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PubMed1990

[A case of urinary undiversion from ileal loop conduit].

A seventeen-year-old girl, who had had an ileal conduit urinary diversion at 5 years of age, underwent a urinary undiversion 12 years after the initial operation. She has been suffering from recurrent episodes of urinary tract infection with fever. The preoperative evaluation revealed dilatation of the bilateral pelvis and ureters on an excretory urography. Ileal conduitgraphy revealed urinary reflux from the ileal loop to the bilateral upper urinary tracts. Cyclic bladder hydrodilatation through a suprapubic cystostomy was performed and a precise urodynamic study was done on the lower urinary tract. The vesical capacity increased from 40 ml to 300 ml in a month. Cystometry and urethral pressure profile revealed a stable bladder with good detrusor contraction and preserved urethral continence. Voiding status was satisfactory with only a small amount of residue. The undiversion was undertaken as follows. The ureters were once isolated from the ileal loop and their distal ends were everted in length of 5 mm to be nipples in shape. The ureters were reanastomosed to the proximal end of the ileal loop with submucosal tunnels of 2 cm. The ileal loop was then tapered and implanted to the bladder with a submucosal tunnel of 5 cm. Eight months after the undiversion, she enjoys good urination, free from urinary tract infection. Although moderate hydronephrosis remains bilaterally, renal function is stable.

Adolescent↗
PubMed1985

[Transvesical prostatic adenomectomy without a urethral catheter. Apropos of a continuous series of 200 cases].

200 transvesical prostatic adenomectomies were performed without urethral catheters between 1977 and 1984. Le Guillou's technique was employed. The catheter was removed after one week. 90% of the patients passed water immediately. The use of Le Guillou's technique was directly responsible for 1 death (iatrogenic mechanical anuria). 19 patients (9.5%) had to be trans urethrally catheterized of 2 to 8 days after the removal of the cystostomy tube. Long-term follow-up available in 148 of the patients showed 1 failure and 10 successfully treated complications. The advantages of Le Guillou's technique are: Reduced bleeding. Reduced postoperative infection. Virtual disappearance of urethral iatrogenic stenosis. Improved post-operative comfort. Simplification of post-operative nursing.

Aged↗
PubMed1986

[Micturition complaints in older men].

There is no correlation between the size of the prostate and the degree of infravesical obstruction or related micturition disorders. If, however, benign prostatic hyperplasia results in bladder outlet obstruction, secondary detrusor hyperreflexia may develop. This bladder dysfunction persists postoperatively in a quarter of the patients treated. When in senile men the symptoms of detrusor instability or detrusor hyperreflexia are in the foreground, then it is very important from the point of view of differential diagnosis to know exactly whether the detrusor dysfunction is due to either outlet obstruction or cerebral insufficiency. Measurement of the sacral latency might be able to answer this question. If the voiding complaints are secondary to outflow obstruction and the neurophysiological parameters of the sacral reflex arc are within normal limits, then it may be assumed that the associated bladder instability (together with the bladder outlet obstruction) may disappear after prostatectomy or TUR of the prostate. In the case of a prostatic carcinoma with outflow obstruction, it seems preferable to start endocrine therapy, rather than to perform a TUR of the prostate. In a large number of cases, endocrine therapy will be able to reduce the size of the prostate and relieve the outflow obstruction. In patients with excessive operation risks, simple endoscopic bladder neck incision or suprapubic puncture cystostomy may prove valuable alternatives to TUR of the prostate.

Aged↗
PubMed1988

[Benign prostatic hyperplasia as a frequent senile disease of the male].

An adenofibromyomatous proliferation starting from the region of the periurethral glands is referred to as benign prostatic hyperplasia. It is the result of a senile endocrinopathy, which leads to a disbalance of the peripheral hormonal milieu, and of an intraglandular disturbance of the utilization of the hormone. It becomes a disease when it is followed by an increase of the vesical outlet resistance and thus by an obstructive disturbance of the voiding of the urinary bladder. The indication for operation is determined by the degree of the obstruction and its pathophysiological sequelae as well as the complaints of the patients. The conservative therapy is above all symptomatic and indicated only at the initial stage of the disease. The transurethral resection is the operative therapy of choice. In very large hyperplasias the open surgical intervention may be necessary. In inoperable patients a urethral catheter should be renounced for a suprapubic puncture cystostomy. Also after operative ectomy of a benign prostatic hyperplasia the patients may fall ill with a carcinoma of the prostatic gland. Therefore, the duty for undergoing an annual preventive medical examination remains.

Aged↗
PubMed1989

[Urethral diverticulum. Complication in males with spinal cord lesions].

We report on 4 spinal cord injury patients with urethral diverticulum from urethral lesions caused by urine collecting systems. We advocate one-stage surgical repair with the following precautions: treatment of the septic condition prior to surgery, puncture cystostomy, and closure of the surgical wound using methylene blue.

Adolescent↗
PubMedDate not supplied

[Chronic pancreatitis: anatomico-clinical and surgical therapy characteristics. Our experience with 321 cases].

Chronic pancreatitis of biliary origin, frequently located in the cephalic portion of the organ, etiopathogenically dependent on biliary lithiasis, the anatomoclinical evolution of which is complicated by their presence, have a better prognosis, and are usually reversible following therapy of the biliary affections. Persistent chronic pancreatitis proper, usually of the recurrent type, associated with calcification and the development of pancreatic stones, and with pseudocysts, although rare in our country, raise diagnostic difficulties from the standpoint of surgery, and have a reserved prognosis. The authors have evaluated a total of 321 cases hospitalized between 1960 and 1987 with chronic pancreatitis of biliary origin (252 cases--78.5%), and chronic pancreatitis proper, not associated to biliary affections (69 cases--21.5%). Male patients totalled 33.6% of all cases. The authors stress the high frequency of chronic pancreatitis associated to biliary lithiasis (181 cases), in contrast with pancreatitis associated to nonlithiasic cholecystopathies (38 cases), or to postoperative cholecystic disturbances (33 cases). Chronic pancreatitis non-associated to biliary affections totalled 69 cases, of which 24 were of the persistent type, 13 were of the recurrent type, one had calcifications, two had pancreatic stones, four followed acute pancreatitis, six were complicated by pancreatic abscesses, and 9 were complicated by pseudocysts. The duration of biliary and pancreatic disturbances was between 3 and 5 years in 43.9% of the cases, and between 6 and 10 years in 21.3%. Chronic pancreatitis achieves a complex clinical syndrome, the dominant feature being the painful biliopancreatic syndrome associated to obstructive jaundice (42.4%), angiocholitis (47.6%), weight loss (46%), hepatic and renal failure (10.9%), diabetes (8.4%), and a tumoral mass (15.7%). Indirect surgical interventions aimed at suppressing the biliary factor were carried out in 291 patients, with very good results in 56% of the cases, good results in 32%, mediocre in 7%. In 2.4% of the cases surgery failed to improve the condition of the patients. Direct interventions on the pancreas, which consisted either in pancreatic decompression or in exeresis of the gland have been performed in 30 patients. Drainage of pancreatic abscesses was done in 6 patients (2 deaths), cystic-digestive anastomoses were performed in 8 patients, Wirsung-jejunostomy in 3 patients (1 death), cystostomy in one patient, distal pancreatectomy in one patient (deceased), viscerolysis and novocaine infiltration in 11 patients. In the 321 cases of chronic pancreatitis operated by direct and indirect procedures very good

Adolescent↗
PubMed1989

[Primary carcinoma of the female urethra].

An 80-year-old female patient with urethral carcinoma is reported. A red, easily bleeding mass at the urethral meatus was diagnosed as transitional cell carcinoma by biopsy. Complete resection of the urethra and tubeless cystostomy were performed. Postoperative M-VAC therapy a combination of methotrexate, vinblastine, adriamycin and cisplatin was employed.

Aged↗
PubMed1989

Penile rupture.

Rupture of the corpus cavernosum is a rare injury; the characteristic history and physical findings usually yield the diagnosis. Blood at the meatus, any degree of hematuria, and difficulty with urination are suggestive of associated urethral injury, which occurs in 10 to 20 per cent of patients and indicates the need for retrograde urethrography. A review of the literature suggests that early surgical repair of the tunical defect is associated with a significantly lower risk of persistent penile angulation, a shorter hospital stay, and more rapid functional return. Conservative treatment may be warranted in cases with minimal hematoma if cavernosography reveals no extracorporal extravasation. Complete urethral disruption is best managed by primary repair, whereas partial disruption can be managed adequately by temporary suprapubic cystostomy. By following these guidelines, long-term morbidity can be kept to a minimum.

Humans↗
PubMed1989

[Malignant melanoma of male urethra: a case report].

A case of male urethral melanoma is reported. A 85-year-old male with a 2-month history of progressive, severe obstructive urinary symptoms and bloody urethral discharge was referred to us after an unsuccessful management at a local doctor. Physical examination revealed an ill looking old man with no evidence of nevi or other cutaneous pigmentation looking like malignant melanoma. Neither palpable periurethral mass nor inguinal lymphadenopathy was noted. RUG showed an irregular shadow defect in bulbous urethral regions. In cystourethroscopy, a raised nodular reddish black lesion in the urethra without adjacent satellite lesions was found. Histologic examination revealed that the tumor was made up of closely spaced, anaplastic, spheroidal or polyhedal cells. Intracellular brown pigment was richly present, gave a negative reaction for iron, but stained black with Masson-Fontana's method. Further examination for evaluating metastases including bone scintigraphy, computer tomographic scan, chest X-ray film were negative. Due to his poor risk, radical operation such as cystourethrectomy might be undesirable. We performed TUR to relieve urethral obstruction, because the patient refused cystostomy. He died of wide spread metastases at 6 months after the operation. This case seems to be the second report in the Japanese literature.

Aged↗
PubMed1989

[Urethral injuries: analysis of 24 cases].

Cases analysis of 24 operations for the anterior urethral injuries is presented. 7 patients were treated one-stage transperineal end-to-end anastomosis and 17 underwent an immediate urethral realignment over a fenestrated catheter. Hospital stays were generally short and the rate of complication was low as well as the number of blood transfusions needed in both groups. The operating time however was longer in patients in the anastomosis group. Postoperatively, urethral strictures occurred in 71% of the patients who underwent one-stage transperineal end-to-end anastomosis and in 65% of those treated by realignment over a fenestrated catheter. The high incidence of postoperative stricture formation caused both techniques indicated neither procedure as a valuable modality for the primary and early treatment of anterior urethral injuries. According to the authors the suprapubic cystostomy and delayed urethroplasty offer a better choice of therapy.

Adolescent↗
PubMed1989

[Diffuse acute periurethritis (urinary phlegmon)].

The authors present 30 patients with diffuse acute periurethral phlegmon. The prevention of signs of toxic-infectious shock involves surgical exposure and resection of necrotic tissues with diversion by cystostomy. Urinary phlegmon constitutes a serious septic entity which requires emergency assessment in order to prevent a fatal outcome. The authors stress several aetiopathogenic, clinical and therapeutic features of this periurethral disease.

Aged↗
PubMed1987

Graft reconstruction to treat disease of the abdominal aorta in patients with colostomies, ileostomies, and abdominal wall urinary stomata.

Abdominal aortic reconstruction combined with colon or urinary tract operations is generally not acceptable because of a supposed greater incidence of graft infection. Similar fears exist regarding aortic reconstruction in the presence of colostomies, ileostomies, and permanent urinary diversion stomata. In fact, the presence of a colostomy has been reported to be a contraindication for abdominal aortic reconstruction. This report is concerned with vascular operations in 13 such patients with aortic disease referred to us for fear of these complications. Eleven patients had abdominal aortic aneurysms and two had atherosclerotic occlusion of the aorta and iliac arteries. Twelve patients had colostomies, ileostomies, or both and one patient had permanent tube cystostomy. All had good renal function and the disease for which the diversion procedure was performed was either cured or under good control. All patients survived the vascular reconstructive procedures without significant complications and long-term follow-up revealed that late graft infection did not occur.

Abdominal Muscles↗
PubMed1988

[Artificial urinary sphincter in the treatment of neurogenic bladder in children].

Over a two years period, the model AS 800 artificial urinary sphincter was implanted in 10 children (mean 14 years old) with incontinence due to a neurogenic bladder (7 spina bifida; 3 sacral agenesis). Goal of continence was achieved in 100% of 7 boys and 3 girls with a follow up between 6-32 months (mean 17 months). Patients selection was rigid and incontinence have failed to response at pharmaceutic manipulation (6) intermittent catheterisation (5) and previous classical surgery enterocystoplasty (2), Young-Dees procedure (1). Age minimum was 8 years. All sphincters were implanted around the bladder neck. Associated surgical techniques were performed in 4 cases: 2 detubularized enterocystoplasties, 1 Teflon injection for vesico ureteral reflux, 1 closure of previous cystostomy. Sphincterotomy was never done. 5 patients are submitted post implantation to intermittent catheterisation without any problem. 2 patients required one revision. Nocturnal desactivation is used in 2 cases. Authors focus on the necessity of correcting previously or at the time of implantation bladder compliance and vesico ureteral reflux.

Adolescent↗
PubMed1988

[Congenital anterior urethral diverticulum: report of a case].

A case of congenital urethral diverticulum is reported. A 6-month-old male was admitted with difficulty to urinate and swelling of the base of penile shaft. Anterior urethral diverticulum was demonstrated by means of retrograde urethrography. A diverticulectomy combined with cystostomy was performed under the general anesthesia. Although the histological findings were insufficient to determine whether the urethral diverticulum was congenital or acquired, the former was strongly suspected judging from his clinical course. He developed urethrocutaneous fistula, one of the most common postoperative complication, on the 7th post-operative day. A complete cure of the fistula was achieved by the conservative treatment. We collected and analyzed 49 cases of congenital anterior urethral diverticulum of male children in Japan.

Diverticulum↗
PubMed1988

Diagnostic and therapeutic urologic procedures.

Urologic procedures useful to the emergency physician in the diagnosis and management of urinary tract disorders are presented in this article. Discussed are urinalysis, diagnostic radiologic modalities (KUB film, intravenous pyelography, retrograde cystourethrography, computerized tomography, angiography, ultrasonography, and renal scintigraphy), and urologic procedures (urethral catheterization, percutaneous suprapubic cystostomy, suprapubic bladder aspiration, dorsal-slit procedure, and meatotomy). Where appropriate, indications, contraindications, method, and complications are presented for the various procedures.

Angiography↗
PubMed1987

Stress incontinence of urine.

At rest, continence of urine depends on intraurethral pressure being higher than intravesical pressure. Intraurethral pressure is produced by elastic fibres and engorged urethral venous sinuses. Low intravesical pressure is preserved by bladder muscle relaxation. Urgency incontinence will result if bladder muscle does not relax. A sudden increase in abdominal pressure may overcome this urethral-vesical pressure gradient and cause stress incontinence. The mechanisms that prevent this from happening are unclear. The pressure gradient would not change if the abdominal pressure was transmitted equally to the urethra and the bladder. Continence could also be protected by pressure of the urethra against the symphysis pubis or pelvic muscles. Stress and urgency incontinence cannot be differentiated clinically with certainty. If surgical correction of stress incontinence is planned, preoperative urethrocystometry is mandatory. The Burch colposuspension is the operative procedure of choice. The suspension is done with Prolene sutures; their correct placement is ensured through the use of intraoperative cystostomy.

Female↗
PubMed1987

[Vesicovaginal fistula. Apropos of 600 cases].

A personal series of 600 cases of vesicovaginal fistula is reviewed. Patients could be classified as a function of site of fistula into 3 groups: I. urethrovaginal fistula (31%); II. cervicovaginal fistula (22%); III. vesicovaginal fistula (46%). Etiology was mainly obstetrical (94%), as was multiparity (69%). An associated lesion was detected in 11% of cases (uterine, ureteral and rectal). Surgery was performed after a minimum period of 3 months with the following results. Type I fistulae, using a low approach and requiring urethral refection, showed good results in only 53% of cases. Type II fistulae, usually treated through a low approach (80%), were relieved in 80% of cases, with the reservation that reinforcement of bladder neck was often necessary. Type III fistulae, treated by a high (60%) or low (40%) approach were nearly always corrected (98%). In 2 cases of destroyed urethra unable to benefit from urethral plastic surgery, bladder repositioning with continent cystostomy was satisfactory. 72 cases with irrecuperable destroyed bladder received definitive high diversion: 34 Coffey, 5 Bricker, and since 1975, 33 continent ileocecal bladders using Benchekrouns' technique.

Adolescent↗