RESUMO
The introduction of foreign bodies in the urethra are uncommon. Given its rarity, the approach to this condition is not standardized but it is highlighted that minimally invasive procedures should be prioritized depending on its feasibility. In the present study, we report a case of a 60-year-old male patient with bipolar disorder and a foreign body impacted in the bulbar urethra with open surgical resolution after a failed endoscopic treatment. We perform an analysis into the diagnostic and therapeutic methods used, with postoperative results.
La introducción de cuerpos extraños uretrales es poco frecuente, razón por la cual, la mayoría de las publicaciones disponibles en la literatura son reportes de casos aislados o pequeñas series con gran heterogeneidad. Existen distintas aproximaciones frente a esta afección, desde métodos menos invasivos hasta cirugías abiertas más complejas. Presentamos un caso de cuerpo extraño impactado en uretra bulbar con el objetivo de analizar métodos diagnósticos empleados y aproximaciones terapéuticas concluyendo en la resolución quirúrgica convencional. Se evaluaron resultados postoperatorios.
Assuntos
Corpos Estranhos , Estreitamento Uretral , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Uretra/cirurgia , Estreitamento Uretral/diagnóstico , Estreitamento Uretral/cirurgiaRESUMO
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
OBJECTIVE: To characterize the bulbospongiosus muscle (BSM) in patients with bulbar urethral strictures. MATERIALS AND METHODS: We studied 21 patients divided into 2 groups: Stricture Group (nâ¯=â¯14; mean ageâ¯=â¯62.00 years) with bulbar stricture submitted to open urethroplasty; and Control Group (nâ¯=â¯7; mean ageâ¯=â¯60.14 years) with penile strictures (hypospadias cripples, penile cancer and/or penile infection) who were submitted to perineal urethrostomy. Samples of the BSM were dissected and histologic sections were stained by histochemical and immunohistochemical techniques. Histomorphometric analyzes were performed on photomicrographs. Means were statistically compared using the unpaired Student t test and the Mann-Whitney test (P <.05). RESULTS: The etiology of bulbar urethral stricture was idiopathic in 2 cases (14.29%), post-TURP in 6 (42.86%), post open radical prostatectomy in 5 (35.71%) and post open prostatectomy in 1 case (7.14%). The average length of the stricture was 2.08 cm. The only parameter analyzed with significant difference between the groups was the vessels (significant difference between the control group: 5.11 ± 1.98% and stricture group: 3.57 ± 1.32%, Pâ¯=â¯.0460). The quantitative analysis of collagen (Control Group: 10.63 ± 5.37% and Stricture Group: 10.83 ± 4.55%, Pâ¯=â¯.9296); diameter of BSM muscle fibers (Control Group: 41.71 ± 14.63 µm and Stricture Group: 40.11 ± 8.59 µm, Pâ¯=â¯.76 and elastic system fibers (Control Group; 3.83 ± 1.54% and Stricture Group: 5.43 ± 2.90%, Pâ¯=â¯.2601) showed no significant difference. CONCLUSIONS: Histologic analysis showed a significant decrease of the BSM vessels in urethral stricture, without changes in elastic fibers, collagen, nerves, and muscle fiber diameter. These findings show that the bulbar urethral stricture causes minimal alterations in the structure of the BSM.
Assuntos
Doenças do Pênis , Pênis , Complicações Pós-Operatórias , Uretra , Estreitamento Uretral , Procedimentos Cirúrgicos Urológicos , Pesos e Medidas Corporais/métodos , Brasil , Constrição Patológica , Correlação de Dados , Técnicas de Imagem por Elasticidade/métodos , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Doenças do Pênis/diagnóstico , Doenças do Pênis/etiologia , Pênis/patologia , Pênis/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/patologia , Procedimentos de Cirurgia Plástica/métodos , Uretra/irrigação sanguínea , Uretra/inervação , Uretra/patologia , Uretra/cirurgia , Estreitamento Uretral/diagnóstico , Estreitamento Uretral/epidemiologia , Estreitamento Uretral/etiologia , Estreitamento Uretral/patologia , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Procedimentos Cirúrgicos Urológicos/métodosRESUMO
Se presentó un caso intervenido en el servicio de Urología del Hospital Nacional "Guido Valadares" de Timor Oriental, con diagnóstico de retención completa de orina, insuficiencia renal aguda obstructiva posrrenal, hidronefrosis bilateral y estenosis uretral e hipospadia, con el objetivo de demostrar el uso de la mucosa prepucial para las hipospadias que concomitan con estenosis uretral. La conducta quirúrgica consistió en una uretroplastia con mucosa prepucial. Se logró la reconstrucción total de la uretra afectada, con buenos resultados finales estéticos y funcionales. El uso de la mucosa oral fue de gran utilidad en el manejo del paciente(AU)
A case was presented in the Department of Urology of Guido Valadares National Hospital in East Timor, diagnosed with complete retention of urine, post renal, obstructive and acute renal failure, bilateral hydronephrosis and urethral stricture and hypospadias, in order to demonstrate the use of prepucial mucosa for hypospadias that concomitan with urethral stricture. The surgical treatment consisted urethroplasty with preputial mucosa. Total reconstruction of the affected urethra was done with good aesthetic and functional outcomes. The use of oral mucosa was very useful in patient management(AU)
Foi apresentado um caso no Departamento de Urologia do Hospital Nacional "Guido Valadares" de Timor Oriental, com diagnóstico de retenção urinária completa, insuficiência renal aguda obstrutiva pós-renal, hidronefrose bilateral e estenose e hipospádia uretral, para demonstrar a utilização da mucosa prepucial para hipospádia que coincide com estenose uretral. O procedimento cirúrgico consistiu em uma uretroplastia com mucosa prepucial. A reconstrução total da uretra afetada foi alcançada, com bons resultados estéticos e funcionais finais. O uso da mucosa oral foi muito útil no manejo do paciente(AU)
Assuntos
Humanos , Masculino , Estreitamento Uretral/diagnóstico , Hipospadia/cirurgia , Hipospadia/diagnóstico , Timor-LesteRESUMO
OBJECTIVES: To evaluate national practice patterns in the treatment of male anterior urethral strictures among Turkish urologists. MATERIALS AND METHODS: A survey form including 12 questions prepared to determine active Turkish urologists' approach to diagnosis and treatment of the adult urethral stricture (US) were filled out. Based on the survey results, the institutions which 218 urologists work and their years of expertise, methods they used for diagnosis and treatment, whether or not they perform open urethroplasty and timing of open urethroplasty were investigated. RESULTS: Optic internal urethrotomy and dilatation are the most commonly used minimal invasive procedures in treatment of US with the ratios of 93.5% and 63.3% respectively. On the other hand it was seen that urethroplasty was a less commonly used procedure, compared to minimal invasive techniques, with the ratio of 36.7%. Survey results showed us that the number of US cases observed and open urethroplasty procedures performed increases with increasing years of professional experience. CONCLUSIONS: As a method demanding special surgical experience and known as a time-consuming and challenging procedure, open urethroplasty will be able to take a greater part in current urological practice with the help of theoretical education and practical courses given by specific centers and experienced authors.
Assuntos
Padrões de Prática Médica/estatística & dados numéricos , Estreitamento Uretral/diagnóstico , Estreitamento Uretral/cirurgia , Urologistas/estatística & dados numéricos , Adulto , Humanos , Masculino , Estatísticas não Paramétricas , Inquéritos e Questionários , Turquia , Uretra/cirurgia , UrologiaRESUMO
ABSTRACT Objectives: To evaluate national practice patterns in the treatment of male anterior urethral strictures among Turkish urologists. Materials and Methods: A survey form including 12 questions prepared to determine active Turkish urologists' approach to diagnosis and treatment of the adult urethral stricture (US) were filled out. Based on the survey results, the institutions which 218 urologists work and their years of expertise, methods they used for diagnosis and treatment, whether or not they perform open urethroplasty and timing of open urethroplasty were investigated. Results: Optic internal urethrotomy and dilatation are the most commonly used minimal invasive procedures in treatment of US with the ratios of 93.5% and 63.3% respectively. On the other hand it was seen that urethroplasty was a less commonly used procedure, compared to minimal invasive techniques, with the ratio of 36.7%. Survey results showed us that the number of US cases observed and open urethroplasty procedures performed increases with increasing years of professional experience. Conclusions: As a method demanding special surgical experience and known as a time-consuming and challenging procedure, open urethroplasty will be able to take a greater part in current urological practice with the help of theoretical education and practical courses given by specific centers and experienced authors.
Assuntos
Humanos , Masculino , Adulto , Estreitamento Uretral/cirurgia , Estreitamento Uretral/diagnóstico , Urologistas/estatística & dados numéricos , Turquia , Uretra/cirurgia , Urologia , Padrões de Prática Médica/estatística & dados numéricos , Inquéritos e Questionários , Estatísticas não ParamétricasRESUMO
The incidence of urethral stenosis in Mexico had not been documented. At the Centro Médico Nacional La Raza, during the year 2010, 629 patients with urethral stenosis were attended as outpatient consultation: 85 % with previous urethral stenosis and 15 % with urethral treatment complication. Urethral stenosis is a chronic illness, with multiple etiological origins and the handling is controversial. It has a great negative impact for the patients and the recurrence reaches 85 %. The treatment consisted of an invasive approach (urethral dilations, endoscopy procedure) and open surgery (urethroplasty). The World Health Organization and World Alliance take the world challenge about the urinary tract infections associated with the attention of patients, focused on urethral stenosis. The objective of the following clinical guide is to offer to the health professional a clinical tool for making decisions in the handling of the hardship or masculine urethral stenosis, based on the best available evidence, carrying out in systematized form with bibliographical research using validated terms of the MeSH: urethral structures, in the databases Trip database, PubMed, Guideline Clearinghouse, Cochrane Library and Ovid.
En México no está documentada la incidencia de la estenosis de uretra en forma consistente. En 2010, en el Centro Médico Nacional La Raza se reportaron 629 pacientes en consulta externa, 85 % de uretra anterior y 15 % de uretra posterior. La estenosis uretral es una enfermedad crónica, de etiología variada y manejo controvertido, con gran impacto negativo para los pacientes y recurrencia hasta de 85 %. El tratamiento puede ser instrumentado (dilataciones, cirugía endoscópica) y por cirugía abierta (uretroplastia). La Organización Mundial de la Salud y Alianza Mundial la consideran un reto de la atención de la salud. El objetivo de la siguiente guía es ofrecer al profesional de la salud, una herramienta clínica para la toma de decisiones en la atención de la estenosis uretral masculina, basada en la mejor evidencia identificada mediante la búsqueda bibliográfica sistematizada en las bases de datos Tripdatabase, PubMed, Guideline Clearinghouse, Cochrane Library y Ovid.