Sexual (Dys)function after Urethroplasty

There is a paucity of published literature on the andrological consequences of urethral repair. Until recently authors have focused mainly on technical aspects and objective results. Reported outcomes of urethral reconstruction surgery have traditionally focused only on urodynamic parameters such as flow rates. Patient reported outcome measures have largely been neglected and there is a scarcity of well conducted systematic studies on the subject. For these reasons whether the different components of sexual life are more or less affected by different types of urethral reconstruction remains largely unknown. In an attempt to clarify the available scientific evidence, the authors make a critical review of available literature, systematizing it by sexual domain and study type. Brief pathophysiological correlations are discussed

Sexual (Dys)function after Urethroplasty

There is a paucity of published literature on the andrological consequences of urethral repair. Until recently authors have focused mainly on technical aspects and objective results. Reported outcomes of urethral reconstruction surgery have traditionally focused only on urodynamic parameters such as flow rates. Patient reported outcome measures have largely been neglected and there is a scarcity of well conducted systematic studies on the subject. For these reasons whether the different components of sexual life are more or less affected by different types of urethral reconstruction remains largely unknown. In an attempt to clarify the available scientific evidence, the authors make a critical review of available literature, systematizing it by sexual domain and study type. Brief pathophysiological correlations are discussed

Calyceal migration of vascular embolization coils used to treat massive hemorrhage following percutaneous nephrolithotomy: an endoscopic finding during repeat percutaneous nephrolithotomy

info:eu-repo/semantics/publishedVersio

Microsurgical vasovasostomy: our experience

To describe the initial experience of CHVNG/E in microsurgical vasovasostomy. The two‐layer technique was applied under microscope magnification in every patient by the same surgeon. 8 bilateral vasovasostomies were performed for vasectomy reversal between 2008 and 2014 at our unit. All the patients were available for follow‐up, with a mean follow‐up time of 6 months. Mean patient age was 38.8 ± 8.7 years and the interval between vasectomy and recanalization of 6 ± 1.5 years. Overall spermatozoid patency rate was 100%, with mobile spermatozoa in the ejaculate of all patients (median 12 x 106 /mL, interquartile interval [7 x 106 /mL‐21 x 106 /mL]). Four of the 8 patients fathered after the procedure. Our results were comparable to the ones described in the literature, confirming the performance of a good surgical technique. Microsurgical vasovasostomy constitutes a very safe method of vasectomy reversal, enabling couples to obtain pregnancies without additional medical treatment. To our knowledge, this is the first group of patients treated by this method in Portugal

Tratamento de Fístulas Uro-Rectais Iatrogénicas em Tumores Pélvicos no Homem: Um Estudo Nacional Multi-Institucional

Introduction: Urorectal fistulas (URF) are a devastating complication of pelvic tumor treatment and a significant surgical challenge. Despite its increasing incidence associated with an increasing use of different forms of non-surgical treatment of pelvic tumours, urorectal fistula remains rare. Given the improbability of spontaneous closure, surgical correction becomes necessary in almost all cases. Despite the existence of various surgical techniques, rates of failure / recurrence are usually high, particularly in radiation fistulas. In this study the authors describe their experience in the treatment of URF resulting from pelvic tumor treatment. Methods: Between October 2008 and February 2015, 12 male patients were identified with URF treated in our institutions. A review of medical records of patients, including age, symptoms, comorbidity, diagnostic approach, type and fistula etiology, type of surgical reconstruction, follow-up and results was performed. Non-neoplastic / inflammatory fistula patients were excluded from the study. Results: We identified and treated 12 patients. One patient with fistula secondary to anterior resection of the rectum developed lymph node and liver metastases 4 months after the diagnosis of urorectal fistula and was consequently excluded from surgical treatment and study. The mean age of patients was 68 years (53-78). Nine patients developed URF after prostate cancer therapy: Two after low-dose brachytherapy combined with external beam radiation therapy; five after retropubic radical prostatectomy, with adjuvant radiation therapy in one; one after low-dose brachytherapy followed by transurethral resection of prostate; and one after high intensity focal ultrasound and radiation therapy. In two patients, the fistula resulted from surgical treatment of rectal carcinoma, associated with radiation therapy in one of them. In all patients with fecal and urinary diversion was performed by means of colostomy and suprapubic catheterization or urethral catheterization during the waiting period for surgical reconstruction. No spontaneous closure of URF occurred in any patient. Eleven patients underwent surgical reconstruction. Perineal approach was exclusively used in seven patients. In four patients, an abdominoperineal approach was employed. Effective fistula closure was reported in six patients after the first surgical attempt. Two patients required a second surgery, while one patient required three surgical procedures to achieve a successful result. Surgical failure occurred in two patients, which at present do not wish any additional reconstructive attempt. These two patients and one patient, in whom the reconstruction was effective, yet remain with colostomy. The mean follow-up was 25.5 months (3-75). Conclusion: URF are an uncommon but serious complication of treatment of pelvic tumors, usually associated with debilitating morbidity and loss of quality of life. Although a surgical reconstruction can be extremely difficult, in most cases it is possible to have a successful outcome by either a perineal or abdominoperineal approach and the use of interposing tissue when indicated.Introdução: As fístulas uro-rectais (FUR) constituem uma complicação devastadora do tratamento de tumores pélvicos e um desafio cirúrgico para o cirurgião reconstrutivo. Contudo, apesar da sua crescente incidência associada a uma utilização cada vez mais frequente das diferentes modalidades não-cirúrgicas, especialmente de radioterapia, com ou sem cirurgia, para o tratamento de tumores pélvicos, a fístula urorectal permanece relativamente rara. Dada a elevada improbabilidade do encerramento espontâneo da fístula uro-rectal, a correcção cirúrgica torna-se necessária na quase totalidade dos casos. Apesar da existência de várias técnicas cirúrgicas, as taxas de falência/recorrência são habitualmente elevadas, particularmente em fístulas rádicas. Descrevemos neste estudo a nossa experiência limitada no tratamento de fístulas urorectais resultantes de tratamentos de tumores pélvicos (aparelho urinário inferior e recto). Métodos: Entre Outubro de 2008 e Fevereiro de 2015, foram identificados 12 pacientes do sexo masculino com fístula urorectal e tratados nas nossas instituições. Foi efectuada revisão dos processos clínicos dos pacientes, incluindo a idade, sintomas, presença de comorbilidades, marcha diagnóstica, tipo e etiologia da fístula, tipo de reconstrução cirúrgica, follow-up e resultados. Foram excluídos do estudo todos os pacientes com fístula não-neoplásica/inflamatória. Resultados: Foram identificados e tratados 12 pacientes nas nossas instituições. Um dos pacientes, após ressecção anterior do recto, desenvolveu metástases ganglionares e hepáticas 4 meses após o diagnóstico da fístula urorectal, durante tratamento médico/antibiótico de abcesso pélvico e sua resolução após drenagem e, consequentemente, foi excluído do tratamento cirúrgico e do estudo. A idade média dos doentes era de 68 anos (53 – 78). Nove pacientes desenvolveram fístula uro-rectal após terapêutica de carcinoma da próstata): Dois após braquiterapia de baixa dosagem combinada com radioterapia externa; cinco após prostatectomia radical retropúbica (PRR), com radioterapia externa adjuvante em um; um após braquiterapia de baixa dosagem seguida de ressecção transuretral por obstrução prostática; e um após ultra-som focalizado de alta intensidade e radioterapia externa. Em dois pacientes, a fístula resultou de tratamento cirúrgico de carcinoma rectal, associado a radioterapia externa em um deles. Foi efectuada em todos os pacientes derivação fecal com colostomia e derivação urinária, ou com cateterização suprapúbica, ou com cateterização uretral durante o período de espera para a reconstrução cirúrgica. Não houve encerramento espontâneo de fístula urorectal em nenhum paciente. Onze pacientes foram submetidos a reconstrução cirúrgica. Foi utilizada abordagem exclusivamente perineal em sete doentes e abdominoperineal em quatro. Obteve-se encerramento eficaz da fístula em seis pacientes à primeira tentativa cirúrgica, dois doentes necessitaram uma segunda tentativa, enquanto que em um doente foram necessárias três tentativas cirúrgicas (duas delas em outras instituições) de forma a atingir um resultado com sucesso. Ocorreu falência cirúrgica em dois doentes, os quais, actualmente, não desejam qualquer tentativa reconstrutiva adicional. Estes dois doentes e um doente, em quem a reconstrução foi eficaz, permanecem ainda com colostomia. O tempo médio de follow-up foi de 25,5 meses (3-75). Conclusão: As fístulas uro-rectais são uma complicação pouco frequente, mas devastadora, do tratamento dos tumores pélvicos, habitualmente associada com morbilidade debilitante e degradação da qualidade de vida. Embora a sua reconstrução cirúrgica possa ser extremamente difícil, ela é possível com sucesso na maioria dos casos através de uma abordagem perineal ou abdominoperineal agressiva e interposição de tecidos, quando indicada

Factor XIII-guided treatment algorithm reduces blood transfusion in burn surgery

Background and objectives: Major burn surgery causes large hemorrhage and coagulation dysfunction. Treatment algorithms guided by ROTEM® and factor VIIa reduce the need for blood products, but there is no evidence regarding factor XIII. Factor XIII deficiency changes clot stability and decreases wound healing. This study evaluates the efficacy and safety of factor XIII correction and its repercussion on transfusion requirements in burn surgery. Methods: Randomized retrospective study with 40 patients undergoing surgery at the Burn Unit, allocated into Group A those with factor XIII assessment (n = 20), and Group B, those without assessment (n = 20). Erythrocyte transfusion was guided by a hemoglobin trigger of 10 g.dL−1 and the other blood products by routine coagulation and ROTEM® tests. Analysis of blood product consumption included units of erythrocytes, fresh frozen plasma, platelets, and fibrinogen. The coagulation biomarker analysis compared the pre- and post-operative values. Results and conclusions: Group A (with factor XIII study) and Group B had identical total body surface area burned. All patients in Group A had a preoperative factor XIII deficiency, whose correction significantly reduced units of erythrocyte concentrate transfusion (1.95 vs. 4.05, p = 0.001). Pre- and post-operative coagulation biomarkers were similar between groups, revealing that routine coagulation tests did not identify factor XIII deficiency. There were no recorded thromboembolic events. Correction of factor XIII deficiency in burn surgery proved to be safe and effective for reducing perioperative transfusion of erythrocyte units. Resumo: Justificativa e objetivos: A cirurgia no grande queimado causa hemorragia de grande porte e disfunção da coagulação. Os algoritmos de tratamento guiados por ROTEM® e fator VIIa reduzem as necessidades de hemoderivados, mas falta evidência em relação ao fator XIII. A deficiência do fator XIII altera a estabilidade do coágulo e diminui a cicatrização. Este estudo avalia a eficácia e a segurança da correção do fator XIII e sua repercussão nas necessidades transfusionais na cirurgia do queimado. Métodos: Estudo retrospectivo randomizado de 40 doentes submetidos à cirurgia na Unidade de Queimados alocados em grupo A com estudo do fator XIII (n = 20) e grupo B sem estudo (n = 20). A transfusão eritrocitária foi guiada por gatilho de hemoglobina de 10 g.dL−1 e os outros hemoderivados por testes de coagulação de rotina e ROTEM®. A análise do consumo de hemoderivados incluiu unidades de eritrócitos, plasma fresco congelado, plaquetas e fibrinogênio. A análise dos biomarcadores da coagulação comparou os valores pré e pós-operatórios. Resultados e conclusões: O grupo A (com estudo de fator XIII) e o grupo B apresentaram área de superfície corporal total queimada idêntica. Todos os doentes do grupo A revelaram déficit pré-operatório de fator XIII, cuja correção reduziu significativamente a transfusão de unidades de concentrado eritrocitário (1,95 vs. 4,05, p = 0,001). Os biomarcadores de coagulação pré e pós-operatórios foram semelhantes entre os grupos, revelaram que os testes de coagulação de rotina não identificam o déficit de fator XIII. Sem eventos tromboembólicos registrados. A correção do fator XIII na cirurgia do queimado revelou-se segura e eficaz na redução da transfusão perioperatória de unidades de eritrócitos. Keywords: Intensive care, Burned, Surgery, Coagulation and hemostasis, Factor XIII, Palavras-chave: Cuidados intensivos, Queimados, Cirurgia, Coagulação e hemostase, Fator XII

Factor XIII-guided treatment algorithm reduces blood transfusion in burn surgery

Abstract Background and objectives: Major burn surgery causes large hemorrhage and coagulation dysfunction. Treatment algorithms guided by ROTEM® and factor VIIa reduce the need for blood products, but there is no evidence regarding factor XIII. Factor XIII deficiency changes clot stability and decreases wound healing. This study evaluates the efficacy and safety of factor XIII correction and its repercussion on transfusion requirements in burn surgery. Methods: Randomized retrospective study with 40 patients undergoing surgery at the Burn Unit, allocated into Group A those with factor XIII assessment (n = 20), and Group B, those without assessment (n = 20). Erythrocyte transfusion was guided by a hemoglobin trigger of 10 g.dL-1 and the other blood products by routine coagulation and ROTEM® tests. Analysis of blood product consumption included units of erythrocytes, fresh frozen plasma, platelets, and fibrinogen. The coagulation biomarker analysis compared the pre- and post-operative values. Results and conclusions: Group A (with factor XIII study) and Group B had identical total body surface area burned. All patients in Group A had a preoperative factor XIII deficiency, whose correction significantly reduced units of erythrocyte concentrate transfusion (1.95 vs. 4.05, p = 0.001). Pre- and post-operative coagulation biomarkers were similar between groups, revealing that routine coagulation tests did not identify factor XIII deficiency. There were no recorded thromboembolic events. Correction of factor XIII deficiency in burn surgery proved to be safe and effective for reducing perioperative transfusion of erythrocyte units