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At least 397 records · Page 22Linked to original sources
PubMed1981

Penile arteriography in impotence after pelvic trauma.

A patient who was impotent following pelvic trauma was evaluated by penile artheriography. The study revealed bilateral disruption of the internal pudendal artery at the level of the urogenital diaphragm. It is concluded that impotence in this case is vasculogenic, although it is not possible to eliminate conclusively the possibility of neurogenic factors. Evaluation of more patients with this new technique of penile arteriography is necessary to establish the frequency of vasculogenic impotence in pelvic trauma. A review of the current literature revealed that impotence is approximately 10 times more common after conventional retropubic urethral realignment for acute prostatomembranous disruption compared to treatment by cystostomy tube alone. Analysis of the pertinent neurovascular anatomy suggests that when impotence is caused by surgical dissection of the periprostatic region the pathogenesis probably is neurogenic because of injury to the prostatic plexus and/or cavernous nerves, and it may be irreversible.

Adult↗
PubMed1981

Single stage repair of rectourinary fistula.

The treatment of 2 prostato-rectal fistulas by a single stage York Mason repair and cystostomy is described. We realize that the therapy of rectourinary fistulas should be individualized and for the ill or septic patient the 3-stage treatment including colostomy is safe and conservative. However, for the patient in good condition the 1-stage repair seems to be an effective shortcut.

Aged↗
PubMed1979

Tuberculosis of the male urethra.

Tuberculosis of the male urethra is a rare lesion, with only 21 cases reported in the literature. Two patients with tuberculosis of the urethra, who presented with multiple periurethral fistulas and a periurethral abscess, are described. In both patients there was associated genitourinary tuberculosis. Mycobacterium tuberculosis could be isolated from the urine and the exudate of the perineal ulcers. Biopsy from the perineal ulcers demonstrated tuberculous granulation tissue with tuberculous bacilli. Treatment consisted of suprapubic cystostomy and a 2-year course of antituberculous drugs, consisting of streptomycin, para-aminosalicylic acid and isoniazid. The urethral fistulas healed with this treatment. The urethral strictures were treated with repeated urethral dilations.

Adult↗
PubMed1979

The radiographic approach to injuries of the prostatomembranous urethra in children.

We favor initial non-operative treatment (suprapubic cystostomy drainage only) for prostatomenbranous urethral injuries in children and adolescents. Non-operative treatment usually results in uncomplicated strictures that can be corrected by a 1-stage transperineal or transpublic operation 4 to 6 months later. A hands-off diagnostic approach, which relies on excretory urography and retrograde injection urethrography to demonstrate partial and complete tears, eliminates the need for blind passage of catheters, an invasive procedure that may lead to complicated strictures unsuitable for a 1-stage repair. If a 1-stage repair is planned it is necessary to determine the length of the stricture, whether there are local complications and whether the anterior urethra can be widely mobilized. The radiographic techniques used to plan a corrective operation and to evaluate the results are described.

Adolescent↗
PubMed1979

Vesicovaginal fistulas on one urological service.

Of 92 vesicovaginal fistulas 57 (62 per cent) were closed, at least temporarily, with 1 or more operations. Functional closure was not attempted in 23 per cent of the cases and failed in 15 per cent. Various techniques were used in these cases. The favorite method involved a combination of colpocleisis, splitting the posterior wall of the bladder suprapubically and a temporary cystostomy on low pressure suction. Five patients (5.4 per cent) died postoperatively.

Aged↗
PubMed1978

Conservative surgical management of urological complications after cadaveric renal transplantation.

Review of a consecutive series of 85 cadaveric renal transplants revealed urinary fistulas in 7 cases. Bladder fistulas originated from the anterior cystostomy suture line in 3 patients and required secondary closure in every case. Ureteral fistulas from the donor ureter often required a multistaged operation. In every case the end result has been satisfactory, with closure of the fistula and preservation of renal function.

Cadaver↗
PubMed1978

Posterior urethral trauma and strictures: an attempt to solve a controversy.

Three cases of traumatic partial or complete posterior urethral rupture and subsequent stricture are reported. Treatment consisted of early suprapubic cystostomy, with/or without concomitant primary realignment of the urethra over a catheter, followed by urethral dilations and internal urethrotomy when indicated. Followup of 4 or more years showed excellent results.

Adult↗
PubMed1977

Management of ruptured posterior urethra in childhood.

Seven boys with fracture(s) of the bony pelvis and associated partial or complete rupture of the posterior urethra were managed by the time-honored technique of early suprapubic cystostomy and concomitant primary realignment of the urethra over a catheter. Of the 4 children who had a functionally significant urethral stricture 3 were cured within a few months by 1 or 2 simple urethral dilatations and 1 by subsequent transperineal lysis of the angulated urethra from its surrounding fibrous tissue. Followup data for 8 to 22 years (mean 14 years) indicate that all 7 patients void with an excellent stream and are continent, free of infection and potent. In fact, 3 of the 4 married boys have fathered children.

Adolescent↗
PubMed1988

Pelvic fracture and injury to the lower urinary tract.

The presence of a urologic injury must be considered in all patients with pelvic fracture. Uroradiographic evaluation starting with retrograde urethrography is indicated in all male patients with concomitant gross hematuria, bloody urethral discharge, scrotal or perineal ecchymosis, a nonpalpable prostate on rectal examination, or an inability to urinate. If the urethra is normal, a catheter may be passed, and in the presence of gross hematuria, a cystogram must be performed. Female patients rarely suffer urethral lacerations. The urethra is examined, and a Foley catheter may be passed without a urethrogram. The immediate management of associated urologic injuries continues to evolve and evoke controversy. Selected cases of extraperitoneal bladder perforation may be safely managed solely by catheter drainage. Intraperitoneal perforations require surgical exploration and repair. Urethral disruption (partial or complete) may be safely managed by primary cystostomy drainage with management of potential complications (stricture, impotence, incontinence) in 4 to 6 months.

Female↗
PubMed2000

Delayed repair of post-traumatic posterior urethral distraction injuries: long-term results.

OBJECTIVES: There is still controversy regarding the treatment of post-traumatic posterior urethral distraction injuries. Initial suprapubic cystostomy and delayed perineal urethral reconstruction has been considered the reference standard. In this report, we review our experience with delayed perineal urethral reconstruction, with a focus on the long-term outcome and complications. METHODS: A total of 77 men with posterior urethral distraction injury due to pelvic trauma underwent reconstruction with delayed perineal approach. In all cases, the area of fibrosis was aggressively excised, the corpus spongiosum was mobilized, and a tension-free, spatulated end-to-end anastomosis was achieved by splitting the corporeal bodies in 66.2% and by an additional perineally performed inferior pubectomy in 49.3% of the patients. The median time from injury to surgical repair was 12 months. The preoperative evaluation consisted of combined antegrade and retrograde cystourethrograms and cystourethrography. A detailed sexual history was obtained in 58 patients (75.3%). RESULTS: After a mean follow-up of 47 months (range 15 months to 14 years), the urethral continuity was adequate in 94. 8%; however, 2 patients required a perineal surgical revision (total of 79 operations). Postoperative incontinence was observed in 7 (9. 1%) of 77 patients. Postoperative erectile dysfunction was noted in 16.2% of patients who were known to be potent by history before surgery. CONCLUSIONS: Our results support the belief that delayed perineal reconstruction with extensive excision of fibrosis and a tension-free, spatulated end-to-end anastomosis is a successful treatment alternative for posterior urethral distraction defects, with acceptable morbidity.

Adolescent↗
PubMed2000

Fournier's gangrene caused by Candida species as the primary organism.

Fournier's gangrene is a rare entity caused by polymicrobial aerobic and anaerobic bacteria. We report a case of Fournier's gangrene caused by Candida as the primary organism. A 65-year-old man presented with perineal soft-tissue infections. He underwent surgical debridement and suprapubic cystostomy with both antifungal and antimicrobial therapy. The histopathologic examination revealed necrotizing fasciitis with Candida species as the sole initial pathogen. The case suggests that primary fungal pathogens should be considered as a causative organism of Fournier's gangrene.

Aged↗
PubMed1994

Endoscopic urethroplasty of posterior urethral avulsion.

OBJECTIVES: Traumatic avulsion of the posterior urethra represents a challenging reconstructive problem that traditionally has been managed by the transpubic or transperineal approach. We report the advantages of endourologic techniques to reconstruct short posterior urethral disruptions based on the principles of establishing proximal urethral control and balloon dilation of the newly constructed urethra. METHODS: Endourologic urethroplasty consists of: (1) antegrade flexible cystoscopy or antegrade passage of a Goodwin sound, (2) retrograde urethrotomy to light or to tip of Goodwin sound, facilitated by C-arm fluoroscopy, (3) establishment of urethral continuity by passage of a guide wire, (4) balloon dilation of the newly established urethra to 24 to 30 F over a length of 4 cm, and (5) long-term urethral stenting (4 to 8 weeks) with a silicone Foley catheter. RESULTS: In four men initially managed by suprapubic cystostomy, endourologic reconstruction was performed. The mean blood loss was 250 mL, and mean length of hospitalization was 5.4 days. All patients were continent and three were potent over a mean follow-up of 10.5 months. Uroflowmetric monitoring showed satisfactory voiding patterns with subsequent minor endoscopic revisions required in three patients. CONCLUSIONS: The technical advantages of this method include stabilization and identification of the proximal urethra, intraoperative shortening of the urethral gap to facilitate the urethrotomy, and radial distention of the urethra by balloon dilation. We conclude that endourologic methods provide a safe and effective initial treatment of urethral avulsion.

Adolescent↗
PubMed2003

Necrobiosis lipoidica of the glans penis.

We report a 65-year-old diabetic man with necrobiosis lipoidica occurring on the glans of penis. He was initially seen with chronic ulcerative balanitis that eventually healed with strict control of diabetes mellitus, cystostomy, and pentoxifylline, leaving heavily depressed scars. Penile necrobiotic palisading granulomas include necrobiosis lipoidica and granuloma annulare. On the basis of the literature review, these 2 diseases manifest different skin lesions.

Aged↗
PubMed2001

[Urofacial Ochoa's syndrome: a clinical case].

An 11 year-old girl had an urinary diversion because of a complex uropathy with vesical sphincter dyssinergism. Her inexpressive face with lost eyes and forced gestures, especially when smiling--her smile looking rather like weeping--was the clue to the diagnosis of Ochoa's syndrome. She underwent psoic bladder fixation, right ureteral reimplantation, bladder neck loosening and cystostomy undiversion. At follow-up, renal function deteriorated. She has recently received a kidney transplantation in another institution, and is now symptom-free.

Child↗
PubMedDate not supplied

[Urethrocystopexy with bone anchors: technical modification].

OBJECTIVE: To communicate a technical modification of urethrocystopexy which consist in the suspension of the urethropelvic ligaments to the posterior pubic bone with using bone fixations inserted with the In-Fast system. MATERIAL AND METHODS: Between August 2000 and January 2001, thirteen patients with an mean age of 56.1 years were operated with this technic. Using a transvaginal approach and after great opening of the endopelvic fascia we insert one fixation screw in each side of the symphisis pubic bone, later we give two or three stitches to the urethropelvic ligament with the polypropylene no. 1 suture that each screw have joined to their end. RESULTS: The mean stay has been 5.1 days. The cystostomy has been remained for a mean of the 10.1 days. We didn't observe any complication neither intra nor postoperatives. With a mean follow-up of 5.3 months all the patients present a disappearance of their stress incontinence. CONCLUSIONS: Lack of confirm with a larger following and more cases, the suspension of the urethropelvisc ligaments with screw fixations directly situated into the pubic bone per vaginal approach, has been a simple method, safe and highly comfortable for the patients.

Female↗
PubMedDate not supplied

[Female urethral diverticulum. Report of a case].

PURPOSE: We describe the successful repair of a large and complex urethral diverticulum in a female by transvaginal approach. Epidemiology, diagnostic methods, treatments and complications of female urethral diverticula are reviewed. PATIENTS AND METHODS: A 35-year-old woman with a history of postvoid dribbling, dyspareunia and recurrent urinary tract infections for 4 months was referred. Magnetic resonance imaging demonstrated two fluido-filled collections in the pelvis of 3.5 and 1 cm in size respectively which may be a very large and complex diverticulum, however, Bartholin gland cyst could not be rule out. Cystourethroscopy revealed a urethral diverticulum at 10 mm from the bladder neck with two ostia. It was performed transvaginal diverticulectomy and an anterior vaginal wall flap was placed. The published literature on female urethral diverticula was identified using a Pubmed Medline search and analysed. RESULTS: Convalescence was unremarkable. Suprapubic cystostomy tube was removed 2 weeks after surgery. The patient regained normal voiding. In the published literature there are no agreement neither in the diagnostic nor in the surgical techniques for female urethral diverticula. CONCLUSIONS: Urethral diverticula are diagnosed with increasing frequency. However, this entity continues to be overlooked because the symptoms may mimic other disorders. Cystourethroscopy, retrograde urethrograme using a double balloon catheter and recently magnetic resonance imaging may diagnose this disease. The cure rate of urethral diverticula with appropriate surgical management has a range of 86-100%. Complete excision through the anterior vaginal wall is the most successful treatment modality with minimum postoperative complications.

Adult↗
PubMed1988

Experience with OKT3 in vascularized pancreas transplantation.

With refinements in technical aspects of whole organ pancreas transplantation, allograft rejection is currently the major cause of graft failure. The monoclonal antibody OKT3 has emerged as a highly effective antirejection therapy in renal and hepatic allograft recipients, but its efficacy in pancreas transplantation remains to be determined. During a 12-month period, 28 vascularized whole organ pancreas transplants were performed with pancreatico-cystostomy. Sixteen episodes of allograft rejection were treated with monoclonal antibody OKT3. Indications for OKT3 use included steroid- or antilymphocyte globulin (ALG)-resistant allograft rejection in isolated pancreas (n = 8) or simultaneous kidney-pancreas (n = 8) transplants. A total of 34 rejection episodes occurred in the 16 patients (mean, 2.1; range, one to five). The diagnosis of rejection was based on clinical criteria, a reduction in urinary amylase clearance, radionuclide scanning, hyperglycemia, or associated renal allograft dysfunction in combined engraftments. Postoperative immunosuppression consisted of cyclosporine, prednisone, azathioprine, and prophylactic ALG. OKT3 was administered for a full 14-day course concomitant with low-dose steroids, azathioprine, and cyclosporine. The mean age of the patient population was 32.1 years (range 24 to 39) with a mean duration of insulin-dependent diabetes mellitus (IDDM) of 20.9 years. Monoclonal antibody therapy was instituted in two clinical settings: early rejection (within 3 months of transplant, n = 10); and late rejection (after 3 months, n = 6). OKT3 successfully reversed allograft rejection in ten (62.5%) cases, including six early (60%) and four late (66.7%) episodes. In isolated pancreas transplants, OKT3 therapy reversed pancreas allograft rejection in only two patients (25%).(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies, Monoclonal↗