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PubMed2005

Management of severe pelvic fracture associated with injuries of adjacent viscera.

OBJECTIVE: To investigate the approach of emergency management for severe pelvic fracture associated with injuries of adjacent viscera and evaluate the therapeutic effect. METHODS: The data of 79 patients with severe pelvic fracture associated with injuries of adjacent viscera were retrospectively studied, and the study covered a period of 14 years. RESULTS: To cease massive bleeding due to pelvic fracture, ligation of internal iliac arteries was performed on 33 cases, and angioembolization on 8. Of 42 patients with cystic or/and urethral injury, 35 underwent cystostomy and delayed reconstruction, and 7 received a primary realignment. All of 17 patients with injury of retroperitoneal rectum underwent diverting colostomy of the proximal end of sigmoid with presacral drainage, but 4 received primary repair without colostomy. In 22 patients with intraperitoneal colorectal injury, 19 were managed with primary repair or anastomosis while 3 received a colostomy. The overall mortality rate was 8.86% (7/79); the main causes were hemorrhagic shock and associated injury. The complications included urethro-rectal fistula in 4 cases, thrombosis of right common iliac artery in 1, ARDS following chest trauma in 1, and paraplegia in 1. Except the patient with paraplegia, all of them were cured. CONCLUSIONS: Prompt diagnosis and proper treatment are the key to success. Devascularization of internal iliac arteries with external fixation cage of the pelvis, cystostomy and proximal sigmoidostomy are effective procedures in emergency treatment of the critical patients.

Abdominal Injuries↗
PubMed2005

[Management of severe pelvic fracture associated with injuries of viscera].

OBJECTIVE: To probe the approach of emergency management for severe pelvic fracture associated with injuries of adjacent viscera and evaluate the therapeutic effect. METHODS: The data of 79 patients with severe pelvic fracture associated with injuries of adjacent viscera were retrospectively studied, and the study covered a period of 14 years. RESULTS: Ligation of internal iliac arteries was performed in 33 cases for ceasing massive bleeding due to pelvic fracture, and angioembolization in 8. Of 42 patients with cystic or/and urethral injury, 35 underwent cystostomy and delayed reconstruction, and 7 received a primary realignment. All of 17 patients with injury of retroperitoneal rectum underwent diverting colostomy of the proximal end of sigmoid with presacral drainage, but 4 received primary repair without colostomy. In 22 patients with intraperitoneal colorectal injury, 19 were managed with primary repair or anastomosis while 3 received a colostomy. The overall mortality rate was 9% (7/79); The main causes were hemorrhagic shock and associated injury. The complications included urethro-rectal fistula in 4, thrombosis of right common iliac artery in 1, acute respiratory distress syndrome (ARDS) following chest trauma in 1, and paraplegia in 1. Except the patient with paraplegia, all of them were cured. CONCLUSIONS: Prompt diagnosis and proper treatment were the key of the success. Devascularization of internal iliac arteries with external fixation cage of pelvis, cystostomy and proximal sigmoidostomy were effective procedures frequently used in the emergency treatment of the severe pelvic fracture patients.

Abdominal Injuries↗
PubMed1990

Urinary ascites in young infants--report of 9 cases.

Nine boys whose age ranged from 5 days to 3 months with urinary ascites were managed in Beijing Children's Hospital. All of them presented with gradual abdominal distension from birth, 5 had dripping of urine, the 5-day old new born had anuria since birth. In 2 other infants one had cystostomy and the other, ureterostomy before admission. Urinary ascites was confirmed by abdominal paracentesis. Intravenous pyelography (IVP) and Voiding cystourethrography (VCUG) in 7 cases showed bilateral hydroureteronephrosis and dilatation of the posterior urethra consistent with congenital posterior urethral valves. The 40-day old infant who had cystostomy followed subsequently by vesicostomy is still waiting for ablation of the valves. The remaining 6 were managed by 2 stage operation, 5 had vesicostomy first, one; ureterostomy. They had valves ablation either through urethra or bladder at the age of 3 months to 2 years old. Urinary ascites disappeared spontaneously after urinary drainage. Two patients died; one due to dehydration after drainage of the obstructed renal pelvis, the other (in 1977) had no urinary drainage for obstructed urinary tract.

Ascites↗
PubMed1989

[Life after urostomy. A retrospective study].

The study reported, which was based on a questionnaire and psychological tests, examined cystostomy patients with respect to the work-up and acceptance of their altered body. It was noted that 30% of the patients judged their situation as good, and 25% could accept the cystostomy, but a great many has to live with sexual disturbances, reduced social mobility, increased dependence, and psychic consequences; some had to give up their jobs. Sex, earlier psychosomatic diseases, developmental disorders in early childhood, which influence the personality, significantly affect the acceptance of the stoma. The problems are discussed. Suggestions are made, which include a plan for a holistic therapy.

Adaptation, Psychological↗
PubMed1988

Injuries to the urethra and urinary bladder associated with fractures of the pelvis.

The posterior urethra or urinary bladder may be injured in patients who sustain fractures of the bony pelvis. It is important to assess the urethra radiologically by retrograde urethrography before introducing a urethral catheter to avoid missing a urethral injury or causing further damage. The author's approach to the immediate management of urethral injury is suprapubic cystostomy. The urethra may be repaired later after other injuries have healed. With this approach the incidence of permanent impotence and incontinence will be low and the stricture cure rate high. If the urethra has not been injured, a catheter is introduced and cystography performed to rule out bladder injuries. If the bladder is ruptured, the area is explored, the perivesical space drained and urinary drainage is provided by either a suprapubic cystostomy or a urethral catheter.

Fractures, Bone↗
PubMed1988

[Endoscopic treatment of pseudocysts and abscess in acute pancreatitis].

We report on 4 cases of necrotic pseudocysts complicating acute pancreatitis, treated by endoscopic cystostomy (3 cystogastrostomies, 1 cystoduodenostomy). Acute pancreatitis was secondary to biliary stones in 2 cases, post-surgical in one case and post-ERCP in the last case. Endoscopic treatment was performed because of recurrence of pseudocysts after percutaneous drainage guided by ultrasonography or CT scan. In 3 cases, pseudocysts were infected (pancreatic abscesses) and in 2 patients, surgery was contraindicated (severe respiratory and multiple organ failure). The outcome was uneventful in all the 4 cases and pseudocysts disappeared in a few days or weeks in 3 patients. The fourth patient underwent a complementary surgical cystogastrostomy. Endoscopic cystostomy appears to be a safe and efficient technique when performed in pseudocysts located close to the digestive wall and responsible for bulging visible during upper GI endoscopy.

Abscess↗
PubMed1979

[Replacement of the lower third of the ureter via the bladder (author's transl)].

The author suggests a special incision in the bladder permitting the formation of a tube using a strip of bladder long enough to permit an anti-reflux vesico ureteral reimplantation. The method is a combination of the Boari and the transverse bipartition described by Turner Warwick. Extraperitonealization of the hemi-bladder opposite to the diseased ureter and section of the umbilical artery. Transverse anterior cystostomy at mid height of the bladder. The mobilized dome of the bladder is stitched up to the psoas muscle above the iliac vessels. Creation of a rectangular flat, the anterior limit of which is the superior margin of the transverse cystostomy, of which the upper part is a split which cuts the dome of the bladder from front to back, of which the posterior limit is a split on the posterior wall of the bladder, parallel to the anterior incision. The length must not be larger than one and one half the width of the flap. Reimplantation of the ureter, creation of the tube and closure of the bladder is done without difficulty. Drawings illustrate the technic. Four cases are reported with three successes.

Adult↗
PubMed1984

[Treatment of urinary incontinence of neurologic origin in children and adolescents].

Recent advances in the treatment of urinary incontinence of neurological origin in children are discussed. The etiology of the neurological changes is mainly congenital (myelomeningocele, sacral agenesis and hidden dysraphism) other causes such as myelitis, radiculitis or cord injuries being very rarely observed. Two fundamental elements can be evaluated by radiologic and urodynamic investigations of the lower urinary tract: the capacity for compliance of the detrusor muscle and the degree of cervico-urethral resistance. The presence of a cervico-urethral obstruction is no longer an indication for its removal but, on the contrary, a factor that can be retained to assist continence. Intermittent use of self-catheterization enables the obstruction to be used to obtain continence (dryness) and makes the obstruction innocuous, since it enables emptying of the bladder. Of 50 patients (26 girls and 24 boys) treated in this way, 11 were not seen again, but the other 39 are still being followed up after an average of 50 months. This method of bladder emptying maintains the integrity of the upper urinary tract when this was normal previously and improves uretero-pyelo-caliceal distension. Uretero-vesical reimplantation can prevent reflux. Of these 39 children, 23 are continent during the day and 13 among them during the night also. A colocystoplasty was performed in 3 cases to enlarge the bladder capacity. The use of a catheter is well accepted by the girls and young boys but less so by the male adolescents. In the absence of a cervico-urethral obstruction it is impossible to relieve incontinence by re-education, and only three solutions exist: high cutaneous diversion continent cystostomy and artificial sphincter. The high diversion operation should be used as a last resort only. The continent cystostomy uses an appendix isolated on its mesothelium an opening on the abdominal wall and into the bladder in a long anti-reflux tunnel. Catheterization is by a catheter which passes through the newly formed ureter and enables the bladder to be siphoned dry four times daily. This method was used in 25 patients but many complications developed, including febrile attacks with dilatation of the upper urinary tract due to too small a bladder under increased pressure (an enlarging colocystoplasty was required). Eight other children continued to have urine loss through the urethra and required repeated closure of the bladder neck, and one child developed a bladder stone.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1983

Management of blunt injury to the lower urinary tract.

Rupture of the bladder and of the urethra are serious injuries, which, if not recognized or treated adequately, can cause considerable morbidity, even death. The possibility of such injuries should be considered in patients who have lower abdominal trauma, especially in association with a fractured pelvis. Retrograde urethrography should be done when urethral injury is likely. A properly performed cystogram is reliable in diagnosing bladder rupture, which, with the possible exception of small extraperitoneal tears, should be treated by surgical exploration. Treatment of urethral injury remains controversial and the choice of primary repair or primary suprapubic cystostomy will depend on the philosophy and experience of the surgeon. Posterior urethral injury is associated with a high rate of stricture, incontinence and impotence. Suprapubic cystostomy and delayed treatment of any resulting stricture yields excellent long-term results and should be the treatment of choice when the patient is seriously ill or the surgeon inexperienced in urethral surgery.

Adolescent↗
PubMed1978

[Animal experimental and clinical experiences with carbon polymer stomas].

Biocarbon implants consist of 99.9% pure carbon and are characterized by chemical inactivity and good tissue compatibility. Biocarbon was used for subfascial implantations, as well as coecostomies, ileostomies and cystostomie on mongrel dogs. The most important clinical results was the good healing over of the material without adverse reaction. The cystostomies showed only a very slight tendency to form incrustations. Drainage was watertight without signs of leakage. The satisfying results with two patients who were provided with a cystostoma are reported and further uses of the procedure, such as ureterocutaneostomy, iliac and colonic conduit, are discussed.

Aged↗
PubMed1982

[The role of foetal surgery in urology (author's transl)].

The authors report a brief experimental study showing that cystostomy performed in utero perfectly prevents, at least in the animal, deterioration of the urinary tract after urethral ligation. In the light of this experimental finding, the authors raised the question as to whether there is not a place for such bypass urinary surgery in utero in the humans. Indications would be highly obstructive forms of valves of the posterior urethra, treated in utero by cystostomy and, secondly, severe obstructions of the excretory system which could be temporarily bypassed by pyelostomy. This risks are described, but the possibility of such surgery is not excluded.

Animals↗
PubMed1981

[Early repair of rupture of the posterior urethra in males. Report on 10 cases (author's transl)].

Repair operations were performed in 10 men with recent ruptures of the posterior urethra, between 1972 and 1980. One-stage segmental urethrectomy and end-to-end urethrorrhaphy was performed immediately (5 cases) or deferred to a late date (5 cases), with (2 cases) or without (8 cases) protective cystostomy. The origin of the lesions in these cases is discussed. The results obtained in these 10 patients are compared with those observed in 6 other cases treated urgently by cystostomy, with or without perineal drainage, followed by urethral reconstruction after a period of 2 to 6 months. Healing occurred within a mean period of 27 days in the first group, and 185 days in the second. Urinary fistulae developed in 20 p. cent of the patients in the first group, and 17 p. cent of those in the second group. Urinary continence was good in 100 p. cent of the first and 67 p. cent of the second group, a sterile urine being obtained in 100 p. cent and 83 p. cent of cases respectively. Sexual disorders were reported in 10 p. cent of the first and 67 p. cent of the second group. The authors conclude that urgent immediate or deferred reconstruction should be conducted in recent ruptures of the posterior urethra in men. Micturition urethrography after IVU. and retrograde urethrography, are essential investigations for detecting the lesions. Retrograde urethrography should be conducted with a small quantity (10 ml) of contrast medium, as soon as possible after plastic surgery. The authors employ segmental urethrectomy followed by end-to-end urethrorrhaphy, which has given better results than Solovov-Badenoch's urethroplasty.

Adult↗
PubMedDate not supplied

[The mechanism of the action of local transrectal hyperthermia in treating prostatic adenoma].

Local transrectal hyperthermia (LTH) was used to treat 139 patients with prostatic adenoma aged 54-86 if they did not demand urgent surgery. LTH mechanism of action was studied by blood rheology, immunity characteristics, prostatic tissue gentamycin concentrations, morphological alterations after hyperthermia followed by TUR and adenomectomy. Clinical evaluation covered dysuria dynamics, uroflowmetry values, quantitation of residual urine and measurement of the prostate. The patients combined adenoma with chronic prostatitis, acute urine retention, cystostomy fistula (43, 22 and 16 patients, respectively). A microwave electromagnetic hyperthermia unit "Yakhta-4M" made in Russia (434 MHz, 200 W) heated the prostate to 43-44 degrees C. Two procedures a week of 60 min duration were performed within 3-5 weeks. LTH results in reduced blood viscosity, has no effect on blood coagulation, enhances neutrophil phagocytic function inhibiting their metabolic activity without affecting humoral immunity, raises 2-fold gentamycin concentrations in the prostatic tissue compared to blood and urine levels. Histologically, LTH does not alter prostatic parenchyma, but induces structural shifts in the muscular and connective tissue of the stroma producing stabilizing action on acinar epithelium. Clinical picture was characterized by subjective improvement in 72% of those treated, by urination recovery in 70% of the patients. 73% of the latter experienced cystostomy drainage which rid them of the fistula without operation. In general, mechanism of LTH action is brought to improvement of microcirculation, enhancement of cellular phagocytosis with a tendency to prostatic tissue sclerosing and stabilization of growth of the glandular tissue.

Acute Disease↗
PubMed1994

[Clam ileocystoplasty for neurogenic bladder due to spina bifida].

A 24-year-old female with neurogenic bladder due to spina bifida consulted our department for further evaluation and treatment of a left renal stone. She innately voided urine by Crede's method. At the age of 15 years, intermittent self-catheterization was started because left severe hydronephrosis was found. At the age of 19 years, cystostomy was performed because of low compliance bladder and an aggravation of hydronephrosis in spite of intermittent catheterization. Thereafter, she was referred to our department for further evaluation and treatment of a left renal stone since the stone was increasing in size. First, left percutaneous nephrolithotomy was performed successfully. Secondly, clam ileocystoplasty using the ileum was carried out, followed by 1) increase of the bladder capacity, 2) improvement of the bladder compliance, 3) adequate intermittent self-catheterization, and 4) disappearance of urinous odor resulting from removal of the cystostomy catheter. Thus, the clinical effects were thought to be significant.

Adult↗
PubMed1996

[Continent urinary diversion in neurogenic bladders].

Many patients with urinary incontinence due to neurogenic sphincter insufficiency are treated by intermittent catheterization combined with drug therapy. A few refractory cases require surgical treatment. The authors report 5 cases of neurogenic bladder in 3 men and 2 women with a mean age of 20 years. The neurological lesion was secondary to spina bifida (2 cases), spinal cord trauma (2 cases) and leprosy (1 case). All patients complained of urinary incontinence due to sphincter atonia, with normal bladder compliance. We opted for continent cystostomy using the Benchekroun hydraulic valve. One death occurred during the postoperative period as a result of an anaesthetic accident. Reopening of the bladder neck occurred in 3 patients and required revision and one patient developed bladder stones 6 years after the operation. The functional results were considered to be excellent. Continent cystostomy using Benchekroun!! technique appears to be a reliable method in the treatment of urinary incontinence due to sphincter incompetence in selected patients.

Adolescent↗
PubMed1998

[Chronic perianal pyoderma with urethrocutaneous fistula: a case report].

A 65-year-old male was hospitalized because of micturition pain and urinary oozing from several fistulas on the perineal and the left gluteal skin. Oozing had been present for about 50 years, after receiving mass resection of his left scrotum or perineum, and left orchiectomy. The main focus was on the left dorsal site of the anus. Compression around this area produced malodorous grayish pus discharge from many fistulas, although the anus was intact. Although he had histories of spinal caries and renal tuberculosis, both pus and urine cultures showed Staphylococcus spp. and no growth of Mycobacterium tuberculosis. Urethrocystography showed urethral stenosis at bulbar urethra and leakage from a site just proximal to the stenosis. Antibiotics for tuberculosis were administrated for fear of recurrent tuberculosis for 6 months. Cystostomy formation and debridement were performed, followed by en-bloc resection and mesh-skin graft after two weeks. Internal urethrotomy was performed six months after the surgery, and subsequently cystostomy removed. After three and a half years, although there was no local recurrence and no difficulty of urination, he died of cholangio-carcinoma. There are many reports of chronic perianal pyoderma subsequent to hemorrhoid or subcutaneous abscess; however, this might be the first report on a case originating from fistulas in the urinary tract.

Aged↗
PubMed1998

[A case of scrotal elephantiasis 30 years after treatment of penile carcinoma].

A 67-year-old man visited our hospital with complaints of scrotal swelling associated with occasional febrile episodes. Physical examination disclosed a huge scrotal mass, approximately the size of a child's head, with numerous papillomatous lesions on its surface. His past medical history was significant in that he was diagnosed with penile carcinoma at the age of 35 years old and was treated with partial penectomy followed by radiation and chemotherapy at other hospital. During this admission tumor marker squamous cell carcinoma (SCC) and microbiological tests for mcroflariae were both negative. Ultrasound (US), computed tomographic (CT) scan and magnetic resonance imaging (MRI) revealed markedly thickened scrotal skin and small hydrocele with no evidence of local recurrence of the previous penile carcinoma. A percutaneous cystostomy was created because of chronic urinary retention and possible urine extravasation into the scrotum. Histopathological examination of the biopsy specimen from the scrotal mass demonstrated lymphangiectasia consistent with elephantiasis of the scrotum. Surgical excision of this huge scrotal mass was performed in August 1997. The resected tissue weighed 1,400 g. Convalescene was uneventful. He subsequently underwent perineal urethrostomy in place of the suprapubic cystostomy.

Aged↗
PubMed1992

Management of urinary incontinence in neurogenic bladder.

The treatment of children with urinary incontinence caused by a neurogenic bladder presents a challenge to the paediatric urologist. Between 1965 and 1989, 527 patients with neurogenic bladder were treated and followed-up in the Department of Paediatric Urology of Debrousse Hospital. Of these, 46 were submitted to continent cystostomy, 39 to urinary artificial sphincter and 177 to clean intermittent catheterization (CIC). This last treatment is of paramount importance in girls and can be associated with complementary procedures if cervico-urethral resistance and/or bladder compliance are poor. Urethral lengthening (Kropp's procedure) in combination with CIC represents a major means of providing dryness in girls. Our technique of urethral lengthening is detailed and the place of CIC among other incontinence treatment is discussed.

Child↗