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PubMedDate not supplied

[A primary odontogenic cyst of the jaws (keratocyst)].

Forty-six patients (21 men and 25 women) with keratocysts were treated at Dental Surgery Chair of the Moscow Medical Stomatological Institute. Cystectomy was carried out in 26 patients, two-staged treatment in 20. Histologic examination of the operative material confirmed the diagnosis. A two-staged method of treatment of this disease in an outpatient setting has been developed. Cystectomy was carried out in cases with cysts up to 2-3 cm in diameter, it did not destroy the cortical plate of the jaw; it was performed similarly as total biopsy and was the final treatment modality. In cases with larger cysts, when the thickness of the cortical layer was less than 0.5 cm and there was a risk of fracture, two-staged treatment was resorted to: the first step, decompression performed similarly as cystostomy and the second, cystectomy a year or more after the first stage, when the size of the cyst reduced to 1.5-2 cm in diameter. The patients were followed up for up to 2-5 years after the treatment. Hence, correct and timely diagnosis of the disease and a two-staged method of treatment of keratocysts developed at out Chair bring about good results with the least injury to the patients.

Adolescent↗
PubMed1995

[Ileovesical fistula caused by long-term indwelling of urethral catheter: a case report].

A case of an ileovesical fistula is reported. The patient was a 32-year-old female who suffered from spina bifida. She had had a urethral catheter indwelt at 13 years old for continuous incontinence caused by atrophic bladder. The patient noted lower abdominal discomfort and fecal urine at age 31 in January, 1989 and urination from anal appeared in March, 1990. In November, 1990, the patient was introduced to our hospital and diagnosed with ileovesical fistula. We performed partial cystectomy, ileal wedge resection and cystostomy on this patient. The pathological findings showed chronic inflammatory change. The ileovesical fistula may have been caused by a long-term indwelling of urethral catheter. We discussed the ileovesical fistula and the treatment of neurogenic bladder in a patient of spina bifida.

Adult↗
PubMed1994

[Prune belly syndrome with atresia ani and urethral stricture: a case report].

A case of prune belly syndrome associated with urethral stricture and atresia ani is reported. Cystostomy and colostomy were performed on his birthday. Cutaneous vesicostomy, bilateral ureterocystoneoplasty and proctoplasty were performed when the patient was one year old, and urethrotomy was performed when he was four years old. He was closely followed for six years and six months, and had developed without any serious episodes. We collected 128 cases of prune belly syndrome from the Japanese literature including this, and made a brief discussion of this syndrome with urethral stricture and atresia ani.

Anal Canal↗
PubMed1994

[Congenital dilatation of the common bile duct in children. Study of a series of 52 cases].

OBJECTIVE: The aim of this study was to evaluate results at long-term follow-up of patients suffering from congenital dilatation of the bile duct according to the type of operative procedure. METHOD: A retrospective study of 52 patients who were operated on during a 25-year period was carried out. Of 52 patients, 43 (83%) were female and 9 (17%) were male, with a ratio of 4.8/1. In six cases, the diagnosis was made antenatally by ultrasonography. Transhepatic cholangiography showed an extrahepatic dilatation in 25 cases (48%) and a combined extra and intrahepatic dilatation in 27 cases (52%). A common bilio-pancreatic channel was found in 25 patients. Mean age at the time of operation was 4.2 years. Operative procedures included: cyst excision and hepaticojejunostomy in 47 cases, cystojejunostomy or cystoduodenostomy in 4 cases and cystostomy in one case. There were two postoperative deaths. RESULTS: Long-term follow-up was established in 43 of 50 survivors (80%). One patient was reoperated because of portal hypertension. Cholangitis developed in 11 patients: 2/2 patients who had undergone in internal drainage and 9/41 patients who had undergone a cyst excision with hepaticojejunostomy. In patients with cyst excision, cholangitis developed twice as frequently in those with associated intrahepatic dilatation. Two of 11 children with recurrent cholangitis died following sepsis, and three others were reoperated because of intrahepatic bile duct stones, one of these 15 years later. CONCLUSION: A total excision of the extrahepatic biliary tract, followed by hepaticojejunostomy is considered as a treatment of choice. The site of the biliary anastomosis should be adapted to the type of dilatation of intrahepatic bile duct in the case of a combined extra and intrahepatic dilatation.

Adolescent↗
PubMed1976

Surgical adjuncts in radical hysterectomy and pelvic lymphadenectomy.

The effectiveness of radical hysterectomy depends upon the skill and the experience of the individual surgeon. A most important requirement of this operation is that it remove all of the cancerous tissue, while causing minimal damage to other structures. The data presented indicate that the use of suprapublic cystostomy, suction drainage of the retroperitoneum and closure with retention sutures of the abdomen can cause a statistically significant reduction in major postoperative complications that occur after radical hysterectomy with pelvic lymphadenectomy.

Drainage↗
PubMed1994

Voiding and erectile function after delayed one-stage repair of posterior urethral disruptions in 50 men with a fractured pelvis.

We evaluated 50 men who suffered a total disruption of the posterior urethra in conjunction with a fractured pelvis. The urethral disruption was treated with immediate placement of a suprapubic cystostomy and delayed one-stage urethroplasty. Subsequently, 15 required at least one visual urethrotomy and three underwent one urethral dilatation. All 50 now have a patent urethra and 38 (76%) void normally and are continent. Five have an areflexic bladder secondary to the injury and intermittently catheterize themselves but are continent. Three patients have mild urge incontinence and three mild stress incontinence, not requiring treatment or protection. One patient with an open bladder neck has moderate stress incontinence which has responded to imipramine therapy. Impotence was present both preoperatively and postoperatively in 24 (48%) of the patients but by one year only 16 (32%) of them were still not having erections. Eighteen patients (36%) claim to have erections equal to their pre-injury quality. However, 16 (32%) of the patients, although potent and able to have intercourse, have less than optimal erections.

Adolescent↗
PubMedDate not supplied

[The percutaneous x-ray endoscopic surgery of simple kidney cysts].

An endoscopical method of treating solitary renal cysts (RC) > 5 cm in diameter has been used in the Research Institute of Urology since 1989. The method implies percutaneous puncture of the cyst controlled by x-ray television or ultrasound, dilatation of the cystostomy fistula, cystoscopy followed by resection or dissection of the cyst wall with a cold knife or electrosurgically. A total of 38 patients with large solitary cysts have been treated. A 6-12-month follow-up revealed no recurrences. Complications of the surgery were not reported. The method is easy to accomplish, effective and well tolerated.

Adult↗
PubMed1994

Patient-controlled analgesia and postoperative urinary retention after hysterectomy for benign disease.

BACKGROUND: Because postoperative urinary retention can result in considerable morbidity and the rate of retention after hysterectomy has recently increased at our institutions, we conducted a study to determine risk factors for the disorder. STUDY DESIGN: A cohort of 366 consecutive patients who had undergone uncomplicated abdominal or vaginal hysterectomy for benign disease and who met strict inclusion criteria were studied retrospectively by means of a review of their medical records. Student's t test and multivariate logistic regression analysis were used to assess the effects of operative time, amount of fluid given perioperatively, type and amount of analgesic agent administered postoperatively, age of the patient, performance of a vaginal versus an abdominal hysterectomy, and the postoperative use of patient-controlled analgesia on the rate of postoperative urinary retention in these patients. RESULTS: After adjustment for confounding factors, only the use of patient-controlled analgesia (p = 0.0001) and vaginal hysterectomy (p = 0.0003) were significantly related to postoperative urinary retention. Patients who used patient-controlled analgesia were 5.7 times (95 percent confidence interval, 2.6 to 12.4) more likely to have urinary retention than those given an intramuscular agent. CONCLUSIONS: Urinary retention after hysterectomy might be avoided by administering analgesic agents intramuscularly or inserting a suprapubic cystostomy catheter postoperatively, especially in patients who have undergone a vaginal procedure.

Adult↗
PubMed1976

Ureteric necrosis after kidney transplantation.

Uretero-cystostomy was used as reconstructive procedure in 298 cadaver kidney transplantations. Necrosis of the graft ureter occured in 10 cases (3.4%). 2 of these graft ureters had malformations and 1 was denuded at donor nephrectomy. The occurrence of ureteral necrosis was not related to histocompatibility or number of rejection crises nor to the duration of the warm ischemia. A higher incidence of ureteral necrosis after long cold ischemia is demonstrated, but the material is too small to permit conclusive evidence on this point.

Adult↗
PubMed1993

[Concomitant rupture of bladder and posterior urethra in fracture of pelvis, analysis of 36 cases].

Among 2120 patients with fracture of pelvis, 36 (1.6%) had simultaneous rupture of bladder and posterior urethra. Of the 36 patients 34 were male and 2 female and the ratio of male to female was 17:1. This urological injury is rare and is often misdiagnosed. The following conditions are typical: (1) anuria after pelvic fracture associated with injured urethra or multiple organic trauma; (2) no fullness of bladder for 4 hours after pelvic fracture with urethral injury (except shock or ARF); (3) bloody urinary fluid in peritoneocentesis or increased urea nitrogen in blood (except shock or ARF). Heavy dose IVP could confirm the diagnosis. The principal treatment included repair of ruptured bladder, suprapubic cystostomy, drainage of urinary extravasation, traction of traumatic posterior urethra, reduction and immobilization of pelvic fracture. In this series, all the patients obtained satisfactory results except one who died of serious traumatic shock.

Adolescent↗
PubMed1994

Successful treatment of severe infection of the femur originating from pelvic abscess.

A 35-year-old man sustained multiple injuries including a fractured pelvis, a ruptured urethra, and a femur fractured at the neck, the shaft, and the supracondylar region. The fractured femur was grade IIIB open. Urethrography showed a ruptured urethra with extravasation of the dye into the upper thigh. Internal fixation of all femur fractures and the pelvis fracture was successful. A suprapubic cystostomy tube was inserted to manage the urethral tear. The tube became infected, and the infection extended from the pelvis into the thigh region, infecting the femoral fracture. The femur infection was thought to be a postoperative one that had originated locally. Computerized tomography (CT) scan was helpful in localizing the infection and its origin from the pelvis. Treatment included incision and drainage, with aggressive serial débridement of both abscesses. In addition, bone grafting of the femur was performed. The infection was controlled completely, and the patient returned to work 18 months after injury. The authors alert the orthopaedic surgeon to the possibility of this serious lesion, particularly when the initial urethrogram shows extension of the dye below the inguinal ligament.

Abscess↗
PubMed1993

[Antegrade-retrograde urethrotomy in therapy of high degree urethral stricture].

In the case of urethral stricture which is non-passable by conventional "cold knife" urethrotomy, open urethroplasty can be avoided by combined antegrade-retrograde urethrotomy (ARUT). A rigid cystoscope is guided, through a dilated, suprapubic cystostomy channel, to the stricture in the membranous or bulbular urethra. A urethrotome is inserted in the retrograde direction and the "cut to the light" procedure is adopted. Using the ARUT method, successful realignment was achieved in 9 patients; 4 strictures were trauma- or urethritis-induced and 5 were the result of transurethral management. Recurrent stricture in 4 out of 7 cases (57%) required further urethrotomy. There was no recurrence in 4 out of 7 patients for at least 5 months subsequent to the last treatment. All patients were spared open surgery. The antegrade-retrograde technique exists since 1978. Up to date, 63 cases have been mentioned in the literature. The primary therapy success rate is 25%. Successful retreatment following recurrence was observed in 65%. We recommend ARUT as first-choice treatment for severe strictures of the bulbular and membranous urethra.

Adult↗
PubMed1993

Management of urethral stricture in patients practising clean intermittent catheterization.

Clean intermittent catheterization (CIC) is used commonly to treat patients with impaired bladder emptying. We treated 6 male patients who were experiencing difficulty with intermittent catheterization. Retrograde urethrography demonstrated stricture of the urethra in all of them and a false passage as well in one patient. Treatment consisted of urethral dilatation using filiform and followers in 4 patients and optical internal urethrotomy in the remaining 2 patients followed by urethral stenting using a 16 Fr. Teflon Foley catheter in all. The stenting Foley catheter was removed after 2 weeks. Subsequently 5 of the 6 patients had resumed CIC regimen to empty their urinary bladder. The sixth patient with a false passage could not perform CIC and suprapubic cystostomy was performed. During a follow-up of 6 of 18 months, none of these five patients developed recurrence of urethral stricture and all are practising CIC without any difficulty. Analysis of our data revealed that forceful manipulation during catheter insertion and significant urethral bleeding during catheterization are important contributory factors for the development of urethral stricture in patients practising CIC.

Adult↗
PubMed1993

Clinical significance of vesicoureteral reflux after kidney transplantation.

In this study 103 out of our 125 CsA-treated patients who received between January 1985 and December 1989 a first cadaver kidney transplant that functioned for at least one year were studied with voiding cystography (VC) for vesicoureteral reflux (VUR). All patients had an external uretero-neo-cystostomy. VUR occurred in 89 (86.4%) patients. Patients were grouped according to VUR: absence of VUR (group 0), VUR grade I-II (group 1-2), and VUR grade III (group 3). The 3 groups were comparable for male/female ratio, cause of renal failure, cause of donor death, recipient and dialytic age, immunosuppressive therapy, follow-up, time of VC performance after transplantation. At 6 months and 1, 2, 3, 4, and 5 years after transplantation graft function, number of rejection episodes, and number of urinary tract infections (UTIs) were similar in the 3 groups. In groups 1-2 and 3 hypertension was more frequent than in group 0 and occurred even after the 6th month (whereas this did not happen in group 0), but the differences between the 3 groups were not significant. However, when only the 13 patients who were followed for 5 years were considered, the prevalence of hypertension after 5 years was significantly higher in groups 1-2 and 3 (both 100.0%) than in group 0 (33.3%) (chi-square = 7.88; p < 0.02). Finally, 4.5% of patients with VUR and no patients without VUR had septic episodes linked to UTIs, but the difference was not significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Acquired urethral diverticulum in males with spinal cord injury].

OBJECTIVES: To study the clinical features, etiology, diagnostic methods and therapeutic possibilities in male patients with medullary lesion presenting with acquired urethral diverticulum. METHODS: A retrospective study was conducted on patients seen in our department over the past twenty years (June, 1974 to June, 1994) for acquired urethral diverticulum. Ten patients have been treated for the foregoing condition. RESULTS: The etiology of the medullary lesion was traumatic injury in 7 cases and spina bifida in 3 cases. The most frequent cause of the acquired urethral diverticulum was a condom-like urinary collecting device associated with a septic factor. Three patients presented intradiverticular lithiasis. These 3 patients had previous or current lithiasis at other sites of the urinary tract and all of them had a condom-like collecting device. All patients underwent surgery consisting in diverticulectomy and lithectomy, when required. One patient had a recurrence 6 years later because the underlying factors causing the diverticulum were still present. CONCLUSIONS: Personal care and hygiene of patients with medullary lesion is one of the most important factors in preventing urethral injuries. In our view, patient follow-up should include regular radiologic assessment and correct training in the use of condom-like urinary collecting devices and urinary catheters. We advocate one-stage surgical repair with temporary cystostomy, preoperative antibiotic therapy according to the antibiotic profile and culture of symptomatic and asymptomatic urinary infections and the use of methylene blue to ensure the suture is watertight.

Adolescent↗
PubMed1995

[Posterior urethral valves in children. Apropos of 22 cases].

We reviewed 22 cases of posterior urethral valves over a five year period (January 1986 to December 1990). We looked at initial management before referral to the urologist, treatment and those factors that influence the outcome. We found that nosocomial infection from catheters was the major source of morbidity and mortality. Other determinants of outcome included postobstructive diuresis and the presence of refluxing or obstructing megaureters. The age of the patients was not as important as the degree of obstruction in this group of patients. We recommend percutaneous cystostomy as initial management for these patients as opposed to urethral catheterisation. This should be followed by antegrade or retrograde valve ablation one week later depending on the size of urethra.

Adolescent↗
PubMed1996

Urodynamic effects of intravesical oxybutynin chloride in conscious rats.

PURPOSE: To examine the factors of intravesical oxybutynin influencing the cystometrogram in normal conscious rats at various pH levels and concentrations of oxybutynin. MATERIALS AND METHODS: A cystostomy catheter was implanted into the bladders of male Sprague-Dawley rats. We compared the urodynamic effects of intravesical oxybutynin dissolved in pH 4.44, 6.44 and 8.44 buffer. Two concentrations of oxybutynin solution were adopted, 0.06 and 0.6 mg./ml., and were dissolved in each pH buffer. RESULTS: Although a 26% increase in bladder capacity was recognized 1 hour after instillation of pH 8.44, 0.06 mg./ml. oxybutynin, no significant difference was found in comparison with control rats. At the concentration of 0.6 mg./ml., bladder capacity markedly decreased 30 minutes to 1 hour after instillation even at pH 6.44 and 8.44. Significant decreases in detrusor contraction pressure were recognized 30 minutes to 1 hour after instillation. However, there were no significant differences among the 3 pH oxybutynin solutions. Compared with preinstillation values, significant increases in residual urine rates were observed in all pH oxybutynin solutions. Furthermore, the residual urine rate after instillation of pH 8.44 oxybutynin solution differed significantly from that of pH 4.44 oxybutynin. CONCLUSION: Our results demonstrate that pH and concentration of intravesical oxybutynin solution may play an important role in relaxation of the bladder. A high concentration of oxybutynin is considered irritating to the bladder mucosa.

Administration, Intravesical↗
PubMed1995

[Spontaneous bladder perforation secondary to bacterial cystitis. Cause of acute abdomen in diabetic elderly].

Presentation of two clinical cases of spontaneous vesical rupture secondary to bacterial cystitis in elderly patients. One corresponds to an intraperitoneal perforation while the second case was extraperitoneal. The patients were, in both cases, diabetic women admitted in emergency due to acute abdomen. We considered that although vesical perforation secondary to bacterial cystitis is a very uncommon process, it should be taken into account in the differential diagnosis of acute abdomen in predisposed patients (diabetic elderly patients with pyuria). In such instances, a retrograde cystography would provide the diagnosis. Although extraperitoneal vesical perforations can be resolved with a vesical catheter or cystostomy, extravasation of the infected urine may result in a perivesical abscess and septic shock. Early surgical management should be considered in these cases.

Abdomen, Acute↗