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[PMID]:28371167
[Au] Autor:Baumgartner TS; Lue KM; Sirisreetreerux P; Metzger S; Everett RG; Reddy SS; Young E; Anele UA; Alexander CE; Gandhi NM; Di Carlo HN; Gearhart JP
[Ad] Endereço:Division of Pediatric Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
[Ti] Título:Long-term sexual health outcomes in men with classic bladder exstrophy.
[So] Source:BJU Int;120(3):422-427, 2017 Sep.
[Is] ISSN:1464-410X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To identify the long-term sexual health outcomes and relationships in men born with classic bladder exstrophy (CBE). MATERIALS AND METHODS: A prospectively maintained institutional database comprising 1248 patients with exstrophy-epispadias was used. Men aged ≥18 years with CBE were included in the study. A 42-question survey was designed using a combination of demographic information and previously validated questionnaires. RESULTS: A total of 215 men met the inclusion criteria, of whom 113 (53%) completed the questionnaire. The mean age of the respondents was 32 years. Ninety-six (85%) of the respondents had been sexually active in their lifetime, and 66 of these (58%) were moderately to very satisfied with their sex life. The average Sexual Health Inventory for Men score was 19.8. All aspects of assessment using the Penile Perception Score questionnaire were on average between 'very dissatisfied' and 'satisfied'. Thirty-two respondents (28%) had attempted to conceive with their partner. Twenty-three (20%) were successful in conceiving, while 31 (27%) reported a confirmed fertility problem. A total of 31 respondents (27%) reported undergoing a semen analysis or post-ejaculatory urine analysis. Of these, only four respondents reported azoospermia. CONCLUSION: Patients with CBE have many of the same sexual and relationship successes and concerns as the general population. This is invaluable information to give to both the parents of boys with CBE, and to the boys themselves as they transition to adulthood.
[Mh] Termos MeSH primário: Extrofia Vesical/epidemiologia
Saúde Reprodutiva/estatística & dados numéricos
Comportamento Sexual/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Extrofia Vesical/fisiopatologia
Extrofia Vesical/psicologia
Epispadia/epidemiologia
Fertilidade/fisiologia
Seres Humanos
Masculino
Estudos Prospectivos
Análise do Sêmen
Inquéritos e Questionários
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170831
[Lr] Data última revisão:
170831
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170404
[St] Status:MEDLINE
[do] DOI:10.1111/bju.13866


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[PMID]:27896576
[Au] Autor:Eftekharzadeh S; Sabetkish N; Sabetkish S; Kajbafzadeh AM
[Ad] Endereço:Section of Tissue Engineering and Stem Cells Therapy, Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr. Qarib's St, Keshavarz Blvd, Tehran, 14194 33151, Islamic Republic of Iran.
[Ti] Título:Comparing the bulking effect of calcium hydroxyapatite and Deflux injection into the bladder neck for improvement of urinary incontinence in bladder exstrophy-epispadias complex.
[So] Source:Int Urol Nephrol;49(2):183-189, 2017 Feb.
[Is] ISSN:1573-2584
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: The aim of this study was to evaluate the efficacy of the endoscopic injection of calcium hydroxyapatite (CaHA) into the bladder neck (BN) region of patients with urinary incontinence and bladder exstrophy-epispadias complex (BEEC). PATIENTS AND METHODS: We designed a retrospective cohort study in which we retrospectively studied medical charts of female and male patients of BEEC who had undergone CaHA or Deflux injection for continence improvement between 2009 and 2014. Sixteen incontinent patients with a mean ± SD age of 8.09 ± 3.5 years received an endoscopic submucosal injection of 5.4 ml of pure CaHA powder with autologous plasma (group A). Patients in group B (N = 21), control group, with a mean ± SD age of 7.51 ± 2.8 years received Deflux injection (5.1 ml). The mean follow-up after injection was 38 ± 5.2 and 33 ± 4.1 months in groups A and B, respectively. RESULTS: No post-injection complication was detected in none of the patients during the follow-up. Eleven patients (68.75%) in group A became socially dry following 1-2 injections, the degree of incontinence was improved in 4 patients (25%), and there was no change in one patient (6.25%). However, Deflux injection resulted in complete dryness in 14 (66.66%), improvement in the degree of incontinence in 5 (23.81%) and no change in 2 patients (9.52%), leading to no significant difference in continence achievement between CaHA and Deflux groups (p = 0.9). The statistical analysis was not significantly different in terms of bladder capacity (p = 0.7) or Q max (p = 0.8). CONCLUSION: The preliminary results of this study revealed that CaHA may be applied as an affordable bulking agent in treatment of urinary incontinence in BEEC.
[Mh] Termos MeSH primário: Extrofia Vesical
Durapatita/administração & dosagem
Epispadia
Incontinência Urinária
[Mh] Termos MeSH secundário: Adolescente
Materiais Biocompatíveis/administração & dosagem
Extrofia Vesical/complicações
Extrofia Vesical/diagnóstico
Extrofia Vesical/fisiopatologia
Criança
Dextranos/administração & dosagem
Monitoramento de Medicamentos
Epispadia/complicações
Epispadia/diagnóstico
Epispadia/fisiopatologia
Feminino
Seguimentos
Seres Humanos
Ácido Hialurônico/administração & dosagem
Injeções/métodos
Irã (Geográfico)
Masculino
Avaliação de Processos e Resultados (Cuidados de Saúde)
Avaliação de Sintomas
Uretra/anormalidades
Uretra/fisiopatologia
Bexiga Urinária/anormalidades
Bexiga Urinária/efeitos dos fármacos
Bexiga Urinária/fisiopatologia
Incontinência Urinária/etiologia
Incontinência Urinária/terapia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biocompatible Materials); 0 (Dextrans); 0 (deflux); 9004-61-9 (Hyaluronic Acid); 91D9GV0Z28 (Durapatite)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161130
[St] Status:MEDLINE
[do] DOI:10.1007/s11255-016-1464-z


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[PMID]:27707652
[Au] Autor:Faure A; Cooksey R; Bouty A; Woodward A; Hutson J; O'Brien M; Heloury Y
[Ad] Endereço:Royal Children's Hospital, Department of Paediatric Urology, Melbourne, Australia. Electronic address: alice.faure@ap-hm.fr.
[Ti] Título:Bladder continent catheterizable conduit (the Mitrofanoff procedure): Long-term issues that should not be underestimated.
[So] Source:J Pediatr Surg;52(3):469-472, 2017 Mar.
[Is] ISSN:1531-5037
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Effective bladder emptying by clean intermittent catheterization for children with severe bladder dysfunction is critical for renal preservation and social integration. Use of a continent catheterizable conduit (CCC) as urethral alternative procedure provides effective bladder drainage. However, it brings a substantive maintenance. METHODS: Retrospective review of the indications and long-term outcomes of 54 patients with a Mitrofanoff procedure in a single center over a 20-year period (1995-2015). RESULTS: Indications of CCC include 21 neurogenic bladders, 12 patients with epispadias/exstrophy, 13 bladder outlet obstruction, 6 malignancies and 2 cloaca. Median age at surgery was 8.3years (4months-20years). The appendix was used in 76% of cases. Most frequently encountered complication was stomal stenosis (n=17/34, 50%), occurring at median time of 9months (2months-13years). The other complications were: leakage in 9 (26.5%); conduit stricture in 5 (14.7%), angulation of the conduit in 2 (5.8%) and prolapse in one (3%). Operative revision was encountered by 33 (61%) patients, the majority in the first 2years. Median follow-up was 4.3years (3months-16years). CONCLUSIONS: CCC has a high incidence of complication. It has to be used only when the native urethra is not suitable for catheterization. Carers, patients and families must be prepared to deal with both the complexity of index conditions and the complications of this procedure.
[Mh] Termos MeSH primário: Epispadia/cirurgia
Obstrução do Colo da Bexiga Urinária/cirurgia
Bexiga Urinaria Neurogênica/cirurgia
Cateterismo Urinário/métodos
Derivação Urinária/métodos
[Mh] Termos MeSH secundário: Adolescente
Apêndice/cirurgia
Criança
Pré-Escolar
Feminino
Seguimentos
Seres Humanos
Masculino
Complicações Pós-Operatórias
Estudos Retrospectivos
Resultado do Tratamento
Coletores de Urina/efeitos adversos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170426
[Lr] Data última revisão:
170426
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161007
[St] Status:MEDLINE


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[PMID]:27649475
[Au] Autor:Suzuki K; Matsumaru D; Matsushita S; Murashima A; Ludwig M; Reutter H; Yamada G
[Ad] Endereço:Department of Developmental Genetics, Institute of Advanced Medicine, Wakayama Medical University (WMU), Wakayama, Japan.
[Ti] Título:Epispadias and the associated embryopathies: genetic and developmental basis.
[So] Source:Clin Genet;91(2):247-253, 2017 Feb.
[Is] ISSN:1399-0004
[Cp] País de publicação:Denmark
[La] Idioma:eng
[Ab] Resumo:The abnormalities in the urogenital organs are frequently observed as human developmental diseases. Among such diseases, the defects in the upper part of external genitalia are rather rare named epispadias. The cleft in the dorsal part of external genitalia often reaches to the urethra. In general, the urogenital abnormalities accompany defects in the adjacent tissues and organs. The ventral body wall and bladder can also be affected in the patients with dorsal defects of the external genitalia. Therefore, such multiple malformations are often classified as bladder exstrophy and epispadias complex (BEEC). Because of the lower frequency of such birth defects and their early embryonic development, animal models are required to analyze the pathogenic mechanisms and the functions of responsible genes. Mutant mouse analyses on various signal cascades for external genitalia and body wall development are increasingly performed. The genetic interactions between growth factors such as bone morphogenetic proteins (Bmp) and transcription factors such as Msx1/2 and Isl1 have been suggested to play roles for such organogenesis. The significance of epithelial-mesenchymal interaction (EMI) is suggested during development. In this review, we describe on such local interactions and developmental regulators. We also introduce some mutant mouse models displaying external genitalia-body wall abnormalities.
[Mh] Termos MeSH primário: Extrofia Vesical/genética
Epispadia/genética
Doenças Fetais/genética
Anormalidades Urogenitais/genética
[Mh] Termos MeSH secundário: Animais
Extrofia Vesical/fisiopatologia
Anormalidades Congênitas/genética
Anormalidades Congênitas/patologia
Modelos Animais de Doenças
Desenvolvimento Embrionário/genética
Epispadia/fisiopatologia
Doenças Fetais/fisiopatologia
Seres Humanos
Camundongos
Anormalidades Urogenitais/fisiopatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170626
[Lr] Data última revisão:
170626
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160921
[St] Status:MEDLINE
[do] DOI:10.1111/cge.12871


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[PMID]:27751834
[Au] Autor:Sol Melgar R; Gorduza D; Demède D; Mouriquand P
[Ad] Endereço:Department of Paediatric Urology, Hôpital Mère-Enfant, Université Claude-Bernard, Bron, France.
[Ti] Título:Concealed epispadias associated with a buried penis.
[So] Source:J Pediatr Urol;12(6):347-351, 2016 Dec.
[Is] ISSN:1873-4898
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The aim was to describe the clinical presentation and the surgical management of penile epispadias associated with a buried penis in five children. PATIENTS AND METHODS: This is a 5-year retrospective review of patients presenting with a buried penis, a congenital defect of the penile skin shaft associated with an unretractable foreskin for whom a penile epispadias was found at the time of surgery. All had undergone surgery combining a Cantwell-Ransley procedure and refashioning of the penile skin following the authors' technique. RESULTS: Three children had a glanular epispadias and two had a midshaft epispadias. Four had a satisfactory outcome, and one required a complementary urethroplasty for glanular dehiscence. CONCLUSION: Buried penis and epispadias are usually isolated congenital anomalies, although they can be associated. It is therefore recommended to warn parents about the possibility of underlying penile anomaly in children with buried penises and unretractable foreskin. Careful palpation of the dorsum of the glans through the foreskin looking for a dorsal cleft could indicate an associated epispadiac urethra. Surgical correction of both anomalies can be done at the same time. Parents of boys with buried penises should be warned that underlying penile anomaly may exist.
[Mh] Termos MeSH primário: Anormalidades Múltiplas/cirurgia
Epispadia/complicações
Pênis/anormalidades
[Mh] Termos MeSH secundário: Pré-Escolar
Epispadia/patologia
Seres Humanos
Lactente
Recém-Nascido
Masculino
Estudos Retrospectivos
Procedimentos Cirúrgicos Urológicos Masculinos/métodos
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171002
[Lr] Data última revisão:
171002
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161019
[St] Status:MEDLINE


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[PMID]:27722172
[Au] Autor:Spinoit AF; Claeys T; Bruneel E; Ploumidis A; Van Laecke E; Hoebeke P
[Ad] Endereço:Department of Urology, Ghent University Hospital, Ghent, Belgium.
[Ti] Título:Isolated Male Epispadias: Anatomic Functional Restoration Is the Primary Goal.
[So] Source:Biomed Res Int;2016:6983109, 2016.
[Is] ISSN:2314-6141
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:. Isolated male epispadias (IME) is a rare congenital penile malformation, as often part of bladder-exstrophy-epispadias complex (BEEC). In its isolated presentation, it consists in a defect of the dorsal aspect of the penis, leaving the urethral plate open. Occurrence of urinary incontinence is related to the degree of dorsal displacement of the meatus and the underlying underdevelopment of the urethral sphincter. The technique for primary IME reconstruction, based on anatomic restoration of the urethra and bladder neck, is here illustrated. . A retrospective database was created with patients who underwent primary IME repair between June 1998 and February 2014. Intraoperative variables, postoperative complications, and outcomes were assessed. A descriptive statistical analysis was performed. . Eight patients underwent primary repair, with penopubic epispadias (PPE) in 3, penile epispadias (PE) in 2, and glandular epispadias (GE) in 3. Median age at surgery was 13.0 months [7-47]; median follow-up was 52 months [9-120]. Complications requiring further surgery were reported in two patients, while further esthetic surgeries were required in 4 patients. . Anatomical restoration in primary IME is safe and effective, with acceptable results given the initial pathology.
[Mh] Termos MeSH primário: Epispadia/patologia
Epispadia/cirurgia
Procedimentos Cirúrgicos Reconstrutivos/métodos
Uretra/patologia
[Mh] Termos MeSH secundário: Seres Humanos
Masculino
Pênis/patologia
Pênis/cirurgia
Uretra/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1702
[Cu] Atualização por classe:170224
[Lr] Data última revisão:
170224
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161011
[St] Status:MEDLINE


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Aguiar, José Lamartine de Andrade
Texto completo SciELO Brasil
[PMID]:27649111
[Au] Autor:Vilar FO; Pinto FC; Albuquerque AV; Martins AG; Araújo LA; Aguiar JL; Lima SV
[Ad] Endereço:Serviço de Urologia do Hospital das Clínicas, Departamento de Cirurgia do Centro de Ciências da Saúde da Universidade Federal de Pernambuco, UFPE, Brasil.
[Ti] Título:A wet dressing for male genital surgery: A phase II clinical trial.
[So] Source:Int Braz J Urol;42(6):1220-1227, 2016 Nov-Dec.
[Is] ISSN:1677-6119
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:PURPOSE: This study was to confirm the safety and efficacy of BC dressing when used in surgical male wound healing at the urogenital area. METHODS: Open, non-controlled clinical study of phase II. A total of 141 patients, among those children, adolescents and adults with hypospadias (112), epispadias (04), phymosis (13) and Peyronie's disease (12) that had a BC dressing applied over the operated area after surgery. A written informed consent was obtained from all participants. Study exclusion criteria were patients with other alternative treatment indications due to the severity, extent of the injury or the underlying disease. The outcomes evaluated were efficacy, safe and complete healing. The costs were discussed. RESULTS: In 68% patients, the BC dressing fell off spontaneously. The BC was removed without complications in 13% of patients at the outpatient clinic during the follow-up visit and 17% not reported the time of removal. In 3% of the cases, the dressing fell off early. Complete healing was observed between 8th and 10th days after surgery. The BC dressings have shown a good tolerance by all the patients and there were no reports of serious adverse events. CONCLUSION: The bacterial cellulose dressings have shown efficacy, safety and that can be considered as a satisfactory alternative for postoperative wound healing in urogenital area and with low cost.
[Mh] Termos MeSH primário: Bandagens
Doenças do Pênis/cirurgia
Pênis/cirurgia
Poliuretanos/uso terapêutico
Anormalidades Urogenitais/cirurgia
Cicatrização
[Mh] Termos MeSH secundário: Adolescente
Criança
Pré-Escolar
Epispadia/cirurgia
Seres Humanos
Hipospadia/cirurgia
Masculino
Meia-Idade
Induração Peniana/cirurgia
Fimose/cirurgia
Período Pós-Operatório
Resultado do Tratamento
Técnicas de Fechamento de Ferimentos
[Pt] Tipo de publicação:CLINICAL TRIAL; CLINICAL TRIAL, PHASE II; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Polyurethanes)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160921
[St] Status:MEDLINE


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[PMID]:27593920
[Au] Autor:Mishra P; Rajendran S; Asimakidou M; Mushtaq I
[Ad] Endereço:Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
[Ti] Título:Kelly procedure for male primary epispadias.
[So] Source:J Pediatr Urol;12(4):212.e1-2, 2016 Aug.
[Is] ISSN:1873-4898
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Primary epispadias is a rare congenital malformation involving the urogenital system. In patients with epispadias, bladder closure enhances bladder growth and continence. METHODS: Several steps were carried out to bring the bladder neck to the midline and allow tension-free bladder neck reconstruction and recreation of the natural angulation of urethra. The urethral plate and penile shaft were dissected and the corpora cavernosa separated, and then the bladder neck repair was performed. The urethral plate was tubularised and brought ventrally. The separated corpora were reapposed, avoiding torsion. The skin was reoriented to provide cover to the penis. RESULTS: The Kelly procedure improves cosmesis and continence by reconstructing a tension-free bladder neck repair and lengthening the penis. CONCLUSION: The video demonstrates the Kelly procedure for primary epispadias in a male child.
[Mh] Termos MeSH primário: Epispadia/cirurgia
[Mh] Termos MeSH secundário: Criança
Seres Humanos
Masculino
Pênis/cirurgia
Uretra/cirurgia
Bexiga Urinária/cirurgia
Procedimentos Cirúrgicos Urológicos Masculinos/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE; VIDEO-AUDIO MEDIA
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170420
[Lr] Data última revisão:
170420
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160906
[St] Status:MEDLINE


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[PMID]:27522307
[Au] Autor:Jacobs R; Boyd L; Brennan K; Sinha CK; Giuliani S
[Ad] Endereço:Department of Paediatric and Neonatal Surgery, St. George's University Hospitals NHS Foundation Trust, London SW17 0QT, United Kingdom.
[Ti] Título:The importance of social media for patients and families affected by congenital anomalies: A Facebook cross-sectional analysis and user survey.
[So] Source:J Pediatr Surg;51(11):1766-1771, 2016 Nov.
[Is] ISSN:1531-5037
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: We aimed to define characteristics and needs of Facebook users in relation to congenital anomalies. METHODS: Cross-sectional analysis of Facebook related to four congenital anomalies: anorectal malformation (ARM), congenital diaphragmatic hernia (CDH), congenital heart disease (CHD) and hypospadias/epispadias (HS/ES). A keyword search was performed to identify relevant Groups/Pages. An anonymous survey was posted to obtain quantitative/qualitative data on users and their healthcare needs. RESULTS: 54 Groups and 24 Pages were identified (ARM: 10 Groups; CDH: 9 Groups, 7 Pages; CHD: 32 Groups, 17 Pages; HS/ES: 3 Groups), with 16,191 Group members and 48,766 Page likes. 868/1103 (79%) of respondents were parents. Male:female ratio was 1:10.9. 65% of the users were 26-40years old. Common reasons for joining these Groups/Pages included: seeking support, education, making friends, and providing support to others. 932/1103 (84%) would like healthcare professionals (HCPs) to actively participate in their Group. 31% of the respondents felt that they did not receive enough support from their healthcare system. 97% of the respondents would like to join a Group linked to their primary hospital. CONCLUSIONS: Facebook Groups/Pages related to congenital anomalies are highly populated and active. There is a need for HCPs and policy makers to better understand and participate in social media to support families and improve patient care.
[Mh] Termos MeSH primário: Atitude Frente à Saúde
Anormalidades Congênitas
Pais/psicologia
Mídias Sociais
Apoio Social
[Mh] Termos MeSH secundário: Adulto
Malformações Anorretais
Estudos Transversais
Epispadia
Feminino
Cardiopatias Congênitas
Hérnias Diafragmáticas Congênitas
Seres Humanos
Hipospadia
Masculino
Pesquisa Qualitativa
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1702
[Cu] Atualização por classe:170201
[Lr] Data última revisão:
170201
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160815
[St] Status:MEDLINE


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[PMID]:27499279
[Au] Autor:Giutronich S; Scalabre A; Blanc T; Borzi P; Aigrain Y; O'Brien M; Mouriquand PD; Heloury Y
[Ad] Endereço:Department of Paediatric Urology, Royal Children's Hospital, Flemington Road, Parkville, VIC, Australia. Electronic address: sgiutronich@me.com.
[Ti] Título:Spontaneous bladder rupture in non-augmented bladder exstrophy.
[So] Source:J Pediatr Urol;12(6):400.e1-400.e5, 2016 Dec.
[Is] ISSN:1873-4898
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Bladder perforation is not commonly described in bladder exstrophy patients without bladder augmentation. The goal of this study was to identify the risk factors of spontaneous perforation in non-augmented exstrophy bladders. METHODS: The study was a retrospective multi-institutional review of bladder perforation in seven male and two female patients with classic bladder exstrophy-epispadias (E-E). RESULTS: Correction of E-E was performed using Kelly repair in two and staged repair in seven (Table). Bladder neck repair was performed in eight patients at a mean age of 6 years. Three patients had additional urethral surgery. Before rupture, six patients were voiding only per urethra. Two patients were voiding urethrally but were also performing occasional CIC via a Mitrofanoff. One patient was performing CIC 3 hourly per urethra. Six were dry during the day. Six of the patients had lower urinary tract symptoms: five had frequency and four were straining to void. Two had suffered episodes of urinary retention. Pre-rupture ultrasound showed that the upper urinary tract was dilated in four patients. Micturating cystourethrogram was performed in six showing vesico-ureteral reflux in five. Two had urethral stenosis. Nuclear medicine was done in three patients with two abnormal differential function. Urodynamics was performed in two patients with low capacity (100 mL) and hypocompliant (<10) bladders. Both had high leak point pressures: 60 cmH O at 100 mL. The mean age at rupture was 11 years, with a range of 5-20 years. Patients presented with abdominal pain, associated with signs of intestinal obstruction in seven and fever in two. Eight patients underwent laparotomy and one prolonged drainage via SPC. Simple closure was performed in seven and bladder neck closure in one, because of extension of the rupture inferiorly. All patients recovered well. Following rupture, five underwent augmentation and Mitrofanoff. One of these suffered a recurrent rupture. Two other patients refused augmentation and Mitrofanoff and one of these has since had a subsequent rupture. CONCLUSIONS: The limitations of this series include the small number of patients and its retrospective nature, without knowledge of the incidence. Bladder rupture is a risk even in non-augmented bladder exstrophy. It is potentially life-threatening and most often requires laparotomy. Rupture occurs because of poor bladder emptying and/or high pressure. Urodynamics may identify those at risk. CIC with or without augmentation should not be delayed once poor bladder emptying and/or high pressure are identified.
[Mh] Termos MeSH primário: Extrofia Vesical/complicações
Doenças da Bexiga Urinária/etiologia
[Mh] Termos MeSH secundário: Adolescente
Criança
Pré-Escolar
Epispadia/complicações
Feminino
Seres Humanos
Masculino
Estudos Retrospectivos
Medição de Risco
Fatores de Risco
Ruptura Espontânea
Doenças da Bexiga Urinária/epidemiologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171002
[Lr] Data última revisão:
171002
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160809
[St] Status:MEDLINE



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