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At least 127 records · Page 7Linked to original sources
PubMed2004

Management of urinary incontinence after bulboprostatic anastomotic urethroplasty for posterior urethral obstruction secondary to pelvic fracture.

OBJECTIVE: To present our experience of the management of urinary incontinence after bulboprostatic anastomotic urethroplasty for post-traumatic posterior urethral obstruction secondary to pelvic fracture. MATERIAL AND METHODS: Between 1979 and 1998, we managed 13 patients with postoperative incontinence after bulboprostatic anastomotic urethroplasty. Of these patients, nine had undergone a transpubic approach and four a perineal approach. The causes of urinary incontinence in the 13 patients were as follows. Ten patients had derangement of the proximal sphincteric mechanism (the distal sphincteric mechanism is usually destroyed as a result of trauma and/or during urethroplasty). These 10 patients were managed by placement of an anterior bladder tube, after the failure of pharmacological manipulations. Two patients who had been managed by transpubic urethroplasty experienced complications due to vesicourethral fistulae. They were managed by excision of the tract and repair of the bladder and the urethral defects. One patient, who was managed additionally by visual urethrotomy (for postoperative obstruction after perineal bulboprostatic anastomosis), experienced complications due to a false tract between the bladder and urethra. He was managed by bulboprostatic anastomosis and excision of the false tract. RESULTS: After 1-6 years follow-up, the outcome of the 10 patients who underwent placement of a bladder tube was good in four (40%), fair in three (30%) and poor in two (20%). The two patients who presented with vesicourethral fistulae regained continence after excision of the fistulae. The patient who had a false tract between the bladder and urethra regained continence after revision of the bulboprostatic anastomosis and excision of the fistulous tract. CONCLUSIONS: The proximal sphincteric mechanism should be fully evaluated before performing bulboprostatic anastomosis. Placement of a bladder tube is a good option for managing urinary incontinence. Vesicourethral fistulae are an unrecognized cause of urinary incontinence following transpubic urethroplasty. Visual urethrotomy should only be used in short, passable strictures.

Adolescent↗
PubMed1978

Use of a silicone shunt for the surgical relief of feline urethral obstruction.

The technique and results of a recently developed surgical procedure for the relief of feline urethral obstruction are described. The method involves implanting a silicone shunt of comparable diameter into the pelvic urethra. Urine and struvite crystals are passed through the wide bore tube. The possibility of crystal accumulation and subsequent obstruction is thus avoided.

Animals↗
PubMed1994

[Physiopathology of cervico-urethral obstruction in benign prostatic hypertrophy].

It's known that benign prostatic hypertrophy arise from the glands that surround the proximal prostatic urethra. In these cases voiding disorders may be due by detrusor instability alone or associated with cervical urethral obstruction. At first Griffiths and Schafer and subsequently Sarky have introduced some correlations that are able to differentiate the bladder outlet obstruction from the impaired detrusor contractility. On the contrary with regard to the behaviour of detrusor during obstruction, in connection with histological findings, several interpretations have been expressed. The theory more credited has been expressed by Gosling who has showed a reduction of the parasympathetic innervation of detrusor and consequent hypersensitivity due to denervation.

Humans↗
PubMed2002

Data from frequency-volume charts versus maximum free flow rate, residual volume, and voiding cystometric estimated urethral obstruction grade and detrusor contractility grade in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia.

AIMS: To examine associations of data from frequency-volume charts with maximum free flow rate, residual volume, and voiding cystometric estimated urethral obstruction grade and detrusor contractility in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH). METHODS: The 160 men included in the study met the criteria of the International Scientific Committee on BPH, i.e., they voided more than 150 mL during uroflowmetry, their residual volume and prostate size were estimated, and they completed frequency-volume charts correctly. From the frequency-volume charts, voiding habits and fluid intake were evaluated. Pressure-flow studies were performed as well. RESULTS: Increasing residual volume was related to a decrease of maximum voided volume and to a decrease of maximum free flow rate. Cystometric capacity was little affected by residual volume. Low contractility did not result in high residual volume. A marked decrease in voided volumes with increasing obstruction grade was observed, due to a decrease of cystometric capacity and an increase of residual volume. Detrusor contractility was little associated with voided volumes. A higher voiding frequency was related to a higher fluid intake. However, increased standardized frequency (number of voidings per 1,000 mL) was associated with a substantial reduction of fluid intake. CONCLUSIONS: Infravesical obstruction is the most important factor influencing voided volumes, cystometric capacity, and residual urine volume. Frequency of voiding was not influenced significantly because patients with small voided volumes minimized their fluid intake.

Diuresis↗
PubMed1999

Prune-belly syndrome diagnosed at 14 weeks' gestation with severe urethral obstruction but normal kidneys.

A fetus was diagnosed with prune-belly syndrome (PBS) found by ultrasound demonstration of cystomegaly at 12 weeks' gestation. Fetal urinary electrolyte and beta2-microglobulin concentrations at 14 weeks' gestation indicated a poor renal prognosis. The pregnancy was therefore terminated. An autopsy showed defects of the abdominal wall muscles and megalocystis caused by severe urethral obstruction. However, the kidneys were histologically normal. Together with previous reports, the present case suggests that renal dysplasia in PBS with severe uretheral obstruction may develop after 14 weeks' gestation. We discuss the possibility of preventing the development of renal dysplasia in PBS by early prenatal decompression of the obstructed fetal urinary tract.

Abortion, Induced↗
PubMed1993

Creation of experimental urethral obstruction in utero: evaluation of fetal renal function.

Management of obstructive uropathy diagnosed in utero would be markedly enhanced by the availability of a simple, safe and quantitative fetal renal function test to predict postnatal renal function. In order to allow experimental evaluation of such a parameter, we adjusted a model of complete urethral obstruction with urachal ligation in 30 fetal lambs at 79 or 99 days of gestation. The method described allows obstruction in male and female fetuses as early as 79 days of gestation, with an overall high survival rate (control: 12/14; obstructed: 23/29), although lower (6/12) when obstruction is performed early (79 days) during gestation. Consequences of obstruction were examined on the 121st day of gestation. Severe hydronephrosis, ureteral and calyceal dilatation, with or without ascites and pulmonary hypoplasia were observed in all fetuses; creatinine clearance determined in utero was decreased in both groups with obstruction (early and late) vs control group: 1.15 +/- 0.5, NS, and 0.58 +/- 0.4, p < 0.01 vs 1.61 +/- 0.8 ml/min/kg respectively. In both obstructed groups, fetuses with ascites displayed lower plasma creatinine concentration and higher creatinine clearance values when compared to fetuses without ascites. In conclusion, the experimental model of obstructive uropathy described appears efficient and easily reproducible, allowing therefore the evaluation of a predictive parameter of postnatal renal function. Our preliminary results suggest that renal fetal function is more dependent on the degree of obstruction than on the term of its creation.

Animals↗
PubMed1984

Pathogenesis of the prune-belly syndrome: a functional urethral obstruction caused by prostatic hypoplasia.

Abdominal muscle deficiency, urinary tract abnormalities, and cryptorchidism are the three major features of the prune-belly syndrome, also referred to as triad syndrome or Eagle-Barrett syndrome. The etiology is unclear and the pathogenesis a subject of continuing debate. Clinical and pathologic experience with seven cases of prune-belly syndrome is reviewed. Findings indicate that the urogenital anomalies can be attributed to a functional urethral obstruction which in turn is the result of prostatic hypoplasia. The histology of the abdominal wall is that of atrophy-ie, the degeneration of already formed muscle--and not of primitive muscle. This observation supports the theory that the abdominal muscle hypoplasia is a nonspecific lesion, resulting from fetal abdominal distension of various causes. Transient fetal ascites may be an important feature of the prune-belly syndrome.

Abdominal Muscles↗
PubMed2004

Prostatic carcinoma causing urethral obstruction and obstipation in a cat.

A 9-year-old intact male cat was presented for vomiting and straining to defecate. A large abdominal mass was palpated. The urinary bladder was full and non-expressible. Exploratory laparotomy revealed that the mass was compressing the colon and encircling the urethra caudal to the bladder. The mass was removed, the urethra transected, and the urinary bladder marsupialized to the ventral abdominal wall to allow urine drainage. Histopathologic examination of the mass revealed a prostatic carcinoma. The cat died approximately 6 weeks after removal of the mass. This is the first reported case of a prostatic carcinoma causing urethral obstruction and obstipation in a cat.

Animals↗
PubMed2001

Preventing urethral obstruction using the 6-point fixation and weight-adjusted spacing nomogram during sling surgery.

The aim of the study was to assess the outcome of a 6-point fixation technique and weight-adjusted spacing nomogram for performing sling surgery. Fifty women with stress incontinence underwent implantation of a Gore-tex patch sling. Sling tension was gauged based on the patient's body weight. Postoperative analysis was performed using cough stress tests, Q-tip tests, pelvic examinations and patient satisfaction questionnaires. Urodynamics were performed for women with persistent incontinence. Mean follow-up was 24 months (range 7-28). Mean age was 58 years (range 29-87). Stress incontinence was cured in 47/50 patients (94.0%). De novo urge incontinence occurred in 1/23 (4.3%) patients. Mean time to suprapubic tube removal was 7 days (range 1-21). No patients experienced urinary retention or urethral obstruction. Mean satisfaction score was 9/10 (range 7-10) and all patients said they would undergo surgery again. The combination of a 6-point fixation technique and a weight-adjusted spacing nomogram allows for a successful sling outcome without obstruction.

Adult↗
PubMed1996

Medical management of feline urethral obstruction.

A step-by-step priority of procedures is recommended when attempting to restore urethral patency in an obstructed male cat. In order of priority they are: (1) massage of the distal urethra, (2) attempts to induce voiding by gentle palpation of the urinary bladder, (3) cystocentesis, (4) retrograde urethral flushing, (5) combinations of 1 through 4, (6) diagnostic radiology to determine if the cause of urethral obstruction is intraluminal, mural or extramural, and if absolutely necessary, (7) surgical procedures.

Animals↗
PubMed2005

Expression of CD44 and E-cadherin cell adhesion molecules in hypertrophied bladders during chronic partial urethral obstruction and after release of partial obstruction in rats.

OBJECTIVES: To determine the functional changes in the bladder and the expression of adhesion molecules in bladder tissue during chronic partial urethral obstruction and after release of partial obstruction in rats. METHODS: Twenty-one male Sprague-Dawley rats were separated into three groups, each containing 7 rats. A sham operation was performed in group 1 and cystometry was done 6 weeks later. In groups 2 and 3, hypertrophied unstable bladders were developed by partial infravesical outflow obstruction during a 6-week period. After this period, cystometry was performed in all group 2 rats. In group 3, the ligature was removed, the rats were followed up for 6 weeks, and then cystometry was performed. After cystometric evaluation, the bladders in all the rats were removed, weighed, and studied immunohistopathologically. RESULTS: After release of infravesical outflow obstruction, the bladder weight, residual volume, bladder capacity, maximal voiding pressure, voiding amplitude, and bladder contraction time decreased and bladder compliance increased in group 3 compared with group 2. CD44 and E-cadherin expression in the interstitial space and uroepithelial bladder tissue in group 2 rats stained intensely compared with those of groups 1 and 3. CONCLUSIONS: After release of 6 weeks of infravesical outflow obstruction, the cystometric parameters were significantly improved. Expression of CD44 and E-cadherin in the obstructed bladder tissue may be a pathologic sign of inflammation.

Animals↗