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BioMed Research International 2020It is currently unknown whether an association exists between polypropylene mesh and urethral diverticulum formation following placement of polypropylene midurethral... (Review)
Review
AIMS
It is currently unknown whether an association exists between polypropylene mesh and urethral diverticulum formation following placement of polypropylene midurethral slings (MUS) for the treatment of stress urinary incontinence (SUI). We aimed to examine the literature associating MUS with the occurrence of urethral diverticula.
METHODS
Multiple online research databases, including PubMed, Google Scholar, EBSCOhost, and the Cochrane Library, were searched, from January 2019 to February 2019, for evidence related to the occurrence of urethral diverticula following polypropylene MUS procedures.
RESULTS
Four case reports were published demonstrating the occurrence of urethral diverticula following the use of polypropylene mesh for surgical treatment of SUI. Subjects of these cases were menopausal and had an elevated body mass index (BMI), recurrent urinary tract infections (UTIs), autoimmune conditions, or prior pelvic floor surgeries. A thorough urologic workup, including imaging prior to sling placement, was not always performed.
CONCLUSION
No clear association exists between polypropylene MUS placement and subsequent urethral diverticulum formation. Factors that diminish polypropylene mesh biocompatibility include elevated BMI, menopause, recurrent UTIs, prior pelvic surgeries, and preexisting medical conditions. Symptoms associated with urethral diverticula should prompt a complete urologic workup prior to MUS placement.
Topics: Adult; Diverticulum; Humans; Middle Aged; Polypropylenes; Suburethral Slings; Surgical Mesh; Urethral Diseases; Urinary Incontinence, Stress
PubMed: 32462011
DOI: 10.1155/2020/6761581 -
BMC Urology Aug 2022At present, there is no specific research on the factors affecting the success rate of urethroplasty in patients with DSD. The purpose of this study is to explore the... (Review)
Review
BACKGROUND
At present, there is no specific research on the factors affecting the success rate of urethroplasty in patients with DSD. The purpose of this study is to explore the factors affecting the success of urethroplasty in DSD patients, and to provide some reference for the surgical treatment of DSD patients undergoing urethroplasty.
METHOD
We reviewed patients with DSD who underwent urethroplasty from January 2016 to December 2019 retrospectively. Patients were divided into four groups: the successful group, the urethrocutaneous fistula group, the urethral diverticulum group, and the urethral stricture group. Risk factors were determined from the following data included the DSD classification, the age of first operation, length of urethral defect, degree of hypospadias, cryptorchidism, micropenis, gonad type, hormone therapy before operation, transposition of penis and scrotum, surgical strategy, urethral covering material, and postoperative catheter removal time. We explored the difference of each factor between four groups through the comparative study of single factor and multifactor logistic regression analysis of related factors.
RESULT
122 cases were enrolled in this group (n = 122), 12 cases were lost to follow-up. Median follow-up was 28 months (12-55 months).We found the success rate of operation decreased with longer urethral defect (B = - 0.473, P = 0.005). The success rate of operation was higher in staged operation and TPIT (TPIT = Transverse Preputial Island Tube operation)-related operation than primary operation (B = 1.238, P = 0.006) and TPIT-nonrelated operation (B = 2.293, P = 0.001). Although there was a significant difference between the age of the first operation and the occurrence of urethrocutaneous fistula (P = 0.006 < 0.05), there was no significant difference in logistic regression analysis (P = 0.161 > 0.05). The incidence of urethrocutaneous fistula was lower in TPIT-related operation than in TPIT-nonrelated operation (B = - 2.507, P = 0.000). The incidence of postoperative urethral diverticulum was lower in staged operation than in primary operation (B = - 1.737, P = 0.015).
CONCLUSION
For patients with disorder of sex development undergoing urethroplasty, the length of urethral defect is an independent risk factor affecting both the success rate of operation and the urethrocutaneous fistula. The age of the first operation has a statistically significant effect on the occurrence of postoperative urethrocutaneous fistula, but it is not an independent factor. Urethrocutaneous fistula is less found in TPIT-related operation in the study. Staged operation is an independent protective factor for postoperative urethral diverticulum compared with one-stage operation but isn't related to urethrocutaneous fistula.
Topics: Diverticulum; Humans; Hypospadias; Male; Postoperative Complications; Retrospective Studies; Urethra; Urethral Stricture; Urologic Surgical Procedures, Male
PubMed: 35948888
DOI: 10.1186/s12894-022-01080-x -
Clinical Journal of Gastroenterology Jun 2023Esophageal epiphrenic diverticulum is a rare condition usually secondary to a primary esophageal motility disorder. Although epiphrenic diverticulum may be treated by... (Review)
Review
Esophageal epiphrenic diverticulum is a rare condition usually secondary to a primary esophageal motility disorder. Although epiphrenic diverticulum may be treated by thoracoscopic and laparoscopic management, the optimal surgical approach have not been established. We successfully treated a left epiphrenic diverticulum along with achalasia and paraesophageal hernia by a planned combination of thoracoscopic and laparoscopic procedures aided by preoperative simulation using three-dimensional imaging. We reviewed a series of 17 reports on esophageal epiphrenic diverticulum that required either planned or unplanned unexpected transthoracic surgery. The main reasons for requiring a transthoracic approach were adhesions, site and size of the diverticulum, and length of the diverticulum neck. Unplanned procedure changes were required in 12 of the 114 cases for a conversion rate of 10.5%. Diverticulectomy, myotomy, and fundoplication were the most common surgical treatments administered at 42.6%. Based on literature review and our experience, we have developed a flowchart to identify the characteristics of epiphrenic diverticulum cases that require a transthoracic approach. This flowchart can help to determine therapeutic strategies and the optimal surgical approach to esophageal epiphrenic diverticulum treatment and may reduce unplanned changes in the surgery.
Topics: Humans; Diverticulum, Esophageal; Esophageal Achalasia; Esophageal Motility Disorders; Diverticulum; Fundoplication; Laparoscopy
PubMed: 36723767
DOI: 10.1007/s12328-023-01765-2 -
The Journal of Craniofacial Surgery Oct 2023Pharyngoesophageal diverticula are rare causes of dysphagia. Zenker's diverticulum is the most common type, followed by Killian-Jamieson diverticulum. A 44-year-old male...
Pharyngoesophageal diverticula are rare causes of dysphagia. Zenker's diverticulum is the most common type, followed by Killian-Jamieson diverticulum. A 44-year-old male presented to our clinic with a longstanding history of dysphagia and globus sensation. Bilateral pharyngoesophageal diverticula were confirmed by imaging CT and esophagogastroscopy. He underwent transcervical resection, and a right Killian-Jamieson diverticulum was observed during surgery. The left diverticulum was found to originate above the cricopharyngeus muscle and was labeled as Zenker's diverticulum. Bilateral pharyngoesophageal diverticula are rare, and physicians should be aware of the variable clinical presentations and management options for pharyngoesophageal diverticula.
Topics: Male; Humans; Adult; Zenker Diverticulum; Deglutition Disorders; Diverticulum; Physicians
PubMed: 37357348
DOI: 10.1097/SCS.0000000000009434 -
Balkan Medical Journal Apr 2020
Topics: Child, Preschool; Female; Humans; Intestinal Obstruction; Meckel Diverticulum
PubMed: 31937023
DOI: 10.4274/balkanmedj.galenos.2020.2019.11.23 -
BMJ Case Reports Mar 2021Meckel's diverticulum is the most common intestinal congenital defect, its prevalence is 0.2%-4.0% and it occurs more commonly in children younger than 2-year old with...
Meckel's diverticulum is the most common intestinal congenital defect, its prevalence is 0.2%-4.0% and it occurs more commonly in children younger than 2-year old with intestinal bleeding and abdominal pain. Perforation in the elderly is very rare with no more than 35 articles reported worldwide. Here we report the case of a 62-year-old man who was admitted to hospital with a history of acute abdominal pain with a 20-day onset. The patient was treated with laparotomy and 30 cm ileal resection was performed for an 8×5 cm perforated ileum tumour at 50 from ileocecal valve with a side-to-side mechanical anastomosis for reconstruction. Having morbidity Clavien-Dindo scale I in postsurgical and good outcome in 6-month follow-up. Meckel's diverticulum is an infrequent pathology in paediatric and even rarer in adult population, however, it is always important to keep in mind how to act when is seen either as a finding or as a complication.
Topics: Abdominal Pain; Adult; Aged; Child; Child, Preschool; Gastrointestinal Hemorrhage; Humans; Ileocecal Valve; Laparotomy; Male; Meckel Diverticulum; Middle Aged
PubMed: 33782062
DOI: 10.1136/bcr-2020-237840 -
Journal of the American College of... Mar 2023An aberrant subclavian artery (ASA) (or lusoria) is the most common congenital anomaly of the aortic arch (0.5%-2.2%; female-to-male ratio 2:1 to 3:1). ASA can become...
BACKGROUND
An aberrant subclavian artery (ASA) (or lusoria) is the most common congenital anomaly of the aortic arch (0.5%-2.2%; female-to-male ratio 2:1 to 3:1). ASA can become aneurysmal and result in dissection, involving Kommerell's diverticulum when present and the aorta. Data of its significance in genetic arteriopathies are not available.
OBJECTIVES
The purpose of this study was to assess the prevalence and complications of ASA in gene-positive and -negative nonatherosclerotic arteriopathies.
MATERIALS
The series includes 1,418 consecutive patients with gene-positive (n = 854) and gene-negative arteriopathies (n = 564) diagnosed as part of institutional work-up for nonatherosclerotic syndromic and nonsyndromic arteriopathies. Comprehensive evaluation includes genetic counseling, next-generation sequencing multigene testing, cardiovascular and multidisciplinary assessment, and whole-body computed tomography angiography.
RESULTS
ASA was found in 34 of 1,418 cases (2.4%), with a similar prevalence in gene-positive (n = 21 of 854, 2.5%) and gene-negative (n = 13 of 564, 2.3%) arteriopathies. Of the former 21 patients, 14 had Marfan syndrome, 5 had Loeys-Dietz syndrome, 1 had type-IV Ehlers-Danlos syndrome, and 1 had periventricular heterotopia type 1. ASA did not segregate with genetic defects. Dissection occurred in 5 of 21 patients with genetic arteriopathies (23.8%; 2 Marfan syndrome and 3 Loeys-Dietz syndrome), all with associated Kommerell's diverticulum. No dissections occurred in gene-negative patients. At baseline, none of the 5 patients with ASA dissection fulfilled criteria for elective repair according to guidelines.
CONCLUSIONS
The risk of complications of ASA is higher in patients with genetic arteriopathies and is difficult to predict. In these diseases, imaging of the supra-aortic trunks should enter baseline investigations. Determination of precise indications for repair can prevent unexpected acute events such as those described.
Topics: Humans; Male; Female; Marfan Syndrome; Loeys-Dietz Syndrome; Prevalence; Vascular Diseases; Subclavian Artery; Heart Defects, Congenital; Aorta, Thoracic; Diverticulum
PubMed: 36889877
DOI: 10.1016/j.jacc.2023.01.005 -
International Journal of Surgery Case... Aug 2022Though Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, it is uncommon in the general population and rare in adults. Its...
INTRODUCTION
Though Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, it is uncommon in the general population and rare in adults. Its preoperative diagnosis is challenging. While obstruction is the commonest complication, its occurrence with gangrenous Meckel's diverticulum is rare. The aim of this presentation is to report this combination and to create awareness among surgeons and radiologists to increase preoperative diagnosis of Meckel's diverticulum preventing morbidity and mortality from delay in intervention.
PRESENTATION OF THE CASE
A twenty-years-old male presented with periumblical pain that later shifted to lower abdomen, vomiting and fever of 10 h durations. He has no history of smoking or diabetes. Physical examination showed tachycardia, fever, and lower abdominal tenderness. Exploratory laparotomy revealed gangrenous Meckel's diverticulum and ileal obstruction by a band arising from the tip of diverticulum to ileal mesentery. We did segmental resection of the ileum containing Meckel's diverticulum and end-to-end anastomosis with the excellent outcome.
DISCUSSION
Preoperative diagnosis of Meckel's diverticulum is challenging because of non-specific clinical presentations and less sensitivity and specificity of imaging investigations. A high index of suspicion can improve its diagnosis. Axial torsion with gangrenous Meckel's diverticulum is the rarest complication. Management of symptomatic Meckel's diverticulum is surgery. Treatment of silent Meckel's diverticulum is controversial with no strong evidence to treat or not to treat.
CONCLUSION
Gangrenous Meckel's diverticulum causing small bowel obstruction is rare. Surgeons must have a high index of suspicion to increase preoperative diagnosis of complicated Meckel's diverticulum.
PubMed: 35863288
DOI: 10.1016/j.ijscr.2022.107419 -
Anatomical Record (Hoboken, N.J. : 2007) Oct 2022Crocodylia has an extensive epithelial pneumatic space in the middle ear, paratympanic sinus system. Although fossil and extant crocodylian paratympanic sinus systems...
Crocodylia has an extensive epithelial pneumatic space in the middle ear, paratympanic sinus system. Although fossil and extant crocodylian paratympanic sinus systems have been studied recently using the computed tomography (CT) and three-dimensional (3D) reconstruction data, due to the soft tissue nature of the pneumatic system and presence of its surrounding soft tissue structures, some boundaries, and definitions of each extension remain ambiguous. We describe the comprehensive paratympanic sinus system in posthatched alligator using soft tissue enhanced CT data with 3D reconstructions. The data are compared to the available data to discuss the ontogenetic pattern in alligator. We introduce further divided entities of the pneumatic system based on their associated bony and soft tissue structures and epithelial membrane and clarify the pneumatic terminologies. We then re-visit the potential homology of the paratympanic sinus in Archosauria. Epithelial boundaries of the ventral portion of the pneumatic system from the histological data suggest that the dual origin of the basioccipital diverticulum derived from the tympanic sinus and basicranial diverticulum medially. The presence of the epithelial boundary and pneumatic changes in ontogeny suggests that the middle ear may function differently in developmental stages. Lastly, a morphogenetic tree is constructed to help future work of comparative developmental studies of the paratympanic sinus system between crocodiles and birds.
Topics: Alligators and Crocodiles; Animals; Birds; Diverticulum; Ear, Middle; Tympanic Membrane
PubMed: 35591791
DOI: 10.1002/ar.24932 -
Revista Espanola de Enfermedades... Dec 2023A 72-year-old woman was referred from primary care to the gastroenterology clinic because of heartburn and occasional dysphagia for the last 8 years, with some isolated...
A 72-year-old woman was referred from primary care to the gastroenterology clinic because of heartburn and occasional dysphagia for the last 8 years, with some isolated food regurgitation events and no other warning signs; she is currently asymptomatic on omeprazole. Gastroscopy revealed a dilated esophagus and food remnants with inability to reach the gastric lumen, which led to the suspicion of achalasia. The study was completed with pH-metry, which found no pathological reflux; esophageal manometry, with absence of esophageal motor abnormalities; and barium swallow, which revealed a large diverticulum on the posterior wall of the lower third of the esophagus, which had food remnants but no other changes or evidence of achalasia. Given these findings, a repeat gastroscopy was carried out that revealed a large diverticulum in the distal third of the esophagus that occluded 50 % of the esophageal lumen, with a length of 4-5 cm and abundant semi-liquid food remnants; upon aspiration of the latter a whitish mucosa with erythematous areas was revealed, as well as a 1.5-cm sliding hiatal hernia. No changes were found on advancing to the second duodenal portion. In view of the above findings and symptoms, the patient was referred to the surgery department to be evaluated for diverticulectomy.
Topics: Female; Humans; Aged; Esophageal Achalasia; Diverticulum, Esophageal; Gastroesophageal Reflux; Manometry; Diverticulum
PubMed: 36896915
DOI: 10.17235/reed.2023.9518/2023