scholarly journals The Comparable Results of Minimally Invasive Therapy versus Primary Anastomosis in the Management of Partial Posterior Urethral Stricture

2020 ◽  
Vol 8 (B) ◽  
pp. 451-454
Author(s):  
Gede Wirya Kusuma Duarsa ◽  
Rheny Subnafeu ◽  
Anak Agung Gde Oka ◽  
I Kadek Budi Santosa ◽  
I Wayan Yudiana ◽  
...  
Keyword(s):  
Urethral Stricture ◽  
Erectile Function ◽  
Primary Anastomosis ◽  
Surgical Techniques ◽  
Minimal Invasive ◽  
Medical Emergency ◽  
Clean Intermittent Catheterization ◽  
Invasive Therapy ◽  
Advantages And Disadvantages ◽  
Bladder Urine

BACKGROUND: Urinary retention has many etiologies. One of them is urethral stricture or the narrowing of urethral lumen due to fibrotic tissue. Urethral stricture is considered a medical emergency condition because it might cause complications in some extent. At present, there are several surgical techniques introduced with their advantages and disadvantages. AIM: The study aimed to compare the outcome of minimal invasive therapy (MIT) or excision and primary anastomosis (EPA) techniques. METHODS: A retrospective cohort study was performed on patients with partial posterior urethral stricture. The inclusion criteria were all patients with partial posterior urethral stricture who underwent MIT or EPA from 2014 to 2018. The data of International Prostate Symptom Score (IPSS), quality of life (QoL), urinary peak flow rate (Qmax), urine residue, erection hardness score, clean intermittent catheterization (CIC), recurrence, and penile perception scores (PPS) were obtained and analyzed postoperatively. RESULTS: Thirty-four patients included in the study, consisted of 17 patients for each group. EPA group showed significantly superior to MIT in Qmax (p < 0.001), CIC (p = 0.007), and PPS score (p = 0.003). However, no significance differences were found in QoL (p = 0.071), IPSS score (p = 0.083), bladder urine residue (p = 0.688), recurrence (p = 0.225), and erectile function (p = 0.303). CONCLUSION: EPA may be superior to MIT in some aspect. However, other advantages of MIT could be outweighed EPA techniques, such as QoL, IPSS, bladder urine residual, stricture recurrence, and erectile function. MIT still has a place to be the first-line management of partial posterior urethral stricture.

How can we Preserve Sexual Function after Ablative Surgery for Benign Prostatic Hyperplasia?

2020 ◽  
Vol 22 (1) ◽  
pp. 4-13
Author(s):  
Ioannis Mykoniatis ◽  
Koenraad Van Renterghem ◽  
Ioannis Sokolakis
Keyword(s):  
Sexual Dysfunction ◽  
Sexual Function ◽  
Gold Standard ◽  
Erectile Function ◽  
Bladder Neck ◽  
Surgical Techniques ◽  
Sperm Retrieval ◽  
Treatment Methods ◽  
Ablative Techniques ◽  
Neurovascular Bundles

: Our aim is to provide a narrative review regarding the prevalence, the associated pathophysiologic pathways and the potential management methods of sexual dysfunction related to ablative surgical techniques for Benign Prostatic Enlargement (BPE). Men suffering from BPE are at high risk of sexual dysfunction due to the disease itself, comorbidities, and pharmacological/surgical treatments. Transurethral resection of the prostate, as the gold standard treatment option for BPE has historically been associated with relatively high rates of postoperative sexual dysfunction problems, mainly retrograde ejaculation but also erectile dysfunction. Ablative surgical techniques, including photoselective vaporization of the prostate (PVP), transurethral needle ablation (TUNA), Transurethral Microwave Therapy (TUMT), Convective Water Vapor Energy Ablation (Rezum®) and Aquablation® have been proposed as treatment methods able to reduce treatment-related complications for BPE patients, including adverse effects on erectile and ejaculatory function, without compromising the efficacy rates for BPE. The neurovascular bundles can be damaged during TURP due to posterolateral capsular perforation. Ablative techniques and especially PVP theoretically seems to skip this hazard as the distance created from the necrotic area to the capsule is generally larger compared to the distance induced after TURP . However, indirect thermal injury of erectile nerves, which could be induced also by the majority of available ablative techniques could potentially lead to ED. Two special technical characteristics (physiological saline use for tissue ablation and real time penetration depth control) of Aquablation® could be proved beneficial with regard to the effect of the method on erectile function. In general ablative techniques seems to have minor impact on sexual function. However, low methodological quality characterize the most of the studies included in this review mainly due to the impossibility, in many cases, to perform a blind randomization. Also in many studies did not have erectile and ejaculatory function as primary outcomes limiting that way their statistical power to identify significant variations. Management of sexual dysfunction problems arising from ablative surgeries for BPE treatment could be divided in two levels. Firstly, intraoperatively the avoidance of manipulation of crucial structures regarding ejaculatory (bladder neck or ejaculatory ducts) and erectile function (neurovascular bundles) could possibly decrease the negative effect of these procedures on sexual function. Thus, in this direction, modifications of classic ablative techniques have been proposed resulting in encouraging outcomes regarding postoperative sexual function. Secondly, if EjD and/or ED are established the already known treatment choices should be chosen in order sexual function rehabilitation to be achieved. Thus, regarding ED: PDE5i daily or on demand remain the gold standard first line treatment choice followed by intracaver-nosal alprostadil injections in cases of failure, while penile prosthesis implantation must be kept as final definitive solution when all the other methods have failed. Regarding ejaculation disorders (retrograde ejaculation or anejaculation): medical therapy with a-agonists (pseudoephedrine), sperm retrieval from the urine, bladder neck reconstruction, prostatic massage, electroejaculation, penile vibratory stimulation and surgical sperm retrieval are the available treatment options. Further, high quality studies are required to investigate potential side effects of BPE surgery on sexual function and efficient treatment methods to manage them.

In-situ simulation

Trauma ◽  
2017 ◽  
Vol 20 (4) ◽  
pp. 281-288 ◽  
Author(s):  
Louise Schofield ◽  
Emma Welfare ◽  
Simon Mercer
Keyword(s):  
Medical Emergency ◽  
In Situ Simulation ◽  
Advantages And Disadvantages ◽  
Medical Emergency Teams ◽  
Clinical Workplace ◽  
Trauma Teams ◽  
New Guidelines

‘In-situ’ simulation or simulation ‘in the original place’ is gaining popularity as an educational modality. This article discusses the advantages and disadvantages of performing simulation in the clinical workplace drawing on the authors’ experience, particularly for trauma teams and medical emergency teams. ‘In-situ’ simulation is a valuable tool for testing new guidelines and assessing for latent errors in the workplace.

scholarly journals The application of C2 transpedicular screw, C1 laminar hook fixation and bone graft in the atlantoaxial instability

2021 ◽  
Vol 38 (2) ◽  
pp. 94-98
Author(s):  
Şükrü ORAL
Keyword(s):  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Surgical Techniques ◽  
Atlantoaxial Instability ◽  
Posterior Arch ◽  
X Rays ◽  
Advantages And Disadvantages ◽  
Transpedicular Screw ◽  
Flexion Extension ◽  
Laminar Hooks

Traumatic atlantoaxial instability usually results from a motor vehicle accident, falls and motorcycle accidents. Atlantoaxial instability can lead to spinal cord compression and neck pain, but, spasticity and radicular symptoms as well. The purpose of surgery is to remove the compression and stabilize the joint permanently. To date, several surgical techniques have been described to remedy C1-C2 instability. In this study, the clinical and radiological outcomes of patients who operated with the C1 (Atlas bone) laminar hooks fixation and bilateral C2 (Axis bone) trans-pedicular screw technique were shown. Also, the advantages and disadvantages of this technique are discussed. From March 2010 to December 2017, 12 patients who have atlantoaxial instability were surgically treated by modified fixation technique which consists C1 laminar hooks fixation and bilateral C2 transpedicular screw. Twelve patients were operated with this procedure from March 2010 to December 2017. All the patients were checked with flexion-extension x-rays at the end of the twelfth week. The posterior bony fusion formation was observed on imaging in all patients. C2 bilateral pedicle screw combined with C1 laminar hook system is a good method for atlantoaxial instability in the conditions which is not convenient for insertion of C1 lateral mass and C2 trans-articular screw. However, this method may not be available in some cases such as traumatic, infection, neoplastic or degenerative pathologies in which the posterior arch of the atlas is damaged.

scholarly journals Minimally-invasive technologies in the treatment of choledocholithiasis complicated by biliary pancreatitis

2021 ◽  
Vol 11 (3) ◽  
pp. 294-309
Author(s):  
I. Deikalo ◽  
D. Osadchuk ◽  
O. Karel ◽  
M. Handzhalas
Keyword(s):  
High Efficiency ◽  
Surgical Techniques ◽  
Liver Parenchyma ◽  
Minimal Invasive ◽  
Biliary Pancreatitis ◽  
Satisfactory Condition ◽  
Biliary Sepsis ◽  
Extrahepatic Bile Ducts ◽  
Group 3 ◽  
Sepsis And Septic Shock

Minimal invasive endoscopic technologies are used in the treatment of patients with biliary pancreatitis with complicated cholangitis and biliary sepsis. 56 patients were treated for the period 2014 - 2018, aged 65.5 ± 15.18 years. ERCP was performed in 31 (55,3%) patients, in 13 (23,2%) - surgical intervention was performed without contrast of extrahepatic bile ducts. Papillotomy in 52 cases (96,4%) was performed by string papilloma and in 4 (7,1%) - by needle. In all cases, subtotal papilloprotectomy was performed [1], supplemented by balloon sphincteroplasty. In the I group, the patients included patients with biliary pancreatitis clinic, in group II patients with clinic of biliary sepsis, in the III group patients with purulent cholangitis clinic, biliary sepsis and septic shock. In the 1st and 2nd groups of patients, mortality was not observed. In the 3rd group, 3 patients died (37,5%). The rest of the patients are discharged from the hospital in a satisfactory condition. A decrease in the level of markers of hepatitis cytolysis (AlAT, AsAT, GGTP, L-FABP) was observed during surgical procedures without ERCP, indicating the toxic effect of contrast on the liver parenchyma. L-FABP is a highly informative marker for hepatocyte cytolysis and can be used as a criterion for hepatic insufficiency and prognosis of biliary sepsis. The high efficiency of transpacillary endoscopic surgical techniques in the treatment of biliary pancreatitis and biliary sepsis was noted.

Cartilage Scales Embedded in Fibrin Gel

2017 ◽  
Vol 33 (02) ◽  
pp. 225-232 ◽  
Author(s):  
Milos Kovacevic ◽  
Frank Riedel ◽  
Jochen Wurm ◽  
Gregor Bran
Keyword(s):  
Regenerative Medicine ◽  
Surgical Techniques ◽  
Fibrin Gel ◽  
Platelet Rich Fibrin ◽  
Preliminary Results ◽  
Advantages And Disadvantages ◽  
The Past ◽  
Dorsal Nasal Augmentation ◽  
Diced Cartilage ◽  
Nasal Augmentation

Multiple techniques have been described for dorsal nasal augmentation in rhinoplasty. In this article, we review common surgical techniques for raising the dorsum or eliminating dorsal irregularities, by highlighting inherent advantages and disadvantages of each method. Within the past few years, the use of diced cartilage grafts has become the workhorse in this field of interest. To overcome drawbacks of methods based on diced cartilage, we present a new concept for autologous augmentation, using regenerative medicine protocols. A mix of cartilage scales with cartilage pâté was embedded in platelet-rich fibrin (PRF). Since December 2015, a total of 48 patients were treated with this technique. Based on our preliminary results, cartilage scales in PRF appear to be a promising and reliable alternative to existing procedures for dorsal nasal augmentation.

scholarly journals The Health Impact of Surgical Techniques and Assistive Methods Used in Cesarean Deliveries: A Systemic Review

2020 ◽  
Vol 17 (18) ◽  
pp. 6894
Author(s):  
Li-Hsuan Wang ◽  
Kok-Min Seow ◽  
Li-Ru Chen ◽  
Kuo-Hu Chen
Keyword(s):  
Blood Loss ◽  
Cesarean Delivery ◽  
Operative Time ◽  
Surgical Techniques ◽  
Systemic Review ◽  
Fetal Head ◽  
Advantages And Disadvantages ◽  
Cesarean Deliveries ◽  
Fundal Pressure

Cesarean delivery is one of the most frequently performed surgeries in women throughout the world. However, the most optimal technique to minimize maternal and fetal morbidities is still being debated due to various clinical situations and surgeons’ preferences. The contentious topics are the use of vacuum devices other than traditional fundal pressure to assist in the delivery of the fetal head and the techniques of uterine repair used during cesarean deliveries. There are two well-described techniques for suturing the uterus: The uterus can be repaired either temporarily exteriorized (out of abdominal cavity) or in situ (within the peritoneal cavity). Numerous studies have attempted to compare these two techniques in different aspects, including operative time, blood loss, and maternal and fetal outcomes. This review provides an overview of the assistive method of vacuum devices compared with fundal pressure, and the two surgical techniques for uterine repair following cesarean delivery. This descriptive literature review was performed to address important issues for clinical practitioners. It aims to compare the advantages and disadvantages of the assistive methods and surgical techniques used in cesarean deliveries. All of the articles were retrieved from the databases Medline and PubMed using the search terms cesarean delivery, vacuum, and exteriorization. The searching results revealed that after exclusion, there were 9 and 13 eligible articles for vacuum assisted cesarean delivery and uterine exteriorization, respectively. Although several studies have concluded vacuum assistance for fetal extraction as a simple, effective, and beneficial method during fetal head delivery during cesarean delivery, further research is still required to clarify the safety of vacuum assistance. In general, compared to the use of in situ uterine repairs during cesarean delivery, uterine exteriorization for repairs may have benefits of less blood loss and shorter operative time. However, it may also carry a higher risk of intraoperative complications such as nausea and vomiting, uterine atony, and a longer time to the return of bowel function. Clinicians should consider these factors during shared decision-making with their pregnant patients to determine the most suitable techniques for cesarean deliveries.

scholarly journals A drug-coated balloon treatment for urethral stricture disease: Two-year results from the ROBUST I study

2020 ◽  
Vol 15 (2) ◽  
Author(s):  
Rachel A. Mann ◽  
Ramon Virasoro ◽  
Jessica M. DeLong ◽  
Rafael E. Estrella ◽  
Merycarla Pichardo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Adverse Events ◽  
Urethral Stricture ◽  
Flow Rate ◽  
Erectile Function ◽  
Urine Volume ◽  
Urethral Stricture Disease ◽  
Residual Urine ◽  
Drug Coated Balloon

Introduction: Mechanical balloon dilation and direct visualization internal urethrotomy (DVIU) are the most widely used treatments for urethral stricture disease in the U.S., but recurrence rates are high, especially after re-treatment. This study investigates the safety and efficacy of the Optilume™ paclitaxel-coated balloon for the treatment of recurrent strictures. Methods: Men with recurrent bulbar strictures ≤2 cm with 1–4 prior endoscopic treatments were treated with the Optilume™ drug-coated balloon. Patients were evaluated within 14 days, three, six, 12, and 24 months post-treatment. The primary safety endpoint was serious urinary adverse events. The primary efficacy endpoint was ≥50% improvement in International Prostate Symptom Score (IPSS) at 24 months. Secondary outcomes included quality of life, erectile function, flow rate, and post-void residual urine volume. Results: A total of 53 subjects were enrolled and treated; 46 completed the 24-month followup. Forty-three percent of men had undergone >1 previous dilations, with a mean of 1.7 prior dilations. There were no serious adverse events related to treatment at two years. Success was achieved in 32/46 (70%), and baseline IPSS improved from a mean of 25.2 to 6.9 at 24 months (p<0.0001). Quality of life, flow rate, and post-void residual urine volumes improved significantly from baseline. There was no impact on erectile function. Conclusions: Two-year data indicates the Optilume™ paclitaxel-coated balloon is safe for the treatment of recurrent bulbar urethral strictures. Early efficacy results are encouraging and support further followup of these men through five years, as well as further investigation with a randomized trial.

Benign Prostatic Hyperplasia (BPH): Therapeutic Options

1994 ◽  
Vol 61 (3) ◽  
pp. 192-196
Author(s):  
N. Caruso
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Endoscopic Surgery ◽  
Benign Prostatic Hypertrophy ◽  
Prostatic Hyperplasia ◽  
Prostatic Hypertrophy ◽  
Therapeutic Options ◽  
Invasive Therapy ◽  
Advantages And Disadvantages ◽  
Symptomatic Form

Researchers' interest in the last few years has been concentrated on finding a medical, if possible, or at least “mini-invasive” therapy for benign prostatic hypertrophy (BPH), which can be used for the symptomatic form instead of open or endoscopic surgery. The various therapeutic options are reviewed, underlining their advantages and disadvantages.

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