Tomografía computarizada con reconstrucción 3D para el diagnóstico de lesiones traumáticas de uretra / Three-dimensional computed tomography reconstruction for the diagnosis of traumatic urethral injuries

RESUMEN La uretrografía retrógrada es la técnica de referencia (gold standard) utilizada clásicamente para hacer diagnóstico de lesiones de uretra. En este contexto se presenta un caso en el que se realizó tomografía computarizada con reconstrucción 3D con contraste intravenoso y endouretral, pudiendo reconstruir la uretra en toda su extensión en forma tridimensional. De esta manera se arribó al diagnóstico de certeza de la lesión de uretra. Como ventaja del método se menciona la posibilidad de diagnosticar ‒ con un solo estudio por imágenes‒ lesiones de todo el tracto urinario, órganos sólidos, huecos y lesión del anillo pélvico asociados al traumatismo, con una alta sensibilidad y especificidad sin necesidad de requerir otros estudios complementarios.

ABSTRACT Retrograde urethrography is the gold standard method for the diagnosis of urethral injuries. In this setting, we report the use of computed tomography with intravenous injection and urethral administration of contrast medium and 3D reconstruction of the entire urethra. The definitive diagnosis of urethral injury was made. The advantage of this method is the possibility of making the diagnosis of traumatic injuries of the entire urinary tract, solid organs, hollow viscera and of the pelvic ring within a single imaging test, with high sensitivity and specificity, with no need to perform other complementary tests.

Linfoma primário do pênis: relato de caso / Primary penile lymphoma: case report

Objetivo: Relatar o caso de um paciente diagnosticado com linfoma peniano primário, um dos subtipos menos comuns de câncer de pênis. Caso clínico: Paciente masculino, 63 anos, hígido, com queixa de ulcerações dolorosas em região balano-prepucial. Sem queixas urinárias, traumatismo peniano ou relação sexual desprotegida. Ao exame inicial, pênis com prepúcio exuberante, sinais de má higiene, tecido necrótico em glande e parafimose. Optou-se por postectomia, desbridamento de glande e cistostomia de proteção, com anatomopatológico demonstrando neoplasia maligna pouco diferenciada e análise imuno-histoquímica sugerindo linfoma de células B. O paciente realizou seis ciclos de quimioterapia, com remissão completa dos sintomas no quarto ciclo. Foi submetido à reconstrução de uretra e glande posteriormente, pela técnica de Mathieu (retalho cutâneo). Comentários: O linfoma peniano primário é ainda pouco relatado e conhecido. Ainda que seu manejo seja controverso, a quimioterapia adjuvante com terapia cirúrgica reconstrutiva se demonstrou uma opção eficiente de tratamento

Objective: To report the case of a patient diagnosed with primary penile lymphoma. Clinical case: A 63-years-old male patient presented with ulcerated lesions on the penis with a 2-week evolution. The patient denied urinary symptoms, penile trauma, or unprotected sex. The initial examination showed a penis with an exuberant foreskin and signs of poor local hygiene, with paraphimosis and necrotic tissue on the gland. A postectomy and debridement of the gland was performed, and the anatomopathological exam showed poorly differentiated malignancy, while the immunohistochemical analysis suggested B-cell lymphoma. The patient was submitted to six cycles of chemotherapy, with complete remission of the symptoms after the fourth cycle. In sequence, a reconstruction of the urethra and glans was performed using the Mathieu's technique. Comments: Primary penile lymphoma is still a poorly reported disease. Although its management remains controversial, adjuvant chemotherapy with reconstructive surgical therapy showed to be an efficient approach

Cistostomia com sonda de Foley para desvio temporário do fluxo urinário em felino acometido por ruptura uretral iatrogênica / Cystostomy with Foley tube for temporary deviation of urinary flow in feline affected by iatrogenic urethral rupture / Cistostomía con tubo de Foley para la desviación temporal del flujo urinario en felino afectado por ruptura uretral iatrogénica

A ruptura uretral iatrogênica geralmente é uma intercorrência secundária à passagem forçada de sondas rígidas durante a tentativa de desobstrução uretral; procedimento este realizado como forma de eliminação imediata da urina em casos de retenção aguda. Pacientes obstruídos podem manifestar sinais de injúria renal aguda, sendo necessário o pronto restabelecimento do fluxo urinário. O presente estudo tem como objetivo demonstrar o uso de uma técnica de cistostomia temporária em felino com ruptura de uretra, feito a partir da inserção de uma sonda tipo Foley na região ventral da bexiga e fixação desta à parede abdominal para que a urina pudesse ser conduzida ao meio externo.(AU)

The iatrogenic urethral rupture is usually an intercurrence secondary to the forced passage of rigid tubes during the urethral clearance attempt; procedure that is performed as a means of immediate elimination of urine in cases of acute retention. Obstructed patients may show signs of acute kidney injury, requiring prompt restoration of urinary flow. The present study aims to demonstrate the use of a temporary cystostomy technique in feline with rupture of the urethra, made from the insertion of a Foley type probe in the ventral region of the bladder and fixation of it to the abdominal wall so that the urine could be conducted to the external environment.(AU)

La ruptura uretral iatrogénica suele ser una intercurrencia secundaria al paso forzado de tubos rígidos durante el intento de aclaramiento uretral; procedimiento que se realizó como un medio de eliminación inmediata de orina en casos de retención aguda. Los pacientes obstruidos pueden mostrar signos de lesión renal aguda, lo que requiere una pronta restauración del flujo urinario. El presente estudio tiene como objetivo demostrar el uso de una técnica de cistostomía temporal en felinos con ruptura de la uretra, realizada mediante la inserción de una sonda tipo Foley en la región ventral de la vejiga y su fijación a la pared abdominal para que la orina pueda ser conducida al ambiente externo.(AU)

Cistostomia com sonda de Foley para desvio temporário do fluxo urinário em felino acometido por ruptura uretral iatrogênica / Cystostomy with Foley tube for temporary deviation of urinary flow in feline affected by iatrogenic urethral rupture / Cistostomía con tubo de Foley para la desviación temporal del flujo urinario en felino afectado por ruptura uretral iatrogénica

A ruptura uretral iatrogênica geralmente é uma intercorrência secundária à passagem forçada de sondas rígidas durante a tentativa de desobstrução uretral; procedimento este realizado como forma de eliminação imediata da urina em casos de retenção aguda. Pacientes obstruídos podem manifestar sinais de injúria renal aguda, sendo necessário o pronto restabelecimento do fluxo urinário. O presente estudo tem como objetivo demonstrar o uso de uma técnica de cistostomia temporária em felino com ruptura de uretra, feito a partir da inserção de uma sonda tipo Foley na região ventral da bexiga e fixação desta à parede abdominal para que a urina pudesse ser conduzida ao meio externo.

The iatrogenic urethral rupture is usually an intercurrence secondary to the forced passage of rigid tubes during the urethral clearance attempt; procedure that is performed as a means of immediate elimination of urine in cases of acute retention. Obstructed patients may show signs of acute kidney injury, requiring prompt restoration of urinary flow. The present study aims to demonstrate the use of a temporary cystostomy technique in feline with rupture of the urethra, made from the insertion of a Foley type probe in the ventral region of the bladder and fixation of it to the abdominal wall so that the urine could be conducted to the external environment.

La ruptura uretral iatrogénica suele ser una intercurrencia secundaria al paso forzado de tubos rígidos durante el intento de aclaramiento uretral; procedimiento que se realizó como un medio de eliminación inmediata de orina en casos de retención aguda. Los pacientes obstruidos pueden mostrar signos de lesión renal aguda, lo que requiere una pronta restauración del flujo urinario. El presente estudio tiene como objetivo demostrar el uso de una técnica de cistostomía temporal en felinos con ruptura de la uretra, realizada mediante la inserción de una sonda tipo Foley en la región ventral de la vejiga y su fijación a la pared abdominal para que la orina pueda ser conducida al ambiente externo.

Vesicostomy button: how is it placed, in whom, and how is quality of life affected?

ABSTRACT Purpose The vesicostomy button has been shown to be a safe and effective bladder management strategy for short- or medium-term use when CIC cannot be instituted. This study reports our use with the vesicostomy button, highlighting the pros and cons of its use and complications. We then compared the quality or life in patients with vesicostomy button to those performing clean intermittent catheterization. Materials and Methods Retrospective chart review was conducted on children who had a vesicostomy button placed between 2011 and 2015. Placement was through existing vesicostomy, open or endoscopically. We then evaluated placement procedure and complications. A validated quality of life questionnaire was given to patients with vesicostomy button and to a matched cohort of patients performing clean intermittent catheterization. Results Thirteen children have had a vesicostomy button placed at our institution in the 4 year period, ages 7 months to 18 years. Indications for placement included neurogenic bladder (5), non-neurogenic neurogenic bladder (3), and valve bladders (5). Five out of 7 placed via existing vesicostomy had leakage around button. None of the endoscopically placed buttons had leakage. Complications were minor including UTI (3), wound infection (1), and button malfunction/leakage (3). QOL was equal and preserved in patients living with vesicostomy buttons when compared to CIC. Conclusion The vesicostomy button is an acceptable alternative to traditional vesicostomy and CIC. The morbidity of the button is quite low. Endoscopic insertion is the optimal technique. QOL is equivalent in patients with vesicostomy button and those who perform CIC.

Vesicostomy button: how is it placed, in whom, and how is quality of life affected?

PURPOSE: The vesicostomy button has been shown to be a safe and effective bladder management strategy for short- or medium-term use when CIC cannot be instituted. This study reports our use with the vesicostomy button, highlighting the pros and cons of its use and complications. We then compared the quality or life in patients with vesicostomy button to those performing clean intermittent catheterization. MATERIALS AND METHODS: Retrospective chart review was conducted on children who had a vesicostomy button placed between 2011 and 2015. Placement was through existing vesicostomy, open or endoscopically. We then evaluated placement procedure and complications. A validated quality of life questionnaire was given to patients with vesicostomy button and to a matched cohort of patients performing clean intermittent catheterization. RESULTS: Thirteen children have had a vesicostomy button placed at our institution in the 4 year period, ages 7 months to 18 years. Indications for placement included neurogenic bladder (5), non-neurogenic neurogenic bladder (3), and valve bladders (5). Five out of 7 placed via existing vesicostomy had leakage around button. None of the endoscopically placed buttons had leakage. Complications were minor including UTI (3), wound infection (1), and button malfunction/leakage (3). QOL was equal and preserved in patients living with vesicostomy buttons when compared to CIC. CONCLUSION: The vesicostomy button is an acceptable alternative to traditional vesicostomy and CIC. The morbidity of the button is quite low. Endoscopic insertion is the optimal technique. QOL is equivalent in patients with vesicostomy button and those who perform CIC.

Development and evaluation of a training model for paracentetic suprapubic cystostomy and catheterization.

OBJECTIVES: Minimally invasive paracentetic suprapubic cystostomy is a technique that should be learned by all surgical trainees and residents. This study aimed to develop a self-made training model for paracentetic suprapubic cystostomy and placement of the suprapubic catheter and then to evaluate its effectiveness in training fourth-year medical students. METHODS: Medical students were divided into an experimental group receiving comprehensive training involving literature, video, and model use and a control group receiving all the same training protocols as the experimental group except without hands-on practice using the model. Each student's performance was video-recorded, followed by subjective and objective evaluations by urology experts and statistical analysis. RESULTS: All students completed the surgical procedures successfully. The experimental group's performance scores were significantly higher than those of the control group (median final performance scores of 91.0 vs. 86.8, respectively). Excellent scores were achieved by more students in the experimental group than in the control group (55% vs. 20%), and fewer poor scores were observed in the experimental group than in the control group (5% vs. 30%). CONCLUSIONS: Based on its cost-effectiveness, reusability, and training effectiveness, this paracentetic suprapubic cystostomy training model is able to achieve goals in teaching practice quickly and easily. Use of the model should be encouraged for training senior medical students and resident physicians who may be expected to perform emergent suprapubic catheter insertion at some time.

From Cystostomy to Active Decompression: The Surgeons' Battle Against Odontogenic Cysts.

Odontogenic cysts represent a challenge for oral and maxillofacial surgeons. Treatment options include resective surgery and conservative approaches. The purpose of this paper is to review the history of marsupialization/decompression and other techniques based on similar principles.

Development and evaluation of a training model for paracentetic suprapubic cystostomy and catheterization

OBJECTIVES: Minimally invasive paracentetic suprapubic cystostomy is a technique that should be learned by all surgical trainees and residents. This study aimed to develop a self-made training model for paracentetic suprapubic cystostomy and placement of the suprapubic catheter and then to evaluate its effectiveness in training fourth-year medical students. METHODS: Medical students were divided into an experimental group receiving comprehensive training involving literature, video, and model use and a control group receiving all the same training protocols as the experimental group except without hands-on practice using the model. Each student's performance was video-recorded, followed by subjective and objective evaluations by urology experts and statistical analysis. RESULTS: All students completed the surgical procedures successfully. The experimental group's performance scores were significantly higher than those of the control group (median final performance scores of 91.0 vs. 86.8, respectively). Excellent scores were achieved by more students in the experimental group than in the control group (55% vs. 20%), and fewer poor scores were observed in the experimental group than in the control group (5% vs. 30%). CONCLUSIONS: Based on its cost-effectiveness, reusability, and training effectiveness, this paracentetic suprapubic cystostomy training model is able to achieve goals in teaching practice quickly and easily. Use of the model should be encouraged for training senior medical students and resident physicians who may be expected to perform emergent suprapubic catheter insertion at some time.

Do anterior catheterizable urinary channels have fewer complications than posterior channels? An international cohort study.

OBJECTIVE: Appendicovesicostomy (APV) and Monti ileovesicostomy (Monti) are durable catheterizable channels. While subfascial revision rates vary by channel type, a channel implanted in the anterior (vs posterior) aspect of the bladder may have a lower subfascial revision risk, due to decreased channel mobility and better fascial fixation. The present study aimed to compare long-term durability of anteriorly compared to posteriorly implanted APV and Monti channels in a large international cohort. MATERIALS AND METHODS: A retrospective cohort study was conducted on patients aged ≤21 years and who underwent APV or Monti surgery with an open technique at three high-volume centers (1990-2015). The following were noted: patient demographics, stomal and subfascial revisions, stomal location, channel placement (anterior/posterior), and channel type - APV, spiral Monti to umbilicus (SMU), other Monti channels. Survival analysis and Cox proportional hazards regression were used to separately examine the three channel groups. RESULTS: Of the 675 patients who met inclusion criteria, 387 had an APV (71.3% anterior), 53 had an SMU (13.2% anterior) and 235 had other Monti channels (42.1% anterior). Median age at surgery was 8.8 years for APV (median follow-up: 5.5 years), 9.2 years for other Monti (follow-up: 6.6 years) and 7.9 years for SMU (follow-up: 9.0 years). Patients originated from the USA (67.9%), Argentina (26.4%) and Chile (5.8%). Overall, 76 stomal and 77 subfascial revisions occurred. Risk of stomal revision was 9.3-12.0% at 5 years of follow-up, and was similar between channel types or location (P = 0.57). Risk of subfascial revision at 5 years was 7.4% for APV, 12.7% for all other Monti channels and 25.9% for SMU (P = 0.001). On survival analysis, stomal and subfascial revision rates were similar between anterior and posterior channels for APV (P ≥ 0.16), other Monti channels (P ≥ 0.62) and SMU (P ≥ 0.43) (Summary Fig.). On multivariate regression, channel configuration was not associated with stomal or subfascial revision for APV (P ≥ 0.18) or other Monti channels (P ≥ 0.64). Sex, age, diagnosis, country and stomal location were not associated with revision risk (P ≥ 0.06). DISCUSSION: Contrary to the hypothesis, subfascial revision rates were no different between anterior and posterior channels. Given that many reported outcomes related to genitourinary reconstruction occur rarely and require prolonged follow-up, collaborative research in this area should be encouraged. CONCLUSIONS: The study demonstrated durable long-term results with the APV and Monti techniques in an international cohort. Risks of stomal and subfascial complications were not significantly different between anteriorly and posteriorly implanted channels. As previously reported, Monti channels, particularly SMU, were more prone to undergoing subfascial revisions.

Cuidado integral à pessoa estomizada na atenção básica - conhecimento e atuação do enfermeiro / Complete care for the stomizedperson in primary care - knowledge and nursing activities / Cuidado integral a la persona con ostomía en la atención básica - conocimiento y actuación del enfermero

O cuidado integral à pessoa com estomia é atividade realizada pelo enfermeiro na atenção básica, logo após a alta hospitalar cirúrgica, efetivando cuidados específicos de enfermagem, esclarecendo as dúvidas do usuário e familiares e orientando para o autocuidado e prevenção de possíveis complicações.O estudo teve como objetivo apreciar o conhecimento e a atuação do enfermeiro no cuidado à pessoa estomizada na atenção básica. Estudo com caráter qualitativo, exploratório e descritivo, utilizou para coleta de dados uma entrevista semiestruturada com questões norteadoras, gravadas e transcritas na íntegra, aplicada a vinte e seis enfermeiros da atenção básica municipal. A partir da análise de conteúdo temático, emergiram as seguintes categorias: identificando o cuidado com os estomas e,percepções do enfermeiro a respeito da assistência prestada ao estomizado. O ensino de enfermagem e a educação permanente poderão contribuir para uma atuação competente e eficaz de cuidado integral ao estomizado, e isso refletiria no processo adaptativo e na qualidade de vida dos estomizados e de suas famílias. [AU]

Complete care for the person with the stoma is an activity performed by the nurse in primary care, shortly after discharge from the hospital, carrying out specific nursing care, explanation to user and family doubts, and guidelines for self-care and prevention of possible complications. The study aimed to appreciate the knowledge and the performance of nurses caring for the stomized person in primary care. A qualitative, exploratory and descriptive study, for data collection a semi-structured interview, with guiding questions, recorded and transcribed in full, applied to twenty-six nurses of the municipal primary care were used. From the analysis of the thematic content emerged the following categories: identifying care with the ostomy; the nurses' perceptions regarding the assistance provided to the ostomy patient. Nursing education and permanent education can contribute to a competent and effective performance of integral care to the ostomy patient, and this would reflect in the adaptive process and quality of life of thestomized patients and their families. [AU]

El cuidado integral a la persona con ostomía es la actividad realizada por el enfermero en la atención básica tras el alta hospitalaria quirúrgica, realizando cuidados específicos de enfermería, aclarando las dudas del usuario y los familiares; y orientando para el autocuidado y la prevención de posibles complicaciones. El estudio tuvo como objetivo evaluar el conocimiento y la actuación del enfermero en el cuidado a la persona con ostomía en la atención básica. El estudio, con carácter cualitativo, exploratorio y descriptivo, utilizó para la recolección de datos entrevista semiestructurada, con cuestiones orientadoras, grabadas y transcriptas en su totalidad, aplicada a veintiséis enfermeros de la atención básica municipal. A partir del análisis del contenido temático surgieron las siguientes categorías: identificando el cuidado con los estomas; percepciones del enfermero sobre la atención prestada a la persona con ostomía. La enseñanza de enfermería y la educación permanente podrán contribuir para una actuación competente y eficaz de cuidado integral al paciente con ostomía, y eso reflejaría en el proceso adaptativo y en su calidad de vida y de sus familias. [AU]

Síndrome de la bolsa de orina púrpura: un fenómeno inusual y muy llamativo / Purple urine bag syndrome: Report of one case

Purple urine bag syndrome is an uncommon but particularly striking phenomenon observed in people with urinary catheters and co-existent urinary tract infections. A chemical reaction between plastic and certain bacterial enzymes results in an intense purple urine color. We report a 72 year-old male with a cystostomy. A purple coloration of his urinary drainage bag and tubing was noted in the context of a urinary tract infection caused by Citrobacter freundii.

Ureteroneocystostomy in primary vesicoureteral reflux: critical retrospective analysis of factors affecting the postoperative urinary tract infection rates.

INTRODUCTION: To determine the parameters affecting the outcome of ureteroneocystostomy (UNC) procedure for vesicoureteral reflux (VUR). MATERIALS AND METHODS: Data of 398 patients who underwent UNC procedure from 2001 to 2012 were analyzed retrospectively. Different UNC techniques were used according to laterality of reflux and ureteral orifice configuration. Effects of several parameters on outcome were examined. Disappearance of reflux on control VCUG or absence of any kind of UTI/symptoms in patients without control VCUG was considered as clinical improvement. RESULTS: Mean age at operation was 59.2 ± 39.8 months and follow-up was 25.6 ± 23.3 months. Grade of VUR was 1-2, 3 and 4-5 in 17, 79, 302 patients, respectively. Male to female ratio was 163/235. UNC was performed bilaterally in 235 patients and intravesical approach was used in 373 patients. The frequency of voiding dysfunction, scar on preoperative DMSA, breakthrough infection and previous surgery was 28.4%, 70.7%, 49.3% and 22.4%, respectively. Twelve patients (8.9%) with postoperative contralateral reflux were excluded from the analysis. Overall clinical improvement rate for UNC was 92%. Gender, age at diagnosis and operation, laterality and grade of reflux, mode of presentation, breakthrough infections (BTI) under antibiotic prophylaxis, presence of voiding dysfunction and renal scar, and operation technique did not affect the surgical outcome. However, the clinical improvement rate was lower in patients with a history of previous endoscopic intervention (83.9% vs. 94%). Postoperative UTI rate was 27.2% and factors affecting the occurrence of postoperative UTI were previous failed endoscopic injection on univariate analysis and gender, preoperative BTI, postoperative VUR state, voiding dysfunction on multivariate analysis. Surgery related complication rate was 2% (8/398). These were all low grade complications (blood transfusion in 1, hematoma under incision in 3 and prolonged hospitalization secondary to UTI in 4 patients). In long term, 12 patients are under nephrologic follow-up because of hypertension in 5, increased serum creatinine in 5, proteinuria in 1 and hematuria in 1 patient and all these patients had preoperative scarred kidneys. CONCLUSIONS: Despite its invasive nature, UNC has a very high success rate with a negligible percent of complications. In our cohort, the only factor that negatively affected the clinical improvement rate was the history of previous antireflux interventions where the predictive factors for postoperative UTI were previous failed endoscopic injection, female gender, preoperative BTI, persistent VUR and voiding dysfunction.

Ureteroneocystostomy in primary vesicoureteral reflux: critical retrospective analysis of factors affecting the postoperative urinary tract infection rates

Introduction To determine the parameters affecting the outcome of ureteroneocystostomy (UNC) procedure for vesicoureteral reflux (VUR). Materials and Methods Data of 398 patients who underwent UNC procedure from 2001 to 2012 were analyzed retrospectively. Different UNC techniques were used according to laterality of reflux and ureteral orifice configuration. Effects of several parameters on outcome were examined. Disappearance of reflux on control VCUG or absence of any kind of UTI/symptoms in patients without control VCUG was considered as clinical improvement. Results Mean age at operation was 59.2 ± 39.8 months and follow-up was 25.6 ± 23.3 months. Grade of VUR was 1-2, 3 and 4-5 in 17, 79, 302 patients, respectively. Male to female ratio was 163/235. UNC was performed bilaterally in 235 patients and intravesical approach was used in 373 patients. The frequency of voiding dysfunction, scar on preoperative DMSA, breakthrough infection and previous surgery was 28.4%, 70.7%, 49.3% and 22.4%, respectively. Twelve patients (8.9%) with postoperative contralateral reflux were excluded from the analysis. Overall clinical improvement rate for UNC was 92%. Gender, age at diagnosis and operation, laterality and grade of reflux, mode of presentation, breakthrough infections (BTI) under antibiotic prophylaxis, presence of voiding dysfunction and renal scar, and operation technique did not affect the surgical outcome. However, the clinical improvement rate was lower in patients with a history of previous endoscopic intervention (83.9% vs. 94%). Postoperative UTI rate was 27.2% and factors affecting the occurrence of postoperative UTI were previous failed endoscopic injection on univariate analysis and gender, preoperative BTI, postoperative VUR state, voiding dysfunction on multivariate analysis. Surgery related complication rate was 2% (8/398). These were all low grade complications (blood transfusion in 1, hematoma under incision ...