RESUMO
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
PURPOSE: Evaluate the main etiologies and clinical characteristics of male urethral stricture disease (USD) in Brazil. METHODS: This multicentric study was performed using retrospective data collected from six Brazilian referral centers of urethral reconstruction. The database comprised data from 899 patients with USD who had undergone surgical treatment from 2008 to 2018. Age, stricture site and primary stricture etiology were identified for each patient. RESULTS: The mean age was 52.13 ± 16.9 years. The most common etiology was iatrogenic (43.4%), followed by idiopathic (21.7%), trauma (21.5%) and inflammatory (13.7%). Of the iatrogenic causes, 59% were secondary to urethral instrumentation (60% by urethral catheterization and 40% by transurethral procedures), 24.8% by other procedures (prostatectomy, radiotherapy, postectomy) and 16.2% by failed hypospadia repairs. Pelvic fracture urethral distraction injuries were responsible for most of the trauma-related strictures (62.7%). When stratified by age, the most common stricture etiology was trauma in the 0-39 years old group (42.8%), idiopathic in the 40-59 years old group (32.4%) and iatrogenic in patients over 60 years old (68%). In regard to the stricture site, 80% presented with an anterior urethral stricture and 20% with a posterior stenosis. In the anterior stenosis group, the most common stricture site was bulbar (39.5%). CONCLUSION: In Brazil, as in many developed countries, the most common cause of urethral stricture diseases is iatrogenic, especially urethral catheterization. These findings emphasize the need of a careful urethral manipulation and a better training of healthcare professionals. Trauma is still responsible for a great proportion of strictures and inflammatory etiologies are now less frequently observed.
Assuntos
Países em Desenvolvimento , Doença Iatrogênica/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Estreitamento Uretral/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Fraturas Ósseas/complicações , Humanos , Hipospadia/cirurgia , Líquen Escleroso e Atrófico/complicações , Líquen Escleroso e Atrófico/epidemiologia , Masculino , Pessoa de Meia-Idade , Ossos Pélvicos/lesões , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Estreitamento Uretral/etiologia , Uretrite/complicações , Uretrite/epidemiologia , Cateterismo Urinário/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Adulto JovemRESUMO
OBJECTIVE: To report the incidence of urethral stricture and its management in patients with spinal cord injury treated with clean intermittent self-catheterization (CIC). MATERIALS AND METHODS: The clinical records of 333 patients with spinal cord injury treated with CIC since 2001 were identified, and those who developed a urethral stricture during their follow-up, including their treatment and results achieved, were analyzed. RESULTS: The patients had a median age at the time of injury of 27 years, of which only 14 patients (4.2%) developed urethral stricture at a mean duration of self-catheterization of 9 years; 86% of them were treated with urethrotomy, without recurrence through a mean of 1-year follow-up. There are no previous reports of rates of urethral stricture in this type of patients in our institution; the rate found is considerably low, as is the recurrence after urethrotomy, which can be decreased by the continuous self-obturation achieved with catheterization. CONCLUSION: Urethral stricture as a complication of CIC in patients with spinal cord injury has a low incidence and can be effectively treated in those who develop it.
Assuntos
Cateterismo Uretral Intermitente/efeitos adversos , Autocuidado/efeitos adversos , Traumatismos da Medula Espinal/complicações , Estreitamento Uretral/epidemiologia , Bexiga Urinaria Neurogênica/terapia , Adulto , Vértebras Cervicais , Feminino , Humanos , Incidência , Vértebras Lombares , Masculino , México/epidemiologia , Recidiva , Estudos Retrospectivos , Traumatismos da Medula Espinal/terapia , Vértebras Torácicas , Estreitamento Uretral/etiologia , Bexiga Urinaria Neurogênica/complicaçõesRESUMO
BACKGROUND: Hypospadias is one of the most common congenital malformations. Few studies have explored the association of age at time of surgery and the occurrence of complications after hypospadias repair. OBJECTIVE: Determine whether age at hypospadias repair is a risk factor for development of complications. METHODS: Retrospective cohort of patients with hypospadias repair in one surgical time. The data included: age, type of hypospadias, surgical technique and complications presented. The monitoring was conducted for six months after the surgery. Patients were classified according to age group A less than 24 months, group B from 24 to 48 months and group C over 48 months. We calculated the relative risk and confidence intervals of 95%. RESULTS: 170 patients were included in the analysis. The incidence of complications was 24.1%, the most frequent complication was urethrocutaneous fistula (52.2%). The median age in months of the complication group was 40.8 (6-196), whereas in the group without complications was 37.5 (6-196). Age was not associated with an increased risk for complications, group B (RR= 0.975 [95% CI 0.374-2.547]), and group C (RR= 0.966 [95% CI 0.386-2.416]) when compared with group A. CONCLUSIONS: Age at time of surgery for hypospadias correction in one phase is not associated with complications.
Antecedentes: el hipospadias es una de las malformaciones congénitas más comunes. Pocos estudios han explorado la asociación de la edad al momento de la cirugía y las complicaciones. Objetivo: determinar si la edad al momento de la corrección del hipospadias es un factor de riesgo de complicaciones. Material y métodos: estudio de cohorte retrospectiva de pacientes con reparación del hipospadias en un tiempo quirúrgico. Los datos incluyeron: edad, tipo de hipospadias, técnica quirúrgica y complicaciones. El seguimiento se efectuó incluso seis meses después de la cirugía. Los pacientes se clasificaron según su edad: el grupo A menores de 24 meses, grupo B de 24 a 48 meses y el grupo C mayores de 48 meses. Se calculó el riesgo relativo y los intervalos de confianza de 95%. Resultados: se analizaron los expedientes de 170 pacientes. La incidencia de complicaciones fue de 24.1%, la más frecuente fue la fistula uretrocutánea (52.2%). La mediana de edad en meses del grupo con complicación fue: 40.8 (6-196), mientras que en el grupo sin complicación fue: 37.5 (6-196). La edad no se asoció con mayor riesgo de complicaciones, grupo B (RR= 0.975 [IC 95% 0.374-2.547]); y el grupo C (RR= 0.966 [IC 95% 0.386-2.416]) al compararla con el grupo A. Conclusiones: la edad al momento de la corrección del hipospadias en un tiempo quirúrgico no se asocia con complicaciones quirúrgicas.
Assuntos
Hipospadia/cirurgia , Fatores Etários , Criança , Pré-Escolar , Intervalos de Confiança , Fístula Cutânea/epidemiologia , Fístula Cutânea/etiologia , Humanos , Hipospadia/classificação , Incidência , Lactente , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Risco , Deiscência da Ferida Operatória/epidemiologia , Doenças Uretrais/epidemiologia , Doenças Uretrais/etiologia , Estreitamento Uretral/epidemiologia , Estreitamento Uretral/etiologia , Fístula Urinária/epidemiologia , Fístula Urinária/etiologiaRESUMO
OBJECTIVES: In this study, we aimed to determine the complications of standard surgical treatments among patients over 75 years in a high-volume urologic center. METHODS: We analyzed 100 consecutive patients older than 75 years who had undergone transurethral prostatic resection of the prostate or open prostatectomy for treatment of benign prostatic hyperplasia from January 2008 to March 2010. We analyzed patient age, prostate volume, prostate-specific antigen level, international prostatic symptom score, quality of life score, urinary retention, co-morbidities, surgical technique and satisfaction with treatment. RESULTS: Median age was 79 years. Forty-eight patients had undergone transurethral prostatic resection of the prostate, and 52 had undergone open prostatectomy. The median International Prostatic Symptom Score was 20, the median prostate volume was 83 g, 51% were using an indwelling bladder catheter, and the median prostatespecific antigen level was 5.0 ng/ml. The most common comorbidities were hypertension, diabetes and coronary disease. After a median follow-up period of 17 months, most patients were satisfied. Complications were present in 20% of cases. The most common urological complication was urethral stenosis, followed by bladder neck sclerosis, urinary fistula, late macroscopic hematuria and persistent urinary incontinence. The most common clinical complication was myocardial infarction, followed by acute renal failure requiring dialysis. Incidental carcinoma of the prostate was present in 6% of cases. One case had urothelial bladder cancer. CONCLUSIONS: Standard surgical treatments for benign prostatic hyperplasia are safe and satisfactory among the elderly. Complications are infrequent, and urethral stenosis is the most common. No clinical variable is associated with the occurrence of complications.
Assuntos
Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Infarto do Miocárdio/etiologia , Prostatectomia/efeitos adversos , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/efeitos adversos , Estreitamento Uretral/etiologia , Distribuição de Qui-Quadrado , Doença das Coronárias/epidemiologia , Diabetes Mellitus/epidemiologia , Seguimentos , Hipertensão/epidemiologia , Infarto do Miocárdio/epidemiologia , Satisfação do Paciente/estatística & dados numéricos , Antígeno Prostático Específico/sangue , Prostatectomia/métodos , Hiperplasia Prostática/epidemiologia , Hiperplasia Prostática/patologia , Resultado do Tratamento , Ressecção Transuretral da Próstata/métodos , Estreitamento Uretral/epidemiologiaRESUMO
OBJECTIVES: In this study, we aimed to determine the complications of standard surgical treatments among patients over 75 years in a high-volume urologic center. METHODS: We analyzed 100 consecutive patients older than 75 years who had undergone transurethral prostatic resection of the prostate or open prostatectomy for treatment of benign prostatic hyperplasia from January 2008 to March 2010. We analyzed patient age, prostate volume, prostate-specific antigen level, international prostatic symptom score, quality of life score, urinary retention, co-morbidities, surgical technique and satisfaction with treatment. RESULTS: Median age was 79 years. Forty-eight patients had undergone transurethral prostatic resection of the prostate, and 52 had undergone open prostatectomy. The median International Prostatic Symptom Score was 20, the median prostate volume was 83 g, 51% were using an indwelling bladder catheter, and the median prostate-specific antigen level was 5.0 ng/ml. The most common comorbidities were hypertension, diabetes and coronary disease. After a median follow-up period of 17 months, most patients were satisfied. Complications were present in 20% of cases. The most common urological complication was urethral stenosis, followed by bladder neck sclerosis, urinary fistula, late macroscopic hematuria and persistent urinary incontinence. The most common clinical complication was myocardial infarction, followed by acute renal failure requiring dialysis. Incidental carcinoma of the prostate was present in 6% of cases. One case had urothelial bladder cancer. CONCLUSIONS: Standard surgical treatments for benign prostatic hyperplasia are safe and satisfactory among the elderly. Complications are infrequent, and urethral stenosis is the most common. No clinical variable is associated with the occurrence of complications.
Assuntos
Infarto do Miocárdio/etiologia , Prostatectomia/efeitos adversos , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/efeitos adversos , Estreitamento Uretral/etiologia , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Doença das Coronárias/epidemiologia , Diabetes Mellitus/epidemiologia , Seguimentos , Humanos , Hipertensão/epidemiologia , Masculino , Infarto do Miocárdio/epidemiologia , Satisfação do Paciente/estatística & dados numéricos , Antígeno Prostático Específico/sangue , Prostatectomia/métodos , Hiperplasia Prostática/epidemiologia , Hiperplasia Prostática/patologia , Ressecção Transuretral da Próstata/métodos , Resultado do Tratamento , Estreitamento Uretral/epidemiologiaRESUMO
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
Se reportaron los primeros pacientes operados en el Instituto Hondureño del Seguro Social, en la Unidad Materno Infantil con diagnóstico de Megaureter obstructivo primario. La técnica operatoria utilizada fue la Plicatura Ureteral propuesta en 1977 por el Dr. Zygmunto Kalinski, más reimplantación ureteral tipo cohen. La evolución postoperatoria de los cuatro pacientes ha sido excelente tanto clínica com radiológicamente
Assuntos
Estreitamento Uretral/cirurgia , Estreitamento Uretral/epidemiologia , Infecções Urinárias/cirurgia , Infecções Urinárias/etiologiaRESUMO
El tratamiento de las lesiones de uretra posterior (estenosis, fistula o ambas) en niños plantea diversos problemas por las limitaciones de los accesos empleados más a menudo y el tamaño pequeño y lo delicado de las estructuras. Se utilizó el acceso transanorrectal sagital posterior (ATSP) para la reparación de lesiones complejas de uretra posterior en 11 niños (nueve varones y dos mujeres). Siete de ellos habían sido sometidos a varios intentos de reparación por técnicas diversas. Se realizaron resecciones y sustancias uretral con mucosa bucal en dos casos, y sustitución uretral con colgajo recal en otro. A seis pacientes se les realizaron resección y reanastomosis primaria. Se efectuó cierre primario en dos niñas con diagnóstico de fístula uretrovaginal. El ATSP ofrece exposición y visualización excelentes de las lesiones que se van a reparar, facilitar su resección y reanastomosisprimaria, y permite la utilización de injertos libres o colgajos pediculados de estructuras vecinas. Los resultados finales fueron satisfactorios en 10 de 11 pacientes. Las complicaciones y la morbilidad relacionadas con este acceso no fueron significativas
Assuntos
Humanos , Masculino , Feminino , Adolescente , Procedimentos Cirúrgicos Operatórios , Estreitamento Uretral/cirurgia , Uretra/cirurgia , Estreitamento Uretral/epidemiologiaRESUMO
En el Hospital IPSS "Alberto Sabogal" del Callao, se estudió desde febrero de 1982 (fecha de su fundación), hasta diciembre de 1986 un total de 127 pacientes con estenosis uretral adquirida, observándose una mayor incidencia entre los 40 y 69 años de edad; de acuerdo al sexo, la totalidad de pacientes afectados fueron hombres, teniéndose como antecedente más importante el adenoma prostático (78%) y la gonorrea (25%). La sintomatología más frecuentemente hallada fueron la disminución del chorro urinario, las infecciones urinarias, la polaquiuria y la disuria por lo que el 76% de pacientes fueron sometidos a cistoscopía y 30% al cistouretrograma. El tratamiento prescrito fue la dilatación en más de una oportunidad (90%), y los casos rebeldes tuvieron necesidad de cirugía (23%) en tanto que solo en un 10% tuvieron necesidad de una sola dilatación. la evolución fue favorable en un 85%, y el 15% restante tuvieron necesidad de controles periódicos por la persistencia de síntomas