Dr. Alexandru Leonida Goman - Medic Urolog

04/09/2022

https://youtu.be/aGSKrC7dGcY

Melodie ca pentru ultima zi de concediu..

Din 6 septembrie reincepem intensiv activitatea cu multe cazuri complexe de uro-oncologie, litiaza, chirurgie reconstructiva si multe altele!

Pt programari si consultatii : 0724245252

Sa aveti un sfarsit de vara minunat!

Depeche Mode - "Enjoy The Silence" (Official Video) directed by Anton CorbijnOriginal song from the 'Violator' album (Sire/Mute Records - 1990)Buy the 12” Si...

25/08/2022

Cu ce ne-am mai indeletnicit in ultimele cateva saptamani in centrul nostru?
Uro-oncologie, uro-oncologie si din nou uro-oncologie in prim plan!

CAZ 1 : Tumora renala stanga pentru care am practicat nefrectomie radicala stanga pe cale laparoscopica (clasificare histopatologica finala pT3aN0Mx).

CAZ 2 : Tumora ureterala stanga (portiune distala) cu HIN stg gr V - citologie negativa pt neoplazie high-grade. Am practicat nefroureterectomie radicala stanga cu limfadenectomie ilio-obturatorie stg prin abord combinat laparoscopic si deschis (pt timpul de cistectomie perimeatica si limfadenectomie).

CAZ 3 : Adenocarcinom de prostata (stadializare cT2aNxMx Gleason 7 - 3+4). Am practicat prostatectomie radicala cu limfadenectomie ilio-obturatorie extinsa bilaterala si nerve-sparing pe partea dreapta.

CAZ 4 : Tumora renala dreapta cu localizare extrem de dificila, chiar anterior de hilul renal, cu pedicul renal complex (2 vene si 2 artere), pt care am practicat nefrectomie radicala dreapta laparoscopica.

In toate cazurile, pacientii au avut o evolutie postoperatorie buna, sub protocolul de recuperare ERAS, fiind externati in ziua 3 sau 4 postoperator. 🤘🤘🤘

BONUS :
CAZ 5 : pionefroza dreapta cu abces perirenal si subhepatic pt care am practicat nefrectomie total prin procedeu “open” si drenajul tuturor abceselor.

CAZ 6 : stenoza de anastomoza uretero-vezicala efectuata in alt serviciu pt endometrioza, pt care am practicat o noua reimplantare uretero-vezicala tip Lich-Gregoir cu psoas-hitch.

Urmeaza un bine-meritat concediu. Ne reintoarcem in activitate pe data de 6 septembrie!!! 💪💪💪

13/08/2022

Bucharest Endometriosis Center for the win 💪💪💪

🇹🇩 Peste 12 ore de anestezie generala si interventie chirurgicala laparoscopica de peste 11 ore. Acesta este recordul echipei noastre din aceasta saptamana…interventie chirurgicala iterativa, la o pacienta ce prezenta o endometrioza complexa la nivelul tuturor compartimentelor pelvisului. Pacienta a mai avut nevoie de o rezectie intestinala in urma cu 3 ani iar acum tulburarile de tranzit erau determinate mai ales din cauza unui sindrom aderential sever si mai putin din cauza leziunilor endometriozice.
A trebuit sa disecam intestinul subtire pe o distanta de aproximativ un metru (aderent la uter, ambele ovare, colon sigmoid, vezica urinara), sa realizam o noua rezectie intestinala re**ala joasa (aproximativ 6 cm de OAE). La finalul interventiei chirurgicale, datorita disectiei ureterale bilaterale extinse am decis sa stentam ambele uretere.
Aceste tipuri de interventii chirurgicale sunt extrem de solicitante si necesita o mare experienta a echipei chirurgicale. In mod normal o interventie chirurgicala ce impune si o rezectie intestinala pentru endometrioza, dureaza in jur de 3-4 ore in cadrul echipei noastre, insa aceste cazuri extreme inseamna mult mai mult. Toti membri echipei trebuie sa fie rutinati in chirurgia pelvina, in chirurgia colo-re**ala, precum si in chirurgia urologica.

Le multumesc colegilor din echipa pentru daruirea si rabdarea de care dau dovada mereu in managementul acestor cazuri solicitante!👍🏻💪🏻

Echipa medicala:
Dr. Gabriel Mitroi - chirurgie ginecologica
Dr. Victor Stefanescu - chirurgie digestiva
Dr. Traian Irimia - chirurgie ginecologica
Dr. Alexandru Goman - chirurgie urologica
Dr. Ema Ravas - medic rezident chirurgie generala
Dr. Alice Eftime - medic ATI

🇬🇧 Over 12 hours of general anesthesia, over 11 hours of laparoscopic surgery. This is the record of our team this week...iterative surgery, in a patient with complex endometriosis in all pelvic compartments. Patient needed an low bowel resection 3 years ago and now the bowel disorders (chronic constipation, chronic pelvic pain) were determined mainly because of a severe adherential syndrome and less because of endometriotic lesions.
We had to dissect the small bowel over a distance of approximately one meter (adherent to the uterus, both ovaries, sigmoid colon, bladder), to perform a new low re**al resection (approximately 6 cm from the OAE).
At the end of the surgery, due to the extensive bilateral ureteral dissection, we decided to stent both ureters.
These types of surgeries are extremely demanding and require great experience of the surgical team. Normally, a surgical intervention requiring a bowel resection for endometriosis takes around 3-4 hours in our team (we are radical with the disease, excising also superficial lesions), but these extreme cases mean much more than a ‘simple’ bowel resection. All team members must be experienced in pelvic surgery, colore**al surgery, as well as urological surgery.

A big ‘thank you’ to my team for dedication and patience they always show in the management of these demanding cases!

Medical team:
Dr. Gabriel Mitroi - gynecologic surgeon
Dr. Victor Stefanescu - digestive surgeon
Dr. Traian Irimia - gynecological surgery
Dr. Alexandru Goman - urologic surgeon
Dr. Ema Ravas - general surgery - resident doctor
Dr. Alice Eftime - anesthesiologist




**alendometriosis

20/07/2022

Uro-oncologia este domeniul care ne pasioneaza cel mai mult. In cadrul Spitalului Victoria ne straduim sa oferim pacientilor cele mai bune solutii pentru tratamentul oricarui tip de cancer al tractului uro-genital, fie ca vorbim de interventii laparoscopice sau clasice.
Cel mai recent caz al nostru este un domn in varsta de 68 de ani, diagnosticat cu cancer de prostata (stadializare cT2aN1Mx scor Gleason 6) pt care am practicat prostatectomie radicala cu limfadenectomie extinsa.
In prezent, pacientul este in ziua 1 postoperator, cu evolutie buna, fara dureri, hidratare si alimentatie orala reluate si a fost mobilizat deja din pat - plan de recuperare conform protocoalelor ERAS.

18/07/2022

D**a un mini-concediu de 5 zile in care ne-am reincarcat bateriile, incepem o noua saptamana cu o patologie bine cunoscuta - LITIAZA (pietrele la rinichi).
Astazi am efectuat multiple interventii minim-invazive pentru litiaza reno-ureterala :
1. Caz de litiaza ureterala abordat prin ureteroscopie semirigida cu litotritie balistica
2. Caz de litiaza renala (calice inferior) abordat prin ureteroscopie flexibila cu litotritie laser
3. Caz de litiaza renala multipla (bazinet, calice inferior si mijlociu) abordat prin nefrolitotomie percutanata (NLP) cu litotritie balistica (IMAGINE)

24/04/2022

Hristos a inviat!
Sa aveti sarbatori linistite precum somnul piticului din poza si sa va bucurati de zilele acestea frumoase impreuna cu cei dragi 🙃

Din 26.04, reincepem intens activitatea 💪

27/03/2022

𝐄𝐧𝐝𝐨𝐦𝐞𝐭𝐫𝐢𝐨𝐬𝐢𝐬 𝐨𝐟 𝐭𝐡𝐞 𝐮𝐫𝐢𝐧𝐚𝐫𝐲 𝐭𝐫𝐚𝐜𝐭

Kidney endometriosis has an incidence of 4% of the urinary tract endometriosis. Due to its rarity it is often misdiagnosed, especially if it's asymptomatic. Giambelluca et al., 2017, reported two cases of renal endometriosis diagnosed incidentally during an oncologic follow-up for gastric sarcoma and melanoma. The initial diagnosis was hemorrhagic cysts, but the biopsy revealed it was renal endometriosis.
When symptomatic, the patient might complain of back pain or might have symptoms that mimic Renal Cell Carcinoma, such as palpable lumbodorsal mass, pain and hematuria. Although the symptoms are common in both pathologies, in case of renal endometriosis, the symptoms are aggravated during menstruation.

The ureters carry urine from the kidney to the bladder. When the disease invades the ureter, and partial blockage occurs, the urine cannot drain out from the kidney leading to swelling of the kidney, known as hydronephrosis.

Urethra endometriosis is quite rare. There are a few cases reported. Chowdry AA et al. reported a case of urethra endometriosis presenting as urethral diverticulum. The patient presented with lower abdominal pain and a history of urinary tract infections in addition to other symptoms. The imaging showed a 1 cm lesion in the urethra believed to be urethral diverticulum. The biopsy revealed that the lesion was endometriosis.

The surgical procedures for endometriosis of the urinary tract depend on the location and type of the disease. The superficial bladder peritoneum lesions can be treated with local excision. Invasive bladder disease will require a partial resection/cystectomy and the bladder nodules infiltrating the bladder wall can be excised or dissected.

Surgical treatment of ureteral endometriosis aims to preserve the kidney function and remove as much as possible of the lesions. Ureterolysis is the first step in cases of limited disease. Re-implantation of the ureter into the bladder - uretero - neocystostomy, ureteral resection and end-to-end anastomosis, auto-transplantation in case of ureteral relapse, are other surgical procedures for endometriosis of the urinary tract. Ureteral lesions iatrogenic or secondary to endometriosis can be treated by JJ stent, cystoscopy and laparoscopy.

The exact number of kidney loss due to endometriosis is not known, but a case of a 36 old woman known with hypertension and infertility that lost a kidney due to endometriosis is described in one study (Nezat et al.). She was diagnosed with severe hydroureter and hydronephrosis, was offered a nephrectomy as she only had 15% of her renal function. She refused, so she was treated with a stent and placed on Lupron. A year later, a new mass was formed, and another stent was placed. The patient lost her kidney.

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