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[PMID]:28845944
[Au] Autor:Kyzlasov PS; Abdulkhamidov AN; Sergeev VP; Bokov AI; Volodin DI; Zabelin MV
[Ad] Endereço:Department of Urology and Andrology, A.I. Burnazyan Federal Medical Biophysical Center, FMBA of Russia, Moscow, Russia.
[Ti] Título:[Penile revascularization using laparoscopic mobilization of the inferior epigastric artery].
[So] Source:Urologiia;(3):84-85, 2017 Jul.
[Is] ISSN:1728-2985
[Cp] País de publicação:Russia (Federation)
[La] Idioma:rus
[Ab] Resumo:The article presents a case of successful penile revascularization using laparoscopic mobilization of the inferior epigastric artery in a 35 y. o. patient with penile arteriovenous insufficiency.
[Mh] Termos MeSH primário: Artérias Epigástricas/cirurgia
Impotência Vasculogênica/cirurgia
Laparoscopia/métodos
Pênis/irrigação sanguínea
Estruturas Criadas Cirurgicamente
Procedimentos Cirúrgicos Vasculares
[Mh] Termos MeSH secundário: Adulto
Seres Humanos
Impotência Vasculogênica/etiologia
Masculino
Insuficiência Venosa/complicações
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170829
[St] Status:MEDLINE


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[PMID]:28737460
[Au] Autor:Bíró V
[Ti] Título:[Applied methods instead of autologous nerve transplantation in the reconstruction of nerve injuries on the hand].
[Ti] Título:Az autológ idegtranszplantátumok helyett alkalmazott módszerek a kéz idegsérüléseinek helyreállításában..
[So] Source:Orv Hetil;158(30):1163-1167, 2017 Jul.
[Is] ISSN:0030-6002
[Cp] País de publicação:Hungary
[La] Idioma:hun
[Ab] Resumo:For a long time in the clinical practice the autologous nerve transplants are used in reconstruction of the segmental defects of injured hand nerves. The published outcomes, especially in case of the motor and mixed (sensory and motor) nerves, however, were not satisfactory. Hence, it remained a problem and in the focus of research. The author aimed to study this topic and drawing conclusions in his literary review publication. According to the recent results, the replacement of the autologous nerve transplants with other materials (e.g. nerve conduits, various allografts, etc.) has shown good outcomes in mixed nerves too, if the distance of the resected nerve ends do not exceed 6 mm and the diameter of the nerves were not more than 3-7 mm. The applications of these methods have shown poor results, if the defect and/or the nerve diameter were larger. So, in these cases the autologous nerve transplantation remains the optimal management in the future. Orv Hetil. 2017; 158(30): 1163-1167.
[Mh] Termos MeSH primário: Traumatismos da Mão/cirurgia
Regeneração Nervosa/fisiologia
Traumatismos dos Nervos Periféricos/cirurgia
Procedimentos Cirúrgicos Reconstrutivos/métodos
Sensação/fisiologia
[Mh] Termos MeSH secundário: Seres Humanos
Microcirurgia
Músculo Esquelético/transplante
Nervos Periféricos/transplante
Recuperação de Função Fisiológica/fisiologia
Estruturas Criadas Cirurgicamente
Transplante Autólogo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170928
[Lr] Data última revisão:
170928
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170725
[St] Status:MEDLINE
[do] DOI:10.1556/650.2017.30813


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[PMID]:28624115
[Au] Autor:Vatsa R; Bharti J; Roy KK; Kumar S; Sharma JB; Singh N; Singhal S; Meena J
[Ad] Endereço:Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
[Ti] Título:Evaluation of amnion in creation of neovagina in women with Mayer-Rokitansky-Kuster-Hauser syndrome.
[So] Source:Fertil Steril;108(2):341-345, 2017 Aug.
[Is] ISSN:1556-5653
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To assess the outcome of amnion vaginoplasty in cases of vaginal agenesis due to Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome managed at the authors' institution. DESIGN: Retrospective study. SETTING: Tertiary care hospital. PATIENT(S): Fifty women with MRKH who underwent neovaginoplasty. INTERVENTION(S): Modified McIndoe's vaginoplasty was done in all the patients, using human amnion graft. MAIN OUTCOME MEASURE(S): Functional status assessed by Female Sexual Function Index, anatomic status (length and width of neovagina), and epithelialization of vagina. RESULT(S): Mean (±SD) vaginal length after surgery was 8.2 ± 1 cm. Mean vaginal length at 6-month follow-up in sexually active patients was significantly longer as compared with the patients who were not sexually active after surgery (8.4 ± 1.04 cm vs. 6.6 ± 2.4 cm). Mean Female Sexual Function Index score was 30.8 ± 2.1. Vaginal biopsy showed complete epithelialization of vaginal mucosa. CONCLUSION(S): In a developing nation like India, McIndoe's method with amnion graft seems to be a promising option owing to its low cost, easy availability, and safety, ease of the procedure not requiring any special instrument, physiologic outcome with respect to epithelialization of the vagina without hair growth, and satisfying functional outcome.
[Mh] Termos MeSH primário: Transtornos 46, XX do Desenvolvimento Sexual/cirurgia
Âmnio/patologia
Âmnio/transplante
Colpotomia/métodos
Anormalidades Congênitas/cirurgia
Ductos Paramesonéfricos/anormalidades
Estruturas Criadas Cirurgicamente/patologia
Vagina/cirurgia
[Mh] Termos MeSH secundário: Transtornos 46, XX do Desenvolvimento Sexual/diagnóstico
Transtornos 46, XX do Desenvolvimento Sexual/patologia
Adolescente
Adulto
Anormalidades Congênitas/diagnóstico
Anormalidades Congênitas/patologia
Feminino
Seres Humanos
Ductos Paramesonéfricos/patologia
Ductos Paramesonéfricos/cirurgia
Procedimentos Cirúrgicos Reconstrutivos/métodos
Estudos Retrospectivos
Resultado do Tratamento
Vagina/anormalidades
Vagina/patologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170825
[Lr] Data última revisão:
170825
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170619
[St] Status:MEDLINE


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[PMID]:28359499
[Au] Autor:Fox MP; Mathisen DJ
[Ad] Endereço:Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
[Ti] Título:Surgical Treatment of Squamous Carcinoma in an Antethoracic Skin Tube Used for Esophageal Replacement.
[So] Source:Ann Thorac Surg;103(4):e361-e363, 2017 Apr.
[Is] ISSN:1552-6259
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:Occasionally, enteric conduits are unavailable or impractical for esophageal replacement. Cutaneous tubes are rarely employed alternatives that remain useful in specific circumstances. We present the case of a patient with a long standing skin tube complicated by malignancy that was replaced with a new skin tube.
[Mh] Termos MeSH primário: Carcinoma de Células Escamosas/etiologia
Carcinoma de Células Escamosas/cirurgia
Esofagoplastia/efeitos adversos
Neoplasias Cutâneas/etiologia
Neoplasias Cutâneas/cirurgia
Estruturas Criadas Cirurgicamente/efeitos adversos
[Mh] Termos MeSH secundário: Idoso
Carcinoma de Células Escamosas/diagnóstico
Esofagostomia
Seres Humanos
Masculino
Neoplasias Cutâneas/diagnóstico
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170522
[Lr] Data última revisão:
170522
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170401
[St] Status:MEDLINE


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[PMID]:27785747
[Au] Autor:Mahmoud O; El-Assmy A; Kamal M; Ashamallah A; Abol-Enein H
[Ad] Endereço:Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
[Ti] Título:Is chronic alkali therapy in orthotopic ileal neobladders necessary? A prospective controlled study.
[So] Source:Int Urol Nephrol;49(1):49-53, 2017 Jan.
[Is] ISSN:1573-2584
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To evaluate the necessity of chronic alkali therapy in non-complicated orthotopic ileal neobladders with normal renal function. MATERIALS AND METHODS: This is a prospective study that included 200 male patients who underwent radical cystectomy and ileal W neobladder for invasive bladder carcinoma between January 1993 and December 2013. The studied patients included 100 consecutive patients who were maintained on regular alkali therapy since surgery and 100 consecutive patients who stopped the use of alkali treatment after initial 3 months postoperative with minimum postoperative observation time of 1 year. All patients had satisfactory function of the reservoirs with normal upper tract. The patients were subjected to blood analysis for creatnine, electrolytes, pH and bicarbonate and urine chemical analysis. The study also included 40 healthy male age-matched volunteers who served as a control group. RESULTS: Both groups were comparable as regard age, BMI, follow-up period and surgical technique. There were no significant differences between both groups as regard serum creatnine, electrolytes blood pH and bicarbonate and the mean values were within normal range; however, the neobladder patients are still toward the acidotic side in comparison to healthy volunteers. Also there were no significant differences between both groups of patients as regard urine pH and excretion of electrolytes, calcium, phosphorus and creatnine. CONCLUSION: Patients with non-complicated ileal neobladders with normal upper tract who were not maintained on alkali prophylaxis for long period have a compensated acid base status. Therefore, the prolonged alkali prophylaxis is not mandatory.
[Mh] Termos MeSH primário: Acidose/prevenção & controle
Carcinoma/cirurgia
Bicarbonato de Sódio/administração & dosagem
Estruturas Criadas Cirurgicamente/efeitos adversos
Neoplasias da Bexiga Urinária/cirurgia
Bexiga Urinária/cirurgia
Derivação Urinária/efeitos adversos
[Mh] Termos MeSH secundário: Acidose/sangue
Acidose/etiologia
Idoso
Cistectomia
Seguimentos
Seres Humanos
Concentração de Íons de Hidrogênio
Íleo/cirurgia
Masculino
Meia-Idade
Estudos Prospectivos
Bicarbonato de Sódio/sangue
Urinálise
[Pt] Tipo de publicação:CONTROLLED CLINICAL TRIAL; JOURNAL ARTICLE
[Nm] Nome de substância:
8MDF5V39QO (Sodium Bicarbonate)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161028
[St] Status:MEDLINE
[do] DOI:10.1007/s11255-016-1447-0


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[PMID]:27696214
[Au] Autor:Maurice MJ; Kim SP; Abouassaly R
[Ad] Endereço:Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
[Ti] Título:Socioeconomic status is associated with urinary diversion utilization after radical cystectomy for bladder cancer.
[So] Source:Int Urol Nephrol;49(1):77-82, 2017 Jan.
[Is] ISSN:1573-2584
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To assess socioeconomic disparities in urinary diversion utilization in a contemporary American cohort. METHODS: In the National Cancer Database, we identified 4538 patients who underwent cystectomy with urinary diversion for clinical T1-2N0M0 bladder cancer from 2010 to 2013. Multivariable logistic regression was used to identify predictors of urinary diversion type: ileal conduit (IC), continent cutaneous reservoir (CCR), or orthotopic neobladder (ON). Covariates included age, gender, race, income, Charlson score, clinical T stage, hospital cystectomy volume, teaching status, and surgical approach. Subgroup analysis by hospital volume (low, intermediate, or high) and teaching status (academic or non-academic) was performed to ascertain the impact of regionalization on urinary diversion use. RESULTS: The final cohort included 4066 (89.6 %) patients with IC, 292 (6.4 %) with CCR, and 180 (4.0 %) with ON. On multivariable analysis, younger age (p < .01), higher income (p < .01), and high cystectomy volume predicted increased use of CCR and ON. Female gender predicted increased use of CCR versus IC (p < .01), and academic hospital status predicted increased use of ON versus IC (p = .04). On subgroup analysis, after further adjustment for hospital volume and teaching status, higher income remained an independent predictor of ON use. CONCLUSIONS: Despite regionalization of care, higher income patients are more likely to receive complex urinary diversions after radical cystectomy. Other related socioeconomic factors, especially patient education, may influence this practice pattern.
[Mh] Termos MeSH primário: Carcinoma de Células de Transição/cirurgia
Classe Social
Estruturas Criadas Cirurgicamente
Neoplasias da Bexiga Urinária/cirurgia
Bexiga Urinária/cirurgia
Derivação Urinária/utilização
[Mh] Termos MeSH secundário: Centros Médicos Acadêmicos/estatística & dados numéricos
Fatores Etários
Idoso
Cistectomia
Escolaridade
Feminino
Disparidades em Assistência à Saúde
Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos
Seres Humanos
Renda
Masculino
Meia-Idade
Sistema de Registros
Estudos Retrospectivos
Fatores Sexuais
Estados Unidos
Derivação Urinária/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1707
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161004
[St] Status:MEDLINE
[do] DOI:10.1007/s11255-016-1422-9


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[PMID]:26688428
[Au] Autor:Nagata T; Kawano A; Koyama M; Nakamura T; Hirahara F; Nakajima T; Sato T; Sakakibara H
[Ad] Endereço:Department of Obstetrics and Gynecology, Yokohama City University, Yokohama, Japan. Electronic address: mokomoko0408@yahoo.co.jp.
[Ti] Título:Efficacy of Fibroblast Growth Factor on Epithelialization of the Neovagina in Patients with Mayer-Rokitansky-Küster-Hauser Syndrome Who Underwent Vaginoplasty.
[So] Source:J Pediatr Adolesc Gynecol;30(3):400-404, 2017 Jun.
[Is] ISSN:1873-4332
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:STUDY OBJECTIVE: To evaluate the effect of fibroblast growth factor (FGF) on epithelialization of neovagina in patients with Mayer-Rokitansky-Küster-Hauser syndrome who underwent vaginoplasty. DESIGN: Observational study. SETTING: University hospital. PARTICIPANTS: Seven patients with Mayer-Rokitansky-Küster-Hauser syndrome. INTERVENTIONS: Cytological examination was done on vaginal smear samples from the site of completed epithelialization, and tissue was collected from the epithelialized part for histological evaluation. Immunostaining for estrogen receptor α, and keratin 13 and 14, and reverse transcription polymerase chain reaction (RT-PCR) analysis of the FGF receptor (FGFR) 1-4 were performed in samples from case 2 three times (ie, during the surgery, during the period of vaginal creation, and at 3 months and 6 months after the surgery). MAIN OUTCOME MEASURES: The primary outcome was the FGF effects on the epithelialization speed and FGFR expression in the neovagina. The second was the role of FGF in the mechanism of vaginal epithelial cell proliferation. RESULTS: The histological structure of the neovagina was consistent with that of normal vagina. RT-PCR analysis revealed that FGFR was expressed in the control vaginas and neovaginas. Among the FGFR subtypes, FGFR-4 was overexpressed during the process of epithelialization and its level decreased after completion of creation of the new vagina. CONCLUSION: The epithelium of the neovagina was morphologically similar to that of normal vagina. It is suggested that FGF plays the role as a growth factor.
[Mh] Termos MeSH primário: Transtornos 46, XX do Desenvolvimento Sexual/cirurgia
Anormalidades Congênitas/cirurgia
Fatores de Crescimento de Fibroblastos/metabolismo
Ductos Paramesonéfricos/anormalidades
Receptores de Fatores de Crescimento de Fibroblastos/metabolismo
Procedimentos Cirúrgicos Reconstrutivos/métodos
Vagina/cirurgia
[Mh] Termos MeSH secundário: Transtornos 46, XX do Desenvolvimento Sexual/metabolismo
Adulto
Anormalidades Congênitas/metabolismo
Receptor alfa de Estrogênio/metabolismo
Feminino
Procedimentos Cirúrgicos em Ginecologia
Seres Humanos
Queratinas/metabolismo
Ductos Paramesonéfricos/metabolismo
Ductos Paramesonéfricos/cirurgia
Reação em Cadeia da Polimerase Via Transcriptase Reversa
Estruturas Criadas Cirurgicamente
Vagina/efeitos dos fármacos
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Estrogen Receptor alpha); 0 (Receptors, Fibroblast Growth Factor); 0 (estrogen receptor alpha, human); 62031-54-3 (Fibroblast Growth Factors); 68238-35-7 (Keratins)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170907
[Lr] Data última revisão:
170907
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:151222
[St] Status:MEDLINE


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[PMID]:28003020
[Au] Autor:Bjørsum-Meyer T; Herlin M; Qvist N; Petersen MB
[Ad] Endereço:Department of Surgery, Odense University Hospital, Sdr. Boulevard 29, Odense, C 5000, Denmark. thomas.bjoersum-meyer@rsyd.dk.
[Ti] Título:Vertebral defect, anal atresia, cardiac defect, tracheoesophageal fistula/esophageal atresia, renal defect, and limb defect association with Mayer-Rokitansky-Küster-Hauser syndrome in co-occurrence: two case reports and a review of the literature.
[So] Source:J Med Case Rep;10(1):374, 2016 Dec 21.
[Is] ISSN:1752-1947
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The vertebral defect, anal atresia, cardiac defect, tracheoesophageal fistula/esophageal atresia, renal defect, and limb defect association and Mayer-Rokitansky-Küster-Hauser syndrome are rare conditions. We aimed to present two cases with the vertebral defect, anal atresia, cardiac defect, tracheoesophageal fistula/esophageal atresia, renal defect, and limb defect association and Mayer-Rokitansky-Küster-Hauser co-occurrence from our local surgical center and through a systematic literature search detect published cases. Furthermore, we aimed to collect existing knowledge in the embryopathogenesis and genetics in order to discuss a possible link between the vertebral defect, anal atresia, cardiac defect, tracheoesophageal fistula/esophageal atresia, renal defect, and limb defect association and Mayer-Rokitansky-Küster-Hauser syndrome. CASE PRESENTATION: Our first case was a white girl delivered by caesarean section at 37 weeks of gestation; our second case was a white girl born at a gestational age of 40 weeks. A co-occurrence of vertebral defect, anal atresia, cardiac defect, tracheoesophageal fistula/esophageal atresia, renal defect, and limb defect association and Mayer-Rokitansky-Küster-Hauser syndrome was diagnosed in both cases. We performed a systematic literature search in PubMed ((VACTERL) OR (VATER)) AND ((MRKH) OR (Mayer-Rokitansky-Küster-Hauser) OR (mullerian agenesis) OR (mullerian aplasia) OR (MURCS)) without limitations. A similar search was performed in Embase and the Cochrane library. We added two cases from our local center. All cases (n = 9) presented with anal atresia and renal defect. Vertebral defects were present in eight patients. Rectovestibular fistula was confirmed in seven patients. Along with the uterovaginal agenesis, fallopian tube aplasia appeared in five of nine cases and in two cases ovarian involvement also existed. CONCLUSIONS: The co-occurrence of the vertebral defect, anal atresia, cardiac defect, tracheoesophageal fistula/esophageal atresia, renal defect, and limb defect association and Mayer-Rokitansky-Küster-Hauser syndrome is extremely rare. This group of patients has unusual phenotypic characteristics. The long-term outcome after treatment of defects is not well reported. A single unifying cause is not known and the etiology probably includes both genetic and non-genetic causes. We stress the importance of future studies to optimized treatment, follow-up, and etiology.
[Mh] Termos MeSH primário: Transtornos 46, XX do Desenvolvimento Sexual/diagnóstico por imagem
Canal Anal/anormalidades
Atresia Esofágica/diagnóstico
Ductos Paramesonéfricos/anormalidades
Procedimentos Cirúrgicos Reconstrutivos
Coluna Vertebral/anormalidades
Estruturas Criadas Cirurgicamente
Fístula Traqueoesofágica/diagnóstico
Vagina/anormalidades
[Mh] Termos MeSH secundário: Transtornos 46, XX do Desenvolvimento Sexual/patologia
Transtornos 46, XX do Desenvolvimento Sexual/cirurgia
Anormalidades Múltiplas
Atresia Esofágica/patologia
Atresia Esofágica/cirurgia
Esôfago/anormalidades
Feminino
Cardiopatias Congênitas
Seres Humanos
Lactente
Recém-Nascido
Rim/anormalidades
Deformidades Congênitas dos Membros
Traqueia/anormalidades
Fístula Traqueoesofágica/patologia
Fístula Traqueoesofágica/cirurgia
Resultado do Tratamento
Vagina/cirurgia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170512
[Lr] Data última revisão:
170512
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161223
[St] Status:MEDLINE
[do] DOI:10.1186/s13256-016-1127-9


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[PMID]:27782992
[Au] Autor:Buncamper ME; van der Sluis WB; van der Pas RS; Özer M; Smit JM; Witte BI; Bouman MB; Mullender MG
[Ad] Endereço:Amsterdam, The Netherlands From the Department of Plastic, Reconstructive, and Hand Surgery, the Center of Expertise on Gender Dysphoria, the EMGO+ Institute for Health and Care Research, and the Department of Epidemiology and Biostatistics, VU University Medical Center; and Gender Surgery Amsterdam.
[Ti] Título:Surgical Outcome after Penile Inversion Vaginoplasty: A Retrospective Study of 475 Transgender Women.
[So] Source:Plast Reconstr Surg;138(5):999-1007, 2016 Nov.
[Is] ISSN:1529-4242
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: For many transgender women, vaginoplasty is the final stage in the gender-confirming process. Penile inversion vaginoplasty is considered the gold standard for vaginal construction in transgender women. In this study, the authors assessed intraoperative and postoperative complications after penile inversion vaginoplasty. METHODS: All patients who underwent penile inversion vaginoplasty between January of 2000 and January of 2014 were identified retrospectively from the authors' hospital registry. A retrospective chart review was conducted. Outcome measures were intraoperative and postoperative complications, reoperations, secondary surgical procedures, and possible risk factors. RESULTS: Between January of 2000 and January of 2014, 475 patients underwent penile inversion vaginoplasty, 405 of whom did not have and 70 of whom did have additional full-thickness skin grafts. The median patient age at surgery was 38.6 years (range, 18.1 to 70.8 years). Median follow-up was 7.8 years (range, 1.0 to 15.9 years). The most frequently observed intraoperative complication was rectal injury [n = 11 (2.3 percent)]. Short-term postoperative bleeding that required transfusion [n = 23 (4.8 percent)], reoperation [n = 7 (1.5 percent)] or both [n = 2 (0.4 percent)] occurred in some cases. Major complications comprised three (0.6 percent) rectoneovaginal fistulas, which were successfully treated. Revision vaginoplasty was performed in 14 patients (2.9 percent). Comorbid diabetes was associated with a higher risk of local infection (OR, 9.8; p = 0.003; 95 percent CI, 2.8 to 34.4), and use of psychotropic medication predisposed to postoperative urinary retention (OR, 2.1; p = 0.006; 95 percent CI, 1.2 to 3.5). CONCLUSIONS: Successful vaginal construction without the need for secondary functional reoperations was achieved in the majority of patients. Intraoperative complications are scarce. Postoperative complications occur frequently but are generally minor and easily treated. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
[Mh] Termos MeSH primário: Pênis/cirurgia
Cirurgia de Readequação Sexual/métodos
Estruturas Criadas Cirurgicamente
Pessoas Transgênero
Transexualismo/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Feminino
Seguimentos
Seres Humanos
Complicações Intraoperatórias/epidemiologia
Complicações Intraoperatórias/etiologia
Masculino
Meia-Idade
Complicações Pós-Operatórias/epidemiologia
Complicações Pós-Operatórias/etiologia
Estudos Retrospectivos
Transplante de Pele
Resultado do Tratamento
Transtornos Urinários/epidemiologia
Transtornos Urinários/etiologia
Vagina/cirurgia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161027
[St] Status:MEDLINE


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[PMID]:27678038
[Au] Autor:Kuessel L; Wenzl R; Marschalek ML; Slavka G; Doerfler D; Husslein H
[Ad] Endereço:Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria.
[Ti] Título:Using the Wharton-Sheares-George method to create a neovagina in patients with Mayer-Rokitansky-Küster-Hauser syndrome: a step-by-step video tutorial.
[So] Source:Fertil Steril;106(7):e20-e21, 2016 Dec.
[Is] ISSN:1556-5653
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To provide a review of the literature regarding this technique as well as a step-by-step description with the goal of increasing its use as a safe surgical option. Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is characterized by vaginal agenesis and a variety of mullerian duct anomalies. To date, a variety of procedures have been described for creating a neovagina, but the best treatment remains debated. The Wharton-Sheares-George method, a minimally invasive surgical approach for the creation of a neovagina, is remarkably simple to perform. DESIGN: Surgical video tutorial. SETTING: University hospital and referral center for pediatric and adolescent gynecology. PATIENT(S): A 20-year-old woman with MRKH syndrome who underwent Wharton-Sheares-George neovaginoplasty. INTERVENTION(S): With the Wharton-Sheares-George neovaginoplasty the rudimentary müllerian ducts are dilated incrementally by pushing Hegar dilators in the direction of the pelvic axis, and the resulting median raphe is then intersected using diathermy. Subsequently a vaginal mold is inserted into the newly created cavity and held in position by two sutures. MAIN OUTCOME MEASURE(S): Discussion of the surgical steps according to the Wharton-Sheares-George method and review of the anatomic and functional results. RESULTS: Reviewing the existing literature shows that a mean vaginal length and width of 8.3 and 3.3 cm, respectively, can be achieved, and so far no major intraoperative or postoperative complications or prolapse of the neovagina has been reported. Patients can achieve a high degree of general well-being as well as sexual and psychosocial functioning. However, as with most other methods, the presented method requires diligent patient compliance due to the lifelong need to actively avoid contraction of the neovagina. Also, as revealed by vaginal cultures and biopsies, the neovaginas remarkably resemble natural vaginas with regard to type of bacterial colonization and structure of epithelium. The process of spontaneous epithelialization of the neovagina is not fully understood, but has been observed to begin at the vaginal orifice and take several months to reach the apex. This leads to the assumption that the nonkeratinizing, stratified squamous epithelium originates from the preexisting vaginal epithelium of the vaginal dimple and migrates in a cranial direction. Alternatively, epithelialization might arise from pluripotent stem cells located in the obliterated müllerian ducts. CONCLUSION(S): The creation of a neovagina using the Wharton-Sheares-George method does not require allogenic or autologous transplants, nor does it require traction devices or specialized surgical equipment. Furthermore, the procedure is comparatively simple to perform and easy to learn. By following our step-by-step description of this technique, surgeons can offer a minimally invasive, quick, and safe surgical option that provides long-term results that are both functionally and anatomically satisfying. We believe that this technique represents a valuable alternative for the creation of a neovagina in patients with MRKH syndrome and thus should be investigated on a broader scale in the future.
[Mh] Termos MeSH primário: Transtornos 46, XX do Desenvolvimento Sexual/cirurgia
Anormalidades Congênitas/cirurgia
Procedimentos Cirúrgicos em Ginecologia/métodos
Ductos Paramesonéfricos/anormalidades
Procedimentos Cirúrgicos Reconstrutivos/métodos
Estruturas Criadas Cirurgicamente
Vagina/cirurgia
[Mh] Termos MeSH secundário: Transtornos 46, XX do Desenvolvimento Sexual/diagnóstico
Anormalidades Congênitas/diagnóstico
Feminino
Seres Humanos
Ductos Paramesonéfricos/cirurgia
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW; VIDEO-AUDIO MEDIA
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170607
[Lr] Data última revisão:
170607
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160929
[St] Status:MEDLINE



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