RESUMO
OBJECTIVE: To review our experience with an extended Q-shaped penile skin flap for the reconstruction of panurethral strictures. PATIENTS AND METHODS: Between 1991 and 1999, 15 men with extensive strictures underwent a single-stage urethral reconstruction with a distal circumferential penile skin flap incorporating a ventral midline extension (Q-flap). None had undergone previous urethroplasty nor had any been circumcised. RESULTS: The Q-flap provided a pedicled strip of penile skin with a mean (range) length of 17 (15-24) cm; no additional graft materials were necessary. Excellent results were obtained in 10 patients; in the remainder, complications included recurrent stricture (in two) and (in one patient each) a cerebral vascular accident, urethrocutaneous fistula, meatal stenosis, femoral neuropathy and prolonged catheterization for focal extravasation. CONCLUSION: The Q-flap provides an abundant hairless penile skin flap that enables single-stage panurethral reconstruction while eliminating the additional time and morbidity of harvesting further grafts.
Assuntos
Retalhos Cirúrgicos , Estreitamento Uretral/cirurgia , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Resultado do TratamentoRESUMO
Angiosarcoma is an uncommon neoplasm that rarely involves the adrenal gland. We report on a patient with primary angiosarcoma of the adrenal gland who presented with symptoms best characterized as a paraneoplastic syndrome.
Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico , Hemangiossarcoma/diagnóstico , Síndromes Paraneoplásicas/diagnóstico , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/patologia , Feminino , Hemangiossarcoma/diagnóstico por imagem , Hemangiossarcoma/patologia , Humanos , Pessoa de Meia-Idade , RadiografiaRESUMO
Serious urinary and bowel complications after ileal conduit diversion are associated with significant morbidity and mortality rates. We reviewed 9 patients treated at our institution during the last 5 years for sequelae after ileal conduit diversion for bladder cancer. Of these patients 8 are well and 1 died postoperatively of a myocardial infarction. In all, 33 operations were required to treat complications after initial diversion. A variety of surgical procedures, including anastomotic revision, ileal ureter, stomal revision, transverse colon conduit and nephrectomy, was used to treat urinary complications. A treatment outline emphasizing an initial conservative approach, the importance of nutritional support and the appropriate options for reconstruction is presented.
