RESUMO
BACKGROUND: The aim of this study was to describe the technique of subtrigonal sling with abdominal fascia and demonstrate its usefulness in resolving complex stress urinary incontinence (SUI). METHODS: We performed a cohort, longitudinal, observational study in adult females who attended the Urodynamics Department of the Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico City, with recurrent SUI or with risk factors for recurrence, whether or not associated with urge urinary incontinence (UUI). RESULTS: Between 1995 and 2006, 40 patients were included. Mean follow-up was 41.95 months (9-106), and the average patient age was 55 years. In 35 patients (87.5%) SUI was resolved, in two patients (5%) it improved, and in three patients (7.5%) it persisted. Of the 40 study patients, 18 had UUI and in only 7/18 patients (39%) was it resolved postoperatively. UUI de novo was noted in 12/40 patients (30%). One patient presented crural hernia, two patients presented postincisional hernia and two patients required blood transfusion. No patient presented acute urinary retention or urinary voiding problems postoperatively. CONCLUSIONS: Results obtained by this surgical technique are effective and long-lasting in patients with complex SUI. We did not observe bladder emptying dysfunction but there were formations of abdominal wall hernias. The minimally invasive approach consisting of the subtrigonal placement of synthetic tapes may maintain efficacy with minimal morbidity.
Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Adulto , Idoso , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Urológicos/métodosRESUMO
Objetivo: Describir la técnica de cabestrillo subtrigonal con fascia abdominal y demostrar su utilidad en la resolución de la incontinencia urinaria de esfuerzo compleja. Material y métodos: Estudio de cohorte longitudinal y observacional en mujeres adultas que acudieron al Servicio de Urodinamia, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, para tratamiento de incontinencia urinaria de esfuerzo recidivante o con factores de riesgo para recidiva, asociada o no a incontinencia urinaria de urgencia. Resultados: Entre 1995 y 2006 incluimos 40 pacientes; el seguimiento fue de 41.95 meses (rango 9 a 106) y el promedio de edad de 55 años. En 35 pacientes (87.5 %) fue resuelta la incontinencia urinaria de esfuerzo, dos pacientes mejoraron (5 %) y tres persistieron (7.5 %) con la incontinencia. De las 40 pacientes, 18 presentaban incontinencia urinaria de urgencia y solo en siete de éstas (39 %) se resolvió después de la cirugía. La incontinencia urinaria de urgencia de novo se presentó en 12 (30 %). Una tuvo hernia crural, dos hernia posincisional y dos requirieron transfusión sanguínea. Ninguna evidenció problemas de vaciamiento urinario posterior a la cirugía. Conclusiones: Los resultados con la técnica descrita son eficaces y duraderos en pacientes con incontinencia urinaria de esfuerzo recidivante o factores de riesgo para recidiva. No se observó disfunción de vaciamiento vesical, sin embargo, hubo hernias abdominales. El abordaje de mínima invasión para colocar las cintas sintéticas en posición subtrigonal podría mantener la eficacia con mínima morbilidad.
BACKGROUND: The aim of this study was to describe the technique of subtrigonal sling with abdominal fascia and demonstrate its usefulness in resolving complex stress urinary incontinence (SUI). METHODS: We performed a cohort, longitudinal, observational study in adult females who attended the Urodynamics Department of the Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico City, with recurrent SUI or with risk factors for recurrence, whether or not associated with urge urinary incontinence (UUI). RESULTS: Between 1995 and 2006, 40 patients were included. Mean follow-up was 41.95 months (9-106), and the average patient age was 55 years. In 35 patients (87.5%) SUI was resolved, in two patients (5%) it improved, and in three patients (7.5%) it persisted. Of the 40 study patients, 18 had UUI and in only 7/18 patients (39%) was it resolved postoperatively. UUI de novo was noted in 12/40 patients (30%). One patient presented crural hernia, two patients presented postincisional hernia and two patients required blood transfusion. No patient presented acute urinary retention or urinary voiding problems postoperatively. CONCLUSIONS: Results obtained by this surgical technique are effective and long-lasting in patients with complex SUI. We did not observe bladder emptying dysfunction but there were formations of abdominal wall hernias. The minimally invasive approach consisting of the subtrigonal placement of synthetic tapes may maintain efficacy with minimal morbidity.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Incontinência Urinária por Estresse/cirurgia , Slings Suburetrais , Estudos Longitudinais , Procedimentos Cirúrgicos Urológicos/métodosRESUMO
BACKGROUND: Prostatic cysts are rare lesions with a reported incidence from 1 to 7.9%. They have been associated with primary infertility. The main characteristic is the benign course and positive prognosis after correct surgical management. CLINICAL CASES: We present three clinical cases, two with primary infertility and another with a history of primary infertility who presented with recurrent hemospermia and refractory medical treatment. All patients had hypospermia and alteration of the seminal parameters represented by moderate oligospermia (MOS), asteno- and teratozoospermia, in addition to hemospermia in two patients. Diagnosis was confirmed by transrectal ultrasound. Transurethral resection (TUR) of the cyst was performed in two cases and resection of the veru montanum in one, obtaining improvement in the seminal parameters after 1 month of follow-up and acceptable parameters for spontaneous conception at 6 months. CONCLUSIONS: Infertility associated with partially obstructed ejaculatory ducts may be suspected clinically by hypospermia. Transrectal ultrasound is essential to confirm the diagnosis. TUR of this lesion reestablishes the free passage of semen in almost all patients, with potential recovery of fertility 6 months after treatment.
Assuntos
Cistos/complicações , Ductos Ejaculatórios/cirurgia , Hemospermia/etiologia , Infertilidade Masculina/etiologia , Oligospermia/etiologia , Doenças Prostáticas/complicações , Adulto , Cistos/congênito , Cistos/diagnóstico por imagem , Cistos/cirurgia , Ductos Ejaculatórios/diagnóstico por imagem , Feminino , Implante de Prótese de Valva Cardíaca , Humanos , Transplante de Rim , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Gravidez , Doenças Prostáticas/congênito , Doenças Prostáticas/diagnóstico por imagem , Doenças Prostáticas/cirurgia , Ressecção Transuretral da Próstata , Ultrassonografia , Ultrassom Focalizado Transretal de Alta Intensidade , Adulto JovemRESUMO
BACKGROUND: Prostatic cysts are rare lesions with a reported incidence from 1 to 7.9%. They have been associated with primary infertility. The main characteristic is the benign course and positive prognosis after correct surgical management. CLINICAL CASES: We present three clinical cases, two with primary infertility and another with a history of primary infertility who presented with recurrent hemospermia and refractory medical treatment. All patients had hypospermia and alteration of the seminal parameters represented by moderate oligospermia (MOS), asteno- and teratozoospermia, in addition to hemospermia in two patients. Diagnosis was confirmed by transrectal ultrasound. Transurethral resection (TUR) of the cyst was performed in two cases and resection of the veru montanum in one, obtaining improvement in the seminal parameters after 1 month of follow-up and acceptable parameters for spontaneous conception at 6 months. CONCLUSIONS: Infertility associated with partially obstructed ejaculatory ducts may be suspected clinically by hypospermia. Transrectal ultrasound is essential to confirm the diagnosis. TUR of this lesion reestablishes the free passage of semen in almost all patients, with potential recovery of fertility 6 months after treatment.
Assuntos
Humanos , Masculino , Feminino , Gravidez , Adulto Jovem , Pessoa de Meia-Idade , Cistos/complicações , Doenças Prostáticas/complicações , Ductos Ejaculatórios/cirurgia , Hemospermia/etiologia , Infertilidade Masculina/etiologia , Oligospermia/etiologia , Cistos/congênito , Cistos/cirurgia , Cistos , Doenças Prostáticas/congênito , Doenças Prostáticas/cirurgia , Doenças Prostáticas , Ductos Ejaculatórios , Implante de Prótese de Valva Cardíaca , Transplante de Rim , Complicações Pós-Operatórias , Ressecção Transuretral da Próstata , Ultrassom Focalizado Transretal de Alta IntensidadeRESUMO
OBJECTIVE: We undertook this study to determine the efficiency of ultrasound-guided transrectal prostate biopsy applying two techniques: systematic extended vs. suspicious sonographic areas. METHODS: Medical files and histopathological reports were reviewed of patients who were treated at the Specialties Hospital of the 21st Century Medical National Center in Mexico City with suspicion of prostate cancer (T1, T2 and PSA <10 ng/ml). Patients had ultrasound-guided transrectal prostate biopsy applying two techniques: systematic extended vs. hypoechoic suspicious sonographic areas. Studies were carried out from January 1, 2005 to July 2006. RESULTS: Of 145 selected patients submitted to ultrasound-guided transrectal prostate biopsy, systematic extended biopsy (group I) was carried out in 73 (50.3%), taking on average 11.75 cylinders per patient. In 72 (49.6%) patients, biopsies were taken on suspicious sonographic areas (group II), taking on average 4.02 cylinders. In group I, 36 (49.3%) patients were positive vs. group II, where 20 (27.7%) patients were positive (p <0.01) with an estimation of risk in favor of group I, determining a probability 2.5 times higher of positivity with this technique (95% confidence interval: range 1.2-5) and a better performance in 22%. CONCLUSIONS: Systematic extended ultrasound-guided transrectal prostate biopsy represents a technique with a higher rate of efficiency than using ultrasound-guided transrectal prostate biopsy in suspicious sonographic areas and has proven over time to be the superior prostate biopsy technique for diagnosis of prostate cancer. It must be considered the method of choice.
Assuntos
Biópsia por Agulha/métodos , Próstata/diagnóstico por imagem , Próstata/patologia , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estudos Transversais , Humanos , Masculino , Pessoa de Meia-Idade , Reto , Estudos Retrospectivos , UltrassonografiaRESUMO
OBJECTIVE: We undertook this study to determine the efficiency of ultrasound-guided transrectal prostate biopsy applying two techniques: systematic extended vs. suspicious sonographic areas. METHODS: Medical files and histopathological reports were reviewed of patients who were treated at the Specialties Hospital of the 21st Century Medical National Center in Mexico City with suspicion of prostate cancer (T1, T2 and PSA <10 ng/ml). Patients had ultrasound-guided transrectal prostate biopsy applying two techniques: systematic extended vs. hypoechoic suspicious sonographic areas. Studies were carried out from January 1, 2005 to July 2006. RESULTS: Of 145 selected patients submitted to ultrasound-guided transrectal prostate biopsy, systematic extended biopsy (group I) was carried out in 73 (50.3%), taking on average 11.75 cylinders per patient. In 72 (49.6%) patients, biopsies were taken on suspicious sonographic areas (group II), taking on average 4.02 cylinders. In group I, 36 (49.3%) patients were positive vs. group II, where 20 (27.7%) patients were positive (p <0.01) with an estimation of risk in favor of group I, determining a probability 2.5 times higher of positivity with this technique (95% confidence interval: range 1.2-5) and a better performance in 22%. CONCLUSIONS: Systematic extended ultrasound-guided transrectal prostate biopsy represents a technique with a higher rate of efficiency than using ultrasound-guided transrectal prostate biopsy in suspicious sonographic areas and has proven over time to be the superior prostate biopsy technique for diagnosis of prostate cancer. It must be considered the method of choice.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Biópsia por Agulha/métodos , Neoplasias da Próstata/patologia , Neoplasias da Próstata , Próstata/patologia , Próstata , Estudos de Coortes , Estudos Transversais , Reto , Estudos RetrospectivosRESUMO
We present three cases of abdominal actinomycosis in females, one presenting with an abdominal mass and the two others underwent emergency surgery because of acute abdomen with a diagnosis of complicated acute appendicitis. The first patient (age 36 years) presented with an abdominal mass in the left lower quadrant arising from the colon as observed by abdominal computed tomography (CT). The patient was brought to the operating room and tumoral resection was done. The second and third patients (37 years and 39 years, respectively) were brought to the emergency room because of acute abdominal pain with leucocytosis. Exploratory laparotomy was performed, finding in the second patient a bilateral ovarian abscess and uterine perforation. Hysterectomy and salpingo-oophorectomy were done. In the third patient, the findings were a sigmoid mass and a bilateral tubo-ovarian abscess and these organs were resected. Samples were sent for pathologic analysis. Microscopic analysis of the specimens sent revealed the presence of "sulfur granules," and a diagnosis of actinomycosis was made. Abdominal actinomycosis is a rare disease and preoperative diagnosis is uncommon. It is necessary to complete the full course of antibiotic therapy in order to completely eradicate the disease.