Assuntos
Divertículo/diagnóstico por imagem , Cálculos Renais/complicações , Cálices Renais , Pelve Renal , Adulto , Divertículo/complicações , Divertículo/cirurgia , Feminino , Humanos , Cálculos Renais/cirurgia , Nefropatias/diagnóstico por imagem , Nefropatias/cirurgia , Masculino , Pessoa de Meia-Idade , RadiografiaRESUMO
The author's technique is illustrated with 10 cases. It is an enlarged approach compared to the classical sacrococcygeal approach, that supposes opening of the sacral canal and location of the last sacrococcygeal nerve endings. The sacrum is divided as high as possible, usually at the level of the middle of S4. This yields excellent view of the junction between prostatic apex and membranous urethra. Section of the urethra at the chosen level can be very precise and completely preserves the innervation and vascularisation of the membranous urethre together with the sphincter function. Resection originates with division of urethra followed by uplifting of prostate and vesicles after ligation and division of the vascular pedicles. The anterior aspect of the bladder is opened and the trigone located. This makes possible the circumscription of the cervix and finally the division of the vas deferens and their vasculatures. This removes the prostate, seminal vesicles, vas ampullae and Denonvilliers aponeurosis en bloc, while scrupulously following the classical rules of carcinologic resection. Reconstruction is obtained either by direct anastomosis between anterior bladder wall and urethra, if enough tissue is available, the opening being closed like a racket; either by inserting a tube flap of reversed Boari type, taken from the anterior and lateral bladder wall. Urinary continency was complete within 3 months in 7 of the 10 operated patients. Two had stress incontinency. They both had extensive lesions and one had invasion of the membranous urethra and bladder cervix, the other had osseous sacrococcygeal matastases. A third patient contends he is incontinent 6 months after operation without obvious functional or neurological disturbance. The author advocates the present technique for its good results concerning continency. However it is still a preliminary work comprising only 10 cases.
