First-Stage Long Buccal Mucosal Graft (BMG) Urethroplasty on Adult Failed Hypospadia Surgery Repair: Our Initial Experience

2018 ◽  
Vol 24 (8) ◽  
pp. 6151-6154
Author(s):  
Adistra Imam Satjakoesoemah ◽  
Prahara Yuri ◽  
Yonas Hutasoit
Keyword(s):  
External Genitalia ◽  
Complication Rates ◽  
Initial Experience ◽  
Long Term Outcomes ◽  
Penile Shaft ◽  
Buccal Mucosal Graft ◽  
Male External Genitalia ◽  
The Right

Hypospadia is one of the most common congenital anomalies of male external genitalia and the only proper management for most cases is repair surgery. Nevertheless, initial hypospadia repair could end up failed, followed by subsequent various complications. BMG has gain popularity due to its good long-term outcomes and favourable complication rates, especially for residual hypospadia. A 24-year-old male came to our outpatient department complaining his urethral orificium was located on the penile shaft since birth. He had a previous hypospadia repair surgery conducted by non-urologist surgeon at the age of seven. Several months after the repair surgery, his penis slightly rotated to the right side and urine remain came out through the hole on his ventral penile shaft. We performed first-stage inlay BMG urethroplasty using a long (6×1 cm) and short (2×1 cm) graft patch. The graft patches were quilted in proximal-distally fashion rather than side-by-side. No scarring or contracture on the neourethral plate was noted during two months of follow-up. We have successfully performed our initial experience on first-stage inlay BMG urethroplasty using a long and short graft patch. Within two months, the graft were completely take without any complications. The second-stage urethroplasty, consisting of tubularization and glansplasty will be performed 6 months after the first procedure.

scholarly journals 439 Conservative Versus Surgical Management of Complicated Diverticulitis - A Retrospective Study of Long-Term Outcomes

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
E Durity ◽  
G Elliott ◽  
T Gana
Keyword(s):  
Complicated Diverticulitis ◽  
Complication Rates ◽  
Long Term Outcomes ◽  
Female Ratio ◽  
Stoma Reversal ◽  
Group A ◽  
Grade 3 ◽  
Group B

Abstract Introduction Management of complicated diverticulitis has shifted towards a conservative approach over time. This study evaluates the feasibility and long-term outcomes of conservative management. Method We retrospectively evaluated a consecutive series of patients managed with perforated colonic diverticulitis from 2013-2017. Results Seventy-three (73) patients were included with a male to female ratio of 1:2. Thirty-one (31) underwent Hartmann’s procedure (Group A) and 42 patients were managed with antibiotics +/- radiological drainage (Group B). Mean follow-up was 64.9 months (range 3-7 years). CT Grade 3 and 4 disease was observed in 64.5% and 40.4% of Group A and Group B patients, respectively. During follow-up, 9 (21.4%) Group B patients required Hartmann’s. Group A had longer median length of stay compared to Group B (25.1 vs 9.2 days). Post-operative complications occurred in 80.6% with 40% being Clavien-Dindo grade III or higher in group A. Stoma reversal was performed in 8 patients (25.8%). Conclusions In carefully selected cases, complicated diverticulitis including CT grade 3 and 4 disease, can be managed conservatively with acceptable recurrence rates (16.7% at 30 days, 4.8% at 90 days, 19.0% at 5 years). Surgical intervention on the other hand, carries high post-operative complication rates and low stoma reversal rates.

Management of Canine Y-T Humeral Fractures Using Titanium Polyaxial Locking Plates in 17 Dogs

2022 ◽  
Vol 58 (1) ◽  
pp. 7-16
Author(s):  
Claudio Motta ◽  
Philip Witte ◽  
Andrew Craig
Keyword(s):  
Functional Impairment ◽  
Complication Rates ◽  
Load Testing ◽  
Inclusion Criteria ◽  
Long Term Outcomes ◽  
Long Term Follow Up ◽  
Mild Impairment ◽  
Condylar Fractures

ABSTRACT The objective of this study was to document the short- and medium-to-long-term outcomes and complication rates of Y-T humeral condylar fractures fixed using titanium polyaxial locking plate (T-PLP). A retrospective review was performed of the medical records and radiographs of dogs with a Y-T humeral condylar fracture treated with T-PLP at a single veterinary referral center (2012–2018). Seventeen cases met the inclusion criteria. Medium- to long-term follow-up (.6 mo) information was derived using the Liverpool Osteoarthritis in Dogs (LOAD) questionnaire. Recorded complications were catastrophic (1/17) and minor (2/17). Gait at 10–12 wk following surgery was subjectively assessed as good or excellent for 13 cases. Radiographic bone union was achieved in 7/12 cases at 4–6 wk. LOAD scores obtained a mean of 15 mo (range 6–29 mo) following surgery and indicated no or mild impairment in 15/16 and moderate functional impairment in 1. The application of T-PLP for the treatment of Y-T humeral condylar fractures resulted in adequate stabilization allowing successful fracture healing and medium- to long-term outcomes comparable to previous reports. According to results of LOAD testing, the medium- to long-term follow-up suggests that clients were aware of mild to moderate functional impairment in all cases.

P1920Long-term outcomes of pulmonary vein isolation using second-generation cryoballoon during atrial fibrillation ablation: A single-center large-scale study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
U Canpolat ◽  
D Kocyigit ◽  
M U Yalcin ◽  
C Coteli ◽  
Y Z Sener ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Large Scale ◽  
Second Generation ◽  
Significant Proportion ◽  
Complication Rates ◽  
Long Term Outcomes ◽  
Free Survival

Abstract Background Currently available second-generation cryoballoon (CB2) is accepted as an effective and safe tool for pulmonary vein isolation (PVI). Although much more data exists about 1-year outcomes of CB2 ablation, data on long-term outcomes are scarce. Objective: We aimed to assess the long-term outcomes of PVI using CB2 in a large-scale symptomatic AF population at our tertiary referral center. Methods In this non-randomized prospective observational study, a total of 486 patients with paroxysmal (71%) or persistent (29%) AF who underwent index PVI using CB2 at our hospital between January 2013 and June 2017 were enrolled. Atrial tachyarrhythmia (ATa) free survival was defined as absence of AF, atrial flutter or atrial tachycardia recurrence >30 s following 3-months blanking period. Predictors of recurrence were evaluated by univariate and multivariate Cox proportional hazards regression models. Results Acute procedural success rate was 99.8% (1898/1902 PVs). Mean procedural and fluoroscopy time were 64.9±9.2 and 12.1±2.6, respectively. At median 39 (IQR: 26–56) months follow-up, ATa free survival was 78.6% after a single procedure (280/345 [81.2%] for paroxysmal AF vs 102/141 [72.3%] for persistent AF, p=0.019) and 84.4% after a mean 1.48±0.42 ablations.Cox regression analysis showed that left atrium diameter, duration of AF history and early ATa recurrence were found as the independent predictors of late recurrence. PNP was observed in 17 (3.5%) patients. Figure 1 Conclusions Second-generation CB based PVI is effective to maintain sinus rhythm in a significant proportion of paroxysmal and early persistent AF patients with an acceptable complication rates at long-term follow-up.

scholarly journals Long Term Outcomes Following Syme’s Amputation

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Michael Pinzur ◽  
Adam Schiff ◽  
Elissa Finkler
Keyword(s):  
Functional Mobility ◽  
Diabetic Patients ◽  
Complication Rates ◽  
Long Term Outcomes ◽  
Transtibial Amputation ◽  
Amputation Level ◽  
Objective Information ◽  
Prosthetic Fitting

Category: Ankle, Diabetes, Trauma Introduction/Purpose: The metabolic cost of walking following Syme’s ankle disarticulation amputation is minimally more than similar non-amputees. The ability to end-bear makes prosthetic fitting relatively simple, and very few patients require extensive rehabilitation or placement in a skilled nursing or rehabilitation facility. In spite of these potential benefits, there is a paucity of objective information on the actual long term outcomes. Methods: Fifty-one patients were identified who underwent single stage Syme’s ankle disarticulation amputation with excision of the lateral and medial malleoli by a single surgeon during a twenty three year period. None of these patients had sufficient tissue to allow amputation at the transmetatarsal or tarsal-metatarsal levels. Thirty-three underwent amputation due to diabetic forefoot infection, eleven secondary to crush injury, three for non-diabetic infection, three for non-correctable acquired deformity and one for neoplasm. The average age at surgery for the di-abetic patients was 62.1 (range 36-81) years, with a follow-up of 6.8 (4-11.6) years. The nondi-abetic patients averaged 37.8 (range 21-65) years, with a follow-up of 9.3 (range 2.2-25.0) years. Patients who were alive and could be contacted were invited to complete a Short Musculoskele-tal Functional Assessment (SMFA) questionnaire that was scored for functional, mobility and bothersome indices. Results: Seventeen of the 33 diabetics died. Four (12.1%) were converted to the transtibial amputation level. One of the non-diabetics had died and one (5.5%) was converted to the transtibial amputation level. Eleven of the thirty-three patients who were con-tacted completed the SMFA. All of these patients demonstrated favorable outcome scores in the mobility, functional and bothersome indices (non-diabetic mean mobility score of 17.2, function-al index of 14.7 and bothersome of index of 16.7 compared to 34.7, 29.9 and 30.6 in the diabetic patients, respectively). Conclusion: The objective information derived from this investigation supports the opinion that patients with Syme’s ankle disarticulation amputation appear to fare better than sim-ilar patients with transtibial amputation. This data also refutes the notion of high complication rates and difficulties with prosthetic fitting. These patients require less rehabilitation and achieve improved levels of functional independence as demonstrated by favorable functional, mobility, and bothersome indices.

Presence of direct vertebrobasilar perforator feeders in posterior fossa arteriovenous malformations and association with poor outcomes after endovascular treatment

2020 ◽  
Vol 133 (6) ◽  
pp. 1802-1810
Author(s):  
Etienne Lefevre ◽  
Thomas Robert ◽  
Simon Escalard ◽  
Robert Fahed ◽  
Stanislas Smajda ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Neurological Deterioration ◽  
Complication Rates ◽  
Long Term Outcomes ◽  
Obliteration Rate ◽  
Brain Avms

OBJECTIVETreatment of posterior fossa arteriovenous malformations (PFAVMs) remains controversial as it is always challenging and may lead to major complications. Nonetheless, these lesions are more likely to bleed and generate poorer outcomes than other brain AVMs. The aim of this study was to evaluate the effect of endovascular treatment on long-term outcomes and identify the patient subgroups that might benefit from endovascular treatment.METHODSThe authors performed a retrospective analysis of all consecutive cases of PFAVM managed at the Fondation Rothschild Hospital between 1995 and 2018. Clinical, imaging, and treatment data were prospectively gathered; these data were analyzed with respect to long-term outcomes.RESULTSAmong the 1311 patients with brain AVMs, 114 (8.7%) had a PFAVM, and 88 (77.2%) of these patients had a history of bleeding. Of the 114 PFAVMs, 101 (88.6%) were treated (83 ruptured and 18 unruptured). The mean duration of follow-up was 47.6 months (range 0–240 months). Good neurological outcome at last follow-up was achieved in 79 cases (78.2%). Follow-up angiography showed obliteration of the PFAVM in 68.3% of treated cases. The presence of direct vertebrobasilar perforator feeders was associated with neurological deterioration (OR 5.63, 95% CI 11.15–30.76) and a lower obliteration rate (OR 15.69, 95% CI 2.52–304.03) after endovascular treatment. Other predictors of neurological deterioration and obliteration rate were consistent with the Spetzler-Martin grading system.CONCLUSIONSAdvances in endovascular techniques have enabled higher obliteration rates in the treatment of PFAVMs, but complication rates are still high. Subgroups of patients who might benefit from treatment must be carefully selected and the presence of direct vertebrobasilar perforator feeders must call into question the indication for endovascular treatment.

Percutaneous Transluminal Laser Angioplasty versus Balloon Dilation for Treatment of Popliteal Artery Occlusions

2002 ◽  
Vol 9 (6) ◽  
pp. 882-888 ◽  
Author(s):  
Hermann J. Steinkamp ◽  
Jürgen Rademaker ◽  
Christian Wissgott ◽  
Dierk Scheinert ◽  
Michael Werk ◽  
...  
Keyword(s):  
Popliteal Artery ◽  
Balloon Dilation ◽  
Laser Angioplasty ◽  
Secondary Patency ◽  
Complication Rates ◽  
Long Term Outcomes ◽  
Percutaneous Transluminal ◽  
Term Benefit

Purpose: To compare the immediate results, complication rates, and long-term outcomes of percutaneous transluminal laser angioplasty (PTLA) versus balloon dilation alone in the treatment of popliteal artery occlusions. Methods: In a prospective nonrandomized study conducted between December 1994 and June 2000, 215 symptomatic patients with unilateral popliteal occlusions were treated with either dilation alone (88 patients: 52 men; mean age 62 years, range 48–83) or PTLA (127 patients: 70 men; mean age 64 years, range 49–86) using a 308-nm excimer laser followed by dilation. The average occlusion length was 10.4 cm (range 3–14). Results: PTLA was successful in recanalizing 105 (82.7%) arteries, while the recanalization rate for dilation alone was only 70.4% (62/88; p=0.045). After a mean follow-up of 36 months (range 6–52), the primary and secondary patency rates were 21.7% and 50.8%, respectively, in patients with PTLA and 16.3% and 35.2% in the angioplasty group (p=0.762). The complication rates associated with both techniques were similar. Conclusions: Although initial recanalization may be better with PTLA, it does not appear to add any long-term benefit over balloon dilation alone.

scholarly journals Outcomes of ventriculoperitoneal shunt insertion in Sub-Saharan Africa

2010 ◽  
Vol 6 (4) ◽  
pp. 329-335 ◽  
Author(s):  
Esther Gathura ◽  
Dan Poenaru ◽  
Richard Bransford ◽  
A. Leland Albright
Keyword(s):  
Sub Saharan Africa ◽  
Complication Rates ◽  
Long Term Outcomes ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
Good Outcome ◽  
Sub Saharan ◽  
Poor Outcomes

Object Ventriculoperitoneal (VP) shunts in Sub-Saharan Africa are traditionally associated with high complication rates and poor outcomes. The aim of this study was to review one large institutional experience with VP shunts, to evaluate the feasibility of shunt insertion procedures with acceptable long-term outcomes in Africa, and to identify factors correlated with good and/or poor outcomes. Methods A retrospective study was conducted by reviewing the charts of all children who underwent primary (93%) or subsequent VP shunt insertions at the Kijabe Hospital between November 2004 and March 2007. Epidemiological data, clinical investigations, etiology of the hydrocephalus, details of the VP shunt insertion, outcome at follow-up, and morbidity and mortality data were collected. Outcomes were graded as good, fair, or poor, according to visual, motor, and seizure criteria. Results The authors analyzed 593 VP shunt insertions in 574 patients. The sex distribution was 53% male and 47% female. The mean age at shunt insertion was 8.5 months (range 0–309 months). The commonest etiologies for hydrocephalus were spina bifida (43.4%) and postinfectious (27.7%). Follow-up was available in 76% of children, with a mean follow-up period of 8.9 months (range 2–30.5 months). The median patient age was 3.3 months. The overall shunt function rate at 2 years was 65%, and the complication rate per procedure was 20%, with infection encountered in 9.1% and shunt malfunction in 11%. Complications were significantly related to hydrocephalus etiology and to sex (p = 0.03 and p = 0.01, respectively). Overall outcomes were good in 40.2% and poor in 59.8%. Overall mortality in the group was 7.1%. Younger patients who survived had an overall good outcome (p = 0.0001). Only 10% of patients with a head circumference greater than 60 cm had a good outcome. Conclusions Despite limited resources, VP shunt procedures can be carried out in Sub-Saharan Africa with acceptable complication rates and fair long-term outcomes.

The long-term outcomes of modified Harrington procedure using antegrade pins for periacetabular metastasis and haematological diseases

2019 ◽  
Vol 101-B (12) ◽  
pp. 1557-1562
Author(s):  
Roger Tillman ◽  
Yusuke Tsuda ◽  
Manoj Puthiya Veettil ◽  
Peter S. Young ◽  
Deepak Sree ◽  
...  
Keyword(s):  
Large Diameter ◽  
Survival Rates ◽  
Late Complications ◽  
Complication Rates ◽  
Implant Survival ◽  
Long Term Outcomes ◽  
Perioperative Mortality ◽  
Acetabular Loosening

Aims The aim of this study was to present the long-term surgical outcomes, complications, implant survival, and causes of implant failure in patients treated with the modified Harrington procedure using antegrade large diameter pins. Patients and Methods A cohort of 50 consecutive patients who underwent the modified Harrington procedure for periacetabular metastasis or haematological malignancy between January 1996 and April 2018 were studied. The median follow-up time for all survivors was 3.2 years (interquartile range 0.9 to 7.6 years). Results The five-year overall survival rate was 33% for all the patients. However, implant survival rates were 100% and 46% at five and ten years, respectively. Eight patients survived beyond five years. There was no immediate perioperative mortality or complications. A total of 15 late complications occurred in 11 patients (22%). Five patients (10%) required further surgery to treat complications. The most frequent complication was pin breakage without evidence of acetabular loosening (6%). Two patients (4%) underwent revision for aseptic loosening at 6.5 and 8.9 years after surgery. Ambulatory status and pain level were improved in 83% and 89%, respectively. Conclusion The modified Harrington procedure for acetabular destruction has low complication rates, good functional outcome, and improved pain relief in selected patients Cite this article: Bone Joint J 2019;101-B:1557–1562

scholarly journals Bentall procedure with the CarboSeal™ and CarboSeal Valsalva™ composite conduits: long-term outcomes

2021 ◽  
Author(s):  
Andrea Lechiancole ◽  
Igor Vendramin ◽  
Sandro Sponga ◽  
Daniela Piani ◽  
Giovanni Benedetti ◽  
...  
Keyword(s):  
Long Term Results ◽  
Long Term Outcomes ◽  
Mechanical Prosthesis ◽  
Actuarial Survival ◽  
Bentall Operation ◽  
Type A Aortic Dissection ◽  
Bentall Procedure ◽  
The Right

Abstract OBJECTIVES Data on the long-term results with the standard CarboSeal™ mechanical conduit used for the modified Bentall procedure are lacking as well as information on performance of the Valsalva CarboSeal™ conduit. METHODS We have analysed 208 recipients of a standard (n = 110) or a Valsalva (n = 98) CarboSeal™ conduit. The median age was 60 years and 90% were males; 35 (17%) had type A aortic dissection and 65 (30%) a bicuspid aortic valve. Data were retrospectively analysed and results were compared between the 2 conduit models. RESULTS Early mortality was 1.9%; the mean follow-up was 175 ± 95 for standard and 94 ± 51 months for Valsalva conduits (P < 0.01). Actuarial survival was 86 ± 4%, 75 ± 6%, 59 ± 7% and 51 ± 9% at 5, 10, 15 and 20 years, respectively. There were 13 thromboembolic episodes with 3 deaths with an actuarial freedom of 98 ± 1%, 94 ± 2%, 90 ± 3% and 89 ± 4% at 5, 10, 15 and 20 years, respectively. Reoperation on the aortic root was performed in 9 patients for endocarditis (n = 8) and pseudoaneurysm at the right coronary button (n = 1) with an actuarial freedom of 97 ± 1%, 95 ± 2%, 92 ± 3% and 87 ± 4% at 5, 10, 15 and 20 years, respectively. There were no differences between the 2 conduit models in survival and major postoperative complications. CONCLUSIONS The CarboSeal™ conduit has shown gratifying overall performance up to 20 years and appears a valid option for a modified Bentall operation, when a mechanical prosthesis is indicated. Both CarboSeal™ conduit models provided not statistically different overall long-term results.

scholarly journals Long-term functional outcome and satisfaction of patients with hypospadias repaired in childhood

2013 ◽  
Vol 2 (1) ◽  
pp. 23 ◽  
Author(s):  
Chris C. Hoag ◽  
Geoff T. Gotto ◽  
Kevin B. Morrison ◽  
Gerald U. Coleman ◽  
Andrew E. MacNeily
Keyword(s):  
Sexual Function ◽  
Chart Review ◽  
Major Complication ◽  
Functional Results ◽  
Complication Rates ◽  
Long Term Outcomes ◽  
Major Complication Rate ◽  
Hypospadias Surgery

Introduction: Potential long-term sequelae of hypospadias and its surgical correctioninclude difficulties in voiding, sexual function, psychosexual adjustmentand self-appraisal. These difficulties often evolve long after surgical repairas children grow to adulthood. Despite this, patient-driven data on long-termfunctional outcomes and satisfaction are limited, leaving the true success ofhypospadias surgery essentially unknown. The aim of this study was to addressthese deficiencies.Methods: We conducted a chart review for all patients operated on by a singleurologist from 1981 to 1988. Extensive efforts were made to obtain accuratecurrent address information for patients. A database of patient demographicsand pathology, operative details and complications was created. A 22-itemquestionnaire was mailed to study subjects. Telephone follow-up by an independentresearch nurse bolstered response rates. Responses from returned questionnaireswere pooled and analyzed.Results: The chart review included 115 patients. Of 100 patients (with addressinformation) who were sent questionnaires, 28 ultimately responded. The chartreview group was comparable to groups in other published studies. Despitea slightly higher initial major complication rate (57.2%), respondents reportedfew long-term complications (11% fistula, 29% persistent chordee and 10%stricture) and excellent urinary and sexual functional results. The most commonfunctional complaints were spraying and hesitancy during micturition.Overall, 86% of patients were satisfied with their surgical result, and 52% wishedthey had been provided longer follow-up.Conclusion: Long-term outcomes data are critical to an honest account of successrates for hypospadias surgery. Obtaining these data remains challenging. In thisseries, despite high initial complication rates, most patients reported excellentlong-term functional results and were quite satisfied with their overall outcome.

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