Retroperitoneal and Transperitoneal Robot-Assisted Pyeloplasty in Adults: Techniques and Results

Abstract
Background

The surgical management of ureteropelvic junction obstruction (UPJO) has dramatically evolved over the past 20 yr due to the development of new technology.
Objective

Our aim was to report the feasibility and efficacy of robot-assisted pyeloplasty (RAP) performed by either the retroperitoneal or the transperitoneal approach.
Design, setting, and participants

A stage 2 investigative study was conducted including development (stage 2a) and exploration (stage 2b) of transperitoneal and retroperitoneal RAP performed in 55 patients at an urban tertiary university department of urology.
Surgical procedure

Retroperitoneal RAP was performed with the patient in full flank position using a 12-mm Hasson-style optical port at the tip of the 12th rib, plus two operative 8-mm robotic trocars and an assistant 5-mm port. The stenotic ureteropelvic junction was excised, the ureter was spatulated, and a dismembered pyeloplasty was performed in all cases. Transperitoneal RAP was performed with the patients in the 60° flank position. The optical port is in the umbilical area, plus two 8-mm operative robotic ports and one 5-mm assistant port. The pyeloplasty technique is similar to the retroperitoneoscopic approach. In both groups, the stent can be positioned in an anterograde or retrograde fashion.
Measurements

Success consisted of no evidence of obstruction on computed tomography urography or mercaptoacetyltriglycine-3 diuretic renal scan, no postoperative symptoms, and no further treatment.
Results and limitations

Thirty-six patients underwent retroperitoneoscopic RAP and 19 transperitoneal RAP for UPJO. All the procedures were completed with robotic assistance. The overall objective success (measured by diuretic renal scan and/or imaging techniques) was 96% with two cases of recurrence (both in the retroperitoneal group). The main limitation was the short follow-up, although all patients reached at least a 6-mo follow-up.
Conclusions

RAP performed either retroperitoneally or transperitoneally was revealed as a feasible and reproducible surgical option for the treatment of UPJO, offering a subjective optimal plasty reconfiguration at short follow-up.
Take Home Message

Robot-assisted pyeloplasty can be performed both with the transperitoneal and retroperitoneal approaches and represents the ideal surgical procedure to be performed robotically because the dissection phase is limited and precise suturing is required during reconstruction.

Readmore..

duloxetine untuk ringan sampai sedang Postprostatectomy Inkontinensia: Hasil Awal dari acak, Placebo-Controlled Trial

Duloxetine for Mild to Moderate Postprostatectomy Incontinence: Preliminary Results of a Randomised, Placebo-Controlled Trial

Abstract

Background

Duloxetine is effective in the management of stress urinary incontinence (SUI) in women but has been poorly evaluated in the treatment of SUI following radical prostatectomy (RP).

Objective

To establish the superiority of duloxetine over placebo in SUI after RP.

Design, setting, and participants

We conducted a prospective, randomised, placebo-controlled, double-blind, monocentric superiority trial. After a placebo run-in period of 2 wk, patients with SUI after RP were randomised to receive either 80 mg of duloxetine daily or matching placebo for 3 mo.

Measurements

The primary outcome measure was the relative variation in incontinence episodes frequency (IEF) at the end of study compared to baseline. Secondary outcomes included quality of life (QoL) measures (Incontinence Impact Questionnaire Short Form [IIQ-SF], Urogenital Distress Inventory Short Form [UDI-SF], Incontinence Quality of Life [I-QoL]), symptom scores (Urinary Symptom Profile [USP] questionnaire, International Consultation on Incontinence/World Health Organisation Short Form questionnaire [ICIQ-SF], the Beck Depression Inventory [BDI-II] questionnaire), 1-h pad test, and assessment of adverse events.

Results and limitations

Thirty-one patients were randomised to either the treatment (n = 16) or control group (n = 15). Reduction in IEF was significant with duloxetine compared to placebo (mean ± standard deviation [SD] variation: −52.2% ± 38.6 [range: −100 to +46] vs +19.0% ± 43.5 [range: −53 to +104]; mean difference: 71.2%; 95% confidence interval [CI] for the difference: 41.0–101.4; p <>p = 0.006, p = 0.02, p = 0.0004, and p = 0.003, respectively). Both treatments were well tolerated throughout the study period.

Conclusions

Duloxetine is effective in the treatment of incontinence symptoms and improves QoL in patients with SUI after RP.

Take Home Message

Duloxetine at a daily dose of 80 mg improves symptoms compared to placebo in the management of stress urinary incontinence after radical prostatectomy.

Keywords: Duloxetine, Urinary incontinence, Stress, Prostatectomy, Randomised controlled trial.

Abstrak
Latar belakang

Duloxetine efektif dalam pengelolaan stres inkontinensia urin (SUI) pada wanita tetapi telah buruk dievaluasi dalam pengobatan SUI berikut prostatektomi radikal (RP).
Tujuan

Untuk membangun keunggulan duloxetine atas plasebo pada SUI setelah RP.
Desain, pengaturan, dan peserta

Kami melakukan, prospektif acak, plasebo-terkontrol, buta ganda, sidang keunggulan monocentric. Setelah plasebo lari-dalam jangka waktu 2 minggu, pasien dengan SUI setelah RP secara acak untuk menerima 80 mg plasebo harian atau pencocokan duloxetine selama 3 mo.
Pengukuran

Ukuran hasil primer adalah variasi relatif pada frekuensi episode inkontinensia (IEF) pada akhir penelitian dibandingkan dengan baseline. Hasil sekunder termasuk kualitas hidup (kualitas hidup) mengukur (Inkontinensia Dampak Formulir Kuesioner Pendek [IIQ-SF], urogenital Distress Inventory Formulir Pendek [UDI-SF], Inkontinensia Kualitas Hidup [I-kualitas hidup]), skor gejala (urin Gejala Profil [USP] kuesioner, Internasional Konsultasi Inkontinensia Kesehatan / kuesioner Dunia Organisasi Short Form [ICIQ-SF], Beck Depression Inventory [BDI-II] kuesioner), uji pad 1-jam, dan penilaian efek samping.
Hasil dan keterbatasan

Tiga puluh satu pasien diacak untuk baik pengobatan (n = 16) atau kelompok kontrol (n = 15). Pengurangan IEF adalah signifikan dengan duloxetine dibandingkan dengan plasebo (rata-rata ± standar deviasi [SD] variasi: -52,2% ± 38,6 [range: -100 sampai 46] vs 19,0% ± 43,5 [jangkauan: -53 ke 104]; berarti perbedaan: 71,2%, 95% confidence interval [CI] untuk perbedaan tersebut: 41,0-101,4; p <0,0001).>IIQ-SF total skor, skor total UDI-SF, SUI subscore dari kuesioner USP, dan pertanyaan 3 dari kuesioner ICIQ-SF menunjukkan perbaikan pada kelompok duloxetine (p = 0,006, p = 0,02, p = 0,0004, dan p = 0,003, masing-masing). Kedua perlakuan ditoleransi dengan baik selama periode penelitian.
Kesimpulan

Duloxetine efektif dalam pengobatan gejala inkontinensia dan meningkatkan kualitas hidup pada pasien dengan SUI setelah RP.
Ambil pesan Depan

Duloxetine pada dosis harian 80 mg memperbaiki gejala dibandingkan dengan plasebo dalam pengelolaan stres inkontinensia urin setelah prostatektomi radikal.

Kata kunci: Duloxetine, inkontinensia urin, Stress, prostatectomy, acak controlled trial.
Pasal Outline

Readmore..

Fungsi TRUS untuk memandu injeksi transperineal toxin botulinum ke sphincter urethra eksterna pada dissenergi sfingter detrusor eksterna

Tujuan: Untuk mengevaluasi efek dari tunggal trans-rektal,USG yang dipandu (TRUS-dipandu) injeksi trans-perineumtoksin botulinum A (Bont / A) ke uretra eksternal sphincter (EUS) untuk mengobati sfingter detrusor eksternal dyssynergia (DESD).

Bahan dan cara: Pasien (N = 18) dengan supra-sakral sumsum tulang belakang cedera yang telah DESD dikonfirmasi pada videourodynamic studi. Dosis tunggal 100 IU Bont / A diterapkan ke dalam sfingter uretra eksternal melalui trans-rektal injeksi dipandu USG-rute trans-perineum. Maksimal detrusor tekanan, tekanan kebocoran-titik detrusor, terintegrasi
elektromiografi, tekanan maksimal pada uretra statis tekanan profilometry dan pasca-void residual.

Hasil: Terdapat penurunan yang signifikan pada terpadu elektromiografi (EMG) dan uretra statis dan dinamis tekanan, tapi tidak dalam tekanan detrusor dan leakpoint detrusor tekanan setelah pengobatan. Pasca-berkemih juga residual menurun secara signifikan dalam 1 dan 2 bulan setelah perlakuan (p <0,012). class="fullpost">

Readmore..

Baksos Katarak: Surabaya Eye Clinic (SEC) dalam rangka World Sight Day

Tgl 31 Oktober 2010, SEC (Surabaya Eye Clinic) akan mengadakan baksos katarak dalam rangka World Sight Day.

Jadi jika ada kenalan/tetangga/saudara/pasien di kliniknya yang butuh operasi katarak tapi kurang mampu masalah biaya bisa diikutkan di sini.

Syarat : Membawa Surat Keterangan Tidak Mampu dari RT/RW setempat, sebelum tanggal 31 Oktober 2010 sudah mengikuti screening di SEC (sebelumnya janjian dulu untuk screening)

Kalo ada daftarkan aja ke Mbak Rinto telp 031-8433050 (no kantor SEC).

Readmore..

Operasi katarak, bibir sumbing GRATIS dan PAKET HEMAT OPERASI HERNIA

Dalam rangka Milad ke 8 RS Muhammadiyah Surabaya bekerjasama dengan PT Pelabuhan Indonesia III mengadakan program:

1. OPERASI KATARAK GRATIS
2. OPERASI BIBIR SUMBING GRATIS
3. PAKET HEMAT OPERASI HERNIA

SYARAT OPERASI KATARAK DAN BIBIR SUMBING :

1. Berlaku Umum
2. Menyerahkan fotokopi KTP dan KK
3. Menyerahkan fotokopi kartu GAKIN/JAMKESMAS atau Surat Keterangan Miskin dari kelurahan (bila tidak memiliki)
4. Mengisi form survey peserta yang telah disediakan oleh RS Muhammadiyah Surabaya

PENDAFTARAN : OKTOBER 2010
PELAKSANAAN : NOVEMBER 2010

untuk informasi lebih lanjut hubungi:
Bagian Humas dan Pemasaran RS Muhammadiyah Surabaya
Jl.KH Mas Mansyur no 180 - 182
Telp 031 3522980, 3570974, 91960269

Readmore..

Learning Series Urology: Urinary Tract Stones

DIAGNOSIS

Anamnesis
Patients with urinary tract stones have a complaint that vary from without complaint, mild back pain with colic, dysuria, hematuria, urinary retention, anuria. These complaints may be accompanied by complications include fever, signs of kidney failure.

PHYSICAL EXAMINATION
Physical examination of patients with urinary tract stones can vary from no physical abnormalities until signs of severe illness depending on the location of the stones and complications caused.
A general physical examination: hypertension, febrile, anemia, shock
Urology specific physical examination
o Angle kosto vertebrae: tender, painful word of the kidney, renal enlargement
o Supra symphysis: tender, palpable stone, full jar
o External Genitalia: palpable stone in the urethra
o Plug Anal: palpable stone in the bladder (bimanual palpation)

LABORATORY EXAMINATION
Routine urine tests to see eritrosituri, lekosituria, bacteriuria (nitrite), pH of urine and urine culture. Blood tests in the form of hemoglobin, leukocyte, urea and creatinine.

IMAGE
Clinical diagnosis should be supported by appropriate imaging procedures.
Routine examination included a plain photo abdomen (KUB) and ultrasonography or intravenous pyelography (IVP) or spiral CT.1, 2.3 IVP examination should not be performed in patients with the following:
• By contrast media allergy
• With serum creatinine levels> 200μmol / L (> 2mg/dl)
• In the treatment metformin
• With myelomatosis

Special examination could involve:
• retrograde or antegrade pyelography
• Scintigraphy

Readmore..

Do U Know about Eritroplasia Queyrat

1. Eritroplasia Queyrat is a colored area velvety redness of the penis, usually above or at the base of the glans penis.
2. This usually occurs in men who are not circumcised.
3. If not treated can turn into malignancy.
4. Given a cream containing fluorouracil.
5. Because of potential malignancy, then the disorder should be checked every few months during and after treatment.
6. Another treatment that can be done is to remove the abnormal tissue surgically.
   

Readmore..

therapy of balantis xerotica obliterans

BXO or Balanitis xerotica obliterans is a condition causing scarring and thickening (sclerosis) of the penis skin.

The good news is that most cases of BXO are effectively treated by the application of topical corticosteroid cream two to four times daily for one or two months.

BXO has also been reported as responding to topical testosterone or carbon dioxide laser treatment. One report in the medical literature shows that long term antibiotic treatment is effective, but it is unclear why this should be so.

Affected men can develop narrowing of the exit of the tube from the bladder (urethral opening). Constriction of the foreskin (phimosis can also occur. However, the latter doesn't apply to you as you have had a circumcision.

Readmore..