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Resumo O cateter vesical de longa permanência pode ser indicado em situações clínicas, como nas doenças crônicas do sistema genitourinário ou neurológico. Além dos riscos de infecção, traumas e sangramentos, a permanência do cateter pode afetar dimensões psicoemocionais e socioeconômicas. Objetivamos compreender como a necessidade de uso do cateter urinário por um longo prazo afeta a autopercepção, as interrelações e o autocuidado deste paciente. Realizamos um estudo qualitativo, descritivo, a partir da entrevista de 17 pacientes, e aplicamos a análise temática e o pensamento complexo. Os diferentes prognósticos e as expectativas em relação ao cateter influenciaram a autopercepção, a adaptação, sua aceitação ou negação. A presença do cateter, seja como medida curativa ou para conforto, pode afetar a autoimagem e a sexualidade, gerar inseguranças e incertezas, que requerem compreensão da multidimensionalidade das situações, que sofrem interferências do meio pessoal, familiar e social, bem como da capacidade dos sistemas de saúde para o seu enfrentamento. Apesar dos desafios, a maioria dos participantes relatou disposição favorável para o autocuidado, seja para viabilizar retirada do cateter, ou para prevenir agravos em indicações vitalícias.
Abstract A long-term indwelling catheter may be indicated in clinical situations, such as chronic diseases of the genitourinary or neurological systems. In addition to the risks of infection, trauma, and bleeding, a catheter's permanence can affect psycho-emotional and socioeconomic dimensions. We aimed to understand how the need to use a long-term indwelling catheter affects this patient's self-perception, interrelationships, and self-care. We carried out a qualitative, descriptive study based on interviews with 17 patients, and applied thematic analysis and complex thinking. The different prognoses and expectations regarding the catheter influenced self-perception, adaptation, acceptance, or denial. The presence of a catheter, whether as a curative measure or for comfort, can affect self-image and sexuality, and generate insecurities and uncertainties, which require understanding the multidimensionality of situations that suffer interference from the personal, family, and social environment, as well as health systems' capacity to deal with it. Despite the challenges, the majority of participants reported a favorable disposition towards self-care, whether to enable catheter removal or to prevent injuries in lifelong indications.
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OBJECTIVE: To describe the surgical technique and clinical outcome of small ruminants treated for obstructive urolithiasis using a modified tube cystostomy (MTC) technique. ANIMALS: 15 goats and 2 sheep treated with an MTC between March 2018 and February 2023. CLINICAL PRESENTATION: Animals were diagnosed with obstructive urolithiasis on the basis of history, physical examination, and ultrasonographic examination. An MTC was performed with sedation and a local block. Postoperative medical management was instituted to help reestablish urethral patency, and Foley catheters were removed after successful urination. RESULTS: Animals were hospitalized an average of 3 nights (range, 0 to 14 nights). Complications included urine spillage in the abdomen and accidental deflation of the Foley balloon. Six animals were euthanized due to poor prognosis or failure to regain urethral patency. Foley catheters were removed an average of 15.7 days postoperatively in animals that regained urethral patency. Long-term (> 1-month) follow-up was available for 8 animals, with an average postoperative survival time of 19.4 months (range, 1 to 58 months). Four animals were lost to long-term follow-up. CLINICAL RELEVANCE: This MTC technique is an effective means of catheterizing the urinary bladder in small ruminants. It can be performed under field conditions and serve as a standalone procedure for providing temporary urine egress. Patient size is limited by the length of the introducer, and an intact, distended urinary bladder and plan for reestablishing urethral patency are important considerations.
Assuntos
Doenças das Cabras , Obstrução Uretral , Cálculos Urinários , Urolitíase , Humanos , Ovinos , Animais , Cistostomia/veterinária , Cistostomia/métodos , Cálculos Urinários/veterinária , Cabras/cirurgia , Obstrução Uretral/cirurgia , Obstrução Uretral/veterinária , Doenças das Cabras/cirurgia , Urolitíase/cirurgia , Urolitíase/veterináriaRESUMO
RESUMO Introdução: A realização da cistostomia suprapúbica deve ser uma competência do médico urologista e cirurgião geral. O treinamento dessa competência por meio da simulação surge como alternativa segura, livre de riscos para pacientes e médicos residentes. Objetivo: Este estudo teve como objetivos criar um simulador realístico para o treinamento de cistostomia suprapúbica e obter sua validação de face e conteúdo. Método: O procedimento foi realizado no simulador por especialistas que posteriormente responderam a um questionário semiestruturado para a avaliação do realismo anatômico e a utilidade do simulador como ferramenta de ensino e treinamento. Resultado: Avaliaram o simulador 21 urologistas com idade média de 41,2 anos. O realismo anatômico teve nota média de 4,24 (nota máxima: 5), e a utilidade como ferramenta de ensino obteve média de 4,76 (nota máxima: 5). Conclusão: O simulador desenvolvido é, portanto, útil para o ensino prático de cistostomia por punção, pois foi validado em face e conteúdo, e, por isso, pode ser incorporado aos currículos da formação de médicos residentes, sobretudo em cirurgia geral e urologia.
ABSTRACT Introduction: Performing a suprapubic cystostomy should be a competence of the urologist and general surgeon. The training of this competence through simulation appears as a safe, risk-free alternative for patients and resident physicians. Objective: to create a realistic simulator for suprapubic cystostomy training and obtain its face and content validation. Method: the procedure was carried out in the simulator by experts who later responded to a semi-structured questionnaire to evaluate anatomical realism and the usefulness of the simulator as a teaching and training tool. Results: Twenty-one urologists with a mean age of 41.2 years evaluated the simulator. Anatomical realism had an average score of 4.24 (maximum score 5) and usefulness as a teaching tool obtained an average of 4.76 (maximum score 5). Conclusion: the developed simulator is, therefore, useful for the practical teaching of puncture cystostomy, it was validated in terms of face and content, and can be incorporated into the curricula for the training of resident physicians, especially in general surgery and urology.
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ABSTRACT Purpose The vesicostomy button has been shown to be a safe and effective bladder management strategy for short- or medium-term use when CIC cannot be instituted. This study reports our use with the vesicostomy button, highlighting the pros and cons of its use and complications. We then compared the quality or life in patients with vesicostomy button to those performing clean intermittent catheterization. Materials and Methods Retrospective chart review was conducted on children who had a vesicostomy button placed between 2011 and 2015. Placement was through existing vesicostomy, open or endoscopically. We then evaluated placement procedure and complications. A validated quality of life questionnaire was given to patients with vesicostomy button and to a matched cohort of patients performing clean intermittent catheterization. Results Thirteen children have had a vesicostomy button placed at our institution in the 4 year period, ages 7 months to 18 years. Indications for placement included neurogenic bladder (5), non-neurogenic neurogenic bladder (3), and valve bladders (5). Five out of 7 placed via existing vesicostomy had leakage around button. None of the endoscopically placed buttons had leakage. Complications were minor including UTI (3), wound infection (1), and button malfunction/leakage (3). QOL was equal and preserved in patients living with vesicostomy buttons when compared to CIC. Conclusion The vesicostomy button is an acceptable alternative to traditional vesicostomy and CIC. The morbidity of the button is quite low. Endoscopic insertion is the optimal technique. QOL is equivalent in patients with vesicostomy button and those who perform CIC.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Qualidade de Vida , Cistostomia/métodos , Fatores de Tempo , Bexiga Urinaria Neurogênica/cirurgia , Cistostomia/instrumentação , Inquéritos e Questionários , Reprodutibilidade dos Testes , Estudos Retrospectivos , Seguimentos , Resultado do Tratamento , Cateterismo Uretral Intermitente/métodosRESUMO
PURPOSE: The vesicostomy button has been shown to be a safe and effective bladder management strategy for short- or medium-term use when CIC cannot be instituted. This study reports our use with the vesicostomy button, highlighting the pros and cons of its use and complications. We then compared the quality or life in patients with vesicostomy button to those performing clean intermittent catheterization. MATERIALS AND METHODS: Retrospective chart review was conducted on children who had a vesicostomy button placed between 2011 and 2015. Placement was through existing vesicostomy, open or endoscopically. We then evaluated placement procedure and complications. A validated quality of life questionnaire was given to patients with vesicostomy button and to a matched cohort of patients performing clean intermittent catheterization. RESULTS: Thirteen children have had a vesicostomy button placed at our institution in the 4 year period, ages 7 months to 18 years. Indications for placement included neurogenic bladder (5), non-neurogenic neurogenic bladder (3), and valve bladders (5). Five out of 7 placed via existing vesicostomy had leakage around button. None of the endoscopically placed buttons had leakage. Complications were minor including UTI (3), wound infection (1), and button malfunction/leakage (3). QOL was equal and preserved in patients living with vesicostomy buttons when compared to CIC. CONCLUSION: The vesicostomy button is an acceptable alternative to traditional vesicostomy and CIC. The morbidity of the button is quite low. Endoscopic insertion is the optimal technique. QOL is equivalent in patients with vesicostomy button and those who perform CIC.
Assuntos
Cistostomia/métodos , Qualidade de Vida , Adolescente , Criança , Pré-Escolar , Cistostomia/instrumentação , Feminino , Seguimentos , Humanos , Lactente , Cateterismo Uretral Intermitente/métodos , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Bexiga Urinaria Neurogênica/cirurgiaRESUMO
Here, two papers are presented, which constitute the first reports of surgical procedures in Mexican children performed at the 19th century. The two publications refer to surgical operations for the extraction of bladder stones. At that time, there was no anesthesia, so part of the description alludes to the suffering of the patients and the operative difficulties. The first case, is referred to as a lithotomy in a 17-year-old girl, performed by surgeon José Victoriano Guerrero in Guadalajara in 1822. The publication is not an academic report, but a pamphlet written as a gift to Emperor Augustin I to celebrate his ascension to the throne. The second work, is a lateral lithotomy in a 5-year-old boy, published by Dr. Luis Jecker in the first issue of the Periódico de la Academia de Medicina de Mégico in 1836.
Se presentan dos trabajos que constituyen los primeros informes de procedimientos quirúrgicos en niños mexicanos en el siglo XIX. Las dos publicaciones se refieren a operaciones para la extracción de cálculos vesicales. En ese tiempo no existía anestesia, por lo que parte de la descripción incluye el sufrimiento de los pacientes y las dificultades operatorias. El primer caso está referido como una litotomía en una joven de 17 años, operada por el cirujano José Victoriano Guerrero en Guadalajara en 1822. La publicación no constituye un informe académico, sino un folleto escrito como un obsequio para el emperador Agustín I para celebrar su ascensión al trono. El segundo trabajo es una talla lateral en un niño de 5 años edad, publicado por el doctor Luis Jecker en el primer número del Periódico de la Academia de Medicina de Mégico en 1836.
Assuntos
Pediatria/história , Procedimentos Cirúrgicos Urológicos/história , Urologia/história , Criança , História do Século XIX , Humanos , México , Cálculos da Bexiga Urinária/história , Cálculos da Bexiga Urinária/cirurgiaRESUMO
OBJECTIVES: Minimally invasive paracentetic suprapubic cystostomy is a technique that should be learned by all surgical trainees and residents. This study aimed to develop a self-made training model for paracentetic suprapubic cystostomy and placement of the suprapubic catheter and then to evaluate its effectiveness in training fourth-year medical students. METHODS: Medical students were divided into an experimental group receiving comprehensive training involving literature, video, and model use and a control group receiving all the same training protocols as the experimental group except without hands-on practice using the model. Each student's performance was video-recorded, followed by subjective and objective evaluations by urology experts and statistical analysis. RESULTS: All students completed the surgical procedures successfully. The experimental group's performance scores were significantly higher than those of the control group (median final performance scores of 91.0 vs. 86.8, respectively). Excellent scores were achieved by more students in the experimental group than in the control group (55% vs. 20%), and fewer poor scores were observed in the experimental group than in the control group (5% vs. 30%). CONCLUSIONS: Based on its cost-effectiveness, reusability, and training effectiveness, this paracentetic suprapubic cystostomy training model is able to achieve goals in teaching practice quickly and easily. Use of the model should be encouraged for training senior medical students and resident physicians who may be expected to perform emergent suprapubic catheter insertion at some time.
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Humanos , Masculino , Feminino , Cistostomia/educação , Desenvolvimento de Programas/métodos , Avaliação Educacional , Treinamento por Simulação/métodos , Gravação em Vídeo/métodos , Cistostomia/instrumentação , Cistostomia/métodos , Cateterismo Urinário/instrumentação , Cateterismo Urinário/métodos , Distribuição Aleatória , Estudos Prospectivos , Análise Custo-Benefício , Paracentese/educação , Paracentese/instrumentação , Paracentese/métodos , Educação de Graduação em Medicina/métodosRESUMO
Supraventricular tachycardia is one of the tachyarrhythmias that do not have its origin in one organic cardiomyopathy. Generally, they have a good prognosis, and its clinical spectrum varies from asymptomatic patients to those with low cardiac output. Treatment will depend on the hemodynamic stability of the pa- tient. The objective of this case report is to make a review on existent literature about adverse cardiac effects with the use of Glycine in patients after urologic surgery.
La taquicardia supraventricular hace parte del grupo de taquiarritmias que no se originan de una cardiopatía orgánica existente y por lo general son de buen pronóstico. Su espectro clínico abarca desde pacientes asintomáticos hasta aquellos con signos de bajo gasto cardíaco que requerirán tratamiento según su estabilidad hemodinámica. El objetivo del presente reporte de caso es realizar una revisión de la literatura sobre los efectos adversos asociados a la irrigación vesical continúa con glicina en un paciente a quien se le realizó prostatectomía.
RESUMO
Here, two papers are presented, which constitute the first reports of surgical procedures in Mexican children performed at the 19th century. The two publications refer to surgical operations for the extraction of bladder stones. At that time, there was no anesthesia, so part of the description alludes to the suffering of the patients and the operative difficulties. The first case, is referred to as a lithotomy in a 17-year-old girl, performed by surgeon José Victoriano Guerrero in Guadalajara in 1822. The publication is not an academic report, but a pamphlet written as a gift to Emperor Augustin I to celebrate his ascension to the throne. The second work, is a lateral lithotomy in a 5-year-old boy, published by Dr. Luis Jecker in the first issue of the Periódico de la Academia de Medicina de Mégico in 1836.
Se presentan dos trabajos que constituyen los primeros informes de procedimientos quirúrgicos en niños mexicanos en el siglo XIX. Las dos publicaciones se refieren a operaciones para la extracción de cálculos vesicales. En ese tiempo no existía anestesia, por lo que parte de la descripción incluye el sufrimiento de los pacientes y las dificultades operatorias. El primer caso está referido como una litotomía en una joven de 17 años, operada por el cirujano José Victoriano Guerrero en Guadalajara en 1822. La publicación no constituye un informe académico, sino un folleto escrito como un obsequio para el emperador Agustín I para celebrar su ascensión al trono. El segundo trabajo es una talla lateral en un niño de 5 años edad, publicado por el doctor Luis Jecker en el primer número del Periódico de la Academia de Medicina de Mégico en 1836.
Assuntos
Cirurgia Geral/história , Pediatria/história , Adolescente , Autopsia/história , Pré-Escolar , Terapia Combinada , Feminino , França , História do Século XIX , Humanos , Masculino , México , Suíça , Cálculos Urinários/história , Cálculos Urinários/cirurgia , Cálculos Urinários/terapiaRESUMO
BACKGROUND: Appendicovesicostomy is commonly employed to facilitate drainage of urine through the catheter. Due to the tendency to less invasive procedures for the treatment of patients with neurogenic bladder, laparoscopy has been used as an alternative to open surgery, with the immediate advantages of postoperative recovery, shorter postoperative ileus, better cosmetic results, lower postoperative pain and early reintegration into everyday life. PURPOSE: Compare the results of laparoscopic procedure with open appendicovesicostomy. METHODS: We conducted an observational, analytical, longitudinal, ambispective cohort study, which included patients from 6-16 years of age diagnosed with neurogenic bladder, operated through laparoscopic and open appendicovesicostomy from January 2009 to June 2013. Information was obtained from clinical records. Six patients were operated laparoscopically and 14 by open approach. RESULTS: Surgical time was longer and statistically significant in the laparoscopic group with a median of 330 min (300-360 min) compared to open procedure of 255 min (180-360 min). Seven patients had complications in the open group and only one in the laparoscopic group. The difference in the dose of analgesics and time of use was statistically significant in favor of the laparoscopic group. The degree of urinary continence through the stoma was higher for laparoscopic (100%) compared to the open procedure (64%). CONCLUSIONS: In neurogenic bladder with urodynamic bladder capacity and leak point pressure bladder within acceptable values, laparoscopic appendicovesicostomy was a better alternative.
Antecedentes: la apendicovesicostomía suele practicarse para facilitar el drenaje de orina por medio del cateterismo. La tendencia a ofrecer procedimientos menos invasivos a pacientes con vejiga neurogénica ha hecho de la laparoscopia una alternativa a la cirugía abierta, por sus ventajas de recuperación, menor tiempo de íleo postoperatorio, mejor cosmética, menor dolor postquirúrgico y reintegración temprana a la vida cotidiana. Objetivo: comparar los resultados de la apendicovesicostomía laparoscópica con la abierta. Material y métodos: estudio de cohorte, observacional, analítico, longitudinal, ambispectivo, que incluyó pacientes de 6 a 16 años, con diagnóstico de vejiga neurogénica, intervenidos mediante laparoscopia y cirugía abierta entre enero de 2009 y junio 2013, recuperándose la información de los expedientes clínicos. Resultados: seis pacientes se operaron mediante laparoscopia y 14 con cirugía abierta. El tiempo quirúrgico fue mayor en el grupo intervenido mediante laparoscopia, con una mediana de 330 minutos (300-360), en comparación con el abierto de 255 minutos (180-360), diferencia estadísticamente significativa. Siete pacientes del grupo abierto tuvieron complicaciones y solo 1 del grupo laparoscópico. La diferencia en la dosis de analgésicos y en el tiempo de su consumo fue estadísticamente significativa a favor del grupo intervenido mediante laparoscopia. El grado de continencia urinaria por la derivación fue mayor para el procedimiento laparoscópico (100%) que para el abierto (64%). Conclusiones: la apendicovesicostomía laparoscópica resultó una mejor alternativa para pacientes con vejiga neurogénica con parámetros urodinámicos de capacidad vesical y presión de punto de fuga dentro de valores aceptables.
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Apêndice/cirurgia , Cateterismo Uretral Intermitente/métodos , Laparoscopia/métodos , Umbigo/cirurgia , Bexiga Urinaria Neurogênica/cirurgia , Bexiga Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Anormalidades Múltiplas , Adolescente , Analgésicos/uso terapêutico , Criança , Feminino , Humanos , Cateterismo Uretral Intermitente/instrumentação , Laparotomia/métodos , Tempo de Internação/estatística & dados numéricos , Meningomielocele , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Estudos Retrospectivos , Teratoma , Resultado do Tratamento , Bexiga Urinaria Neurogênica/complicaçõesRESUMO
This paper aims to disclose the technique of cystopexy through cystostomy with introduction of foley catheter in the treatment of chronic recurrent perineal hernia with bladder content. Recurrence of perineal hernia is still challenge for surgeons and techniques to prevent or treat this complication should be disseminated. Thus, the realization of cystopexy aims to minimize relapse cases of retroflexion of the organ, considered an emergency situation. In this clinical case, was obtained the cystopexy after conducting cystostomy and introduction of foley catheter through the abdominal wall in a dog with a history of chronic perineal hernia with bladder retroflexion and recurrence after hernia repair with perineal affixing of the pelvic diaphragm muscles. The probe was maintained for eight days to provide adhesion of the urinary bladder with the retroumbilical ventral abdominal wall, allowing satisfactory recovery of the patient. Although some similar techniques have been described, the application of this method was not found in the literature as an adjunct to correction of perineal hernia method.
Este trabalho tem o intuito de divulgar a técnica de cistopexia por meio de cistostomia com introdução de sonda de foley no tratamento de hérnia perineal crônica recidivante com conteúdo vesical. Recidivas da herniação perineal são ainda desafio ao cirurgião e técnicas que previnam ou tratem tal complicação devem ser difundidas. Deste modo, a realização da cistopexia tem por objetivo minimizar os casos de recidiva da retroflexão do órgão, situação considerada de urgência. No presente caso clínico, obteve-se a cistopexia após a realização de cistostomia e introdução de sonda de foley através da parede abdominal em cão com histórico de hérnia perineal crônica com retroflexão de bexiga e recidiva após herniorrafia perinal com aposição dos músculos do diafragma pélvico. A sonda foi mantida por oito dias proporcionando a adesão da vesícula urinária à parede abdominal retro-umbilical ventral, permitindo satisfatória recuperação do paciente. Embora algumas técnicas similares já tenham sido descritas, a aplicação do referido método não foi encontrado na literatura como método adjuvante à correção de hérnia perineal.
Assuntos
Masculino , Animais , Cães , Cistostomia/veterinária , Hérnia/veterinária , Períneo , Sonda de Prospecção , Herniorrafia/veterinária , Osso PúbicoRESUMO
This paper aims to disclose the technique of cystopexy through cystostomy with introduction of foley catheter in the treatment of chronic recurrent perineal hernia with bladder content. Recurrence of perineal hernia is still challenge for surgeons and techniques to prevent or treat this complication should be disseminated. Thus, the realization of cystopexy aims to minimize relapse cases of retroflexion of the organ, considered an emergency situation. In this clinical case, was obtained the cystopexy after conducting cystostomy and introduction of foley catheter through the abdominal wall in a dog with a history of chronic perineal hernia with bladder retroflexion and recurrence after hernia repair with perineal affixing of the pelvic diaphragm muscles. The probe was maintained for eight days to provide adhesion of the urinary bladder with the retroumbilical ventral abdominal wall, allowing satisfactory recovery of the patient. Although some similar techniques have been described, the application of this method was not found in the literature as an adjunct to correction of perineal hernia method.(AU)
Este trabalho tem o intuito de divulgar a técnica de cistopexia por meio de cistostomia com introdução de sonda de foley no tratamento de hérnia perineal crônica recidivante com conteúdo vesical. Recidivas da herniação perineal são ainda desafio ao cirurgião e técnicas que previnam ou tratem tal complicação devem ser difundidas. Deste modo, a realização da cistopexia tem por objetivo minimizar os casos de recidiva da retroflexão do órgão, situação considerada de urgência. No presente caso clínico, obteve-se a cistopexia após a realização de cistostomia e introdução de sonda de foley através da parede abdominal em cão com histórico de hérnia perineal crônica com retroflexão de bexiga e recidiva após herniorrafia perinal com aposição dos músculos do diafragma pélvico. A sonda foi mantida por oito dias proporcionando a adesão da vesícula urinária à parede abdominal retro-umbilical ventral, permitindo satisfatória recuperação do paciente. Embora algumas técnicas similares já tenham sido descritas, a aplicação do referido método não foi encontrado na literatura como método adjuvante à correção de hérnia perineal.(AU)
Assuntos
Animais , Masculino , Cães , Cistostomia/veterinária , Sonda de Prospecção , Hérnia/veterinária , Períneo , Osso Púbico , Herniorrafia/veterináriaRESUMO
Introduction: Hydatidosis is a neglected parasitic disease that is endemic in Chile. We present the clinical experience of a single center in Santiago from 1996 to 2010. Methods: Cases were identified using hospital's database. Clinical and pathological features, treatment and outcomes were retrospectively analyzed. Results: In total, 23 patients were identified requiring 30 surgical interventions. Median age was 40 years old (range 5 to 73), and 76.5% visited or resided in regions of known endemicity in Chile. Abdominal cysts were predominant (78.3%), and most patients were symptomatic (73.9%). Elimination of cyst material by cough was reported in 42.9% of patients with symptomatic thoracic cysts. Eosinophilia was present in 41.2% of patients, and 57.1% had positive serology for hydatidosis. Aill patients underwent surgical treatment, in 60.9% in combination with albendazole treatment. While the majority of liver cysts (88.9%) were treated by complete cyst resection, lung cysts (83.3%) were predominantly treated by cyst resection plus capitonnage. Pathological examination revealed fertile cysts in 24%. Postsurgical morbidity was frequent (37.9%), and 13.3% of the series required readmission for this cause. Near 25% of patients remained in hospital > 14 days, a feature associated with fever during admission (p < 0.05). No recurrence was reported in the fraction of patients that were followed-up for 2 years or more. Conclusions: Our analysis of 23 cases demonstrates that patients were mainly adults suffering from abdominal cysts. Most patients were successfully treated by surgery with or without antiparasitic drugs but complications leading to prolonged hospital stays and readmissions were not infrequent.
Introducción: La hidatidosis es una enfermedad endémica en Chile. Se presenta la experiencia clínica de un hospital en Santiago, desde 1996 al 2010. Métodos: Los casos fueron identificados usando las bases de datos institucionales y se analizaron las características clínicas y patológicas, el tratamiento y la evolución en forma retrospectiva. Resultados: Se identificaron 23 pacientes intervenidos en 30 oportunidades. La mediana de edad fue de 40 años (rango 5 a 73) y 76,5% visitó o residía en zonas endémicas en Chile. Los quistes abdominales fueron predominantes (78,3%) y la mayor parte de los pacientes eran sintomáticos (73,9%). Un 42,9% de aquellos con quistes sintomáticos torácicos reportó eliminación de vesículas con la tos. Un 41,2% presentó eosinofilia y 57,1% tuvo serología positiva para hidatidosis. Todos los pacientes fueron tratados quirúrgicamente, en 60,9% en combinación con albendazol. La mayoría de los quistes hepáticos fueron tratados con cirugía radical (88,9%) y los pulmonares predominantemente con quistostomía y capitonaje (83,3%). Un 24% de los quistes eran fértiles. La morbilidad post-quirúrgica fue frecuente (37,9%) y 13,3% de la serie requirió reingresos por esta causa. Cerca de 25% de los pacientes estuvo hospitalizado por más de 14 días, un fenómeno asociado con la presencia de fiebre por complicación séptica al ingreso (p < 0,05). No se registraron recurrencias en la fracción de pacientes seguidos por más de dos años. Conclusiones: La hidatidosis afecta principalmente a adultos en su cavidad abdominal. Aunque los pacientes fueron tratados exitosamente con cirugía, las complicaciones, estadías prolongadas y reingresos por esta causa no fueron infrecuentes.
Assuntos
Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Equinococose Hepática/diagnóstico , Equinococose Pulmonar/diagnóstico , Albendazol/uso terapêutico , Anti-Helmínticos/uso terapêutico , Chile , Terapia Combinada/métodos , Equinococose Hepática/tratamento farmacológico , Equinococose Hepática/cirurgia , Equinococose Pulmonar/tratamento farmacológico , Equinococose Pulmonar/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
Dentre as diferentes técnicas para a realização de prostatectomia radical, a obtida pelo acesso perinealé utilizada por mais de um século na medicina humana. Porém, esse acesso não é comumente utilizadoem cães com hérnia perineal. Esse relato apresenta um caso de prostatectomia radical perineal emcão com diagnóstico de hérnia perineal unilateral envolvendo vesícula urinária e próstata. A operaçãofoi realizada através de incisão sobre o aumento do volume, a partir da qual se realizou dissecçãode aderências, ligadura de vasos prostáticos e ressecção e anastomose vesicouretral com fi o de poliglactina910. A vesícula urinária foi reposicionadae a herniorrafi a obtida com tela de polipropileno.Procedeu-setambém cistostomia e orquiectomia. Não houve sinais de recidiva ou complicações doismeses após o procedimento, demonstrando a viabilidade da prostatectomia total via hérnia perinealem cães
Among all techniques for radical prostatectomy, the perineal access itsthe most common in medicine.However, this technique is not common for perineal hernia treatment in dogs. This case reportpresents a perineal prostatectomy in a dog with unilateral perineal hernia containing bladder andprostate. The procedure was made by an incision over the hernia, dissecting adherences, hemostasyof prostatic vessels, resection and vesicourethral anastomosis with poliglactine 910. The bladder wasrepositioned and the herniorraphy was made by polypropylene mesh application.Cystostomy followedby orchiectomy was made for vesical outfl ow maintenance. No signs of complications happenedafter two months of the procedure, showing that radical prostatectomy is viable by perineal hernia indogs
Assuntos
Animais , Cães , Cistostomia/métodos , Cistostomia/veterinária , Cães , Hérnia , Orquiectomia , Prostatectomia/métodos , Prostatectomia/veterináriaRESUMO
Dentre as diferentes técnicas para a realização de prostatectomia radical, a obtida pelo acesso perinealé utilizada por mais de um século na medicina humana. Porém, esse acesso não é comumente utilizadoem cães com hérnia perineal. Esse relato apresenta um caso de prostatectomia radical perineal emcão com diagnóstico de hérnia perineal unilateral envolvendo vesícula urinária e próstata. A operaçãofoi realizada através de incisão sobre o aumento do volume, a partir da qual se realizou dissecçãode aderências, ligadura de vasos prostáticos e ressecção e anastomose vesicouretral com fi o de poliglactina910. A vesícula urinária foi reposicionadae a herniorrafi a obtida com tela de polipropileno.Procedeu-setambém cistostomia e orquiectomia. Não houve sinais de recidiva ou complicações doismeses após o procedimento, demonstrando a viabilidade da prostatectomia total via hérnia perinealem cães(AU)
Among all techniques for radical prostatectomy, the perineal access itsthe most common in medicine.However, this technique is not common for perineal hernia treatment in dogs. This case reportpresents a perineal prostatectomy in a dog with unilateral perineal hernia containing bladder andprostate. The procedure was made by an incision over the hernia, dissecting adherences, hemostasyof prostatic vessels, resection and vesicourethral anastomosis with poliglactine 910. The bladder wasrepositioned and the herniorraphy was made by polypropylene mesh application.Cystostomy followedby orchiectomy was made for vesical outfl ow maintenance. No signs of complications happenedafter two months of the procedure, showing that radical prostatectomy is viable by perineal hernia indogs(AU)
Assuntos
Animais , Cães , Prostatectomia/métodos , Prostatectomia/veterinária , Cistostomia/métodos , Cistostomia/veterinária , Orquiectomia , Hérnia , CãesRESUMO
PURPOSE: Urodynamic studies in small animals can be performed through urethral sounding or cystostomy. OBJECTIVE: To compare the two methods of urodynamic evaluation in female rats. METHODS: Ten female rats weighing on average 250g, under anesthesia with urethane (1,25 mg/kg) were submitted in three repeats to an urethal catheter of 0,64 mm in external diameter for cystometric measurements of vesicle pressure(VP1) and contraction time (CT1). The catheter was extracted at a constant velocity of 0.05 cm/minute until complete exteriorization and determinations of maximal urethral pressure (UP1) and functional urethral length (FUL1). This was followed by a cystostomy with catheter PE50 and a new determination of the vesical pressure (VP2). After bladder denervation, a new cystometric record indirectly infered the maximum urethral closure pressure (UP2). The peak urethal pressure (UP3) and the functional urethral length (FUL2) were determined in another urethral sounding. The pressure registration system consisted of a continuous infusion pump regulated to a flow of 0.1 ml/minute connected both to the cystostomy catheter (PE-50) or the urethal catheter (0.64mm) and the polygraph Narco-Biosystem. Statistical analysis employed the Wilcoxon non-parametric test RESULTS: Mean VP1= 48,2 mmHg (11,8 SD); Mean VP2 = 38,2 mmHg (9,0 SD) "p" (VP1 X VP2) = 0,0039. Mean CT1=30,2 s (21,5 SD); Mean CT2=20,0 s(7 SD) p (CT1 X CT2) = 1,28. Mean UP1 = 47,2 mmHg (6,5 SD); Mean UP2 = 21,3 mmHg (6,6 SD), mean UP3 = 40,7 mmHg(13,3 SD) p (UP1 X UP2) = 0,002; "p" (UP1 X UP3) = 0,084; p (UP2 X UP3) = 0,002. Mean FUL1=14,2 mm (1,9 SD); Mean FUL2= 14,1mm (1,9 SD); p (FUL1 X FUL2) = 0,64. CONCLUSIONS: The methods employed to evaluate vesical and urethral pressures are different. The presence of the urethral catheter may be an obstructive factor. Surgical denervation up to the bladder neck level does not compromise urethral function.(AU)
INTRODUÇÃO: O estudo urodinâmico em ratas pode ser realizado através de sondagem vesical por via uretral ou por cistostomia. O objetivo deste estudo foi comparar estes dois métodos. MÉTODOS: Foram utilizadas 10 ratas da raça Wistar, peso médio de 250 gramas, anestesiadas com uretana (1,25 mg/kg). Inicialmente foi realizado estudo por sonda uretral (0,64 mm de diâmetro externo) para determinação da pressão vesical (PV1) e tempo de contração (TC1), após isto a sonda foi tracionada a velocidade constante (0,05 cm/m) até sua exteriorização pelo meato uretral, avaliando-se a pressão uretral máxima (PU1) e o comprimento funcional uretral (CFU1). Fez-se, então, a cistostomia (sonda PE50) para determinação da pressão vesical (PV2). A seguir, realizou-se desnervação cirúrgica da bexiga e realizou-se novo registro cistométrico para se inferir a pressão uretral indireta (PU2). Logo após, foi passada sonda uretral para determinação da pressão uretral máxima (PU3) e do comprimento funcional uretral (CFU2). O sistema de registro das pressões foi constituído de uma bomba de infusão contínua regulada para 0,1 ml/minuto conectada em Y com o cateter de cistostomia (PE-50) ou cateter uretral (0,64mm) a um polígrafo Narco-Bioystem. A análise estatística foi realizada através do método não paramétrico de Wilcoxon. RESULTADOS: Média PV1= 48,2 mmHg (11,8 SD); Média PV2 = 38,2 mmHg (9,0 SD). "p" (PV1 X PV2) = 0,0039. Média TC1=30,2 s (21,5 SD); Média TC2=20,0 (7 SD) p (TC1 X TC2) = 1,28. Média PU1 = 47,2 (6,5 SD); Média PU2 = 21,3 mmHg (6,6 SD), média PU3 = 40,7(13,3 SD) p (PU1 X PU2) = 0,002; "p" (PU1 X PU3) = 0,084; p (PU2 X PU3) = 0,002. Média CFU1=14,2 (1,9 SD); Média CFU2= 14,1 (1,9 SD); p (CFU1 X CFU2) = 0,64. CONCLUSÃO: Os métodos de avaliação urodinâmica são diferentes. A presença do cateter na uretra pode ser um fator obstrutivo. A desnervação cirúrgica, até o nível do colo vesical, não compromete a função uretral.(AU)
Assuntos
Animais , Feminino , Ratos , Cistostomia/normas , Uretra/fisiopatologia , Bexiga Urinária/fisiopatologia , Cateterismo Urinário/normas , Micção/fisiologia , Urodinâmica/fisiologia , Denervação , Modelos Animais de Doenças , Contração Muscular/fisiologia , Pressão , Ratos Wistar , Uretra/cirurgia , Bexiga Urinária/inervação , Bexiga Urinária/cirurgia , Cateterismo Urinário/métodosRESUMO
PURPOSE: Urodynamic studies in small animals can be performed through urethral sounding or cystostomy. OBJECTIVE: To compare the two methods of urodynamic evaluation in female rats. METHODS: Ten female rats weighing on average 250g, under anesthesia with urethane (1,25 mg/kg) were submitted in three repeats to an urethal catheter of 0,64 mm in external diameter for cystometric measurements of vesicle pressure(VP1) and contraction time (CT1). The catheter was extracted at a constant velocity of 0.05 cm/minute until complete exteriorization and determinations of maximal urethral pressure (UP1) and functional urethral length (FUL1). This was followed by a cystostomy with catheter PE50 and a new determination of the vesical pressure (VP2). After bladder denervation, a new cystometric record indirectly infered the maximum urethral closure pressure (UP2). The peak urethal pressure (UP3) and the functional urethral length (FUL2) were determined in another urethral sounding. The pressure registration system consisted of a continuous infusion pump regulated to a flow of 0.1 ml/minute connected both to the cystostomy catheter (PE-50) or the urethal catheter (0.64mm) and the polygraph Narco-Biosystem. Statistical analysis employed the Wilcoxon non-parametric test RESULTS: Mean VP1= 48,2 mmHg (11,8 SD); Mean VP2 = 38,2 mmHg (9,0 SD) "p" (VP1 X VP2) = 0,0039. Mean CT1=30,2 s (21,5 SD); Mean CT2=20,0 s(7 SD) p (CT1 X CT2) = 1,28. Mean UP1 = 47,2 mmHg (6,5 SD); Mean UP2 = 21,3 mmHg (6,6 SD), mean UP3 = 40,7 mmHg(13,3 SD) p (UP1 X UP2) = 0,002; "p" (UP1 X UP3) = 0,084; p (UP2 X UP3) = 0,002. Mean FUL1=14,2 mm (1,9 SD); Mean FUL2= 14,1mm (1,9 SD); p (FUL1 X FUL2) = 0,64. CONCLUSIONS: The methods employed to evaluate vesical and urethral pressures are different. The presence of the urethral catheter may be an obstructive factor. Surgical denervation up to the bladder neck level does not compromise urethral function.
INTRODUÇÃO: O estudo urodinâmico em ratas pode ser realizado através de sondagem vesical por via uretral ou por cistostomia. O objetivo deste estudo foi comparar estes dois métodos. MÉTODOS: Foram utilizadas 10 ratas da raça Wistar, peso médio de 250 gramas, anestesiadas com uretana (1,25 mg/kg). Inicialmente foi realizado estudo por sonda uretral (0,64 mm de diâmetro externo) para determinação da pressão vesical (PV1) e tempo de contração (TC1), após isto a sonda foi tracionada a velocidade constante (0,05 cm/m) até sua exteriorização pelo meato uretral, avaliando-se a pressão uretral máxima (PU1) e o comprimento funcional uretral (CFU1). Fez-se, então, a cistostomia (sonda PE50) para determinação da pressão vesical (PV2). A seguir, realizou-se desnervação cirúrgica da bexiga e realizou-se novo registro cistométrico para se inferir a pressão uretral indireta (PU2). Logo após, foi passada sonda uretral para determinação da pressão uretral máxima (PU3) e do comprimento funcional uretral (CFU2). O sistema de registro das pressões foi constituído de uma bomba de infusão contínua regulada para 0,1 ml/minuto conectada em Y com o cateter de cistostomia (PE-50) ou cateter uretral (0,64mm) a um polígrafo Narco-Bioystem. A análise estatística foi realizada através do método não paramétrico de Wilcoxon. RESULTADOS: Média PV1= 48,2 mmHg (11,8 SD); Média PV2 = 38,2 mmHg (9,0 SD). "p" (PV1 X PV2) = 0,0039. Média TC1=30,2 s (21,5 SD); Média TC2=20,0 (7 SD) p (TC1 X TC2) = 1,28. Média PU1 = 47,2 (6,5 SD); Média PU2 = 21,3 mmHg (6,6 SD), média PU3 = 40,7(13,3 SD) p (PU1 X PU2) = 0,002; "p" (PU1 X PU3) = 0,084; p (PU2 X PU3) = 0,002. Média CFU1=14,2 (1,9 SD); Média CFU2= 14,1 (1,9 SD); p (CFU1 X CFU2) = 0,64. CONCLUSÃO: Os métodos de avaliação urodinâmica são diferentes. A presença do cateter na uretra pode ser um fator obstrutivo. A desnervação cirúrgica, até o nível do colo vesical, não compromete a função uretral.