reoperation rate.


Assuntos
Humanos , Masculino , Uretra/cirurgia , Estreitamento Uretral/patologia , Estudos Prospectivos , Hipospadia/cirurgia , Reoperação/estatística & dados numéricos
11.
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
12.
S Afr Med J ; 109(12): 947-951, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31865957

RESUMO

BACKGROUND: Limited data are available on outcomes of the surgical management of inflammatory urethral strictures secondary to infection, a major cause of stricture. Several shortcomings that need to be addressed have been identified in the past. OBJECTIVE: To determine the impact of stricture length, position and degree of obliterative urethral lumen on the surgical outcomes of corrective procedures for inflammatory anterior urethral strictures. METHODS: This retrospective analysis used the records of patients who presented with proven infective anterior urethral strictures at an academic hospital from 2007 to 2010. All patients were followed up after 48 months. Urethroplasty outcomes were analysed according to stricture location and length and effect of urethral obliteration. RESULTS: The median age of the 174 patients in the study was 47 (range 21 - 86) years. Anastomotic urethroplasty was successful in 59/99 (59.6%) patients. Augmented anastomotic urethroplasty was successful in 11/15 (73.3%) patients. Dorsal onlay buccal mucosa graft urethroplasty was successful in 23/32 (71.9%) patients, significantly higher than in 2/9 (22.2%) patients who underwent ventral onlay buccal mucosa graft urethroplasty (p=0.017; hazard ratio 3.4; 95% confidence interval 1.29 - 9.40). The one-stage circular pedicled penile skin-flap urethroplasty was successful in 1/12 (8.3%) patients. Two-stage urethroplasty was successful in 5/7 (71.4%) patients. A primary component analysis of the 73 failed procedures showed that stricture length was the main contributor to failure (eigenvalue 1.79; 45%). CONCLUSIONS: Urethroplasty remains a challenge in inflammatory urethral strictures, where stricture length was the main reason for treatment failure.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Uretra/patologia , Uretra/cirurgia , Estreitamento Uretral/patologia , Estreitamento Uretral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Seguimentos , Humanos , Inflamação/microbiologia , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/transplante , Estudos Retrospectivos , Fatores de Risco , Retalhos Cirúrgicos , Falha de Tratamento , Estreitamento Uretral/microbiologia , Infecções Urinárias/complicações , Adulto Jovem
13.
Rev Med Suisse ; 15(673): 2186-2189, 2019 Nov 27.
Artigo em Francês | MEDLINE | ID: mdl-31778046

RESUMO

Surgical treatments for female stress urinary incontinence is in perpetual evolution. This article reviews the current surgical treatments for stress urinary incontinence in female. Bulking agents, Burch colposuspension, autologous sling, midurethral slings, single incision slings, artificial urinary sphincter and adjustable continence therapy (ACT) are discussed.


Assuntos
Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos , Feminino , Humanos , Slings Suburetrais , Uretra/cirurgia
14.
Curr Urol Rep ; 20(11): 74, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31705324

RESUMO

PURPOSE OF REVIEW: In this review, we describe the incidence, diagnosis, and management of urethral strictures in women. RECENT FINDINGS: Definitive repair of urethral strictures in women traditionally utilizes vaginal and labial flaps. Oral mucosal buccal graft urethroplasty also has high success rates, with larger series demonstrating feasibility and durability. Urethral strictures in women are very rare. When they do occur, they are often difficult to diagnose, requiring a high index of suspicion. Women with urethral strictures often present with symptoms of obstructed urinary flow, such as incomplete emptying, straining, and elevated postvoid residual. First line, minimally invasive treatment consists of urethral dilation and urethrotomy, though urethrotomy is rarely performed. Repeat urethral dilation has low success rates compared with urethroplasty, which is a more definitive treatment.


Assuntos
Mucosa Bucal/transplante , Uretra/cirurgia , Estreitamento Uretral/diagnóstico , Estreitamento Uretral/terapia , Dilatação , Feminino , Humanos , Retalhos Cirúrgicos , Estreitamento Uretral/etiologia , Vagina/cirurgia
15.
Pan Afr Med J ; 33: 170, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31565131

RESUMO

Congenital mega-urethra is a rare malformation causing micturition disturbance sometimes associated with upper urinary tract impairment. Despite the frequent association with other urinary and non-urinary abnormalities in children, stone-related complication has been reported only once in the literature. We report a case of congenital mega urethra complicated by stasis and stone formation in a 3 year old child successfully treated in the Department of Paediatric Surgery at the Mother-Child Hospital in Nouakchott. This study highlights the epidemiological clinical and therapeutic features of this association between congenital mega-urethra and urinary stones.


Assuntos
Uretra/anormalidades , Cálculos Urinários/diagnóstico , Pré-Escolar , Humanos , Masculino , Resultado do Tratamento , Uretra/cirurgia , Cálculos Urinários/patologia , Cálculos Urinários/cirurgia
16.
Urol Clin North Am ; 46(4): 567-580, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582030

RESUMO

Single-stage phalloplasty may be accomplished by having both the microsurgical and the reconstructive urology team operate simultaneously. Phalloplasty with pars pendulans urethroplasty is completed by the microsurgeons, and pars fixa urethroplasty, vaginectomy, scrotoplasty, and perineal reconstruction are performed by the reconstructive urologist. Some surgeons prefer separating phalloplasty from the urologic portions of the procedure. The single-staged approach is favored in patients whose ultimate goal is to have an aesthetic, sensate, and functional phallus and scrotum. Complications remain high but are predictably lower in higher-volume centers. Reconstructive urologists manage the urethral complications that develop.


Assuntos
Cirurgia de Readequação Sexual/métodos , Transexualismo , Feminino , Genitália Feminina/cirurgia , Humanos , Masculino , Seleção de Pacientes , Complicações Pós-Operatórias/epidemiologia , Cirurgia de Readequação Sexual/efeitos adversos , Uretra/cirurgia
17.
Urol Clin North Am ; 46(4): 581-590, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582031

RESUMO

The treatment of gender dysphoria related to genitourinary anatomy can be effectively treated with phalloplasty. A phalloplasty may include some or all of the following: penile shaft, glans, shaft urethra, perineal urethra, scrotoplasty, vaginectomy, testicular implants, and erectile devices. The literature does not currently support a gold standard for how best to stage these procedures. This article reviews current techniques for phalloplasty staging and proposes that a staged urethral reconstruction is a reliable technique that allows for potential complications to be managed individually, while minimizing the severity of complications and their impact on the outcome of the final reconstruction.


Assuntos
Disforia de Gênero/cirurgia , Genitália Feminina/cirurgia , Cirurgia de Readequação Sexual/métodos , Transexualismo , Feminino , Humanos , Masculino , Seleção de Pacientes , Prótese de Pênis , Complicações Pós-Operatórias/epidemiologia , Cirurgia de Readequação Sexual/efeitos adversos , Uretra/cirurgia
18.
Urol Clin North Am ; 46(4): 591-603, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582032

RESUMO

Significant developments have enabled the transformation of phalloplasty to a functional organ. Differences exist in the surgical placement of a prosthesis when within a phallus, such as the lack of corpora, pubic fixation requirement, distal sock placement, and the consideration of a vascular pedicle. Increased complications compared with nonphalloplasty cohorts remain one of the biggest challenges, including rates of infection, erosion, mechanical malfunction, and malposition. Nonetheless, the placement of penile prosthesis within a phalloplasty enables trans men to achieve a once near-impossible goal of penetrative sexual intercourse without an external device.


Assuntos
Genitália Feminina/cirurgia , Implante Peniano/efeitos adversos , Prótese de Pênis , Cirurgia de Readequação Sexual/instrumentação , Transexualismo , Feminino , Humanos , Masculino , Seleção de Pacientes , Complicações Pós-Operatórias/epidemiologia , Cirurgia de Readequação Sexual/efeitos adversos , Uretra/cirurgia
19.
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
20.
Cir. pediátr ; 32(4): 201-206, oct. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-184110

RESUMO

Introducción y objetivo. Los hipospadias peneanos proximales, escrotales y perineales son un reto para el cirujano. Tras toda una carrera dedicada a los hipospadias, la autora principal del trabajo resume su experiencia y demuestra que prácticamente cualquier tipo de hipospadias puede ser resuelto completamente en un único tiempo. Método. Se trata de una revisión retrospectiva y la discusión de una serie de hipospadias proximales consecutivos tratados en una única intervención por el mismo equipo quirúrgico entre 1999 y 2016. Resultados. 196 pacientes fueron intervenidos. El 68% de los casos quedaron satisfactoriamente resueltos tras la operación. Todos los hipospadias fueron reparados con una de las siguientes técnicas: onlay, colgajo prepucial tubularizado (Duckett) o injertos de mucosa. Los injertos se utilizaron solo hasta 2005; posteriormente, el refinamiento de las técnicas quirúrgicas expuestas permitió que cualquier hipospadias fuera reparado con las técnicas de onlay o Duckett. Solo un 13% de los casos necesitó algún tipo de procedimiento quirúrgico adicional, más allá del cierre de una fístula uretral puntiforme (presente en el 25% de los pacientes).Conclusión. El diseño de las incisiones cutáneas es fundamental en la reparación de los hipospadias. Cuando las incisiones siguen las líneas que de forma natural se forman en la piel del pene y escroto se obtiene como resultado un colgajo óptimo para realizar una neouretra y recubrirla con piel, evitando incluso los injertos de mucosa. Estas modificaciones permiten que cualquier tipo de hipospadias sea reparado en un único tiempo con muy buenos resultados a largo plazo


Purpose. Proximal, scrotal and perineal hypospadias challenge the surgeon. After 40 years devoted to hypospadias surgery, the senior author summarizes her experience, share her tricks and shows that almost any hypospadias can be fully repaired in one surgery. Methods. Retrospective review and discussions of a large series of consecutive proximal hypospadias treated in one surgery by the same team from 1999 to 2016. Results. 196 patients were operated. 68% of all patients were successfully repaired after the surgery. All hypospadias were treated using one of the following techniques: onlay double flap, tubularized preputial flap or mucosal grafts (only until 2005). Urethrocutaneous fistula was present in 25% of cases, but only 13% of patients needed other further surgical procedures. Conclusion. Cutaneous incisions design is fundamental in hypo-spadias repair. When the incisions follow the natural folds that appear in penile and scrotal skin, it's possible to obtain optimal flaps for both urethroplasty and skin coverage (even avoiding the need for mucosal grafts). Consequently, almost all kinds of hypospadias can be repaired in one surgery with very good long-term results


Assuntos
Humanos , Masculino , Criança , Hipospadia/cirurgia , Uretra/cirurgia , Retalhos Cirúrgicos/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Estudos Retrospectivos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Escroto/cirurgia
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