RESUMO
We report the case of a fetus with severe megabladder, displaying the 'keyhole' sign on ultrasound imaging, that underwent cystoscopy at 22 weeks' gestation. There was a familial history of mild urethral atresia. Fetal cystoscopy revealed congenital urethral atresia. A guide wire was advanced through the fetal urethra and a transurethral vesicoamniotic stent was placed successfully. The fetus was delivered at 36 weeks' gestation and postnatal cystoscopy confirmed the absence of posterior urethral valves or urethral atresia. The infant was 5 years old with normal renal function at the time of writing. We conclude that fetal cystoscopic placement of a transurethral stent for congenital urethral stenosis is feasible.
Assuntos
Cistoscopia/métodos , Doenças Fetais/cirurgia , Feto/cirurgia , Stents , Uretra/diagnóstico por imagem , Estreitamento Uretral/cirurgia , Adulto , Cateterismo , Feminino , Doenças Fetais/diagnóstico por imagem , Idade Gestacional , Humanos , Lactente , Masculino , Gravidez , Ultrassonografia Pré-Natal/métodos , Uretra/embriologia , Obstrução Uretral/diagnóstico , Obstrução Uretral/diagnóstico por imagem , Obstrução Uretral/cirurgia , Estreitamento Uretral/diagnóstico por imagem , Bexiga Urinária/anormalidades , Bexiga Urinária/diagnóstico por imagemRESUMO
PURPOSE: Repairing abdominal wall defects after cloacal exstrophy reconstruction always poses a challenge. Our proposal for repair consists of bilateral posterior iliac osteotomy and external iliac fixation with Schanz pins, together with abdominoplasty through bilateral groin flaps of skin and muscular aponeuroses, in a single staged procedure. METHODS: 7 patients (5 male and 2 female; mean age 3.1 years) with cloacal exstrophy underwent reconstructive surgery at our institution. Cloacal exstrophy reconstruction was performed in 3 stages, whenever possible. In Stage 1, the intestinal tract is separated from the hemi-bladders; the small colon is tubularized (colorrhaphy) with an opening on the left flank. The hemi-bladders are joined and the pathology is converted into classic bladder exstrophy, followed by primary repair (cystorraphy). At this stage, closure of the abdominal wall is made by groin flap plasty, following bilateral posterior iliac osteotomy with an external iliac fixator. Stage 2 consists of bladder augmentation and the management of urinary continence. Stage 3 is genitoplasty. The aim of this study was to demonstrate our results for the first stage. RESULTS: After a mean follow-up of 7 years, closure of abdominal wall was found to be excellent and successful in all 7 patients. Their abdominal walls are strong and solid, with no retraction, fistula or eventration. CONCLUSION: The association, in a single stage, of a posterior osteotomy with an external iliac bone fixator and bilateral groin flaps for the closure of soft tissue defects of the abdominal wall in cloacal exstrophy appears to be a safe and cosmetically acceptable alternative technique.
Assuntos
Parede Abdominal/cirurgia , Extrofia Vesical/cirurgia , Cloaca/cirurgia , Fixadores Externos , Osteotomia/efeitos adversos , Procedimentos de Cirurgia Plástica/instrumentação , Retalhos Cirúrgicos , Pré-Escolar , Cloaca/anormalidades , Fasciotomia , Feminino , Seguimentos , Virilha/cirurgia , Humanos , Ílio/cirurgia , Lactente , Masculino , Osteotomia/métodos , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos/métodosRESUMO
OBJECTIVES: To report the feasibility of early fetal cystoscopy for the prenatal diagnosis and therapy of severe first-trimester megacystis. METHODS: Between January 2008 and February 2010, early fetal cystoscopy at 16 weeks of gestation was offered to 15 patients whose fetuses presented with severe first-trimester megacystis. All infants were followed up for 6-12 months after birth. Autopsy was always performed whenever fetal or neonatal deaths occurred. RESULTS: Seven patients decided to undergo fetal therapy, and eight elected to continue with expectant observation. One fetus died before early fetal cystoscopy was performed. Therefore, six fetuses underwent early fetal cystoscopy. Urethral atresia was diagnosed in three fetuses during fetal cystoscopy and confirmed at autopsy following termination of pregnancy at 19-20 weeks in all cases. Posterior urethral valves were diagnosed and successfully fulgurated by laser during early cystoscopy in three fetuses, two of which survived with normal renal and bladder function after birth; the remaining fetus had a postnatal diagnosis of megacystis-microcolon intestinal hypoperistalsis syndrome and died neonatally. In the expectantly managed group, no survivals were observed, even among cases with 'isolated' posterior urethral valves. CONCLUSIONS: Percutaneous early fetal cystoscopy is feasible for prenatal diagnosis and therapy of severe megacystis.
Assuntos
Cistoscopia/métodos , Ultrassonografia Pré-Natal/métodos , Bexiga Urinária/cirurgia , Duodeno/anormalidades , Duodeno/diagnóstico por imagem , Duodeno/embriologia , Duodeno/cirurgia , Estudos de Viabilidade , Feminino , Doenças Fetais/diagnóstico por imagem , Doenças Fetais/cirurgia , Humanos , Lactente , Recém-Nascido , Terapia a Laser/métodos , Masculino , Gravidez , Resultado da Gravidez , Primeiro Trimestre da Gravidez , Diagnóstico Pré-Natal , Estudos Prospectivos , Uretra/anormalidades , Uretra/diagnóstico por imagem , Uretra/cirurgia , Bexiga Urinária/anormalidades , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/embriologiaRESUMO
PURPOSE: Animal bites to the external genitalia are rare. We retrospectively evaluated our experience with treating genital trauma caused by animal attacks. MATERIALS AND METHODS: We studied the medical records of 10 patients treated in the surgical emergency department at our hospital who presented with genital injury caused by an animal bite from 1983 to 1999. Special attention was given to the severity of injury, surgical treatment, antibiotic prophylaxis and outcome. RESULTS: Of the 2 men and 8 boys 8 were attacked by dogs, 1 by a horse and 1 by a donkey, respectively. In all cases initial local treatment involved débridement and copious wound irrigation with saline and povidone-iodine solution. Five patients who presented with minimal or no skin loss underwent primary skin closure, including 2 in whom urethral lacerations were surgically repaired. There was moderate to extensive tissue loss in 5 patients, including degloving penile injury in 2, traumatic spermatic cord amputation in 1, complete penile and scrotal avulsion in a 5-month-old infant, and partial penectomy in 1. Reconstructive procedures provided satisfactory cosmetic and functional results in 8 cases. Antibiotic prophylaxis was administered in all patients and no infectious complications developed. CONCLUSIONS: Animal bite is a rare but potentially severe cause of genital trauma and children are the most common victims. Morbidity is directly associated with the severity of the initial wound. Because patients tend to seek medical care promptly, infectious complications are unusual. Management involves irrigation, débridement, antibiotic prophylaxis, and tetanus and rabies immunization as appropriate as well as primary wound closure or surgical reconstruction. Good functional and cosmetic results are possible in the majority of cases.
Assuntos
Mordeduras e Picadas/complicações , Genitália Masculina/lesões , Adulto , Amputação Traumática/etiologia , Amputação Traumática/cirurgia , Animais , Antibioticoprofilaxia , Criança , Desbridamento , Cães , Equidae , Cavalos , Humanos , Masculino , Pênis/lesões , Procedimentos de Cirurgia Plástica , Estudos Retrospectivos , Irrigação TerapêuticaRESUMO
We review 38 cases of surgically corrected incontinent epispadias with a followup of 5 months to 18 years. In 20 cases the Leadbetter, in 8 the Tanagho and in 8 the Young-Dees techniques of bladder neck reconstruction were used. Of 3 patients with minimal (15 to 25 ml.) bladder capacity the Arap procedure was performed in 1, while small constriction of the bladder neck to improve the bladder capacity and compliance was done in 2. In 1 of the latter patients a 60 ml. capacity was achieved and a secondary Leadbetter operation provided an excellent result. Continence was attained after the initial operation in 18 patients, followup is too short to determine the result in 3 and 15 did not acquire urinary control. Revision of the bladder neck plasty was performed in 11 patients, which resulted in continence in 4 and partial continence in 2. Among 34 patients with an adequate followup 22 (73.3 per cent) are continent and 8 (26.4 per cent) are incontinent. The results were similar with the 3 techniques.
Assuntos
Epispadia/cirurgia , Incontinência Urinária/etiologia , Adolescente , Criança , Pré-Escolar , Epispadia/complicações , Epispadia/diagnóstico por imagem , Epispadia/fisiopatologia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Métodos , Radiografia , UrodinâmicaAssuntos
Extrofia Vesical/cirurgia , Colo/cirurgia , Bexiga Urinária/cirurgia , Derivação Urinária , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Retalhos CirúrgicosAssuntos
Hipospadia/cirurgia , Pênis/cirurgia , Retalhos Cirúrgicos , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , MasculinoAssuntos
Extrofia Vesical/cirurgia , Osteotomia , Ossos Pélvicos/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Imobilização , Lactente , Tempo de Internação , Masculino , Osteotomia/efeitos adversosRESUMO
Os autores estudaram retrospectivamente uma serie de 16 pacientes submetidos a osteotomia pelvica, como recurso auxiliar na reconstrucao cirurgica da extrofia vesical. Onze pacientes eram do sexo masculino e cinco do feminino, com media de idade de 3,1 anos; em oito casos processou-se a osteotomia iliaca posterior, em sete a osteotomia inominada e em um caso a osteotomia pubiana. A analise dos resultados mostrou as vantagens, os inconvenientes e as complicacoes da osteotomia. Concluem que: a osteotomia e eficiente no fechamento da parede abdominal como artificio cirurgico, diminuindo a tensao dos tecidos; a imobilidade no leito foi em media de 30 dias; a hospitalizacao de 75 dias utilizando-se a osteotomia posterior e 45 dias nas demais tecnicas; a rotacao medial e inferior da pelvis provocou sepultamento adicional do penis, assim como a reconstrucao do monte de venus foi prejudicada, permitindo cicatriz glabra mediana; um caso com osteomielite dos iliacos com sequelas graves sobre a marcha e postura; presenca de fistulas urinarias, supuracoes nos casos em que se usou o gesso