Résumé
ABSTRACT Introduction: We report on the surgical results of a series of 91 patients who received gastric neobladders as urinary diversion after radical cystectomies performed for the treatment of muscle-invasive bladder cancers. Materials and Methods: We report on a retrospective case series of 91 patients who received gastric neobladders as urinary diversion after radical cystectomies performed for the treatment of muscle-invasive bladder cancers. Different techniques of gastric neobladders were employed from 1988 to 2013 at a university hospital in the South of Brazil. Results: Initial outcomes utilizing Leong (Antral) and Nguyen-Mitchell (Wedge) technique were unsatisfactory, yielding high pressure, low capacity reservoirs. Further developments of these techniques, with the detubularized gastric neobladder and the "spherical" gastric neobladders resulted in low pressure, high capacity reservoirs, with better surgical and urodynamic outcomes. Complication and perioperative mortality rates of our series of gastric neobladders were significantly higher than historical results of techniques using ileum or colon. Conclusions: Stomach is an exceptional option for the creation of neobladders after radical cystectomies, but due to the increased complication rates it should be reserved for specific situations (e.g., renal insufficiency, previous pelvic/abdominal radiotherapy, short bowel syndromes).
Sujets)
Humains , Mâle , Femelle , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Dérivation urinaire/méthodes , Tumeurs de la vessie urinaire/chirurgie , Cystectomie/méthodes , Poches urinaires/effets indésirables , Complications postopératoires , Études rétrospectives , Études de suivi , Résultat thérapeutique , Adulte d'âge moyen , Invasion tumoraleRésumé
Pacientes submetidos a radioterapia pélvica poderäo necessitar de derivaçöes urinárias, seja por recidiva local, estenose ureteral ou cistite actínica grave. A maioria das técnicas descritas para a confecçäo de reservatórios continentes exigem o emprego de segmentos íleocolônicos que sofrem igualmente os efeitos deletérios da irradiaçäo. Nesta situaçäo, o estômago tem sido nova opçäo primária. Os autores relatam dois casos em que houve falha no uso de tecido gástrico na reconstruçäo urinária pós-radioterapia, discutem uma proposta alternativa para resoluçäo desta situaçäo, aspectos técnicos envolvidos e os resultados iniciais
Sujets)
Humains , Mâle , Femelle , Adulte , Adulte d'âge moyen , Moignon gastrique/chirurgie , Dérivation urinaire/rééducation et réadaptation , Pelvis/effets des radiations , , Colectomie/rééducation et réadaptation , Gastrectomie/rééducation et réadaptationRésumé
Os autores questionam a validade do método tradicional do diagnóstico da prostatite, através do aumento de leucócitos encontrados na secreçäo prostática e, ao mesmo tempo, consideram de pouca exeqüibilidade a técnica das culturas fracionadas de Stamey e Meares, durante a consulta urológica de rotina. Sugerem a realizaçäo do citológico, que permite a identificaçäo dos macrófagos como parâmetro mais seguro de reaçäo inflamatória no tecido prostático, além de servir como teste de localizaçäo, pois ele näo se verificam nos exudatos uretrais