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PubMed2002

Experience in management of Fournier's gangrene.

We report our experience and results in the management of Fournier's gangrene. Fournier's gangrene is a synergistic infective necrotizing fasciitis, which involves perianal, perineal and genital regions, originated mostly from colorectal and genitourinary sources. Charts and records from 28 patients with Fournier's gangrene diagnosed between 1993 and 1997 were reviewed. The mean patients age was 57.8 years (range, 22-82 years); mean hospital stay was 19 days. Eighteen patients (64.3%) were diabetic. The most common source of gangrene was ischiorectal abscess in 22 patients (78.6%). Colostomy was performed on 14 patients (50%) and cystostomy on 7 patients (25%). Ten patients (35.7%) died because of sepsis. In conclusion, medical and surgical treatment should be aggressive. Colostomy should only be performed if sphincter complex is damaged. Multidisciplinary management is mandatory, because of high morbidity and mortality.

Adult↗
PubMed1986

Repair of cloacal anomalies: current techniques.

This paper describes an experience with 29 additional cases of urogenital sinus malformation with an anorectal anomaly, usually rectal atresia with rectovaginal fistula. Right transverse divided colostomy is recommended in the neonate. Low end colostomy is contraindicated. After colostomy has been performed to relieve the intestinal obstruction, the urinary tract is the most life-threatening aspect of cloacal malformation. Intermittent catheterization of the bladder and/or urine-filled vagina can often provide adequate decompression; however, simple cystostomy or tube vaginostomy may be required in some. Major urinary diversion should be avoided. Occasionally, the urinary tract should be repaired before correcting other aspects of the malformation. In most cases rectal pull-through should not be performed first as an isolated procedure. In the majority of cases, all three systems can be repaired simultaneously, ie, rectum, vagina, and urinary tract. However, that is usually a large undertaking. The posterior sagittal midline approach, often together with an abdominoperineal approach, has proven very useful in these cases. An overall experience with 64 cloaca patients has shown that most can be repaired with a satisfactory functional and anatomic result.

Age Factors↗
PubMed1993

Comprehensive planning of operative strategy for separation of ischiopagus tripus twins with particular reference to quality of life.

A 27-year-old mother was diagnosed by prenatal ultrasonography as having triplets at gestational age 32 weeks. Following cesarean section at 37 weeks, a pair of female babies were noted for the first time to be joined by a common pelvis with three lower limbs. They had separate upper gastrointestinal tracts, which joined in the distal ileum, leading to a common colon, rectum, and a single anus. Each twin had a functioning kidney, with a single ureter leading to a common bladder. A common urethra originating from the bladder neck ran into the urogenital sinus of one baby. Prior to the surgical separation, placement of four tissue expanders and 20 pneumoperitoneums were performed, in order to stretch the parietes for easier approximation of the wound edges. At 13 months of age, separation was performed, requiring 17 hours. The skin and musculature from the conjoined third leg was used as a fillet for abdominal wall closure in each patient. One infant was given the distal half of the colon and an entire anus with a temporary jejunostomy, and the right half of the bladder with the urethra. The other infant was given the proximal half of the colon with a permanent colostomy, and the left half of the bladder with permanent cystostomy using appendiceal pedicle graft (Mitrofanoff's procedure). This is the 10th case of surgical separation in ischiopagus tripus twins reported in the literature, and the seventh successful separation with both patients alive.

Female↗
PubMed1975

Experience with Kaufman III procedure for urinary incontinence.

The Kaufman III procedure for urinary incontinence is an effective means of treating postprostatectomy incontinence. The technique was modified by the routine inclusion of suprapubic cystostomy; operative assessment of the efficacy of the prostheses was possible. Four of our 7 patients (57 per cent) achieved excellent results, 2 of 7 (29 per cent) good, and 1 (14 per cent) poor. In the surgical technique it is important to stress that the mobilization of the crura from the pubic arch should be limited to allow only for the straps. Excessive dissection in this area will limit the degree of compression. This was thought to be a factor in the failure of our first case. Although the Kaufman III procedure for postprostatectomy urinary incontinence may not be ideal, the ease of insertion, good results, and low morbidity make it a desirable method of combating urinary incontinence in many male patients.

Aged↗
PubMed1975

Urologic trauma by compressed gas.

A case of urologic trauma by compressed gas is reported. Emergency treatment consisting of surgical exploration of the peritoneum and cystostomy was required. Subsequently, the stricture which caused the trauma was treated.

Abdominal Injuries↗
PubMed1977

Gibbons ureteral stent in renal transplant recipients.

The Gibbons indwelling ureteral stent was used in 5 renal recipients. Early post-operative obstructions at the ureterovesical junction in 2 cases and 1 at the ureteroplevic junction were treated by placing the stent through an open cystostomy. Late strictures were treated in 2 patients by inserting the stent endoscopically. It was also used to stent a ureteroureterostomy. After removal of the stent in 2 of 3 patients, no further treatment of the obstriction was required. In the third case it provided time to allow the steroid dose to be lowered so definitive repair could be undertaken. One stent has remained patent for fourteen months. The Gibbons stent appears to be a valuable new tool in the treatment of post-transplant ureteral obstruction.

Adolescent↗
PubMed1978

Childhood urethral trauma.

Urethral trauma in childhood due to external violence other than vehicular accident is discussed. The need for careful, planned management is highlighted by a satisfactory outcome in each of 4 cases, with no incontinence and no persistent urethral stricture. Temporary suprapubic cystostomy in 2 of these children caused no difficulty in the ultimate repair and permitted a more deliberate approach to these diminutive strictures in the pediatric age group.

Child↗
PubMed1978

Urethral injury due to external trauma.

Fifty-six patients with urethral injuries comprised 35 involving the posterior urethra and 21 involving the anterior urethra. Immediate retrograde urethrography confirmed the clinical diagnosis made when blood was found at the external urinary meatus after external trauma. Traffic accidents caused most of the posterior urethral injuries and were associated with severe injuries to multiple systems and a significant mortality rate (34 per cent). Primary realignment of the urethral injury by a urethral catheter in all cases of urethral rupture (plus a suprapubic cystostomy in most of these cases) resulted in a stricture rate of 62 per cent on follow-up. However, only half of these strictures required surgical correction. The incidence of incontinence was 10 per cent and of impotence 38 per cent.

Accidents, Traffic↗
PubMed1979

Partial tears of prostatomembranous urethra in children.

Five boys having sustained a pelvic fracture were found to have incomplete tears of the prostatomembranous urethra. Three patients were treated with suprapubic cystostomy drainage alone and fared better than 2 who were treated with urethral catheter stenting and drainage. A recommendation is made for the "hands-off" approach to the evaluation and management of membranous urethral injuries.

Adolescent↗
PubMed1985

Self-inflicted foreign bodies involving lower urinary tract and male genitals.

A great variety of self-inflicted foreign bodies have been removed from the lower urinary tract and male external genitalia. These foreign bodies were inserted or applied for autoerotic, psychiatric, therapeutic, or no definite reasons by the patient. Most patients were too ashamed to admit they had inserted or applied any object and usually presented when a complication had occurred from the foreign body such as difficulty voiding, hematuria, pain or swelling, extravasation, or abscess formation. Inspection and palpation diagnosed foreign bodies involving the male external genitalia in 3 patients and anterior urethra in 6. Radiographic studies with and without contrast medium and endoscopy were required to diagnose foreign bodies in the posterior urethra and bladder in 9 patients, and the exact location, shape, and orientation of the foreign bodies in all sites, radiolucent objects, and the complications of mucosal laceration and extravasation. All 16 foreign bodies in the anterior urethra (below urogenital diaphragm) were removed by endoscopic manipulation in the 6 patients. Nine foreign bodies in the posterior urethra or bladder (above the urogenital diaphragm) were removed by endoscopic manipulation in 2 females and 2 males, while suprapubic cystostomy was required in 1 female and 4 males. The 3 foreign bodies applied to the external genitalia of 3 males were removed carefully to avoid injury to the underlying skin. Foreign bodies lying below the urogenital diaphragm were palpable and readily removed endoscopically while foreign bodies above the urogenital diaphragm required greater endoscopic manipulation or open surgical procedures.

Adolescent↗
PubMed1987

Urethral gap in complete disruption of membranous urethra.

In patients with complete disruption of the membranous urethra treated initially with placement of a suprapubic cystostomy, delayed synchronous retrograde and voiding cystourethrograms failed to demonstrate accurately the distance between the two urethral ends. Radiographic exposure obtained during synchronous instrumentation of the anterior and posterior urethra in the anesthetized patient was the most precise method of defining the extent of the urethral gap. Any surgical decision should be based on this type of investigation. In most cases of pelvic crush injuries, the severed membranous urethra probably remains attached in close proximity to the distal segment, thus directing the redescent of the prostate and bladder base in the presence of a contracting pelvic hematoma.

Adult↗
PubMed1988

Flexible cystoscopy in surgical repair of traumatic urethral strictures in children.

Flexible cystoscopy via a suprapubic cystostomy tract was utilized to locate the proximal segment of a complete traumatic disruption of the bulbar urethra secondary to a pelvic fracture. With the fiberoptic light of the instrument visible in the perineum, the proximal urethra was easily and safely dissected free from the enveloping fibrotic scar tissue and a simple one-stage urethroplasty performed. The patient is voiding normally eight months postoperatively.

Child↗
PubMed1988

Delayed retropubic urethroplasty of completely transected female membranous urethra.

Injuries to the female urethra, especially in childhood, are rarely seen with pelvic trauma. Complete transection of the membranous urethra was sustained by a ten-year-old girl in a car accident. A delayed retropubic urethroplasty after suprapubic cystostomy drainage was accomplished. The technique of the repair is described. Delayed repair in a female child is an excellent alternative to primary realignment if a primary repair cannot be accomplished.

Accidents, Traffic↗
PubMed1989

Nonoperative management of iatrogenic prostatorectal fistula.

Iatrogenic prostatorectal fistula is a rarely seen urologic complication of transurethral resection of the prostate and stricture dilatation with sounds. In the past, such cases have been managed with colostomy diversion of the fecal stream and suprapubic cystostomy diversion of the urinary stream and in most cases operative closure of the fistula. This case illustrates that a more conservative nonoperative approach can lead to successful closure of such a fistula in selected cases. The management of the case described here utilizes low residue dietary supplements, Foley catheter drainage, and broad-spectrum antibiotics to allow the fistula to heal.

Fistula↗
PubMed1991

Evolution of endoscopic urethropexy: seven-year experience with various techniques.

The surgical techniques for correction of stress urinary incontinence continues to evolve particularly those utilizing the endoscopic approach. Various forms of endoscopic urethropexy have been performed in 142 women with a minimum of one-year follow-up. The cure rate for the entire series was 94 percent. In the last two years the no-incision technique was used whenever feasible (31 patients) with an identical cure rate of 94 percent. Varying degrees of urinary retention occurred in 58 percent and was even more prevalent following the no-incision technique (68%). Owing to the high incidence of urinary retention a punch suprapubic cystostomy is now used in most patients. We conclude that endoscopic urethropexy is an effective means of correcting stress urinary incontinence. The no-incision technique is associated with even less morbidity and a reduction in hospital stay without compromising the outcome.

Adult↗
PubMed1991

Extended double-J ureteral stent.

Continent forms of urinary diversion using intestinal segments are becoming increasingly common. As this new treatment modality evolves, our instruments and mechanical devices are likewise evolving and adapting to the changing needs placed on them. We have used a new type of double-pigtail ureteral catheter in patients requiring continent urinary diversion. It allows stenting of the ureteral-intestinal anastomosis and safeguards against urinary leak or extravasation; at the same time the catheter is accessible to the outside for easy replacement, manipulation, and radiographic evaluation. The catheter has also shown to be useful for other purposes such as uretero-neo-cystostomy. This is particularly important in the pediatric population where repeated cystoscopy for stent removal or manipulation can be a significant drawback.

Equipment Design↗
PubMed2006

[Neurogenic bladder in children: basic principles in diagnosis and treatment].

The diagnosis of neurogenic bladder can be easy in myelomeningocele and much more difficult in occult dysraphia or medical etiologies. Careful clinical examinations and urodynamic investigations are mandatory for the diagnosis and the follow up of affected patients. Clinico-anatomical correlations are poor. If urinary leak is the first apparent symptom, preservation of the upper urinary tract is the main goal of the surgeon. If natural history of the neurogenic bladder is destruction of the detrusor and paralysis of the trigona, obstructive uropathy is the main physiological concern. Urinary leak must be integrated in the global context of the bladder function in order to determine urinary incontinence type. Ideal micturition is voluntary, must be complete, and needs the synergistic action of a reservoir with a good capacity, a normal compliance, and adequate sphincter outlet resistances. Continence is obtained by balancing these functions, and associating medical treatment and surgery is necessary. Bladder intermittent catheterization is the clue to obtain in most of the cases complete evacuation of the bladder and protection of the upper urinary tract. Increasing bladder capacity is achieved more often by augmentation cystoplasty (colon, ileus, stomach and ureter can be used). Autoplasty at the beginning, artificial tissue engineering will be the future. Augmentation of the bladder outlet resistances need surgical reconstruction (young dees, Pipi-salles procedures...) or uretral and bladder neck suspensions, artificial urinary sphincters, endoscopic injections of bulking agents. All these techniques can be proposed and combined according to the patient's gender, age and social environment. Continent cystostomy allows obtaining continence in difficult cases and after unsuccessful surgery of the bladder neck. Other techniques are under evaluation and sacral neuromodulation give at the moment some promising results. Managing neurogenic bladder must not be considered only in urological terms: orthopedic troubles, digestive and sexual disorders must not be forgotten in order to obtain at least an "acceptable social life".

Child↗
PubMed2006

[Trauma to the anterior urethra: diagnosis and management].

Injuries to anterior urethra are uncommon, mainly due to blunt trauma, and rarely associated with pelvic fractures or life threatening multiple lesions. Straddle type injury is the most frequent lesion, in which the immobile bulbar urethra is crushed or compressed on the inferior surface to the pubic symphysis. Diagnosis of urethral injury is easy, suspected due to trauma circumstances, presence of urethrorragy or initial hematuria, and eventually difficult micturition and penile scrotal for perineoscrotal hematoma. It should always be confirmed and classified by retrograde urethro-gram, realized either immediately or after a few days. Initial acute management is suprapubic cystostomy, if possible before any attempt of urethral catheterization or miction. Urethral contusions only require this urinary diversion or urethral catheter for a few days and usually heal without any sequelae. Management of partial and complete disruptions remains controversial: suprapubic diversion only and secondary endoscopic or open surgical repair of the urethral stricture that occurs in the great majority of the cases (always after complete disruption), early endoscopic realignment and prolonged urethral catheterization (4 for 8 weeks according to the lesion), in partial disruptions, more controversial in complete disruptions; delayed (after a few days) open surgical repair (urethrorraphy) that is the preferred European and French attitude for complete disruptions. Penetrating anterior urethral trauma and urethral lesions associated with penile fracture require immediate surgical exploration and repair if possible. After anterior urethral disruption, the main morbidity is urethral stricture very often requiring surgical treatment (visual urethrotomy if the structure is short, end to end spatulated urethrorraphy, flap or graft urethroplasty if longer).

Humans↗