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At least 487 records · Page 27Linked to original sources
PubMed1999

The effect of partial cystectomy on the residual urine of a large bladder demonstrated in diabetic rats.

PURPOSE: Streptozotocin-induced diabetic male rats underwent a pressure-flow study (P/Q study) under urethane anesthesia to determine whether partial cystectomy improves the percentage of bladder volume voided (V%) in a large bladder. MATERIAL AND METHODS: P/Q studies were performed 12 weeks after the administration of streptozotocin to 8-week-old-rats. P/Q studies were also carried out after partial cystectomy in these diabetic rats. The method of the P/Q study was to perform cystometrograms via a cystostomy, and measure the micturition flow rate by differentiating the cumulative volume voided. RESULTS: The measured urodynamic parameters show that bladder capacity increased and V% decreased significantly in diabetic rats compared with control rats. However, there were no significant differences in detrusor contraction strength (Wmax) as derived from the detrusor pressure and flow rate in the diabetic versus control rats throughout the experiment. Partial cystectomy in the diabetics improved V% dramatically from 53.4 to 73.7%. CONCLUSION: These observations suggest that the increased post-void residual urine in diabetic rats is related to the increased bladder capacity rather than a decrease in detrusor contractility. Further, reduction cystoplasty increases the percentage of voided urine.

Animals↗
PubMed1978

[Differential therapy of vesico-intestinal fistulas].

40 patients with vesico-intestinal fistulas (50% inflammatory, 30% traumatic, 20% neoplastic) were treated within 10 years. Closure was achieved in 97% of 31 patients operated on with curative intention. The remaining 9 patients had palliative surgery, i.e. colostomy or cystostomy. The decision single- or multiple-stage procedure depends upon the etiology, localization and extent of the fistula.

Colostomy↗
PubMed1999

Transurethral thermotherapy for benign prostatic hyperplasia significantly decreases infravesical obstruction: results in 134 patients after 1 year.

PURPOSE: We prospectively evaluated a decrease in outflow obstruction caused by benign prostatic hyperplasia (BPH) with second generation thermotherapy. MATERIALS AND METHODS: Transurethral microwave therapy was given with local anesthesia to 134 patients with urodynamically and cystoscopically documented obstruction by BPH and preserved detrusor function. Of 134 patients 67 (50%) had a general health score of 3 or greater. RESULTS: Urgency was the main complaint during thermotherapy. After a median followup of 24 months (minimum 12) 100 patients were evaluable at 6 and 12 months. Of the initial 134 patients 17 (13%) who required additional treatment (repeat thermotherapy, transurethral prostatic resection, permanent cystostomy), 7 who died during followup for treatment unrelated reasons and 10 who were lost to followup or refused evaluation were excluded from further analysis. Mean International Prostate Symptom Score decreased from 22.5 before to 3.6 at 6 months after treatment and remained stable at 12 months. Mean Quality of Life Index improved from 4.3 before to 1 at 12 months after treatment. Mean maximum flow increased from 7.3 ml. per second before to 14.5 at 6 months and 13.9 at 12 months after treatment. Mean post-void residual decreased from 199 to 34.8 and 37.2 ml. at 6 and 12 months, respectively. Urodynamic evaluation of 84 patients after 6 months revealed a decrease in mean detrusor opening pressure from 96.8 to 53 cm. water and mean detrusor pressure at maximum flow from 99.8 to 59.7 cm. water. Mean ultrasonographic prostate volume decreased from 57.6 to 42.4 cc and a cavity in the prostate was documented in 65 of the 84 cases (77%). All changes between the pretreatment and posttreatment values at 6 and 12 months, respectively, were statistically significant (paired t test p<0.00001). CONCLUSIONS: Targeted transurethral thermotherapy with second generation microwave equipment is minimally invasive, easy to apply and generally well tolerated with local anesthesia. Infravesical outlet obstruction and voiding pressures as assessed by pressure flow studies significantly decreased 6 months after treatment. Subjective voiding symptoms as well as post-void residual urine were significantly decreased, and urinary flow was improved 6 and 12 months after treatment of documented BPH.

Aged↗
PubMedDate not supplied

[Brachytherapy for urinary bladder cancer].

OBJECTIVE: To present the results achieved by brachytherapy in the treatment of bladder cancer and to review the literature on this subject. METHODS: 120 patients with bladder cancer were treated with brachytherapy at two Dutch Centres. Selection criteria were good general condition allowing anesthesia, good bladder function (capacity of 300 ml), solitary tumor maximum 5 cm diameter, T1G3, T2, T3a. Before the implant an extensive transurethral resection was performed. The urologist carried out a cystostomy and the radiation oncologist did the implant using iridium-192 wires. The administered tumor dose was 60 Gy at a dose rate of 60-90 cGy/hour. RESULTS: The 5-year overall survival and disease-free survival was 67% and 73%, respectively. By stage, the 5-year disease-free survival was 100% in T1, 80% in T2 and 67% in T3. Local failure was observed in 15 patients (13%). Six of these relapses were salvaged by cystectomy. Ten patients had a superficial tumor Ta-T1 in bladder sites other than the original tumor site. Acute and late complications were unusual. The results compare quite well with those of other series published in the literature. CONCLUSION: Brachytherapy achieves excellent results in selected patients with solitary bladder cancer maintaining a fully functional bladder. Acute and late complications of this treatment modality are relatively infrequent.

Adult↗
PubMedDate not supplied

[Surgical alternatives in the treatment of hepatic hydatidosis].

Echinococcosis is an endemic zoonosis in the south of Chile, so we have the opportunity to treat many patients especially the liver location which is the most common situation of this disease. Hepatic hydatid cyst presents its own morbidity and mortality due its complications and associated with surgical procedures. Morbidity has rates between 11 and 86% and is related with previous surgical interventions, cysts complications, the necessity of perform additional procedures during surgery and the treatment of other disease locations. Mortality by otherwise has rates below 5%. But both, morbidity and mortality persist high in spite of technological advances and therapeutical improvement. The surgical treatment of hepatic hydatidosis can be divided in four phases: surgical area isolation, cysts evacuation, treatment of cyst complications (biliary tract rupture, hepatothoracic transit, etc.), and residual cavity treatment. For each one exist different alternatives. On the other hand, hydatid cyst surgery can be classified in conservative and resective procedures. In the first group we consider marsupialization, cystostomy, Knowsly or Posadas operation and cystojejunostomy. In the resective group we include pericystectomy, partial or subtotal cystectomy and the different types of hepatectomies. Finally, some other surgical procedures are under evaluation. These include the laparoscopic approach of liver echinoccosis with few studies in the field, but with hopeful results.

Digestive System Surgical Procedures↗
PubMed1999

[Fournier's gangrene. Our experience over 10 years. A review of the literature].

OBJECTIVE: To report our experience over the last 10 years with Fournier's gangrene, an extensive fulminant infection of the perineoscrotal region, and to review the literature. METHODS: The medical records of 9 patients with Fournier's gangrene that had been diagnosed from January 1988 to December 1997 were reviewed. Patient age, etiology and predisposing factors, microbiological findings, duration of hospital stay, treatment and outcome were analyzed. RESULTS: The mean age of the patients was 53.8 years (range 43-71). The source of the gangrene was perirectal (22.22%), urinary (66.66%) and cutaneous (11.11%). Predisposing factors included diabetes mellitus, alcoholism, malnutrition and low socio-economic status. All patients were treated with surgical debridement and broad-spectrum antimicrobial therapy. Two patients underwent delayed reconstructive surgery. Cystostomy was performed in 100% of the cases. Two patients died from severe sepsis. CONCLUSIONS: Necrotizing fasciitis of the perineum and genitalia is a severe condition with a high morbidity and mortality. Good management is based on aggressive debridement, broad-spectrum antibiotics and intensive supportive care.

Adult↗
PubMed1999

The "crushed open pelvis" in children.

A retrospective analysis was performed in order to review the outcome of open pelvic fractures in children. Medical records, radiographs and CT scans of 15 children with open pelvic fractures admitted to our trauma centre between 1983 and 1995 were reviewed. The minimal follow-up on the survivors was two years. Out of 15 open pelvic fractures ten were vertically unstable. The mechanism of injury was auto-pedestrian collision in 93% (n = 14) of the cases. 86% (n = 13) of the fractures were a result of a "run-over" mechanism, 40% (n = 6) were caused by heavy duty vehicles. All children had injuries in the proximity of the pelvis. Despite the severity of trauma, we found mortality to be 20% (n = 3). Sepsis and deep infection originating from anorectal and genitourinary excretions were found to be the most frequent complications. The improvement in surgical techniques of the pelvis influenced the orthopaedic treatment in these 15 children. External fixation of the pelvis is not always sufficient and to achieve better stabilization of the pelvis, open reduction and internal fixation should be considered. In order to minimize complications, aggressive intervention is needed including irrigation, debridement, intravenous antibiotics, diverging colostomies and cystostomies and fracture fixation. The coordination between trauma teams of different disciplines throughout all stages of the treatment is crucial to achieving better results.

Accidents, Traffic↗
PubMed2000

Clinics in diagnostic imaging (54).

A 29-year-old man sustained a pelvic fracture and haemorrhagic shock after a road traffic accident. He underwent an exploratory laparotomy open cystostomy, and iliac artery embolisation. Subsequent antegrade cystography and computed tomography showed a complete traumatic posterior urethral rupture with a "high riding" bladder. Delayed repair of the posterior urethra was performed 6 months later with good functional outcome. The risk of urethral injury in pelvic fractures, the mechanism of injury, and the role of imaging in the diagnosis of possible urethral injury in pelvic fractures are discussed.

Accidents, Traffic↗
PubMed2001

[Comparative results of the treatment of post-traumatic ruptures of the membranous urethra with endoscopic realignment and surgery].

OBJECTIVE: Retrospective, comparative study of the long-term results of endoscopic realignment and surgery in the treatment of complete rupture of the posterior urethra. MATERIAL AND METHODS: Between 1989 and 1998, 40 men were managed for traumatic posterior rupture of the membranous urethra: 30 were treated by endoscopic realignment for complete rupture while 10 were treated by surgery (perineal or transsymphyseal incision) for a long stenosis (> 3 cm) secondary to extensive rupture of the urethra. RESULTS: With a mean follow-up of 30 months (12 to 72 months), all patients treated by endoscopic realignment are continent and urinate with a satisfactory urine output (Qmax > or = 15 ml/s). This result was obtained after internal urethrotomy in 7 patients (23.33%) and transperineal urethroplasty in one patient. Six patients developed persistent impotence (20%). For the ten patients treated surgically, the voiding stream was considered to be satisfactory (Qmax > 15 ml/s in 6 patients while 4 developed short strictures accessible to endoscopic urethrotomy. Nine patients are continent, while one completely incontinent patient with perineal fistulas required a continent cystostomy. Four out of 10 patients reported sexual impotence. CONCLUSION: Endoscopic realignment of complete rupture of the membranous urethra is a simple, minimally aggressive technique, ensuring optimal preservation of continence and sexuality in young subjects.

Adolescent↗
PubMed2001

Dorsal placement of the pedicled preputial/penile onlay flap for anterior urethral stricture: is it more logical?

OBJECTIVES: We present our preliminary experience in the management of inflammatory anterior urethral strictures with a dorsally/dorsolaterally placed penile/preputial vascularized flap and discuss the distinct advantages of this procedure over a traditional ventrally placed flap. METHODS: Twelve patients (age, 20-66 years; mean age, 40.5 years) with recurrent inflammatory strictures of the penile and/or bulbar urethra (penile, 2; bulbar, 5 and bulbopenile, 5) were treated with dorsally/dorsolaterally placed penile/preputial (penile skin, 5; prepuce, 7) vascularized flap substitution urethroplasty. Prior to surgery, 7 patients had suprapubic cystostomy for acute urinary retention and 5 had a mean peak flow rate of 6.2 ml/sec. Inferior pubectomy was performed as an adjunct in two patients to facilitate proximal placement of the flap. Follow-up (5 to 24 months; mean, 15.5) included uroflowmetry and retrograde urethrograms at 6, 12 and 18 months, and thereafter as required. RESULTS: The mean stricture length was 5.8 cm (range, 3 to 12 cm) and all strictures were associated with dense spongifibrosis. Temporary urethral fistulae, which healed spontaneously, occurred in 4 patients. The clinical and radiological outcome during the mean follow up of 15.5 months was gratifying. The mean peak flow rate improved to 24.2 ml/sec. No stricture recurrence has been noted to date. Sacculation of the flap, diverticulum formation and post-void dribble have not been encountered. None of the patients developed chordee or erectile dysfunction. CONCLUSIONS: Dorsal onlay preputial/penile flap urethroplasty is a versatile procedure in the treatment of inflammatory anterior urethral strictures. The dorsal pedicle flap may be anatomically and functionally more logical as compared to the traditional ventrally placed flap.

Adult↗
PubMed2000

[Endoscopic treatment of complete obliteration of posterior urethra].

The authors shared their experience in regard of treatment of complete urethral obliteration. In a 14-year they diagnosed and treated 37 patients (aged 22-74 years) with obstruction of the lower urinary tract as a result of complete urethral obliteration. The etiology include 14 patients after perineal urethral trauma, in 10 patients the main cause was urethral inflammation of posterior urethra, in 8--as a consequence of transurethal surgery and in 5--after suprapubic prostatectomy. Main diagnostic methods they used were retrograde urethrography and urethroscopy with 0. fiberoptic. In all patients an endoscopic incision of fibrotic tissue was carried out thus the entering the bladder cavity was successful. In some patients operative technique with a Benique through cystostomy cannel and bladder neck just opposite to the urethrotome knife was used. In three patients (8.2%) the procedure failed due to the massive urethral hemorrhage. They report recurrent urethral strictures in 24 patients (64.8%), treated with visual urethrotomy. The continence was compromised in 6 patients (16.2%).

Adult↗
PubMed2001

Difficulty in removing suprapubic urinary catheters in home based patients: a comparative descriptive study.

The aim of the study was to monitor difficulties being experienced by community nurses when removing suprapubic catheters in 94 patients living in two area health services in Sydney. The study identified one catheter brand (Simpla) that was associated with more pain and bleeding for patients, and increased difficulties in removal for the nurses. It was found that muscle relaxant medications taken by patients contributed significantly in ease of catheter removal. In over 50% of all-silicone catheters surveyed, there was evidence of hysteresis leading to balloon cuffing on deflation. This phenomenon could be associated with increased trauma to the suprapubic cystostomy tract on catheter removal. A review of the risks and benefits associated with all-silicone catheters used for suprapubic insertion is recommended.

Adolescent↗
PubMed1975

Effective drainage of the bladder after transvesical prostatectomy.

The series presented consisted of 94 patients who underwent transvesical prostatectomy and whose bladders were drained by using a cystostomy tube (silastic) with an 8 mm lumen, in addition to a urethral catheter. Retention by blood clot was avoided. The wounds healed well, and no infection of the urinary tract occurred. The mean period of postoperative hospitalization was 9.5 days.

Drainage↗
PubMed2002

[Anterior urethral injury. Report of 23 cases].

UNLABELLED: We reviewed our experience in managing anterior urethral traumatic rupture. PATIENTS AND METHODS: Between January 1986 and December 1998 a total of 23 consecutive male patients with anterior urethral trauma were studied prospectively, including a clinical and radiographic of the pelvis examination, excretory urography and retrograde urethrography. The average patient age was 29 years (range 19 and 65 years). The mechanism of injury was represented by the blunt perineal trauma in 17 cases and the cavernous body rupture in six cases. Clinical manifestations are dominated by the urethrorragia (19 cases), urinary retention (16 cases), perineal hematoma (14 cases). Radiological imaging have shown a pelvic fracture (six cases), urethral rupture (17 cases) and bladder rupture (three cases). Therapeutic procedure realized in emergency in six patients having a cavernous body lesion and delayed repair in 17 other patients. RESULT: The outcame was favorable in 12 patients and recurrence stenosis has occurred in 11 patients who are corrected by optical urethrotomy (four cases), end-to-end anastomosis (two cases), B. Johanson urethroplasty (three cases) urethroplasty by penile skin (one case), dilations (one case). CONCLUSION: Suprapubic cystostomy with healing control of the partial ruptures, delayed end-to-end anastomosis for total ruptures and immediate reparation of the urethral rupture when associated with a penile fracture are even the best warrant of a correct functional recovery.

Adult↗
PubMed2002

Transurethral microwave therapy in 200 patients with a minimum followup of 2 years: urodynamic and clinical results.

PURPOSE: We investigated the long-term efficacy of the second generation Targis thermotherapy device (Urologix, Inc., Minneapolis, Minnesota) for decreasing outflow obstruction caused by benign prostatic hyperplasia. MATERIALS AND METHODS: At a minimum followup of 24 months 200 patients with bladder outlet obstruction documented on urodynamics and cystoscopy document with preserved detrusor function underwent transurethral microwave therapy while under local anesthesia. In 45% of cases the general American Society of Anesthesiologists health score was 3 or greater. RESULTS: After a median observation time of 42 months (range 2 to 72) 43 patients (22%) who required additional treatment (repeat thermotherapy, transurethral prostate resection or permanent cystostomy) were excluded from further analysis, as were 15 (7.5%) who died of causes unrelated to treatment during followup and 13 (6.5%) who were lost to followup or refused followup investigations. In the 162 patients evaluated 6 months after treatment the median International Prostate Symptom Score decreased from 23 points (range 10 to 34) before treatment to 3 (range 0 to 21) and remained stable at 12 and 24 months. Median maximum flow increased from 6 ml. per second (range 1 to 15) before treatment to 14.5 (range 4 to 50) 6 months after treatment and remained stable at 12 and 24 months. Median post-void residual urine volume decreased from 170 ml. (range 35 to 720) before treatment to 17 (range 0 to 327) after 6 months and then remained unchanged. Urodynamic evaluation in the 162 patients after 6 months showed a decrease from pretreatment median detrusor opening pressure of 87.5 to 53 cm. water. Median detrusor pressure at maximum flow decreased from 86 to 58 cm. water 6 (p <0.0001). At the 24-month followup 59 of the 129 evaluable patients agreed to undergo repeat urodynamic evaluation. Pressure flow analysis in these 59 cases revealed a decrease in median minimal urethral opening pressure from 70 to 40 cm. water at 6 months and to 38 cm. water at 24 months (p <0.0001). Median detrusor pressure at maximum flow decreased significantly from the pretreatment value of 86 to 55 cm. water at 6 months and 58 cm. water at 24 months (p <0.0001). CONCLUSIONS: In patients with a good initial response to treatment, which is achieved in approximately 80%, transurethral microwave therapy provides excellent long-term subjective and objective results. Improved urinary flow, decreased post-void residual urine volume and urodynamic parameters remain stable at 2 years. Transurethral microwave therapy with second generation microwave equipment did not compromise any conventional treatment needed in the 22% of patients who were nonresponders at 6 months.

Adult↗
PubMed2002

Herpes zoster induced neuropathic bladder--a case report.

Herpes zoster infection involving the sacral dermatomes has been associated with bladder dysfunction and, although rarely, with acute urinary retention. Less than 150 cases have been reported in the literature. After reviewing our institute's chart records covering a period of time dating from 1991 to 2001, we found that three of our patients had developed acute urinary retention following herpes zoster skin lesions of the S2-4 dermatomes. Herein we report our findings. These three patients had previously been found to have normal voiding status. However, at the time of complaint urodynamic studies revealed detrusor areflexia or detrusor hyporeflexia with decreased sensation of bladder filling. After micturation recovery, repeat urodynamic studies revealed detrusor pressure and bladder sensation recovery. After one to six weeks of treatment, all three patients could void spontaneously without catheterization. We found that, when treated with antiviral medication, supportive analgesics, and temporary urinary drainage, which included urethral catheterization and suprapubic cystostomy, acute urinary retention associated with herpes zoster has a generally favorable prognosis. In other words, we found that in spite of its rarity, herpes zoster induced neuropathic bladder dysfunction is reversible when treated appropriately.

Adult↗
PubMed2001

[Endoscopic treatment of complete obliteration of posterior urethra].

The authors shared their experience in regard of treatment of complete urethral obliteration. In a 14-year they diagnosed and treated 37 patients (aged 22-74 years) with obstruction of the lower urinary tract as a result of complete urethral obliteration. The etiology include 14 patients after perineal urethral trauma, in 10 patients the main cause was urethral inflammation of posterior urethra, in 8--as a consequence of transurethral surgery and in 5--after suprapubic prostatectomy. Main diagnostic methods they used were retrograde urethrography and urethroscopy with 0 degree fiberoptic. In all patients an endoscopic incision of fibrotic tissue was carried out thus the entering the bladder cavity was successful. In some patients operative technique with a Benique through cystostomy cannel and bladder neck just opposite to the urethrotome knife was used. In three patients (8.2%) the procedure failed due to the massive urethral hemorrhage. They report recurrent urethral strictures in 24 patients (64.8%), treated with visual urethrotomy. The continence was compromised in 6 patients (16.2%).

Adult↗
PubMed2002

Urethrorectal fistula by bull horn injury.

Bull horn injuries are common in rural India. Here one such case causing urethrorectal fistula has been reported. The patient was presented with history of bull horn injury 6 hours back. He was examined under general anaesthesia and found to have lacerations in the anus and anterior wall of rectum. Urgent retrograde urethrography and cystography showed partial rupture of bulbar urethra and urethrorectal fistula. Initially sigmoid colostomy and suprapubic cystostomy was done. Later optical internal urethrotomy was done. The patient was catheterised for 3 weeks and the fistula healed completely.

Adult↗