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PubMed2002

[Penile incarceration by multiple metal rings].

OBJECTIVE: Penile incarceration is an infrequent clinical reality. Diagnosis is evident in most cases, and the challenges are to find the best way to retrieve the constrictive ring and repair the damage. Nevertheless, this event being curious has motivated us to report it. METHODS AND RESULTS: We report the case of a 48 year old patient victim of a "joke" resulting in a 13 day penile incarceration produced by 7 double metallic rings, 24 mm in internal diameter and 4 mm wide, which required section and extraction of the rings as well as wide tissue debridement and posterior plastic reconstruction using partial thickness cutaneous grafts. We review diagnostic an therapeutic features from the literature. CONCLUSIONS: Penile incarceration should be considered an emergency, so that the earlier the constrictive object is retrieved the lower the risk for complications secondary to penile devascularization, urinary retention and urethral damage. We emphasise the need to perform retrograde urethrography and suprapubic cystostomy if urethral lesion is suspected, a cutaneous vascular evaluation with doppler ultrasound or fluorescein test and the opportunity of cutaneous grafts to solve tissue lesion.

Alcoholic Intoxication↗
PubMed2002

[Tuberculous prostato-rectal fistula].

In a 60-year-old man admitted for right epididymo-orchitis with scrotal fistula and urine leak via the rectum, the diagnosis of tuberculosis was based on histological examination of a tissue sample of the scrotal fistula. The fistula was successfully treated with tuberculostatic drugs and cystostomy.

Antitubercular Agents↗
PubMedDate not supplied

Posterior urethral valves.

Posterior urethral valves represent the most common post-vesical obstructive malformation. They affect the male gender and appear as intraluminal folds located immediately proximal to the verumontanum. One of the most credited pathogenetic theories considers them an anomalous insertion of mesonephric duct into the cloaca or an incomplete involution of plicae colliculi. At present, the diagnosis of posterior urethral valves is prenatal and the pattern is characterized by detrusor hypertrophy and more or less marked hydroureteronephrosis. Urinary tract disorders that accompany posterior urethral valves include moderate hydroureteronephrosis to severe functional impairment of the entire urinary tract with consequent renal failure. Treatment of posterior urethral valves consists in their resection. At present, with miniaturized endoscopes, valve fulguration is feasible also in newborn infants. In low-weight patients or in case of poor general condition, temporary external urinary bypass (e.g. cystostomy) is feasible.

Female↗
PubMed2003

[Primary malignant melanoma of the female urethra: a case report].

A 72-year-old female with a complaint of hemorrhagic leucorrhea was referred to our department. She had a black tumor on her urethral meatus suspected as a malignant melanoma. Urethrectomy, vulvectomy, partial vaginectomy, bilateral inguinal lymphadenectomy, and cystostomy were performed. Pathological diagnosis was malignant melanoma of the urethra. Local recurrence and lymph node metastasis were found 9 months later, and she has been given DAV-feron combined therapy.

Aged↗
PubMed1997

Catheter management related to radical retropubic prostatectomy.

The clinical course of 108 consecutive radical retropubic prostatectomy (RRP) patients with regards to postoperative cystograms and suprapubic cystostomy was retrospectively reviewed. All patients had a urethral Foley (UF), suprapubic catheter (SP) and were discharged with both catheters in place. Two of 9 patients who had excessive drainage had biochemical evidence of urine. Cystogram on these 2 patients, deferred till days 19 and 27, was normal. Among the other 7 patients with excessive JP drainage, only 1 showed a minor anastomotic look on day 15, necessitating catheter drainage for 1 additional week, with uneventful Foley removal then. Ten patients showed some degree of extravasation on the initial cystograms, 6 patients were judged to be insignificant and the catheter was removed the same day, 4 patients had extravasation (performed days 7, 13, 15, 22) which warranted repeat cystogram 1 week later, which then turned out to be normal. Five patients experienced problems with the UF early in the postoperative period and the SP served as a backup for bladder drainage. The SP entails negligible morbidity and may serve a useful function in the most critical early postoperative period. Based on our data, routine cystogram prior to catheter removal did not appear to alter the management of the catheters significantly and appears unnecessary, especially if the catheter is left in situ for close to 3 weeks prior to removal. In selected cases where technical anastomotic problems were encountered or if delayed healing was anticipated, a c;ystogram prior to catheter removal would still be available.

Journal Article↗
PubMed2003

[Two cases of vesical nephrogenic adenoma].

Case 1: A 52-year-old man receiving regular treatment for quadriplegia due to Friedreich disease visited our hospital with the chief complaint of macroscopic hematuria. He had undergone cystostomy 12 years ago due to neurogenic bladder. The computed tomography and cystoscopic examination revealed a bladder tumor with a few bladder stones. Transurethral resection of bladder tumor (TUR-Bt) was performed after bladder stone removal in May 2000. The pathological diagnosis showed nephrogenic adenoma. Case 2: A 54-year-old man had been treated with bladder tumor by TUR-Bt in Nov. 1995. The pathological diagnosis showed transitional cell carcinoma, G3, pT2 and intravesical instillation therapy using THP was performed. The bladder tumor had recurred twice and the instillation therapy had been exchanged to BCG since Nov. 1997. A small bladder tumor was observed in Jan. 2001, and from the biopsy specimen it was diagnosed as nephrogenic adenoma. Forty-six cases of urothelial nephrogenic adenoma including our cases have been reported in Japan. Chronic stimulation such as bladder stone and infection is thought to induce nephrogenic adenoma. BCG instillation therapy is believed to be an initiation factors for nephrogenic adenoma.

Adenoma↗
PubMedDate not supplied

[Indirect electrochemical blood oxidation in the prophylaxis of suppurative-inflammatory complications after transurethral resection of the prostate].

To investigate efficiency of indirect electrochemical blood oxidation in prophylaxis of infectious complications, 28 patients were treated with 0.06% hypochlorite solution (2 infusions, 2-3 days before TURP). These patients belonged to a high-risk group of infectious complications (80% of them had chronic prostatitis, 8 patients had bladder stones, 8 had undergone cystostomy). The results demonstrated that the complication rate in the above prepared patients fell four times as compared to the control group and the postoperati hospital stay was reduced by 3 days.

Aged↗
PubMed1992

[Two cases of mucinous adenocarcinoma of the prostate].

We report two cases of mucinous adenocarcinoma of the prostate. A 56-year-old man underwent subcapsular prostatectomy under the diagnosis of benign prostatic hyperplasia in 1968, and was found to have mucinous adenocarcinoma of the prostate, which proved to be prostatic acid phosphatase (PAP) and prostate specific antigen (PSA) positive, and carcinoembryonic antigen (CEA) negative by immunohistochemical staining. Subsequently he received 70 Gy of irradiation to the prostate, but died in 1976, when serum PAP was elevated. Autopsy revealed metastases to the liver, lungs, bone, peritoneum, spleen, pancreas, lymph nodes, and no primary gastrointestinal adenocarcinoma. The other case was a 57-year-old man, who underwent transurethral resection (TUR) for papillary tumor located just lateral to the verumontanum in 1982. The tumor was misdiagnosed as adenomatous polyp, and was PSA and PAP negative, and CEA positive. After 3 TURs of the recurrent tumor on the prostatic urethra, he underwent prostatourethrectomy, pelvic lymphadenectomy, and cystostomy for radical cure in 1985. The specimen proved to be mucinous adenocarcinoma of the prostate. He suffered recurrence of the tumor in the retrovesical space in 1987, and died in 1990. Autopsy revealed no evidence of metastasis except the local recurrence and no primary gastrointestinal adenocarcinoma.

Adenocarcinoma, Mucinous↗
PubMed1992

Penile metastasis from lung cancer.

A case of metastatic tumor of the penis from lung cancer is reported. The patient, who had received a right pneumonectomy 17 months previously for a squamous cell carcinoma of the lung, complained of urinary retention and painful erection of the penis. He underwent an emergency suprapubic cystostomy. Twenty days after the procedure, he died of disseminated lung carcinoma. The autopsy demonstrated massive metastasis to the penis from squamous cell carcinoma of the lung. Penile metastasis from lung cancer is a very rare condition and only 14 cases of this secondary carcinoma have been reported.

Aged↗
PubMed2003

[A case of perineal abscess due to urethral fistula in a patient with spinal cord injury].

We report a case of perineal subcutaneous abscess due to urethral fistula in a patient with spinal cord injury. A 39-year-old male visited our hospital complaining of left scrotal swelling and fever. The left scrotum and perineal skin were swollen to the size of a goose egg, and pus was discharged from the perineal swollen bump. Magnetic resonance imaging (MRI) suggested an urethral fistula with a large subcutaneous abscess. The abscess was resected with debridement of necrotic tissue, and a cystostomy was placed. Endoscopy revealed a fistula in the bulbar urethra. The characteristics of this rare entity are discussed.

Abscess↗
PubMed1992

Surgical procedures in centenarians.

Sixteen patients 100 years of age and older underwent surgical procedures at a single institution during the 11-year period ending December 1991. There were 11 (69%) females and five males. Patient ages ranged from 100 to 104 (mean, 101.1 years). Procedures included six ophthalmologic operations, three permanent pacemaker implantations, three compression hip screw fixations, two leg amputations, one hemiglossectomy, and one cystostomy. There was one (6%) perioperative death. Long-term follow-up was established for each patient. One-year survival rate in these 16 centenarians was 69%. We conclude that selected patients 100 years old and older can survive certain surgical procedures with acceptable perioperative and long-term results.

Aged↗
PubMed2003

An unusual cause of vesical stone: a migrant intrauterine device.

Intrauterine contraceptives devices have been in use for many years. Although perforation of the uterus by an intrauterine device is not uncommon, intravesical migration with secondary stone formation is a rare complication. We report on a 32-year-old woman in whom an intrauterine contraceptive device (Copper T) migrated from her uterus into the bladder. She had lower urinary tract symptoms for nearly 2 years but sought no treatment. The onset of hematuria and fear of cancer prompted her to seek treatment. On investigation, a vesical stone was discovered that had formed on a copper T contraceptive device. It was removed via suprapubic cystostomy. In any woman in whom an intrauterine device is fitted and who presents with lower urinary tract symptoms, the possibility of intravesical migration of the device should be included in the differential diagnosis.

Adult↗
PubMed1992

Hydraulic valve for continence and antireflux. A 17-year experience of 210 cases.

The hydraulic ileal valve ensures urinary continence and can be employed in many different reservoirs. The valve is constructed by isolating a 14 cm long intestinal loop with its mesentery. The isolated ileal segment is then folded inward on itself throughout its length. This hydraulic valve was used in the construction of 210 continent urostomies--ileocaecal reservoir in 184 cases (including 8 detubularized), ileal reservoir in 15, sigmoid in three, rectum and transverse colon one each, and bladder (continent cystostomy) in six cases. The indications for continent urostomy included bladder tumour (45.5% of cases), complex vesicovaginal fistula (31%), neurogenic bladder (11%) and bladder exstrophy (7%). Continence was immediately achieved in 155 patients (75%), rising to 91.5% after valve repair. The mean postoperative follow-up was 56 (range 3-205) months.

Adult↗
PubMed2004

[Changes in serum Na+ and blood hemoglobin levels during three types of transurethral procedures for the treatment of benign prostatic hypertrophy].

BACKGROUND: Transurethral holmium YAG laser resection of the prostate (HoLR-P) and transurethral electrovaporization of the prostate (TUV-P) have recently received increasing attention as an effective minimally invasive approach for the treatment of prostatic hypertrophy. However, less information is available regarding the intraoperative changes in the serum Na+ and blood hemoglobin levels during either HoLR-P or TUV-P. METHODS: Intraoperative changes in serum Na+ and blood hemoglobin levels were investigated in 17 patients undergoing transurethral resection of the prostate (TUR-P, n = 7), HoLR-P (n = 7) or TUV-P (n = 3). The 3% D-sorbitol solution was used as the irrigating fluid in all the patients. RESULTS: In three patients, severe hyponatremia (118-123 mEq x l(-1)) developed abruptly (< or = 15 min) at various time points during TUR-P with (n = 1) or without (n = 2) cystostomy. However, no clinical symptoms were observed after development of the hyponatremia in those awake patients. No large (> 10 mEq x l(-1)) decreases in the Na+ level were observed in any of the patients undergoing HoLR-P or TUV-P. In patients undergoing TUR-P and HoLR-P, percent changes in serum Na+ level significantly correlated with those in blood hemoglobin level, but not with the resection time; the slopes were significantly larger than unity. CONCLUSIONS: The TUR syndrome is less likely to occur during HoLR-P or TUV-P. During TUR-P, the onset of severe hyponatremia appears to be unpredictable, and may not necessarily be accompanied by clinical symptoms. Frequent measurements of the serum Na+ level appear essential for early detection of severe hyponatremia.

Aged↗
PubMed2004

Quality of life in males with spinal cord injury in Saudi Arabia.

OBJECTIVE: To assess the interests and post-hospitalization of quality of life (QOL) and career of patients with spinal cord injury (SCI). METHODS: This study took a period that extended for 20 years (1982-2003). Fifty-seven male patients in the Riyadh, Armed Forces Hospital and Al-Kharj Hospital Program (RKH), Kingdom of Saudi Arabia (KSA) with SCI responded to a questionnaire, which was distributed manually to 120 contributors. The questionnaire items include health status, occupation and educational level. RESULTS: The majority of the SCI patients belonged to the age group of 21-30 years (40.4%) and 31-40 years (33.3%). The injury levels were cervical (43.9%), thoracic (40.35%) and lumbar (23.5%). The urinary incontinence was managed by intermittent catheter (28%), indwelling catheter (17.5%), suprapubic cystostomy (15.8%), condom (12.3%) and continent (14.1%). Pressure sores were common and complication led urinary tract infections in 80.7% of patients. Spinal cord injury was a major cause and has a significant influence on patients' employment and career. Rehabilitation equipments and supplies support were provided by the RKH (45.6%), Ministry of Health (19.3%), self-purchasing (12.3%) and other source (22.8%). The important factors affecting the patient's QOL were financial status, employment, equipment supply and social isolation. CONCLUSION: Spinal cord injury is practically affecting the young adult population of KSA. The patient's QOL is significantly affected and hampered by factors such as accessibility, financial status and employment. Effective measures for the management and social awareness may improve the patient's style and QOL.

Adult↗
PubMedDate not supplied

[Injuries of the urinary bladder: tactics and results of treatment].

A retrospective analysis of 87 cases of isolated traumas and multitraumas of the urinary bladder treated in 1986-2002 covered 69 men and 18 women aged 21-79 years. Young and middle-aged patients (20-50 year olds) prevailed. Isolated traumas of the bladder were diagnosed in 52 patients (4 extra- and 48 intraperitoneal trauma), 35 patients had multitraumas (7 extra- and 28 intraperitoneal trauma). Isolated traumas were most frequently caused by beating (79.4%), multitraumas--by road accidents (79.2%). Examination included catheterization of the bladder, ultrasonic investigation, x-ray contrast studies, laparocentesis, laparoscopy. Injury of the bladder combined with fractures of skeletal bones, craniocerebral trauma, abdominal injuries. Surgery was made in 86 cases, bladder drainage was made by cystostomy, transurethral drain was conducted in 17 patients. Bladder surgery was combined with abdominal operations in 14 patients. Three operations were delayed. Out of 87 patients 67 was cured. 20 (23%) patients died. Lethal outcomes were mostly due to progression of traumatic shock.

Adult↗
PubMed2005

[Vesicorectal fistula caused by pelvic metastasis of penile cancer: a case report].

A 65-year-old man was referred to our hospital complaining of glans induration. Tumor biopsy revealed squamous cell carcinoma. Although he was given radiation therapy and subcutaneous injection therapy of bleomycin, viable cancer cells remained. Then he was given combination chemotherapy of bleomycin and cisplatin, and paint therapy of bleomycin ointment. Local recurrence with a cauliflower-like tumor occurred five years after the chemotherapy. Then we performed total penectomy and reconstructive surgery of penis. Five years later, discharge of urine from anal appeared. Computerized tomography of pelvis demonstrated a mass 3 cm in diameter in the anterior portion of anal and cystogram demonstrated a vesicorectal fistula. We tried to perform fistulectomy, but foiled because of large fistula. Then we inserted a urethral catheter, which resulted in obstruction of fistula by its balloon, and we made a cystostomy for securing urinary tract. Pathological examination of tissue around the fistula revealed squamous cell carcinoma. His quality of life was improved, but his general condition became worse gradually and he died of cancer.

Aged↗
PubMed2005

[Diagnosis and treatment of urinary neurofibrosarcoma].

OBJECTIVE: To investigate the clinical characteristics, diagnosis and treatment of urinary neurofibrosarcoma. METHODS: Clinical data of 1 case of urinary neurofibrosarcoma was analyzed retrospectively and related literature reviewed. The 61-year old male patient had undergone TURP for benign prostate hyperplasia ten months before. RESULTS: Total urethral cavernostomy, total cystectomy and ileal cystostomy were performed on the patient and pathological diagnosis pointed to urinary neurofibrosarcoma. Another operation was done for metastatic rectal mass, which revealed abdominal metastasis. With progressing consumptive constitution, the patient died 40 days after the second operation. CONCLUSION: It is difficult to make a definite diagnosis in urinary neurofibrosarcoma, and the effective treatment for this highly malignant disease needs to be further studied.

Humans↗