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1.
Urologiia ; (3): 82-86, 2021 Jun.
Artigo em Russo | MEDLINE | ID: mdl-34251106

RESUMO

AIM: To study the influence of the technique of posterior reconstruction of the vesicourethral anastomosis (VUA) on the prevention of urinary incontinence after robotic-assisted radical prostatectomy (RARP). MATERIAL AND METHODS: A total of 67 patients (mean age 63 years) with localized prostate cancer were included in the study. All patients were divided into two groups. In the group 1 (n=32) the standard technique of the VUA was used, while in the group 2 (n=35) the two-layer posterior reconstruction was done. The impact of urinary incontinence on the quality of life was analyzed using the ICIQ-SF questionnaire 1, 3 and 6 months after operation. On postoperative days 5-7, all patients underwent cystography to assess the tightness of the VUA. RESULTS: One month after RARP in the group 1 the mean score of ICIQ-SF questionnaire was 6.72, compared to 4.57 in group 2 (p=0.04). After 3 and 6 months the respective values were 3.8 vs. 2.3 (p=0.09) and 1.94 vs. 1.2 (p=0.23), respectively. Cystography revealed no extravasation of the contrast. CONCLUSION: The results of a retrospective comparative study suggest that a two-layer posterior reconstruction of the VUA during RARP, being a simple method, provides better continence rate one month postoperatively compared to standard technique, although larger randomized clinical trials are needed.


Assuntos
Neoplasias da Próstata , Procedimentos Cirúrgicos Robóticos , Anastomose Cirúrgica , Humanos , Masculino , Pessoa de Meia-Idade , Prostatectomia , Neoplasias da Próstata/cirurgia , Qualidade de Vida , Estudos Retrospectivos , Uretra/diagnóstico por imagem , Uretra/cirurgia , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/cirurgia
2.
Arch Esp Urol ; 74(4): 449-454, 2021 May.
Artigo em Espanhol | MEDLINE | ID: mdl-33942739

RESUMO

INTRODUCTION: Urethral insertion of foreign bodies is an infrequent emergency, being it exceptionally rare in prepubertal children. Both clinical presentation and the introduced elements are varied. Although sexualabuse and mental disorders must always be considered, these events are mainly related to the children's own  body self-discovery without any sexual connotation. Endourologic approach is the treatment of choice while the need for conventional surgery is unusual. OBJECTIVE: To review clinical and therapeutic aspects of the insertion of urethral foreign bodies in early childhood, and to report two new clinical cases. MATERIALS AND METHODS: A 7-year-old boy and a 5-year-old boy, brought to emergency for referring the insertion of a metallic foreign body in the urethra. Both were oligosymptomatic, and the diagnosis was confirmed by radiology. They were treated with an endourological approach without any complications. CONCLUSION: The introduction of foreign bodies in the urinary tract is an unusual problem in prepubertal children. Theirs approach must be individualized, not only limited to the removal of the foreign body but also to the exclusion of child abuse and psychiatric disorders.


Assuntos
Corpos Estranhos , Criança , Pré-Escolar , Serviço Hospitalar de Emergência , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Humanos , Masculino , Radiografia , Comportamento Sexual , Uretra/diagnóstico por imagem , Uretra/cirurgia
3.
Urologiia ; (2): 86-89, 2021 May.
Artigo em Russo | MEDLINE | ID: mdl-33960164

RESUMO

Urethral destruction in women is a rare pathology which is result of traumatic damage of the urethra during pelvic fractures, sexual trauma, iatrogenic effects (operative vaginal delivery, prolonged catheterization of the bladder, complicated surgical interventions on the urethra, etc.). The main symptom of urethral destruction is involuntary urinary incontinence. The relevance and complexity of this problem are determined by the fact that the choice of surgical treatment for urethral destruction is still unsolved. This requires such kind of intervention, which will be aimed not only at restoring of the anatomy, but also at correcting urinary incontinence - often in several stages. This article describes two clinical cases of urethral destruction in women with iatrogenic damage to the urethra.


Assuntos
Fraturas Ósseas , Ossos Pélvicos , Incontinência Urinária por Estresse , Incontinência Urinária , Feminino , Humanos , Masculino , Uretra/diagnóstico por imagem , Uretra/cirurgia , Bexiga Urinária , Incontinência Urinária/etiologia , Incontinência Urinária/cirurgia , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária por Estresse/cirurgia
4.
Eur J Obstet Gynecol Reprod Biol ; 261: 148-153, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33940425

RESUMO

OBJECTIVE: We aimed to compare the morphological characteristics of pelvis and urethra in nulliparous pregnant women with and without stress urinary incontinence (SUI) by 3D high-frequency endovaginal ultrasound (3D-EVUS). STUDY DESIGN: At 36-38 weeks of gestation, 40 nulliparous pregnant women with and without SUI underwent 3D-EVUS assessment. The anteroposterior and transverse diameters of levator hiatus (LH), pubovisceral muscle thicknesses at 3,9 and 12 o'clock, right and left paravaginal areas, symphysis angle, bladder-symphysis distance (BSD), uretral complex thickness (Ut), urethral complex width (Uw), urethral complex volume (UV), urethral length (UL), intramural urethra, rhabdosphincter thickness (Rt), rhabdosphincter width (Rw), rhabdosphincter length (RL), and rhabdosphincter volume (RV) were measured by 3D-EVUS. RESULTS: Longer LH transverse diameter (34.8 ± 3.8 mm vs 31.1 ± 2.1 mm), shorter LH anteroposterior diameter (47.8 ± 6.2 mm vs 52.4 ± 2.6 mm), and wider symphysis angle (116.3 ± 5.6 vs 111.5 ± 5.3 degrees) were detected in nulliparous pregnant women with SUI compared those without SUI (p = 0.001, p = 0.001 and p = 0.013; respectively). RV of less than 1.26 cm3 was found to have a sensitivity of 100 % and a specificity of 100 % for the presence of SUI in nulliparous pregnant women. CONCLUSIONS: Constitutionally different pelvic shape and decreased urethral rhabdosphincter measurements can be used to predict SUI in nulliparous pregnant women.


Assuntos
Incontinência Urinária por Estresse , Feminino , Humanos , Masculino , Pelve , Gravidez , Ultrassonografia , Uretra/diagnóstico por imagem , Bexiga Urinária/diagnóstico por imagem , Incontinência Urinária por Estresse/diagnóstico por imagem
5.
BMJ Case Rep ; 14(5)2021 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-34011667

RESUMO

An 8-month-old male child presented with the complaint of two separate urinary streams from the penis. The child had no complaints of incontinence or recurrent UTI (urinary tract infection). Initial diagnosis of urethrocutaneous fistula was made and proceeded to micturating cystourethrography (MCU) and found to be having a urethral duplication. The duplicated urethra was excised and accessory urethra closed. Postoperatively, the child was followed up for 1 year and had no complaints of recurrence or incontinence. Through this case report, we learn about different classification systems and types of urethral duplication and their associated anomalies, and mode of management, which is mainly surgical. Further, management should be individualised to each patient based on their complaints and intraoperative findings.


Assuntos
Fístula , Doenças Uretrais , Infecções Urinárias , Criança , Humanos , Lactente , Masculino , Pênis/diagnóstico por imagem , Pênis/cirurgia , Uretra/diagnóstico por imagem , Uretra/cirurgia , Doenças Uretrais/diagnóstico por imagem , Doenças Uretrais/cirurgia
8.
Ann R Coll Surg Engl ; 103(4): e114-e115, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33661045

RESUMO

Neuropathic bladder may be a co-associated morbidity in newborn babies following resection of a sacrococcygeal teratoma. We report a case of a male newborn showing features of incomplete urinary voiding requiring intermittent catheterisation after operation for bladder emptying. Videourodynamic assessment excluded neuropathic bladder and posterior urethral valves were demonstrated on micturating cystography. Urology outcomes have been excellent following curative valve ablation. This report highlights the crucial importance of being aware of the rare coexistence of lower urinary tract pathology in male babies with sacrococcygeal teratoma. Routine urodynamic assessment should be considered in all children following sacrococcygeal teratoma resection.


Assuntos
Complicações Pós-Operatórias/diagnóstico , Teratoma/cirurgia , Uretra/anormalidades , Bexiga Urinaria Neurogênica/diagnóstico , Anormalidades Urogenitais/diagnóstico , Cistografia , Diagnóstico Diferencial , Humanos , Recém-Nascido , Masculino , Região Sacrococcígea , Teratoma/complicações , Teratoma/diagnóstico , Uretra/diagnóstico por imagem , Anormalidades Urogenitais/etiologia
10.
J Pediatr Urol ; 17(2): 231.e1-231.e7, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33648856

RESUMO

INTRODUCTION: Anterior urethral valves (AUV) are a rare cause of lower urinary tract obstruction which could progress to renal damage, Clinical presentation varies according with patient's age and severity of obstruction, but, in most cases, diagnosis is based on voiding cysto-urethrogram (VCUG). To date, the treatment of choice is endoscopic ablation even if approved guidelines about the overall management of AUVs, including the recognition and treatment of residual valves, are not available. OBJECTIVE: We describe our protocol for AUV treatment based on primary endoscopic valve ablation followed by check cystoscopy 15 days later. STUDY DESIGN: Medical records of 5 patients with AUVs admitted from 2008 to 2018 to our Pediatric Urology Unit were retrospectively reviewed. Blood tests, urinalysis, renal US and VCUG were performed in all children, while urodynamic evaluation was performed in the 3/5 patients who could void spontaneously. All patients underwent endoscopic valves ablation and after 15 days after a second look cystoscopy was performed. Follow up was based on clinical and radiological evaluation with US, urinalysis and blood tests. Postoperative non-invasive urodynamic studies were performed in the 3/5 patient toilet-trained patients and VCUG was performed in 1/5 patient. RESULTS: and Discussion: At primary endoscopic ablation cystoscopy revealed AUVs in the penile urethra in three patients, in the penoscrotal urethra in one case, in the bulbar urethra in another case. In 3/5 patients check cystoscopy found residual valves and a second endoscopic ablation was performed. All patients achieved symptoms release and improved urodynamic parameters. No intra or post-operative complication were reported. The assessment of residual valves is variable in literature and it is usually described for posterior urethral valves (PUVs). Few series report the use of VCUG within the first week after valve ablation, our experience instead suggests that performing a second look cystoscopy, is very effective to evaluate the presence of residual AUVs and eventually proceed with further ablation. CONCLUSION: Endoscopic ablation is the gold standard treatment for AUV, but residual valves management is not clearly defined. According to our experience, a check cystoscopy 15 days after primary ablation allows to identify and treat possible residual valves showing good results in terms of safety and efficacy.


Assuntos
Cistoscopia , Obstrução Uretral , Criança , Humanos , Masculino , Estudos Retrospectivos , Uretra/diagnóstico por imagem , Uretra/cirurgia , Obstrução Uretral/diagnóstico por imagem , Obstrução Uretral/etiologia , Urodinâmica
11.
J Med Case Rep ; 15(1): 91, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33608031

RESUMO

BACKGROUND: Primary urethral carcinoma (PUC) is rare and accounts for < 1% of all genito-urinary cancers. There is a male predominance of 3:1 and a peak incidence in the 7th and 8th decades. The aetiology of this cancer is similar to penile cancer, and the human papilloma virus (HPV) is thought to be an essential factor in tumorigenesis. Urethral cancer should be diagnosed and staged with a combination of tumour biopsy, MRI, and CT with treatment involving a multimodal approach. Contemporary management emphasises phallus-preserving surgery where feasible. CASE PRESENTATION: Here, we describe a case of distal urethral carcinoma, which presented as a metastatic groin mass and identifying the primary lesion proved challenging. Diagnostic flexible cystoscopy identified a tiny lesion in the navicular fossa, which was biopsied and confirmed to be a squamous cell carcinoma. The patient then underwent phallus preserving surgery, including distal urethrectomy with bilateral inguinal lymph node dissections. The final stage was pT1N1M0, and adjuvant chemotherapy was started. The distal urethrectomy involved the surgical creation of a hypospadic meatus in the midshaft of the penis. Normal voiding and sexual function were preserved. CONCLUSIONS: Urethral cancer is a rare malignancy and clinicians should bear in mind that early diagnosis of this disease can be very difficult depending on the anatomical location of the tumour. Treatment currently favours penis-preserving surgery.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Penianas , Neoplasias Uretrais , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/cirurgia , Humanos , Masculino , Neoplasias Penianas/diagnóstico por imagem , Neoplasias Penianas/cirurgia , Pênis , Uretra/diagnóstico por imagem , Uretra/cirurgia , Neoplasias Uretrais/diagnóstico por imagem , Neoplasias Uretrais/cirurgia
12.
BMC Urol ; 21(1): 17, 2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33541312

RESUMO

BACKGROUND: Several approaches for urethral catheterization after the failure of initial urethral catheterization have been introduced. However, standard procedures regarding what should be done after failed conventional urethral catheterization have been not established. Therefore, we investigated the clinical efficacy of retrograde urethrography (RGU)-assisted urethral catheterization after failed conventional urethral catheterization. METHODS: Between July 2015 and July 2018, 136 patients who underwent RGU-assisted urethral catheterization after failed conventional urethral catheterization were included in this retrospective study. Patients' clinical data, such as age, catheterization site, and previous history of urologic operations, were collected and assessed via chart review. Univariate and multivariate logistic regression analyses were performed to identify predictive factors for the failure of this procedure. RESULTS: Of the 136 patients, 94 (69.1%) experienced successful RGU-assisted urethral catheterization. Having a previous history of urologic operations, such as urethrotomy and transurethral prostatectomy, was identified as an independent predictive factor for the failure of RGU-assisted urethral catheterization (odds ratio = 9.453, 95% confidence interval = 2.703-33.063, p < 0.001). CONCLUSIONS: RGU-assisted urethral catheterization can be one of the modalities for providing successful catheterization after failed conventional urethral catheterization. We believe that RGU-assisted urethral catheterization can be an effective procedure if patients have no previous history of urologic operations, such as urethrotomy and transurethral prostatectomy. Trial registration Soonchunhyang university institutional review board approval (No. 2018-08-021).


Assuntos
Uretra/diagnóstico por imagem , Cateterismo Urinário/métodos , Urografia , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Urografia/métodos
13.
J Small Anim Pract ; 62(5): 365-372, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33604908

RESUMO

OBJECTIVE: The aim of this study was to investigate causes for feline urethral obstruction and determine whether the frequency of radiographic diagnoses differs between cats radiographed before or after unobstruction of the urethra. MATERIALS AND METHODS: A retrospective cross-sectional study of cats with naturally occurring urethral obstruction was performed. Only cats presenting for their first urethral obstruction in which radiography was integrated in the initial evaluation were included. The diagnosis frequency (overall and for each disease type) was compared between cats radiographed before or after unobstruction of the urethra. RESULTS: Eighty cats (52%) had radiographs obtained before unobstructing the urethra and 73 cats (48%) had radiographs taken after unobstructing the urethra. Cats radiographed before unobstruction had a greater frequency of radiographic diagnoses than those radiographed after unobstruction (61% versus 45%). This difference was largely due to a greater frequency of urethral plugs detected before unobstruction versus after unobstruction (45% versus 5.5%). CLINICAL SIGNIFICANCE: Radiographs obtained before unobstructing the urethra provided a diagnostic advantage for detecting a cause for urethral obstruction compared to radiographs obtained after unobstructing the urethra. Urethral plugs were the most common diagnosis.


Assuntos
Doenças do Gato , Obstrução Uretral , Animais , Doenças do Gato/diagnóstico por imagem , Doenças do Gato/epidemiologia , Gatos , Estudos Transversais , Masculino , Radiografia , Estudos Retrospectivos , Uretra/diagnóstico por imagem , Obstrução Uretral/diagnóstico por imagem , Obstrução Uretral/epidemiologia , Obstrução Uretral/etiologia , Obstrução Uretral/veterinária
14.
Abdom Radiol (NY) ; 46(5): 2115-2126, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33386912

RESUMO

Urethral strictures arise from a variety of etiologies, most commonly either iatrogenic or inflammatory in the anterior urethra and iatrogenic/surgical or traumatic etiologies in the posterior urethra. Diagnosis and treatment planning depend on urethrography, usually performed with a combination of retrograde urethrography (RUG) and voiding cystourethrography (VCUG) to evaluate the anterior and posterior urethra, respectively. While this is most commonly performed fluoroscopically, sonographic urethrography is an alternative, although at the expense of the posterior urethra, it is only visualized using a transrectal approach. In addition to understand urethral anatomy, familiarity with normal periurethral structures is necessary to avoid misdiagnosis, such as Cowper's ducts, the glands of Littré, and the prostatic and ejaculatory ducts. Surgical management depends on the stricture location, length, and number and options range from balloon dilatation to endoscopic urethrotomy to anastomotic and substitution urethrotomy. Postprocedural management includes urethrography to identify potential complications including urethral leak, graft failure, and stricture recurrence.


Assuntos
Estreitamento Uretral , Anastomose Cirúrgica , Constrição Patológica , Humanos , Masculino , Uretra/diagnóstico por imagem , Estreitamento Uretral/diagnóstico por imagem , Procedimentos Cirúrgicos Urológicos
15.
Medicina (Kaunas) ; 57(1)2021 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-33435420

RESUMO

Background and Objectives: Vesicoureteral reflux (VUR) describes a common pediatric anomaly in pediatric urology with a prevalence of 1-2%. In diagnostics, in addition to the gold standard of voiding cystourethrography (VCUG), contrast-enhanced urosonography (ceVUS) offers a radiation-free procedure, which, despite its advantages, is not yet widely used. In the present single-center study, subsequent therapeutic procedures and outcomes after ceVUS of 49 patients were investigated. The aim of the study is to investigate the efficacy of ceVUS with the intention of broader clinical implementation. Materials and Methods: Between 2016 and 2020, 49 patients were retrospectively included and received a ceVUS to evaluate VUR. With a distribution of 47:2 (95.9%), a clear female predominance was present. The age of the patients varied between 5 months and 60 years at the time of ceVUS. All examinations were all performed and subsequently interpreted by a single experienced radiologist (EFSUMB level 3). Results: Compared to intraoperative findings, ceVUS shows a sensitivity of 95.7% with a specificity of 100%. Allergic reactions to the contrast medium could not be observed. Conclusion: With its high sensitivity and intraoperative validation, ceVUS offers an excellent alternative to VCUG, the gold standard in the diagnosis of VUR. In addition, ceVUS is a radiation-free examination method with a low risk profile that offers an exceptional diagnostic tool in the diagnostic clarification of recurrent urinary tract infections with the suspected diagnosis of VUR and should also be included in the consideration of a diagnosis next to the established VCUG, especially in younger children.


Assuntos
Meios de Contraste , Técnicas de Diagnóstico Urológico , Ultrassonografia/métodos , Refluxo Vesicoureteral/diagnóstico por imagem , Adolescente , Adulto , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Cistografia , Feminino , Humanos , Lactente , Injeções , Laparoscopia , Masculino , Pessoa de Meia-Idade , Fosfolipídeos , Politetrafluoretileno , Exposição à Radiação , Recidiva , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Hexafluoreto de Enxofre , Ureteroscopia , Uretra/diagnóstico por imagem , Bexiga Urinária/diagnóstico por imagem , Infecções Urinárias/etiologia , Infecções Urinárias/prevenção & controle , Urografia , Refluxo Vesicoureteral/classificação , Refluxo Vesicoureteral/complicações , Refluxo Vesicoureteral/terapia , Adulto Jovem
16.
Int J Urol ; 28(5): 538-543, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33483992

RESUMO

OBJECTIVES: Female urethral stricture is a rare disease. Urethroplasty with different techniques using grafts or flaps are successful treatment options. The objective of this study was to present our experience with ventral onlay buccal mucosa graft urethroplasty for the treatment of female urethral stricture disease. METHODS: Eight female patients treated with ventral onlay buccal mucosa graft urethroplasty were identified retrospectively. Patient evaluation included physical examination, uroflowmetry with postvoid residual urine measurement, videourodynamics and urethrocystoscopy. Stricture was identified by videourethrography and/or urethrocystoscopy. Urodynamic evidence of stricture was considered as a persistent low maximum flow rate of <12 mL/s combined with detrusor pressure at maximum measured flow rate of >20 cmH2 O in the pressure flow study. RESULTS: The mean age was 50.5 ± 4.14 years. Stricture etiology was idiopathic (62.5%) or iatrogenic (37.5%). Two patients (25%) had undergone prior urethral dilations before buccal mucosa graft urethroplasty. Mean stricture length was 1.62 ± 0.44 cm. Stricture location was as follows: four distal urethra (50%), two mid-distal (25%) and two mid-urethra (25%). The mean postoperative follow-up period was 16.37 ± 5.75 months, and the during follow-up success rate was 100%. No complication, such as incontinence or vaginal fistula, was noted, except dyspareunia developed in one patient (12.5%). CONCLUSIONS: Ventral onlay buccal mucosa graft urethroplasty is a safe and effective treatment option for female urethral stricture. Unnecessary dilation should not be carried out and buccal mucosa graft urethroplasty in expert centers should be recommended to these patients.


Assuntos
Estreitamento Uretral , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Bucal , Estudos Retrospectivos , Resultado do Tratamento , Uretra/diagnóstico por imagem , Uretra/cirurgia , Estreitamento Uretral/diagnóstico por imagem , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
17.
Curr Urol Rep ; 22(2): 14, 2021 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-33515366

RESUMO

PURPOSE OF REVIEW: This review summarizes recent developments in gender affirmation surgery, imaging findings in patients undergoing these surgeries, focusing on common postoperative radiologic appearances, complications, and pitfalls in interpretation. RECENT FINDINGS: The imaging workup of masculinizing and feminizing genitourinary surgeries uses multiple modalities in presurgical planning and within the immediate and long-term postoperative period. CT and MRI can help identify immediate and remote postoperative complications. Fluoroscopic examinations can diagnose postoperative urethral complications after gender affirmation surgeries. Lastly, the patients can undergo imaging for unrelated acute and chronic pathology, and knowledge of these imaging findings can be very helpful. Imaging plays a significant role in the care of transgender patients and, particularly, in those pursuing gender affirmation surgery. As insurance coverage expands for these surgical procedures, radiologists should be prepared to encounter, understand, and interpret pre and postoperative findings.


Assuntos
Cirurgia de Readequação Sexual , Transexualidade/cirurgia , Uretra/diagnóstico por imagem , Feminino , Fluoroscopia , Humanos , Imageamento por Ressonância Magnética , Masculino , Período Perioperatório , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Cirurgia de Readequação Sexual/efeitos adversos , Tomografia Computadorizada por Raios X , Uretra/cirurgia
18.
Vet Radiol Ultrasound ; 62(3): 342-349, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33476091

RESUMO

Sono-urethrography is a technique used to evaluate the integrity of the urethra utilizing fluid dilation of the urethral lumen. The purpose of this prospective, method comparison, pilot study was to investigate the feasibility of sono-urethrography in male dogs and to compare the quality of the images obtained using three different contrast solutions. The prostatic, membranous, and penile urethra was evaluated using saline, agitated saline, and ultrasound contrast agent (Sonovue) in 10 adult, male Beagles. Visibility of the urethral wall was better with sono-urethrography than with conventional ultrasonography, and the conspicuity of urethra could be assessed using all solutions. Hyperechoic lines created by agitated saline and Sonovue were more useful than anechoic saline in allowing identification of the urethra. Visibility scores for the internal margin of the urethral wall using sono-urethrography were significantly higher with saline and one-minute post agitated saline injection. However, the individual layers of the urethral wall could not be observed, regardless of the contrast solution used. Shadowing created by the pelvic bone deteriorated the window through which the urethra could be visualized, and this could not be overcome using sono-urethrography. The results of this study indicated that sono-urethrography is a feasible option for the visualization of the male urethra in dogs. The authors recommend sono-urethrography using saline or agitated saline infusion to evaluate the urethral wall and lumen. Sono-urethrography using ultrasound contrast agent can be applied to assess the integrity of the urethra by improving its conspicuity.


Assuntos
Cães/anatomia & histologia , Fosfolipídeos/farmacologia , Hexafluoreto de Enxofre/farmacologia , Uretra/diagnóstico por imagem , Animais , Meios de Contraste/farmacologia , Masculino , Projetos Piloto , Estudos Prospectivos , Radiografia/métodos , Radiografia/veterinária , Ultrassonografia/métodos , Ultrassonografia/veterinária
19.
J Vasc Interv Radiol ; 32(3): 343-349, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33272814

RESUMO

PURPOSE: To evaluate the clinical outcomes of fluoroscopic primary posterior urethral realignment (PPUR) for complete posterior urethral disruption (PUD) accompanied by complex pelvic fractures. MATERIALS AND METHODS: Data from 15 male patients (median age, 58 years; range, 32-76 years) with traumatic PUD treated with fluoroscopic PPUR between 2016 and 2019 at a regional trauma center were retrospectively analyzed. The technical success (continuity of the ruptured urethra in PUD by Foley catheter placement) rate of fluoroscopic PPUR, trauma mechanism, concurrent embolization for pelvic arterial hemorrhage, time from the hospital visit to the start of the procedure, procedure time, Foley catheterization duration, and delayed complications were investigated. RESULTS: Fluoroscopic PPUR was technically successful for 13 of 15 (87%) patients. Concurrent embolization for pelvic arterial hemorrhage was performed in 11 of 15 (73%) patients. The mean time between the hospital visit and procedure initiation was 181.6 minutes ± 83.2. The mean procedure time was 66.3 minutes ± 26.6. The mean Foley catheterization duration for 13 patients (technical success group) was 52.3 days ± 39.8 (median, 40 days; range, 21-177 days). Symptomatic urethral stricture developed in 9 of 13 (69.2%) patients after the procedure; 7 underwent visual internal urethrotomy, 4 required regular urethral dilatation, and 2 needed urethral stent insertion. Three of 13 (23%) patients did not have delayed complications during the 1-year follow-up. CONCLUSIONS: PPUR with fluoroscopic guidance appears safe and effective for achieving the continuity of the ruptured urethra in PUD. It enables PPUR without general anesthesia and the lithotomy position in patients with complex pelvic fractures.


Assuntos
Endoscopia , Fraturas Ósseas/etiologia , Ossos Pélvicos/lesões , Radiografia Intervencionista , Uretra/lesões , Ferimentos não Penetrantes/terapia , Adulto , Idoso , Embolização Terapêutica , Endoscopia/efeitos adversos , Fluoroscopia , Fraturas Ósseas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Ossos Pélvicos/diagnóstico por imagem , Radiografia Intervencionista/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , Uretra/diagnóstico por imagem , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/etiologia
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