[Nursing of patients with postoperative urination disorders. Bladder training in a child with urination disorders].
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Enuresis nocturna in children must not be confused with incontinence associated with disorders of urination. Questioning and clinical examination are sufficient to distinguish between these two entities. The former is a psychogenic condition which does not require urological examination, whereas the latter is of urological or neurological origin and requires additional explorations to reach an aetiological diagnosis. These explorations (urography, cystography, cystomanometry, neurophysiological and/or neuroradiological studies) are determined according to the type of the presumed lesion and to the child's age.
Experience is recorded with the study of 16 patients with neurogenic disorders of urination following radical operative interventions for rectal cancer. Their causes and the changes which they produce in the urinary tract are discussed in detail. The need of purposely carried out urologic investigations, such as excretory urography, cystography in anteroposterior, lateral and oblique projections and during micturition, bladder tonometry and measurement of residual urine is emphasize. The experience gained with conservative, operative and physical therapy is discussed. Particular attention is focused on the provision of adequate drainage of the urine from the bladder during the early postoperative period and the prophylaxis of urinary infection. Inferences are drawn on the complexity of the problem and the need of early diagnosis, treatment and repeated check-up of the patient state.
For assessment of the incidence and characteristics of urination disorders and erectile dysfunction after radical surgical treatment of anorectal congenital defects in children, 60 patients (12 girls, 48 boys) without urination disorders before operation, who have undergone 1-4 proctoplasties were examined. Their was Hirschsprung's disease in 20 patients, anorectal atresia in 40 patients. Iatrogenic urination disorders and erectile dysfunction were revealed in 38 (63.3%) patients, majority of them (24) underwent repeated proctoplasty. The main urination disorders were urinary incontinence (30 patients), infravesical obstruction (10), hyporeflexion of urinary bladder. Erectile dysfunction after operation was in 11 (34.4%) patients from 32. The combination of disorders was revealed in 17 (44.7%) patients. Primary radical operations in children with anorectal defects often cause iatrogenic urination disorders and erectile dysfunction. The number of complications increases progressively after repeated proctoplasty. It is necessary to improve the treatment and the methods of surgical correction bearing in mind the risk of iatrogenic disorders of genitourinary apparatus.
Disorders of urination are a frequent cause of consultation in paediatric urology units, even when enuresis is excluded. These disorders consist of frequencies, dysuria, urgencies, burning sensation at voiding and incontinence. Since their mechanisms are diverse, their treatment should be increasingly specific.
The management of a child with disorders of urination must begin with a high-quality clinical examination. Detailed questioning in an atmosphere of confidence yields information on the type of disorder (dysuria, frequencies, urgencies, burning sensation at voiding, enuresis, incontinence) either alone or in association. Physical examination aims to find signs pointing to the cause of the disorder. Particular attention must be paid to an inspection fo the external genitalia and to a search for possible abnormalities affecting the pinna of the ear and the extremities, since they are frequently found in association with deep malformations of the urinary tract. Collecting the urine provides an opportunity to observe the process of urination and possible abnormalities in the initial, middle and terminal voiding streams. The reagent dipstick is a minute but true laboratory test accessible to children, which makes it possible to detect glomerular, tubular and interstitial lesions. This clinical examination will lead to a precise diagnosis, inform on the need, if any, for additional explorations and enable the clinician to select the correct treatment.
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The aim of the study was to clarify the role of hypoxia of detrusor as a component of aging in establishment of urination disorders in patients with benign prostatic hyperplasia (BPH). A total of 54 patients were examined. Whether the capacity of detrusor to absorb oxygen was affected or not was judged by the difference in oxygen tension and acid-base balance in blood samples obtained intraoperatively from a radialis, v. mediana cubiti, v. vesicalis in 30 patients (experimental group) versus control values (5 females operated for stenosis of the distal ureter, ureterovaginal fistulas). The findings provided evidence for marked hypoxia of the detrusor diminishing reservoir function of the bladder and promoting urination disorders. A course of hyperbaric oxygenation given to 17 BPH patients has improved the capacity of the bladder for urine accumulation, reduced pollakiuria, especially at night. This supports involvement of detrusor hypoxia in pathogenesis of urination disorders in BPH patients.
The authors studied potentialities of outpatient urodynamic monitoring in diagnosis of subclinical urination defects in females. The examination was made of 31 females aged 25-55 years (mean age 43.8 years) with complaints of pollakiuria, precipitant urination. Laboratory urodynamic investigation combined retrograde cystometry, profilometry and uroflowmetry (Jupiter 8000 Video produced by WIEST) and was followed by urodynamic monitoring (CAMSYS 6300 by WIEST). Standard combined urodynamic evaluation registered normal urodynamic parameters in 17 females, unstable urethra in 4, unstable detrusor in 7, unstable urethra and detrusor in 3 patients. The curves devised on the basis of the outpatient urodynamic monitoring data indicated that; normal urodynamics, unstable urethra, unstable detrusor, detrusor-sphincter dyssynergia, combined instability of urethra and detrusor, unstable detrusor plus detrusor-sphincter dyssynergia in 4, 10, 7, 3, 2, 2 females, respectively. 3 cases were ineligible. The above investigation promoted accurate diagnosis in 41.9% of cases. Outpatient monitoring is a method of choice in diagnosis of subclinical urination disorders.
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The paper discusses a procedure for prevention of urination disorders in females undergoing combined surgery for rectal cancer. The procedure is based on suturing the round ligaments of the uterus.