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PURPOSE: We assessed the long-term results of total reconstructive bladder surgery as initial treatment of ectopic ureteroceles. MATERIALS AND METHODS: Long-term followup was evaluated in 54 children treated for ectopic ureteroceles with total upper and lower urinary tract reconstructive surgery between 1988 and 2003, with special focus on the primary outcome factors continence and urinary tract infections. RESULTS: Patient age at surgery was 0 to 8.8 years old (median 1.0), including 34 patients younger than 1 year. Followup was 2.3 to 15.6 years (median 9.6). Of the patients 94% became continent. During the last 2 years 17% of the patients experienced 1 or 2 uncomplicated episodes of urinary tract infection. One of the patients with incontinence received chemoprophylaxis due to frequent urinary tract infections. Secondary endoscopic procedures were necessary in 10 patients due to persistent reflux, and in 7 patients due to obstructive voiding. Reflux was present preoperatively in 33 patients, and low grade reflux was present postoperatively in 7, all of whom were treated conservatively. A total of 11 children presenting with dysfunctional voiding will be or have been trained in biofeedback. CONCLUSIONS: The vast majority of patients treated with total reconstructive bladder surgery become continent and do not suffer from lower urinary tract symptoms during the long term. The reoperation rate is low compared to series beginning with endoscopic surgery. Based on the results of this study, we suggest that total reconstructive upper and lower urinary tract surgery be the treatment of choice for ectopic ureteroceles. 相似文献
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Laura Llado Emilio Ramos Alex Bravo Carme Baliellas Kristel Mils Juli Busquets Alba Cachero Lluis Secanella Nuria Pelaez Emma Gonzalez‐Vilatarsana Joan Fabregat 《Transplant international》2019,32(10):1053-1060
Several techniques have been proposed for liver transplantation with inadequate hepatic artery (HA) anastomosis. We aimed to analyze outcomes of arterial reconstruction with the splenic artery (SA). This was a prospective study of our experience with recipients who underwent arterial anastomosis on the SA compared with patients who underwent standard HA. We included 54 patients in the SA group and 1405 in the HA group. Patients in SA group were more frequently retransplantation (31% vs. 8%; P = 0.001), required more transfusion (11 ± 12 vs. 6 ± 9.9 PRC; P = 0.001), had longer surgeries (424 ± 95 vs. 394 ± 102 min; P = 0.03), and longer hospital stays (28 ± 29 vs. 20 ± 18 days; P = 0.002). There were no differences in vascular and biliary complications (15% and 7%; P = 0.18; and 32% and 23%; P = 0.32), primary dysfunction (11% and 9%; P = 0.74), reoperation (12% and 10%; P = 0.61), postoperative mortality (13% and 7%; P = 0.12) and 5 years survival (66% vs. 63%; P = 0.71). Following primary transplantation, there were no differences. The outcomes of arterial reconstruction using the recipients' SA in adult liver transplantation are comparable to those for standard HA reconstruction after a first transplant. 相似文献
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Long‐term follow‐up of anterior vaginal repair: A comparison among colporrhaphy,colporrhaphy with reinforcement by xenograft,and mesh
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Matteo Balzarro Emanuele Rubilotta Antonio B. Porcaro Nicolò Trabacchin Alessandra Sarti Maria A. Cerruto Salvatore Siracusano Walter Artibani 《Neurourology and urodynamics》2018,37(1):278-283
Aims
To assess the long‐term complications and outcomes in patients treated for pelvic organ prolapse (POP) with transvaginal anterior colporrhaphy (AC) alone, transvaginal naterior AC with reinforcement by using porcine Xenograft (AC‐P) (Pelvisoft® Biomesh), and transvaginal anterior repair with polypropylene mesh (AC‐M).Methods
This was a retrospective analysis of 109/123 consecutive patients, who underwent cystocele repair: 42 AC, 19 AC‐P, and 48 AC‐M. Subjective outcomes included validated questionnaires as well as questions that had not been previously validated. Objective outcomes have been evaluated considering failure the anterior vaginal wall recurrence >2 stage POP‐Quantification. Statistical analysis included the chi‐square or Fisher exact test.Results
The mean follow‐up was 94.80 ± 51.72 months (19‐192 months). In all groups, the patient's personal satisfaction was high. There was no evidence of difference in outcome based on whether a biological graft was or was not performed, or whether synthetic mesh was used to reinforce the repair. Data showed a higher rate of complications in the AC‐M group (P < 0.05) that could explain the lower subjective satisfaction of these patients.Conclusions
This study evaluated long‐term outcomes to anterior vaginal repair over a period of more than 5 years in all the groups. Our data show that anterior vaginal repair with mesh and xenograft did not improve significantly objective and subjective outcomes. Rather, prosthetic device use leads to higher rate of complications. 相似文献12.
心脏外科停用抑肽酶前后围术期结果比较 总被引:2,自引:0,他引:2
目的 比较2007年12月19日中国食品及药品监督管理局下令心脏外科术中停用抑肽酶前、后心脏手术围术期结果,进一步探讨在心脏外科病人应用抑肽酶的作用及安全性.方法 回顾分析停用抑肽酶前、后各6个月的病人资料,所有人选者均在体外循环下行心脏外科手术,年龄均大于18岁.2007年6月19日至2007年12月18日的手术者为抑肽酶组,入选者均在术中应用抑肽酶.2007年12月19日至2008年6月18日手术者为对照组,入选者在术中均未用抑肽酶.比较两组围术期结果.包括术后失血量、输血量、二次开胸发生率、住院病死率及心、脑、肾、肺等重大并发症的发生率.同时进行多因素Lo~tic回归分析进一步确认初步比较的结果.结果 抑肽酶组入选1699例,对照组2225例.抑肽酶组与对照组比较,术后24 h出血量[(402.5±267.3)ml对(628.1±378.2)ml,P相似文献
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Qin Jiang Xudan Yang Jin Tan Keli Huang Wenhua Li Shengshou Hu 《Journal of cardiac surgery》2019,34(11):1416-1419
A 48‐year‐old man presented with chest pain and ischemic manifestations according to an electrocardiogram due to coronary artery compression from a cardiac mass and was admitted to the emergency room and underwent extensive debulking followed by right atrium and ventricular three‐dimensional reconstruction with concomitant tricuspid valve remodeling. He recovered a normal sinus rhythm and was discharged from the hospital a week later with a diagnosis of cardiac malignant angiosarcoma according to the pathological examination. He survived and had a normal cardiac structure and function performance, but vertebral metastasis was suspected after more than 4 months of follow‐up after the procedure. 相似文献
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会阴型尿道下裂的矫形和尿道重建 总被引:1,自引:0,他引:1
目的 探讨采用分期手术治疗会阴型尿道下裂,行阴茎、阴囊矫形、重建缺损尿道的临床效果.方法 22例会阴型尿道下裂采用分期手术:一期手术将阴茎海绵体完全伸直,阴茎包皮内板和背侧皮肤预置于阴茎腹侧和阴囊裂缝凹陷处;二期手术重建阴茎尿道采用半环状阴茎皮岛+半环状膀胱黏膜丛行侧面缝合形成阴茎尿道,阴囊尿道采用一期预置的组织丛行卷曲侧侧缝合重建阴囊尿道,在两尿道的接合点端端吻合,同时施行阴囊矫形.结果 22例会阴型尿道下裂矫形后几乎接近正常状态,重建阴茎尿道长度为4~9 cm,平均7 cm.手术的成功率为68%(15/22),尿瘘发生率为32%(7/22),5例(5/22)发生阴茎阴囊尿道交界处狭窄,经尿道扩张治疗后痊愈.结论 会阴型尿道下裂行分期手术治疗可以修复超过10 cm长的缺损尿道,而且完成手术以后外形形态较好. 相似文献
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Pisters LL Rewcastle JC Donnelly BJ Lugnani FM Katz AE Jones JS 《The Journal of urology》2008,180(2):559-564
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Marc‐Olivier Timsit Pierre E. Mouriquand Alain Ruffion Alain Bouillot Diala Dembelé Arnaud Mejean Fanny Lalloue Albert Leriche Nicolas Morel‐Journel 《BJU international》2009,103(10):1418-1421
OBJECTIVE
To assess the long‐term outcome and cosmetic results of forearm free‐flap phalloplasty for correcting micropenis associated with bladder exstrophy in men.PATIENTS AND METHODS
From 1992 to 2000, six men with bladder exstrophy and unsatisfactory penile appearance underwent phalloplasty at our institution. The mean (range) follow‐up was 113 (62–153) months. The surgical procedure consisted of a modified radial free‐flap phalloplasty and prosthesis implantation. One‐stage urethroplasty was electively performed according to the patient’s voiding pattern. Early and late complications were recorded and quality of life after phalloplasty was assessed.RESULTS
The mean (range) age was 21.2 (17–26) years and flap survival was 100%. Two incontinent patients underwent immediate perineal urethrostomy. One sepsis occurred, requiring the removal of the penile prosthesis and a cutaneous continent urinary diversion; this patient was the only one to complain about the outcome. Two anastomotic urethral strictures were conservatively treated by endoscopic urethrotomy and only one patient underwent subsequent urethral self‐dilatations. Five patients were very satisfied with the cosmesis of the neophallus and three patients reported having regular sexual intercourse.CONCLUSIONS
Although short, this series indicates the low incidence of early complications and the excellent long‐term satisfaction with forearm free‐flap phalloplasty in bladder exstrophy. Phalloplasty has potential indications when adult exstrophy patients are dissatisfied with the cosmetic appearance of their external genitalia or have unsatisfactory sexual intercourse. 相似文献19.
Devendra Lakhoti Gaurav Sharm Kavin Khatri G.N. Kiran Kumar Vijay Sharm Kamran Farooque 《中华创伤杂志(英文版)》2016,19(1):39-44
Purpose: Soft tissue healing is of paramount importance in distal tibial fractures for a successful outcome. There is an increasing trend of using anterolateral plate due to an adequate soft tissue cover on anterolateral distal tibia. The aim of this study was to evaluate the results and complications of minimally invasive anterolateral locking plate in distal tibial fractures.
Methods: This is a retrospective study of 42 patients with distal tibial fractures treated with minimally invasive anterolateral tibial plating. This study evaluates the bone and soft tissue healing along with emphasis on complications related to bone and soft tissue healing.
Results: Full weight bearing was allowed in mean time period of 4.95 months (3-12 months). A major
local complication of a wound which required revision surgery was seen in one case. Minor complications were identified in 9 cases which comprised 4 cases of marginal necrosis of the surgical wound, 1 case of superficial infection, 1 case of sensory disturbance over the anterolateral foot, 1 case of muscle hernia and 2 cases of delayed union. Mean distance between the posterolateral and anterolateral incision was 5.7 cm (4.5-8 cm).
Conclusion: The minimally invasive distal tibial fixation with anterolateral plating is a safe method of stabilization. Distance between anterolateral and posterolateral incision can be placed less than 7 cm apart depending on fracture pattern with proper surgical timing and technique. 相似文献