RESUMO

The introduction of foreign bodies in the urethra are uncommon. Given its rarity, the approach to this condition is not standardized but it is highlighted that minimally invasive procedures should be prioritized depending on its feasibility. In the present study, we report a case of a 60-year-old male patient with bipolar disorder and a foreign body impacted in the bulbar urethra with open surgical resolution after a failed endoscopic treatment. We perform an analysis into the diagnostic and therapeutic methods used, with postoperative results.

La introducción de cuerpos extraños uretrales es poco frecuente, razón por la cual, la mayoría de las publicaciones disponibles en la literatura son reportes de casos aislados o pequeñas series con gran heterogeneidad. Existen distintas aproximaciones frente a esta afección, desde métodos menos invasivos hasta cirugías abiertas más complejas. Presentamos un caso de cuerpo extraño impactado en uretra bulbar con el objetivo de analizar métodos diagnósticos empleados y aproximaciones terapéuticas concluyendo en la resolución quirúrgica convencional. Se evaluaron resultados postoperatorios.

Assuntos

RESUMO

Abstract The introduction of foreign bodies in the urethra are uncommon. Given its rarity, the approach to this condition is not standardized but it is highlighted that minimally invasive procedures should be prioritized depending on its feasibility. In the present study, we report a case of a 60-year-old male patient with bipolar disorder and a foreign body impacted in the bulbar urethra with open surgical resolution after a failed endoscopic treatment. We perform an analysis into the diagnostic and therapeutic methods used, with postopera tive results.

Resumen La introducción de cuerpos extraños uretrales es poco frecuente, razón por la cual, la mayoría de las publicaciones disponibles en la literatura son reportes de casos aislados o pequeñas series con gran heteroge neidad. Existen distintas aproximaciones frente a esta afección, desde métodos menos invasivos hasta cirugías abiertas más complejas. Presentamos un caso de cuerpo extraño impactado en uretra bulbar con el objetivo de analizar métodos diagnósticos empleados y aproximaciones terapéuticas concluyendo en la resolución quirúrgica convencional. Se evaluaron resultados postoperatorios.

RESUMO

Introduction: Ejaculatory dysfunction is a common complication of surgeries for benign prostatic obstruction. It causes a clear deterioration in quality of life. Techniques have been developed to attempt to preserve antegrade ejaculation (AE). Our objective was to analyze results of ejaculatory function using an AE preservation technique during anatomical vaporization with XPS 180-W. Methods: Between 2017 and 2019, sexually active patients were treated using this technique by the same surgical team. A questionnaire (MSHQ-EjD Short Form) was mailed, patients who did not answer were contacted by phone or personally during follow-up. Responses were analyzed. Voiding function was evaluated using International Prostatic Symptoms Score (IPSS), Qmax, and postvoid residual volume. t-Test for paired samples was used to compare conformity of patients with and without AE and voiding results. A p < 0.05 was considered statistically significant. Results: In total, 77 of 112 patients (68.8%) completed questionnaires and were included. Mean age was 64.1 years (standard deviation [SD] 6.9) and median prostate size was 57.2 g (interquartilic range 30-85). A total of 68 of 77 (88.3%) patients reported AE. Of these, 58 (85.3%) reported AE always or most of the time and 10 (14.7%) reported AE half of the time. In total, 42 (61.7%) patients had preserved strength or slightly less than before the procedure, and 33 (48.5%) reported the same or slightly less volume than before. In terms of satisfaction, the average response values of patients with preserved AE and ejaculatory disfunction were 0.97 (SD 1.12) and 2.7 (SD 1.78), respectively (p = 0.000). Pre- and postoperative variables were as follows: mean Qmax was 11.6 mL/sec vs 19.6 (p = 0.00), mean IPSS was 13.8 vs 8.9 (p = 0.000), and mean postvoiding residual urine was 125.3 vs 33.1 mL (p = 0.00), respectively. Conclusion: It is feasible to perform the AE preservation technique with anatomical vaporization XPS 180-W. In our medium size prostate series, we had a satisfactory patient perception of the ejaculatory function and satisfactory voiding function results.

Assuntos

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OBJECTIVE: To determine if individual, instead of group, patient progression risk could be predicted using p53, Ki67 and CK20 biomarker percentage values at initial transurethral resection of bladder tumor specimens. METHODS: This was an observational study where biomarkers were measured with no knowledge of tumor outcome. Initial bladder tumor specimens were classified as non-invasive and invasive to sub-epithelium (pT1). Percentages of stained biomarker cells were tested as progression predictors from non-invasive to pT1 and pT1 to pT2. Progression probability was correlated with biomarker percentages resulting in a regression equation. RESULTS: We studied 112 patients (median age = 67, range 37-91, males 83/112 (73%), with median follow-up of 39 months (range 1.7-140). Mean biomarker values were higher in stage pT1 than in non-invasive (all p < 0.001). Cut-off points separating progression from non-progression groups in stage pT1 were higher than in non-invasive for all biomarkers. Correlation R values for progression probability vs. biomarker percentages varied from 0.7 to 0.9 (all p < 0.001), regression slopes from 0.1 to 0.8 and intercepts from 11 to 35. A novel individual progression probability was calculated as the product of biomarker percentage of stained cells and slope, plus the prevalence-adjusted intercept. CONCLUSIONS: Identification of individual risk of progression in patients with non-muscle-invasive bladder tumors was possible using p53- and Ki67-derived progression probability using a regression equation. Combining biomarker-derived progression probability to tumor stage pT1 improves progression to pT2 predictive accuracy.

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OBJECTIVE: To report our initial experience in 3 cases of laparoscopic partial nephrectomy with selective parenchymal clamping using a novel laparoscopic clamp. METHODS: A total of 3 laparoscopic partial nephrectomies were performed using the Simon clamp (Aesculap). Mean patient age was 67 years (range 60 to 74 years), two patients were males. All patients had an ASA score of 2. Mean tumor size was 2.2 cm (range 2 to 2.4 cm) and all tumors were of the lower pole. Two tumors were on the right kidney and one on the left kidney. RESULTS: Mean operative time was 100 minutes (range 70 to 120 min). Mean operative bleeding was 16 ml (range 0 to 50 ml). Mean warm ischemia time of the renal pole was 33 minutes (range 30 to 40 min). All patients were discharged on postoperative day 2. There was no intra or postoperative complications. Surgical margins were negative in all cases. CONCLUSION: The Simon clamp allows for tumor resection without bleeding and for renal defect repair without collateral renal injury. We hope that in the future the development of other instruments will allow for selective clamping in any tumor location.

Assuntos

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OBJECTIVE: To report a case of laparoscopic radical cystectomy and pelvic lymphadenectomy with vaginal extraction of the surgical specimen in an elderly patient with muscle invasive bladder tumor. METHOD: A 78 year old patient with history of hematuria was diagnosed of muscle invasive bladder cancer. Laparoscopic radical cystectomy and pelvic lymphadenectomy with vaginal extraction of the surgical specimen was performed without incident. RESULTS: Operative time was 240 minutes, surgical bleeding was 200 ml and hospital stay 8 days. The patient evolved uneventfully and remains disease free after 9 months of follow-up. CONCLUSION: Laparoscopic radical cystectomy provides adequate oncologic results with decreased morbidity, making this surgery an attractive alternative for the management of patients in a delicate condition.

Assuntos