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.
原创: 十六点五 中山二院糖尿病足中心
糖尿病足的预防是各种指南中最重要的部分,无论是国内还是国外的,在各版的IWGDF指南都是重要内容,而且说明得特别详细及有比较多得循证医学的证据支持。但比较几个版本的IWGDF指南及国内外其他指南,这部分是肯定存在的,从中可以看出“糖尿病足的预防”已经深入人心。
糖尿病足实质上就是一种糖尿病人足部出现难以愈合的皮肤慢性溃疡,如何使糖尿病人足部皮肤慢性溃疡愈合是糖尿病足治疗的中心,因此,围绕足部皮肤慢性溃疡愈合是糖尿病足治疗的中心环节。
IWGDF(The International Working Group on the Diabetic Foot)是一个以欧美从事糖尿病足工作的专家为主的,有其他大洲有关专家共同组成的,目前国际上有关糖尿病足的预防、诊断、治疗、研究、管理等方面最专业的国际组织之一(基本上没有之一)。
脓腔切开,3型安尔碘纱布填塞一天之后,重新打开伤口,进行第二次清创,这次清创也是非常重要的。一般需要完成三个任务:探查创面、鉴别坏死及感染的组织、仔细清除各种需要清除的组织。
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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