Rohan G. Bhalla a , Belinda Li b,d, *, Mark C. Adams b , Wallace W. Neblett c , John C. Thomas b
Summary
Objective
To describe our experience with robot-assisted laparoscopic transperitoneal repair of a congenital rectourethral fistula in a pediatric patient with a urethral duplication.
Methods
The patient is a 2-year-old male with a past medical history of Tetralogy of Fallot presenting with a febrile urinary tract infection (UTI). He was diagnosed with urethral duplication and a rectourethral fistula by voiding cystourethrogram (VCUG). The parents were counseled on various options and agreed to proceed with a robotic repair.
Results
Robotic-assisted transperitoneal rectourethral fistula repair was performed. The procedure time was 229 min with an estimated blood loss (EBL) of 15 mL. His postoperative course was unremarkable. At his 2- week follow-up, the urethral catheter was removed and the patient was voiding normally and having normal bowel movements.
Conclusion
Congenital rectourethral fistula with urethral duplication is a rare anomaly with only a few reports in the literature. Pediatric robotic-assisted trans-peritoneal rectourethral fistula repair is a technically feasible approach in infants with minimal morbidity that allows for excellent visualization and avoids open repair.
Antonio Macedo Jr a,b , Se´rgio Leite Ottoni b , Paula Cartaxo Barros Camilato b , Hugo Santiago Crespo Ganchozo b , Gilmar Garrone b , Ricardo de Mattos Marcondes b , Marcela Leal da Cruz b, *
Introduction
Diphallia is a rare anomaly. It has a range of appearances from a small accessory penile to complete duplication.
We present a 2 year-old boy with complete penile duplication. The left penile was the largest. NMR (Nuclear Magnetic Resonance) suggested one corporal body for each penile and VCUG (Voiding Cystourethrogram) showed a normal urethra in the right penile and stricture at glandular and mid penile urethra of the left penis. A Y confluence to bulbar urethra was observed confirming only one prostate and bladder.
The cystoscopy through the right penile identified the urethral confluence in the bulbar area. We performed a meatotomy in the left penile to insert the cystoscope and confirmed the blind ending urethra. We decided to remove this penile. The penile was degloved entirely and clamped and took out the corpora at the base.
Discussion
Diphallia can have three presentations: only glans duplication, bifid diphallia and complete diphallia (two corpora cavernosa and a corpus spongiosum for each penile). In our case, each penile presented only one corpora cavernosa and the decision taken was based on urethral patency.
The treatment should always be planned individually whereas associated anomalies with the goal of attaining satisfactory functional and cosmetic.
创伤是指由于各种致伤因素导致的机体软组织、骨骼甚至内脏器官等等各个系统的损伤,创伤可以根据发生地点、受伤部位、受伤组织、致伤因素及皮肤完整程度进行分类。 按发生地点分为战争伤、工业伤、农业伤、交通伤、体育伤、生活伤等;按受伤部位分为颅脑创伤、胸部创伤、腹部创伤、各部位的骨折和关节脱位、手部伤等;按受伤类型分为骨折、脱位、脑震荡、器官破裂等;相邻部位同时受伤者称为联合伤(如胸腹联合伤);按受伤的组织或器官分类时,又可按受伤组织的深浅分为软组织创伤、骨关节创伤和内脏创伤。软组织创伤指皮肤、皮下组织和肌肉的损伤,也包括行于其中的血管和神经。单纯的软组织创伤一般较轻,但广泛的挤压伤可致挤压综合征。血管破裂大出血亦可致命。骨关节创伤包括骨折和脱位,并按受伤的骨或关节进一步分类并命名。如股骨骨折、肩关节脱位等。内脏创伤又可按受伤的具体内脏进行分类和命名。如脑挫裂伤、肺挫伤、肝破裂等。同一致伤原因引起两个以上部位或器官的创伤,称为多处伤或多发伤。按致伤因素,分为火器伤、切伤、刺伤、撕裂伤、挤压伤、扭伤、挫伤等。按皮肤完整程度,分为闭合性创伤、开放性创伤等。
伤口世界平台生态圈,以“关爱人间所有伤口患者”为愿景,连接、整合和拓展线上和线下的管理慢性伤口的资源,倡导远程、就近和居家管理慢性伤口,解决伤口专家的碎片化时间的价值创造、诊疗经验的裂变复制、和患者的就近、居家和低成本管理慢性伤口的问题。
2019广东省医疗行业协会伤口管理分会年会
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