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PubMed1976

Urethral injuries in Lagos.

Good results have been obtained following the treatment of incomplete urethral rupture while the results of complete urethral rupture treated in this hospital by the conventional method have been very poor. This poor result is comparable to those from other centers using similar methods. A review of various treatment methods was undertaken and reasons are given for advocating the method of initial suprapubic cystostomy, followed by delay urethroplasty.

Accidents, Traffic↗
PubMed1981

Urethrography in urethral trauma: tissue reaction to extravasation of contrast dye and iatrogenic infection.

The reaction of periurethral tissue to retrograde urethrography with 30 or 60% contrast dye and/or iatrogenic infection following a sharp, penetrating injury of the urethra was investigated in rabbits. Urine was diverted continuously by tubeless cystostomy throughout the experiment. The local healing processes did not differ from the normal reaction after urethrography with 10 ml 30 or 60% sodium-meglumine-amidotrizoate or instillation of 1--2 . 10(6) E. coli in 10 ml saline. An increased inflammatory reaction was only observed when urethrography and the instillation of E. coli saline was combined, thus increasing the total fluid volume instilled and with it probably also the intraurethral pressure. The results suggest that retrograde urethrography as a diagnostic procedure immediately after an acute urethral trauma is free of adverse effects on the normal healing processes if performed under aseptic standards, with a small volume of contrast dye and as low as instillation pressure as possible.

Animals↗
PubMed1992

Implantation metastasis after a suprapubic catheter in a case of bladder cancer.

We report about a patient who was treated with a percutaneous suprapubic cystostomy in order to relieve repeated urinary retention. Two hours later a bladder tumor was found and the suprapubic catheter was removed. After transurethral resection of the bladder tumor the histological specimen showed a pT3 G3 squamous cell carcinoma. Because of the age and reduced performance status of the patient a radical cystectomy was contraindicated. In a second approach we performed again a transurethral resection of the bladder tumor simultaneously with a resection of the prostate. Eight weeks later the patient was admitted to our hospital because of reduced performance status and gross haematuria. We found a widespread bladder tumor with an implantation metastasis in the abdominal wall at the site where the suprapubic catheter was placed and multiple lung metastases. The patient died within one week after admission. The literature is reviewed and therapeutic strategies are discussed.

Aged↗
PubMed1992

Application of flexible renoureteroscope for antegrade urethroscopy in the treatment of congenital anterior urethral valve.

Antegrade urethroscopy was performed through a cystostomy using a 10.8-fr caliber flexible renoureteroscope in 4 children (aged 2 years and 8 months, 2 months, 14 years and 1 month) with anterior urethral valve. The anatomy of the valves as well as their destruction after transurethral resection (TUR) were well visualized by antegrade urethroscopy. This technique was helpful in performing TUR-valve, after which the findings of voiding cystourethrography in every case and the findings of uroflowmetry in the elder 2 cases showed remarkable improvement. This technique is relatively simple to perform and is thought to be one of the best methods to treat anterior urethral valve. This technique is also applicable to other lower urinary tract lesions in children.

Adolescent↗
PubMed2001

Evrim Bougie: a new instrument in the management of urethral strictures.

BACKGROUND: In this study a new instrument and technique is described for the endoscopic treatment of complete posterior urethral strictures, which may result in serious complications and sometimes require troublesome treatments. METHODS: Three patients with complete posterior urethral obstruction were treated endoscopically with the guidance of a new instrument: Evrim Bougie. Evrim Bougie looks like a Guyon Bougie, has a curved end, which facilitates getting into the bladder through the cystostomy tract and with a built in channel of 1.5 mm in diameter for a sliding needle exiting at its tip. Having confirmed fluoroscopically and endoscopically that the sliding needle had passed across the strictured segment, the strictured segment was incised with internal urethrotomy, distal to the strictured segment, and urethral continuity was accomplished. At the end of the operation a Foley urethral catheter was easily placed into the bladder per urethra. Patients were instructed in self-catheterization after removal of the urethral catheter. All patients achieved normal voiding at postoperative 7th month follow-up evaluation. CONCLUSION: Internal urethrotomy could be performed under the guidance of the sliding needle of Evrim Bougie advanced from above the posterior urethral strictures, which to our knowledge was described for the first time in the English literature. We also believe that there may be other possible indications of Evrim Bougie for different procedures in urethral surgery.

Adult↗
PubMed2005

Immediate endoscopic management of complete iatrogenic anterior urethral injuries: a case series with long-term results.

BACKGROUND: Urethral injury produces partial or complete disruption of the urethral integrity. Advances in endourology have made endoscopic management of most of these injuries feasible without greatly compromising the final result. We report our institutional experience of immediate endoscopic realignment of complete iatrogenic anterior urethral injury. METHODS: From May 1997 to May 2003, seven patients with complete anterior urethral disruption were managed by immediate endoscopy guided splinting of urethra. Retrograde urethroscopy, combined with fluoroscopic guidance and in some cases antegrade cystoscopy through a suprapubic stab cystostomy was performed. A guide wire was negotiated across the disruption. Later, a 16 F Foley catheter was placed for 1-3 weeks. Patients were followed up at 1, 3, 6 and 12 months and then yearly to assess the long-term outcome of endoscopic management. RESULTS: Immediate endoscopic realignment was achieved in all patients. Three patients developed recurrence at six months; that was treated by optical urethrotomy. Only one patient developed multiple recurrences over an average follow-up of 49.2 months (range 7 to 74 months). He was offered open end-to-end urethroplasty at twenty months after third recurrence. Thus immediate endoscopic realignment avoided any further intervention in four patients (57.14%); while after an additional optical urethrotomy, urethroplasty could be avoided in six patients (87.2%). CONCLUSION: Immediate endoscopic realignment of traumatic urethral disruption is a feasible, safe and effective treatment modality for management of patients with iatrogenic complete anterior urethral injuries.

Adult↗
PubMed2024

Protein-losing enteropathy with congenital kidney stones in a 2-month-old boy: a rare case report and literature review.

BACKGROUND: Protein-losing enteropathy (PLE) is a rare condition featured by severe loss of proteins through the gastrointestinal tract. Rare PLE cases complicated with congenital kidney stones have been reported. This case study aimed to illustrate our experiences on the diagnosis and treatment of PLE and congenital kidney stones in a neonate. CASE PRESENTATION: A 10-day-old boy fed on breast milk presented to our department because of severe diarrhea, which showed no significant attenuation after free amino acid milk formula. Gastrointestinal endoscopy revealed absence of brush border of surface villi. Genetic testing was strongly recommended given intractable early-onset diarrhea, severe malnutrition and hypoalbuminemia. Then the patient was diagnosed with PLE based on the clinical manifestations and identification of DGAT1 gene by whole-exome sequencing. The patient underwent percutaneous suprapubic cystostomy to remove the urine, and ultrasonography examination showed kidney stones. CONCLUSIONS: We reported a rare newborn with PLE and congenital kidney stones carrying DGAT1 mutations.

Humans↗
PubMed1982

Hyperthermic irrigation of urinary bladder tumor in rabbits.

Hyperthermic treatment for bladder tumor in the rabbit was investigated by the irrigation with hot saline through cystostomy after the transplantation of V2 carcinoma cells. When the bladder was irrigated with 42-44 degrees C saline, the inhibitory effect on transplanted tumor growth in the urinary bladder was significant in comparison with control groups. Antitumor effect on the survival and changes in body weight were also significant. Histological study showed the tumor cells were more susceptible to heat than normal mucosal layer. The results suggest that the hyperthermic irrigation of the urinary bladder was effective in preventing the tumor growth with minimum damage on the normal bladder mucosa. Moreover, this malignant bladder tumor of rabbit seems especially suitable for the purpose of studying the new method for transurethral hyperthermic treatment of the urinary bladder cancer.

Animals↗
PubMed1996

Chronic bile diversion to the urinary bladder enhances cholecystokinin release and suppresses gastric inhibitory polypeptide release in dogs.

The role of intestinal luminal bile on cholecystokinin (CCK) and gastric inhibitory polypeptide (GIP) release was examined in dogs with chronic external bile diversion. In 6 mongrel dogs, cholecysto-jejuno-cystostomy (C-J-C) was performed using a small segment of the middle small intestine interposed between the gallbladder and urinary bladder with section of the common bile duct. Butter dissolved in 30 ml of lukewarm water was orally ingested before surgery, and same amount of butter solution with or without graded volumes of canine bile were orally ingested between four to six weeks after C-J-C surgery. Increases in both plasma triglyceride and GIP levels after butter ingestion were almost completely abolished by C-J-C, but they were restored by oral bile feeding in a volume-dependent manner. Both basal and fat-stimulated CCK release were enhanced significantly by C-J-C, and oral bile feeding inhibited fat-stimulated CCK release by bile in a dose dependent manner. These data suggest that intraluminal bile regulates basal and fat-stimulated CCK release and fat-stimulated GIP release in dogs.

Animals↗
PubMed1984

An unusual complication to transurethral resection of the prostate. A case report.

During a transurethral resection of the prostate, performed in epidural anaesthesia, a 77-year-old man developed dyspnoea and distension of the lower abdomen. Acute cystostomy revealed a large bladder diverticulum containing 2 liters of irrigating fluid together with some tissue chips and 3 small bladder tumours. The tissue chips functioned as a stop valve only permitting entrance of fluid. In the absence of preoperative radiological examination of the urinary bladder meticulous cystoscopic examination of every tiny opening in the bladder is mandatory.

Aged↗
PubMed1991

Improved method of porcine renal allografting for transplantation research.

This study presents a refined, reproducible, and clinically appropriate animal model of renal transplantation. A pair of kidneys are harvested from a donor pig and preserved in Euro-Collins' solution (4 degrees C). After a set period of preservation, the allografts are transplanted to two recipient pigs. The abdomen is entered through a midline incision. The right common iliac artery and vein are dissected and bilateral native nephrectomy is performed. Each allograft is then randomly assigned and transplanted to the recipients. Three minutes before unclamping, 100 mg of furosemide and 10 g of mannitol are given IV. Immediately after reperfusion, urine output is measured for 1 h. The allograft is biopsied and ureteroneocystostomy is created. Cystostomy is then placed using a 16F Foley catheter. The bladder neck is ligated to secure complete diversion of urine, and the abdomen is closed in layers. This kidney transplant model allows an absolutely paired study of the kidney allograft function from the same donor and also collection of pure urine at any time postoperatively, obviating the need for metabolic cages or sedation for urinary collection. This model and its unique modifications allow various transplant studies, including organ preservation, immunosuppressive protocol, and the prevention of reperfusion injury from oxygen free radicals.

Animals↗
PubMedDate not supplied

Development of a protocol to provide prolonged general anesthesia to pregnant sows.

This study was designed to determine whether a pregnant sow could be maintained under conditions of prolonged general anesthesia in order to provide access to prematurely delivered piglets for purposes of acute experimentation. Fifteen time-dated pregnant (90% of gestation) sows were preanesthetized with intramuscular xylazine (Rompun Mobay Pharmaceutical, Shawnee, KS)/ketamine (Aveco Pharmaceutical, Fort Dodge, IA). After anesthesia was induced with intravenous sodium thiopental, the animals underwent tracheotomy and mechanical ventilation. The electrocardiogram was monitored externally; systemic arterial pressure was supervised by the insertion of a brachial artery cannula; and urine output was determined by inserting a cystostomy tube. A surgical plane of anesthesia was achieved by the "balanced" technique: an inhalant, isoflurane, supplemented by intravenous doses of sufentanil citrate, propofol (Stuart Pharmaceuticals, Wilmington, DE), and vecuronium. Sows were maintained under general anesthesia for an average of 12 h; piglets were delivered, one or two at a time, by a modified cesarean section technique. No sows or piglets were lost to anesthetic complications. It is concluded that, with appropriate precautions, pregnant sows can be anesthetized for a prolonged period of time, and provide viable premature neonates for acute experimentation.

Anesthesia, General↗
PubMed1989

A case of urethral replacement with polytetrafluoro-ethylene graft for multiple anterior urethral strictures.

Recently, the authors had an opportunity to treat a 73-year-old male patient who was transferred to our institution with problematic multiple strictures of the anterior urethra subsequent to a suprapubic cystostomy. A proximal urethra was reconstructed with scrotal skin, but due to the shortage of distal skin, as a last resort we reconstructed a distal urethra using a polytetrafluoroethylene graft in place of 10 cm long urethral strictures. About 5 months after surgery, we had to reexplore the polytetrafluoroethylene graft area because of pain and found, much to our surprise, that the urethra had been completely regenerated around the length of polytetrafluoroethylene graft which now remained freely detached in the urethral canal. Following removal of the polytetrafluoroethylene graft, the patient could urinate normally and was subsequently discharged without further problems. We concluded that this case was incidentally successful with good regeneration of urethral mucosa of the anterior urethra by grafting a polytetrafluoroethylene tube.

Aged↗
PubMed1999

Traumatic hemipelvectomy before body image has developed.

Traumatic hemipelvectomy is rarely observed because very few patients have survived from the initial trauma. We describe one male child who survived from this massive trauma with a good functional outcome. The boy was 28 months old when he was accidentally struck by a truck. He had severe open trauma of the pelvis and hemorrhage of the left lower limb. Amputation of the left hemipelvis, colostomy, cystostomy and removal of the left avulsed testicle were performed. Once healing had been achieved, he was transferred to our Department of Physical Medicine and Rehabilitation and rehabilitative management was begun, including prosthetic measurement and psychologic intervention for the patient and his parents. For 13 years of long-term follow-up, his prosthesis was readjusted annually. Now he is a 16-year-old middle school student. He is functioning remarkably well with a prosthesis. The psychologic report shows that he is emotionally stable and has good scholastic performance. Although hemipelvectomy appears to be a radical procedure in children, the potential for rehabilitation in a group of children before body image has developed appears to be unexpectedly good.

Adolescent↗
PubMed2006

Comparative effects of clomipramine and duloxetine on detrusor and striated sphincter function in male and female rabbits.

OBJECTIVE: Serotonin and norepinephrine systems are involved in the neural control of lower urinary tract function. The aim of this study was to compare the response on striated anal sphincter electromyographic (SAS-EMG) activity and cystometric parameters, when duloxetine and clomipramine were intravenously administrated. METHODS: The effects of intravenous 1 and 2 mg./Kg. duloxetine or clomipramine on lower urinary tract function were studied in a total of 32 male and 32 female rabbits, under nonirritative conditions (intravesical infusion of saline) and in a model of bladder irritation (i.e., transvesical infusion of 0.5% acetic acid). A transurethral double-lumen catheter in male rabbits, and a subcutaneous cystostomy in female rabbits, were used for liquid infusion and recording of intravesical pressure during a cystometrogram. Simultaneously, SAS-EMG was recorded through electromyography electrodes placed in the perianal striated muscle. RESULTS: Cystometric parameters: Under irritative conditions, 2 mg./Kg. clomipramine in male rabbits and 1 or 2 mg./Kg. in female rabbits, depending on the dose, increased bladder capacity (BC), contraction duration (CD) and intercontraction interval (ICI), and decreased baseline pressure (BP). In male and female rabbits, duloxetine dose-dependently increased BC, CD and ICI. Under nonirritative conditions, clomipramine at 2 mg./Kg. and duloxetine dose-dependently solely increased BC in female rabbits. Electromyographic activity: A marked effect on SAS-EMG activity of duloxetine under irritative conditions was revealed in male and female rabbits. Under these conditions, clomipramine increased SAS-EMG activity only in female rabbits. Under nonirritative conditions, 2 mg./Kg. duloxetine increased SAS-EMG activity only in female rabbits. CONCLUSIONS: The stronger effects on the SAS-EMG activity were produced by duloxetine in female rabbits under irritated bladder conditions. Clomipramine, under irritative conditions, had a relaxing effect on intravesical pressure, which is not the case with duloxetine.

Animals↗
PubMed1991

[Radical surgery with pubectomy for primary male posterior urethral cancer--a case report].

A 38-year-old male patient with the past history of polioencephalopathy was admitted with urinary retention and high grade fever. Although he was able to walk he had the intelligence of a 3-year-old child and his spine, thorax, fingers were deformed remarkably. Immediately after the admission, cystostomy was carried out and 600 ml of stinky and cloudy urine was noted. Although intensive antibiotic therapy was performed, high grade fever with leucocytosis (greater than 15,000/mm2) persisted for more than 10 days. Retrograde urethrogram showed stricture in the anterior urethra as well as irregular filling defect in the bulbomembranous urethra. After urethral dilation using urethral dilators, 18Fr nephrostomy balloon catheter was indwelled and the patient was discharged. However, the urethral irregular filling defect was unchanged and cytological examination of urine and urethral secretions revealed class V. After the readmission, endoscopic examination revealed papillary tumor lesions occupying the whole posterior urethra were found. With the diagnosis of invasive posterior urethral cancer, anterior exenteration by en bloc pubectomy, pelvic lymphadenectomy and ileal conduit urinary diversion were carried out. On the surgical specimen, the tumor occupied the bulbomembranous and prostatic urethra. Histopathological diagnosis was TCC G3 greater than SCC, stage B. Since the tumor invaded the serosa of the membranous urethra, we thought it could not be removed completely without the pubctomy.

Adult↗
PubMed1992

[Endoscopic operation of congenital anterior urethral valve. Application of flexible renoureteroscope for antegrade urethroscopy].

4 children with anterior urethral valve were treated by TUR-Valve. Before TUR, valve anatomy could be easily seen by antegrade urethroscopy through cystostomy using a 10.8Fr caliber flexible renoureteroscope and destruction of the valve could be recognized after TUR. Antegrade urethroscopy with a flexible fiberscope was so helpful to TUR-Valve and the findings of voiding cystourethrography and micturition have remarkably improved. This technique is not so difficult to apply and thought to be one of the best methods to recognize valve anatomy and degree of resection. This technique is also applicable to other lower urinary tract lesions in children.

Adolescent↗
PubMed1996

[Laser prostatectomy--image analysis by transurethral ultrasonography].

BACKGROUND: Conventional transurethral Nd:YAG laser ablation of the prostate does not significantly reduce the volume of prostate and patients frequently experience post-operative urinary retention. Thus in the present study, prostatic tissue was extensively vaporized with laser fiber to produce a definite cavity during the operation. METHODS: Between August 1993 and April 1995, laser prostatectomy utilizing Ultraline was carried out on 91 patients with BPH, 38 of these patients had histories of urinary retention. The size and form of the prostate were examined by transurethral ultrasonography (TUUS) prior to surgery and ablation was conducted based on the findings. The results were checked by TUUS a second time. RESULTS: Operating time was 84.1 minutes on the average including the time for systematic needle biopsy and cystostomy for irrigation. Total irradiation dose was 132,035J on the average. The catheter was removed at an average 5.8 days postoperatively. I-PSS was noted to improve from 15.3 to 5.6, maximum flow rate, 9.3 to 15.8 ml/s, average flow rate, 4.6 to 9.2 ml/s and residual urine, 76.0 to 15.9 ml. The volume of the prostate was reduced by 31.5% (39.3 to 26.6 ml) and the patients could urinate for more than a year without discomfort. No serious complications were encountered though epididymitis was noted in 5 and urethral stricture in 10 patients. CONCLUSION: The present laser prostatectomy is less invasive than TUR-P and the results might be equal to it.

Humans↗