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2.
Int Braz J Urol ; 46(2): 152-157, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31961620

RESUMO

OBJECTIVE: To present the evolution and the recent data on the etiology, diagnosis, management and outcomes of penile fracture (PF) with concomitant urethral injury. MATERIALS AND METHODS: We searched the Pubmed database between 1998 and 2019 using the following key words: "penile fracture", "fracture of penis", "trauma to penis", "rupture of corpora cavernosa", "urethral injury", "urethral rupture" and "urethral reconstruction". RESULTS: The incidence of urethral lesion in patients with PF varies by geographic region and etiology. Blood in the meatus, hematuria and voiding symptoms are highly indicative of urethral rupture. The diagnosis of PF is eminently clinical and complementary exams are not necessary. The treatment consists of urethral reconstruction and the most common complications found are urethral stenosis and urethrocutaneous fistula. CONCLUSION: PF is an uncommon urological emergency, particularly in cases with urethral involvement. Urethral injury should be suspected in the presence of suggestive clinical signs, and diagnosis is usually clinical. Urgent urethral reconstruction is man-datory and produces satisfactory results with low levels of complications.


Assuntos
Doenças do Pênis , Pênis/lesões , Uretra/lesões , Doenças Uretrais/etiologia , Humanos , Masculino , Doenças do Pênis/diagnóstico , Doenças do Pênis/etiologia , Doenças do Pênis/cirurgia , Pênis/cirurgia , Ruptura/diagnóstico , Ruptura/etiologia , Ruptura/cirurgia , Uretra/cirurgia , Doenças Uretrais/cirurgia
3.
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
4.
Urology ; 134: 213-216, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31560918

RESUMO

Mayer-Rokitansky-Küster-Hauser syndrome is a congenital malformation disorder resulting in agenesis of the proximal vagina, absence of cervix, and variable development of the uterus. This report describes the repair of a complex iatrogenic urethrovaginal injury due to a missed diagnosis of Mayer-Rokitansky-Küster-Hauser. Our treatment utilized a primary urethroplasty through a transvaginal approach with bladder neck reconstruction and a Martius flap for secondary coverage. Urinary continence was restored postoperatively.


Assuntos
Transtornos 46, XX do Desenvolvimento Sexual/diagnóstico , Anormalidades Congênitas/diagnóstico , Doença Iatrogênica , Ductos Paramesonéfricos/anormalidades , Uretra/lesões , Bexiga Urinária/lesões , Incontinência Urinária/etiologia , Adolescente , Amenorreia/cirurgia , Feminino , Humanos , Hímen/cirurgia , Imagem por Ressonância Magnética , Uretra/cirurgia , Bexiga Urinária/cirurgia , Incontinência Urinária/cirurgia
5.
BMJ Case Rep ; 12(8)2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31439562

RESUMO

Iatrogenic creation of false tract in posterior urethra while managing a case of pelvic fracture urethral injury is a dreadful complication. The spectrum of presentation ranges from complete urinary incontinence to urinary retention. We describe three such cases created due to railroading or attempted repair. Case 1 presented with total urinary incontinence following open perineal urethroplasty for posterior urethral trauma while two cases presented with failure to void after endoscopic or open surgical management for the same. One patient was managed with endoscopic resection of the septum between the false passage and true posterior urethra; two cases required redo urethroplasty. All patients voided well postoperatively and were continent. Surgeon experience and meticulous endoscopic evaluation are the keys to success. Forceful attempt at per urethral catheter placement in the acute setting should be avoided. Blind railroading of the catheter and unnecessarily forceful passage of suprapubic metal bougie during urethroplasty should be condemned.


Assuntos
Fraturas Ósseas/cirurgia , Ossos Pélvicos/lesões , Uretra/lesões , Estreitamento Uretral/diagnóstico , Acidentes de Trânsito , Adulto , Diagnóstico Diferencial , Humanos , Doença Iatrogênica , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos
6.
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
7.
Hinyokika Kiyo ; 65(5): 167-170, 2019 May.
Artigo em Japonês | MEDLINE | ID: mdl-31247695

RESUMO

We report a rare case of primary adenocarcinoma in an 82-year-old man that developed 30 years after vesicocutaneostomy was performed to treat pelvic fractures and urethral injury sustained in a traffic accident. He was lost to follow-up after the surgery. However, he presented again at our hospital with gross hematuria. We detected adenocarcinoma at the edge of the vesicocutaneostomy site in the cystoscopic examination and biopsy findings through the stoma. Computed tomography revealed no evidence of metastasis. We conducted radical cystectomy and abdominal wall resection around the vesicocutaneostomy site and ileal conduit formation. Histopathological examination of surgical specimens revealed primary adenocarcinoma of enteric metaplasia origin and skin involvement. The pathological diagnosis was T4b N0 M0 (stage IV) adenocarcinoma of the bladder. In our case, chronic irritation at the stoma was thought to have induced enteric metaplasia of the bladder epithelium and adenocarcinoma. Although the only symptom exhibited was mild gross hematuria, our case was of advanced cancer with skin involvement. Primary adenocarcinoma of the bladder is rare, and only a few cases of adenocarcinoma associated with vesicocutaneostomy have been reported. However, careful examination should be performed to avoid overlooking malignant tumors in cases with bleeding from the vesicocutaneostomy site.


Assuntos
Adenocarcinoma , Cistectomia , Neoplasias da Bexiga Urinária , Adenocarcinoma/cirurgia , Idoso de 80 Anos ou mais , Humanos , Masculino , Uretra/lesões , Uretra/cirurgia , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária
8.
Urology ; 131: e7-e8, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31132425

RESUMO

OBJECTIVE: To define clinical features and surgical management of urethro-cavernosal fistulas (UCF). METHODS: A literature search was performed using PubMed to identify publications with the key word urethro-cavernosal fistula. RESULTS: We herein describe surgical techniques and long-term outcomes for UCF repair. CONCLUSION: UCFs is a rare urological condition with only 9 cases reported to date. UCFs can be diagnosed with careful history, physical examination, and retrograde urethrography. Surgical management includes basic tenets of fistula repair, including adequate mobilization, tension-free but watertight approximation, multilayered closure with nonoverlapping suture lines, and maximal bladder drainage.


Assuntos
Fístula/etiologia , Fístula/cirurgia , Doenças do Pênis/etiologia , Doenças do Pênis/cirurgia , Uretra/lesões , Doenças Uretrais/etiologia , Doenças Uretrais/cirurgia , Fístula Urinária/etiologia , Fístula Urinária/cirurgia , Adulto , Humanos , Masculino , Fatores de Tempo , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
9.
Urology ; 129: e6, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30935937

RESUMO

Urethral obstruction due to retained bullets migrating into the genitourinary system has rarely been reported. The literature describes 2 main methods of retained bullet removal from the genitourinary system: (1) spontaneous expulsion during voiding and (2) manual extraction due to urethral obstruction causing acute urinary retention. We present a case in which a 21-year-old man presented with acute urinary retention 3 years after suffering a gunshot wound to the abdomen. A retained bullet eroded through the bladder wall, migrated through the bladder and urethra, and eventually became lodged in the external urethral meatus, causing obstruction and urinary retention.


Assuntos
Migração de Corpo Estranho/complicações , Uretra/lesões , Obstrução Uretral/etiologia , Retenção Urinária/etiologia , Ferimentos por Arma de Fogo/complicações , Doença Aguda , Humanos , Masculino , Fatores de Tempo , Adulto Jovem
10.
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
11.
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
12.
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
13.
Curr Urol Rep ; 20(2): 10, 2019 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-30701330

RESUMO

PURPOSE OF REVIEW: This review summarizes the latest reports in inflatable penile prosthesis (IPP) complication management. RECENT FINDINGS: IPP complications are rare, and reports are limited to retrospective studies. However, recent multi-institutional studies and use of national databases have provided further insight into risk factors for complications. Guidance on complication management is largely limited to techniques recommended by experts within the field. American Urological Association guidelines place IPP implantation as a first line erectile dysfunction treatment. However, the majority of cases are performed by low-volume (≤ 4 cases/year) surgeons. Herein, we summarize the IPP literature and our personal experience to provide guidance on managing IPP complications.


Assuntos
Disfunção Erétil/cirurgia , Implante Peniano/efeitos adversos , Prótese de Pênis/efeitos adversos , Pênis/lesões , Dilatação/efeitos adversos , Dilatação/métodos , Humanos , Masculino , Necrose , Implante Peniano/métodos , Pênis/irrigação sanguínea , Pênis/patologia , Pênis/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Fatores de Risco , Uretra/lesões , Uretra/cirurgia
14.
World J Urol ; 37(4): 655-660, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30643973

RESUMO

PURPOSE: To report our experience with delayed anastomotic urethroplasty for pelvic fracture urethral injury (PFUI) during the last 10 years and evaluate both surgical and patient-reported outcomes. METHODS: Retrospective analysis of 115 patients undergoing delayed anastomotic urethroplasty for PFUI between 2008 and 2017 by a single surgeon (AH) was performed. Success was defined as a urethral lumen large enough for passage of a 17-Fr flexible cystoscope. We asked patients to complete questionnaires before (baseline) and 1 year after urethroplasty and compared by paired t and Wilcoxon signed-rank tests the answers to a question about LUTS-specific QOL and the health-related QOL indicated by EQ-5D index and visual analogue scores (EQVAS). Overall patient satisfaction 1 year after urethroplasty was also evaluated. RESULTS: Urethroplasty was successful in 108 patients (93.9%), and failed urethroplasty was significantly associated with greater intraoperative blood loss (p = 0.009) and smaller surgical experience (p = 0.018). Sixty-six patients (57.4%) completed questionnaires 1 year after urethroplasty, and 65 of those 66 (98.5%) were "satisfied" (36.4%) or "very satisfied" (62.1%) with the outcome of their urethroplasty. The LUTS-specific QOL scores (p < 0.0001), EQ-5D index scores (p < 0.0001), and EQVAS scores (p < 0.0001) all improved significantly after urethroplasty. CONCLUSIONS: Delayed anastomotic urethroplasty has a high success rate and significant beneficial effects on both LUTS-specific and health-related QOL, resulting in high patient satisfaction. Careful manipulation in a bloodless operative field by experienced surgeons could be the key to successful urethroplasty.


Assuntos
Anastomose Cirúrgica/métodos , Fraturas Ósseas/complicações , Satisfação do Paciente , Ossos Pélvicos/lesões , Procedimentos Cirúrgicos Reconstrutivos/métodos , Uretra/lesões , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Ferimentos e Lesões/cirurgia , Adulto , Humanos , Japão , Sintomas do Trato Urinário Inferior , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Estudos Retrospectivos , Fatores de Tempo
15.
Arch Ital Urol Androl ; 90(4): 283-287, 2019 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-30655641

RESUMO

Penile fracture is a rare urological emergency that always requires immediate attention. It may be associated with urethral trauma in 9% to 20% of cases. We present our experience in treating 12 such cases. This is a prospective observational study extending from January 2000 to December 2016. Each patient with penile fracture underwent a thorough clinical evaluation and received proper treatment. Seventy-five patients with penile fracture, aged 25 to 36 years (mean, 31.5 years) were evaluated in this study. Sexual intercourse was the common mechanism of injury in most of the patients. 12 of the patients had associated urethral injury. All the patients were diagnosed on taking proper history and after clinical examination. All patients were subjected emergency surgical exploration. All the patients underwent minimum of 1 year of follow-up, and were evaluated with local examination, uroflowmetry and Colour Doppler ultrasonography. Penile fracture is associated with urethral injury especially in the presence of suggestive history and physical examination like acute urinary retention, bleeding per urethra. Immediate primary surgical management of both the penile fracture and urethral injury is a safe and effective option with minimal complications.


Assuntos
Pênis/lesões , Ultrassonografia Doppler em Cores/métodos , Uretra/lesões , Procedimentos Cirúrgicos Urológicos/métodos , Adulto , Coito , Seguimentos , Humanos , Masculino , Pênis/diagnóstico por imagem , Pênis/cirurgia , Estudos Prospectivos , Centros de Atenção Terciária , Uretra/diagnóstico por imagem , Uretra/cirurgia
16.
Arch Ital Urol Androl ; 90(4): 295-296, 2019 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-30655643

RESUMO

Penile fractures are generally rare and underreported. The mechanism of injury is due to a rupture of the corpora cavernosa following blunt or sexual trauma to the penis when fully erect. Penile fractures usually present with a 'popping' sound with concomitant sudden swelling and ecchymosis of the penis followed by rapid detumescence. Urethral involvement occurs only in a small part of the cases. Isolated spongiosal injury after sexual intercourse is also extremely rare. The cardinal sign of urethral injury is blood at the meatus. A small laceration can be repaired by simple closure with absorbable sutures, while a complete rupture requires a more complex anastomotic repair. We report a case of a typically presenting penile fracture that was eventually proven to be an isolated corpus spongiosum injury, with no corpora cavernosa involvement.


Assuntos
Pênis/lesões , Uretra/lesões , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Coito , Humanos , Masculino , Pessoa de Meia-Idade , Pênis/cirurgia , Ruptura , Uretra/cirurgia
17.
World J Urol ; 37(4): 595-600, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30251050

RESUMO

The cost of urethral catheterisation injury (UCI) is significant, but the true incidence of patient care error is difficult to establish in the absence of specific hospital codes recording difficult urethral catheterisation (DUC) and UCI. For many years urologists are familiar passing a non-traumatic hydrophilic guidewire blindly into the bladder to aid urethral catheter insertion in difficult circumstances. However, so far, no purpose-built regulated medical device was available on the market and clinicians had to improvise. Urethrotech filled that gap and developed the Urethral Catheterisation Device (UCD®), which integrates a standard hydrophilic Nitinol guidewire into a 3-way 16F Silicone urethral catheter design to enable safe second-line urethral catheterisation when first-line catheterisation with a standard urethral catheter is unsuccessful. The safety and efficacy of UCD® catheterisation were evaluated in consecutive cohorts of men undergoing cardiac surgery and compared to the incidence of DUC and UCI with standard Foley catheterisation. A simple new Male Catheterisation Algorithm is proposed that can deliver a safe male urethral catheterisation treatment protocol for all clinical settings of healthcare services, which is easy to implement and integrate into standard catheterisation training programs to manage DUC and avoid UCI, empowering a frontline workforce to deliver better patient care.


Assuntos
Cateterismo Urinário/instrumentação , Cateteres Urinários , Idoso , Desenho de Equipamento , Hemorragia/epidemiologia , Hemorragia/etiologia , Humanos , Masculino , Estudos Prospectivos , Uretra/lesões , Doenças Uretrais/epidemiologia , Doenças Uretrais/etiologia , Cateterismo Urinário/efeitos adversos
18.
Int Urol Nephrol ; 51(1): 9-15, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30402718

RESUMO

OBJECTIVES: The present study aimed to investigate the influence of urine on re-epithelialization in canine prostatic urethra after prostatectomy and explore possible causes. METHOD: We established two groups of prostatic canine models. The first group contained urine that canines underwent the surgery by two-micron laser resection of the prostate-tangerine technique (TmLRP-TT), and no transurethral catheter was required. The second group was without urine that canines accepted the surgery by TmLRP-TT add ureter skin ostomy urine bypass. Histopathology of re-epithelialization of repair in trauma in canine prostatic urethra was observed by hematoxylin and eosin (HE) staining, and immunochemistry was used to determine the expression of transforming growth factor-ß1 (TGF-ß1). Human prostate epithelial line (BPH-1) cells were cultured with or without urine and the abilities of proliferation and migration were tested by CCK-8 and transwell assays, respectively. RESULTS: The histology displayed that there was distinct proliferation of prostatic cell under the wound after 3 days, re-epithelialization began after 9 days, and finished after 28 days at urine group. The TGF-ß1 like-IR in prostatic epithelium cells and fibroblast cells under the wound at urine group were strikingly increased as compared with the cells at no urine group after 3, 9, and 11 days, respectively (p < 0.05). In CCK-8 and Transwell assays, an increase of cells' proliferation and migration was detected in urine culture group compared with no urine culture group (p < 0.05). CONCLUSION: Urine may speed up the re-epithelialization process for prostatic urethra wounds by promoting proliferation and migration of prostate epithelial cells.


Assuntos
Movimento Celular , Proliferação de Células , Células Epiteliais/fisiologia , Complicações Intraoperatórias , Próstata , Reepitelização/fisiologia , Ressecção Transuretral da Próstata , Uretra , Urina/fisiologia , Animais , Células Cultivadas , Cães , Humanos , Complicações Intraoperatórias/patologia , Complicações Intraoperatórias/fisiopatologia , Masculino , Próstata/patologia , Próstata/cirurgia , Hiperplasia Prostática/cirurgia , Fatores de Crescimento Transformadores/metabolismo , Ressecção Transuretral da Próstata/efeitos adversos , Ressecção Transuretral da Próstata/métodos , Uretra/lesões , Uretra/fisiopatologia , Cicatrização/fisiologia
19.
Urology ; 124: 260-263, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30447268

RESUMO

OBJECTIVE: To examine the rate of urethral trauma and pubic symphysis diastasis in saddle horn injury, which occurs when horseback riders are bucked into the air and land with their perineum striking the rigid saddle horn, compared to pelvic fracture from other mechanisms. METHODS: A retrospective review was performed of male patients presenting to our level-1 trauma center with pelvic ring fractures between January 1, 2001 and December 30, 2016. Demographics, injury severity score, mechanism of injury (saddle horn vs other), pubic symphysis diastasis, and lower genitourinary (GU) injuries (bladder and urethra) were identified in the trauma registry. Chart review confirmed accuracy of lower GU trauma. RESULTS: A total of 1195 males presented with pelvic ring fractures, average age 43 years (SD 19 years). Of these, 87 of 1195 (7%) presented with lower GU injuries. Saddle horn injuries had a higher rate of lower GU injuries, 12/60 (20%) versus 75 of 1135 (7%) [P = .001]. In those with lower GU injuries, 47 of 87 (54%) had urethral injury. The rate of urethral injury was significantly higher in the saddle horn cohort, 10 of 12 (83%) versus 37 of 75 (49%) [P = .03]. Furthermore, rate of pubic symphysis diastasis was higher amongst saddle horn injuries, 12 of 12 (100%) versus other mechanisms 39 of 75 (52%) [P = .001]. CONCLUSION: We found that urethral injury and pubic symphysis diastasis were higher in patients with saddle horn injury compared to other mechanisms of pelvic ring disruption. Clinicians should be aware of these associations when treating pelvic fracture following equestrian injuries.


Assuntos
Traumatismos em Atletas/complicações , Fraturas Ósseas/complicações , Ossos Pélvicos/lesões , Diástase da Sínfise Pubiana/etiologia , Uretra/lesões , Adulto , Humanos , Masculino , Estudos Retrospectivos
20.
J Pediatr Adolesc Gynecol ; 32(2): 135-138, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30447292

RESUMO

STUDY OBJECTIVE: The objective of this study was to describe prevalence and location of obstetric lacerations in adolescents. DESIGN: Retrospective cohort study. SETTING: We performed an analysis of the Consortium on Safe Labor database including tertiary care university-affiliated urban hospitals. PARTICIPANTS: All primiparous women who delivered vaginally were included. INTERVENTIONS: Vaginal and perineal lacerations were compared between age groups 15 or younger, 16-21, 22-34, 35-39, and older than 40 years. MAIN OUTCOME MEASURES: Outcome measures included vaginal, perineal, labial, and periurethral lacerations. χ2 and Fisher exact tests were used as appropriate, with P < .05 considered significant. RESULTS: A total of 9777 patients were included in the analysis. Young adolescents and adolescents had significantly higher rates of labial and periurethral lacerations compared with individuals aged 22-34 years. The prevalence of third- and fourth-degree perineal tears increased with age. CONCLUSION: Adolescent primiparous women are less likely to have severe perineal obstetric tears, but have higher rates of labial and periurethral tears.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Lacerações/epidemiologia , Complicações do Trabalho de Parto/epidemiologia , Gravidez na Adolescência/estatística & dados numéricos , Adolescente , Adulto , Estudos de Coortes , Bases de Dados Factuais , Parto Obstétrico/efeitos adversos , Episiotomia/efeitos adversos , Feminino , Humanos , Lacerações/etiologia , Mães/estatística & dados numéricos , Paridade , Períneo/lesões , Gravidez , Prevalência , Estudos Retrospectivos , Uretra/lesões , Vagina/lesões , Adulto Jovem
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