Adjustable perineal male sling using tissue expander as an effective treatment of post-prostatectomy urinary incontinence

Purpose To report our intermediate experience in treating patients with severe incontinence using an adjustable perineal male sling with a tissue expander. Materials and Methods An adjustable male sling procedure was performed on 21 patients with severe incontinence. The underlying etiology of urinary incontinence was radical prostatectomy in 13 patients, open prostatectomy in 5 patients and transurethral prostate resection in 3 patients. The difference between the classical and the adjustable sling is that in the latter there is a 25 mL tissue expander between the two layers of polypropylene mesh with an injection port. Adjustment of the sling was performed with saline via an inflation port, in case of recurrence or persistence of incontinence. Results The mean age of the patients was 66.2±7.3 (50-79) years and mean pad usage was 6.4±0.6 per day. The mean follow-up time was 40.1±23.2 (6-74) months. The balloon was postoperatively inflated on average with 11.6±5.7 (5-25) mL. After the mean 40.1 months of follow-up, 16 of the 21 patients (76.2%) were dry (11 patients, 0 pads; 5 patients using safety pads), 3 patients (14%) had mild and 2 (9.8%) had moderate degree post-prostatectomy urinary incontinence (PPI). The average maximum urine flow rate of the patients was 15.6±4.7 (10-31) mL/s. No residual urine was found. In 2 patients, all parts of the device were removed due to infection and discomfort, and in 3 patients only the inflation component was removed due to local scrotal infection. Conclusions Our results show that using an adjustable perineal male sling with a tissue expander seems to be an efficient, and safe surgical treatment option in patients with PPI. .

Breast reconstruction with permanent expander: a different approach / Reconstrução mamária com expansor definitivo: enfoque diferenciado

BACKGROUND: Immediate or delayed breast reconstruction with tissue expanders can be performed in one or several surgical sessions. We opted to perform breast reconstruction over several sessions. The aim of this study was to report our experiences with the breast reconstruction technique involving Becker permanent tissue expanders and complete expander coverage with a flap comprising the pectoralis major, pectoralis minor, serratus anterior, and rectus abdominis aponeurosis. METHODS: The medical records of 21 patients who underwent postmastectomy breast reconstruction with Becker permanent tissue expanders were retrospectively analyzed. RESULTS: During muscle flap preparation, the aponeurotic dissection was performed 6-8 cm below the inframammary crease, aiming at full expander coverage without tension, enabling lower suturing in the inframammary crease, and avoiding disruption of the pectoralis major attachments. Only two patients developed infection, one in the first postoperative week and the other in the third postoperative month. CONCLUSIONS: The flap comprising the pectoralis major, pectoralis minor, serratus anterior, and rectus abdominis aponeurosis is a good choice for breast reconstruction with permanent tissue expanders because it ensures adequate expander and skin-flap protection. Moreover, the technique enables tissue expansion without confining the expanders in the submuscular cavity.

INTRODUÇÃO: As reconstruções de mama imediatas ou tardias com uso de expansores podem ocorrer em um ou mais de um tempo cirúrgico. Optou-se por reconstruções em mais de um tempo cirúrgico, com expansores definitivos tipo Becker. Este estudo teve como objetivo demonstrar a utilização da técnica de reconstrução mamária com expansor definitivo tipo Becker, com retalho dos músculos peitoral maior e menor, serrátil anterior e aponeurose do músculo reto abdominal para cobertura completa do expansor. MÉTODOS: Estudo retrospectivo, por meio de análise de prontuário, incluindo 21 pacientes submetidas a reconstrução mamária com expansor permanente. RESULTADOS: Na confecção do retalho muscular, é necessária a realização de dissecção abaixo do sulco submamário definido no pré-operatório, com o propósito de cobertura total do material aloplástico usado na reconstrução, englobando a aponeurose do músculo reto abdominal, 6 cm a 8 cm abaixo do sulco submamário, evitando-se lesão de sua continuidade com o músculo peitoral maior. Neste estudo, duas pacientes apresentaram infecção, uma delas na primeira semana de pós-operatório e a outra, no terceiro mês. CONCLUSÕES: A utilização do retalho dos músculos peitoral maior e menor, serrátil anterior e bainha do músculo reto abdominal é uma boa opção nas reconstruções mamárias com utilização de expansor definitivo de tecidos, visto que promove proteção adequada ao expansor e aos retalhos cutâneos que se posicionam sobre ele. Além disso, a técnica permite expansão tecidual, sem que os expansores fiquem encarcerados ou presos à loja muscular.