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1.
Asian J Androl ; 25(6): 719-724, 2023 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-37040216

RESUMO

Long-segment lichen sclerosus (LS) urethral stricture is a challenge for urologists. Limited data are available for surgeons to make a surgical decision between Kulkarni and Asopa urethroplasty. In this retrospective study, we investigated the outcomes of these two procedures in patients with LS urethral stricture. Between January 2015 and December 2020, 77 patients with LS urethral stricture underwent Kulkarni and Asopa procedures for urethroplasty in the Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine (Shanghai, China). Of the 77 patients, 42 (54.5%) underwent the Asopa procedure and 35 (45.5%) underwent the Kulkarni procedure. The overall complication rate was 34.2% in the Kulkarni group and 19.0% in the Asopa group, and no difference was observed ( P = 0.105). Among the complications, no statistical difference was observed in the incidence of urethral stricture recurrence ( P = 0.724) or glans dehiscence ( P = 0.246) except for postoperative meatus stenosis ( P = 0.020). However, the recurrence-free survival rate between the two procedures was significantly different ( P = 0.016). Cox survival analysis showed that antiplatelet/anticoagulant therapy use ( P = 0.020), diabetes ( P = 0.003), current/former smoking ( P = 0.019), coronary heart disease ( P < 0.001), and stricture length ( P = 0.028) may lead to a higher hazard ratio of complications. Even so, these two techniques can still provide acceptable results with their own advantages in the surgical treatment of LS urethral strictures. The surgical alternative should be considered comprehensively according to the patient characteristics and surgeon preferences. Moreover, our results showed that antiplatelet/anticoagulant therapy use, diabetes, coronary heart disease, current/former smoking, and stricture length may be contributing factors of complications. Therefore, patients with LS are advised to undergo early interventions for better therapeutic effects.


Assuntos
Doença das Coronárias , Diabetes Mellitus , Líquen Escleroso e Atrófico , Estreitamento Uretral , Masculino , Humanos , Estreitamento Uretral/etiologia , Estudos Retrospectivos , Constrição Patológica/complicações , Constrição Patológica/cirurgia , Líquen Escleroso e Atrófico/complicações , Líquen Escleroso e Atrófico/cirurgia , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , China , Uretra/cirurgia , Complicações Pós-Operatórias/etiologia , Mucosa Bucal , Diabetes Mellitus/etiologia , Anticoagulantes
2.
J Vis Exp ; (189)2022 11 18.
Artigo em Inglês | MEDLINE | ID: mdl-36468711

RESUMO

Skin shortages and scar contractures are common complications following penile trauma and tumor surgery, resulting in significant pain and erectile dysfunction. Currently, skin grafts and scrotal flaps are widely used to reconstruct skin shortages. However, various limitations still exist; for instance, the skin graft may cause severe scarring in patients, and the traditional scrotal flap usually requires a two-stage procedure due to the large skin defect. To treat the shortage of foreskin, a modified bilateral scrotal pedicled flap is used. In this procedure, flaps located on each side of the midline of the scrotum, which was pedicled from the anterior scrotal artery, are harvested. Subsequently, these bilateral scrotal flaps, like a butterfly, can successfully cover the foreskin defect. In this study, seven patients underwent this procedure, and satisfactory outcomes were obtained. Only two patients developed necrosis in some small areas of the flaps, which were recovered after wound care. Postoperative penile length significantly increased compared to the preoperative status in both flaccid and erectile states. We believe that modified bilateral scrotal flaps are a simple and effective solution to penile skin shortages and scar contractures.


Assuntos
Contratura , Transplante de Pele , Masculino , Humanos , Cicatriz , Pênis/cirurgia , Retalhos Cirúrgicos
3.
J Vis Exp ; (184)2022 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-35781527

RESUMO

Artificial urethral sphincter (AUS) implantation is the definitive management of male stress urinary incontinence (SUI). Under the long-term pressure of the cuff, recurrence of incontinence caused by urethral atrophy can always be observed in patients. In this situation, distal cuff locations are needed, and new cuff sites should be sought in patients who need to undergo AUS reimplantations. Meanwhile, the circumference of the more distal urethra is often too small to fit with a 4.0 cm cuff. This means that the bulk of the urethra should be added not only for a sufficient urethral circumference but also for better protection. Here, we report a case that required AUS reimplantation because of urethral atrophy. This 73-year-old man had undergone AUS implantation 7 years ago and developed incontinence in the past 3 months. Physical examination and ultrasonography determined that the device still worked, and no obstruction or injury was observed through cystoscopy. Surgery for revision of the AUS was needed. In this operation, a new cuff was implanted transcorporally, which was 2 to 3 cm distal to the original cuff site. During a 6 month short-term follow-up, no stress incontinence, urethral injury, or dysuria was observed. The transcorporal technique offers significant advantages in patients with urethral atrophy: corporal tunica albuginea is added to the urethra, allowing a suitable cuff size and lower risk of erosion. It is worth recommending in the reoperation of AUS implantation.


Assuntos
Incontinência Urinária por Estresse , Esfíncter Urinário Artificial , Idoso , Atrofia/complicações , Atrofia/patologia , Atrofia/cirurgia , Humanos , Masculino , Reoperação/efeitos adversos , Uretra/patologia , Uretra/cirurgia , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária por Estresse/patologia , Incontinência Urinária por Estresse/cirurgia , Esfíncter Urinário Artificial/efeitos adversos
4.
Transl Androl Urol ; 11(6): 761-772, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35812200

RESUMO

Background: This study describes and compares three surgical procedures for the construction of urethral stricture (US) models in rabbits. Methods: Forty adult male rabbits were allocated to four groups: 36 rabbits were randomly assigned to three experimental groups, while the remaining 4 were assigned to a sham group. The penis was separated from the rectum. Then along the ventral midline, a longitudinal penile skin incision was made while ensuring that the urethral mucosa was intact and the muscular layer was not completely incised. In group 1 (n=12), ventral semi-circumferential mucosa electrocoagulation of a 1-cm length of the anterior urethra was performed until ulceration occurred. In group 2 (n=12), the ventral urethral mucosa was incised, and electrocoagulation of the dorsal semi-circumferential mucosa was performed. In group 3 (n=12), whole-circumferential mucosa electrocoagulation was performed. In group 4 (n=4), no special treatment was performed. Four weeks later, urethrography, urethroscopy, and histological evaluation were carried out. Results: The weights of the rabbits in the four groups were comparable. There was no significant difference between groups 2 and 3 with regard to operative time, but the operative time in these groups was significantly longer than that in group 1 (group 2 vs. group 1: P<0.05, group 3 vs. group 1: P<0.001). After the surgery, urinary fistula with infection occurred in one rabbit in group 1, and one rabbit died due to urethral atresia in group 3. According to the urethrography and urethroscopy findings, 9 out of 12 rabbits in group 1, 5 out of 12 rabbits in group 2, and 11 out of 11 rabbits in group 3 developed US, while no rabbits in the sham group developed US. Histopathological examination revealed injury to the urothelium, inflammatory infiltration, a decrease in the amount of blood vessels and smooth muscle fibers, and a decrease in the amount of collagen fibers. Conclusions: Compared with the semi-circumferential procedures, the whole-circumferential procedure had a higher success rate. Therefore, this procedure seems to have potential for the construction of long-segment rabbit US models.

5.
Asian J Androl ; 24(3): 294-298, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35381692

RESUMO

General recommendations regarding surgical techniques are not always appropriate for all Peyronie's disease (PD) patients. Therefore, the purpose of this study was to investigate the effects of plication procedures in PD patients with severe penile curvature and the effects of early surgical correction in patients who no longer have progressive deformities. The clinical data from 72 patients who underwent plication procedures were analyzed in this study. Patients were divided into Groups A and B according to the curvature severity (≤60° or >60°) and Groups 1 and 2 according to the duration of disease stabilization (≥3 months or <3 months). At the 1-year follow-up, 90.0% (36/40) and 90.6% (29/32) patients reported complete penile straightening, and 60.0% (24/40) and 100.0% (32/32) patients reported penile shortening in Groups A and B, respectively. No curvature recurrence occurred in any patient, and no significant differences were observed in postoperative International Index of Erectile Function-Erectile Function domain (IIEF-EF), erectile pain, sensitivity, or suture knots on the penis whether such outcomes were grouped according to the curvature severity or the duration of stabilization. However, the duration from symptom onset to surgical management in Group 1 was significantly longer than that in Group 2 (mean ± standard deviation [s.d.]: 20.9 ± 2.0 months and 14.3 ± 1.2 months, respectively, P < 0.001). The present study showed that the plication procedures seemed to be an effective choice for the surgical treatment of PD patients with severe penile curvature. In addition, the early surgical treatment seemed to benefit those patients who already had no erectile pain and no longer exhibited progressive deformity.


Assuntos
Disfunção Erétil , Induração Peniana , Disfunção Erétil/cirurgia , Humanos , Masculino , Satisfação do Paciente , Dor Pélvica , Induração Peniana/cirurgia , Pênis/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
6.
BMC Med Genomics ; 14(1): 291, 2021 12 11.
Artigo em Inglês | MEDLINE | ID: mdl-34895219

RESUMO

BACKGROUND: Extramammary Paget's disease (EMPD) is a rare malignant intraepidermal adenocarcinoma that is poorly understood. Regulatory long noncoding RNAs (lncRNAs) are characterized in many species and shown to be involved in processes such as development and pathologies, revealing a new layer of regulation in different diseases, especially in cancer studies. In the present study, we used high-throughput sequencing to reveal the lncRNA-mRNA interaction network in extramammary Paget's disease. METHODS: High-throughput sequencing was used to identify differentially expressed lncRNA and mRNA profiles between EMPD patients and healthy controls. Then, a series of bioinformatics analyses were conducted to construct the lncRNA-mRNA interaction network, which was finally confirmed in vitro. RESULTS: Six pairs of EMPD tumor and normal skin samples were collected and sequenced to identify the differentially expressed lncRNA and mRNA profiles between EMPD and healthy controls. A total of 997 differentially expressed mRNAs and 785 differentially expressed lncRNAs were identified. The GO and KEGG analyses show that epidermal development and cell adhesion play important roles in EMPD. The results of the lncRNA-mRNA interaction network analysis suggested that NEAT1, PGAP1, FKBP5 and CDON were the pivotal nodes of the network and that lncRNA NEAT1 might regulate mRNA PGAP1, FKBP5 and CDON. The results of the quantitative real-time RT-PCR performed in ten other patients for NEAT1, PGAP1, FKBP5 and CDON were consistent with those of the sequencing analysis. Moreover, an in vitro experiment confirmed the interactions between NEAT1 and PGAP1, FKBP5 and CDON in human immortalized keratinocytes. CONCLUSION: These findings suggest that the lncRNA-mRNA interaction network based on four pivotal nodes, NEAT1, PGAP1 FKBP5 and CDON, may play an important role in EMPD, which will contribute to a deeper understanding of the pathogenesis of EMPD.


Assuntos
Doença de Paget Extramamária , RNA Longo não Codificante , Perfilação da Expressão Gênica , Humanos , Doença de Paget Extramamária/genética , RNA Longo não Codificante/genética , RNA Longo não Codificante/metabolismo , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Transcriptoma
7.
Asian J Androl ; 23(5): 484-489, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33975988

RESUMO

Surgical correction can be considered for treating patients with a chronic phase of Peyronie's disease (PD) and persistent penile curvature. In clinical practice, some patients pay too much attention to surgical complications and refuse the recommended feasible surgical types. Meanwhile, they require operations according to their preferences. This study aimed to evaluate the effects of patients' own choice of surgical type on postoperative satisfaction. This retrospective study analyzed data from 108 patients with PD who underwent surgical correction according to doctors' recommendations or patients' own demands. The objective and subjective surgical outcomes were assessed. Patients' understanding of the disease was analyzed using a questionnaire survey. Objective measurements of surgical outcomes, including penile straightening, penile length, and sexual function, in patients who received the recommended surgery, were similar to those in patients who did not accept the recommended surgery. However, subjective evaluations, including erectile pain, discomfort because of nodules on the penis, and decreased sensitivity in the penis, were more obvious in patients who did not follow doctors' recommendations. In addition, a questionnaire survey showed that understanding PD and the purpose of surgery of patients who did not follow doctors' advice were inappropriate, as they did not conform to the principle of treatment. The present study showed that surgical correction seemed to be an objectively effective option in the management of patients in the stable chronic phase of PD. Low patient satisfaction might be related to patients' lack of correct understanding of the disease and its treatment strategy as well as unrealistic expectations.


Assuntos
Satisfação do Paciente , Induração Peniana/cirurgia , Complicações Pós-Operatórias/diagnóstico , Procedimentos Cirúrgicos Urogenitais/métodos , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Induração Peniana/complicações , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do Tratamento , Procedimentos Cirúrgicos Urogenitais/psicologia , Procedimentos Cirúrgicos Urogenitais/estatística & dados numéricos
8.
Transl Androl Urol ; 10(3): 1040-1047, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33850738

RESUMO

BACKGROUND: To present our experience of transposing the penis to the perineum, with penile-prostatic anastomotic urethroplasty, for the treatment of complex bulbo-membranous urethral strictures. METHODS: Between January 2002 and December 2018, 20 patients with long segment urethral strictures (mean 8.6 cm, range 7.5 to 11 cm) and scarred perineoscrotal skin underwent a procedure of transposition of the penis to the perineum and the penile urethra was anastomosed to the prostatic urethra. Before admission 20 patients had unsuccessful repairs (mean 4.5, range 2 to 12); five patients were associated urethrorectal fistula; 16 patients reported severe penile erectile dysfunction (PED) or no penile erectile at any time and four reported partial erections. RESULTS: The mean follow-up period was 45.9 (range 12 to 131) months. Nineteen patients could void normally with a mean Qmax of 22.48 (range 15.6 to 31.4) mL/s. One patient developed postoperative urethral stenosis. After 1 to 10 years of the procedure, nine patients underwent the second procedure. Of the nine patients, four underwent straightening the penis and one-stage anterior urethral reconstruction using a penile circular fasciocutaneous skin flap, and five underwent straightening the penis and staged Johanson urethroplasty. Seven patients could void normally, one developed urethrocutaneous fistula and one developed urethral stenosis. CONCLUSIONS: Transposition of the penis to the perineum with pendulous-prostatic anastomotic urethroplasty may be considered as a salvage option for patients with complex long segment posterior urethral strictures.

9.
Ann Palliat Med ; 10(3): 2979-2989, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33615818

RESUMO

BACKGROUND: Oral medication therapies are more conventional than other non-surgical therapies in the acute phase of Peyronie's disease (PD). Although the commonly used oral drugs for PD have shown poor or indeterminate outcomes, most patients prefer oral medications. The aim of this study was to evaluate the efficacy and safety of Scutellaria baicalensis extract for treating acute-phase PD patients and examine the practicality of treatment strategies for PD according to the disease course. METHODS: This retrospective study was performed at our institution from 2005 to 2015 and analyzed the data of 261 patients with PD. The acute-phase PD patients received Scutellaria baicalensis extract for 6 months. After oral treatment, the patients with persistent curvature underwent surgical correction during the stable phase. RESULTS: During this study period, 183 patients received oral treatment with Scutellaria baicalensis, and 78 patients did not. Compared to the untreated patients, treatment with Scutellaria baicalensis had a significant effect in improving the symptoms of acute-phase PD. The mean time required for stabilization also showed a significant statistical difference. Treatment with Scutellaria baicalensis was safe and well-tolerated. After the disease stabilized, 70 and 31 patients with significant penile curvature underwent surgical correction by 16- dot plication and great saphenous vein grafting procedures, respectively. At the one-year follow-up, complete penile straightening and penile length shortening were observed in 92.86% and 41.43% of the patients after 16-dot plication and in 87.10% and 25.81% of the patients after grafting procedures, respectively. The postoperative Erectile Function domain of the International Index of Erectile Function scales were maintained in all patients after the 16-dot plication procedure and decreased in 54.84% of the patients after the grafting procedure. Overall, 92.86% and 83.87% of the patients who received 16-dot plication and grafting procedures, respectively, were satisfied with the final surgical results. CONCLUSIONS: Treatment with extract of Scutellaria baicalensis seems to be beneficial for improvements in symptoms of acute phase PD and acceleration of the disease stabilization. The 16-dot plication and great saphenous vein grafting procedure seem effective options in the surgical management of the stable phase after Scutellaria baicalensis administration in the acute phase of PD.


Assuntos
Induração Peniana , Scutellaria baicalensis , Humanos , Masculino , Satisfação do Paciente , Induração Peniana/tratamento farmacológico , Induração Peniana/cirurgia , Extratos Vegetais/uso terapêutico , Estudos Retrospectivos , Resultado do Tratamento
10.
Stem Cell Res Ther ; 11(1): 535, 2020 12 11.
Artigo em Inglês | MEDLINE | ID: mdl-33308306

RESUMO

RATIONALE: Tissue engineering is a promising alternative for urethral reconstruction, and adipose-derived stem cells (ADSCs) are widely used as seeding cells. Hypoxia preconditioning can significantly enhance the therapeutic effects of ADSCs. The low oxygen tension of postoperative wound healing is inevitable and may facilitate the nutritional function of ADSCs. This study aimed to investigate if hypoxia-preconditioned ADSCs, compared to normoxia-preconditioned ADSCs, combined with scaffold could better promote urethral reconstruction and exploring the underlying mechanism. METHODS: In vitro, paracrine cytokines and secretomes that were secreted by hypoxia- or normoxia-preconditioned ADSCs were added to cultures of human umbilical vein endothelial cells (HUVECs) to measure their functions. In vivo, hypoxia- or normoxia-preconditioned ADSCs were seeded on a porous nanofibrous scaffold for urethral repair on a defect model in rabbits. RESULTS: The in vitro results showed that hypoxia could enhance the secretion of VEGFA by ADSCs, and hypoxia-preconditioned ADSCs could enhance the viability, proliferation, migration, angiogenesis, and glycolysis of HUVECs (p < 0.05). After silencing VEGFA, angiogenesis and glycolysis were significantly inhibited (p < 0.05). The in vivo results showed that compared to normoxia-preconditioned ADSCs, hypoxia-preconditioned ADSCs combined with scaffolds led to a larger urethral lumen diameter, preserved urethral morphology, and enhanced angiogenesis (p < 0.05). CONCLUSIONS: Hypoxia preconditioning of ADSCs combined with scaffold could better promote urethral reconstruction by upregulating angiogenesis and glycolysis. Hypoxia-preconditioned ADSCs combined with novel scaffold may provide a promising alternative treatment for urethral reconstruction.


Assuntos
Adipócitos , Células-Tronco , Tecido Adiposo/metabolismo , Animais , Glicólise , Hipóxia/metabolismo , Coelhos , Regulação para Cima
11.
Biomed Mater ; 15(6): 065008, 2020 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-32580173

RESUMO

Anterior urethral reconstruction is still a challenging clinical task, and tissue engineering technology offers new options for anterior urethroplasty. In this work, we evaluated an extracellular matrix (ECM) mimicking scaffold for anterior urethral reconstruction in a New Zealand white rabbit model. After the creation of a urethral defect, the ECM-mimicking scaffold was applied in six rabbits, and small intestinal submucosa (SIS) was used in three rabbits. The outcomes of urethrography and histological analysis were evaluated six months postoperatively. A larger urethral diameter was observed in the ECM-mimicking scaffolds (3.01 ± 0.12 mm) than in the SIS grafts (0.95 ± 0.07 mm). Urethral fistulae and stenosis were observed in the SIS grafts. Urothelial and smooth muscle cells were observed in all rabbits, but the ECM-mimicking scaffold showed better performance. The ECM-mimicking scaffold may be an effective clinical treatment option for congenital and acquired urethral pathologies.


Assuntos
Matriz Extracelular/metabolismo , Bicamadas Lipídicas/química , Nanoestruturas/química , Engenharia Tecidual/métodos , Alicerces Teciduais/química , Uretra/cirurgia , Animais , Biomimética , Modelos Animais de Doenças , Masculino , Microscopia Eletrônica de Varredura , Miócitos de Músculo Liso/citologia , Nanofibras , Porosidade , Coelhos , Procedimentos de Cirurgia Plástica , Regeneração
12.
BMC Urol ; 19(1): 104, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31664996

RESUMO

BACKGROUND: Male genital skin loss is a common disease in urology. However, male genital skin loss accompanying a penile urethra defect is rarely reported. Herein, we describe a novel surgical technique using a composite local flap and oral mucosal graft to reconstruct the penis, which may provide a new solution for patients with similar conditions. CASE PRESENTATION: A 36-year-old male with a penile urethra defect and a large area of genital skin loss required urethral reconstruction. The meatus had descended to the penoscrotal junction. This procedure was divided into three stages. The first stage of the surgery involved burying the nude penile shaft beneath the skin of the left anteromedial thigh for coverage of the skin defect. The second stage consisted of releasing the penis and expanding the size of the urethral plate for further urethroplasty. The third stage consisted of reconstruction of the anterior urethra 6 months later. Postoperatively, the patient reported satisfactory voiding. The maximal flow rate (MFR) was 22.2 ml/s with no postvoiding residual urine at the 24-month follow-up visit. No edema, infection, hemorrhage, or cicatricial retraction were observed. The patient's erectile function was satisfactory, and his international index of erectile function-5 score (IIEF-5 score) was 23 at the 24-month follow-up visit. Additionally, the presence of nocturnal penile tumescence demonstrated that he had normal erectile function. CONCLUSIONS: This procedure is an effective surgical option for men with complete foreskin and penile urethra defects. It could also be extended as a treatment strategy when composite local or pedicle transposition flaps and free grafts are needed for specific patients.


Assuntos
Mucosa Bucal/transplante , Pênis/lesões , Pênis/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto , Humanos , Masculino
13.
Sex Med ; 7(3): 352-356, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31235448

RESUMO

Penile amputation is a rare clinical emergency necessitating urgent urologic and microsurgical intervention. Microvascular replantation has become a conventional form of management, associated with significantly increased viability of the implanted tissue and a lower rate of complications. However, postreplantation treatment intended to promote early recovery of sexual function has been reported only seldomly. Here we report 2 cases of successful penile replantation with postreplantation daily sildenafil therapy. The patients were followed for 24 months and 8 months, respectively, from the date of repair. First intercourse was achieved at 92 days and 105 days, respectively. This is the first report of the use of phosphodiesterase type 5 inhibitors in postoperative care of penile replantation. Fu S, Zheng D, Xie M, et al. Successful Penile Replantation and the Role of Postreplantation Sildenafil Therapy: Report of 2 Cases and Literature Review. Sex Med 2019;7:352-356.

14.
Adv Ther ; 36(3): 684-690, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30684137

RESUMO

INTRODUCTION: To present 12 cases of arterial priapism treated by superselective embolization and propose our management algorithm for this condition. METHODS: Between February 2013 and May 2018, 12 cases of arterial priapism caused by blunt trauma were treated by superselective embolization. The mean age of patients was 36 years (25-47 years). All of the patients had normal sexual capability before priapism (IIEF-5 scores 24-25). All patients were treated with superselective embolization after more than 3 weeks of simple conservative treatment had failed. All cases but one used a gelatin sponge as embolic agent. A microcoil was added in one case in which the gelatin sponge failed to occlude the pseudoaneurysm. After superselective embolization, ice pack and "observation" treatments continued. The sexual capability of the patients was evaluated by IIEF-5 scores at 6 months and 12 months postoperatively. RESULTS: The mean follow-up period was 27.2 months (13-48 months). Three patients achieved complete detumescence immediately. Nine cases needed 2-17 days to return to a flaccid nonpainful state. No patient underwent a second embolization. The time needed to improve erectile function was from 7 days to 4 months. There has been no recurrence. Eleven patients treated with gelatin sponge have normal erectile function, while one patient treated with additional microcoil embolization had mild erectile dysfunction. CONCLUSION: Superselective embolization of the fistula is an effective option for arterial priapism. Absorbable agents should be used. Superselective arterial embolization should be considered after 3 weeks of conservative treatment. Patients should undergo another 3 weeks of "observation" treatment before repeated intervention.


Assuntos
Embolização Terapêutica/métodos , Priapismo/terapia , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Fatores de Tempo
15.
Zhonghua Nan Ke Xue ; 25(6): 544-548, 2019 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-32223091

RESUMO

OBJECTIVE: To investigate the clinical features, pathogenesis, diagnosis and scrotal reconstruction in the treatment of idiopathic scrotal calcinosis (ISC). METHODS: From March 2007 to October 2018, 10 ISC patients, aged 28-79 (mean 45) years and with a disease course of 6-497 (mean 128.4) months, were treated in our hospital. We retrospectively analyzed their clinical data and reviewed related literature. RESULTS: All the patients underwent physical examination and biochemical and parathyroid function tests. None of them had a history of endocrine or metabolic disease, or trauma, or a family member with similar diseases, and none had subjective symptoms except local pruritus in 1 case. All were treated surgically and post-operative follow-up revealed no recurrence. Histopathological examination of the excised lesion confirmed it to be ISC. CONCLUSIONS: ISC is a rare localized benign disease, of which surgery seems an effective option for the definite diagnosis and treatment. Occasionally scrotal reconstruction may be required in case of extensive involvement of the scrotal skin.


Assuntos
Calcinose/diagnóstico , Doenças dos Genitais Masculinos/diagnóstico , Escroto/patologia , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos
16.
Zhonghua Nan Ke Xue ; 24(1): 59-61, 2018.
Artigo em Chinês | MEDLINE | ID: mdl-30157362

RESUMO

OBJECTIVE: To introduce our experience in the treatment of arterial priapism by superselective embolization. METHODS: This study included 5 cases of perineal trauma-induced arterial erectile dysfunction treated in our departmentbetween February 2011 and May 2015, all failingpreviously to respond to 3 weeks of conservative treatment. The patients were aged 25-47 (mean 35) years, with the onset of arterial priapism at 2-5 days after trauma, and all subjected to physical examination, blood gas analysis, color Doppler ultrasonography of the corpora cavernosum, and IIEF-5 scoring. All the patients underwent superselective embolization, followed by local pressing and cold compression, and IIEF-5 scores were obtained again at 6 and 12 months postoperatively. RESULTS: All the patients had normal erectile functionbefore trauma, with a mean IIEF-5 scoreof 24.60 ± 0.55. Complete detumescenceor painless flaccidity of the penis was achieved in 1 case immediately after surgery and in the other 4 after 3-17 days of postoperative conservative treatment. None of the patients needed a second embolization and no relapse was found during a mean follow-upof 27.2 (13-48)months. The IIEF-5 scores obtained at 6 (24.00 ± 1.02) and 12 months (24.20 ± 0.82) were normal, with no statistically significant differencesfrom that before trauma. CONCLUSIONS: Selective embolization is a safe and effective option for the treatment of arterial priapism. In case of no immediate painless flaccidity of the penis after surgery, conservative treatment can be extended rather than a second operation.


Assuntos
Embolização Terapêutica/métodos , Pênis/irrigação sanguínea , Priapismo/terapia , Adulto , Artérias , Disfunção Erétil/etiologia , Disfunção Erétil/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Períneo , Período Pós-Operatório , Priapismo/etiologia , Recidiva , Ultrassonografia Doppler em Cores
17.
BMC Cancer ; 18(1): 403, 2018 04 10.
Artigo em Inglês | MEDLINE | ID: mdl-29636019

RESUMO

BACKGROUND: Extramammary Paget disease (EMPD) is a rare malignant dermatosis with poorly defined outcomes. We investigated clinical characteristics of invasive EMPD at different anatomic sites and by subject demographics to determine prognostic factors for overall survival (OS). METHODS: All patient data were collected from the Surveillance, Epidemiology, and End Results (SEER) program, 1973-2013, of the U.S. National Cancer Institute. Patients with invasive EMPD of skin, vulva/labia, vagina, scrotum/penis, or other sites were included. After excluding patients with unknown radiation status, data of 2001 patients were analyzed. Primary endpoint was EMPD mortality by anatomic sites. Independent variables included patients' demographic data, concurrent malignancy (ie, non-EMPD related cancers), tumor size, distant metastasis, and surgery and/or radiation or not. RESULTS: Multivariate regression analysis showed that mortality was significantly higher in patients with vaginal EMPD than in patients with vulvar/labial EMPD (adjusted hazard ratio [aHR] = 3.26, p < 0.001). Patients with distant metastasis had higher mortality than those without (aHR = 3.36, p < 0.001). Patients who received surgery had significantly lower mortality than those who did not receive surgery (aHR = 0.77, p = 0.030), and those treated with radiation had significantly higher mortality than those who did not receive radiation (aHR = 1.60, p = 0.002). Older age was associated with significantly increased mortality (aHR = 1.09, p < 0.001), and mortality was significantly higher in males than in females (aHR = 1.42, p = 0.008). CONCLUSIONS: In conclusion, among EMPD patients, mortality is higher in patients with vaginal EMPD than in those with vulvar/labial EMPD and higher in those who are older, those with concurrent malignancy or distant metastasis. Mortality is also higher in males than in females. Surgery is a protective factor and radiation is a risk factor for OS. Greater understanding of EMPD clinical characteristics, and considering EMPD in differential diagnosis of chronic genital and perianal dermatoses may provide support for early EMPD diagnosis and definitive surgical treatment.


Assuntos
Doença de Paget Extramamária/mortalidade , Doença de Paget Extramamária/patologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Doença de Paget Extramamária/epidemiologia , Vigilância da População , Modelos de Riscos Proporcionais , Programa de SEER , Análise de Sobrevida , Estados Unidos/epidemiologia
18.
Eur J Surg Oncol ; 44(9): 1425-1431, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29656798

RESUMO

INTRODUCTION: Till date, there have been few reports of comparative studies on the outcomes of these different treatment modalities. In this study, we have aimed to comparatively evaluate the quality-of-life parameters, including sexual function, urinary function, and health-related quality of life (HRQOL), in patients with early stage penile cancers who underwent two different organ-sparing surgeries. MATERIAL AND METHODS: From March 2012 to March 2015, we enrolled 15 patients with early stage penile cancers who underwent either wide local excision or partial penectomy as organ-sparing surgical treatments. We assessed their sexual and urinary functions and their HRQOL, using the International Index of Erectile Function (IIEF-15), Self-Esteem and Relationship (SEAR), and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaires and urodynamic determinations, and comparatively analyzed the outcomes of these patients who underwent either type of surgery. RESULTS: All patients who underwent these two types of surgeries experienced satisfactory outcomes. The patients who underwent wide local excision performed relatively better, in terms of their sexual functions, urinary functions, and HRQOL, but no statistically significant differences were observed in the data collected via the IIEF-15, SEAR, EDITS, and EORTC-QLQ-C30 questionnaires and urodynamic determinations (p > 0.05), except in the data corresponding to the orgasmic function (p = 0.033). CONCLUSION: Both types of organ-sparing surgeries assessed in this study achieved good outcomes, in terms of the aesthetics, sexual functions, urinary functions, and HRQOL in patients, without compromising the therapeutic effects of these surgeries. However, the observed decreases in orgasmic function will need to be addressed further.


Assuntos
Ereção Peniana/fisiologia , Neoplasias Penianas/cirurgia , Pênis/cirurgia , Qualidade de Vida , Comportamento Sexual/fisiologia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Idoso , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Penianas/diagnóstico , Neoplasias Penianas/fisiopatologia , Pênis/fisiopatologia , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do Tratamento
19.
J Craniofac Surg ; 28(3): 654-658, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28468143

RESUMO

Cephalometry has been used to measure hard and soft facial tissues as well as to conduct the ostectomy to determine the characteristics of the prominent mandibular angles (PMA). The changes produced on the mandibles by reduction mandibuloplasty are not known. The objective of the present study was to identify by cephalometric analysis the anatomical changes of the mandibles that occur in patients with PMA after reduction mandibuloplasty. Forty-two patients with PMA were submitted to cephalometric analysis before, 1 week and 6 months after surgery to evaluate the changes of the mandibles produced by reduction mandibuloplasty. Cephalometry was standardized to obtain descriptive measurements of the dimensions of the mandibles. The modifications of the mandibles due to reduction mandibuloplasty showed a significant change obtained by cephalometry. At 1 week after surgery, the average distance between the gonions decreased 17.70 ±â€Š8.46 mm, the average length of the mandibular ramus reduced 5.84 ±â€Š3.26 mm, the average mandibular body length increased 4.61 ±â€Š2.74 mm, the average gonial angle increased 14.78 ±â€Š6.65°, the average mandibular plane angle increased 10.29 ±â€Š3.82°. At 6 months postoperatively, the first 3 linear measurements increased 3.68 ±â€Š2.91, 1.66 ±â€Š2.51, and 2.10 ±â€Š2.37 mm respectively; however, the last 2 angular measurements reduced 2.86 ±â€Š3.02° and 1.77 ±â€Š2.62° respectively. The results demonstrated that reduction mandibuloplasty can modificate mandibular contouring three-dimensionally. The data of 6 months postoperatively compare to those of the beauty people reported in the literature, there were statistically differences between the linear measurements, but no statistically differences between the angular measurements. Despite bone regeneration result in linear or angular measurements change, postoperative angular shape was predominantly maintained, and the preoperative angular prominence did not recur.


Assuntos
Cefalometria/métodos , Osteotomia Mandibular/métodos , Adulto , China , Estética Dentária , Feminino , Seguimentos , Humanos , Satisfação do Paciente , Radiografia Dentária , Adulto Jovem
20.
Medicine (Baltimore) ; 96(47): e8238, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29381913

RESUMO

The staged graft urethroplasty is a recommended technique for repairing complex hypospadias. This retrospective study aimed to investigate the outcomes of this technique in hypospadias patients undergoing reoperation and to analyze the underlying contributing factors including age, meatus location, and graft and suture type.We retrospectively analyzed 40 hypospadias patients undergoing reoperation who received a staged oral graft urethroplasty, including 15 buccal mucosal grafts and 25 lingual mucosal grafts. Median age at presentation was 18.5 years, and median follow-up was 17.5 months (range 8-30 months). The patients were classified according to their original meatus location.Twenty-five complications developed in 12 of 40 (30%) cases, including 6 fistulas (15%), 7 infections (17.5%), 9 cases of glans dehiscence (22.5%), and 3 cases of stenosis (7.5%). There was no significant difference in the overall complication rates between prepuberty and postpuberty groups. In addition, no significant difference in complications was found between the 2 graft techniques. The complications were significantly higher in the original perineal type compared with the original penoscrotal type (7/10 vs 5/30, P = .0031). Seven patients who originally had perineal hypospadias developed multiple complications.Based on this study, the staged graft urethroplasty is an effective technique in reoperative hypospadias repairs with reasonable complication risk. The hypospadias classification affects the surgical outcomes.


Assuntos
Hipospadia/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adolescente , Adulto , Fatores Etários , Criança , Pré-Escolar , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Bucal , Complicações Pós-Operatórias/epidemiologia , Procedimentos de Cirurgia Plástica/efeitos adversos , Reoperação , Estudos Retrospectivos , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Adulto Jovem
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