RESUMO
OBJECTIVE: To describe dorsal onlay buccal mucosa graft urethroplasty technique by subcoronal approach and glans preservation in distal penile urethral strictures with fossa navicularis involvement and to report safety, effectiveness, and cosmetic outcomes. METHODS: Retrospective review of a prospective database of patients treated at Hospital Italiano de Buenos Aires between January 2011 and December 2019. Main surgical steps: ventral subcoronal incision, dorsal dissection of glandelar urethra until piercing the tip of the glans, dorsal urethrotomy, and graft transposition. Low urinary tract symptoms, uroflowmetry, and urinalysis were assessed at follow-up. Simplified International Index Erectile Function and Hypospadias Objective Scoring Evaluation were applied 1 year after surgery. RESULTS: Sixteen patients with a median age of 56.5 years (IQR 35.7-66.7) were included. Median stricture length was 5.5 cm (IQR 4-8.7). In 3 patients, Clavien-Dindo grade I-II complications were reported. At 1 year, median peak flow was 18 mL/seg (IQR 12.7-27.4) and median mean flow 7.8 mL/seg (IQR 6.1-9.9). At 41.5 months follow-up (IQR 13.2-74), all patients were stricture free and had no changes in erectile function. Hypospadias Objective Scoring Evaluation score ≥14 points was achieved by 14 patients (87.5%). CONCLUSION: For treatment of distal penile urethral strictures with fossa navicularis involvement, dorsal onlay buccal mucosa graft by subcoronal approach and glans preservation is a feasible technique with excellent functional outcomes, minimal complications, and substantial cosmetic results.
Assuntos
Sintomas do Trato Urinário Inferior/cirurgia , Mucosa Bucal/transplante , Procedimentos de Cirurgia Plástica/métodos , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto , Idoso , Estética , Estudos de Viabilidade , Seguimentos , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/métodos , Pênis/cirurgia , Estudos Prospectivos , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Uretra/cirurgia , Estreitamento Uretral/complicações , Estreitamento Uretral/diagnósticoRESUMO
INTRODUCTION: Vesicourethral anastomotic stricture following prostatectomy is uncommon but represents a challenge for reconstructive surgery and has a significant impact on quality of life. The aim of this study was to relate our experience in managing vesicourethral anastomotic strictures and present the treatment algorithm used in our institution. PATIENTS AND METHODS: We performed a descriptive, retrospective study in which we assessed the medical records of 45 patients with a diagnosis of vesicourethral anastomotic stricture following radical prostatectomy. The patients were treated in the same healthcare centre between January 2002 and March 2015. Six patients were excluded for meeting the exclusion criteria. The stricture was assessed using cystoscopy and urethrocystography. The patients with patent urethral lumens were initially treated with minimally invasive procedures. Open surgery was indicated for the presence of urethral lumen obliteration or when faced with failure of endoscopic treatment. Urinary continence following the prostatectomy was determinant in selecting the surgical approach (abdominal or perineal). RESULTS: Thirty-nine patients treated for vesicourethral anastomotic stricture were recorded. The mean age was 64.4 years, and the mean follow-up was 40.3 months. Thirty-three patients were initially treated endoscopically. Seventy-five percent progressed free of restenosis following 1 to 4 procedures. Twelve patients underwent open surgery, 6 initially due to obliterative stricture and 6 after endoscopic failure. All patients progressed favourable after a mean follow-up of 29.7 months. CONCLUSIONS: Endoscopic surgery is the initial treatment option for patients with vesicourethral anastomotic strictures with patent urethral lumens. Open reanastomosis is warranted when faced with recalcitrant or initially obliterative strictures and provides good results.
Assuntos
Complicações Pós-Operatórias/cirurgia , Prostatectomia , Estreitamento Uretral/cirurgia , Obstrução do Colo da Bexiga Urinária/cirurgia , Idoso , Anastomose Cirúrgica , Humanos , Masculino , Pessoa de Meia-Idade , Prostatectomia/métodos , Estudos Retrospectivos , Estreitamento Uretral/complicações , Obstrução do Colo da Bexiga Urinária/complicações , Procedimentos Cirúrgicos Urológicos/métodosAssuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Stents , Estreitamento Uretral/cirurgia , Cateterismo Urinário/métodos , Seguimentos , Complicações Pós-Operatórias , Implantação de Prótese/métodos , Recidiva , Stents/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Estreitamento Uretral/complicações , Cateterismo Urinário/efeitos adversos , Incontinência Urinária por Estresse/etiologiaRESUMO
PURPOSE: To evaluate the long term outcomes of permanent Memotherm urethral stent in the treatment of recurrent bulbar urethral stricture. MATERIALS AND METHODS: Twenty patients who underwent permanent Memotherm urethral stent implantation due to recurrent bulbar urethral stricture following previous unsuccessful surgical procedure from 1996 to 2002 were included in the study. Long-term outcomes of the patients were evaluated. RESULTS: The overall success rate was 87.5% at the end of the tenth year. There was discomfort in implantation area in eight patients about 1 month following the procedure. These patients were treated with alpha-blocker and anti-inflammatory drugs. Stone formation was observed at the urethral stent implantation area in two patients. Post-void dripping has been observed in 15 patients up to the postoperative 3rd month. Stress urinary incontinence was observed in a patient with a 1-year follow-up. Partial stent migration was observed in two patients. None of the patients experienced pain during erection. CONCLUSION: Memotherm urethral stent is a minimal invasive surgical procedure which can be safely and effectively used in patients with recurrent urethral stricture.
Assuntos
Stents , Estreitamento Uretral/cirurgia , Cateterismo Urinário/métodos , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Implantação de Prótese/métodos , Recidiva , Stents/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Estreitamento Uretral/complicações , Cateterismo Urinário/efeitos adversos , Incontinência Urinária por Estresse/etiologia , Adulto JovemRESUMO
Purpose: To evaluate the long term outcomes of permanent Memotherm urethral stent in the treatment of recurrent bulbar urethral stricture. Materials and Methods: Twenty patients who underwent permanent Memotherm urethral stent implantation due to recurrent bulbar urethral stricture following previous unsuccessful surgical procedure from 1996 to 2002 were included in the study. Long-term outcomes of the patients were evaluated. Results: The overall success rate was 87.5% at the end of the tenth year. There was discomfort in implantation area in eight patients about 1 month following the procedure. These patients were treated with alpha-blocker and anti-inflammatory drugs. Stone formation was observed at the urethral stent implantation area in two patients. Post-void dripping has been observed in 15 patients up to the postoperative 3rd month. Stress urinary incontinence was observed in a patient with a 1-year follow-up. Partial stent migration was observed in two patients. None of the patients experienced pain during erection. Conclusion: Memotherm urethral stent is a minimal invasive surgical procedure which can be safely and effectively used in patients with recurrent urethral stricture. .
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Stents , Estreitamento Uretral/cirurgia , Cateterismo Urinário/métodos , Seguimentos , Complicações Pós-Operatórias , Implantação de Prótese/métodos , Recidiva , Stents/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Estreitamento Uretral/complicações , Cateterismo Urinário/efeitos adversos , Incontinência Urinária por Estresse/etiologiaRESUMO
Se revisa la morbilidad de las más frecuentes anomalías congénitas del Sistema Urinario en la provincia de Matanzas, Cuba, en un período de 30 años. Se encuentra que las más frecuentes malformaciones Urológicas son el Reflujo Vésico Ureteral, la Hidronefrosis Congénita, por compromiso de la unión pielo ureteral, la Estenosis Urétero Vesical y el Ureterocele. Se analizan la incidencia de estas patologías, edad, sexo, raza, síntomas más frecuentes, técnicas quirúrgicas utilizadas y las patologías asociadas
We review the morbidity of the more frequently congenital anomalies of the Upper Urinary System in the province of Matanzas, Cuba, in a period of 30 years. We found that the more frequently urological malformations are the vesicourethral Reflux; the congenital hydronefrosis for the compromise of the skin-urethral joint; vesico-urethral stenosis and ureterocele. We analyze the incidence of these pathologies, age, sex, race, and more frequent symptoms; used surgical techniques and associated anomalies.
Assuntos
Humanos , Recém-Nascido , Anormalidades Urogenitais/cirurgia , Anormalidades Urogenitais/complicações , Anormalidades Urogenitais/epidemiologia , Hidronefrose/congênito , Hidronefrose/epidemiologia , Refluxo Vesicoureteral/congênito , Refluxo Vesicoureteral/epidemiologia , Estreitamento Uretral/cirurgia , Estreitamento Uretral/complicações , Estreitamento Uretral/congênito , Estreitamento Uretral/epidemiologia , Obstrução Uretral/cirurgia , Obstrução Uretral/epidemiologia , Ureterocele/cirurgia , Ureterocele/epidemiologiaRESUMO
La derivación urinaria por medio de un cateterismo intermitente y limpio (C.I.L.) realizado a través de una derivación urinaria continente (D.U.C.) tiene indicaciones precisas. Esta medida mejora la calidad de vida de los niños pero no está exenta de complicaciones. Nuestro objetivo es evaluar y analizar una década de experiencia en D.U.C. en nuestro hospital. Método: Revisión retrospectiva de fichas clínicas de los pacientes sometidos a D.U.C. entre los años 1996-2006. Resultados: En una década hubo 33 pacientes sometidos a D.U.C.: 18 niñas y 15 niños. La edad promedio al momento de la cirugía fue de 6 años (rango 1-15) Los principales diagnósticos fueron vejiga neurogénica (N=21), extrofia vesical (N=3), RVU (N=3). En 27 niños (82 por ciento) se utilizó apéndice cecal (Mitrofanoff), en 5 (15 por ciento) uréter y en 1 (3 por ciento) intestino (Monti). En 32 (97 por ciento) el ostoma se ubicó a nivel umbilical. En 21 niños (64 por ciento) la D.U.C. se realizó concomitantemente con ampliación vesical. La complicación más frecuente fue la estenosis del ostoma (7/34); 3 debido a no uso de C.I.L. Conclusiones: La D.U.C. puede presentar complicaciones, siendo la estenosis del ostoma la más frecuente. En 3/7 se debió al no uso de C.I.L., por lo que la educación del paciente y su familia es fundamental. El apéndice sigue siendo nuestra preferencia. La derivación urinaria continente es una alternativa a considerar en pacientes con dificultades de C.I.L. por uretra, pudiendo mejorar significativamente su calidad de vida.
Objective: The indications for urinary diversion using clean intermittent catheterization (CIC) through a continent urinary diversion (CUD) are precise. This measure improves patients life style, although it is not complications free. The aim is to evaluate a decade of experience using CUD in a single institution. Methods: Case note review of all patients who underwent CUD surgery in our hospital between 1996-2006. Results: In the studied decade there were 33 patients with CUD: 18 girls and 15 boys. The mean age at surgery was 6 years (range 1-15). The main diagnosis was neurogenic bladder (N=21), bladder extrophy (N=3), and VUR (N=3). With regards to segment used, in 27 patients (83%) was the appendix (Mitrofanoff), in 5 (15%) ureter and in 1 (3%) ileon (Monti). In 32 (97%) the ostoma was located at umbilicus. In 21 cases (64%) CUD was done concomitant with bladder augmentation. The most frequent complication was stomal stenosis (7/34); 3 due to no use of CIC. Conclusions: CUD could have complications; being the most frequents the stenosis of the stoma. In 3/7 this was due to no use of CIC, therefore patient and family education are vital. The appendix is still our first choice. The continent urinary diversion is a valid alternative in patients with problems doing CIC by urethra, improving their like style.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Cateterismo Urinário/efeitos adversos , Complicações Pós-Operatórias , Derivação Urinária/métodos , Estreitamento Uretral/complicações , Estudos RetrospectivosRESUMO
Os autores descrevem um caso de associaçäo entre estenose de JUP e refluxo vesicoureteral. a investigaçäo propedêutica e orientaçäo terapêutica é discutida. Por se tratar de duas afecçöes de tratamento potencialmente cirúrgico, o momento e a ordem correta da correçäo cirúrgica säo revistos
Assuntos
Humanos , Masculino , Criança , Estreitamento Uretral/complicações , Refluxo Vesicoureteral/complicaçõesRESUMO
En el presente trabajo se analizaron los expedientes de 63 casos de hipospadias severos, corregidos mediante injerto autólogo de piel o mucosa vesical, con la técnica de Horton-Devine, en el periodo de 1986 a 1993 en el servicio de Urología del Instituto Nacional de Pediatría. La suma de porcentajes de fístulas, divertículos y estenosis, alcanzó el 85 por ciento de todos los casos, resultado distinto y en mayor proporción a las series publicadas. Analizados los pacientes con estímulo hormonal preoperatorio, comparados con aquellos en los que no se usaron hormonas, sus porcentajes de complicaciones disminuyeron significativamente. El resultado estético final fue entre excelente y bueno en 84 por ciento de los casos. Se concluye que aunque es un procedimiento que ofrece excelentes resultados estéticos y funcionales, amerita una segunda operación en el 85 por ciento de los casos