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Urachal Sinus Surgery: Clinical Picture 尿管窦外科:临床图片
Pub Date : 2021-07-31 DOI: 10.26420/austinjurol.2021.1070
M. M, Dieudonné Zoj, J. M, Youness R, Mustapha A, Soufiane M, Fadl Tm, Eddine Ej, Jamal Em, Hassan Fm
The urachus is a fibrous cord, a remnant of the duct, which in the embryo, connects the bladder with the allantois duct [1]. The urachus can be the site of two types of lesions: on the one hand, congenital anomalies resulting from a defect in the obliteration of the allantois duct (diverticula, fistulas, cysts, sinus), and on the other hand, acquired lesions, essentially of a tumoral nature and most often malignant (urachus carcinoma) [2]. We report the clinical picture of a 28-year-old patient, with a history of uropathology since childhood (hypospadias), chronic renal failure since 2017 under dialysis, neobladder type Mitrofanoff since 2009, admitted for the management of an umbilical abscessed collection. Abdominal MRI revealed a superinfected urachus sinus. The treatment consisted of complete open excision of the sinus (Figure 1) from the umbilicus to the urinary bladder. The postoperative course was simple. Figure 1: The resected specimen (urachal sinus (black arrow), bladder wall (white arrow). A purulent umbilical discharge is often indicative of the presence of a urachus sinus; ultrasound and fistulography are sufficient for the diagnosis [3]. Excision of the urachus sinus by surgery is the standard treatment in this clinical situation [4].
尿管是一根纤维索,是导管的残余,在胚胎时期连接膀胱和尿囊管[1]。尿路可发生两种类型的病变:一方面是由于尿囊管闭塞缺陷引起的先天性异常(憩室、瘘管、囊肿、窦),另一方面是获得性病变,本质上是肿瘤性质的,通常是恶性的(尿路癌)[2]。我们报告了一名28岁的患者的临床情况,该患者自童年以来有泌尿病理学史(尿道下裂),自2017年以来透析慢性肾衰竭,自2009年以来新膀胱类型Mitrofanoff,因脐脓肿收集而入院。腹部核磁共振显示一个重复感染的urachus窦。治疗包括从脐到膀胱的窦(图1)的完全开放切除。术后过程简单。图1:切除标本(尿管窦(黑色箭头),膀胱壁(白色箭头)。脐带脓性分泌物常提示存在尿静脉窦;超声和瘘管造影足以诊断[3]。手术切除urachus sinus是这种临床情况下的标准治疗方法[4]。
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引用次数: 0
Comparison of Modified Mathieu versus Standard Tubularised Incised-Plate Urethroplasty for Distal Hypospadias Repair 改良Mathieu与标准管状切开钢板尿道成形术在尿道下裂远端修补中的比较
Pub Date : 2021-07-22 DOI: 10.26420/austinjurol.2021.1068
N. M, Khan Mk, S. G., Izhar M, Qayyum A
Objective: To compare the outcomes of modified Mathieu versus standard tubularised incised-plate urethroplasty for distal hypospadias repair. Materials and Methods: This prospective comparative study was conducted on 54 cases affected by distal hypospadias presenting to Institute of Kidney Disease, Hayatabad, Peshawar form February 2015 to June 2020. The inclusion criteria was patients with distal hypospadias (coronal, sub-coronal, or distal penile), age range of 15 to 60 months. Cases with severe chordee/ventral curvature, history of previous hypospadias repair, and poorly developed urethral plate were excluded. The patients with distal hypospadias were divided into two equal groups: in-group I repair done with Mathieu procedure plus incision of the urethral plate (modified Mathieu) and in-group II repair was performed with Tubularized Incised Plate (TIP). The principal author performed functional and cosmetic assessment at follow up visits which includes; denvo meatus; size and pressure of the stream; and complications like meatal stenosis, urethral cutaneous fistula. Fisher Exact test was used to compare categorical variables between the two groups and student t test for continuous variables. Results: The mean age of the study was 38.13±12.55 months. The operating time was less in TIP than modified Mathieu procedure statistically (P=0.036, 95% CI=0.315, 9.02). In modified Mathieu procedure the sprayed stream of micturition was higher (n=4, 14.8%) while in TIP procedure the frequency of narrow stream was higher (n=4, 14.8%). The difference was statistically significant (P=0.054). Only in modified Mathieu procedure the meatus shape was round in 4 (14.8%) cases and the results were statistically different (P=0.038). Post-operative fistula was higher TIP (n=6, 22.2%) than modified Mathieu (n=1, 3.7%) statistically (P=0.043). Only in TIP procedure postoperative meatal stenosis was found in 5 (18.5%) and the difference was statistically significant (P=0.019). Conclusion: The modified Mathieu technique can improve the cosmetic outcome through creation of slit-like meatus, low incidence of fistula and meatal stenosis than tubularized incised plate urethroplasty in the repair of distal hypospadias.
目的:比较改良Mathieu输尿管成形术与标准管状切开钢板输尿管成形术在尿道下裂远端修补中的效果。材料与方法:对2015年2月至2020年6月在白沙瓦Hayatabad肾脏疾病研究所就诊的54例远端尿道下裂患者进行前瞻性比较研究。纳入标准为尿道下裂远端(冠状、冠状下或阴茎远端)患者,年龄范围15 ~ 60个月。排除有严重脊索/腹侧弯曲、尿道下裂修复史和尿道板发育不良的病例。将远端尿道下裂患者分为两组,第一组采用Mathieu法联合切开尿道板(改良Mathieu法)修复,第二组采用管状切开钢板(TIP)修复。主要作者在随访中进行了功能和外观评估,其中包括;denvo道;流的尺寸和压力;并发症,比如尿道狭窄,尿道皮瘘。两组间分类变量比较采用Fisher精确检验,连续变量比较采用student t检验。结果:患者平均年龄为38.13±12.55个月。TIP手术时间较改良Mathieu手术时间短(P=0.036, 95% CI=0.315, 9.02)。改良Mathieu法排尿时喷流发生率较高(n=4, 14.8%), TIP法排尿时窄流发生率较高(n=4, 14.8%)。差异有统计学意义(P=0.054)。仅改良Mathieu手术的切口形状为圆形4例(14.8%),差异有统计学意义(P=0.038)。术后瘘管TIP (n=6, 22.2%)高于改良Mathieu (n=1, 3.7%),差异有统计学意义(P=0.043)。仅在TIP手术中出现术后金属狭窄5例(18.5%),差异有统计学意义(P=0.019)。结论:改良Mathieu技术与管状切开钢板尿道成形术相比,在尿道下裂远端修补术中可形成裂隙状尿道,瘘道发生率低,狭窄发生率低,改善了美观效果。
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引用次数: 0
Radical Nephroureterectomy: A Clinical Image 根治性肾输尿管切除术:临床影像
Pub Date : 2021-07-22 DOI: 10.26420/austinjurol.2021.1069
M. M, Dieudonné Zoj, J. M, Soufiane E, Youness R, Mustapha A, Soufiane M, Fadl Tm, Elizalde Je, Jamal Em, Hassan Fm
Upper Urinary Tract Urothelial Carcinoma (UTUC) remain rare. Radical Nephroureterectomy (RNU) is the Gold standard for management of these tumours. We are reporting a clinical image of a 45-year-old patient admitted in emergency for left lumbar pain (nephritic colic). The checkups requested computed tomography scanner showed a nephromegaly and left hydronephrosis upstream of a suspicious parietal thickening of the lumbar ureter with cortical and functional repercussion, neighborhood infiltration, and atypical lateral-aortic ganglia. Left lower calicial lithiasis of stasis, pancreatic nodular lesion and the left adrenal gland. The patient was a candidate for an open Radical Left Nephroureterectomy (RNU) (Figure 1). Figure 1: Radical Nephroureterectomy (RNU) picture U (Ureter) R (Renal). There are prognostic factors of tumors of the upper urinary excretory tract, which are the patient’s status, the preoperative, the operation and the anatomopathology [1]. According to current literature data, the oncology outcomes of radical nephrouretrectomy by laparoscopic are lower than those of open RNU surgery [2].
上尿路尿路上皮癌(UTUC)仍然罕见。根治性肾输尿管切除术(RNU)是治疗这些肿瘤的金标准。我们报告一位45岁的患者因左腰痛(肾病性绞痛)急诊入院的临床影像。检查要求计算机断层扫描显示肾肿大和左侧肾积水上游可疑的腰椎输尿管壁增厚,伴有皮质和功能反射,邻近浸润和非典型外侧主动脉神经节。左下钙质结石,胰脏结节状病变及左肾上腺。患者是开放性根治性左肾输尿管切除术(RNU)的候选人(图1)。图1:根治性肾输尿管切除术(RNU)图U(输尿管)R(肾脏)。影响上尿排泄道肿瘤预后的因素有:患者状态、术前、手术及解剖病理[1]。根据目前的文献资料,腹腔镜根治性肾切除术的肿瘤预后低于开放式RNU手术[2]。
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引用次数: 0
Augmentation Cystoplasty in Children: Institute of Kidney Diseases Peshawar Experience 儿童膀胱增大成形术:白沙瓦肾脏疾病研究所的经验
Pub Date : 2021-06-14 DOI: 10.26420/austinjurol.2021.1066
M. Naeem, M. K. Khan, A. D., Majid Khan, Mehboob ul Wahab, Ihsanulla h
Objective: The aim of this study is to share our single-center experience of Augmentation Cystoplasty (AC) in children regarding indications, bowel segment used, associated procedures, and its complications. Materials and Methods: We analyzed data of all pediatric patients who underwent AC at Institute of Kidney Diseases (IKD), Peshawar between July 2017 and March 2020. Results: A total of 18 pediatric patients are included in the study who underwent Bladder augmentation (BA) either isolated in 1 (5.5%), or along with other associated procedures like Mitrofanoff 17 (94.4%), Antegrade Continent Enema (ACE) 6 (33.3%), Bladder Neck Reconstruction (BNR) 5 (27.7%) and Bilateral ureteric Re-implantation (B/L UR) in 3 (16.6%). Indication for Bladder augmentation were Neurogenic bladder (NGB) 13 (72.2%), Exstrophy Epispadias Complex (EEC) 3 (16.6%) and Posterior urethral value with small functional capacity bladder 2 (11.1%). Small gut used in 15 (83.3%) and large gut in 3 (16.6%) for BA. For Mitrofanff associated with bladder augmentation, Appendix was used in 14 (82.35%) and small gut (Monti) in 3 (17.6%) cases. For ACE associated with BA, in 4 (66.6%) Appendix used as right-sided ACE and in 2 (33.3%) small gut (Monti) as left-sided ACE. No intraoperative complications noted, while early post-op complications, 2 wound infection and 1 urinary leakage from wound, were noted in 3(16.6%) cases and late post-op complications (stomal stenosis) in 4(22.2%) patients.
目的:本研究的目的是分享我们在儿童增强膀胱成形术(AC)的单中心经验,包括适应症、肠段使用、相关手术及其并发症。材料和方法:我们分析了2017年7月至2020年3月期间在白沙瓦肾脏疾病研究所(IKD)接受AC治疗的所有儿科患者的数据。结果:研究中共有18例儿童患者接受了膀胱增强术(BA),其中1例(5.5%)单独进行,或与其他相关手术一起进行,如米特罗法诺夫17例(94.4%)、顺行大陆灌肠(ACE) 6例(33.3%)、膀胱颈重建术(BNR) 5例(27.7%)和双侧输尿管再植术(B/L UR) 3例(16.6%)。膀胱增强指征为神经源性膀胱(NGB) 13例(72.2%)、外展性尿道复合膀胱(EEC) 3例(16.6%)和后尿道价值伴小功能膀胱2例(11.1%)。小肠子15例(83.3%),大肠子3例(16.6%)。米特罗凡夫联合膀胱增大术中,使用阑尾14例(82.35%),小肠3例(17.6%)。对于合并BA的ACE, 4例(66.6%)阑尾为右侧ACE, 2例(33.3%)小肠(Monti)为左侧ACE。术中无并发症,术后早期并发症3例(16.6%)出现伤口感染2例,伤口漏尿1例,术后晚期并发症(造口狭窄)4例(22.2%)。
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引用次数: 0
Rupture of Dorsal Vein Mimicking Penile Fracture: a Case Series Report and Literature Review 模仿阴茎断裂的背静脉破裂:病例系列报告及文献复习
Pub Date : 2021-06-14 DOI: 10.26420/austinjurol.2021.1067
Ba Z, Ziba Ojd, Khatraty Csb, Kanza R, O. C.
Penile fracture is a rare and traumatic emergency in andrology. Immediate surgical repair is widely accepted as the therapy of choice in penile fracture. But some situations mimic penile fracture such as superficial dorsal vein rupture. There are few cases reported in the literature. Aim: To present a case series of injuries of the penile dorsal vein that occurred during sexual intercourse. Methods: A 48-year-old and 45-year-old patients both received in emergency for suspected penile fracture after one hour of vigorous sexual intercourse, the clinical examination and ultrasound were performed and the penile fracture was suspected. Surgical management in an emergency was indicated. Results: Per-operative diagnosis was a dorsal vein injury. The surgical management which consisted of early exploration, evacuation of hematoma, and ligation of the bleeding vessel in this case was good with preserving erectile function after surgery, without abnormal curvature erection. Conclusions: Vascular injuries of the penis can mimic perfectly penile fractures. The medical history and clinical examination can lead to prompted exploration for suspected penile fracture. The ultrasound exploration can be limited for detection of penile vascular injury and final surgical exploration offers final diagnosis and repairment of the trauma. Clinical evolution is favorable, without painful nocturnal erections or deviation of the penis or hypoesthesia of the glans.
阴茎骨折是男科中一种罕见的创伤性急症。立即手术修复被广泛接受为阴茎骨折的治疗选择。但有些情况类似阴茎骨折,如浅背静脉破裂。文献中鲜有病例报道。目的:报道一例发生在性交过程中的阴茎背静脉损伤。方法:1例48岁、45岁患者,均因剧烈性交1小时后疑似阴茎骨折急诊就诊,行临床检查及超声检查,怀疑为阴茎骨折。需要紧急手术处理。结果:术中诊断为背静脉损伤。手术处理包括早期探查、清除血肿和结扎出血血管,手术后保持勃起功能,无异常弯曲勃起。结论:阴茎血管损伤完全可以模拟阴茎骨折。病史和临床检查可提示探查疑似阴茎骨折。超声探查可局限于阴茎血管损伤的检测,而最终的手术探查可提供创伤的最终诊断和修复。临床进展良好,无夜间勃起疼痛或阴茎偏离或龟头感觉减退。
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引用次数: 0
Giant Testicular Cancer: Clinical Picture 巨大睾丸癌:临床图片
Pub Date : 2021-05-20 DOI: 10.26420/austinjurol.2021.1065
M. Mohammed, Chu Hassan Fez Morocco Urology Division, Dieudonné Zoj, M. Jaafar, R. Youness, E. Soufiane, A. Mustapha, M. Soufiane, Fadl Tm, Jalal Eddine E-A, Jamal Em, Hassan Fm
Testicular tumour is the most malignant cancer in young males 15 to 34 years of age. Its accounts for 1% of all male cancer and 5% of urological malignancy [1]. The management of this type of cancer is radical inguinal orchiectomy which is the gold standard for the diagnosis and initial management of a suspected testicular cancer. Trans -scrotal orchiectomy is discouraged because scrotal violation is associated with higher rates of local recurrence and altered pathways of metastatic dissemination [2]. We report a young patient 23 years old. History: Chronic smoking, cannabis. Admitted for large bursa evolving for 14 months. The history of the disease dates back to 14 months by the gradual increase in the volume of the bursa with an alteration of the general status with a weight loss estimated at 10kgs. Clinical examination showed: right hemi-scrotum increased in volume with a hard consistency with a left testicle repressed in extreme lateral and some inflammatory lesions. Right testis was not palpable with a cord repulsed and glued to the inguinal orifice. The ultrasound of the scrotal content showed: large right testis hypervascularized with moderate anterior cloisonnae hydrocele, bilateral testicular microlithiasis. Tumor markers: Lactate Dehydrogenase (LDH) 229IU, beta-Human Chorionic Gonadotropin (beta-hCG) 29.73mUI/ ml, Alpha-Foetoprotein (AFP) 400IU/ml. Patient benefited from a complete pre-operative assessment that did not object to any abnormality. Programmed for a right inguinal orchiectomy and reduction scrotoplasty (Figure 1).
睾丸肿瘤是15至34岁年轻男性最常见的恶性肿瘤。它占所有男性肿瘤的1%,占泌尿系统恶性肿瘤的5%[1]。这种癌症的治疗方法是根治性腹股沟睾丸切除术,这是诊断和初步治疗疑似睾丸癌的金标准。经阴囊睾丸切除术是不可取的,因为阴囊侵犯与较高的局部复发率和转移传播途径的改变有关[2]。我们报告一位23岁的年轻病人。病史:长期吸烟,大麻。因大粘液囊演变14个月入院。该疾病的病史可追溯到14个月,滑囊体积逐渐增加,总体状况改变,体重减轻估计为10kg。临床检查显示:右半阴囊体积增大,呈硬稠度,左侧睾丸极外侧受压,有部分炎性病变。右睾丸不可触及,脊髓被排斥并粘在腹股沟口。阴囊内容物超声示:右侧大睾丸血管充血伴中度景泰蓝前囊积液,双侧睾丸微石症。肿瘤标志物:乳酸脱氢酶(LDH) 229IU, β -人绒毛膜促性腺激素(β - hcg) 29.73mUI/ ml,甲胎蛋白(AFP) 400IU/ml。患者受益于完整的术前评估,不反对任何异常。计划行右侧腹股沟睾丸切除术和阴囊缩小成形术(图1)。
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引用次数: 0
Prevalence of Stress Urinary Incontinence in Women from a Rural Community in the Brazilian Amazon 巴西亚马逊地区农村社区妇女压力性尿失禁的患病率
Pub Date : 2021-05-14 DOI: 10.26420/austinjurol.2021.1064
Doil'nitsyna Ad, Morais Acm, Molisani Jt, Nascimento Lga
Introduction: Stress urinary incontinence affects a significant number of women and causes great loss of Quality of Life (QoL). Its prevalence varies from 15 to 41.5%. Objective: To assess the prevalence of Stress Urinary Incontinence (SUI) in women living in a rural community in Amapá, the main risk factors and quality of life assessment using a standardized questionnaire. Methodology: A screening questionnaire was applied to 235 women residing in Igarapé da Fortaleza, in the city of Macapá, in 2015. Patients with SUI complaints were submitted to the King’s Health Questionnaire (KHQ) questionnaire. For statistical processing, BioEstat software version 5.3 was used. Results: The prevalence of SUI was 28.9% (68 women). A significant age difference was found between women with SUI (44.2) and without SUI (37.9 ± 12.5 years). Childbirth, birth interval, smoking and Body Mass Index (BMI) showed to be statistically significant differences between groups. Variables such as number of deliveries, birth weight, menopause, education and race did not express a real difference. Conclusion: The prevalence of SUI was 28.9%. There was a significant difference in the group with SUI in terms of age, smoking, parity, interval between births and BMI. In assessing QoL in patients with SUI using KHQ, we found the worst results in general health perception, impact of incontinence, personal relationships, sleep/mood and severity of symptoms.
导读:压力性尿失禁影响了相当数量的女性,并导致生活质量(QoL)的巨大损失。其患病率从15%到41.5%不等。目的:采用标准化问卷调查方法,了解阿玛屿某农村社区妇女压力性尿失禁(SUI)的患病率、主要危险因素及生活质量。方法:对2015年居住在马卡帕市伊加拉帕伊勒达福塔莱萨的235名妇女进行了筛查问卷调查。对SUI患者进行国王健康问卷(KHQ)调查。统计处理采用BioEstat软件5.3版。结果:SUI的患病率为28.9%(68例)。SUI患者(44.2岁)与无SUI患者(37.9±12.5岁)年龄差异显著。分娩、生育间隔、吸烟和身体质量指数(BMI)组间差异有统计学意义。分娩次数、出生体重、更年期、教育程度和种族等变量并没有表现出真正的差异。结论:SUI的患病率为28.9%。SUI组在年龄、吸烟、胎次、生育间隔和体重指数方面存在显著差异。在使用KHQ评估SUI患者的生活质量时,我们发现一般健康感知、尿失禁的影响、个人关系、睡眠/情绪和症状严重程度的结果最差。
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引用次数: 0
FOXO3a: A Potential Target in Prostate Cancer. FOXO3a:前列腺癌的潜在靶点
Pub Date : 2014-01-01
Sanjeev Shukla
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引用次数: 0
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Austin journal of urology
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