scholarly journals Urethral meatus preserving ventral onlay augmentation urethroplasty for female urethral stricture: our technique with initial experience

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Varun Kumar Katiyar ◽  
Rajeev Sood ◽  
Anurag Singla ◽  
Hemant Kumar Goel ◽  
Nikhil Khattar ◽  
...  
Keyword(s):  
Urethral Stricture ◽  
Initial Experience ◽  
Urethral Meatus ◽  
Urinary Tract Symptoms ◽  
Minimal Complication ◽  
The Mean ◽  
Percent Success ◽  
Reconstructive Techniques ◽  
Female Urethral Stricture

Abstract Background Female urethral stricture (FUS) is an uncommon cause of lower urinary tract symptoms (LUTS) in women. Reconstructive techniques are being increasingly used for strictures resistant to the more conservative form of management. Most forms of reconstruction require cutting open of urethral meatus, thereby resulting in some loss of the meatus function. We hereby describe the technique of urethral meatus sparing ventral onlay mucosal graft augmentation urethroplasty with our initial experience. Methods We performed this procedure in 10 cases of FUS with normal meatus and prospectively studied the outcomes over a period of 6 months follow-up. Results There was 90 percent success rate with one recurrence. The mean Qmax increased from 7.2 to 19.5 ml/s, mean post-void residual urine (PVRU) decreased from 96.5 to 22.7 ml and the mean IPSS decreased from 26.1 to 5.7. There were no major complications noted and the patients demonstrated significant subjective and objective improvement of symptoms in the follow-up period. Conclusion The technique of meatus sparing ventral onlay augmentation graft urethroplasty is a promising approach with good outcomes, is reproducible and has minimal complication rate.

Understanding an unusual urothelial disorder: cystitis cystica et glandularis

2021 ◽  
pp. 205141582110328
Author(s):  
Harshit Garg ◽  
Prabhjot Singh ◽  
Brusabhanu Nayak ◽  
Rishi Nayyar ◽  
Seema Kaushal ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Lower Urinary Tract Symptoms ◽  
Lower Urinary Tract ◽  
Bladder Tumour ◽  
Preoperative Imaging ◽  
Urinary Tract Symptoms ◽  
The Mean ◽  
Cystitis Cystica ◽  
Lower Urinary

Objectives: To study the presentation and natural course of cystitis cystica et glandularis. Methods: A retrospective analysis of patients with histopathologically confirmed cystitis cystica et glandularis from March 2016 to March 2018 who at least completed their 2 years’ follow-up was performed. Perioperative details along with the last available follow-up were included in the analysis. Results: A total of 10 patients were included. The mean age (± standard deviation) was 33.4 (±14.0) years and nine (90%) were men. The most common presentation was storage and voiding lower urinary tract symptoms (80%) along with haematuria (40%) and dysuria (20%). Four patients had the presence of hydronephrosis in preoperative imaging, of which three patients had bilateral mild hydroureteronephrosis. All the patients underwent transurethral resection of the bladder tumour as all were diagnosed with urinary bladder mass on preoperative imaging. All the patients had a trigonal lesion with a bullous appearance partially obstructing the bladder neck. Six patients underwent double J stenting in the perioperative period. The mean (± standard deviation) follow-up duration was 32.8 (±7.5) months. Patients were kept on regular surveillance with imaging and cystoscopy as indicated. Eight patients (80%) developed recurrence in the follow-up period. The mean number of recurrences was 1.5 (±1.1). One of the patients had to undergo augmentation ileocystoplasty with bilateral ureteric reimplantation because of the recurrent lesion with small contracted bladder, while another patient underwent cystectomy with urinary diversion owing to recurrence and refractory lower urinary tract symptoms. Besides, there was no evidence of malignancy after this entity in any of the patients. Conclusion: Cystitis cystica et glandularis is a rare clinic pathological entity which often mimics bladder tumour. Cystitis cystica et glandularis is common in men and often presents with lower urinary tract symptoms. Transurethral resection forms the mainstay of treatment. However, it is often associated with upper tract hydronephrosis. Its controversial premalignant nature compounded with recurrence and risk of upper tract deterioration warrants close surveillance. Level of evidence: 4

Transoral Incisionless Fundoplication: Initial Experience in Patients Referred to an Integrated Academic Institution

2011 ◽  
Vol 77 (10) ◽  
pp. 1386-1389 ◽  
Author(s):  
Allan Nguyen ◽  
Thomas Vo ◽  
Xuan-Mai T. Nguyen ◽  
Brian R. Smith ◽  
Kevin M. Reavis
Keyword(s):  
Gastric Surgery ◽  
Late Complications ◽  
Initial Experience ◽  
Additional Time ◽  
Transoral Incisionless Fundoplication ◽  
Working Space ◽  
Symptom Scores ◽  
The Mean ◽  
New Treatment

Transoral incisionless fundoplication is a new treatment for patients with gastroesophageal reflux disease. We present our initial experience with 10 patients undergoing this procedure with varying past surgical histories. All procedures were performed under general nasotracheal anesthesia. RAND-36 and Visual Analog Scale symptom scores were collected at pre and postoperative appointments for a mean of 9.2 months. The mean procedure time was 68 minutes. There were no intraoperative or postoperative complications. Patients with prior pancreaticoduodenectomy had observed reduced working space due to prior distal gastrectomy and required additional insufflation due to no pyloric resistance to insufflation of the small bowel. The patient with prior fundoplication required additional time and force for fastener penetration of the resultant scar from the partially disrupted fundoplication. All patients were discharged within 23 hours of the procedure. Throughout the follow-up period, patients reported gradual changes in medication requirements and symptom scores. There were no late complications. Transoral incisionless fundoplication is technically safe in well-selected patients including those with prior esophageal and gastric surgery.

scholarly journals Outcome of One Stage Urethroplasty Using Buccal Mucosa for Long Segment Urethral Stricture

2020 ◽  
Vol 18 (2) ◽  
pp. 68-73
Author(s):  
Md Sirajul Islam ◽  
Md Faisal Islam ◽  
Anamur Rashid Choudhury ◽  
Sarforaj Ali Khan ◽  
Pranashis Saha
Keyword(s):  
Retrospective Study ◽  
Physical Examination ◽  
Urethral Stricture ◽  
Buccal Mucosa ◽  
Private Hospital ◽  
One Stage ◽  
Buccal Mucosal Graft ◽  
The Mean

Objective: To assess the outcome of one stage urethroplasty using buccal mucosa for long segment (>2cm) urethral stricture. Material & Method: This retrospective study was done in a private Hospital at Jessore from May, 2010 to October, 2012. Twenty nine patients were managed with one stage dorsal on lay buccal mucosal graft (BMG). Patients were followed up 3 monthly with history, physical examination and relevant investigations. The mean duration of follow up was 23 months. Result: The age of the patients ranged from18 years to 65 years with mean of 35years. The length of the stricture ranged from 2.5cm to 10 cm with mean length 5.5 cm. The mean duration operative period was 3.5 hours with range from 2 hours to 4.5 hours. Of the 29 patients, 15 patients (51.7%) had bulbar urethral stricture, 10 patients (34.5%) had penile urethral stricture and 4 patients (13.8) had pan urethralstricture. Success was defined as normal voiding without further procedure. The rate of recurrence noted in this study was 10.34%. Conclusion: One stage dorsal on lay BMG urethroplsaty is a reliable and satisfactory procedure for the management of long segment urethral stricture with minimum complication. Bangladesh Journal of Urology, Vol. 18, No. 2, July 2015 p.68-73

Creation of the Miami Pouch During Laparoscopic-Assisted Pelvic Exenteration: The Initial Experience

2009 ◽  
Vol 19 (3) ◽  
pp. 466-470 ◽  
Author(s):  
Gwénaël Ferron ◽  
Timothy Yong Kuei Lim ◽  
Christophe Pomel ◽  
Michel Soulie ◽  
Denis Querleu
Keyword(s):  
Operative Time ◽  
Pelvic Exenteration ◽  
Iliac Fossa ◽  
Initial Experience ◽  
Pelvic Malignancies ◽  
The Mean ◽  
Continent Diversion ◽  
Laparoscopic Assisted ◽  
Mean Time

Purpose:To describe the initial experience of laparoscopic hand-assisted Miami pouch in a group of patients undergoing pelvic exenterations for pelvic malignancies.Materials and Methods:Thirteen female patients underwent laparoscopic-assisted pelvic exenteration in our center between September 2000 and November 2007. Six of them had the Miami pouch created for urinary diversion. The continent diversion was created extracorporeally through a right iliac fossa minilaparotomy.Results:The mean total operative time for the laparoscopic-assisted exenteration and reconstruction was 382 minutes (range, 270-480 minutes), but specifically for the Miami pouch, it took a mean time of 106 minutes (range, 90-130 minutes). Four patients (66.7%) had postoperative urinary tract infection that resolved with antibiotics. One patient had a ureteral stenosis requiring stenting and one had a Miami pouch cutaneous fistula that required a fistulectomy. The mean follow-up was 23 months (range, 9-48 months). All patients were continent and were able to self-catheterize approximately 3 to 6 times/d.Conclusions:It is technically feasible to incorporate the creation of the Miami continent urinary pouch through a minilaparotomy during laparoscopic pelvic exenteration without compromising the benefits of laparoscopic surgery.

scholarly journals Laparoscopic treatment of symptomatic simple renal cysts in children: single-center experience

2018 ◽  
Author(s):  
Antonio Marte ◽  
Lucia Pintozzi
Keyword(s):  
Operating Time ◽  
Case Series ◽  
Renal Cysts ◽  
Laparoscopic Treatment ◽  
Ultrasound Guided ◽  
Cytological Examination ◽  
Single Center Experience ◽  
Urinary Tract Symptoms ◽  
The Mean

Simple renal cysts, although common in adults, are rare in children. They are usually discovered incidentally in the course of the study of other urinary tract symptoms, although they are not always asymptomatic. Renal cysts can be classified as being either simple or complex. The purpose of this review is to present our case series of simple symptomatic renal cysts treated with laparoscopy. Nineteen patients with symptomatic renal cysts (6 to 13.5 cm) were referred to our institution between January 2006 and January 2017. They comprised 12 (40.5%) females and seven (59.5%) males, aged 8 to 15, with a mean age of 12.2 years. Of these patients, nine had previously been treated unsuccessfully by ultrasound-guided aspiration/alcoholization with 95%-ethanol, between 9 and 13 months prior to the laparoscopy. Five patients had undergone one treatment and four had undergone two treatments. All of the patients were treated by laparoscopic threetrocar deroofing. The cysts were opened and the wall excised using scissors and a monopolar hook. In most cases, to better handle the edges of the cyst and obtain a better grip, a needle was used to aspirate a small amount of fluid (used for cytological examination). The wall of the cyst was excised, the cyst edges were sealed, and the perirenal fat was placed on the bottom of the cyst (wadding technique). The mean operating time was 95 minutes (range 50- 150). The postoperative course was uneventful for all of the patients. The hospital stay ranged from one to three days. All of the patients were asymptomatic following the treatment. At a mean follow-up time of 3.6 years, none of the patients had experienced a recurrence. Renal function, as assessed by a MAG3 renal scintigraphy scan, was well-preserved in all of the patients, and all of them undergo an annual ultrasound scan.

scholarly journals A novel three-dimensional printed vacuum bell for pectus excavatum treatment: a preliminary study

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Xicheng Deng ◽  
Peng Huang ◽  
Jinwen Luo ◽  
Jinghua Wang ◽  
Liwen Yi ◽  
...  
Keyword(s):  
Pectus Excavatum ◽  
Three Dimensional ◽  
Optimal Timing ◽  
Initial Experience ◽  
Improved Outcomes ◽  
3D Printed ◽  
Logistic Regressions ◽  
The Mean ◽  
Scan Data

Abstract Objective Conservative treatment with a vacuum bell (VB) for pectus excavatum (PE) has now been gradually popularized as an alternative to surgery. We describe our initial experience with a novel three dimensional (3D) printed VB device. Methods Prospectively collected data of all patients who started using a 3D printed VB in 2018 at our institution were analyzed. Linear and logistic regressions were used to identify factors associated with effectiveness of device usage. Results In total, forty-two patients with a median age of 3.6 years were treated with the device. The median follow-up duration was 11.1 months and the mean initial Depth Ratio (DR) was 0.129. There were no permanent sequelae from side effects. Thirty patients with at least one follow-up body scan data showed varying improvement (z = − 4.569, p = 0.0000). Linear regression suggested that longer usage improved outcomes (R2 = 0.235, p = 0.014). By logistic regression there was a trend of younger ages and less initial DR for better improvement though neither was statistically significant (p = 0.086, 0.078, respectively). Conclusion Our initial experience has shown the 3D printed VB may be as effective as other conventional VBs and could be used as an alternative to surgical treatment for selected patients with PE. More experience and studies with this type of VB are needed to demonstrate its superiority with regard to the 3D printing design and optimal timing and indication for use.

scholarly journals Thoracoscopic Surgery for Posterior Mediastinal Mass: Our Initial Experience

2019 ◽  
Vol 15 (2) ◽  
pp. 75-79
Author(s):  
Ranjan Sapkota ◽  
Prakash Sayami
Keyword(s):  
Mediastinal Mass ◽  
Thoracoscopic Surgery ◽  
Surgical Techniques ◽  
Tumor Diameter ◽  
Initial Experience ◽  
Mediastinal Tumors ◽  
Benign Schwannoma ◽  
Posterior Mediastinal ◽  
The Mean

Background: Thoracoscopic surgery has been increasingly used for a variety of indications. Posterior mediastinal tumors form an important component of a thoracic surgeon’s workload. This report represents a summary of our initial experience in thoracoscopic management of such tumors. Methods: We retrospectively reviewed the clinical and operative data from records over the study period. We also describe our usual perioperative management and surgical techniques. Results: A total of 11 patients, 8 being females, were operated during the period of 30 months. Seven were incidental findings, and chest pain was the commonest presentation in symptomatic patients. The mean age of the patients was 38.7 years; mean tumor diameter was 4.4 cm; eight had benign schwannoma, and no patient had a malignant tumor. Mean operative duration was 175.5 min; there were no conversions and no transfusion was required. Mean length of stay in the hospital was 5.6 days. There were no perioperative deaths or major complications. Three minor complications were recorded. Follow-up (4 to 18 months) was uneventful. Conclusions: Thoracoscopic management of posterior mediastinal tumors is feasible and safe.

scholarly journals Manual Replacement of Double J Stent Without Fluoroscopy

2015 ◽  
Vol 100 (2) ◽  
pp. 381-385 ◽  
Author(s):  
Osman Kose ◽  
Sacit Nuri Gorgel ◽  
Sait Ozbir ◽  
Sekan Yenigurbuz ◽  
Cengiz Kara
Keyword(s):  
Ovarian Cancer ◽  
Serum Creatinine ◽  
Renal Pelvis ◽  
Guide Wire ◽  
Urethral Meatus ◽  
Ureteric Stent ◽  
External Meatus ◽  
Double J Stent ◽  
The Mean

It is not always possible to replace a ureteric stent with a new one due to the fact that tumoral effect increases in ureter with time. We present our experience of manual replacement of double J stent without fluoroscopy. The data from 23 female patients who underwent double J stent replacement with a total of 110 times was retrospectively analyzed. The steps of technique are as follows: take out distal end of the double J stent through urethra to external urethral meatus cystoscopically, insert a 0.035-inch guide wire through double J stent to the renal pelvis or intra pelvicaliceal system, take out old double J stent over guide wire, slide new stent over guide wire and at external meatus level take out guide wire while gently sliding distal end of double J stent over guide wire into urethra. The mean age was 58.39 ± 9.21 years. Cervical, endometrial, and ovarian cancer were diagnosed in 16, 4, and 3 patients respectively. The mean follow-up and indwelling period were 13.8 ± 5.2, 3.8 ± 0.6 months, respectively. Increased pelvicaliceal dilatation, serum creatinine level, or renal parenchymal loss was not observed. Replacement of double J stents with this technique is easy and can be used successfully in distal ureteral obstructions.

Clinical and radiological results of two hybrid reconstructive techniques in noncontiguous 3-level cervical spondylosis

2014 ◽  
Vol 21 (6) ◽  
pp. 944-950 ◽  
Author(s):  
Lisheng Kan ◽  
Jian Kang ◽  
Rui Gao ◽  
Xiongsheng Chen ◽  
Lianshun Jia
Keyword(s):  
Scale Score ◽  
Cervical Spondylosis ◽  
Cervical Disc ◽  
Improvement Rate ◽  
Score Improvement ◽  
The Mean ◽  
Reconstructive Techniques ◽  
Anterior Cervical Corpectomy ◽  
Two Hybrid

Object To date, formulation of the optimal surgical protocol for noncontiguous multilevel cervical spondylosis remains controversial, and the corresponding clinical data continue to be limited. The purpose of this study was to compare the clinical and radiological outcomes of two hybrid reconstructive techniques in noncontiguous 3-level cervical spondylosis (2 contiguous disc levels and 1 “skip” disc level [nonoperated level between 2 operated levels]). The incidence of adjacent-segment degeneration (ASD) was also evaluated. Methods Sixty-three consecutive patients with noncontiguous 3-level cervical spondylosis who underwent two different hybrid methods of treatment were retrospectively reviewed. The patients were divided into 2 groups, the fusion group and the arthroplasty group. A titanium mesh cage and an anterior cervical plate were used after the anterior cervical corpectomy, and then a stand-alone cage (the fusion group) or an artificial cervical disc (the arthroplasty group) was used after the discectomy. Clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA) scale score and the JOA scale score improvement rate preoperatively and during follow-up. Radiological results were assessed using global angle and global range of motion (ROM) of the cervical spine. The ASD was also evaluated. Results The JOA scores of the patients significantly improved postoperatively and were well maintained within the follow-up period, as did the JOA scale score improvement rate. The mean global angle of the cervical spine of the patients significantly increased postoperatively. At the last follow-up evaluation, the mean global ROM was retained by patients in the arthroplasty group (p > 0.05) but not by patients in the fusion group (p = 0.00). There was no significant difference in the incidence of ASD between the 2 groups (p = 0.114). However, at the skip levels, patients in the fusion group had a higher incidence of ASD than patients in the arthroplasty group (p = 0.038). Conclusions Both of the hybrid procedures (anterior cervical corpectomy and fusion [ACCF] + anterior cervical discectomy and fusion, and ACCF + cervical disc arthroplasty [CDA]) yielded favorable clinical and radiological outcomes in the treatment of noncontiguous 3-level cervical spondylosis. Moreover, the ACCF + CDA procedure may have the ability to decrease the likelihood of ASD in appropriate patients.

scholarly journals The impact of repeated prostate biopsies on sexual function and urinary symptoms in patients with diagnosis of Atypical Small Acinar Proliferation (ASAP): Can ecoDoppler reduce side effects?

2014 ◽  
Vol 86 (4) ◽  
pp. 356 ◽  
Author(s):  
Luigi Quaresima ◽  
Vito Lacetera ◽  
Luca Leone ◽  
Lorenzo Montesi ◽  
Ubaldo Cantoro ◽  
...  
Keyword(s):  
Erectile Function ◽  
Transrectal Ultrasound ◽  
Ultrasound Guided ◽  
Atypical Small Acinar Proliferation ◽  
Prostate Biopsies ◽  
Imaging Results ◽  
Urinary Tract Symptoms ◽  
The Mean ◽  
The Impact

Objectives: To establish whether repeated trans-rectal ultrasound-guided Prostate Needle Biopsies (PNBx) performed in men with diagnosis of Small Acinar Atypical Proliferation (ASAP) predispose these subjects to Erectile Dysfunction (ED) and to evaluate if EcoColorDoppler (ECD) can help to reduce this side effect. Materials and methods: We performed a retrospective study regarding 190 men with diagnosis of ASAP detected between January 2001 and December 2011, who underwent to repeated prostate needle biopsies (PNBx). These patients were investigated about Erectile Function (EF) and Lower Urinary tract Symptoms (LUTS) using International Index of Erectile Function (IIEF-5) and International Prostate Symptom Score (IPSS) questionnaires before the first PNBx and 3 months after each other one. In particular, among the 89 men without ED before first PNBx, we compared IIEF-5 score between 64 patients who underwent to standard PNBx and 25 patients submitted to a PNBx done with in addition ECD ultrasound imaging. Results: Mean patient age was 65 years (SD 7.7); mean follow-up was 3.2 years (SD 1.8) and the mean number of re-biopsies completed was 2 (SD 1.5). Among the 143 men considered, only 89 resulted with a normal EF (IIEF-5 score > 21): in this group incidence of ED (IIEF-5 score < 21) among patients who underwent to standard PNBx was 4/64 (6.25%) while in patients submitted to a PNBx with ECD was 1/25 (4%). A greater decrease of EF was observed in patients undergone to 3 or more biopsies; no relationship between IPSS score and re-PNBx was identified. Conclusion: Repeated PNBx done in patients with diagnosis of ASAP appear to get worse EF; number of biopsies seems to increase the risk of ED. Use of ECD in transrectal ultrasound- guided PNBx may have a role to avoid neurovascular bundles (NVBs) and preserve EF; anyway further studies are highly recommended to validate this hypothesis.

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