Navegando por Autor "Burity, Camila R. T."
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Artigo Laparoscopic bladder diverticulectomy assisted by cystoscopic transillumination(International Braz J Urol, 2014-03) Rebouças, Rafael B.; Monteiro, Rodrigo C.; Souza, Thiago N. S. de; Burity, Camila R. T.; Lisboa, João B. R. M.; Pequeno, Giovanna B. M.; Figueiredo, Luciano G. de; Silva, Emanuel R. M.; Britto, Cesar AraujoInroduction Acquired bladder diverticula are herniations of the bladder mucosa through detrusor muscle. Due to the ineffective emptying of the bladder diverticulum, urine accumulation may lead to urinary tract infection, stone disease, and lower urinary tract malignancy in the diverticulum (1). The symptomatic bladder diverticula may require surgical treatment. Surgical approaches include open operation via an extravesical or a transvesical approach for large diverticula or endoscopically with transurethral fulguration for small diverticula (2). Herein, we present a video of a Laparoscopic Bladder Diverticulectomy for recurrent urinary tract infection, aided by concurrent cystoscopy. Materials and methods Female patient, 37 years old, complaining of recurrent urinary tract infection for three years. A bladder diverticulum was found on ultrasonography. Cystoscopy revealed a posterior right-side diverticulum next to the ipsilateral ureteral ostium. A laparoscopic bladder diverticulectomy with the aid of intraoperative cystoscopy was proposed. Surgical Technique Under general anesthesia, the patient was placed in lithotomy and Trendelenburg position. An umbilical incision was used for pneumoperitoneum creation and insertion of a 10mm trocar. Three other 5mm trocars were inserted at positions equidistant between the navel and the pubis, and between the umbilicus and the iliac crests bilaterally. Concomitant cystoscopy was performed for location of the diverticulum by transillumination and help to identify the diverticular neck. The diverticulum was dissected both sharply and bluntly until the whole diverticulum was freed. After completion the ressection, a catheter was inserted in the right ureter near the diverticulum to assess inadvertent lesions. The mouth of the diverticulum was closed by 2-0 double-layered absorbable running suture and a suction drain was placed through a lateral 5mm port. RESULTS The surgery was uneventful. The operative time was 120 minutes with minimal blood loss. There was no postoperative leakage, the drain was removed after 24 hours and the patient discharged. The indwelling catheter was removed after 7 days and the patient progresses without voiding complaints or new infectious episodes in a follow-up of 10 months. Conclusions Laparoscopic diverticulectomy is technically feasible and safe. The concomitant use of cystoscopy facilitates the identification and location of the diverticulum, thereby minimizing dissection of the bladder and decreasing operative time. Cystoscopy may also be useful in the delineation of margins in cases of neoplasia within the diverticulum.Artigo Pure laparoscopic augmentation Ileocystoplasty(International Braz J Urol, 2014-11) Rebouças, Rafael Batista; Britto, Cesar Araujo; Monteiro, Rodrigo C.; Souza, Thiago N. S. de; Aragão, Augusto J. de; Burity, Camila R. T.; Nóbrega, Júlio C. de A.; Oliveira, Natália S. C. de; Abrantes, Ramon B.; Dantas Júnior, Luiz B.; Cartaxo Filho, Ricardo; Negromonte, Gustavo R. P.; Sampaio, Rafael da C. R.Introduction Guillain-Barre syndrome is an acute neuropathy that rarely compromises bladder function. Conservative management including clean intermittent catheterization and pharmacotherapy is the primary approach for hypocompliant contracted bladder. Surgical treatment may be used in refractory cases to improve bladder compliance and capacity in order to protect the upper urinary tract. We describe a case of pure laparoscopic augmentation ileocystoplasty in a patient affected by Guillain-Barre syndrome. Presentation A 15-year-old female, complaining of voiding dysfunction, recurrent urinary tract infection and worsening renal function for three months. A previous history of Guillain-Barre syndrome on childhood was related. A voiding cystourethrography showed a pine-cone bladder with moderate post-void residual urine. The urodynamic demonstrated a hypocompliant bladder and small bladder capacity (190mL) with high detrusor pressure (54 cmH2O). Nonsurgical treatments were attempted, however unsuccessfully. The patient was placed in the exaggerated Trendelenburg position. A four-port transperitoneal technique was used. A segment of ileum approximately 15-20cm was selected and divided with its pedicle. The ileal anastomosis and creation of ileal U-shaped plate were performed laparoscopically, without staplers. Bladder mobilization and longidutinal cystotomy were performed. Enterovesical anastomosis was done with continuous running suture. A suprapubic cystostomy was placed through a 5mm trocar. Results The total operative time was 335 min. The blood loss was minimal. The patient developed ileus in the early days, diet acceptance after the fourth day and was discharged on the seventh postoperative day. The urethral catheter was removed after 2 weeks. At 6-month follow-up, a cystogram showed a significant improvement in bladder capacity. The patient adhered well to clean intermittent self-catheterization and there was no report for febrile infections or worsening of renal function. We did not experience any complication related to the intestinal anastomosis fully prepared intracorporeally. Conclusions Albeit technically challenging, pure laparoscopic enterocystoplasty was feasible and safe. Preparing the enteral anastomosis and the pouch intracoporeally may prolong surgical time and contribute to postoperative ileus. Surgical staplers can assist in the procedure, however they are not essential.