RESUMEN

INTRODUCTION: Antegrade continence enema (ACE) is recommended for patients with fecal incontinence/constipation refractory to conservative management. The Malone ACE utilizes the appendix as a catheterizable channel whereas the Macedo-Malone (MM) precludes the use of the appendix. We aimed to illustrate the MM procedure. METHODS: The left colon is brought out through a small transverse incision on the upper left abdomen and a 3-cm transverse flap in a tenia is created. A 12-Fr silicone Foley catheter is placed on the mucosal surface of the flap to allow creating a tubular conduit. After closure of the anterior wall colonic, the continence valve mechanism is produced by embedding the tube over a serous lined tunnel created by interrupted sutures. The distal portion of the tube is anastomosed into a V shape to the skin flap to avoid stoma stenosis. DISCUSSION: The advantage of this technique is the all-the time availability for not requiring the appendix which some authors prefer to use for urinary reconstruction. In a previous study, we have shown that the MM produces a high rate (89%) of fecal continence (Mean follow-up: 75 months). CONCLUSION: We are convinced that this procedure can be incorporated into fecal incontinence/constipation armamentarium.

Asunto(s)

Apéndice , Incontinencia Fecal , Apéndice/cirugía , Colon , Estreñimiento/cirugía , Enema/métodos , Incontinencia Fecal/cirugía , Humanos

RESUMEN

OBJECTIVE: To assess the reliability and validity of the Quality of Life Assessment in Spina Bifida (QUALAS), children and teenager's versions (QUALAS C and T, respectively). This is the first self-applicable quality of life assessment tool for patients under 13 years of age, which also addresses the issue of urinary and fecal incontinence. METHODS: Two urologists performed the translation of both QUALAS versions. A commission produced a consensus version (Version 2), which was applied as a pilot study to define Version 3. It was then backtranslated into English and compared with the original version for equivalence of concepts. Internal consistency with Cronbach's alpha and the intraclass correlation coefficient (ICC) reproducibility was analyzed after two assessments with an interval from two to four weeks. Convergent and divergent validities between the QUALAS and a generic health-related quality of life questionnaire, the KIDSCREEN-27, were studied through Pearson's correlation. RESULTS: The reliability analysis showed good internal consistency for QUALAS-C (α=0.73) and QUALAS-T (α=0.79) and good reproducibility in both questionnaires (QUALAS-C - ICC=0.86; QUALAS-T - ICC=0.92). For QUALAS-C convergent validity, there was a low correlation between its items (r=0.35). In addition, a low correlation was also found in the divergent validity analysis, when compared to the KIDSCREEN-27 (r≤0.33). Convergent and divergent validities of the QUALAS-T questionnaire had similar results: r=0.46 and r≤0.49, respectively. CONCLUSIONS: After the adaptation and validation process, QUALAS-C and QUALAS-T questionnaires showed to be reliable and valid instruments for measuring the health-related quality of life of children and teenagers with spina bifida aged 8 years or older.

Asunto(s)

Calidad de Vida , Disrafia Espinal/psicología , Encuestas y Cuestionarios/normas , Adolescente , Brasil , Niño , Incontinencia Fecal/etiología , Incontinencia Fecal/psicología , Femenino , Humanos , Masculino , Reproducibilidad de los Resultados , Disrafia Espinal/complicaciones , Traducciones , Incontinencia Urinaria/etiología , Incontinencia Urinaria/psicología

RESUMEN

ABSTRACT Objective: To assess the reliability and validity of the Quality of Life Assessment in Spina Bifida (QUALAS), children and teenager's versions (QUALAS C and T, respectively). This is the first self-applicable quality of life assessment tool for patients under 13 years of age, which also addresses the issue of urinary and fecal incontinence. Methods: Two urologists performed the translation of both QUALAS versions. A commission produced a consensus version (Version 2), which was applied as a pilot study to define Version 3. It was then backtranslated into English and compared with the original version for equivalence of concepts. Internal consistency with Cronbach's alpha and the intraclass correlation coefficient (ICC) reproducibility was analyzed after two assessments with an interval from two to four weeks. Convergent and divergent validities between the QUALAS and a generic health-related quality of life questionnaire, the KIDSCREEN-27, were studied through Pearson's correlation. Results: The reliability analysis showed good internal consistency for QUALAS-C (α=0.73) and QUALAS-T (α=0.79) and good reproducibility in both questionnaires (QUALAS-C - ICC=0.86; QUALAS-T - ICC=0.92). For QUALAS-C convergent validity, there was a low correlation between its items (r=0.35). In addition, a low correlation was also found in the divergent validity analysis, when compared to the KIDSCREEN-27 (r≤0.33). Convergent and divergent validities of the QUALAS-T questionnaire had similar results: r=0.46 and r≤0.49, respectively. Conclusions: After the adaptation and validation process, QUALAS-C and QUALAS-T questionnaires showed to be reliable and valid instruments for measuring the health-related quality of life of children and teenagers with spina bifida aged 8 years or older.

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RESUMO Objetivo: Avaliar a confiabilidade e a validade do questionário QUALAS (Quality of Life Assessment in Spina Bifida) nas versões para crianças e adolescentes (QUALAS-C e QUALAS-T, respectivamente). Este é o primeiro instrumento autoaplicável de avaliação da qualidade de vida para pacientes menores de 13 anos e que também aborda a questão das incontinências urinária e fecal. Métodos: Dois urologistas realizaram a tradução das duas versões do QUALAS. Uma comissão produziu uma versão de consenso (Versão 2), a qual foi aplicada no estudo piloto para definir a Versão 3. Esta foi retrotraduzida para o inglês e comparada à versão original para equivalência de conceitos. Para verificar a confiabilidade, analisou-se a consistência interna com o alfa de Cronbach e a reprodutibilidade com o coeficiente de correlação intraclasse (CCI) após duas aplicações do questionário em intervalo de duas a quatro semanas. As validades convergente e divergente foram estudadas por meio da correlação de Pearson entre o QUALAS e um questionário genérico de qualidade de vida relacionada à saúde, o KIDSCREEN-27. Resultados: A análise de confiabilidade revelou que ambos os questionários apresentaram boa consistência interna (QUALAS-C - α=0,73; QUALAS-T - α=0,79) e boa reprodutibilidade (QUALAS-C - CCI=0,86; QUALAS-T - CCI=0,92). Na análise da validade convergente do QUALAS-C, observou-se baixa correlação entre os itens (r=0,35). Além disso, a análise da validade divergente também demonstrou baixa correlação quando comparada ao KIDSCREEN-27 (r≤0,33). As validades convergente e divergente do questionário QUALAS-T tiveram resultados semelhantes: r=0,46 e r≤0,49, respectivamente. Conclusões: Após o processo de adaptação e validação, pode-se afirmar que os questionários QUALAS-C e QUALAS-T são instrumentos confiáveis e válidos para a mensuração da qualidade de vida relacionada à saúde de crianças e adolescentes com espinha bífida a partir dos 8 anos de idade.

Asunto(s)

Humanos , Masculino , Femenino , Niño , Adolescente , Calidad de Vida , Encuestas y Cuestionarios/normas , Disrafia Espinal/psicología , Traducciones , Incontinencia Urinaria/etiología , Incontinencia Urinaria/psicología , Brasil , Reproducibilidad de los Resultados , Disrafia Espinal/complicaciones , Incontinencia Fecal/etiología , Incontinencia Fecal/psicología

RESUMEN

Ochoa syndrome is rare and its major clinical problems frequently unrecognized. We describe facial characteristics of six patients to help health professional recognize the inverted smile that these patients present and refer them to proper treatment. Patients’ medical records were reviewed and patients’ urological status clinically reassessed. At last evaluation patients’ mean age was 15.5 years, and age ranged from 12 to 32 years. Mean follow-up was 35 months (12 to 60). Initial symptoms were urinary tract infections in four patients (67%) associated with enuresis and incontinence in three of them (50%). One patient had only urinary tract infection and two lower urinary tract symptoms without infections. Initial treatment consisted of clean intermittent catheterization with anticholinergics for all patients. Four patients (67%) were submitted to bladder augmentation. Two patients had end-stage renal disease during follow-up, one received kidney transplantation and one patient remained on the waiting list for a renal transplantation. Familial consanguinity was present in only one case. This significant condition is rare, but it must be recognized by pediatricians, nephrologists and urologists in order to institute early aggressive urological treatment.

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A síndrome de Ochoa é rara, e seus principais problemas clínicos são frequentemente não reconhecidos. Descrevem-se aqui características faciais de seis pacientes para auxiliar profissionais de saúde a reconhecer o sorriso invertido que eles apresentam e encaminhá-los para o tratamento adequado. Os prontuários médicos foram revisados e a condição urológica dos pacientes foi reavaliada clinicamente. A média de idade na última avaliação foi de 15,5 anos, variando de 12 a 32 anos. O seguimento médio foi de 35 meses (12 a 60). Os sintomas iniciais foram infecções do trato urinário em quatro pacientes (67%) associadas com enurese e incontinência urinária em três deles (50%). Um paciente apresentou infecções do trato urinário isoladamente e dois apresentaram sintomas do trato urinário inferior, porém sem infecções. O tratamento inicial consistiu em cateterismo intermitente limpo, com anticolinérgicos em todos os pacientes. Reconstrução urinária foi realizada em quatro pacientes (67%) por meio de ampliação vesical. Dois pacientes apresentaram doença renal em estágio terminal no seguimento, um recebeu transplante renal e outro manteve-se em lista de espera para transplante renal. Consanguinidade familiar esteve presente em apenas um caso. Essa condição significativa é rara, porém deve ser reconhecida por pediatras, nefrologistas e urologistas, a fim de instituir tratamento urológico agressivo precoce.

Asunto(s)

Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Cateterismo Uretral Intermitente/métodos , Infecciones Urinarias/complicaciones , Enfermedades Urológicas/diagnóstico , Antagonistas Colinérgicos/uso terapéutico , Facies , Estudios de Seguimiento , Trasplante de Riñón , Fotograbar , Estudios Retrospectivos , Sonrisa , Vejiga Urinaria Neurogénica/complicaciones , Vejiga Urinaria Neurogénica/diagnóstico , Vejiga Urinaria Neurogénica/terapia , Incontinencia Urinaria/complicaciones , Incontinencia Urinaria/terapia , Infecciones Urinarias/terapia , Enfermedades Urológicas/complicaciones , Enfermedades Urológicas/terapia

RESUMEN

Ochoa syndrome is rare and its major clinical problems frequently unrecognized. We describe facial characteristics of six patients to help health professional recognize the inverted smile that these patients present and refer them to proper treatment. Patients' medical records were reviewed and patients' urological status clinically reassessed. At last evaluation patients' mean age was 15.5 years, and age ranged from 12 to 32 years. Mean follow-up was 35 months (12 to 60). Initial symptoms were urinary tract infections in four patients (67%) associated with enuresis and incontinence in three of them (50%). One patient had only urinary tract infection and two lower urinary tract symptoms without infections. Initial treatment consisted of clean intermittent catheterization with anticholinergics for all patients. Four patients (67%) were submitted to bladder augmentation. Two patients had end-stage renal disease during follow-up, one received kidney transplantation and one patient remained on the waiting list for a renal transplantation. Familial consanguinity was present in only one case. This significant condition is rare, but it must be recognized by pediatricians, nephrologists and urologists in order to institute early aggressive urological treatment.

Asunto(s)

Cateterismo Uretral Intermitente/métodos , Infecciones Urinarias/complicaciones , Enfermedades Urológicas/diagnóstico , Adolescente , Adulto , Niño , Antagonistas Colinérgicos/uso terapéutico , Facies , Femenino , Estudios de Seguimiento , Humanos , Trasplante de Riñón , Masculino , Fotograbar , Estudios Retrospectivos , Sonrisa , Vejiga Urinaria Neurogénica/complicaciones , Vejiga Urinaria Neurogénica/diagnóstico , Vejiga Urinaria Neurogénica/terapia , Incontinencia Urinaria/complicaciones , Incontinencia Urinaria/terapia , Infecciones Urinarias/terapia , Enfermedades Urológicas/complicaciones , Enfermedades Urológicas/terapia

RESUMEN

We report on a 16-year-old male with paratesticular rhabdomyosarcoma who underwent retroperitoneal lymph node dissection due to a stage I tumor (normal retroperitoneal computed tomoghaphy). The surgical finding was three enlarged nodes, positive for metastatic disease. Patient was referred to adjuvant chemotherapy. This case suggests that the Intergroup Rhabdomyosarcoma Study Group IV protocol is subject to questions regarding adolescents with paratesticular rhabdomyosarcoma, and that negative retroperitoneal CT does not preclude the need of lymph node dissection.

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Apresentamos o caso de um adolescente de 16 anos com rabdomiossarcoma paratesticular, submetido à linfadenectomia retroperitonial por tumor clínico estágio I (tomografia computadorizada retroperitonial normal), cujo resultado cirúrgico demonstrou três linfonodos aumentados e positivos para doença metastática; o paciente foi encaminhado para tratamento quimioterápico adjuvante. Este caso sugere que o protocolo Intergroup Rhabdomyosarcoma Study Group IV é questionável para adolescentes com rabdomiossarcoma paratesticular, e que a tomografia computadorizada de abdome negativa para linfonodos não deve afastar a necessidade de linfadenectomia retroperitoneal.

Asunto(s)

Humanos , Masculino , Adolescente , Escisión del Ganglio Linfático/métodos , Rabdomiosarcoma , Neoplasias Testiculares , Tomografía Computarizada por Rayos X

RESUMEN

We report on a 16-year-old male with paratesticular rhabdomyosarcoma who underwent retroperitoneal lymph node dissection due to a stage I tumor (normal retroperitoneal computed tomoghaphy). The surgical finding was three enlarged nodes, positive for metastatic disease. Patient was referred to adjuvant chemotherapy. This case suggests that the Intergroup Rhabdomyosarcoma Study Group IV protocol is subject to questions regarding adolescents with paratesticular rhabdomyosarcoma, and that negative retroperitoneal CT does not preclude the need of lymph node dissection.

RESUMEN

PURPOSE: To translate and culturally adapt the Dysfunctional Voiding Symptom Score (DVSS), questionnaire into Brazilian Portuguese. MATERIALS AND METHODS: The 10-item Dysfunctional Voiding Symptom Score (DVSS) was translated into Brazilian Portuguese according to a standard methodology: translation, synthesis, back-translation, Expert Committee, and pre-testing. After the translation process the final version was pre-tested and patient responses were analyzed to identify necessary modifications. Reliability was evaluated using the test-retest method, and internal consistency was assessed using Cronbach’s alpha. RESULTS: The Cronbach’s alpha coefficient was calculated in the test and retest phases. Internal consistency was found to be satisfactory, as confirmed by a Cronbach’s alpha coefficient of 0.76 for the test and 0.77 for the retest. A high degree of stability was found in the test/retest, with an intraclass correlation coefficient (ICC) of 0.960 (p < 0.001; 95 percent CI: 0.943-0.972). CONCLUSION: The cross-cultural adaptation process of the Dysfunctional Voiding Symptom Score questionnaire to be used on Brazilian children was successfully completed following internationally accepted methodologies.

Asunto(s)

Femenino , Humanos , Masculino , Comparación Transcultural , Encuestas y Cuestionarios/normas , Vejiga Urinaria/fisiopatología , Incontinencia Urinaria/fisiopatología , Brasil , Lenguaje , Traducciones

RESUMEN

Purpose: To compare the efficacy and costs of circumcision versus topical treatment using a prospective pharmacoeconomic protocol. Materials and methods: We treated 59 patients (3-10 years of age) randomized into two groups: 29 underwent an 8-week course of topical treatment with 0.2 percent betamethasone-hyaluronidase cream twice a day; and 30 underwent circumcision. Topical treatment success was defined as complete exposure of the glans. In cases of treatment failure, circumcision was performed and its cost imputed to that of the initial treatment. The pharmacoeconomic aspects were defined according to the Brazilian National Public Health System database and the Brazilian Community Pharmacies Index. Results: The two groups were statistically similar for all clinical parameters evaluated. Topical treatment resulted in complete exposure of the glans in 52 percent of the patients. Topical treatment was associated with preputial pain and hyperemia. However, treatment suspension was unnecessary. Minor complications were observed in 16.6 percent of the surgical group patients. The mean cost per patient was US$ 53.70 and US$ 125.20, respectively, for topical steroid treatment (including the costs related to treatment failure) and circumcision. The total costs were US$ 2,825.32 and US$ 3,885.73 for topical treatment and circumcision, respectively. Conclusions: Topical treatment of phimosis can reduce costs by 27.3 percent in comparison with circumcision. Therefore, topical treatment of phimosis should be considered prior to the decision to perform surgery.

Asunto(s)

Niño , Preescolar , Humanos , Masculino , Betametasona/uso terapéutico , Circuncisión Masculina/métodos , Hialuronoglucosaminidasa/uso terapéutico , Fimosis/tratamiento farmacológico , Fimosis/cirugía , Administración Tópica , Betametasona/administración & dosificación , Análisis Costo-Beneficio , Circuncisión Masculina/economía , Hialuronoglucosaminidasa/administración & dosificación , Estudios Prospectivos , Fimosis/economía , Resultado del Tratamiento

RESUMEN

Purpose: To review our clinical experience with urinary continent catheterizable reservoir in children under five years of age. Materials and Methods: A total of 23 patients (16 males, 7 females) with a median age of 3.64 years were evaluated. Among these, 6 (26.08 percent) had a posterior urethral valve, 9 (39.13 percent) myelomeningocele, 4 (17.39 percent) bladder exstrophy, 2 (8.69 percent) genitourinary rabdomyosarcoma, 1 (4.34 percent) had spinal tumor and 1 (4.34 percent) an ano-rectal anomaly. Results: Perioperative complications were observed in four patients consisting of one febrile urinary tract infection, one partial operative wound dehiscence, one partial stomal dehiscence and one vesico-cutaneous fistula after a secondary exstrophy repair. The overall long-term complications rate was 40.90 percent and consisted of two stomal stenoses (9.09 percent), one neobladder mucosal extrusion (4.54 percent), three neobladder calculi (13.63 percent) and persistence of urinary incontinence in three patients (13.63 percent). The overall surgical revision was 36.36 percent and final continence rate was 95.45 percent with mean follow-up of 39.95 months Conclusion: Continent urinary diversion is technically feasible even in small children, with acceptable rates of complications.

Asunto(s)

Preescolar , Femenino , Humanos , Lactante , Masculino , Reservorios Urinarios Continentes , Derivación Urinaria/métodos , Estudios de Factibilidad , Estudios Retrospectivos , Resultado del Tratamiento , Derivación Urinaria/efectos adversos , Reservorios Urinarios Continentes/efectos adversos

RESUMEN

INTRODUCTION: The appendix is the gold-standard channel for the Mitrofanoff principle in pediatric urology, but the search for alternatives is justified considering it may not be available or preferably used for colonic stomas (Malone antegrade continence enema). The aim of this study is to report on technical feasibility of a new approach for creating catheterizable channels in a rabbit model and to present our preliminary clinical experience. MATERIAL AND METHODS: We configured a tube from two rectangular skin flaps 1x4 cm opposite each other in the middle line of the lower inferior abdomen. The channel was anastomosed to the bladder dome with embedding sutures to create a valvular mechanism. The experimental study consisted of 12 rabbits, divided in 4 groups according to the sacrifice schedule at 2, 4, 8 and 12 weeks. At 30th postoperative day, an urodynamic evaluation was performed to record continence of the stoma. A histological analysis of the specimens stained with hematoxylin-eosin, Masson trichrome and Picrosirius red was also done in group 2 (sacrifice at 4 weeks postoperatively). We used this method in 3 patients with congenital non-neurogenic bladder disease presenting with massive residual volumes without compliance deficits. RESULT: The technique proved feasible in all animals, 9 of 12 could be easily catheterized and underwent urodynamic study. No stoma leakage was observed in 7 animals at high bladder pressures (> 50 cm H20) and only 2 animals had some leakage at 40 cm H20. Urodynamics performed through the stoma showed urethral leakage at 20 cm H20, therefore demonstrating the efficacy of the valvular mechanism. Histological analysis confirmed good integration between the tube and the bladder. Mean follow-up of the clinical series (3 patients) was 7.2 months. Two patients remained continent up to 4 hours, whereas 1 patient had some leakage after 2 hours. CONCLUSION: We were able to confirm feasibility of a new extra-abdominal...

Asunto(s)

Animales , Niño , Humanos , Masculino , Conejos , Apéndice/cirugía , Cistostomía/métodos , Reservorios Urinarios Continentes , Enfermedades de la Vejiga Urinaria/cirugía , Anastomosis Quirúrgica , Estudios de Factibilidad , Estudios de Seguimiento , Modelos Animales , Presión , Técnicas de Sutura , Urodinámica , Incontinencia Urinaria/cirugía

RESUMEN

OBJECTIVE: To evaluate, in an experimental study in rabbits, a new model of neophalloplasty based on two lower abdominal skin flaps and ventral buccal mucosa graft for planned two-stage urethroplasty procedure. MATERIAL AND METHODS: Sixteen rabbits were operated and divided into four equal groups which were sacrificed at 2, 4, 8 and 12 weeks. The inflammatory pattern, presence of sub-epithelial fibrosis and epithelial changes in the grafted area were evaluated histologically. RESULTS: There were no deaths and no dehiscence of the wound was seen. One animal in the 2-week group developed an ulcer in the grafted area. We found minimal contracture of the neophallus, but this was not statistically significant between groups. Buccal mucosa graft showed good uptake in all groups, with vascular support from subcutaneous tissue of the flaps. The grafted area developed epithelial metaplasia, showing a decrease in cell layers with time, with disappearance of the sub-epithelial papillae and appearance of stratum granulosum and keratinization of the epithelial graft surface. A decrease in sub-epithelial fibrosis with replacement of immature by mature (eosinophilic) collagen was found. In the later groups was also observed an important decrease in inflammatory response, and the chorion of the grafted area presented a dilated capillary network, indicating that the process of neoangiogenesis was effective. CONCLUSION: Buccal mucosa displayed histological integration in the abdominal flaps with epithelial metaplasia in all groups. The surgical aspect of the neophallus was cosmetically acceptable, with minimal contracture.

Asunto(s)

Mucosa Bucal/trasplante , Pene/cirugía , Colgajos Quirúrgicos/irrigación sanguínea , Uretra/cirugía , Procedimientos Quirúrgicos Urológicos Masculinos/métodos , Animales , Biopsia , Supervivencia de Injerto , Masculino , Modelos Animales , Mucosa Bucal/citología , Neovascularización Fisiológica , Pene/anomalías , Conejos , Recto del Abdomen/cirugía , Colgajos Quirúrgicos/patología , Dehiscencia de la Herida Operatoria , Trasplante Autólogo , Uretra/citología

RESUMEN

PURPOSE: Buccal mucosa is a widely accepted tissue for urethroplasty. The exact healing and tissue integration process, mainly the histological characteristics of dorsal buccal mucosa graft urethroplasty when used dorsally to reconstruct the urethral plate has not previously been assessed, and thus we developed an experimental model to address this question. MATERIALS AND METHODS: In 12 New Zealand rabbits (weight 2.5 kg) we surgically created a dorsal penile urethral defect. A buccal mucosa graft was sutured to the corpora and tunica albuginea, and the ventral urethra anastomosed to this new urethral plate. The animals were divided in three groups and sacrificed 1, 3 and 6 weeks after surgery (groups 1, 2 and 3). A retrograde urethrogram was obtained at autopsy in the last group and the penis analyzed histologically with hematoxylin-eosin and Masson's staining. RESULTS: The urethrograms showed no evidence of fistula or stricture. In group 1 the histopathological analysis showed submucosal lymph-mononuclear inflammatory edema, numerous eosinophils and squamous epithelium integrated into the adjacent urothelium. In group 2 there was no evidence of an inflammatory response but rather complete subepithelial hyaline healing, which was more marked in group 3. CONCLUSION: Healing of buccal mucosa grafts to reconstruct the urethral plate can be achieved by total integration of the squamous epithelium with the urothelium, maintaining the original histological properties of the graft with no fibrosis or retraction.

Asunto(s)

Animales , Masculino , Conejos , Mucosa Bucal/trasplante , Uretra/cirugía , Estrechez Uretral/cirugía , Procedimientos Quirúrgicos Urológicos Masculinos/métodos , Cicatrización de Heridas/fisiología , Modelos Animales de Enfermedad , Células Epiteliales/patología , Pene/cirugía , Procedimientos de Cirugía Plástica , Colgajos Quirúrgicos , Factores de Tiempo , Uretra/patología

RESUMEN

INTRODUCTION: Nowadays, buccal mucosa grafts are the most successful method to reconstruct bulbar urethral strictures. Dorsal placement of the graft has been recently proposed, allowing the graft to be spread fixed on the tunica albuginea of the corporal bodies overlying the stricture. The dorsal graft is ingenious and represents a useful addition to the surgical armamentarium, since it offers a better chance for graft take than does the spongiosum when the urethra is diseased and poorly vascularized. We developed an additional reconstructive option using tunica vaginalis grafts, placed dorsally, for the treatment of anterior urethral strictures. SURGICAL TECHNIQUE: A total of 11 patients with anterior urethral strictures were treated with a tunica vaginalis graft urethroplasty. The surgical technique was done as described by Barbagli. The urethra was dissected from the corpora cavernosa and rotated 180 degrees. The dorsal urethral surface was exposed and fully opened. Both the distal and proximal lumina were calibrated. The tunica vaginalis graft was sutured, splayed and quilted over the corpora cavernosa using 6-0 PDS running stitches. The left side of the urethral mucosa was sutured to the graft using 6-0 PDS sutures. A 18F silicone Foley catheter was inserted at this point. The urethra was rotated back to its original position and sutured laterally to the right side of the graft. At the end of the procedure, the graft was completely covered by the urethra. With a follow-up ranging from 7 weeks to 5 months, all patients were voiding well (uroflowmetry > 14 mL per second). CONCLUSION: This initial experience in 11 patients indicates that tunica vaginalis dorsal graft urethroplasty may be considered within the reconstructive armamentarium of genitourinary surgeons.

Asunto(s)

Adulto , Anciano , Humanos , Masculino , Persona de Mediana Edad , Mucosa Bucal/trasplante , Colgajos Quirúrgicos , Membrana Serosa/trasplante , Uretra/cirugía , Estrechez Uretral/cirugía , Anastomosis Quirúrgica , Estudios de Seguimiento , Procedimientos Quirúrgicos Urológicos Masculinos/métodos

RESUMEN

OBJECTIVE: We developed an experimental ex-vivo model to define factors that may influence continence of catheterizable channels by urinary and colonic stomas based on the principle of imbrication of the outlet tube. MATERIALS AND METHODS: From 20 pigs, colon specimens with 25 cm length were obtained and a transverse flap with 3.0 cm length x 1.5 cm width in the average point of the intestine was tubulated to create an efferent tube. With the tube configured, it was embedded by 3 seromuscular stitches far 0.5 cm each other. A pressure study of both intra-luminal surface and channel was then conducted during the filling of the submerse piece with environmental air in a water container, to define the efferent channel continence. The study was repeated after the progressive release of suture stitches until only one stitch remains. RESULTS: Channel continence analyzed in each segment in three different valve length situations, making a total of 20 segments, revealed that with 3 stitches (1.5 cm valve) the maximum average pressure prior to overflow was 54 cm H2O; 53.65 cm H2O with 2 stitches (1.0 cm of valve), and 55.45 cm H2O with only one stitch (0.5 cm of valve), which are the same values. The record at the segment explosion pressure was 67.87 cm H2O. CONCLUSION: The study showed that angulation of channel with colon, maintained by only one stitch (0.5 cm imbrication) was more important than a larger extension of the valve, represented by 3 suture stitches (1.5 cm imbrication) in order to allow continence to the efferent channel.

Asunto(s)

Animales , Femenino , Masculino , Incontinencia Fecal/cirugía , Estomas Quirúrgicos , Reservorios Urinarios Continentes , Cateterismo Urinario/métodos , Colectomía , Modelos Animales , Porcinos

RESUMEN

OBJECTIVE: To evaluate the role of elective appendicovesicostomy in association with Monfort abdominoplasty to avoid urinary tract infection (UTI) and renal damage in the post-operative follow-up of patients with prune belly syndrome. MATERIALS AND METHODS: We followed 4 patients operated in our institution (UNIFESP) (Monfort, orchidopexy and Mitrofanoff) and compared them to 2 patients treated similarly, but without an appendicovesicostomy, in a second institution (UFBA). We evaluated postoperative clinical complications, UTI and preservation of renal parenchyma. Patients were followed as outpatients with urinalysis, ultrasonography (US) and occasionally with renal scintigraphy. RESULTS: Mean follow-up was 23.5 months. Immediate post-operative course was uneventful. We observed that only one patient with the Mitrofanoff channel persisted with UTI, while the 2 patients used as controls persisted with recurrent pyelonephritis (> 2 UTI year). CONCLUSION: Our data suggest that no morbidity was added by the appendicovesicostomy to immediate postoperative surgical recovery and that this procedure may have a beneficial effect in reducing postoperative UTI events and their consequences by reducing the postvoid residuals in the early abdominoplasty follow-up. However, we recognize that the series is small and only a longer follow-up with a larger number of patients will allow us to confirm our suppositions. We could not make any statistically significant assumptions regarding differences in renal preservation due to the same limitations.

Asunto(s)

Humanos , Masculino , Lactante , Preescolar , Niño , Adolescente , Músculos Abdominales/cirugía , Apendicectomía/métodos , Síndrome del Abdomen en Ciruela Pasa/cirugía , Derivación Urinaria/métodos , Satisfacción del Paciente , Complicaciones Posoperatorias , Procedimientos de Cirugía Plástica , Cateterismo Urinario , Infecciones Urinarias/prevención & control

RESUMEN

O importante tema da UTI em pediatria é revisto em todos os seus aspectos, com ênfase na elevada frequência, classificação, diagnóstico clínico, laboratorial e por exames de imagem, tratamento curativo e profilático. Os autores destacam, em especial, a importância do diagnóstico e da terapêutica precoces, visando garantir à criança melhor qualidade de vida.

Asunto(s)

Niño , Infecciones Urinarias

RESUMEN

OBJECTIVE: To assess the results of an upper pole nephrectomy technique on 5 children. MATERIALS AND METHODS: Upper pole nephrectomy was performed on 5 children, including 4 females and 1 male. Age ranged from 3 to 6 years old. The technique was performed without initial dissection of the renal pedicle. The upper pole is incised and removed. Upon its complete dissection, the segment that drains the upper pole is easily identified, clamped and sectioned. RESULTS: Three children with ureterocele and 2 with ectopic ureter underwent this procedure. There was no intra- or postoperative complication with this technique. DSMA scintigraphy showed no decrease in renal function in the remaining kidney following the procedure. CONCLUSION: The polar nephrectomy technique is simple, and has the advantage of not approaching the renal hilum, which makes surgery less laborious and prevents risk of renal damage, hemorrhage and decreased function in the remaining renal portion.

Asunto(s)

Niño , Preescolar , Femenino , Humanos , Masculino , Riñón/anomalías , Riñón/cirugía , Nefrectomía/métodos , Resultado del Tratamiento , Ureterocele/etiología

RESUMEN

Cake kidney is a rare congenital anomaly of the urogenital tract, with a few more than 20 cases described in the literature. It can be diagnosed at any age range. Normally, drainage is achieved by 2 ureters, and there are only 5 reports in the literature of cake kidney drained by a single ureter. The authors describe one more case of this rare malformation of the urinary tract.

Asunto(s)

Humanos , Lactante , Masculino , Riñón/anomalías , Uréter/anomalías , Obstrucción Ureteral/etiología , Infecciones Urinarias/etiología , Hidronefrosis/etiología , Hidronefrosis/terapia , Cálculos Renales/etiología , Cálculos Renales/cirugía , Riñón/cirugía , Riñón , Resultado del Tratamiento , Uréter/cirugía , Obstrucción Ureteral/cirugía

RESUMEN

A qualidade dos eletrodos do marcapasso determina a eficiência dos sistemas modernos de marcapasso. O eletrodo bipolar Merox para marcapasso (Biotronik, Alemanha) apresenta revestimento fractal nas áreas de superfície eletricamente ativas. Uma seção é dividida em quatro segmentos, que são partes da superfícies geométrica que cobre uma área de 1,3 milímetros ao quadrado (ponta). O propósito desse design é criar um equilíbrio entre contato tecidual e estabilidade, assim reduzindo a incidência de irritação tecidual intracardíaca e microdeslocamento. Este estudo clínico- Registro Merox_ envolve 160 eletrodos Merox por um período de seis meses. Além dos parâmetros elétricos usuais dos eletrodos(amplitude, limiar de estimulação e impedância), o levantamento de dados enfocará especialmente a avaliação do investigador sobre a manipulação no implante e o design do eletrodo, e também a obtençao de informações sobre possíveis complicações. Até o momento, já reunimos dados sobre o implante de 77 eletrodos Merox (15 canais atriais e 62 ventriculares); para 49 desses eletrodos; já temos dados incluindo o acompanhamento de 6 meses. As medições intra-operatórias forneceram os seguintes resultados para os eletrodos intraventriculares (V) e atriais (A)...

Asunto(s)

Humanos , Adolescente , Persona de Mediana Edad , Marcapaso Artificial , Electrodos , Factores de Tiempo