PURPOSE: We determined whether fibrin sealant augmented by an absorbable bolster could salvage kidneys with major, centrally located stab wounds. MATERIALS AND METHODS: A grade 4 renal injury was created in 16 commercial swine via a 1.5 cm sagittal, centrally located, through-and-through right renal laceration. Animals were randomized to 1 of 4 treatment arms, including control groups that received conventional renal capsule suture repair with an absorbable gelatin sponge bolster (3 in group 1) or a microfibrillar collagen sheet (3 in group 2) and experimental groups that received sutureless treatment entailing fibrin sealant instillation into the knife tract augmented by an external gelatin sponge (5 in group 3) or an external microfibrillar collagen sheet (5 in group 4). Arterial occlusion was not performed. Blood loss and time to hemostasis were recorded. Abdominal computerized tomography was performed at 1 week and necropsy was done at 6 weeks. RESULTS: Renal reconstruction with fibrin sealant resulted in significantly lower blood loss (62 vs 155 ml, p <0.05) and time to hemostasis (3.5 vs 6.5 minutes, p <0.05) than in the conventional suture groups. There was no radiographic or gross evidence of significant postoperative bleeding, urinoma formation or abnormal tissue healing in the recovery period. Gelatin sponge and collagen sheet demonstrated similar hemostatic efficacy. CONCLUSIONS: In this porcine renal trauma model fibrin sealant augmented by absorbable gelatin sponge or a microfibrillar collagen sheet effectively promoted hemostasis and renal salvage. Because of its safety, ease of use and efficiency, fibrin sealant appears to be an appropriate adjunct for managing challenging renal injuries.

Animals↗

PubMed2004

Initial experience with fibrin sealant in pendulous urethral reconstruction. Is early catheter removal possible?

PURPOSE: We assessed whether fibrin sealant promotes early catheter removal after pendulous urethral reconstruction. MATERIALS AND METHODS: Between 1997 and 2003, 43 men with complex stricture disease underwent pendulous urethral reconstruction by a single surgeon (AFM). In 18 consecutive cases with a mean stricture length of 7.24 cm from 2000 to 2003 fibrin sealant was applied over a ventral onlay anastomosis performed with running 5-zero polydiaxanone suture. Results were compared with those in 25 men who underwent the procedure without fibrin sealant from 1997 to 2000, who served as a control group (mean stricture length 8.30 cm, p = 0.418). Catheter duration was recorded after anastomosis integrity was radiographically confirmed. RESULTS: All 18 patients with sealant were completely healed within 14 days, which was significantly shorter than in controls (p <0.001). In the sealant group increased stricture length was associated with longer catheter time (p = 0.677). Our impressions were that patient satisfaction was enhanced by early catheter removal, and postoperative penile edema and ecchymosis were decreased in the fibrin sealant group. CONCLUSIONS: Fibrin sealant appears to promote early catheter removal and enhanced wound healing after pendulous urethral reconstruction.

Fibrin Tissue Adhesive↗

PubMed2004

Urethroplasty in patients older than 65 years: indications, results, outcomes and suggested treatment modifications.

PURPOSE: Despite an aging population, the results of urethroplasty in elderly patients have not been extensively reported. We performed a multi-institutional review of urethroplasty results in 70 elderly males to determine outcomes. MATERIALS AND METHODS: We reviewed all urethroplasties performed on males older than 64 years with at least 6 months of followup at 4 medical centers. Stricture type varied and included anastomotic urethroplasty (44%), penile fasciocutaneous onlay flap (31%), Johanson urethroplasty (stage 1, 6%, stages 1 and 2, 4%), buccal mucosa grafts (7%), foreskin grafts (6%) and meatoplasty (1%). RESULTS: Stricture recurred in 11 (16%) patients, but was managed with a single direct visual internal urethrotomy or dilation in 5 of 11 patients, yielding a final success rate of 91%. Recurrent strictures were more common after fasciocutaneous flaps (7 of 22 cases, 32%) than end-to-end urethroplasty (2 of 31 cases, 6%, p <0.05). Compared to patients younger than 65 years there were more treatment failures, but this was not statistically significant. Perioperative complications were uncommon. Moderate bladder outlet obstructive symptoms developed in 3 patients due to benign prostatic hyperplasia. Notably 6 patients treated previously for post-radiation strictures did well without complications. CONCLUSIONS: Older men tolerate urethroplasty and these data indicate that therapy should not be withheld solely on the basis of age. The potential for impaired flap blood supply in this population is suggested but has not been proven. Benign prostatic hyperplasia must be considered in those patients who have decreased stream after stricture repair.

Age Factors↗

PubMed2004

Fibrin sealant enables tubeless percutaneous stone surgery.

PURPOSE: Fibrin sealant has been demonstrated to be safe and effective as a hemostatic agent and urinary tract sealant. We assessed the ability of fibrin sealant to facilitate tubeless management after uncomplicated percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: Eight consecutive patients underwent single access tubeless PCNL for renal calculi in a total of 9 renal units in a 2-month period. An additional patient with distal ureteral obstruction underwent antegrade ureteroscopy for an 8 x 8 mm distal ureteral stone. Average patient age was 47 years and mean stone size was 3.37 cm (range 0.64 to 9.90). Following complete stone clearance a Double-J (Medical Engineering Corp., New York, New York) ureteral stent was placed antegrade and 2 cc HEMASEEL APR (Haemacure Corp., Sarasota, Florida) fibrin sealant was injected under nephroscopic or fluoroscopic visualization into the parenchymal defect just within the renal capsule. Preoperative and postoperative hematocrit (HCT) was determined. Computerized tomography was performed on postoperative day 1 or 2 to evaluate retained stone fragments, perinephric fluid and urinary extravasation. RESULTS: In the 10 renal units treated via this tubeless technique no intraoperative or postoperative complications were noted. Average hospital stay was 1.1 days. All patients were discharged home on postoperative day 1 except 1 undergoing asynchronous bilateral PCNL on consecutive days. The mean intraoperative change in HCT was 2.8%. There was no significant change in HCT on postoperative day 1. No patient required transfusion. Seven renal units and 1 ureteral unit had no residual stone fragments for a complete stone-free rate of 80%. No gross leakage was observed on dressings and postoperative computerized tomography failed to demonstrate urinary extravasation. CONCLUSIONS: Tubeless PCNL using fibrin sealant at the renal parenchymal defect appears to be safe and feasible. Further experience is necessary to determine the role of fibrin sealant in percutaneous renal surgery.

Adult↗

PubMed2004

Bladder calculus resulting from the migration of an intrauterine contraceptive device.

Explore the source record for details and available documents.

Adult↗

PubMed2004

Consensus on genitourinary trauma: external genitalia.

Explore the source record for details and available documents.

Amputation, Traumatic↗

PubMed2003

Balanitis xerotica obliterans: epidemiologic distribution in an equal access health care system.

BACKGROUND: We analyzed the incidence of balanitis xerotica obliterans (BXO) by both age and ethnicity at an equal-access health care facility. METHODS: We retrospectively reviewed discharge records from 1997 to 1999 at Brooke Army Medical Center to determine ethnicity and age of patients with BXO. RESULTS: Of 153,432 male patients, 108 (0.070%) had a diagnosis of BXO. The age distribution was similar over a range from 2 to 90 years, with the exception of the third decade, when the incidence almost doubled. Black and Hispanic patients had twice the incidence found in white patients (10.59, 10.67 and 5.07 per 10,000 patients, respectively). CONCLUSION: At our equal-access health care facility, the incidence of BXO in black and Hispanic patients was double that in whites. This unexpected finding, in concert with the greater incidence in the third decade, may result from greater access to medical attention for these patients in the military setting. Nevertheless, further research into the origin of the disease is warranted.

Adolescent↗

PubMed2003

Fibrin sealant for the management of genitourinary injuries, fistulas and surgical complications.

PURPOSE: We report our preliminary experience with the use of fibrin sealant to manage iatrogenic urinary tract injuries, complex urinary fistulas, and urological surgical complications. MATERIALS AND METHODS: Topical fibrin sealant was used in 19 patients for iatrogenic urinary tract injury during gynecological or general surgical procedures (7), complex urinary fistulas (5) or urological surgical complications (7). RESULTS: Successful resolution of the injury, fistula or complication was attained after a single application of fibrin sealant in the 18 patients (94.7%) in whom a direct injection technique was used. The only failure (formation of a vesicovaginal fistula) occurred with the air driven sprayed sealant delivery technique after sutured closure of iatrogenic cystotomy during vaginal hysterectomy. CONCLUSIONS: Liquid fibrin sealant appears to be safe and prudent for use in urological "damage control" from trauma, fistulas or surgical complications. Direct injection over a sutured urinary anastomosis appears to be highly effective in preventing urinary drainage. Additional study is needed to define further the role and best use of tissue adhesives in urology.

Female↗