Acta Urológica Portuguesa最新文献

Introduction

The ureterointestinal stenosis is a relatively frequent complication after urinary diversions. The laparoscopic approach is rarely used but stay a therapeutic option.

Purpose

Show the surgical technique, step by step, of the laparoscopic ureteral/ureterointestinal estenosis correction.

Methods

A vídeo of a distal ureteral stenosis laparoscopic correction, on a patient that undergone laparoscopic radical cystectomy with orthotopic neobladder confection, was presented.

Results

It was possible the laparoscopic correction of a distal right ureter estenosis with good results and no complications.

Conclusion

The laparoscopic approach proved effective for treating ureter/ureterointestinal anastomosis stenosis and should be taken as a good option of treatment.

Objective

Due to considerable morbidity and mortality rates, radiation‐induced hemorrhagic cystitis is an important complication of pelvic irradiation. The available conservative treatment techniques show limited results. Hyperbaric oxygen has shown to be effective in the treatment of radiation‐induced lesions, including radiation cystitis. Our aim was to analyze the effectiveness and safety of hyperbaric oxygen therapy for refractory radiation‐induced hemorrhagic cystitis.

Materials and Methods

Clinical records of 176 patients with refractory radiation‐induced hemorrhagic cystitis treated at our centre were retrospectively analyzed. The evolution of macroscopic hematuria was the main therapeutic outcome analyzed.

Results

23,9% of patients showed other radiation‐induced soft tissue lesions. After an average of 37 sessions of hyperbaric oxygen, 89,8% of patients showed resolution of hematuria. Adverse events were reported in 1,7% of patients.

Conclusions

Hyperbaric oxygen was a safe and effective therapy for radiation‐induced hemorrhagic cystitis. Concomitant radiation‐induced soft tissue lesions were relatively frequent, which makes hyperbaric oxygen an excellent choice as first line treatment in those patients.

Aims

Spinal cord injury in males is frequently associated with infertility, due to ejaculatory dysfunction and/or semen properties alterations. Penile vibratory stimulation can be used as a semen collecting method. The aim of this work is to disclose the use of this method in spinal cord injured male patients, evaluate its possible complications and clarify if the ejaculated semen is prone to fertilization.

Material and Methods

Vibratory stimulation was used in three spinal cord injured patients to collect semen and, after that procedure, the evaluation of sperm parameters was performed.

Results

Vibratory stimulation was efficient in all the subjects, in the majority of the sessions. The ejaculates present normal sperm concentration, but variable sperm progressive motility and morphology, when comparing with the standard criteria.

Conclusion

Penile vibratory stimulation is an efficient procedure to induce ejaculation in spinal cord injured patients. Despite the considerable variability between the subjects, the ejaculates met the required quality to allow fertilization trough assisted reproductive technologies.

Introduction and Objectives

Multiparametric Magnetic Resonance Imaging of the prostate (Mp‐MRI) allows the detection, localization and characterization of suspicious lesions for prostate cancer (PCa). When done prior to the diagnosis it also allows targeting of the biopsy, significantly improving the performance of the standard random prostate biopsy.

Our goal is to compare a targeted biopsy technique (cognitive fusion) with the standard double sextant randomized prostate biopsy, and to determine which has better accuracy in the detection of cinically significant prostate cancer.

Materials and Methods

30 patients aged 61‐67 were selected with a PSA greater than 4 ng/mL (PSA between 5.6 – 19.2) and with suspicious PCa lesions on Mp‐MRI (Pi‐RADS 3‐5). A total of 75 suspicious lesions were detected.

All biopsies were performed by the same Urologist (JMP), using trans‐rectal ultrasound guidance and after previous visualization of MRI images. Sampling was targeted to the area considered suspicious on MRI, using a Cognitive Fusion Technique, collecting two samples per area. After that, a double‐sextant standard prostate biopsy was also done in all patients. The variables used for statistical analysis were PCa detection rate and amount of cancer per sample.

Results

22 patients were diagnosed with PCa. In 5 patients, cancer was only detected on targeted cores. Targeted biopsies diagnosed 17% more PCa when compared to random biopsies, and almost doubled the amount of cancer per sample.

The overall PCa detection rate was 61% for all samples. 360 fragments were collected from standard randomized prostate biopsy, of which 169 were positive for PCa (47%), with a median Gleason score of 6 (3+3). The average amount of cancer per sample was 25% (5%‐85%).

105 of 150 fragments collected by cognitive fusion targeted biopsies were positive for PCa (70%). The median Gleason score was 7(3+4) with a median amount of cancer per sample of 45% (10%‐90%).

Conclusions

Multiparametric prostatic MRI detects areas highly suspicious for PCa, allowing targeted biopsies, which increases diagnostic accuracy and improves the detection of clinically significant PCa.

Although exceedingly rare in developed countries nowadays, we still come across some devastating sequels of genitourinary tuberculosis, requiring careful medical evaluation and expertise on surgical reconstruction. A 58‐year‐old man, previously submitted to a right nephrectomy, developed a life‐threatening episode of urosepsis, leading to the need of a percutaneous nephrostomy due to a long stricture of the terminal ureter of the remaining left kidney. The patient had also developed very severe urinary frequency related to an extremely crippled bladder, with a capacity under 20 mL. After medical treatment of the tuberculosis, an augmentation cystoplasty was performed but in a patient‐tailored way, using an ileal neobladder constructed following the Studer technique that was anastomosed to the remaining bladder tissue with implantation of the healthy segment of the shortened ureter on the afferent limb of the reservoir. The normalisation of bladder capacity (over 250 mL), with preserved filling sensation allowed an excellent patient adaptation. The combination of a severely decreased bladder capacity with a stenosis of the terminal ureter of a single kidney led to a need of a great capacity reservoir as well as a reimplantation of a shortened ureter. The use of an orthotopic ileal neobladder as a large ileocystoplasty patch was the solution adopted.

Introduction

The prevalence of neurogenic lower urinary tract disfunction (NLUTD) is unknown, but the risk of developing NLUTD associated with spinal cord injury (SCI) is high.

Objectives

Verify the changes of intradetrusor BTX‐A injection on urodynamic parameters and in the QoL of NLUTD patients due to SCI.

Material and methods

Retrospective study of 38 patients with SCI submitted to BTX‐A injection in our departments. Urodinamic studies were performed before and 3 to 6 months after treatment. QoL was evaluated by the Qualiveen questionnaire applied to 20 patients. Statistical analysis was performed with correlation tests for paired samples.

Results

Mean age was 38 years (Min = 23; Máx = 63), with 63.2% of males. The most frequent level of SCI was thoracic (52.6%). The average period between the SCI and the first treatment was 92 months (15 to 240 months). The patients had a mean of 3 treatments (min = 1;máx = 8), with 3 episodes of side effects ‐ transient and mild hypoasthenia. We collected data of urodynamic studies in 35 patients that showed increase in bladder capacity (p = 0,24) and compliance (p < 0,01) as well as a reduction in Pdet_max (p < 0.01). 20 patients answered the Qualiveen questionnaire with a mean result of 1 (possible final score 0‐4)

Discussion/Conclusion

The use of BTX‐A in our NLUTD patients is a treatment option with very good outcomes and important improvements in urodynamic parameters and in patients quality of life.

Overview and Aims

Currently, the use of mesh in surgery for pelvic organ prolapse has increased, mainly due to the high anatomic failure rate of native tissues repair. The objectives of this study were to analyze the results obtained in the surgical treatment of anterior and posterior defects with native tissues and assess the success rate.

Methods

Retrospective study of 418 vaginal surgeries to repair defects in the anterior and posterior compartments using native tissues, performed in the Department of Urogynecology, from January 2008 to December 2012.

Results

In our sample, mean age was 64 years, with 90% of patients in menopause. 48.1% of women was hysterectomized, 78.2% were submitted to anterior colporrhaphy and 72.7% to posterior colporrhaphy. The correction of anterior paravaginal defect occurred in 32.5% of the surgeries and the posterior in 25.4%. Enterocele was repaired in 68.1% of cases. The intra‐operative and postoperative complications rate was 5%. Of the 347 patients evaluated in the postoperative period, 91.6% was discharged. Seven were later readmitted (2.2%). 29 women were kept in surveillance, mostly for recurrent prolapse, which worsened after a year of follow‐up. A total of 18 women was re‐operated, 13 for recurrence (3.7%). Therefore, the anatomic success rate was 80%. After adding the asymptomatic cases, in which anatomic cure was not achieve, the rate rose to 94%.

Discussion/Conclusions

The compartment defects correction rate of success, in our department, is in accordance with that described in the literature, with lower rates of complications and re‐interventions.

Introduction

Until the late 1980s, it was considered that any testicular mass, if suspicious, should be removed totally by radical orchiectomy; however, a marked increase in incidental testicular mass diagnosis, the high accuracy of diagnosis obtained from frozen section examinations, and evidence showing the potential advantages of testis‐sparing surgery, threw into question the need to sacrifice the entire testis even when a normal contralateral testis was present.

Clinical Case

We present a 23‐year‐old patient who was asymptomatic at diagnosis of a non‐palpable testicular mass with a size of approximately 7.5 mm and negative for tumor markers. He underwent a Testis‐sparing surgery guided by ultrasound with frozen section examination, however, with the suspicious of Germ cell tumor, it was decided to complete the orchiectomy. The final histological results were Leydig cell tumor. Given the high likelihood of non‐palpable and small testicular lesions being benign (80%), the negative impact of radical orchiectomy on spermatogenesis, cosmetic aspects, and endocrine function, impossible to ignore, Testis‐sparing surgery is a procedure that although it is not a standard procedure must be employed as the first approach in selected cases and specialized reference centers.

Renal oncocytoma account for 3 to 7% of primary renal tumors. It is usually diagnosed incidentally and typically has a benign behavior. No currently used imaging techniques can reliably distinguish it from malignant lesions. Similarly, the microscopic diagnosis of oncocytoma remains a challenge. We present a case of an asymptomatic elderly, hypertensive, diabetic and with moderate chronic renal insufficiency, who underwent radical nephrectomy for a solid exophytic lesion of 4.7 cm in the renal pole, detected accidentally. Pathological examination revealed a renal oncocytoma. In this situation, partial nephrectomy would be the preferred surgical treatment, avoiding the long‐term risk of living with a single kidney. The lack of diagnostic tools that reliably differentiate between benign and malignant lesions makes this an important area of study, in order to reduce the number of surgical interventions and the associated morbidity.

Objectives

To describe the initial experience of CHVNG/E in microsurgical vasovasostomy.

Methods

The two‐layer technique was applied under microscope magnification in every patient by the same surgeon.

Results

8 bilateral vasovasostomies were performed for vasectomy reversal between 2008 and 2014 at our unit. All the patients were available for follow‐up, with a mean follow‐up time of 6 months. Mean patient age was 38.8 ± 8.7 years and the interval between vasectomy and recanalization of 6 ± 1.5 years. Overall spermatozoid patency rate was 100%, with mobile spermatozoa in the ejaculate of all patients (median 12 x 10⁶/mL, interquartile interval [7 x 10⁶/mL‐21 x 10⁶/mL]). Four of the 8 patients fathered after the procedure.

Conclusions

Our results were comparable to the ones described in the literature, confirming the performance of a good surgical technique.

Microsurgical vasovasostomy constitutes a very safe method of vasectomy reversal, enabling couples to obtain pregnancies without additional medical treatment.

To our knowledge, this is the first group of patients treated by this method in Portugal.