scholarly journals Surgical treatment of urethral stricture disease – the earlier, the better

Folia Medica ◽  
2021 ◽  
Vol 63 (4) ◽  
pp. 481-487
Author(s):  
Valeri Mariyanovski ◽  
Emil Dorosiev ◽  
Boris Mladenov
Keyword(s):  
Surgical Treatment ◽  
Sexual Function ◽  
Reconstructive Surgery ◽  
Open Surgery ◽  
Treatment Options ◽  
Functional Results ◽  
Surgical Reconstruction ◽  
Urethral Reconstruction ◽  
Complication Rates ◽  
Urethral Strictures

Introduction: Surgical treatment of urethral strictures is a constantly evolving process. There are various treatment options like internal urethrotomy (IUT) and open surgery. A variety of techniques for urethral reconstruction are available (grafts, flaps, and excision-reanastomosis). Functional results of urethral reconstructive surgery are very satisfying and with low rate of complications. Aim: We assessed the early open surgical reconstruction in comparison with the continuation with the endourological treatment &ndash; IUTs. Materials and methods: The study included 129 patients with urethral strictures referred to our center. At that time point, they had received two unsuccessful IUTs and were divided into two groups &ndash; consecutive IUT and surgical repair, which included excision and reanastomosis or augmented urethroplasty. These patients were evaluated at 12 months using urethrography and uroflowmetry. Sexual function was evaluated using the international index of erectile function questionnaire 5-IIEF. Chi-squared test for statistical analysis was used. Results: Successful outcomes (urethrography presented equal caliber and Qmax was >15 ml/sec 12 months after the procedure) were achieved in 59 (88%) of the patients using reconstructive surgery versus 26 (41.9%) of the patients with consecutive IUT (p<0.001). Mild sexual dysfunction was reported by 12 (17.9%) patients from the group with open surgery and 7 (11.3%) from the group with continuous IUT (p=0.289). Conclusions: Early open surgery seems a reasonable solution to the problem of urethral strictures as there are only a few complications from this surgery and the functional results are satisfactory. The success rate using open surgery was found to be significantly greater than that in the consecutive IUT group, whereas no differences in the complication rates regarding sexual function were observed.

scholarly journals Arteria iliaca aneurysma nyitott és endovascularis kezelése

2018 ◽  
Vol 159 (13) ◽  
pp. 520-525
Author(s):  
Dávid Garbaisz ◽  
András Boros ◽  
Péter Legeza ◽  
Zoltán Szeberin
Keyword(s):  
Surgical Treatment ◽  
Retrospective Analysis ◽  
Iliac Artery ◽  
Open Surgery ◽  
Elective Surgery ◽  
Artery Aneurysm ◽  
Complication Rates ◽  
Iliac Artery Aneurysm ◽  
Term Survival ◽  
Acute Surgery

Abstract: Introduction and aim: Iliac artery aneurysms make up 2% of all aneurysms. There are only a few data available on the results of surgical treatment, therefore the optimal treatment is unclear. Our objective was the retrospective analysis of the perioperative morbidity and mortality of patients who underwent iliac artery surgery as well as the comparison of elective open surgery and endovascular iliac aneurysm repair (EVIAR). Method: Retrospective analysis of patients who underwent surgery for iliac artery aneurysm between 1 January 2005 and 31 December 2014. Results: During the 10-year period, 62 patients with a mean age of 68.9 years underwent elective surgery for iliac artery aneurysm (54 males, 87.1%). In 10 cases acute surgery was performed due to aneurysm ruptures (13.9%), 3 patients died within the perioperative period (30%). Regarding anatomical localisation, aneurysm developed mostly on the common iliac artery (80.6%). As an elective surgery, 35 patients (56.5%) underwent open surgery, 25 (40.3%) underwent EVIAR and other endovascular interventions were performed in 2 cases (3.2%). Postoperative complications (1 patient [4.0%] vs. 17 patients [48.5%]; p<0.001) and intensive care treatment (29 patients [82.8%] vs. 2 patients [8.0%]; p<0.001) were significantly rarer after EVIAR than after open surgery. Furthermore, EVIAR resulted in considerably shorter postoperative hospital stays (4.7 ± 2.3 days vs. 11.8 ± 12.2 days; p = 0.006) and significantly less blood transfusion demand (1 patient [4.0%] vs. 26 patients [74.2%]; p<0.001). There were no significant differences regarding long-term survival rates between EVIAR and open surgery (81.4% vs. 71.4%; p = 0.95). Conclusion: In case of the surgical treatment of iliac artery aneurysms, owing to the lower complication rates and shorter postoperative length of stay, EVIAR is primarily recommended. Orv Hetil. 2018; 159(13): 520–525.

Need for standard outcome reporting systems in craniosynostosis

2011 ◽  
Vol 31 (2) ◽  
pp. E1 ◽  
Author(s):  
Caroline Szpalski ◽  
Katie Weichman ◽  
Fabio Sagebin ◽  
Stephen M. Warren
Keyword(s):  
Health Care Professionals ◽  
Treatment Options ◽  
Case Series ◽  
Functional Results ◽  
Series Data ◽  
Quality Level ◽  
Complication Rates ◽  
Outcome Reporting ◽  
Radiographic Measurements ◽  
Patient Reported

Craniosynostosis is the premature fusion of one or more cranial sutures. When a cranial suture fuses prematurely, skull growth is altered and the head takes on a characteristic pathological shape determined by the suture(s) that fuses. Numerous treatment options have been proposed, but until recently there were no parameters or guidelines of care. Establishing such parameters was an important step forward in the treatment of patients with craniosynostosis, but results are still assessed using radiographic measurements, complication rates, and ad hoc reporting scales. Therefore, clinical outcome reporting in the treatment of craniosynostosis is inconsistent and lacks methodological rigor. Today, most reported evidence in the treatment of craniosynostosis is level 5 (expert opinion) or level 4 (case series) data. Challenges in obtaining higher quality level 1 or level 2 data include randomizing patients in a clinical trial as well as selecting the appropriate outcome measure for the trial. Therefore, determining core outcome sets that are important to both patients and health care professionals is an essential step in the evolution of caring for patients with craniosynostosis. Traditional clinical outcomes will remain important, but patient-reported outcomes, such as satisfaction, body image, functional results, and aesthetic outcomes, must also be incorporated if the selected outcomes are to be valuable to patients and families making decisions about treatment. In this article, the authors review the most commonly used tools to assess craniosynostosis outcomes and propose a list of longitudinal parameters of care that should be considered in the evaluation, diagnosis, and treatment evaluation of a patient with craniosynostosis.

scholarly journals Surgical treatment of hemorrhoids: a critical appraisal of the current options

2014 ◽  
Vol 27 (1) ◽  
pp. 66-70 ◽  
Author(s):  
Marlise Mello CERATO ◽  
Nilo Luiz CERATO ◽  
Patrícia PASSOS ◽  
Alberto TREIGUE ◽  
Daniel C. DAMIN
Keyword(s):  
Surgical Treatment ◽  
Postoperative Pain ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Postoperative Recurrence ◽  
Long Term Results ◽  
Published Data ◽  
Complication Rates ◽  
Recurrence Rates

Introduction : Surgical treatment of hemorrhoids is still a dilemma. New techniques have been developed leading to a lower rate of postoperative pain; however, they are associated with a greater likelihood of recurrence. Aim : To review current indications as well as the results and complications of the main techniques currently used in the surgical treatment of hemorrhoidal disease. Methods : A systematic search of the published data on the options for treatment of hemorrhoids up to December 2012 was conducted using Medline/PubMed, Cochrane, and UpToDate. Results : Currently available surgical treatment options include procedure for prolapse and hemorrhoids (PPH), transanal hemorrhoidal dearterialization (THD), and conventional hemorrhoidectomy techniques. Excisional techniques showed similar results regarding pain, time to return to normal activities, and complication rates. PPH and THD were associated with less postoperative pain and lower complication rates; however, both had higher postoperative recurrence rates. Conclusion : Conventional surgical techniques yield better long-term results. Despite good results in the immediate postoperative period, PPH and THD have not shown consistent long-term favorable results.

Surgical Reconstruction Options in Chronic Distal Biceps Tendon Ruptures – Case Report and Literature Review

2019 ◽  
Author(s):  
Hans-Joachim Riesner ◽  
Carsten Hackenbroch ◽  
Patricia Lang ◽  
Gerhard Achatz ◽  
Hans-Georg Palm ◽  
...  
Keyword(s):  
Biceps Tendon ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Functional Results ◽  
Surgical Reconstruction ◽  
Medical Database ◽  
Distal Biceps Tendon ◽  
Distal Biceps ◽  
Tendon Ruptures ◽  
Tendon Grafts

Abstract Introduction Chronic distal biceps tendon ruptures are rare and conservative or operative treatment options are suitable. There is a consensus in the literature in case of acute traumatic ruptures the operative refixation should be preferred. Disagreement exists in the best way of care of old ruptures (> 4 weeks) of distal biceps tendon. Several kinds of refixation possibilities up to tendon grafts are described. Aim of this publication is showing an overview of the literature of the approved methods in reconstruction of the distal biceps tendon using autogenous and allogenic grafts, comparing the outcomes and transferring them on an own case. Material and Methods A literature research was carried out using the online medical database “PubMed” with the following keywords “chronic rupture distal biceps tendon, surgical techniques”. 59 citations were found concerning the topic, 37 publications were relevant for this work. Results There is consensus that even in chronic ruptures the operative management of the distal biceps tendon generates the best results. Consistently the experiences and results of only little patient collectives are reported. Numerous techniques of surgery are described without predominance of one method. Reinsertions of the tendon butts are reported in different techniques: with achilles, palmaris longus, fascia lata, triceps, quadriceps and semitendinosus tendon grafts. All together they showed postoperative satisfactory results. Conclusion With surgical treatment of chronic ruptured distal biceps tendons comparable outcomes can be achieved by primary refixation and graft augmentations. In case of graft augmentations several tissue options are available which showed in all cases satisfactory functional results in the end.

Challenging Knosp high-grade pituitary adenomas

2020 ◽  
Vol 132 (6) ◽  
pp. 1739-1746 ◽  
Author(s):  
Alexander Micko ◽  
Johannes Oberndorfer ◽  
Wolfgang J. Weninger ◽  
Greisa Vila ◽  
Romana Höftberger ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Carotid Artery ◽  
Pituitary Adenomas ◽  
Treatment Options ◽  
Cohort Analysis ◽  
Proliferation Rate ◽  
Biological Behavior ◽  
Complication Rates ◽  
High Grade ◽  
Significant Difference

OBJECTIVEParasellar growth is one of the most important prognostic variables of pituitary adenoma surgery, with adenomas regarded as not completely resectable if they invade the cavernous sinus (CS) but potentially curable if they displace CS structures. This study was conducted to correlate surgical treatment options and outcomes to the different biological behaviors (invasion vs displacement) of adenomas with parasellar extension into the superior or inferior CS compartments or completely encasing the carotid artery (Knosp high grades 3A, 3B, and 4).METHODSThis was a retrospective cohort analysis of 106 consecutive patients with Knosp high-grade pituitary adenomas with parasellar extension who underwent surgery via a primary endoscopic transsphenoidal approach between 2003 and 2017. Biological tumor characteristics (surgical status of invasiveness and tumor texture, 2017 WHO classification, proliferation rate), extent of resection, and complication rate were correlated with parasellar extension grades 3A, 3B, and 4 on preoperative MRI studies.RESULTSInvasiveness was significantly less common in grade 3A (44%) than in grade 3B (72%, p = 0.037) and grade 4 (100%, p < 0.001) adenomas. Fibrous tumor texture was significantly more common in grade 4 (52%) compared to grade 3A (20%, p = 0.002), but not compared to grade 3B (28%) adenomas. Functioning macroadenomas had a significantly higher rate of invasiveness than nonfunctioning adenomas (91% vs 55%, p = 0.002). Mean proliferation rate assessed by MIB-1 was > 3% in all groups but without significant difference between the groups (grade 3A, 3.2%; 3B, 3.9%; 4, 3.7%). Rates of endocrine remission/gross-total resection were significantly higher in grade 3A (64%) than in grade 3B (33%, p = 0.021) and grade 4 (0%, p < 0.001) adenomas. In terms of complication rates, no significant difference was observed between grades.CONCLUSIONSAccording to the authors’ data, the biological behavior of pituitary adenomas varies significantly between parasellar extension patterns. Adenomas with extension into the superior CS compartment have a lower rate of invasive growth than adenomas extending into the inferior CS compartment or encasing the carotid artery. Consequently, a significantly higher rate of remission can be achieved in grade 3A than in grade 3B and grade 4 adenomas. Therefore, the distinction into grades 3A, 3B, and 4 is of importance for prediction of adenoma invasion and surgical treatment considerations.

scholarly journals Treatment of Achilles tendon rupture using different methods

2012 ◽  
Vol 69 (8) ◽  
pp. 663-668 ◽  
Author(s):  
Predrag Grubor ◽  
Milan Grubor
Keyword(s):  
Surgical Treatment ◽  
Achilles Tendon ◽  
Spinal Anaesthesia ◽  
Local Anaesthesia ◽  
Open Surgery ◽  
Achilles Tendon Rupture ◽  
Plaster Cast ◽  
Surgical Reconstruction ◽  
Orthopedic Procedures ◽  
Tendon Ruptures

Background/Aim. Today there are controversies about searching for the ideal surgical method (conservatively with plaster cast, with open and percutaneous tenorrhaphy) for repairing a ruptured Achilles tendon. The aim of this study study was to examine the results of treating Achilles tendon ruptures in patients by using the following methods: percutaneous suturing, open surgery technique and non-surgical treatment by plaster cast immobilisation. Methods. Forty two patients treated at our facility in the period August 2003 - September 2010 for Achilles tendon ruptures were included in the study. They were operated on by using different orthopedic procedures (percutaneous reconstruction of the Achilles tendon, open surgery, plaster cast only) and two anaesthesia technique (spinal aneasthesia and local infiltrational anaesthesia). The following parameters were monitored after interventions performed and compared: duration of hospital stay, postsurgical complications, incidence of the reruptures of the Achilles tendon and time for full leg functionality. Results. The patients sustained their respective injuries in the following manner: 8 of them while pursuing sports activities, 24 while pursuing recreational activities, 4 at workplace, 4 while performing everyday activities, and 2 of the patients did not know how they had sustained their injuries. The average age of the patients was 40.5, with 37 (88%) men and 5 (12%) women. Surgeries were performed under spinal anaesthesia in 29 (69%) patients, and in 5 (12%) patients tenorrhaphy was performed under local anaesthesia. Anaesthesia was not used in 8 (19%) patients treated with plaster cast. We performed percutaneous reconstruction of the Achilles tendon in 19 (45%) patients. A total of 14 (33%) patients were treated under spinal anaesthesia, and 5 (11.9%) under local infiltrational anaesthesia with 2% xylocain. We treated 15 (36%) patients with open surgery. The patients treated conservatively stayed in hospital on average for up to 5 hours. Those who underwent an percutaneous surgery stayed 2 days and those who underwent an open surgery stayed 9 days. A total of 28 (66%) patients from the given series experienced no complications. The patients treated with open surgical reconstruction experienced skin complications ranging from inflammatory changes on the skin in 6 (14%) patients to dehiscence and skin necrosis in 3 (7%). The 5 (11.9%) patients whose ruptured Achilles tendon was treated percutaneously experienced temporary redness and delayed healing of the incision(s) longer than 5 mm. A total of 3 (7%) patients treated with open surgery and 1 (2%) patient treated with percutaneous tenorrhaphy had temporary peroneal nerve prolapses. A total of 7 (16.6%) patients had reruptures: 4 were treated with plaster cast, 2 underwent open surgery, and 1 was treated percutaneously. Out of the 8 patients who were treated with plaster cast, 4 sustained reruptures and 3 of the 4 had diabetes. Conclusion. Surgical treatment, percutaneous tenorrhaphy, performed in a small operating theatre under local anaesthesia, should be preferred in cases of fresh ruptures of the Achilles tendon.

scholarly journals New Techniques in Hemorrhoidal Disease but the Same Old Problem: Anal Stenosis

2021 ◽  
Author(s):  
Sezai Leventoglu ◽  
Bulent Mentes ◽  
Bengi Balci ◽  
Halil Can Kebiz
Keyword(s):  
Surgical Treatment ◽  
Functional Results ◽  
Surgical Reconstruction ◽  
Anal Stenosis ◽  
Ultrasonic Dissector ◽  
Significant Deterioration ◽  
New Techniques ◽  
Different Shapes ◽  
Non Surgical Treatment

Anal stenosis, which develops as a result of aggressive excisional hemorrhoidectomy, especially with the stoutly use of advanced technologies (LigaSure, Ultrasonic Dissector, Laser, etc.), has become common, causing significant deterioration in the patient's quality of life. Although non-surgical treatment is effective for mild anal stenosis, surgical reconstruction is unavoidable for moderate to severe anal stenosis that causes distressing, severe anal pain, and inability to defecate. The problem in anal stenosis, unlike anal fissure, is that the skin does not stretch as a result of chronic fibrosis due to surgery. Therefore, the application of lateral internal sphincterotomy does not provide satisfactory results in the treatment of anal stenosis. Surgical treatment methods are based on the use of flaps of different shapes and sizes to reconstruct the anal caliber and flexibility. This article aims to review the functional results, postoperative care, and complications of these methods.

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.

scholarly journals Sagittal balance of the cervical spine

2021 ◽  
Vol 29 (1_suppl) ◽  
pp. 230949902110244
Author(s):  
Justin K Scheer ◽  
Darryl Lau ◽  
Christopher P Ames
Keyword(s):  
Cervical Spine ◽  
Surgical Treatment ◽  
Sagittal Balance ◽  
Treatment Options ◽  
Complication Rates ◽  
Rapid Rate ◽  
Cervical Deformity ◽  
Cervical Sagittal Balance ◽  
Surgical Options ◽  
Conservative And Surgical Treatment

The treatment of adult cervical deformity continues to be complex with high complication rates. However there are many new advancements and overall patients do well following surgical correction. To date there are now many types of cervical deformity that have been classified and there exists a variety of surgical options. These recent advances have been developed in the last few years and the field continues to grow at a rapid rate. Thus, the goal of this article is to provide an updated review of cervical sagittal balance including; cervical alignment parameters, deformity classification, clinical evaluation, with both conservative and surgical treatment options.

scholarly journals Treatment of urethral strictures with balloon dilation: A forgotten tale

2015 ◽  
Vol 87 (3) ◽  
pp. 254
Author(s):  
Konstantinos Stamatiou ◽  
Georgios Christopoulos ◽  
Hippocrates Moschouris ◽  
Dimitrios Zavradinos ◽  
Michalis Kiltenis ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Treatment Options ◽  
Balloon Dilation ◽  
Health Condition ◽  
Internal Urethrotomy ◽  
Urethral Strictures ◽  
Urinary Infections ◽  
Therapeutic Outcomes ◽  
Urethral Trauma ◽  
Patient Health

Urethral stricture is a common condition that can lead to serious complications such as urinary infections and renal insufficiency secondary to urinary retention. Treatment options include catheterization and dilation, urethroplasty and endoscopic internal urethrotomy as well. Although treatment option depends on the type, length and aetiology of stricture, the choice can be influenced to varying degrees by the simplicity of the method, the preferences of the patient the available accoutrements and the patient health condition. Both urethroplasty and endoscopic internal urethrotomy require anaesthesia and thus are not suitable for many elder and unfit for surgical treatment patients. On the other hand, dilations are easy to perform in every day clinical practice however they have been associated with iatrogenic urethral trauma. In contrast, balloon dilation under vision dilates by radial application of forces against the stricture, avoiding the potentially shearing forces associated with sequential rigid dilation. Since it reduces the possibility of an iatrogenic urethral trauma and the subsequent spongiofibrosis may lead into improved therapeutic outcomes. In this report we describe a technique for the treatment of urethral strictures with balloon dilation in elder and unfit for surgical treatment patients.

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