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PubMed2005

Case analysis of purple urine-bag syndrome at a long-term care service in a community hospital.

BACKGROUND: Purple urine-bag syndrome (PUBS) is a rare phenomenon in which the contents of urine bags turn purple or blue following patient catheterization. The condition often causes care givers tremendous distress. We investigated the prevalence and possible causes of PUBS for a group of elderly patients. METHODS: A total of 157 patients featuring urine catheterization, 13 of whom exhibiting PUBS were analyzed with regards to age, functional status, duration of catheterization, number of daily medications, living location, feeding route, bowel habits, and the pattern of use of a urinary catheter. Urine samples were cultured from all the PUBS patients participating. RESULTS: Two men who underwent cystostomy and 11 women who underwent urethral catheterization who exhibited PUBS were observed for this study. The age, duration of catheterization, number of daily medications feeding pattern and functional status between the group exhibiting PUBS and the group of patients without PUBS demonstrated no significant differences. A total of 69.2% of the PUBS-affected patients, as compared to 43.1% of the non-PUBS patients, lived in nursing homes, and 84.6% of the PUBS-affected patients were constipated, as were 66% of the non-PUBD subjects. In total, 72.7% of PUBS patients were reported to be using a laxative suppository, compared with 41% of the non-PUBS group, whereas 92.3% of PUBS patients were catheterized using a plastic (PVC) foley, as compared to 70.8% of the non-PUBS patients. The pH for 12 out of 13 PUBS patients' urine was > or = 7. Escherichia coli, Provendicia var. spp., Proteus mirabilis, Klebsiella pneumoniae were the common pathogens isolated from the urine samples provided by our PUBS patients. CONCLUSION: We found that PUBS was more likely associated with the female gender, alkaline urine, constipation, institutionalization, the use of a plastic (PVC) urinary catheter, and certain bacteria such as Provendicia var. spp., Escherichia coli, Proteus mirabilis, and Klebsiella pneumoniae.

Adult↗
PubMed1991

Leiomyosarcoma of the broad ligament--report of two cases.

Leiomyosarcoma of the broad ligament (LBL) is a very rare tumor. Up to 1989, there had been only 7 cases reported in the English literature. During recent 12 years, we have had 15 cases of leiomyosarcoma in our department. Among them, there were two cases of LBL. The others were leiomyosarcoma of the uterine corpus. The first patient was 36 years old. She received total abdominal hysterectomy, bilateral salpingo-oophorectomy and paraaortic lymph node sampling followed by chemotherapy with adriamycin. Intra-abdominal recurrence with hepatic metastasis occurred 18 months after operation and she received palliative radiotherapy. The second patient was 65 years old and received subtotal hysterectomy, bilateral salpingo-oophorectomy, omental biopsy and suprapubic cystostomy followed also by chemotherapy with adriamycin. She received segmental resection of ileum and ileostomy due to intestinal obstruction caused by metastasis 5 months after her initial operation. Both patients were still alive when reported with 33 and 26 months of survival, respectively. The nature and management for LBL are scarcely reported, accumulation of cases and clinical experiences are needed.

Adult↗
PubMed2006

[Radical parametrectomy in women with invasive cervix cancer after previous simple hysterectomy].

OBJECTIVE: Evaluate technique, indications and limits of surgical procedure in the treatment of cervical cancer diagnosed from uterus specimen from simple hysterectomy. DESIGN: Retrospective observational study, review of literature. SETTINGS: Department of Obstetrics and Gynecology, 1st Medical Faculty and General Faculty Hospital, Charles University, Prague, Czech Republic. METHODS: Women following radical parametrectomy with upper vaginectomy and pelvic lymphadenectomy were enrolled to the study. In all patients unexpected invasive cervical cancer was found from the uterus specimen after simple hysterectomy. RESULTS: Together 10 patients were enrolled to the study. CIN was the indication for primary hysterectomy in all but two patients. There were two operative complications, cystostomy in both cases, treated properly during surgery. In the specimen from radical procedure residual tumor in parametria was found in 2 cases, and metastasis to pelvic nodes in 4 cases. There was no postoperative complication. Adjuvant radiotherapy was recommended in 4 patients due to positive lymph nodes, in one case due to residual tumor in parametria, and in one case for both reasons. CONCLUSIONS: Radical parametrectomy with upper vaginectomy and pelvic lymphadenectomy should be considered as an alternative solution in patients following simple hysterectomy with unexpected finding of invasive cervical cancer. Morbidity of the procedure is higher in comparison to standard radical hysterectomy, however majority of complications are easy to repair. The most significant criteria for patient's selection for surgical approach is a depth of invasion to cervical stroma. In our group radical procedure obviated the need for radiotherapy in half of the patients.

Adult↗
PubMed2006

Fournier gangrene. Approaches to diagnosis and treatment.

OBJECTIVE: To investigate the factors associated with patients with Fournier's gangrene, and to clarify the effect of diabetes mellitus (DM) as a comorbid disease on morbidity and mortality of patients with Fournier's gangrene. METHODS: Twenty-six Fournier's gangrene patients who were admitted to the Emergency Department of Ankara Numune Teaching and Research Hospital, Ankara, Turkey from 1997 to 2003 were examined retrospectively. RESULTS: The mean age of the patients was 52.8 years. There were 8 female (30.8%) and 18 male (69.2%) patients. The etiological causes were as follows: diseases of the perianal region, history of operations, trauma and injections. Major comorbid disease states were diabetes mellitus (DM) and hypertension. The lesions in Fournier's gangrene were most commonly located in the perineum and genital region. Female patients with diabetes mellitus had significantly unusual extensive involvement, especially abdominal wall involvement. The most frequently isolated pathogen was Escherichia coli, while staphylococcal infection was most commonly seen in the presence of DM. Colostomy was performed on 53.8% of the patients, and cystostomy on 7.6% of the patients. Average time of staying at the hospital was 25 days with a mortality rate of 34.6%. Patients with DM had high mortality rates and stayed longer at the hospital than the non-diabetic patients. CONCLUSION: In addition to early diagnosis, early and aggressive debridement and administration of multiple wide spectrum antibiotics chosen for the causative agent are the golden standard for decreasing the mortality and morbidity. Diabetes mellitus has been found to be an important factor to increase mortality rates of patients with Fournier's gangrene.

Adult↗
PubMed1990

Pancreatitis necessitating urinary undiversion in a bladder-drained pancreas transplant.

After successful combined pancreaticoduodeno-renal transplant in an insulin-dependent diabetic, recurrent episodes of transplant pancreatitis were treated with Foley catheter drainage. The apparent cause of pancreatitis was increased pressure on the pancreatic duct due to infrequent voiding and a large bladder. A frequent voiding program partially relieved the pancreatitis, but final resolution necessitated conversion of the pancreaticoduodeno-cystostomy to a Roux-en-Y duodenojejunostomy at 6 months posttransplant. Both renal and pancreatic function are stable after 1 year, with no recurrence of pancreatitis since urinary undiversion. We believe pressure pancreatitis or urine reflux pancreatitis to be an infrequently reported cause of graft dysfunction in bladder-drained pancreas transplant recipients.

Acute Disease↗
PubMed1990

[Video-guided TUR].

Video-TUR has become a very important new technique in urology, causing far less discomfort than conventional techniques for the surgeon. A mini-chip camera (Olympus OTVS-2) is attached to the lens system of a continuous-flow resectoscope (Olympus). A television monitor (Sony PVM 1442) provides reliable guidance for the cutting loop when resection is necessary for the treatment of benign hypertrophy or carcinoma of the prostate or carcinoma of the bladder. To maintain a good intravesical flow system, which is very important for a clear field of view, a suprapubic cystostomy should be placed. The surgeon sits in a comfortable position with both eyes on the screen so that eye-strain, back pain and mental stress can be reduced. The excellent depth perception is due to a 50-times enlargement by the camera, so that tissue-orientated TUR is possible. Even when it is not possible to place the patient in an optimal position, because of scrotal hernia or coxarthrosis, TUR can still easily be performed. In 120 transurethral prostate resections and 30 transurethral bladder tumour resections, the video technique has proved comfortable for the surgeon and safe for the patient. Video-TUR has been helpful in the presentation of this technique in urologic teaching. TUR of the prostate has been freed from much of its mystique, since the procedure can be watched while it is in progress. The video technique has opened up a new epoch in endourology, whose importance cannot yet be realized.

Humans↗
PubMed1990

[Open surgery of elderly patients with benign prostatic hypertrophy].

Thirty three patients with benign prostatic hypertrophy (BPH) over age 80 who had undergone an open prostatectomy at our ward in the period of January of 1968-December of 1987 (20 years), were retrospectively studied for their complications before, during, or after the operation and prognosis. Preoperative complications were observed at a very high rate. When these complications may influence the prognosis, prudent care is required. The incidence of complications during or after the operation seemed also to be slightly high. This is probably because the number of patients with recurring urinary retention or those who had received cystostomy before the operation were relatively high among the elderly people. In such cases especially prudent care is required, for the prognosis may be poor. About 88% of the patients felt better post-operatively and had a good prognosis. In addition, there was no indication of the operation shortening their life. Consequently, an open prostatectomy was considered to be useful for elderly patients.

Aged↗
PubMedDate not supplied

[The surgical treatment of urinary incontinence in children].

The paper reports examination, treatment and follow-up data on 8 children aged 4-13 suffering from total enuresis, who failed previous conservative or operative treatment. Upon examination enuresis was attributed to trauma or malformations of the neck of the urinary bladder (NUB) or urethra (in 2 and 6 patients, respectively). Out of the latter, NUB congenital defect was in 4, total epispadia in 1, spina bifida in 1 patient. Urodynamic studies showed the absence of detrusor-sphincter dyssynergia and confirmed organic nature of NUB lesion. Six children underwent NUB electromyography which recorded no uniform, preformed complexes with adequate voltage. All the children were operated on: NUB reconstruction according to Davis, bilateral uretero-cystostomy according to Coen. An immediate postoperative response was seen in 7 children who were able to retain urine for 40 min-2.5 hours. Long-term response (6 months-3 years) was achieved in 7 children who recovered normal uresis. Total enuresis persisted in 1 patient with spina bifida. 2.5-3 years after the treatment the bladder capacity increased in spite of its resection by 1/3.

Adolescent↗
PubMed1991

[Two cases of traumatic bladder rupture with multiple organ failure].

We report two cases of traumatic bladder rupture complicated by multiple organ failure (MOF). The first patient had an extraperitoneal bladder rupture and right femoral bone fracture, which were treated conservatively. However, intrapelvic abscess and adult respiratory distress syndrome (ARDS) which was caused by fat embolism resulted in MOF. The second patient who had been under treatment for malignant lymphoma for three years had an intraperitoneal bladder rupture with ruptures of spleen, intestine and diaphragm. We closed the defects in the bladder, intestine, diaphragm and performed splenectomy. We also provided suprapubic cystostomy and a urethral catheter. However, wound abscess and hepatic failure occurred postoperatively. She died of MOF 20 days after the operation. We stress that in the treatment of bladder rupture, intensive chemotherapy for infection must be done when there are complications of other visceral injuries.

Accidents, Traffic↗
PubMedDate not supplied

[The selection of the method for urinary diversion in children].

Ninety-five urinary fistulas have been produced at various urinary tract levels in 62 infants and children, aged 20 days to 13 years, for uni- or bilateral megaureter and hydronephrosis 14 days to 16 months prior to major reconstructive-plastic surgery. Efficacy of draining (21 cystostomies, ureterostomies and nephropyelostomies) and nondraining (74 ureterocutaneostomies) techniques was evaluated 2-6 months or later using clinical, laboratory, X-ray, tracer and urologic cinematographic studies. Fistula application and removal maneuvers and complications are described. The draining techniques were found to be inefficient in prolonged preliminary urinary diversion and to be associated with frequent infection relapses and less satisfactory results of plastic surgery. Ureterocutaneostomy proved to be the most reliable and convenient method of prolonged drainage even though it required additional operations to replace the patent ureters. The drainage should be prolonged to 12-16 months if the urinary tract deteriorates, especially in young children.

Acute Kidney Injury↗
PubMed1990

Surgical treatment of the ruptured bladder: 22 years reviewed.

During the 22-year interval from 1964 to 1985, 36 patients with bladder injuries were treated at the Kaohsiung Medical College Hospital. Thirty-two cases were male (89%) and 4 cases were female (11%), the sex ratio of patients was 8 to 1, respectively. The average patient age was 33 years and 75% were less than 40 years of age. Hematuria was present in all of the patients and it was microscopic in 25%. Traffic accidents accounted for 55% of the injuries; penetrating trauma was responsible in only 6% of the patients. Of the 36 bladder trauma cases, 11 (30.5%) had intraperitoneal injury, 24 (66.7%) had extraperitoneal injury and 1 (2.8%) had intraperitoneal and extraperitoneal injury. Of the 28 cases with pelvic fracture and bladder trauma in this study, 18 (60%) had extraperitoneal rupture, and 9 (30%) had intraperitoneal rupture. The position of intraperitoneal rupture was mostly at the posterior wall and dome, whereas that of the extraperitoneal rupture was partly located at the anterior wall and the bladder neck. Bladder rupture was treated by operative repair of the defect, bladder drainage by suprapubic cystostomy and/or urethral catheter and drainage of the perivesical space. The mortality rate with the ruptured bladder was 17%. Multiple injuries associated with the ruptured bladder and postoperative complications especially septic shock, were the main causes of mortality.

Adolescent↗
PubMedDate not supplied

[Current status of pancreas transplantation].

Today, combined kidney and pancreas transplantation is the best treatment for patients with type I diabetes and pre-end or end-stage renal disease due to the diabetic nephropathy. Twenty-nine patients underwent that procedure at our Institution. Recent technical modifications--with the use of a whole pancreas graft with urinary drainage of the exocrine secretion in the recipient by performing a pancreatico-duodeno-cystostomy--allow the monitoring of the exocrine secretion which is a pertinent immunological marker for pancreas rejection. In the next future, pancreas alone should be considered safely using the same procedure, in non uremic diabetic recipients in whom extra-renal secondary complications are more serious than the potential side effects of chronic immunosuppression. That type of pancreas transplantation should benefit of the forthcoming immunosuppressive drugs.

Diabetes Mellitus, Type 1↗
PubMed1990

[Treatment of suprasellar arachnoid cysts by percutaneous transfrontal ventriculocystostomy. Apropos of a series of 17 cases].

The treatment of suprasellar cysts is controversial and most often disappointing: on the one hand, subfrontal approaches to the cysts, in view of removal or fenestration, are frequently dangerous and ineffective; on the other hand, ventricular shunting frequently leads to the paradoxical increase in the size of the cyst. Because of these difficulties, the authors have treated 17 consecutive cases by the means of a percutaneous transfrontal ventriculocystostomy. In 11 cases, the cyst was perforated by a leukotome which was guided radiologically in 10 cases and by ultrasounds in 1 case. In the remaining 6 patients, the cystostomy was achieved by a monopolar coagulation under ventriculoscopic control. The results were as follows: in 3 cases, it was not possible to achieve the fenestration of the cyst with the leukotome due to the resistance of the membrane; in 1 case, the ventriculocystostomy was complicated by a poor control of the trocar progression under ultrasounds; the other 14 procedures were successful: signs of increased I.C.P. disappeared; the neurological symptoms regressed; the cysts diminished in size. However, the preoperative endocrine troubles did not decrease. The persistence of a post operative ventriculomegaly apparently did not affect the level of the intellectual development of the patients. The authors emphasize the interest of the percutaneous ventriculocystostomy, this procedure being simple, benign and efficacious. The fenestration of the cyst by coagulation appeared more suitable than by the leukotome.

Adolescent↗
PubMed1990

Pancreatic transplantation in the rat. An experimental model.

Following the induction of experimental diabetes in two groups of rats using an isograft model, a comparative study was made of two types of pancreas transplants in which several procedures were employed. The vascular anastomosis in one group were to the renal artery and vein, and in the other, to the iliac vessels. The pancreatic ducts in one subgroup were ligated, in another, they were diverted to the urinary system; in a third sub-group, they were diverted to the intestine. The results obtained for the sub-group with the transplant anastomosed to the renal vessels were the best. It is suggested that this was due to two factors: the simplicity of the technique and the short operating times. In this present work the two best methods of dealing with the exocrine secretion were diversion to the ureter and ligation of the common bile duct. The worst results were in the group with duodeno-cystostomy.

Animals↗
PubMed1990

[Delayed spontaneous rupture of the bladder following augmentation enterocystoplasty].

Delayed spontaneous rupture of the urinary bladder following augmentation enterocystoplasty is a serious life-threatening complication of uncertain etiology. Multiple factors are believed to contribute to the mechanism of bladder perforation. Ruptured augmented bladders share a common urodynamic pattern of high leak point pressure of the urethra, with sensory and mechanical tolerance of high filling pressure. This combination seems to be the main predisposing factor for spontaneous perforation. Other risk factors, including catheter trauma during intermittent self-catheterization, urinary retention due to mucus retention or noncompliance with the catheterization protocol, chronic infection, and decreased sensation of bladder filling, may play roles in the mechanism of rupture. Clinically, patients present with sepsis, abdominal pain and distension, ileus, fever, oliguria and peritoneal irritation. The diagnosis is made on low pressure cystography, although failure of cystography to demonstrate extravasation is not unusual. Aggressive surgical treatment consists of immediate exploration, primary repair of the perforation, drainage of the perivesical space, suprapubic cystostomy and broad-spectrum antibiotics. Longterm management includes a strict intermittent catheterization schedule, anticholinergic therapy and urodynamic evaluation. Failure to achieve a low pressure storage reservoir by conservative means entails an increased risk of recurrent perforation. In such cases further surgical intervention should be considered. We present a 21-year-old paraplegic man 5 months after augmentation enterocystoplasty who required operation because of spontaneous rupture of the augmented bladder. Spontaneous delayed rupture of the bladder should be considered in the differential diagnosis of acute abdomen in patients after augmentation enterocystoplasty. Early surgical treatment and subsequent monitoring of the low pressure reservoir are recommended.

Adult↗
PubMed1990

[Cystostomia. Preliminary surgery for a voluminous cyst].

The Authors present a case of voluminous dentigerous mandible cysts, treated by cystostomy as described by Partsch and resected after eighteen months, when the radiographical tests showed a remarkable reduction of its dimension. The Authors, even if they prefer the radical technique of operation as their choice in the treatment of the cystic forming of the jaw, underline the importance of an accurate clinical and X-ray valuation in the choice of the surgical protocol to follow in the treatment of the cysts of great dimension.

Adult↗
PubMed1990

Unitary drainage bag.

A urinary bag in which the collection bag is part of a panel that hangs from a belt around the patient's waist avoids local irritation of the thigh and embarrassment of the superficial venous circulation. The bag can be used with nephrostomy and cystostomy tubes as well as urethral catheters.

Drainage↗
PubMed1990

[Vesico-prostatic calculi treated by microexplosion lithotripsy: a case report].

A 48-year-old male suffering from neurogenic bladder due to spinal injury was admitted to our clinic with a chief complaint of macrohematuria. Examinations revealed some calculi located in the bladder and in the prostate. Microexplosion lithotripsy for the prostatic calculi (29 x 23 mm etc.) was performed via the urethra and for the vesical calculus (65 x 55 mm) via the suprapubic cystostomy channel. The calculi were fragmented and removed out completely.

Calculi↗