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PubMed1985

[Vesicostomy: a temporary urinary diversion in childhood].

The authors report on 21 pediatric cases of tubeless cystostomies (19 males and 2 females). 15 cases of posterior urethral valves (septic condition and very narrow urethra). 3 primitive vesico-renal refluxes (small bladder, severe impairment of renal function and extensive dilatation of the upper urinary tract). 2 prune-belly syndromes. 1 neurogenic bladder. (Impracticable intermittent catheterization). 19 of the 21 cases showed dramatic improvement (narrowing of the upper urinary tract, disappearance of infection and resumption of staturo-ponderal thrive). Only 1 child with valves had to be put on cutaneous ureterostomy. The improvement in the upper urinary tract, as seen on the IVP, is very rapid in valve cases without reflux. The improvement is visible earlier on isotopic renal scans than on IVP. 11 children suffered acute pyelonephritis during vesicostomy. There were no cases of cutaneous peristomal modification. Simultaneous closure of the derivation and surgery of the primitive disease were performed in 10 cases after a 1-3 year period of vesicostomy. Vesicostomy will succeed in those babies who have shown clinical and biological improvement after a short period of trans-urethral or suprapubic catheterization. The suprapubic endoscopis treatment of the valves becomes possible through the vesicostomy hole excluding urethral trauma.

Child, Preschool↗
PubMed1985

[Polyp of the posterior urethra. Apropos of 6 cases].

Polyp of posterior urethra is a rare cause of urinary obstruction. Attached by a pedicle to the superior part of the veru montanum, such a polyp is mobile and can move in the bulbar urethra, causing urinary retention. If can also bleed provoking either hematuria or urethrorrhagia. Urinary infection can be present. Vesico-urethral ultrasound examination can show the polyp. But the diagnosis is made on a voiding cystourethrogram either at the end of an intravenous pyelogram or after suprapubic puncture of the bladder. Cystourethroscopy can also diagnose the lesion, and can treat it by electrocoagulation of the pedicle. Surgery by suprapubic incision and cystostomy is another method of treatment. It is perhaps less dangerous that the endoscopic treatment because the pedicle is very close to the ejaculatory ducts. Pathology of polyp of posterior urethra is variable but benign. The most frequent lesion is a fibrous polyp specially in children. Recurrency of such a lesion is very exceptional.

Child, Preschool↗
PubMed1985

[Principles of the surgical treatment of cloacal malformation. Apropos of 3 cases].

The persistent cloaca is one of the most complex and challenging developmental malformation. It is a rare anomaly occuring only in the female newborn and represented by the association of a urogenital sinus with an anorectal malformation. We report here three cases seen and recently treated in Montpellier (France) in the unit of visceral pediatric surgery (Pr J.G. Pous) between 1981 and 1983. A precise knowledge of normal embryology is very helpful in order to understand these complex anatomical situations. Every case is probably unique, but some main principles of management can be stressed. Neonatal loop colostomy is probably safer in most cases and can allow temporizing until the child is 6 months to 1 year of age. Interim management is often needed: intermittent catheterisation of the bladder and/or urine-filled vagina via the uro-genital sinus, avoiding urinary diversions, except possible temporary supra-pubic cystostomy. Definitive reconstruction is often a long and complex procedure, strictly dependent on absolutely thorough radio-endoscopic pre-operative investigations. It is vital to know exactly the length of the cloacal canal and of the urethra, because surgical reconstruction will vary according to the level at which the various structures converge. Cloacas represent a wide anatomic spectrum: as the severity of the defect increases, there is urogenital sinus with anterior anus ("Near cloacal malformation"), low and high confluence of all three systems. The goal of surgery is to perform in a single operation, the separation of the different conduits and to preserve all the sphincteric mechanisms for urinary-anal continence and genital functions.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormalities, Multiple↗
PubMed1983

[Injuries of the membraneous urethra in children. 2 case reports and analysis of the literature].

Two cases of total disruption of the membraneous urethra in boys, 4 years of age, are reported. This experience and the literature suggest that a totally ruptured urethra should be realigned and the bladder drained by way of a suprapubic cystostomy. Urinary extravasation causes severe pelvic fibrosis with stricture or even closure of the urethra in children. The best procedure for similar adult cases, namely resection of the fibrosis and stricture with direct anastomosis of the intact urethra, is also best in pediatric cases.

Age Factors↗
PubMed1984

[Congenital urethral diverticulum in a male infant: a case report].

A case of congenital anterior urethral diverticulum of a male infant is reported. The patient was a 3-year-old boy who had complained of a sac-like swelling and urinary fistula of the anterior penis. The diagnosis was made by means of retrograde urethrocystography. Diverticulectomy and cystostomy were done. The post-operative course was uneventful. The microscopic examination showed that the diverticulum was lined with normal urethral epithelium. We made a statistical survey on 47 male children up to 15 years of age with congenital anterior urethral diverticulum reported in the Japanese literature.

Child, Preschool↗
PubMed1983

[Bladder and urethral injuries - report of experiences].

Injuries of bladder and urethra cause diagnostic and therapeutic problems to urologists and surgeons. A retrospective study of 98 patients from 1975 until 1982 with pelvic trauma and damage of the lower urinary tract is presented concerning etiology, mechanism of accident and therapeutic possibilities, as well as the analysis of 24 patients with anterior urethra damage. In all 38 cases with ruptured bladder operation was performed. 66 patients with posterior urethra damage were treated with regard to their general status. In this study conservative management with catheter or cystostomy seems to be more favourable in posterior urethra damage than primary reconstructions especially when considering the rate of urethral structure. Furthermore problems of posttraumatic difficulties with sexual potency are discussed.

Adolescent↗
PubMed1977

[Aspects of the operative treatment of prostatic adenoma].

The authors have gained minimum blood losses when suturing with provisional catgut ligature through the urinary bladder bottom between interureteral fold and internal urethral orifice yet before dessection of adenoma surgical capsule and tumor enucleation. Depending on the functional state of the upper urinary tract, the bladder tonus and adenoma size, the method of postoperative drainage of the urinary bladder is selected: cystostomy, microirrigation, active suction, etc.

Aged↗
PubMed1983

[Accidental urethral rupture during coitus].

Emergency surgery in three cases of accidental urethral rupture during coitus involved suture of the tunica albuginea corpus cavernosum and immediate repair of the urethra under cover of a urethral guide and a cystostomy. The three perfect results obtained, with normal micturition and more particularly normal erections, together with data from reports in the published literature, strongly suggest the need for urgent repair of traumatic lesions of the corpora cavernosae during coitus. The possibility of a urethral rupture makes urgent operation even more essential, before the patient urinates, to avoid transformation of a traumatic hematoma into a urohematoma.

Adult↗
PubMed1983

[Enlarged substitutive colocystoplasty for congenital neurological bladder in children. Apropos of 8 cases].

The encouraging success of replacement of the detrusor for contracted bladder due to a tuberculosis or other causes prompted an attempt to reconstruct bladder in a patient with neuropathic bladder. Colocystoplasty has been used by the authors in a total of 12 children with neurogenic bladder: 8 with a sufficient follow-up (6 months to 10 years). Technical data are given with some details. The sclerosed detrusor inducing elevated bladder pressure must be resected and the sigmoid is anastomosed to the trigone of the bladder. The sigmoid conduit is extraperitonized. The new colonic bladder give ample and supply cystern allowing protection of ureters and kidneys. The incontinence is not modified. Simultaneously with colocystoplasty the patient must be managed by self-catheterization or by urinary artificial sphincter or by a continent cystostomy. The initial results are very encouraging.

Adolescent↗
PubMed1983

[Leakproof external urinary derivation. Apropos of a new technic].

Confronted by the need to find a system for cutaneous urinary derivation free of leakage, the authors used an invaginated isolated ileal loop which serves as a form of system of continence. When the bladder is intact the bladder neck is closed and the intestinal cuff attached directly to the bladder. This results in a leakproof trans-intestinal cystostomy. Good results have been obtained in 4 patients operated upon using this technique but follow up remains limited (maximum: 10 months). Elimination of the bladder as reservoir requires a different system which then becomes a leakproof trans-intestinal cutaneous ureterostomy. The system for avoiding leakage is extremely simple since using a Bricker type intestinal graft, the proximal end is closed and the distal end is merely invaginated inside the intestine for a distance of 8 cm. Six patients have been operated upon in this way, with a perfect functional result in 4 and 2 incomplete results. Because of necrosis of the invaginated segment of ileum, seen twice, in the future the authors intend to use a trans-sigmoid ureterostomy with a short invagination not exceeding 3 or 4 cm. This technique for continent external urinary derivation is of great social benefit. However it implies a need for discipline on the part of the patient and the small number of cases treated thus far is such that there must be great caution in terms of the assessment of long term results, in particular in children with malformations and vesicorenal reflux which might be worsened by the elevated pressure within the system.

Adolescent↗
PubMed1982

Ureteric complications following treatment of gynaecological cancer.

The incidence, development and diagnosis of ureteric injuries secondary to radical operative or radiological treatment of uterine malignancy is described. Special attention is paid to the importance of early detection and management. Immediate peroperative repair of surgical ureteric damage gives most favourable results. Also in postoperatively diagnosed ureteric lesions the definitive treatment has to be carried out without delay. Ureteroneocystostomy, psoas-hitch procedure or transureteroureterostomy are the most preferable methods. In the late ureteric strictures secondary to radiotherapy the operation techniques employing nonirradiated tissues are recommended, eg. transureteroureterostomy, ileal replacement of strictured ureter and ileo-uretero-cystostomy or ileo-uretero-cutaneostomy. An ureteric prosthesis or ureteric stent may also be used in special cases. Ureteric complications following operative or radiological treatment of pelvic malignancy are usually curable. Therefore the employment of isotope renography or intravenous pyelography regularly is essential in the follow-up of asymptomatic patients and always immediately at the appearance of any urinary tract complaint in patients previously treated for pelvic malignancy.

Female↗
PubMed1980

[Perineal wound with urethral lesion in man. Two cases].

The author reports two cases of perineal wounds with section of the membranous urethra, one operated upon as a delayed emergency (36 hours) and the other as an emergency via a double hypogastric and perineal approach which permitted the opening of the bladder, anterograde catheterisation of the posterior urethra, liberation of the ends of the urethra and their preparation, mobilisation of the anterior urethra and finally end-to-end suture. Both patients seen with a follow-up of 6 months and one year had an excellent mictional result and preservation of erection. The author emphasises the following: --the need for confirming integrity of the bladder by I.V.U.; --the possibility of operating as a delayed emergency after packing of the wound, under cover of bladder drainage via a suprapubic catheter; --the need for a double hypogastric and perineal approach for lesions of the posterior urethra; --the usefulness of urethral catheter for 5 days and drainage of the urine by cystostomy for 3 to 4 weeks. Neither of the patients required secondary dilatation (at least within the limits of the period of postoperative follow-up).

Adolescent↗
PubMed1995

[Therapeutic tactics and results of prostatic adenomectomy in the presence of aggravating factors].

Outcomes of radical surgery for prostatic adenoma have been analyzed for 426 patients divided into 3 groups. Group 1 included 160 patients subjected to urgent adenomectomy for acute urine retention, group 2 comprised 166 patients with severe intercurrent diseases subjected to one- and two-stage radical surgery, group 3 of 100 patients was free of intercurrent diseases. Urgent and delayed (within 72 hours and 5-10 days, respectively) radical adenomectomies are thought valid in management of acute urinary retention in patients with prostatic adenoma. Adequate preoperative preparation in deficient circulation, diabetes mellitus and other preexisting or concurrent diseases increased by 20-30% indications to the operation. Good outcomes were reported in 90%, 81.4% and 94% of patients from group 1, 2 and 3, respectively. 98.7% of 388 patients avoided suprapubic fistula and resumed natural urination. Only 1.3% of patients were discharged with cystostomy drainage of the bladder because of urethral stricture, urethrorectal fistula, renal failure and pyelonephritis. The differential approach provided good outcomes in 87.6% of seriously ill patients in overall hospital lethality 8.9%. The majority of the lethal outcomes resulted from purulent pyelonephritis (71%). The rest cases were due to acute affections of circulation, respiration and digestion.

Aged↗
PubMed1995

[Problems of the therapeutic approach in subperitoneal wounds to the rectum].

We present four observations about the treatment of subperitoneal rectal injuries. Left iliac colostomy and cystostomy are usually necessary as first time operations in those cases with associated urogenital injuries. For the subperitoneal rectal injuries simple suture of rectum and drainage are sufficient.

Accidental Falls↗
PubMedDate not supplied

[The treatment of prostatic adenoma by local hyperthermia].

A total of 116 patients aged 51-84 with prostatic adenoma were exposed to local hyperthermia (LHT) using "Thermex II" generator (Thechnorex, Israel). The analysis of the results involved 4 patient groups: group 1 (34 patients) had nycturia > 3 times, residual urine > 50 ml, uroflowmetry index > 8 ml/s; group 2 (47 patients) had marked symptoms, nycturia < 3 times, residual urine < 50 ml, uroflowmetry index 3-7 ml/s; group 3 (2 patients) had cystostomy drainage; group 4 (2 patients) had acute uresis disorders. The response of the patients was registered by subjective complaints, residual urine, uroflowmetry index, pre- and after-treatment size of the prostate 1 and 6 months following a session of local hyperthermia. A positive effect was achieved in 70% of the patients. LHT proved effective in a compensated and subcompensated stages of the disease and in case of small-size adenoma nodes.

Aged↗
PubMed1995

[Transurethral needle ablation (TUNA) of the prostate: preliminary results].

A multicentric prospective study was designed in Italy to verify the efficacy and the safety of TUNA-BPH patients treatment. The study is co-ordinate by Progress in Urology Association was started in January 1994. Thirty five patients were treated (Mean age 68.4 +/- 4.1 aa). All patients were selected and evaluated to respect the recommendations of the International Consensus Committee (Paris 1993). The procedure was performed with lidocaine 2.5% urethral gel, oral intake of 10 mg of diazepam and steroidal antiphlogistic drugs 1 hour before treatment. Maximal number of prostatic lesions were 6; in 2 BPH initial cases were done 2 lesions alone. The treatment was interrupted at the third lesion in 2 patients because uncomfortable. Hematuria was observed in all patients, but it was resolved within 12 hours. Irritative symptoms were referred by 10 patients (28.6%) and they spontaneously were insignificant within 24 hours. One patient had an acute prostatitis. In 15 patients (42.6%) was necessary to put a suprapubic cystostomy, but all except one voided within 36 hours. We noted narrow connection between prostatic lesions number and urinary acute retention after TUNA. The average follow-up is 3.2 months (range 0.5-6). At the follow-up urine culture was always negative and PSA values increased in the first month. The value of PSA was always higher than pre-treatment, but from 1 month to 3 months progressively reduced.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

Posterior urethral disruption associated with pelvic fracture: the place for delayed repair.

Posterior urethral injuries are most commonly associated with pelvic fractures. Retrograde urethrogram is the study of choice for evaluation of urethral injuries. Controversy exists between advocates of various methods of initial management. Simple suprapubic cystostomy placement with delayed urethral reconstruction is best reserved for patients with life-threatening, extensive injuries or for surgeons with limited experience in the management of this injury.

Fractures, Bone↗
PubMed1993

[The therapeutic preparation and management characteristics of patients following emergency prostatic adenomectomy].

Basing on the analysis of 136 urgent radical surgeries for acute retention of urine in prostatic adenoma patients, the author specifies indications for immediate and delayed adenomectomies. These were combined in a group of urgent adenomectomies because they were not preceded with cystostomy, being performed in one-stage for acute urologic disorders. Immediate operations (36.1%) were conducted within 3 post-admission days unless radical surgery was contraindicated. Delayed operations (63.9%) needed preoperative drug correction of complicating disorders, mainly cardiovascular. The operative risk arose due to complications of the adenoma itself, urological and cardiovascular diseases. Among the latter cardiac and cerebral ischemia occurred most commonly. It was proved useful to drain the bladder with a permanent urethral catheter when preparing patients for delayed adenomectomy. High efficacy (91.9%) of urgent adenomectomy for acute retention of urine in preexisting somatic diseases suggests its significant practical value.

Acute Disease↗