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A Preliminary Validation of a New Surgical Procedure for the Treatment of Primary Bladder Neck Obstruction Using a Computational Modeling Approach

A new surgical procedure for the treatment of primary bladder neck obstruction with maintenance of anterograde ejaculation is proposed. In place of monolateral or bilateral bladder neck incision, associated with a loss of ejaculation rate of up to 30%, the new surgical procedure consists of laser dr...

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Autores principales: Serpilli, Michele, Zitti, Gianluca, Dellabella, Marco, Castellani, Daniele, Maranesi, Elvira, Morettini, Micaela, Lenci, Stefano, Burattini, Laura
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8301152/
https://www.ncbi.nlm.nih.gov/pubmed/34206356
http://dx.doi.org/10.3390/bioengineering8070087
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author Serpilli, Michele
Zitti, Gianluca
Dellabella, Marco
Castellani, Daniele
Maranesi, Elvira
Morettini, Micaela
Lenci, Stefano
Burattini, Laura
author_facet Serpilli, Michele
Zitti, Gianluca
Dellabella, Marco
Castellani, Daniele
Maranesi, Elvira
Morettini, Micaela
Lenci, Stefano
Burattini, Laura
author_sort Serpilli, Michele
collection PubMed
description A new surgical procedure for the treatment of primary bladder neck obstruction with maintenance of anterograde ejaculation is proposed. In place of monolateral or bilateral bladder neck incision, associated with a loss of ejaculation rate of up to 30%, the new surgical procedure consists of laser drilling the bladder neck with a number of holes and without muscle fiber disruption. The effect of this novel procedure has been studied numerically, with a simplified two-dimensional numerical model of the internal urethral sphincter, varying the position and the number of holes in the fibrotic region of the urethral tissue. Results show an improvement of the urethral sphincter opening by increasing the number of holes, ranging from about 6% to 16% of recovery. Moreover, a non-aligned position of holes positively influences the opening recovery. The concentrations of maximum principal strain and stress have been registered in the proximity of the interface between the physiologic and diseased sphincter, and in those regions where the radial thickness is significantly thinner. The effects on the first five patients have been included in the study, showing improvement in micturition, lower urinary tract symptoms, sustained ejaculatory function, and quality of life.
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spelling pubmed-83011522021-07-24 A Preliminary Validation of a New Surgical Procedure for the Treatment of Primary Bladder Neck Obstruction Using a Computational Modeling Approach Serpilli, Michele Zitti, Gianluca Dellabella, Marco Castellani, Daniele Maranesi, Elvira Morettini, Micaela Lenci, Stefano Burattini, Laura Bioengineering (Basel) Article A new surgical procedure for the treatment of primary bladder neck obstruction with maintenance of anterograde ejaculation is proposed. In place of monolateral or bilateral bladder neck incision, associated with a loss of ejaculation rate of up to 30%, the new surgical procedure consists of laser drilling the bladder neck with a number of holes and without muscle fiber disruption. The effect of this novel procedure has been studied numerically, with a simplified two-dimensional numerical model of the internal urethral sphincter, varying the position and the number of holes in the fibrotic region of the urethral tissue. Results show an improvement of the urethral sphincter opening by increasing the number of holes, ranging from about 6% to 16% of recovery. Moreover, a non-aligned position of holes positively influences the opening recovery. The concentrations of maximum principal strain and stress have been registered in the proximity of the interface between the physiologic and diseased sphincter, and in those regions where the radial thickness is significantly thinner. The effects on the first five patients have been included in the study, showing improvement in micturition, lower urinary tract symptoms, sustained ejaculatory function, and quality of life. MDPI 2021-06-22 /pmc/articles/PMC8301152/ /pubmed/34206356 http://dx.doi.org/10.3390/bioengineering8070087 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Serpilli, Michele
Zitti, Gianluca
Dellabella, Marco
Castellani, Daniele
Maranesi, Elvira
Morettini, Micaela
Lenci, Stefano
Burattini, Laura
A Preliminary Validation of a New Surgical Procedure for the Treatment of Primary Bladder Neck Obstruction Using a Computational Modeling Approach
title A Preliminary Validation of a New Surgical Procedure for the Treatment of Primary Bladder Neck Obstruction Using a Computational Modeling Approach
title_full A Preliminary Validation of a New Surgical Procedure for the Treatment of Primary Bladder Neck Obstruction Using a Computational Modeling Approach
title_fullStr A Preliminary Validation of a New Surgical Procedure for the Treatment of Primary Bladder Neck Obstruction Using a Computational Modeling Approach
title_full_unstemmed A Preliminary Validation of a New Surgical Procedure for the Treatment of Primary Bladder Neck Obstruction Using a Computational Modeling Approach
title_short A Preliminary Validation of a New Surgical Procedure for the Treatment of Primary Bladder Neck Obstruction Using a Computational Modeling Approach
title_sort preliminary validation of a new surgical procedure for the treatment of primary bladder neck obstruction using a computational modeling approach
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8301152/
https://www.ncbi.nlm.nih.gov/pubmed/34206356
http://dx.doi.org/10.3390/bioengineering8070087
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