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1.
Isr Med Assoc J ; 22(4): 241-243, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32286028

RESUMO

BACKGROUND: Transurethral prostatectomy is the gold standard surgical treatment of bladder outlet obstruction due to benign enlargement of the prostate, with more than 30,000 procedures performed annually in the United States alone. The success rate of this minimally invasive procedure is high and the results are durable. The development of urethral stricture is a long-term complication of the procedure and is noted in about 2% of patients. The stricture narrows the urethral lumen, leading to re-appearance of obstructive urinary symptoms. Traditionally, the evaluation of the stricture was performed by retrograde urethrography. Advancements in the fields of flexible endoscopy allowed rapid inspection of the urethra and immediate dilatation of the stricture in selected cases. OBJECTIVES: To compare the efficacy of urethrography versus cystoscopy in the evaluation of urethral strictures following transurethral prostatectomy. METHODS: A retrospective review was conducted of a series of 32 consecutive patients treated due to post-transurethral resection of prostate (TURP) urethral stricture. RESULTS: Twenty patients underwent both tests. In 16 there was concordance between the two tests. Four patients had no pathological findings in urethrography but had strictures in cystoscopy. All strictures were short (up to 10 mm) and were easily treated during cystoscopy, with no complaints or re-surgery needed in 24 months follow-up. CONCLUSIONS: Cystoscopy was superior to urethrography in the evaluation of post-TURP strictures. Strictures where often short and treated during the same procedure. We recommend that cystoscopy be the procedure of choice in evaluating obstructive urinary symptoms after TURP, and retrograde urethrography be preserved for selected cases.


Assuntos
Cistoscopia/métodos , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Uretra/diagnóstico por imagem , Estreitamento Uretral/diagnóstico , Urografia/métodos , Idoso , Estudos de Coortes , Cistografia/métodos , Seguimentos , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Ressecção Transuretral da Próstata/efeitos adversos , Resultado do Tratamento , Estreitamento Uretral/etiologia , Estreitamento Uretral/cirurgia , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/cirurgia
2.
Pediatrics ; 145(2)2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31915193

RESUMO

Imaging modalities for diagnosing kidney and urinary tract disorders in children have developed rapidly over the last decade largely because of advancement of modern technology. General pediatricians and neonatologists are often the front line in detecting renal anomalies. There is a lack of knowledge of the applicability, indications, and nephrotoxic risks of novel renal imaging modalities. Here we describe the clinical impact of congenital anomalies of the kidneys and urinary tract and describe pediatric-specific renal imaging techniques by providing a practical guideline for the diagnosis of kidney and urinary tract disorders.


Assuntos
Nefropatias/diagnóstico por imagem , Rim/anormalidades , Rim/diagnóstico por imagem , Criança , Meios de Contraste , Cistografia/métodos , Imagem de Difusão por Ressonância Magnética , Ecocardiografia Tridimensional , Técnicas de Imagem por Elasticidade , Humanos , Nefropatias/congênito , Impressão Tridimensional , Tomografia Computadorizada por Raios X , Ultrassonografia/métodos , Ultrassonografia/tendências , Uretra/diagnóstico por imagem , Bexiga Urinária/diagnóstico por imagem , Sistema Urinário/anormalidades , Sistema Urinário/diagnóstico por imagem
4.
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 , 25783
5.
Br J Radiol ; 93(1107): 20190845, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31904261

RESUMO

OBJECTIVES: The purpose of this study is to investigate the dosimetric effect and clinical impact of delivering a focal radiotherapy boost dose to multiparametric MRI (mp-MRI)-defined dominant intraprostatic lesions (DILs) in prostate cancer using proton therapy. METHODS: We retrospectively investigated 36 patients with pre-treatment mp-MRI and CT images who were treated using pencil beam scanning (PBS) proton radiation therapy to the whole prostate. DILs were contoured on co-registered mp-MRIs. Simultaneous integrated boost (SIB) plans using intensity-modulated proton therapy (IMPT) were created based on conventional whole-prostate-irradiation for each patient and optimized with additional DIL coverage goals and urethral constraints. DIL dose coverage and organ-at-risk (OAR) sparing were compared between conventional and SIB plans. Tumor control probability (TCP) and normal tissue complication probability (NTCP) were estimated to evaluate the clinical impact of the SIB plans. RESULTS: Optimized SIB plans significantly escalated the dose to DILs while meeting OAR constraints. SIB plans were able to achieve 125, 150 and 175% of prescription dose coverage in 74, 54 and 17% of 36 patients, respectively. This was modeled to result in an increase in DIL TCP by 7.3-13.3% depending on α/ß and DIL risk level. CONCLUSION: The proposed mp-MRI-guided DIL boost using proton radiation therapy is feasible without violating OAR constraints and demonstrates a potential clinical benefit by improving DIL TCP. This retrospective study suggested the use of IMPT-based DIL SIB may represent a strategy to improve tumor control. ADVANCES IN KNOWLEDGE: This study investigated the planning of mp-MRI-guided DIL boost in prostate proton radiation therapy and estimated its clinical impact with respect to TCP and NTCP.


Assuntos
Imageamento por Ressonância Magnética Multiparamétrica , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/radioterapia , Terapia com Prótons/métodos , Reirradiação/métodos , Idoso , Idoso de 80 Anos ou mais , Fracionamento da Dose de Radiação , Humanos , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/métodos , Órgãos em Risco/diagnóstico por imagem , Órgãos em Risco/efeitos da radiação , Próstata/diagnóstico por imagem , Próstata/efeitos da radiação , Neoplasias da Próstata/patologia , Lesões por Radiação/prevenção & controle , Dosagem Radioterapêutica , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Uretra/diagnóstico por imagem
6.
Urology ; 135: 146-153, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31626854

RESUMO

OBJECTIVE: To evaluate the magnetic resonance imaging (MRI) findings of traumatic bulbar stricture and to evaluate their ability to estimate repair complexity. METHODS: Eighty-nine men with traumatic bulbar stricture who underwent urethrography and MRI at least 3 months postinjury and subsequent excision and primary anastomosis were retrospectively analyzed. The associations of MRI findings, including continuity of the tunica albuginea of the corpus spongiosum, periurethral fistula, spongiofibrosis length (SFL), and distal and proximal bulbar urethral length from the stricture, with urethrography and operative parameters were evaluated. RESULTS: Mean SFL was significantly longer than mean stricture length on urethrography (14.9 vs 7.9 mm, P <.0001). Periurethral fistula was found in 18 (20.2%) patients on MRI but not in 10 (55.6%) of them on urethrography. The corpus spongiosum was disrupted in 40 patients (55.1%) on MRI. On multivariate linear regression, SFL (standard coefficient, 0.25; t value, 2.31; P = .02) predicted operation time, while SFL (standard coefficient, 0.22; t value, 2.04; P = .04) and proximal bulbar urethral length (standard coefficient, -0.25; t value, -2.11; P = .04) independently predicted blood loss. Corporal splitting to reduce anastomotic tension and/or increase visualization during repair was needed in 33 patients (37.1%). Stricture length on urethrography (odds ratio [OR], 1.22; 95% confidence interval, 1.04-1.42; P = .006) and corpus spongiosum disruption (odds ratio, 5.51; 95% confidence interval, 1.57-19.34, P = .005) were independent predictors for the need of corporal splitting. CONCLUSION: In contrast to urethrography findings, MRI findings help predict traumatic bulbar stricture repair complexity.


Assuntos
Planejamento de Assistência ao Paciente , Doenças do Pênis/complicações , Pênis/lesões , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto , Estudos de Viabilidade , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças do Pênis/cirurgia , Pênis/diagnóstico por imagem , Período Pré-Operatório , Estudos Retrospectivos , Resultado do Tratamento , Uretra/diagnóstico por imagem , Estreitamento Uretral/diagnóstico por imagem , Estreitamento Uretral/etiologia
7.
Urologiia ; (5): 44-47, 2019 Dec.
Artigo em Russo | MEDLINE | ID: mdl-31808631

RESUMO

AIM: to improve treatment results of patients with stress urinary incontinence and severe cystocele by optimizing surgical tactics and rehabilitation methods. MATERIALS AND METHODS: a total of 56 women aged 54 to 68 years with stages III-IV of the anterior vaginal wall prolapse (according to the POP-Q classification) and urethral sphincter insufficiency were evaluated. All patients underwent a transvaginal extraperitoneal anterior mesh repair without concomitant sling procedure. The severity of prolapse, a presence or absence of stress urinary incontinence, and ultrasound signs of sphincter insufficiency were re-evaluated two months after procedure. RESULTS: in all cases, the anterior wall prolapse was eliminated or reduced to subclinical stage. Two months after procedure, 48 patients (85,7%) noted the onset of stress urinary incontinence (moderate and severe) with progressive deterioration. In the remaining cases (14,3%), patients did not have any urinary incontinence. All patients underwent active rehabilitation for 6 months. In 6 cases (12,5%), there was a decrease in the severity of urinary incontinence to the level that had virtually didnt affect the quality of life; in remaining cases, conservative treatment was considered ineffective and sling procedure was recommended. DISCUSSION: A diagnosis of latent urinary incontinence remains to be controversial. To detect this form, a cough test with a prolapse reduction is usually performed. In addition, preoperative urodynamic testing can be used, since it has good sensitivity in identifying latent urinary incontinence, but it is an expensive procedure for the routine practice. A determination of the urethral sphincter insufficiency makes it possible to predict the development of the stress urinary incontinence with a high accuracy, but this method also has a number of limitations. CONCLUSION: patients with stages III-IV of the anterior vaginal wall prolapse and ultrasound signs of sphincter insufficiency have a risk of developing stress urinary incontinence after surgical treatment. In this group of patients, a simultaneous surgery can be recommended in order to correct prolapse and to prevent subsequent urinary incontinence.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Qualidade de Vida , Uretra/diagnóstico por imagem , Incontinência Urinária por Estresse/reabilitação , Prolapso Uterino/cirurgia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Telas Cirúrgicas , Uretra/fisiopatologia , Incontinência Urinária por Estresse/complicações , Urodinâmica
8.
Med Ultrason ; 21(3): 359-361, 2019 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-31476219

RESUMO

Sonourethrography (SUG) is one of the basic imaging tools in the diagnosis of male anterior urethral strictures. So far, no one has described the use of this examination in transgender patients after "female-to-male" operation. Based on the presented case, we describe ultrasonographical features of the construction of a neophallus and offer information allowing a more accurate evaluation of urethral disorders in this group of patients.


Assuntos
Endossonografia/métodos , Pessoas Transgênero , Estreitamento Uretral/diagnóstico por imagem , Adulto , Humanos , Masculino , Uretra/diagnóstico por imagem
9.
Int J Radiat Oncol Biol Phys ; 105(5): 1086-1094, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31419510

RESUMO

PURPOSE: Use of stereotactic body radiation therapy (SBRT) is increasing in patients with localized prostate cancer, but concerns about early and late gastrointestinal (GI) and genitourinary (GU) toxicity exist after moderately or extremely hypofractionated radiation therapy schemes. Magnetic resonance guided radiation therapy (MRgRT) was clinically introduced in 2014. MrgRT allows for SBRT delivery with smaller uncertainty margins and permits daily adaptive planning. A phase 2 study in patients with localized prostate cancer was performed to study early GI and GU toxicity after SBRT using MRgRT. METHODS AND MATERIALS: One hundred one patients with clinical stage T1-3bN0M0 prostate cancer were enrolled in this prospective phase 2 study. All but 4 patients had intermediate- or high-risk prostate cancer, and 82.2% received adjuvant hormonal treatment. MRgRT was delivered in 5 fractions of 7.25 Gy to the target volume using daily plan adaptation with simultaneous relative sparing of the urethra to a dose of 6.5 Gy per fraction. Early toxicity was studied using both clinician- (Common Terminology Criteria for Adverse Events and Radiation Therapy Oncology Group) and patient-reported outcome measurements (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30, Quality of Life Questionnaire PR25, and International Prostate Symptom Scoring). RESULTS: The maximum cumulative grade ≥2 early GU and GI toxicity measured by any symptom at any study time point was 23.8% and 5.0%, respectively. No early grade 3 GI toxicity was observed. Early grade 3 GU toxicity was 0% and 5.9% according to the Common Terminology Criteria for Adverse Events and Radiation Therapy Oncology Group and scoring systems, respectively, as a result of different grading of radiation cystitis. The low incidence of early GI toxicity was confirmed by patient-reported outcome data. GU grade ≥2 toxicity peaked to 19.8% at the end of MRgRT, followed by a return to the baseline average score at 3-month follow-up. CONCLUSIONS: This prospective study of MRgRT in patients with localized prostate cancer observed a low incidence of early GI and GU toxicity, both in clinician- and patient-reported outcome measurements.


Assuntos
Imagem por Ressonância Magnética Intervencionista , Neoplasias da Próstata/radioterapia , Radiocirurgia/efeitos adversos , Radioterapia Guiada por Imagem/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Trato Gastrointestinal/efeitos da radiação , Humanos , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/métodos , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Hipofracionamento da Dose de Radiação , Radiocirurgia/métodos , Radioterapia Guiada por Imagem/métodos , Resultado do Tratamento , Uretra/diagnóstico por imagem , Sistema Urogenital/efeitos da radiação
10.
BMC Urol ; 19(1): 71, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31357972

RESUMO

BACKGROUND: In this case report, giant calculus in the urethral diverticulum was found through ureteroscopy investigation, the pneumatic lithotripsy combined with ultrasound lithotripsy (PLCUL) was successfully performed to break down this rare and giant urethral calculus in the diverticulum without open surgery. CASE PRESENTATION: A 82-year-old male presented to the urology department, complaining of frequent urination and dysuria. One giant, dark brown stone (6.5 × 6 × 5.5 cm) was revealed in the diverticulum of the anterior urethra using combination of local ultrasound, pelvic Computer Tomography (CT) and Magnetic Resonance Imaging (MRI). The stone was then successfully broken down via the PLCUL, and the emptied anterior urethral diverticulum was left untreated. In the 18 months' follow-up, no new calculus was found in urethral tract, anterior diverticula became gradually smaller, eventually disappeared. CONCLUSION: In the treatment of giant calculus in the urethral diverticulum, this case report provides an effective method of lithotripsy in the clinical trials.


Assuntos
Divertículo/diagnóstico por imagem , Divertículo/terapia , Litotripsia/métodos , Uretra/diagnóstico por imagem , Doenças Uretrais/diagnóstico por imagem , Doenças Uretrais/terapia , Idoso de 80 Anos ou mais , Humanos , Masculino , Cálculos Urinários/diagnóstico por imagem , Cálculos Urinários/terapia
11.
Radiol Med ; 124(12): 1270-1280, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31302847

RESUMO

In an emergency department, penile traumas are uncommon and a prompt diagnosis is necessary. Penile injury may result from penetrating and non-penetrating trauma. Non-penetrating injuries can produce cavernosal hematomas or fractures: if not treated promptly, these lesions can result in fibrosis or erectile dysfunction. Penile traumatic lesions need a clinical approach first, but a radiological study is often required: ultrasonography with color and spectral Doppler study is usually the first approach. In some cases, magnetic resonance imaging may be performed to better recognize even small discontinuity of the tunica albuginea. Radiologists have to be aware of the various radiological patterns of penile traumatic lesions, in order to establish a prompt and correct diagnosis.


Assuntos
Pênis/lesões , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/diagnóstico por imagem , Cicatriz/etiologia , Serviço Hospitalar de Emergência , Disfunção Erétil/etiologia , Fibrose/etiologia , Hematoma/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Ereção Peniana , Pênis/anatomia & histologia , Priapismo/etiologia , Ruptura/diagnóstico por imagem , Ruptura/etiologia , Ultrassonografia Doppler em Cores , Uretra/diagnóstico por imagem , Uretra/lesões , Ferimentos não Penetrantes/complicações , Ferimentos Penetrantes/complicações
12.
Ann R Coll Surg Engl ; 101(6): e139-e141, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31155906

RESUMO

Urethral diverticulum is a condition where the urethra or the periurethral glands push into the connective tissue layers that surround it. Patients of urethral diverticulum present with nonspecific symptoms such as incontinence, urinary frequency and urgency, and pain during sexual intercourse and urination. The incidence of this condition is low. We report a case of giant anterior urethra stones combined with a diverticulum with no lower urinary tract symptoms. We believe that this case is extremely rare, and the process of diagnosis and treatment is of great significance in clinical practice.


Assuntos
Divertículo/complicações , Doenças Uretrais/complicações , Cálculos Urinários/complicações , Divertículo/diagnóstico , Divertículo/diagnóstico por imagem , Divertículo/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Uretra/diagnóstico por imagem , Uretra/cirurgia , Doenças Uretrais/diagnóstico , Doenças Uretrais/diagnóstico por imagem , Doenças Uretrais/cirurgia , Cálculos Urinários/diagnóstico , Cálculos Urinários/diagnóstico por imagem , Cálculos Urinários/cirurgia
13.
Acta Biomed ; 90(2): 259-264, 2019 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-31125005

RESUMO

INTRODUCTION: Sexologists have described the urethrovaginal space (UVS) as a region of the body involved in the female orgasm. Recently certain authors have described the UVS via ultrasound (US). Pregnancy is associated with a myriad of physiological, anatomical and biochemical changes. To measure the UVS thickness in the third trimester of pregnancy and to investigate the relationship between the UVS thickness and the presence of vaginal orgasm. MATERIAL AND METHODS: Sexually active pregnant patients in the third trimester were included. We measured the UVS via US. Each patient compiled a modified female sexual function index (FSFI) questionnaire and was categorized in group with or without vaginal orgasm. Association between vaginal orgasm and UVS thickness was evaluated via t-test and ROC curve analysis. RESULTS: UVS thickness resulted greater than 15 mm (average) in the third trimester, and was not related to the presence of vaginal orgasm (p>0.05). CONCLUSION: UVS thickness is high in the third trimester of pregnancy but it is not related to the presence of vaginal orgasm.


Assuntos
Orgasmo/fisiologia , Terceiro Trimestre da Gravidez , Inquéritos e Questionários , Uretra/anatomia & histologia , Vagina/anatomia & histologia , Adulto , Distribuição de Qui-Quadrado , Estudos de Coortes , Feminino , Humanos , Itália , Gravidez , Ultrassonografia Pré-Natal , Uretra/diagnóstico por imagem , Vagina/diagnóstico por imagem , Adulto Jovem
14.
Radiol Med ; 124(9): 812-818, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31087214

RESUMO

PURPOSE: We performed this prospective cohort study to compare the accuracy and technical characteristics of ultra-low-dose CT cystography with those of conventional retrograde cystography. MATERIALS AND METHODS: A cohort of 31 patients referred for cystography after bladder repair were enrolled. To detect urine leakage, we initially performed conventional cystography after retrograde distention of the bladder with dilute iodinated contrast material, followed by ultra-low-dose CT cystography. The diagnostic accuracy of these two modalities was compared, and the technical characteristics of ultra-low-dose CT cystography were examined. RESULTS: All 31 referred patients were included in this study. Of the 31 patients, 27 (87.1%) underwent bladder repair after radical prostatectomy, 3 (9.7%) after radical cystectomy, and 1 (3.2%) after bladder diverticulectomy. Four of the 31 patients were diagnosed with urine leakage by conventional cystography. These four patients were confirmed to have urine leakage by ultra-low-dose CT cystography. Another five patients who did not have urine leakage according to conventional cystography were diagnosed with urine leakage by ultra-low-dose CT cystography. Moreover, performing ultra-low-dose CT cystography enabled us to identify the precise location and amount of urine leakage in all nine patients. Based on these findings, we were able to establish a proper treatment plan. CONCLUSIONS: Ultra-low-dose CT cystography is an accurate method for evaluating urine leakage after bladder repair, and this technique may help determine the most appropriate treatment strategy for patients with urine leakage after bladder repair.


Assuntos
Fístula Anastomótica/diagnóstico por imagem , Cistectomia , Cistografia/métodos , Tomografia Computadorizada por Raios X/métodos , Uretra/diagnóstico por imagem , Uretra/cirurgia , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/cirurgia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doses de Radiação , Urina
15.
Med Phys ; 46(7): 3034-3043, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31049993

RESUMO

PURPOSE: Assessment of urethral dynamics is clinically regarded to be important in analyzing the functional impact of pathological features like urethral obstruction, albeit it is difficult to perform directly in vivo. To facilitate such an assessment, urethra phantoms may serve well as investigative tools by reconstructing urethral dynamics based on anthropomorphic factors. Here, our aim is to design a new class of anatomically realistic, deformable urethra phantoms that can simulate the geometric, mechanical, and hydrodynamic characteristics of the male prostatic urethra. METHODS: A new lost-core tube casting protocol was devised. It first involved the drafting of urethra geometry in computer-aided design software. Next, 3D printing was used to fabricate the urethra geometry and an outer mold. These parts were then used to cast a urinary tract using a polyvinyl alcohol (PVA)-based material (with 26.6 ± 4.0 kPa Young's elastic modulus). After forming a surrounding tissue-mimicking slab using an agar-gelatin mixture (with 17.4 ± 3.4 kPa Young's modulus), the completed urethra phantom was connected to a flow circuit that simulates voiding. To assess the fabricated phantoms' morphology, ultrasound imaging was performed over different planes. Also, color Doppler imaging was performed to visualize the flow profile within the urinary tract. RESULTS: Deformable phantoms were devised for the normal urethra and a diseased urethra with obstruction due to benign prostatic hyperplasia (BPH). During voiding, the short-axis lumen diameter at the verumontanum of the BPH-featured phantom (0.91 ± 0.08 mm) was significantly smaller than that for the normal phantom (2.49 ± 0.20 mm). Also, the maximum flow velocity of the BPH-featured phantom (59.3 ± 5.8 cm/s; without Doppler angle correction) was found to be higher than that of the normal phantom (22.7 ± 9.0 cm/s). CONCLUSION: The fabricated phantoms were effective in simulating urethra deformation resulting from urine passage during voiding. They can be used for mechanistic studies of urethral dynamics and for the testing of urodynamic diagnostic techniques in urology.


Assuntos
Imagens de Fantasmas , Próstata/fisiologia , Urodinâmica , Fenômenos Biomecânicos , Humanos , Masculino , Próstata/diagnóstico por imagem , Próstata/fisiopatologia , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/patologia , Hiperplasia Prostática/fisiopatologia , Ultrassonografia , Uretra/diagnóstico por imagem , Uretra/patologia , Uretra/fisiopatologia , Sistema Urinário/anatomia & histologia , Sistema Urinário/diagnóstico por imagem , Sistema Urinário/patologia
17.
Pediatr Int ; 61(6): 595-600, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30888085

RESUMO

BACKGROUND: There is confusion surrounding the precise indications for voiding cystourethrography (VCUG) during the assessment of vesicoureteral reflex (VUR) after a first febrile urinary tract infection (UTI). The aim of this study was to determine the combination of clinical, laboratory and ultrasonography factors correlating with grades IV-V VUR in young children with a first febrile UTI. METHODS: Children 0-24 months of age who were brought to the emergency department at National Center for Child Health and Development with the diagnosis of first time febrile UTI between March 2004 and May 2011, were enrolled. We compared clinical, laboratory and ultrasonography findings between children with grades IV-V VUR (high-grade VUR) and those with no or grades I-III VUR (normal or low-grade VUR). RESULTS: A total of 231 patients were eligible and 19 had high-grade VUR. Poor clinical appearance, presence of a uropathogen other than Escherichia coli, positive blood culture, hydroureter and thickened renal pelvic wall were all independently associated with high-grade VUR. When one or more of these factors were present, sensitivity, specificity, positive or negative predictive value, and positive or negative likelihood ratio were 94.7%, 69.4%, 23.1%, 99.3%, 3.1 and 0.1, respectively. When none of the factors was present, the proportion of high-grade VUR was 0.7%; if one factor, 11.3%; two factors, 55.6%; three factors, 85.7%. CONCLUSIONS: In the absence of five specific factors during the first febrile UTI episode in young children, VCUG is not necessary to detect high-grade VUR. When more than one factor is present, however, VCUG is indicated.


Assuntos
Cistografia , Uretra/diagnóstico por imagem , Infecções Urinárias/complicações , Refluxo Vesicoureteral/diagnóstico por imagem , Pré-Escolar , Feminino , Febre/etiologia , Humanos , Lactente , Recém-Nascido , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Ultrassonografia , Procedimentos Desnecessários , Refluxo Vesicoureteral/etiologia
18.
Urology ; 128: 96-101, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30890421

RESUMO

OBJECTIVE: To describe our experience with management of lower genitourinary foreign bodies (FBs); to introduce our novel, but simple and minimally-invasive retrieval method compared with standard techniques for anterior urethral FBs; and to propose a derived, practical management algorithm. METHODS: We reviewed all male patients presenting with inserted urethral and/or bladder FBs between January2000 and October 2018. Patient characteristics and number of episodes were identified. Episodes were stratified by FB type, FB location, diagnostic modality, and removal method. We performed a subgroup analysis of anterior urethral FB management techniques comparing retrieval outcomes using our novel Retrieval of Anterior urethral Materials Safely (RAMS) technique which utilizes urethral hydrodistension via retrograde injection of lidocaine jelly to expel FBs vs forceps extraction. Cost analyses were performed, and a management algorithm was then derived. RESULTS: We identified 116 episodes. Eighty-seven of 116 (75%) episodes involved items located within the anterior urethra. A subset of episodes (14/116, 12%) was managed using the RAMS technique. There was no difference in FB extraction success rates between RAMS (13/14, 92.9%) and forceps extraction (37/40, 92.7%), P = 1.00. FBs were successfully removed using RAMS when utilized for nonembedded FBs located entirely within the anterior urethra. Among FBs located within the anterior urethra, the median total hospital cost was nearly 10 times less with utilization of RAMS compared with cystoscopic extraction ($379.09 v s$3,214.21, P <.05). CONCLUSION: Because an overwhelming majority of FBs are located within the anterior urethra, the RAMS technique represents a simple, cost-conscious, and minimally-invasive strategy with low risk and potentially high-yield for initial extraction in the emergency department.


Assuntos
Corpos Estranhos/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Uretra/lesões , Doenças Uretrais/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto , Seguimentos , Corpos Estranhos/diagnóstico , Humanos , Masculino , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Uretra/diagnóstico por imagem , Doenças Uretrais/diagnóstico
19.
Injury ; 50(5): 1053-1057, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30857738

RESUMO

Urethral injury in major trauma is infrequent, with complex problems of diagnosis and treatment. The aims of this study are to determine the incidence and epidemiological factors relating to urethral injury in major trauma, as well as determine if any additional prognostic factors are evident within this cohort of patients. A retrospective review of patients sustaining urethral injury following major trauma was made over a 6-year period, from 2010 to 2015. Quantitative analysis was made using the national trauma registry for England and Wales, the Trauma Audit and Research Network (TARN) database, identifying all patients with injury codes for urethral injury. 165 patients with urethral injuries were identified, over 90% were male, most commonly injured during road traffic accidents and with an associated overall mortality of 12%. Urethral injury in association with pelvic fracture occurred in 136 patients (82%), representing 0.6% of all pelvic fractures, and was associated with double the rate of mortality. Urethral injury was associated with unstable pelvic fractures (LC2, LC3, APC3, VS, CM) but not with a specific pelvic fracture type. This study confirms the rare incidence of this injury in major trauma at 1 per 2 million population per year.


Assuntos
Traumatismos Abdominais/complicações , Fraturas Ósseas/complicações , Traumatismo Múltiplo/fisiopatologia , Ossos Pélvicos/lesões , Uretra/lesões , Traumatismos Abdominais/diagnóstico por imagem , Adulto , Estudos de Avaliação como Assunto , Feminino , Fraturas Ósseas/diagnóstico por imagem , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/epidemiologia , Ossos Pélvicos/diagnóstico por imagem , Guias de Prática Clínica como Assunto , Reino Unido/epidemiologia , Uretra/diagnóstico por imagem , Uretra/fisiopatologia
20.
J Urol ; 202(3): 552-557, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30840543

RESUMO

PURPOSE: We evaluated the role of magnetic resonance imaging of the penis in the diagnosis of penile fracture and/or concomitant urethral lesions in real-life emergency settings compared with intraoperative findings. MATERIALS AND METHODS: A total of 43 patients presented with suspicion of penile fracture between January 2006 and December 2016. Magnetic resonance imaging was performed in 28 patients prior to surgical treatment in the emergency setting. Surgery was done in all patients via a subcoronal, circumferential degloving approach. We calculated sensitivity, specificity, and positive and negative predictive values as well as likelihood ratios of the positive and negative results of the agreement between magnetic resonance imaging and intraoperative findings. RESULTS: Intraoperatively penile fracture was confirmed in 19 of 28 patients (67.9%) and a concomitant urethral lesion was observed in 5 of 28 (17.9%). Magnetic resonance imaging findings were highly associated with intraoperative findings of tunical rupture, including 100% sensitivity (95% CI 98.5-100), 77.8% specificity (95% CI 50.6-100), 90.5% positive predictive value (95% CI 78-100), 100% negative predictive value (95% CI 97.6-100) and a positive result likelihood ratio of 4.5. Magnetic resonance imaging had lower accuracy for urethral lesions with 60% sensitivity (95% CI 17.1-100), 78.3% specificity (95% CI 61.5-95.1), 37.5% positive predictive value (95% CI 4-71), 90% negative predictive value (95% CI 76.9-100) and a positive result likelihood ratio of 2.76. CONCLUSIONS: Magnetic resonance imaging may be applicable in the emergency setting if the goal is to treat all men who warrant intervention. It has high sensitivity and negative predictive value for tunical rupture and concomitant urethral lesions. Therefore, it could help avoid unnecessary surgery by excluding the diagnosis. However, solitary magnetic resonance imaging is not sufficient for diagnosis and it should not replace clinical assessment or delay surgical exploration.


Assuntos
Imagem por Ressonância Magnética , Pênis/lesões , Ruptura/diagnóstico por imagem , Uretra/lesões , Adulto , Idoso , Emergências , Humanos , Masculino , Pessoa de Meia-Idade , Pênis/diagnóstico por imagem , Pênis/cirurgia , Valor Preditivo dos Testes , Ruptura/cirurgia , Sensibilidade e Especificidade , Uretra/diagnóstico por imagem , Uretra/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos
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