MedWorm: Bladder Catheterization

Washout policies in long-term indwelling urinary catheterisation in adults.

Cochrane Database of Systematic Reviews — Sat, 20 Mar 2010 06:22:03 +0100

CONCLUSIONS: The data from five trials comparing differing washout policies were sparse and trials were generally of poor quality or poorly reported. The evidence was too scanty to conclude whether or not washouts were beneficial. In the first instance we require further rigorous, high quality trials with adequate power to detect any benefit from washout being performed as opposed to none. Then trials comparing different washout solutions, washout volumes, frequencies/timings and routes of administration are needed. PMID: 20238325 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

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Laparoscopic assisted radical vaginal hysterectomy versus radical abdominal hysterectomy—a randomised phase II trial: perioperative outcomes and surgicopathological measurements

BJOG: An International Journal of Obstetrics and Gynaecology — Fri, 12 Mar 2010 00:00:00 +0100

Conclusions This study confirms the short-term surgical benefits of LARVH. In addition, LARVH has been shown to be a less radical procedure than RAH, supporting the need for strict patient selection and to restrict the procedure to small tumours. (Source: BJOG: An International Journal of Obstetrics and Gynaecology)

Laparoscopic assisted radical vaginal hysterectomy versus radical abdominal hysterectomy-a randomised phase II trial: perioperative outcomes and surgicopathological measurements.

BJOG : An International Journal of Obstetrics and Gynaecology — Fri, 12 Mar 2010 00:00:00 +0100

Conclusions This study confirms the short-term surgical benefits of LARVH. In addition, LARVH has been shown to be a less radical procedure than RAH, supporting the need for strict patient selection and to restrict the procedure to small tumours. PMID: 20236108 [PubMed - as supplied by publisher] (Source: BJOG : An International Journal of Obstetrics and Gynaecology)

Urinary infection before and after prostatectomy.

Saudi Journal of Kidney Diseases and Transplantation — Mon, 01 Mar 2010 00:00:00 +0100

Authors: Pourmand G, Abedi AR, Karami AA, Khashayar P, Mehrsai AR To determine the prevalence of pre and post prostatectomy related urinary tract in-fection and its correlation with peri-operative events, we studied 120 patients who underwent pros-tatectomy due to benign prostatic hypertrophy from September 2005 to September 2006. Urine cultures were performed before the operations, after a week, and three months later. Data including prostate volume, prostatic specific antigen (PSA), post voiding residue (PVR) and histopathological reports as well as the duration of urinary leak, bladder irrigation, hospitalization, and catheterization were studied. The mean age of the studied patients was 70.5 +/- 8 years. Significant preoperative bac-teriuria was revealed in 18 (15%) patients of who...

MR urography in children. Part 1: how we do the F0 technique

Pediatric Radiology — Thu, 25 Feb 2010 06:48:55 +0100

Abstract MR urography (MRU) has been widely accepted as a substitute to intravenous urography for investigating children with a dilated urinary tract after preliminary assessment by US and voiding cystourethrography. Hydronephrosis is by far the main indication for MRU because upper tract dilatation is a frequent condition in infants and children. Recent advances in technology have allowed MR to go beyond morphology and to assess renal function parameters such as split renal function and drainage. In this article we report our routine practice of the F0 MRU technique. The main advantages of our protocol are no requirement for general anaesthesia, no bladder catheterization, use of low-dose gadolinium-based contrast agent (0.05–0.1 mmol/kg) and total acquisition time...

Urinary Tract Infections Complicating Stroke. Mechanisms, Consequences, and Possible Solutions.

Stroke — Thu, 18 Feb 2010 00:00:00 +0100

CONCLUSIONS: Patients with stroke have different risks for, consequences of, and barriers to reducing UTI than other hospitalized patients. Further research is needed to develop an effective approach to decreasing this important complication in the stroke population. PMID: 20167905 [PubMed - as supplied by publisher] (Source: Stroke)

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Prevalance of latex sensitization and associated risk factors in Turkish children with spina bifida

Pediatric Surgery International — Wed, 17 Feb 2010 06:53:46 +0100

Conclusion The incidence of latex sensitization in this study was lower than reported in the literature. Environmental factors such as the type and number of operations and geographical location may play a role in the development of latex sensitization. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-010-2575-8Authors E. Ozkaya, Vakıf Gureba Education and Research Hospital Department of Pediatrics Istanbul TurkeyY. Coskun, Maternal and Children Hospital Department of Pediatrics Kayseri TurkeyY. Turkmenoglu, Okmeydanı Education and Research Hospital Department of Pediatrics Istanbul TurkeyN. Samancı, Vakıf Gureba Education and Research Hospital Department of Pediatrics Istanbul Turkey Journal Pediatric Surgery InternationalOnline ISS...

[Are parents present during invasive procedures? Assessment in 32 Spanish hospitals.]

Anales de Pediatria — Tue, 09 Feb 2010 00:00:00 +0100

CONCLUSIONS: Parental presence during IP is limited in Spanish PED, due to parental anxiety and is detrimental to the success of the procedure. Physicians and nurses disagree with family presence, especially during the most invasive procedures. PMID: 20149769 [PubMed - as supplied by publisher] (Source: Anales de Pediatria)

Long-term outcome of tension-free vaginal tape for treating stress incontinence in women with neuropathic bladders

BJU International — Wed, 03 Feb 2010 00:00:00 +0100

Study Type [ndash] Therapy (case series)Level of Evidence 4 To evaluate the long-term safety and efficacy of the tension-free vaginal tape (TVT) for the treatment of stress urinary incontinence (SUI) in women with neuropathic bladder dysfunction. Twelve women (mean age 53.3 years, range 41[ndash]80) with neuropathic bladder dysfunction and SUI confirmed by video-cystometrography (VCMG) were treated with a TVT in one institution by an expert neuro-urologist between November 1997 and December 2000. The patient's notes, clinical annual follow-up and VCMG after the procedure, and the incontinence impact questionnaire (IIQ) forms (Urinary Distress Inventory, and IIQ-7) were assessed during the long-term clinical follow-up for SUI, in addition to a health-related quality of life assessment. The ...

Teapot Ureterocystoplasty and Ureteral Mitrofanoff Channel for Bilateral Megaureters: Technical Points and Surgical Results of Neurogenic Bladder

The Journal of Urology — Fri, 22 Jan 2010 00:00:00 +0100

Conclusions: Although neurogenic bladder and high grade reflux are poor prognostic factors for ureterocystoplasty, the present modification resulted in enduring bladder augmentation with no calculus formation. Bladders remained compliant with good capacity, presumably because sufficient tissue and blood supply were provided for the augmented flap. (Source: The Journal of Urology)

Editorial Comment

The Journal of Urology — Fri, 22 Jan 2010 00:00:00 +0100

Despite the originality of this technique, the patients for whom it is described should nowadays no longer be seen. I understand that there are still places in the world where these patients are encountered. However, in most of these countries application of intermittent catheterization is not an option. This issue is the main criticism of this report. Original? Yes. Applicable? Not in countries with a good medical system where end stage neurogenic bladder is no longer seen, and not in developing countries where intermittent catheterization is not always an option. A further question is whether all patients with end stage neurogenic bladder need continent diversion. Compared to wheelchair bound girls, continent diversion provides less of an advantage for boys with a normal urethra. Thus, t...

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Editorial Comment

The Journal of Urology — Fri, 22 Jan 2010 00:00:00 +0100

The authors are to be congratulated for excellent results with 2 procedures that in most hands give unsatisfactory results, namely ureteral Mitrofanoff and ureterocystoplasty. The authors have done the best they could, given the catastrophic cases they faced. However, the reader should be aware that a child with neurogenic bladder, extreme ureteral dilatation and renal insufficiency represents a failure of medical care, inadequate socioeconomic support or inadequately addressed cultural barriers to proper preventive treatment with adequate surveillance, intermittent catheterization, occasional use of anticholinergic agents and judicious use of antibiotics. I almost never do a ureterocystoplasty, and obtain the best results for a catheterizable channel constructed with appendix, or a reconf...

Photoselective Prostatic Vaporization for Bladder Outlet Obstruction: 12-Month Evaluation of Storage and Voiding Symptoms

The Journal of Urology — Thu, 21 Jan 2010 00:00:00 +0100

Purpose: We evaluated voiding and storage symptom evolution in patients treated with prostate photoselective vaporization by a KTP laser.Materials and Methods: Enrolled in the study were 150 consecutive patients with lower urinary tract symptoms due to benign prostatic hyperplasia and a diagnosis of bladder outlet obstruction. Patients underwent prostate photoselective vaporization with the 80 W KTP laser. Baseline parameters included prostate volume, International Prostate Symptom Score with voiding and storage symptom subscores, uroflowmetry, pressure flow study and serum prostate specific antigen. Patients were followed 1, 3, 6 and 12 months after surgery.Results: Mean ± SD patient age was 69.6 ± 10 years. Mean prostate volume was 52 ± 18 ml. Mean International Prostate Symptom Score...

Psychological morbidity in catheterized prostate-enlarged men in a Nigerian hospital

International Journal of Urological Nursing — Fri, 08 Jan 2010 00:00:00 +0100

This paper describes a cross-sectional study investigating the level of psychological morbidity occasioned by long-term indwelling urethral catheters among men with a clinical diagnosis of an enlarged prostate gland. A survey of 100 purposely selected men who had experienced catheterization for a minimum of 2 weeks was conducted. The tool used was the short version of the general health questionnaire (GHQ-12), which measures psychological morbidity in individuals. These men were attending the urology clinic at the University College Hospital, Ibadan, Nigeria. The length of time participants had a catheter in situ was correlated with respondents' score on the GHQ-12. Results supported the hypothesis that lengthy periods of catheterization are associated with depressive symptoms, particularl...

To clamp or not to clamp? Bladder management by suprapubic catheterization in patients with neurogenic bladder dysfunction

World Journal of Urology — Mon, 04 Jan 2010 18:16:39 +0100

Conclusions According to our study, routine use of anticholinergic medication and clamping of catheter does not seem to be necessary to preserve detrusor compliance and renal function in patients with SPC and neurogenic bladder dysfunction. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00345-009-0501-2Authors Jürgen Pannek, Schweizer Paraplegiker-Zentrum Chefarzt Neuro-Urologie Guido A. Zäch Strasse 1 6207 Nottwil SwitzerlandKonrad Göcking, Schweizer Paraplegiker-Zentrum Chefarzt Neuro-Urologie Guido A. Zäch Strasse 1 6207 Nottwil SwitzerlandUlf Bersch, Schweizer Paraplegiker-Zentrum Chefarzt Neuro-Urologie Guido A. Zäch Strasse 1 6207 Nottwil Switzerland Journal World Journal of UrologyOnline ISSN 1433-8726Print ISSN 0724-4983 (Source: ...

Experience with Injections of Botulinum Toxin Type A into the Detrusor Muscle.

Aktuelle Urologie — Fri, 01 Jan 2010 00:00:00 +0100

CONCLUSIONS: Injecting 300 units of BTX-A into 30 sites in the muscle located in the body of the bladder region is effective for neurogenic bladder patients with intermittent catheterization who have urge and reflective types of incontinence. Injec-tions of 100 and 200 units of BTX-A to treat non-neurogenic overactive bladder with urinary incontinence provided together without retention. The optimal dose of BTX-A requires further investigation. Injection with 200 units of BTX-A was not useful against interstitial cystitis. None of the patients developed any adverse effects after injecting the bladder wall with BTX-A. PMID: 20094947 [PubMed - as supplied by publisher] (Source: Aktuelle Urologie)

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Risk Factors for Urinary Tract Infections During the First Year After Kidney Transplantation

Transplantation Proceedings — Fri, 01 Jan 2010 00:00:00 +0100

Conclusion: This type of study makes it possible to identify risk factors and to formulate strategies focused on particular risk factors. (Source: Transplantation Proceedings)

Secondary amyloidosis of the bladder and massive hematuria.

Actas Urologicas Espanolas — Fri, 01 Jan 2010 00:00:00 +0100

CONCLUSIONS: Despite its rarity, as shown by the few cases reported, secondary amyloidosis of the bladder should be considered in patients already diagnosed with systemic amylodosis and/or the conditions reported who require simple urethral catheterization. PMID: 20223142 [PubMed - as supplied by publisher] (Source: Actas Urologicas Espanolas)

The single needle method for urethrovesical anastomosis with strengthened posterior fixation during laparoscopic radical prostatectomy

Journal of Huazhong University of Science and Technology -- Medical Sciences -- — Mon, 28 Dec 2009 06:42:12 +0100

Summary The single needle method for urethrovesical anastomosis with strengthened posterior fixation during laparoscopic radical prostatectomy was explored. The method was initiated by performing a fixing suture with a knot at 4 o’clock of the posterior lip of bladder neck, and another suture at nearby position was performed to leave the knot outside. From 5 o’clock to 8 o’clock, sutures were performed every one o’clock to secure posterior approximation, then every two o’clock a suture. To avoid a loose anastomosis, lock sutures were performed every 3 sutures. The needle was always driven full-thickness outside-in in the bladder neck and inside-out on the urethra. After completing the full circumference, the needle was drawn near the 4 o’clock and tied at the t...

Long-Term Results of Bulking Agent Injection for Persistent Incontinence in Cases of Neurogenic Bladder Dysfunction

The Journal of Urology — Fri, 18 Dec 2009 00:00:00 +0100

Conclusions: Bladder neck injection after failure of primary sling procedures has limited value in patients with neurogenic lower urinary tract dysfunction. Repeat bladder neck injection yields no additional benefits. (Source: The Journal of Urology)

Study of Botulinum Toxin A in Neurogenic Bladder Due to Spina Bifida in Children

ANZ Journal of Surgery — Fri, 04 Dec 2009 00:00:00 +0100

We report results of a pilot study investigating the safety and efficacy of Botulinum A toxin on urinary incontinence and bladder function in children with neurogenic bladder.Methods: This was a prospective, non-randomized clinical trial. Seven children with median age of 16 years with spina bifida who had high storage pressures, poor bladder compliance and had failed treatment with anticholinergic medications were offered a single intra-detrusor injection of Botulinum A toxin. All subjects were on clean intermittent catheterization before and during the study. Follow-up videourodynamic studies were performed at 1 month, between 3 and 6 months, and at 9 months. Data were collected on safety and on subjective outcomes through validated questionnaires filled out by patients at each visit.Res...

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[Diagnosis and therapy of functional disorders of the bladder in persons with diabetes mellitus : What do we actually know?]

Der Urologe. Ausg. A — Sat, 28 Nov 2009 00:00:00 +0100

Authors: Pannek J Although diabetes mellitus is one of the most common diseases worldwide, only few studies evaluating diagnosis and treatment of lower urinary tract complications of this disorder exist. In addition to diabetic cystopathy (impaired sensation, reduced detrusor muscle contractility, elevated residual urine), 30-50% of patients can develop an overactive bladder. Basic diagnostics should include patient history, bladder diary, post-void residual and urinalysis. Advanced diagnostics include uroflowmetry, symptom scores and urodynamics.The evidence for all treatment options in patients with diabetes mellitus is low. Residual urine may be treated with coping strategies, Metoclopramid, alpha blockers and intermittent catheterization, but there is no evidence for parasympathomi...

Robotic-assisted laparoscopic pyeloplasty: initial Australasian experience

Journal of Robotic Surgery — Fri, 27 Nov 2009 07:07:48 +0100

Abstract Laparoscopic dismembered pyeloplasty has a success rate in excess of 90% for the treatment of uretero-pelvic junction (UPJ) obstruction. Laparoscopic intracorporeal suturing, however, remains technically challenging and may lead to prolonged operating times. Robotic-assisted suturing using the da Vinci® surgical system (Intuitive Surgical, CA, USA) may reduce the difficulty associated with intra-corporeal suturing. The da Vinci® surgical system was used to facilitate intra-corporeal suturing in adults undergoing trans-peritoneal robotic-assisted laparoscopic pyeloplasty (RALPY) at our institution. Initially, the robot was only docked for the anastomosis, but in the later part of the series the robot was used for all parts of the dissection and reconstruc...

Re: Opposing Views: T. B. Boone and I. Perkash J Urol 2009; 181: 1538–1540

The Journal of Urology — Mon, 23 Nov 2009 00:00:00 +0100

Today detrusor relaxation combined with intermittent catheterization is regarded as standard treatment in patients with neurogenic detrusor overactivity due to spinal cord injury (SCI). However, in a substantial percentage of patients intermittent catheterization cannot be established. Therefore, decreasing the detrusor leak point pressure still is a viable treatment option, especially in quadriplegic men. These 2 editorials, which offer opposing views, present 2 methods for achieving this goal—external sphincterotomy and external urethral stenting. (Source: The Journal of Urology)

Infectious Complications in Patients With Chronic Bacteriuria Undergoing Major Urologic Surgery

Urology — Mon, 23 Nov 2009 00:00:00 +0100

Conclusions: In a medically complex population of patients, those with neurogenic bladder and frequent catheterization undergoing major abdominal surgery, we demonstrate an infectious complication rate of 20.2%. Wound infections were as common in patients whose urine cultures revealed multiple unspeciated organisms as those that were resistant to the perioperative antibiotics, and in this population, further characterization may allow for more appropriate perioperative coverage and a decreased rate of wound infections. (Source: Urology)

Perspectives by patients and physicians on outcomes of mid-urethral sling surgery

International Urogynecology Journal — Thu, 19 Nov 2009 07:39:19 +0100

Conclusions No differences were found in the five most important outcome parameters. In pre-operative counselling and future clinical trials, time to resume work and dyspareunia should be given more consideration by clinicians. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00192-009-1047-yAuthors R. Marijn Houwert, St. Elisabeth Hospital Tilburg Department of Obstetrics and Gynecology Tilburg The NetherlandsDaphne N. van Munster, University Medical Centre Utrecht Department of Obstetrics and Gynecology Utrecht The NetherlandsJan Paul W. R. Roovers, Academic Medical Centre Amsterdam Department of Obstetrics and Gynecology Amsterdam The NetherlandsPieter L. Venema, Haga Ziekenhuizen Department of Urology The Hague The NetherlandsMarcel G. W. Dijkgraaf...

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Treatment strategies to minimize or prevent chronic allograft dysfunction in pediatric renal transplant recipients: an overview.

Paediatric Drugs — Wed, 04 Nov 2009 16:10:02 +0100

Authors: Höcker B, Tönshoff B Long-term allograft survival poses a major problem in pediatric renal transplantation, with allograft nephropathy being the principal cause of graft failure after the first post-transplant year. The mechanisms of nephron loss resulting in graft dysfunction are multiple, comprising both immunologic factors such as acute and chronic antibody- or T-cell-mediated rejection and non-immunologic components. The latter include peri-transplant injuries and renovascular lesions (renal artery stenosis, thrombosis) as well as cardiovascular risk factors such as arterial hypertension and hyperlipidemia. Another relevant issue leading to progressive nephron loss and declining kidney transplant function is acute and chronic nephrotoxicity induced by the calcine...

Robot-assisted extraperitoneal laparoscopic radical prostatectomy: experience in a high-volume laparoscopy reference centre

BJU International — Tue, 03 Nov 2009 00:00:00 +0100

To describe our current procedure of robot-assisted laparoscopic radical prostatectomy (RALP), and to assess the effect of the learning curve on perioperative data, early oncological outcomes and functional results, as RALP has increasingly become a treatment option for men with localized prostate cancer. In all, 206 consecutive men had a RALP between July 2001 and November 2008 for localized prostate cancer. Among the overall cohort, the 175 men operated on by the same surgeon were distributed into five groups according to the chronological order of the procedures. The mean follow-up after RALP was 18.3 months. Patient demographics, surgical data and postoperative variables were collected into a prospective database. Data were compared by chronological groups into single-surgeon cohort. T...

The Boari bladder flap: an effective continent stoma for the high-compliance neurogenic bladder

BJU International — Tue, 03 Nov 2009 00:00:00 +0100

To determine if a continent urinary stoma can be created effectively using a Boari bladder flap (BBF) technique. Selected patients (15, eight women and seven men) with a neurogenic bladder and a bladder compliance of >20 mL/cmH2O had a procedure to create a BBF continent urinary stoma. The technique consisted of tubularising a trapezoidal, full-thickness detrusor flap 10 cm long, 5[ndash]6 cm wide at the base and 2 cm at the tip, over a 12 F catheter, and plication of detrusor muscle around the stomal base. Outcomes after surgery were assessed by reviewing stomal continence, stomal patency, and stability of the upper urinary tract. Ten BBF procedures were performed using native detrusor muscle, four with enterocystoplasty tissue and one in a defunctionalized bladder. Over a mean follow-up ...

A case with spontaneous bladder rupture mimicking acute kidney injury.

Clinical Nephrology — Sun, 01 Nov 2009 00:00:00 +0100

We report a case with spontaneous bladder rupture mimicking acute kidney injury forty years after postoperative pelvic irradiation for uterine cancer. PMID: 19863882 [PubMed - in process] (Source: Clinical Nephrology)

Less Urinary Tract Infection by Earlier Removal of Bladder Catheter in Surgical Patients Receiving Thoracic Epidural Analgesia

Regional Anesthesia and Pain Medicine — Sun, 01 Nov 2009 00:00:00 +0100

Conclusions: Leaving the bladder catheter as long as the epidural analgesia is maintained results in a higher incidence of UTI and prolonged hospital stay. Removal of the bladder catheter on the morning after surgery does not lead to higher rate of catheterizations. (C)2009 American Society of Regional Anesthesia and Pain Medicine (Source: Regional Anesthesia and Pain Medicine)

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Lower urinary tract dysfunction in MS: management in the community.

British Journal of Community Nursing — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Panicker J, Haslam C Lower urinary tract dysfunction in multiple sclerosis is common and is highly amenable to treatment. Individuals may have bladder storage and/or voiding dysfunction. The risk of progression to renal failure is low and hence lower urinary tract dysfunction should be considered medically manageable in most individuals. Evaluation begins with history taking and is supplemented by using a bladder diary. Ultrasonography is used to assess the degree of incomplete bladder emptying, and for assessing upper urinary tract damage. Incomplete bladder emptying is most often managed by clean intermittent self-catheterization and should be initiated if post-void residual urine is greater than 100 mls. Storage symptoms are most often managed using antimuscarinic medicatio...

[Case Report] Green urine, but no infection

LANCET — Fri, 30 Oct 2009 00:00:00 +0100

In September, 2007, an unconscious 88-year-old woman was brought to the emergency room. She had undergone a hysterectomy and radiotherapy because of carcinoma of the cervix 30 years previously; 10 years later she had developed neurogenic bladder dysfunction, requiring intermittent self-catheterisation. She had had mild renal insufficiency (creatinine 100 μmol/L) and mild hydronephrosis unilaterally, because of ureteric obstruction following the irradiation. Her medical history also included bilateral femoral artery angioplasty, a transient ischaemic attack, and group B streptococcal endocarditis with remaining mild mitral valve insufficiency. Medications included an ACE-inhibitor, aspirin, and dipyridamole for the past 4 years. (Source: LANCET)

Urethral stricture Yemen experience

International Urology and Nephrology — Thu, 29 Oct 2009 07:15:19 +0100

Conclusion Trauma is the commonest cause of urethral stricture in our country, therefore the control of it will decrease extremely the urethral stricture disease. No one technique is suitable for all types of the stricture, and the surgeon should be familiar with the different techniques and choose the most suitable one according to the case he deals with. Content Type Journal ArticleCategory Urology - Original PaperDOI 10.1007/s11255-009-9657-3Authors Tawfik H. Al-Ba’adani, Al-Thawra Modern General Teaching Hospital, Medical College-Sana’a University Urology Department, Urology and Nephrology Center Sana’a YemenWalid Al-Asbahi, Al-Thawra Modern General Teaching Hospital, Medical College-Sana’a University Urology Department, Urology and Nephrology Center Sana�...

Ileovesicostomy Update: Changes for the 21st Century

Advances in Urology — Tue, 27 Oct 2009 15:44:24 +0100

Conclusions. Based on our experience, we suggest that patients with severe lower urinary tract symptoms and who are unable to perform clean intermittent catheterization and/or refractory to medical therapy ileovesicostomy should be the procedure of choice. (Source: Advances in Urology)

Locoregional anesthesia and anticoagulation

European Journal of Pain Supplements — Tue, 27 Oct 2009 13:42:23 +0100

Abstract: Spinal hematoma is a rare and potentially catastrophic complication of spinal or epidural anesthesia. Risk factors include traumatic needle/catheter placement, sustained anticoagulation in an indwelling neuraxial catheter, and catheter removal during therapeutic levels of anticoagulation. Generally, a patient’s coagulation status should be optimized at the time of spinal or epidural needle/catheter placement, and the level of anticoagulation should be monitored during epidural catheterization. Signs of cord compression, such as severe back pain, progression of numbness or weakness, and bowel and bladder dysfunction, warrant immediate radiographic evaluation. A delay in diagnosis and intervention of spinal hematoma may lead to irreversible cord ischemia. (Source: European Journa...

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Rupture of the male membranous urethra

Irish Journal of Medical Science — Fri, 23 Oct 2009 22:28:43 +0100

Conclusions If the patient is stable and requires emergency laparotomy for other abdominal injuries, he should have immediate realignment of the urethra. Early realignment of the urethra at taparotomy at 1–2 weeks can be combined with orthopaedic fixation of pelvic fractures. Patients who remain unstable due to associated injuries should have delayed urethroplasty at three months. Content Type Journal ArticleCategory Original PaperDOI 10.1007/BF03167698Authors M. S. Khan, The Adelaide & Meath Hospital, Incorporating The National Children’s Hospital Urology Department Tallaght, Dublin IrelandJ. A. Thornhill, The Adelaide & Meath Hospital, Incorporating The National Children’s Hospital Urology Department Tallaght, Dublin IrelandR. Grainger, The Adelaide & Meath Ho...

Are all Urethral Catheters Created Equal?

The Journal of Urology — Mon, 19 Oct 2009 00:00:00 +0100

Although catheterization traces its historical roots approximately 5,000 years, innovations in catheter design remain sparse and clinical evidence comparing various types of commercially available catheters is limited. Intermittent catheterization was advocated following spinal cord injury as early as 1901 and after laminectomy in 1913. Nevertheless, indwelling catheterization remained the preferred technique for urinary drainage during World War I and World War II, despite its failure to prevent urosepsis, often resulting in death for patients with spinal cord injuries. (Source: The Journal of Urology)

Safety and Tolerability of Solifenacin Add-on Therapy to α-Blocker Treated Men With Residual Urgency and Frequency

The Journal of Urology — Mon, 19 Oct 2009 00:00:00 +0100

Purpose: VICTOR was a 12-week, double-blind, placebo controlled trial assessing the safety and tolerability of solifenacin plus tamsulosin in men with residual overactive bladder symptoms after tamsulosin monotherapy. Efficacy of solifenacin plus tamsulosin vs placebo plus tamsulosin was also evaluated.Materials and Methods: A total of 398 men 45 years old or older were randomized to 12 weeks of solifenacin plus tamsulosin or placebo plus tamsulosin once daily. The study population had 8 or more micturitions per 24 hours and 1 or more urgency episode per 24 hours after taking tamsulosin for 4 or more weeks, a total International Prostate Symptom Score of 13 or greater, a Patient Perception of Bladder Condition score of 3 or greater, a post-void residual of 200 ml or less and a peak flow ra...

Alpha blockers prior to removal of a catheter for acute urinary retention in adult men

NeLM - Drug Class Focused Reviews — Wed, 14 Oct 2009 23:00:00 +0100

Source: Cochrane Library Area: Evidence > Drug Class Focused Reviews Background Acute urinary retention is a urological emergency in men and requires urgent catheterisation. Any intervention which aims at increasing the rate of a successful trial without a catheter following an acute urinary retention episode would be considered potentially beneficial. Alpha blockers relax prostatic smooth muscle cells thereby decreasing the resistance to urinary flow and by doing so improve urinary symptoms. Objectives To assess the effects of alpha blockers on successful resumption of micturition following removal of a urethral urinary catheter after an episode of acute urinary retention in men. Search strategy We searched the Cochrane Incontinence Group Specialised Register (11 February 2009) ...

The Use of a Ureteral Access Sheath for the Urethral Dilatation and Catheterization of Difficult Urethral Strictures

Urologia Internationalis : Last 20 articles — Mon, 12 Oct 2009 23:00:00 +0100

Urol Int 2009;83:359-361 (DOI:10.1159/000241683) (Source: Urologia Internationalis : Last 20 articles)

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Urinary fluorescence in situ hybridization assay for detecting urothelial carcinoma in Taiwanese patients

BJU International — Fri, 09 Oct 2009 23:00:00 +0100

To investigate the cytogenetic marker detected by fluorescence in situ hybridization (FISH; UroVysionTM, Vysis, Inc., Abbott Laboratories, Des Plaines, IL, USA) in the diagnosis of bladder cancer and upper tract urothelial carcinoma (UC) in Taiwanese patients, as FISH has been used in Western countries for detecting UC, but there are limited results in Asian populations. We analysed polyploidy of chromosome 3, 7, 17 and aneuploidy of chromosome 21, using uroepithelial cells collected at the first void or by instrumental extraction of urine, for bladder cancer, and shedding cells from the upper tract flushed by normal saline via ureteric catheterization or ureterorenoscopy. The criteria for positive tumour cells included three or more positive staining in two or more chromosomes showing pol...

Friendly Foley

Consultant Live — Wed, 07 Oct 2009 15:00:01 +0100

When patients experience discomfort with Foley catheterization, fill a 2-mL syringe with lidocaine jelly and inject this (without using the needle!) through the urethral meatus and into the urethra. Wait several minutes, then insert the catheter. (Source: Consultant Live)

A Modified Technique for Neourethral Anastomosis in Orthotopic Neobladder Reconstruction

Urology — Mon, 05 Oct 2009 00:00:00 +0100

Conclusions: The clinical outcome of our modified technique for urethral anastomosis in orthotopic neobladder substitution was excellent, but the advantage of this technique needs prospective controlled study. (Source: Urology)

Coping with clean intermittent catherization – experiences from a patient perspective

Scandinavian Journal of Caring Sciences — Sat, 03 Oct 2009 23:00:00 +0100

Scand J Caring Sci; 2009Coping with clean intermittent catherization [ndash] experiences from a patient perspectiveBackground: Poor bladder emptying is a well-known phenomenon in urology which increases the risk of urinary tract infection. Thus, it is important to insure effective bladder emptying for the patient. This may be performed by emptying the bladder intermittently by means of a disposable catheter. The method is called clean intermittent catheterization (CIC). The purpose of CIC is, apart from the scientific reasons, to give patients the opportunity to live the life they did prior to experiencing problems with bladder emptying. In our view, a large number of patients do not cope with their new life with CIC in spite of learning programmes and written guidance.Aim: The aim of this...

Straddle injuries to the bulbar urethra: management and outcome in 53 patients

International Braz J Urol — Fri, 02 Oct 2009 17:57:53 +0100

Conclusions: Suprapubic cystostomy is better than urethral realignment and catheterization as primary management after straddle injury to the bulbar urethra. Stricture excision and re-anastomosis is better than VIU as delayed management for strictures that develop after straddle injury to the bulbar urethra. (Source: International Braz J Urol)

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Frequency of Pseudomonas aeruginosa Colonizations/Infections in Lung Transplant Recipients

Transplantation Proceedings — Thu, 01 Oct 2009 00:00:00 +0100

Conclusion: LT recipients in our center are at high risk for pseudomonal airway colonisation and lower respiratory tract infection that may have a significant impact on posttransplant follow-up. (Source: Transplantation Proceedings)

Predictors of postoperative urinary retention.

The American Surgeon — Thu, 01 Oct 2009 00:00:00 +0100

Authors: Shadle B, Barbaro C, Waxman K, Connor S, Von Dollen K Postoperative urinary retention (PUR) rates vary greatly depending on the population studied. PUR leads to urinary tract instrumentation, which causes increased hospital costs and morbidity. We sought to determine our PUR rate and the risk factors that associated with it. One hundred seventy-six adult surgical inpatients were included in the study. Excluded were those receiving intraoperative catheterization, epidural anesthesia, and urologic procedures. The study population included 42 per cent spinal, 24 per cent laparoscopic abdominal, 20 per cent neck surgeries excluding the spine, and 14 per cent miscellaneous surgeries. Patient bladder volumes were determined using ultrasound scanning at three different intervals: a p...

Intermittent self-catheterization and the risk of squamous cell cancer of the bladder: An emerging clinical entity?

Canadian Urological Association Journal — Wed, 30 Sep 2009 23:00:00 +0100

We report on an eighth case, and the first case described in a patient with a Mitrofanoff continent appendicovesicostomy. A description of the case and review of the literature are presented. Risk factors for squamous cell cancer include recurrent urinary tract infections, keratinising squamous metaplasia (leukoplakia) and local mucosal trauma from intermittent self-catheterization. There is no recognized or validated monitoring program for patients performing ISC who may also have these risk factors. Reasonable protocols may include regular urinary cytology and cystoscopy with random or targeted bladder biopsies. Squamous cell cancer may present late in this cohort of patients and is associated with a dismal prognosis. PMID: 19829719 [PubMed - as supplied by publisher] (Source: Canadi...

A UK consensus on the management of the bladder in multiple sclerosis [Reviews]

Postgraduate Medical Journal — Tue, 29 Sep 2009 12:31:07 +0100

Bladder symptoms in multiple sclerosis (MS) are common and distressing but also highly amenable to treatment. A meeting of stakeholders involved in patients’ continence care, including neurologists, urologists, primary care, MS nurses and nursing groups was recently convened to formulate a UK consensus for management. National Institute for Health and Clinical Excellence (NICE) criteria were used for producing recommendations based on a review of the literature and expert opinion. It was agreed that in the majority of cases, successful management could be based on a simple algorithm which includes using reagent sticks to test for urine infection and measurement of the post micturition residual urine volume. This is in contrast with published guidelines from other countries which reco...

[Reviews] A UK consensus on the management of the bladder in multiple sclerosis

Postgraduate Medical Journal — Mon, 28 Sep 2009 23:00:00 +0100

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Long-term lower urinary tract dysfunction after radical hysterectomy in patients with early postoperative voiding dysfunction

International Urogynecology Journal — Thu, 17 Sep 2009 12:44:24 +0100

Conclusion High postvoid residual urine and abdominal straining increased significantly in patients with early postoperative voiding dysfunction without impairment on quality of life. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00192-009-0996-5Authors Tarinee Manchana, Chulalongkorn University Department of Obstetrics and Gynecology, Faculty of Medicine Bangkok 10330 ThailandChalisa Prasartsakulchai, Chulalongkorn University Department of Obstetrics and Gynecology, Faculty of Medicine Bangkok 10330 ThailandApirak Santingamkun, Chulalongkorn University Division of Urology, Department of Surgery, Faculty of Medicine Bangkok 10330 Thailand Journal International Urogynecology JournalOnline ISSN 1433-3023Print ISSN 0937-3462 (Source: Internation...

Bladder Function After Total Urogenital Mobilization for Persistent Cloaca

The Journal of Urology — Wed, 16 Sep 2009 23:00:00 +0100

Conclusions: Most patients with persistent cloaca can achieve urinary continence after total urogenital mobilization. Two-thirds of patients display bladder dysfunction after the procedure. Detrusor overactivity can resolve with development of the bladder but persistent detrusor overactivity might delay the achievement of mechanisms of urinary continence. (Source: The Journal of Urology)

Catheter balloon-related urethral trauma in children

Journal of Paediatrics and Child Health — Sun, 13 Sep 2009 23:00:00 +0100

Aim: To review urethral injuries arising from incorrect balloon inflation in children undergoing urinary catheterisation.Method: Retrospective review from 1995[ndash]2006. Children who sustained catheter-related injury at The Children's Hospital at Westmead were identified through medical records database and reviewed.Results: Six patients were identified over the 11-year period. All six were boys. Age ranged from (Source: Journal of Paediatrics and Child Health)

Posttraumatic ventral urethral fistula: case report and review of literature

Cases Journal — Tue, 08 Sep 2009 23:00:00 +0100

Conclusion: Self retraction of the urethral catheter with balloon may result with clinically important urethral fistula. A wide range of possible options such as complete excision of the fistula tract and primary closure may be considered for individual cases. (Source: Cases Journal)

Transurethral incision of the bladder neck to treat bladder neck dysfunction and voiding dysfunction in patients with high-level spinal cord injuries

Neurourology and Urodynamics — Wed, 02 Sep 2009 23:00:00 +0100

We report the surgical outcomes in patients with high-level SCI who underwent transurethral incision of the bladder neck (TUI-BN).Twenty-two patients with SCI at or above the mid-thoracic level who presented with voiding dysfunction due to BND with different types of DSD received TUI-BN. Surgical outcome was determined by comparing preoperative with postoperative urodynamic parameters and clinical presentations. Satisfactory outcome was defined as having improvement of AUA/IPSS quality-of-life (QoL) index by [ge]2.Among the patients, 19 (86.4%) were men and 3 (13.6%) were women. Thirteen patients had cervical and nine had thoracic SCI. Postoperatively, spontaneous voiding by abdominal triggering with an open urethral sphincter was noted in 19 patients (86%) and AD had resolved in 15 patien...

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Acute urinary retention in a neonate due to a mucus plug

Journal of Pediatric Surgery — Mon, 31 Aug 2009 23:00:00 +0100

A 12-hours postpartum male newborn with urinary retention was referred to us for assessment. There was no history of oligohydramnios, and there had been no witnessed micturition after birth. On examination, the neonate was in distress and crying. His abdomen was distended, tense, and tender. The external genitalia were normal. On gentle retraction of the foreskin, a plug of mucus-like substance was revealed, blocking the external urethral meatus (). After cleansing the foreskin with chlorhexidine solution, catheterization of the urethra was attempted with a 6F feeding catheter lubricated with Lignocaine gel 2%. The tip of the feeding tube was used as a probe, and the mucus plug was partially removed, revealing the normal external urethral meatus. The feeding tube was inserted easily into t...

Postoperative Urinary Retention

Anesthesiology Clinics — Mon, 31 Aug 2009 23:00:00 +0100

Postoperative urinary retention (PUR) is a common complication of surgery and anesthesia. The risk of retention is especially high after anorectal surgery, hernia repair, and orthopedic surgery and increases with advancing age. Certain anesthetic and analgesic modalities, particularly spinal anesthesia with long-acting local anesthetics and epidural analgesia, promote the development of urinary retention. Portable ultrasound provides rapid and accurate assessment of bladder volume and aids in the diagnosis and management of PUR. Catheterization is recommended when bladder volume exceeds 600 mL to prevent the negative sequelae of prolonged bladder overdistention. (Source: Anesthesiology Clinics)

Lidocaine Jelly and Plain Aqueous Gel for Urethral Straight Catheterization and the Q-tip Test: A Randomized Controlled Trial.

Obstetrics and Gynecology — Wed, 26 Aug 2009 10:15:19 +0100

CONCLUSION:: When compared with plain aqueous gel, 2% lidocaine jelly significantly reduces pain perception during evaluation of postvoid residual volume and the Q-tip test. CLINICAL TRIAL REGISTRATION:: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00883103. LEVEL OF EVIDENCE:: I. PMID: 19701033 [PubMed - in process] (Source: Obstetrics and Gynecology)

An adjustable sling in the management of recurrent urodynamic stress incontinence after previous failed midurethral tape

Neurourology and Urodynamics — Tue, 18 Aug 2009 23:00:00 +0100

The aim of this prospective study was to evaluate the feasibility and outcome of an adjustable sling system AMI in patients with recurrent urinary stress incontinence after failed suburethral sling insertion.Twenty-five patients with recurrent urinary stress incontinence treated with an adjustable sling system AMI were analyzed for feasibility and outcome. Patients' incontinence bother was quantified using the Visual Analogue Scale (VAS) from 0 to 10. Multichannel urodynamics and pad tests were pre- and postoperatively performed. Time of adjustment, time of the surgical intervention, and clinical outcome were also recorded.Twenty-five patients were treated with the adjustable sling system AMI. Median time of adjustment was 3 days (range 1-8) and a median follow up time of 12 months. Twenty...

Indwelling catheters and neurogenic bladder: Are they really that bad?

Current Bladder Dysfunction Reports — Mon, 17 Aug 2009 21:18:18 +0100

Abstract Indwelling catheters are one viable option in treatment of neurogenic bladder. Indwelling catheters require appropriate and regular follow-up to avoid associated complications, which may be severe. However, even if a high rate of complications was reported with the use of indwelling catheters, they still have their place in neurogenic bladder management. The most common complications associated with their use are catheter blockage, catheter-associated urinary tract infection (CAUTI), and stone formation. Indwelling catheters violate the sterile bladder environment by providing a route for bacterial entry along both the internal and external surfaces. This violation leads to a high rate of CAUTI. However, there are innovative ways to reduce the CAUTI rate. In patie...

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Overactive bladder symptoms following urethrolysis procedures

Current Bladder Dysfunction Reports — Mon, 17 Aug 2009 21:18:14 +0100

Abstract Female bladder outlet obstruction following stress urinary incontinence surgery is well described but requires a high index of suspicion given that patients often present clinically with both overactive bladder (OAB) and voiding symptoms. Furthermore, only 25% of patients have frank urinary retention that requires indwelling or clean intermittent catheterization. Historically, urethrolysis and sling lysis procedures ameliorate obstructive voiding symptoms with a success rate approaching 85% to 90%. In reviewing the literature, it has been my experience as well as those of other experts that OAB symptoms remain refractory in a significant percentage of women, often leading to further invasive therapies and additional morbidity. This review describes the OAB symptom...

Botulinum Toxin A for Overactive Bladder and Detrusor Muscle Overactivity in Patients With Parkinson's Disease and Multiple System Atrophy

The Journal of Urology — Sun, 16 Aug 2009 23:00:00 +0100

Conclusions: The new beneficial effect that we report in a small study sample encourages larger trials to confirm botulinum toxin type A injection into the detrusor muscle as an effective and safe treatment for refractory overactive bladder symptoms and detrusor overactivity related to Parkinson's disease and multiple system atrophy. (Source: The Journal of Urology)

Robotic Assisted Laparoscopic Mitrofanoff Appendicovesicostomy: Preliminary Experience in a Pediatric Population

The Journal of Urology — Sun, 16 Aug 2009 23:00:00 +0100

Conclusions: The robotic assisted laparoscopic Mitrofanoff procedure is feasible to perform, is associated with satisfactory outcomes and minimal complications, and has the benefits of a minimally invasive approach. (Source: The Journal of Urology)

Editorial Comment

The Journal of Urology — Sun, 16 Aug 2009 23:00:00 +0100

The authors describe the outcome of reflux in patients with posterior valves who not only were diagnosed in a heterogeneous manner, but also were treated differently. The article contains an array of historical data on the nature of posterior urethral valve pathology. However, given the lack of adequate collection of preoperative and postoperative variables in the surgical patients, flaws in interpreting the data are possible. For instance it is compelling to think of patients with posterior urethral valves as needing ancillary treatment such as clean intermittent catheterization or anticholinergic therapy. However, few of these patients eventually required such treatment options. Furthermore, we do not know the reasons or indications for surgery, whether reimplantation or nephrectomy. It ...

Spontaneous intra-peritoneal perforation of the bladder secondary to peritoneal tuberculosis

British Journal of Medical and Surgical Urology — Fri, 14 Aug 2009 11:16:58 +0100

A 28-year-old Indian female presented to the Urology department with acute urinary retention, having being diagnosed 4 weeks previously with peritoneal tuberculosis. Prior to this episode of retention, she had complained of urinary frequency and poor stream for 3 days. Her post-catheterisation residual volume was 1500ml. She failed a subsequent trial without catheter due to large post-micturition residual volumes, and therefore commenced intermittent self-catheterisation. After 2 weeks of self-catheterisation her residuals became insignificant, and this was discontinued. Spinal magnetic resonance imaging (MRI) to investigate her symptoms revealed no abnormality. Cystoscopy revealed a diverticulum at the dome of the bladder, but otherwise normal bladder mucosa. (Source: British Journal of M...

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The additional value of ambulatory urodynamic measurements compared with conventional urodynamic measurements

BJU International — Mon, 10 Aug 2009 23:00:00 +0100

To study the additional diagnostic value of ambulatory urodynamic measurements/monitoring (AUM) in patients with lower urinary tract symptoms (LUTS). We reviewed the urodynamic data, collected at the urology department of our University Hospital between 2002 and 2007. During this period, 2393 urodynamic investigations were conducted. In 108 patients both conventional urodynamic measurements (CUM) and AUM were conducted. In 25 patients an AUM was conducted for bladder evacuation problems due to absent bladder contractility, seen on CUM. In 21 cases, AUM showed the presence of contractility of the bladder under normal conditions at home. Their symptoms were due to other factors such as a concomitant non-relaxation of the urinary sphincter or pelvic floor, psychological reasons or obstruction...

Emphysematous cystitis

International Journal of Infectious Diseases — Mon, 10 Aug 2009 00:00:00 +0100

A 74-year-old female with a history of diabetes mellitus, hypertension, dyslipidemia, and ischemic stroke, with a sequela of right hemiparesis, presented to our emergency room with fever, lower abdominal pain, and confused consciousness for one day. No cough, vomiting, diarrhea, or flank pain was present. Her blood urea nitrogen concentration was 57.2mg/dl and the serum creatinine concentration was 1.7mg/dl. Other laboratory tests showed an elevated white blood cell count of 27.42×109/l with 4% band forms and C-reactive protein of 15.4mg/dl. Computed tomography of the abdomen and pelvis demonstrated a thickened bladder wall containing pockets of gas (). Physical examination revealed no flank knocking tenderness and no abdominal pain or rebounding pain. Cultures of urine and blood grew mor...

Marked hydronephrosis and hydroureter after distigmine therapy in an adult male patient with paraplegia due to spinal cord injury: a case report

Cases Journal — Wed, 05 Aug 2009 23:00:00 +0100

Conclusion: Distigmine therapy resulted in marked bilateral hydronephrosis and hydroureter. Persistence of hydronephrosis after omitting distigmine, and presence of residual urine in bladder over many years probably predisposed to formation of polypoid cystitis and follicular cystitis, and contributed to prolonged haematuria, which occurred after an episode of urine infection. This case illustrates the dangers of prescribing distigmine to promote spontaneous voiding in spinal cord injury patients. Instead of using distigmine, spinal cord injury patients should be advised to consider intermittent catheterisation together with oxybutynin or propiverine to achieve complete, low-pressure emptying of urinary bladder. (Source: Cases Journal)

Enterovesical Fistula: A Rare Complication of Urethral Catheterization

Advances in Urology — Mon, 03 Aug 2009 11:56:42 +0100

This report describes the case of an eighty-two-year old lady with an indwelling urethral catheter inserted eight years prior to her presentation to manage her urinary incontinence. She underwent radiotherapy for muscle-invasive bladder cancer (stage T2b) in 1991 and had a laparotomy and drainage of an appendicular abscess in her early twenties. She presented with a short history of fecaluria, pneumaturia, and passage of urine per rectum. On laparotomy she was found to have an inflated catheter balloon that has eroded through the bladder wall into the lumen of a terminal ileal segment. To our knowledge this is the first reported case in literature of a patient developing an enterovesical fistula as a result of a urethral catheter eroding through the bladder wall into the bowel lumen. There...

Multilayer Transducer for Acoustic Bladder Volume Assessment on the Basis of Nonlinear Wave Propagation

Ultrasound in Medicine and Biology — Sun, 02 Aug 2009 23:00:00 +0100

Abstract: Catheterization remains the gold standard for bladder volume assessment, but it is invasive, uncomfortable to the patient and introduces the risk of infections and traumas. Acoustic measurement of the bladder volume reduces the need for a urinary catheter. Recently, a new method to non-invasively measure the volume of liquid filled cavities in vivo on the basis of nonlinear wave propagation has been introduced. To implement this method, two different multilayer ultrasound transducers were developed. Both transducers consisted of a first piezo-electric layer of lead zirconate titanate (PZT) to transmit waves at a fundamental frequency (2MHz) and a second piezo-electric layer (copolymer) to receive a wide range of frequencies including harmonics. To suppress the inherent susceptibi...

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Enterococcal urinary tract infections in a university hospital: clinical studies.

Braz J Infect Dis — Sat, 01 Aug 2009 00:00:00 +0100

Authors: Barros M, Martinelli R, Rocha H Although urinary tract infections (UTI) represent the most common infection caused by enterococci, some aspects remain to be fully clarified. The aim of this study was to determine the clinical characteristics present in UTI caused by Enterococcus spp. in patients followed up at the Prof. Edgard Santos Teaching Hospital of the Federal University of Bahia. All patients consecutively examined between 1997 and 2005, who received a diagnosis of UTI caused by Enterococcus spp. were included in the study. UTI was defined as the presence of 10(5) colony-forming units per mL of urine. Standard microbiological techniques were used. During the study period, 6.2% of the urine cultures were positive for Enterococcus spp. The mean age of the patients was 48....

Dystrophic calcification and stone formation on the entire bladder neck after potassium-titanyl phosphate laser vaporization for the prostate: a case report.

J Korean Med Sci — Fri, 31 Jul 2009 23:00:00 +0100

Authors: Jeon SW, Park YK, Chang SG Dystrophic calcification can be defined as a calcification that occurs in degenerated or necrotic tissue. It is associated with multiple clinical conditions, such as collagen vascular diseases. It involves the deposition of calcium in soft tissues despite no generalized disturbance in the calcium or phosphorus metabolism, and this is often seen at sites of previous inflammation or damage. Potassium-titanyl phosphate (KTP) laser vaporization of the prostate is safe and relatively bloodless procedure that results in a shorter catheterization, immediate symptomatic improvement, and less severe postoperative irritative symptoms. However, longer follow-up studies or reports about complications are lacking. Here in we report a case of dystrophic calcificat...

Editorial Comment

Urology — Fri, 31 Jul 2009 11:49:58 +0100

This study evaluates 30 children with myelomeningocele (MMC) (mean age 5.6 ± 2.7 years) and refractory neurogenic detrusor overactivity using pelvic floor electrostimulation with interferential (IF) current. The children had moderate to severe retractable incontinence, detrusor overactivity, and a high maximal detrusor end-fill pressure. Each child required anticholinergic therapy (oxybutynin or baclofen) and clean intermittent catheterization. They were randomly allocated to the treatment (IF stimulation, n = 20) and control (sham stimulation, n = 10) groups with a 2:1 ratio (balanced block randomization). The patients were evaluated with the following: urodynamic studies before treatment, 2 weeks after treatment, and 6 months after treatment, a subjective questionnaire, and measurement ...

Proof of principle: The effect of antimuscarinics on bladder filling sensations in healthy subjects - A placebo controlled double blind investigation using 4 and 8 mg tolterodine extended release

Neurourology and Urodynamics — Mon, 27 Jul 2009 23:00:00 +0100

There is evidence that antimuscarinic drugs have depressant influence not only on bladder muscle activity, but also on bladder sensations. The aim of this study was to evaluate the effect of a single dose tolterodine extended release (ER) 4 and 8 mg on bladder sensations during filling cystometry.After approval of the local ethics committee, 30 healthy female subjects (23.7 ± 2.3 years) were included and randomly assigned to three groups: (A) placebo, (B) tolterodine ER 4 mg, and (C) tolterodine ER 8 mg in a double blind manner. Measurements were performed at baseline and 4 hr postmedication in each group, consisting of: (1) Filling cystometry with 25 ml/min at which subjects had to indicate first sensation of filling (FSF), first desire to void (FDV), and strong desire to void (SDV). (2)...

Efficacy and Safety of Oxybutynin Transdermal System in Spinal Cord Injury Patients With Neurogenic Detrusor Overactivity and Incontinence: An Open-label, Dose-titration Study

Urology — Tue, 21 Jul 2009 23:00:00 +0100

Conclusions: Oxybutynin-TDS was efficacious in spinal cord injury patients with neurogenic detrusor overactivity and was well tolerated at up to 3 times the standard dose. (Source: Urology)

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Protocol for the value of urodynamics prior to stress incontinence surgery (VUSIS) study: a multicenter randomized controlled trial to assess the cost effectiveness of urodynamics in women with symptoms of stress urinary incontinence in whom surgical treatment is considered.

BMC Women's Health - Latest articles — Mon, 20 Jul 2009 23:00:00 +0100

Background: Stress urinary incontinence (SUI) is a common problem. In the Netherlands, yearly 64.000 new patients, of whom 96% are women, consult their general practitioner because of urinary incontinence. Approximately 7500 urodynamic evaluations and approximately 5000 operations for SUI are performed every year. In all major national and international guidelines from both gynaecological and urological scientific societies, it is advised to perform urodynamics prior to invasive treatment for SUI, but neither its effectiveness nor its cost-effectiveness has been assessed in a randomized setting.The Value of Urodynamics prior to Stress Incontinence Surgery (VUSIS) study evaluates the positive and negative effects with regard to outcome, as well as the costs of urodynamics, in women with sym...

Etiology of Urethral Stricture Disease in the 21st Century

The Journal of Urology — Mon, 20 Jul 2009 23:00:00 +0100

Conclusions: Of strictures treated with urethroplasty today iatrogenic causes account for about half of the urethral stricture cases in the developed world. In about 1 of 3 cases no obvious cause could be identified. The etiology is significantly different in younger vs older patients and among stricture sites. (Source: The Journal of Urology)

Combination Drug Therapy Improves Compliance of the Neurogenic Bladder

The Journal of Urology — Mon, 20 Jul 2009 23:00:00 +0100

Purpose: Typical management of increased bladder storage pressures and decreased compliance related to neurogenic bladder dysfunction consists of antimuscarinic therapy with or without clean intermittent catheterization. However, these measures are often unsuccessful. In this patient group we commonly use combination therapy consisting of antimuscarinics combined with imipramine and/or an α-blocker.Materials and Methods: A retrospective chart review was performed identifying all patients with neurogenic bladder dysfunction who were initially on no drug therapy or antimuscarinic therapy alone and were later switched to 2 or 3 drug therapy.Results: In the group initially on no therapy and subsequently on 2 drugs (22) mean bladder pressure at capacity decreased 52% and mean compliance increa...

High Power Diode Laser Vaporization of the Prostate: Preliminary Results for Benign Prostatic Hyperplasia

The Journal of Urology — Mon, 20 Jul 2009 23:00:00 +0100

Conclusions: The high power diode laser provided significant improvements in International Prostate Symptom Score and the maximal flow rate with low morbidity. Thus, these results of prostate vaporization with the high power diode laser, representing what is to our knowledge the first clinical study in the literature, are encouraging. (Source: The Journal of Urology)

Limited value of bladder sensation as a trigger for conditional neurostimulation in spinal cord injury patients

Neurourology and Urodynamics — Thu, 16 Jul 2009 23:00:00 +0100

Conditional stimulation of dorsal genital nerves suppresses undesired detrusor contractions (UDC) and consequently increases bladder capacity and prevents incontinence. No clinically applicable sensor exists for reliable bladder activity monitoring as a trigger for conditional stimulation. Primary objective of this study was to determine whether bladder sensation concomitant with UDC may be used for spinal cord injury (SCI) patients to trigger neurostimulation in daily life.Nineteen male and 7 female SCI patients suspected of detrusor overactivity (DO) underwent conventional and 6-hr ambulatory urodynamics. Patients were instructed to do normal daily activities and to activate event buttons of the ambulatory recorder to mark events: physical activity, bladder sensation, micturition or inte...

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Robotic-assisted Ileovesicostomy: Initial Results

Urology — Wed, 15 Jul 2009 23:00:00 +0100

Conclusions: This study is the first to describe the robotic ileovesicostomy procedure. Robotic ileovesicostomy appears to be safe and effective, with low morbidity. (Source: Urology)

Long-term follow-up of male patients after reconstruction of the bladder–exstrophy–epispadias complex: Psychosocial status, continence, renal and genital function

Journal of Pediatric Urology — Mon, 13 Jul 2009 00:00:00 +0100

Conclusion: After functional BEEC reconstruction, long-term bladder function is preserved with mostly normal renal function. The number of bladder neck attempts has a significant influence on andrologic outcome. Detailed analysis may detect multifactorial pathogenesis from the impaired sperm quality in the BEEC. (Source: Journal of Pediatric Urology)

A radially expanding sheath for urethral dilation

Medical Hypotheses — Wed, 08 Jul 2009 23:00:00 +0100

Summary: Urethral trauma caused by urethral dilation often leads to complications including gross hemorrhage and inflammation. The injury of the urethral mucosa is, in a large part, due to the shearing forces imposed on it during the introduction of dilation devices. In this article, a radially expanding sheath for urethral dilation is hypothesized by the authors. This device aims to reduce the axial forces during the insertion of dilators, thereby protecting the urethral mucosa from friction. When performing the endoscopy, the device could act as a barrier between urethral mucosa and the endoscope. Moreover, in the situation of encountering difficulties in catheterization, the sheath could also be used as a guide-wire to lead the catheter through its lumen course. Thus, it is proposed tha...

Commentary to “Outcome of complete primary bladder exstrophy repair: Single-center experience”

Journal of Pediatric Urology — Wed, 08 Jul 2009 00:00:00 +0100

This is a seminal paper in the field of bladder exstrophy. Firstly, it is the largest single institutional experience with the Mitchell (CPRE) repair. In fact, it is larger than that reported by Mitchell himself in 2008 . Secondly, by its pure size it puts to rest the idea that a truly complete repair of a birth defect of the magnitude of bladder exstrophy could be achieved in a single stage. This clearly demonstrates that the continence rate with this procedure is usually associated with bladder augmentation and intermittent catheterization. The authors describe vesicocutaneous fistula as a failure in 11.8%, but I would totally disagree that this complication denotes failure as it is common in this repair. However, recent evidence from Gearhart et al. shows that when vesicocutaneous fist...

Urinary Side Effects and Complications After Permanent Prostate Brachytherapy: The MD Anderson Cancer Center Experience

Urology — Tue, 07 Jul 2009 23:00:00 +0100

Conclusions: Short-term urinary side effects after prostate brachytherapy are common, follow a predictable course, and typically resolve within 1 year. Conservative management of short-term urinary side effects is recommended to minimize the risk of long-term urinary complications. (Source: Urology)

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How long is strict bed rest necessary after renal biopsy?

Clinical and Experimental Nephrology — Mon, 06 Jul 2009 20:23:15 +0100

Conclusions Shortening the period of strict bed rest after renal biopsy from 7 h to 2 h decreased the incidence of back pain, but there was no increase in bleeding or other biopsy-related complications. Our findings suggest that a shorter period of strict bed rest can safely reduce discomfort in renal biopsy patients. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10157-009-0206-2Authors Eiji Ishikawa, Mie University Graduate School of Medicine Department of Cardiology and Nephrology 2-174 Edo-Bashi Tsu Mie 514-8507 JapanShinsuke Nomura, Mie University Graduate School of Medicine Department of Cardiology and Nephrology 2-174 Edo-Bashi Tsu Mie 514-8507 JapanToshihide Obe, Mie University Graduate School of Medicine Department of Cardiology a...

Botulinum toxin type A for neurogenic detrusor overactivity due to spinal cord lesions in children: A retrospective study of seven cases

Journal of Pediatric Urology — Mon, 06 Jul 2009 00:00:00 +0100

Conclusion: Injection with BTA proved effective and safe in the short term. This may be an alternative to surgery in children with neurogenic detrusor overactivity. (Source: Journal of Pediatric Urology)

Ultrasound for prostate cancer

NHS News Feed — Thu, 02 Jul 2009 16:06:00 +0100

“A pioneering treatment for the UK's most common male cancer is more successful than surgery or radiotherapy,” The Daily Telegraph reported. The newspaper said that new research shows that intensive ultrasound therapy is as effective as traditional treatments (surgery or radiotherapy) but that side effects are dramatically reduced. This research found reasonably favourable results from high-intensity focused ultrasound (HIFU) treatment in 172 men with localised prostate cancer (cancer that had not spread). It also found that there were relatively low rates of urinary incontinence and erectile dysfunction following treatment. At present, treatment for localised prostate cancer is normally either radical (surgery or radiotherapy) or involves ‘watchful waiting’, where the cancer is m...

[Photoselective vaporization of the prostate with Laser Greenlight HPS: current role, technical aspects and review of the literature]

Actas Urologicas Espanolas — Tue, 30 Jun 2009 23:00:00 +0100

Authors: Capitán Manjón C, de la Morena Gallego JM, de la Peña Zarzuelo E, Gómez dos Santos V, Llorente Abarca C Photoselective vaporization of the prostate with 120W HPS Greenlight laser is one of the most attractive modalities of surgical treatment for benign prostatic hyperplasia at present. The specific physical characteristics of this laser provides an excellent safety and effectiveness profile, making it the ideal technique for high-risk patients or patients ongoing oral anticoagulation. Moreover, the undeniable reduction of urethral catheterization time and hospital stay compared to transurethral resection of prostate (TURP) involves a much more comfortable postoperative period for patients. We have conducted a Medline/Pubmed search, presenting in this review...

Re: Long-Term Outcomes of External Sphincterotomy in a Spinal Injured Population: D. Pan, A. Troy, J. Rogerson, D. Bolton, D. Brown and N. Lawrentschuk J Urol 2009; 181: 705–709

The Journal of Urology — Thu, 18 Jun 2009 23:00:00 +0100

We read this retrospective study with great interest. Sphincterotomy was the routine bladder treatment for all patients with detrusor-sphincter dyssynergia (DSD) who participated during the 8-year study. In the discussion the authors state that clean intermittent catheterization (CIC) remains the gold standard for treating patients with DSD, achieving a state of balanced low bladder pressure totally emptied at regular intervals without residual urine or leakage. Not all readers will agree with this statement. (Source: The Journal of Urology)

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Potentially inappropriate urinary catheter indwelling among long-term care facilities residents

Journal of Evaluation in Clinical Practice — Wed, 10 Jun 2009 04:00:00 +0100

Conclusion The prevalence of long-term UC indwelling among Taiwanese LTCF residents was high and a high proportion of their UC may be removable. A national audit and introducing a practice guideline for continence care in LTCFs may help to promote quality of care for institutionalized older people in Taiwan. (Source: Journal of Evaluation in Clinical Practice)

Probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 May Help Downregulate TNF-Alpha, IL-6, IL-8, IL-10 and IL-12 (p70) in the Neurogenic Bladder of Spinal Cord Injured Patient with Urinary Tract Infections: A Two-Case Study

Advances in Urology — Wed, 10 Jun 2009 00:06:29 +0100

The management of urinary tract infection (UTI) in individuals with spinal cord injury (SCI) continues to be of concern, due to complications that can occur. An emerging concept that is a common underlying pathophysiological process is involved, wherein pathogens causing UTI have a role in inflammatory progression. We hypothesized that members of the commensal flora, such as lactobacilli, may counter this reaction through anti-inflammatory mediation. This was assessed in a pilot two-patient study in which probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri were administered to one patient and placebo to another, both along with antibiotics to treat acute UTI. Urinary TNF-alpha was significantly downregulated (P=.015) in the patient who received the probiotic and who used inte...

Probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 May Help Downregulate TNF-Alpha, IL-6, IL-8, IL-10 and IL-12 (p70) in the Neurogenic Bladder of Spinal Cord Injured Patient with Urinary Tract Infections: A Two-Case Study

Advances in Urology — Fri, 05 Jun 2009 18:56:56 +0100

Embolotherapy for Lower Urinary Tract Hemorrhage

Journal of Vascular and Interventional Radiology : JVIR — Thu, 04 Jun 2009 23:00:00 +0100

The patient characteristics, techniques used, and outcomes of 11 patients with lower urinary tract hemorrhage treated with embolotherapy are described. The authors focus on bilateral superselective embolization of the arterial supply to the bladder and techniques to embolize multiple small vessels supplying the bladder when the vascular anatomy is complicated and superselective catheterization is not possible. The immediate success rate was 100%, with three later recurrences. One procedure was complicated by asymptomatic occlusion of the posterior division of the internal iliac artery. Embolotherapy can provide at least short-term success adequate to improve quality of life for palliation with few complications. (Source: Journal of Vascular and Interventional Radiology : JVIR)

Periurethral Cleaning Prior to Urinary Catheterization in Children: Sterile Water versus 10% Povidone-Iodine

Clinical Pediatrics — Thu, 04 Jun 2009 04:00:00 +0100

Conclusions. Cleaning the periurethral area of children with sterile water prior to catheterization is not inferior to cleaning with povidone-iodine. (Source: Clinical Pediatrics)

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Healthcare-Acquired Catheter-Associated Urinary Tract Infections in a Community Hospital Setting: How do We Keep Patients Safe and Keep Reimbursement?

American Journal of Infection Control — Mon, 01 Jun 2009 04:00:00 +0100

Sandra E. Gallegos, RN, BSN,CIC, ICP, St. Mary Corwin Medical Center, Pueblo, CO Background: Each year, urinary catheters are inserted in more than 5 million patients in acute-care hospitals and extended-care facilities. Catheter-associated urinary tract infection (CAUTI) is the most common nosocomial infection in hospitals and nursing homes. According to the Center for Disease Control 40% of healthcare-associated infections are urinary tract infections; 90% of those UTIs are a sequela of indwelling bladder catheters, the risk with short-term catheterization is 5% per day. CAUTIs comprise perhaps the largest institutional reservoir of nosocomial antibiotic-resistant pathogens. Foley catheters have been associated with increased morbidity and mortality, increased length of stay and higher ...

Gangrenous Cholecystitis Caused by Hafnia alvei: A Case Report and Review of Literature

Journal of the American Medical Directors Association — Mon, 01 Jun 2009 04:00:00 +0100

To the Editor: A 75-year-old male with coronary artery disease was transferred from a nursing home with chest pain and shortness of breath. He was in severe respiratory distress, and a diagnosis of pulmonary edema was made. Examination of abdomen, extremities, skin, and neurological system were unremarkable. The patient was intubated and needed mechanical ventilation for a week. Two days after he was extubated, he complained of right upper quadrant pain and an ultrasonogram of the abdomen showed features of acalculous cholecystitis. He underwent laparoscopic cholecystectomy which revealed a gangrenous gall bladder. Gram stain of bile and the gall bladder specimen were positive for moderate amounts of gram-negative bacilli and leukocytes. Cultures subsequently grew Hafnia alvei in large nu...

Long-term Outcomes of Augmentation Enterocystoplasty with an Ileal Segment in Patients with Spinal Cord Injury.

J Formos Med Assoc — Sun, 31 May 2009 23:00:00 +0100

Conclusion: AE with an ileal segment provides effective and safe therapeutic outcomes in SCI patients. However, problems with UTI, reservoir calculi and new-onset upper tract urolithiasis still need to be solved. PMID: 19515628 [PubMed - in process] (Source: J Formos Med Assoc)

Lower urinary tract symptoms following neurological illness may be influenced by multiple factors: Observations from a neurorehabilitation service in a developing country

Neurourology and Urodynamics — Wed, 27 May 2009 04:00:00 +0100

To evaluate the pattern of lower urinary tract dysfunction (LUTD) in patients with neurological disease in the setting of a rehabilitation service in a developing country, and analyze causes for unexpected lower urinary tract symptoms (LUTS).Patients with neurological disorders and having significant LUTS were prospectively evaluated. Level of neurological lesion was localized by neurological examination and investigations. LUTD was evaluated by symptom analysis, bladder diaries and ultrasonography. Storage symptoms were managed using antimuscarinic medications and voiding dysfunction, when significant, was managed by catheterization and patients were regularly followed up. Patients with symptoms that had not been expected based upon their level of neurological lesion were further evaluate...

Unfortunate complication of feeding tube used as a urethral catheter in a newborn and its endoscopic retrieval

Journal of Pediatric Urology — Sun, 24 May 2009 23:00:00 +0100

We report an unfortunate spontaneous complication in the form of internal knotting of the feeding tube, preventing urine output monitoring or retrieval of the catheter. The complete and tight knot at the end of the catheter did not allow retrieval of the catheter (), and the previously described use of an endoluminal guidewire to open such knots, in our experience, has always failed . (Source: Journal of Pediatric Urology)

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Pr01a 5 year program of surgical treatment of encephalocoeles in vietnam by operation smile australia

ANZ Journal of Surgery — Tue, 19 May 2009 04:00:00 +0100

We report on a five year program to Cho Ray Hospital in Ho Chi Minh City, Vietnam, where the local team has been successfully taught how to manage encephalocoeles. During this time 19 patients with encephalocoeles were surgically treated by the Operation Smile Team, with increasing responsibility assumed by the local medical team. Three patients with very large encephalocoeles were brought to Australia for treatment, and two Vietnamese Neurosurgeons were brought to Australia for further education and experience. Complications were minimal, and consist of a false passage created by urethral catheterisation and a CSF leak from a lumbar drain, both of which recovered completely with conservative management. (Source: ANZ Journal of Surgery)

Outcome of complete primary bladder exstrophy repair: Single-center experience

Journal of Pediatric Urology — Mon, 18 May 2009 00:00:00 +0100

Conclusion: Patients may require more than one procedure for reconstruction. In our series, augmentation was required to achieve acceptable dryness. Early promising results with dry intervals in young patients did not translate to continence in older patients. (Source: Journal of Pediatric Urology)

Editorial Comment

The Journal of Urology — Sun, 17 May 2009 23:00:00 +0100

In this study the authors report a 3% rate of intraoperative bladder injury. This complication is unique to this procedure, occurring during the step where the new internal ring is created lateral to the bladder and medial to the obliterated umbilical ligament, and the spermatic cord is brought down into the scrotum. This injury rate is quite high, and the authors offer some advice aimed to prevent future injuries, including avoiding this area for the ring, routine bladder catheterization, aspiration of all bladder urine, avoidance of using the Trendelenburg position to reduce residual urine and careful perivesical dissection. (Source: The Journal of Urology)

Reply by Authors

The Journal of Urology — Sun, 17 May 2009 23:00:00 +0100

Evidence based surgery is based on the continuous assessment and improvement of practices in the operating room. Immediately after 2 laparoscopic orchiopexy associated bladder injuries occurred within a short time we implemented this data driven process by carefully reviewing our laparoscopic orchiopexies for other bladder injuries, and we uncovered a third case. Thus, the true incidence of bladder injury during laparoscopic orchiopexy is likely to be lower than 3 per 101 cases. Indeed we have not encountered this complication again since the most recent injury perhaps because of the urethral catheterization practices we now use. (Source: The Journal of Urology)

Feasibility of a computerized male urethral catheterization simulator

Nurse Education in Practice — Thu, 14 May 2009 00:00:00 +0100

This study aims to study the feasibility of a new portable computer-based male urethral catheterization simulator, Urecath (Melerit Urecath Vision®). The simulator consists of three software modules: teaching (explains the different procedures in the catheterization), learning (game settings with practice and self-assessments tests), and simulator module that is connected to a box with a model of a penis where syringes and the urinary catheter can be inserted. Registered nurses (n=23), nurse assistants (n=14), nurse students (n=12), and a nurse assistant student (n=1) participated in a simulation session and answered 30 questions about the feasibility of the simulator. The participants appreciated the different modules, particularly the teaching and learning modules. The simulator module ...

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Occult dural arteriovenous fistula causing rapidly progressive conus medullaris syndrome and paraplegia after lumbar microdiscectomy

The Spine Journal — Wed, 13 May 2009 23:00:00 +0100

Conclusions: This represents the first case of an occult spinal DAVF becoming acutely symptomatic after lumbar disc surgery. Although the etiology of the lesion and its symptomatic progression remains unknown, an alteration of blood flow through the DAVF as a result of surgery may have resulted in progressive venous congestive myelopathy. The present case highlights the importance of considering a spinal DAVF in the differential diagnosis of any patient with signs of myelopathy or conus medullaris syndrome after lumbar discectomy. In addition, this case underscores the gravity of recognizing subtle features that suggest the presence of an occult vascular malformation on preoperative imaging, as symptomatic progression of these lesions carries significant potential morbidity. (Source: The S...

“Scrotal Pouch”—Scrotal Herniation of Bladder Secondary to Extensive Bone Resection Due to Chondrosarcoma: A Simple and Effective Surgical Treatment of Urinary Obstruction

Urology — Sun, 10 May 2009 23:00:00 +0100

A patient developed a scrotal hernia of the bladder 6 years after resection of the pubic ramus for treatment of a chondrosarcoma. Because reconstruction of the pelvis was impossible, an alternative surgical solution was needed. A continent vesicocutaneous stoma with a full-thickness bladder tube was created. The hernia itself was not repaired, leaving the bladder and bowel loops in the scrotum. Nine years after surgery, the patient continued to perform clean intermittent catheterization. The patient had not experienced any strictures or infections. The demonstrated technique appears to be a feasible option when hernia repair is impossible. (Source: Urology)

Does Optimizing Bladder Management Equal Optimizing Quality of Life? Correlation Between Health-related Quality of Life and Urodynamic Parameters in Patients With Spinal Cord Lesions

Urology — Sun, 10 May 2009 23:00:00 +0100

Conclusions: The results of our study have demonstrated that a treatment regimen leading to favorable urodynamic data and continence correlates with better quality of life. (Source: Urology)

Adaptive equipment to assist with one-handed intermittent self-catheterization: a case study of a patient with multiple brain injuries.

The American Journal of Occupational Therapy — Thu, 30 Apr 2009 23:00:00 +0100

Authors: Carver MD Intermittent self-catheterization is common for patients who have neurogenic bladder associated with traumatic brain injury (TBI). Intermittent self-catheterization is considered the gold standard for bladder drainage because of the significantly decreased incidence of urinary tract infection in comparison with other catheterization methods. Occupational therapists educate patients in how to complete intermittent self-catheterization and assist them with adaptive equipment so that they may catheterize themselves independently. This case study describes adaptive equipment fabricated to allow a male patient with TBI who was independent with intermittent self-catheterization to continue independent intermittent self-catheterization after a second injury resulting in hem...

[Urinary tract infections characterization in a spinal cord injury rehabilitation unit]

Acta Medica Portuguesa — Thu, 30 Apr 2009 23:00:00 +0100

CONCLUSIONS: E. coli continues to be the most frequent bacteria causing this infection. Fluoroquinolones resistance is rising. Amoxicilin/Clavulanic acid is an alternative for immediate empiric treatment. Intermittent catheterization is the best method of bladder management since most of the UTI's were found in patients with indwelling catheters. ASIA D spontaneously voiding patients were the ones with fewer infections. Asymptomatic bacteriúrias should not be treated since we observed a weekly change in microbiological studies of 47% without any therapeutic intervention The small number of UTI's, compared to other SCI Rehabilitation Units, may be due to the strictly fulfilment of the hospital infection preventive program. Moreover, the care given to prompt identification and surveilla...

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Female hypospadias with vaginal stones: A rare congenital anomaly

Journal of Pediatric Urology — Mon, 27 Apr 2009 00:00:00 +0100

Conclusions: Vaginal voiding leads to urinary stagnation in the vagina causing urinary pseudo-incontinence and vaginal stones. Early diagnosis requires a high index of suspicion. (Source: Journal of Pediatric Urology)

Clinically unrecognised urinary retention as a cause of bowel obstruction: A rarely reported phenomenon

European Journal of Radiology Extra — Fri, 24 Apr 2009 16:12:21 +0100

We report two cases of mechanical intestinal obstruction due to clinically undiagnosed urinary retention. Both patients were able to micturate at the time of diagnosis, however the residual volumes of urine on catheterisation were both over 1000ml. In both instances, the diagnosis of acute urinary retention was not reached due to the co-existing features of intestinal obstruction. Further investigations showed that extrinsic intestinal compression by a dilated urinary bladder aggravated or caused intestinal obstruction. This is rarely reported in the literature. When diagnoses cannot be made in patients with uncharacteristic presenting features, radiological investigations such as water soluble enema or CT are instrumental in reaching an outcome. (Source: European Journal of Radiology Extr...

Prevention of urinary tract infection in six spinal cord-injured pregnant women who gave birth to seven children under a weekly oral cyclic antibiotic program

International Journal of Infectious Diseases — Wed, 22 Apr 2009 11:02:01 +0100

Summary: Background: Pregnancies in spinal cord-injured (SCI) patients present unique clinical challenges. Because of the neurogenic bladder and the use of intermittent catheterization, chronic bacteriuria and recurrent urinary tract infection (UTI) is common. During pregnancy the prevalence of UTI increases dramatically. Recurrent UTI requires multiple courses of antibiotics and increases the risks of abortion, prematurity, and low birth weight. A weekly oral cyclic antibiotic (WOCA) program was recently described for the prevention of UTI in SCI patients.Objective: To test the impact of WOCA in six SCI pregnant women (four paraplegic, two tetraplegic).Design: This was a prospective observational study. WOCA consists of the alternate administration of one of two antibiotics once per week....

[Review] A UK consensus on the management of the bladder in multiple sclerosis

Journal of Neurology, Neurosurgery & Psychiatry — Thu, 16 Apr 2009 04:00:00 +0100

Urethro-subcutaneous fistula and bilateral abscesses of the thighs

International Journal of Infectious Diseases — Thu, 16 Apr 2009 00:00:00 +0100

A 69-year-old Taiwanese diabetic man underwent a transurethral resection of the prostate for urinary retention that had developed 5 years previously. Localized prostate cancer was diagnosed. He then received definitive radiotherapy, which was complicated with mixed stress and urge urinary incontinence; he had a low level of serum prostate-specific antigen (PSA) at follow-up. Over the course of 2 weeks, he developed bilateral groin pain. Physical examination was unremarkable except for bilateral redness and tenderness in the area of the bilateral groin and medial thighs. Laboratory evaluation revealed a white blood cell count of 15.1×109/l. A transverse computed tomography view of the pelvis () revealed a urethro-subcutaneous fistula (arrow), which allowed urine to leak into the subcutaneo...

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Stress incontinence

Clinical Evidence — Tue, 14 Apr 2009 23:00:00 +0100

New evidence; conclusions changed for: Serotonin reuptake inhibitors (duloxetine) One systematic review updated to now include one further RCT. One subsequent RCT added, which found reduced incontinence episode frequency but no significant improvement in quality of life with duloxetine compared with placebo. Categorisation changed (Beneficial to Likely to be beneficial). Non-tension-free vaginal tape/transobturator foramen tape suburethral slings One systematic review updated. One RCT added comparing suburethral slings other than tension-free vaginal tape (TVT) versus open retropubic colposuspension, found that non-TVT suburethral autologous sling improved overall urinary incontinence and specific urinary incontinence measures at 2 years' follow-...

Can medical students achieve skills proficiency through simulation training?

American Journal of Surgery — Sun, 12 Apr 2009 23:00:00 +0100

Conclusions: Objective scores and trainee self-ratings suggest that this structured curriculum using simulator training allows junior medical students to achieve proficiency in basic surgical skills. (Source: American Journal of Surgery)

The Significance of 99mTechnetium Dimercapto-Succinic Acid Renal Scan in Children With Spina Bifida During Long-Term Followup

The Journal of Urology — Fri, 10 Apr 2009 12:11:38 +0100

Purpose: 99mTechnetium dimercapto-succinic acid renal scans are ideal for demonstrating renal scarring in children with spina bifida. However, doubt persists about the need for routine application. We assessed the associations among abnormal 99mtechnetium dimercapto-succinic acid renal scans, vesicoureteral reflux and urodynamic findings in patients with spina bifida during long-term followup.Materials and Methods: We retrospectively reviewed the records of 64 patients with spina bifida followed at our center. All patients were older than 10 years (mean 15.8, range 10 to 23). Dimercapto-succinic acid renal scans were considered abnormal with differential function of less than 40% or focal defects. Patient age, gender, previous febrile urinary tract infections, positive vesicoureteral reflu...

Benign Prostatic Obstruction and Parkinson's Disease—Should Transurethral Resection of the Prostate be Avoided?

The Journal of Urology — Fri, 10 Apr 2009 12:11:28 +0100

Conclusions: Transurethral prostate resection for benign prostatic obstruction in patients with Parkinson's disease may be successful in up to 70% and the risk of de novo urinary incontinence seems minimal. Thus, Parkinson's disease should no longer be considered a contraindication for transurethral prostate resection provided that preoperative investigations including urodynamic assessment indicate prostatic bladder outlet obstruction. (Source: The Journal of Urology)

Meatoplasty using double buccal mucosal graft technique

International Urology and Nephrology — Tue, 07 Apr 2009 05:54:57 +0100

Conclusions Our double graft technique for treatment of meatal/glanular strictures has shown promise and can be a treatment option for such strictures in adults. Content Type Journal ArticleCategory Urology - Original PaperDOI 10.1007/s11255-009-9555-8Authors Apul Goel, King George’s Medical University Lucknow IndiaAnuj Goel, University of Oxford Wellcome Trust Centre for Human Genetics Oxford UKDiwakar Dalela, King George’s Medical University Lucknow IndiaSatya N. Sankhwar, King George’s Medical University Lucknow India Journal International Urology and NephrologyOnline ISSN 1573-2584Print ISSN 0301-1623 (Source: International Urology and Nephrology)

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26. Fowler’s syndrome: Relevance of neurophysiological findings

Clinical Neurophysiology — Wed, 01 Apr 2009 04:00:00 +0100

In 1988, Fowler et al. described a syndrome in young women: an idiopathic, non-obstructive urinary retention in which electromyography (EMG) of the striated urethral sphincter revealed a striking abnormality. Until then, the etiology was felt to be psychiatric, and intermittent self-catheterization and/or biofeedback represented the only effective treatment options. (Source: Clinical Neurophysiology)

Management of Acute and Chronic Retention in Men

European Urology Supplements — Wed, 01 Apr 2009 04:00:00 +0100

Abstract: Urinary retention is complex and may present in various ways as a result of a myriad of pathologic processes. Retention is >10 times more common in men than in women, and acute urinary retention (AUR) is rare in younger men; men in their 70s are at five times more risk of AUR than men in their 40s. Most of the epidemiologic data referred to in the literature are for AUR; data for chronic urinary retention (CUR) are sparse. Management of urinary retention must begin with modifying risk factors for developing AUR by using 5α-reductase inhibitors, follow-up, and early surgical intervention for those who may benefit. Once retention occurs, delay of surgery when possible must be the aim to reduce the risk of perioperative morbidity and mortality as well as to allow the bladder to rec...

Acute urinary retention and subsequent catheterization cause lipid peroxidation and oxidative DNA damage in the bladder: preventive effect of edaravone, a free-radical scavenger

BJU International — Tue, 31 Mar 2009 04:00:00 +0100

To investigate the effect of a free-radical scavenger, edaravone, on the changes occurring with acute urinary retention (AUR) and subsequent catheterization in the rat bladder. Eight-week-old male Sprague Dawley rats were allocated to one of four groups; an AUR group that had urinary retention induced, with subsequent catheterization; two edaravone groups, given edaravone at 1 or 10 mg/kg body weight for 60 min and then the same urinary retention and subsequent catheterization; and a sham-operated control group given edaravone 10 mg/kg. Urinary retention was induced by the clamping the rat penile urethra with a small clip, making a cystostomy, and then infusing 3 mL (0.6 mL/min) of saline with an infusion pump. The obstruction was sustained for 30 min and then the bladder was allowed to dr...

Our initial experience with the technique of complete primary repair for bladder exstrophy

Journal of Pediatric Urology — Mon, 30 Mar 2009 23:00:00 +0100

Conclusion: Our early experience with this technique has been encouraging, with few major complications, a highly successful closure rate and a cosmetically normal result. (Source: Journal of Pediatric Urology)

Radical soft tissue mobilization and reconstruction (Kelly procedure) for bladder exstrophy repair in males: initial experience with nine cases

Pediatric Surgery International — Fri, 27 Mar 2009 06:53:27 +0100

Conclusion The Kelly procedure is feasible in a vast array of BE patients, but may be formidable, especially in secondary phalloplasties. It allows for complete reconfiguration and lightening of the penis, but exposes to potentially catastrophic complications, such as partial or complete penile loss. Longer follow-up is needed to assess the results in terms of continence. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-009-2356-4Authors Alfredo Berrettini, University Hospital of Padova Section of Paediatric Urology, Urology Unit, Department of Oncological and Surgical Sciences Monoblocco Ospedaliero, Via Giustiniani, 2 35100 Padua ItalyMarco Castagnetti, University Hospital of Padova Section of Paediatric Urology, Urology Unit, Department of On...

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Transurethral Sphincterotomy

The Journal of Urology — Wed, 18 Mar 2009 00:24:20 +0100

The current optimal management options for detrusor sphincter dyssynergia (DSD) include intermittent self-catheterization, transurethral sphincterotomy (TURS) to ablate the external urethral sphincter or the aforementioned urethral stent. All of these modalities have their limitations. (Source: The Journal of Urology)

External Urethral Sphincter Stent for Dyssynergia

The Journal of Urology — Wed, 18 Mar 2009 00:23:54 +0100

Transurethral resection of the external urethral sphincter or sphincterotomy has been a primary option for treating detrusor external sphincter dyssynergia (DESD) in neurologically impaired men unable to perform intermittent self-catheterization. Lowering urethral resistance at the external sphincter reduces voiding pressure, provides better emptying in some cases and may resolve vesicoureteral reflux, thereby helping preserve urinary tract function. Ross et al reported the first sphincterotomy in 10 spinal cord injured patients in 1958, and the procedure routinely required blood transfusions after using a cold punch to resect portions of the external sphincter. Electrosurgical cautery replaced the punch technique but bleeding, incomplete resection of the sphincter and erectile dysfunction...

Inadvertent insertion of a Foley’s catheter through the orifice of a duplex ureter during catheterisation for laparotomy

Gynecological Surgery — Wed, 11 Mar 2009 15:04:21 +0100

We report a case of inadvertent insertion of a 14-Fr Foley's catheter through the orifice of one branch of a previously unrecognised duplex ureter. The unintentional insertion of the catheter occurred at urethral catheterisation during laparotomy for gynaecological malignancy and lead to false intraoperative identification of the female anatomy and injury to the ureter. Postoperatively, cystoscopy and intravenous urography confirmed the existence of a duplex ureter on the affected side. Content Type Journal ArticleCategory CommunicationDOI 10.1007/s10397-009-0475-5Authors E. Papacharalabous, Royal Surrey County Hospital Department of Gynaecological Oncology Guildford UKM. Ford, Royal Surrey County Hospital Department of Gynaecological Oncology Guildford UKS. Butler-Manuel, Royal Su...

Avoidable iatrogenic complications of urethral catheterization and inadequate intern training in a tertiary-care teaching hospital

BJU International — Wed, 11 Mar 2009 04:00:00 +0100

This study identified that interns receive inadequate training on UC. Finally, most of the complications are potentially avoidable and can be prevented by adopting a proper technique of catheterization. Adequate training and supervision of medical students and interns can achieve this. (Source: BJU International)

The role of urethral dilation in managing pediatric neurogenic bladder dysfunction

Current Urology Reports — Tue, 10 Mar 2009 08:12:16 +0100

Abstract Urethral dilation is an effective method of treating children with neurogenic bladders who have poor bladder compliance, high leak point pressure, and are unresponsive to standard therapy with anticholinergic medications and clean intermittent catheterization. Urethral dilation can be successfully applied to boys and girls and has few side effects. There are no demonstrated long-term effects on continence. However, the use of urethral dilation has been limited by two factors: 1) general disregard given to urethral dilation when applied to children and adults with recurrent urinary tract infections and lower urinary tract symptoms, and 2) the general efficacy of conventional therapy that limits the number of children who may actually benefit from the procedure. C...

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Surgical treatment for female stress urinary incontinence: what is the gold-standard procedure?

International Urogynecology Journal — Sat, 07 Mar 2009 11:54:32 +0100

Abstract In the last few years, the Burch colposuspension and the fascial slings were often defined from the pages of the most relevant journals of general medicine, as gold-standard procedures for the surgical treatment of stress urinary incontinence (SUI), whereas mid-urethral slings (tension-free vaginal tape (TVT) and tension-free vaginal tape obturator) were attributed a marginal and almost experimental role in this field. This poorly reflect the current scenario of the surgical management of SUI: Recently, a number of meta-analysis have demonstrated that TVT is significantly more effective if compared to colposuspension and that it is followed by significantly lower perioperative morbidity if compared to pubovaginal slings. It is not realistic to suggest to general p...

Surgical Treatment of 31 Complex Traumatic Posterior Urethral Strictures Associated with Urethrorectal Fistulas.

European Urology — Fri, 06 Mar 2009 05:00:00 +0100

CONCLUSIONS: Surgical approaches for the treatment of URFs associated with complex urethral strictures should be based on a number of considerations including the location of the URF, its aetiology, the length of the urethral strictures, and a history of previous unsuccessful repairs. These results demonstrate that the transperineal-inferior pubic approach may be appropriate as a first-line procedure. PMID: 19282100 [PubMed - as supplied by publisher] (Source: European Urology)

Continent catheterizable vesicostomy in an adult population: Success at high costs

Neurourology and Urodynamics — Tue, 03 Mar 2009 05:00:00 +0100

To evaluate the long term outcome, to review the complication ratio and to analyze predicting factors of catheterizable continent vesicostomy in an adult population. To deduct a proper patient counseling policy.We identified all patients that underwent a continent vesicostomy between 1998 and 2008. We did not consider patients that underwent orthotopic bladder reconstruction. Patient satisfaction, urinary leakage, catheterization problems were assessed by chart review or interview. Type of primary surgery, revisions (number and type), renal function and complications were assessed by chart review.Thirty-four patients underwent continent vesicostomy using an ileal segment (Monti or Spiral-Monti/Casale technique) or the appendix (Mitrofanoff). One patient underwent a detrusor wall flap. Twen...

Experimental use of labial mucosa free graft urinary conduit in the Mitrofanoff principle

Journal of Pediatric Surgery — Sun, 01 Mar 2009 05:00:00 +0100

Conclusions: A number of investigators have extrapolated Mitrofanoff method using the ileum, the ureter, or others. The use of a tube made by labial mucosa free graft is an easily performed technique, and as with the Mitrofanoff method, continence and easy catheterization are successfully achieved. (Source: Journal of Pediatric Surgery)

Obstructive acute renal failure related to amantadine intoxication.

The American Journal of Emergency Medicine — Sun, 01 Mar 2009 05:00:00 +0100

We report the case of a 69-year-old woman with seizures and acute renal failure with hyperkalemia. She presented with bladder turgescence and hydronephrosis on admission and was diagnosed as obstructive acute renal failure. Urethral catheterization was performed after a single-session hemodialysis. It resulted in immediate improvement of renal function and consciousness, and subsequent disappearance of seizures. Improvement of serum creatinine level to 0.7 from 10.6 mg/dL was associated with a fall in blood level of amantadine hydrochloride from 4.40 to 0.47 microg/mL. Physicians should be aware of urinary retention in patients treated with amantadine as a first sign of intoxication that could lead if untreated to obstructive acute renal failure. And we recommend to check the overdose symp...

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Obstructive acute renal failure related to amantadine intoxication

The American Journal of Emergency Medicine — Sun, 01 Mar 2009 05:00:00 +0100

We report the case of a 69-year-old woman with seizures and acute renal failure with hyperkalemia. She presented with bladder turgescence and hydronephrosis on admission and was diagnosed as obstructive acute renal failure. Urethral catheterization was performed after a single-session hemodialysis. It resulted in immediate improvement of renal function and consciousness, and subsequent disappearance of seizures. Improvement of serum creatinine level to 0.7 from 10.6 mg/dL was associated with a fall in blood level of amantadine hydrochloride from 4.40 to 0.47 μg/mL. Physicians should be aware of urinary retention in patients treated with amantadine as a first sign of intoxication that could lead if untreated to obstructive acute renal failure. And we recommend to check the overdose symptom...

Combined Pelvic Reconstructive Surgery and Transobturator Tape (Monarc) in Women with Advanced Prolapse and Urodynamic Stress Incontinence: A Case Control Series

The Journal of Minimally Invasive Gynecology — Sun, 01 Mar 2009 05:00:00 +0100

Conclusion: Using separate incisions and sequencing the TOT as the last procedure, the combination surgery is safe and effective for USI and advanced pelvic prolapse. The bladder outlet obstructions caused by severe prolapse and preoperative severity of urinary incontinence seem to be a risk factor for prolonged postoperative catheterization and failure of antiincontinent procedure, respectively. Additional information on treatment of recurrent prolapse required a longer period of follow-up. (Source: The Journal of Minimally Invasive Gynecology)

Biofilm and other causes of pain in catheterization.

British Journal of Community Nursing — Sun, 01 Mar 2009 00:00:00 +0100

This article looks at the anatomy of the bladder and how sensations, including pain, are transmitted to the brain. The use of urinary catheters is discussed and initially, the development of biofilm is addressed, from its cause, structure and effect, to how it can be treated. Many of the problems arising from biofilm and the resulting encrustation, can lead to pain, and the causes of this are discussed. Other problems which can cause patients to experience pain are also considered, and where there are possible solutions, these have been put forward. However, even when good practice is carried out, there will still be problems encountered, and further research is needed. PMID: 19440176 [PubMed - in process] (Source: British Journal of Community Nursing)

Urethrocutaneous fistula: preserve the tract and turn it inside out: the PATIO repair

BJU International — Fri, 27 Feb 2009 05:00:00 +0100

To describe a novel technique for repairing penile urethrocutaneous (UC) fistula, by dissecting out the fistula tract, but instead of excising it, to preserve it and turn it inside out (PATIO); this creates a flap valve inside the urethral lumen that prevents the ingress of urine allowing the fistula to heal. Five UC fistulae in four patients (two adults and two children) were repaired using the PATIO technique over a 4-year period. The two adults had developed the UC fistula after complex salvage hypospadias repair for failed surgery as children. In addition, three UC fistulae were recurrent after failed attempts to close them using conventional techniques, including the interposition of locally sourced 'waterproofing' subcutaneous tissue and, in one child, a rotational skin flap. One chi...

Retrospective observational study of the incidence of short-term indwelling urinary catheters in elderly patients with neck of femur fractures

Geriatrics and Gerontology International — Fri, 20 Feb 2009 05:00:00 +0100

Conclusion: This study revealed a higher incidence of short-term IDC insertion ([sim]75%) in elderly patients with neck of femur fractures in comparison to general hospital admissions of 15[ndash]25%. There is a role for more effective documentation in patient notes on the reasons behind urinary IDC insertion and increased clinical vigilance in preventing unnecessary catheterizations. (Source: Geriatrics and Gerontology International)

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Epidemiology of hospital acquired urinary tract infections in a medical college hospital in Goa

Indian Journal of Urology — Wed, 18 Feb 2009 16:35:08 +0100

Conclusion:</b> High infection rate coupled with widespread isolation polyantimicrobial resistant nosocomial pathogens emphasizes the importance of meticulous surveillance of nosocomial infections in the hospital, with due attention to antibiotic prescription practices. (Source: Indian Journal of Urology)

Neonatal bladder rupture

Indian Journal of Pediatrics — Wed, 11 Feb 2009 07:14:51 +0100

Abstract Neonatal bladder rupture is rare as a complication of bladder obstruction due to abnormal anatomy or iatrogenic cause such as umbilical catheterization. The present study describes the case of a 27-day old infant with ascites due to bladder perforation secondary to bladder wall necrosis as a result of severe urinary tract infection. The baby was treated aggressively with antibiotics and underwent successful surgical repair of the perforation. Content Type Journal ArticleCategory Clinical BriefDOI 10.1007/s12098-009-0006-4Authors Hoang Tran, Danang Hospital Neonatal Unit Da Nang VietnamNgoc Nguyen, Danang Hospital Neonatal Unit Da Nang VietnamTap Nguyen, Danang Hospital General Surgery Department Da Nang Vietnam Journal Indian Journal of PediatricsOnline I...

[Botulinum toxin in nonneurogenic bladder dysfunction.]

Der Urologe. Ausg. A — Fri, 06 Feb 2009 05:00:00 +0100

Authors: Mehnert U, Schurch B Nonneurogenic overactive bladder with or without detrusor overactivity and/or incontinence is a bothersome symptom for many people. Until a few years ago, it could be treated only with anticholinergic drugs or invasive surgery. Intradetrusor injection with botulinum toxin type A is a minimally invasive alternative therapy option for patients who do not respond to or tolerate anticholinergic treatment. This literature overview summarises the relevant articles on this topic over the last 6 years and provides information on the efficacy, adverse events, currently used dosages, and injection techniques. Overall, a favourable initial efficacy has been observed starting around day 4 after injection and can last up to approximately 31 weeks. Depending on the dose...

Benign prostatic hyperplasia presenting with renal failure--what is the role for transurethral resection of the prostate (TURP)?

Ir Med J — Sun, 01 Feb 2009 00:00:00 +0100

Authors: Thomas AZ, Thomas AA, Conlon P, Hickey D, Little DM The aim of the study was to determine the role of transurethralresection of prostate (TURP) in normalising renal function in men presenting with obstructive renal failure secondary to benign prostatic hyperplasia. We reviewed the cases of 14 men who presented in the last 5 years with renal impairment associated with symptoms of bladder outflow obstruction and radiological evidence of obstructive uropathy. The mean serum creatinine at presentation was 632 ng/mL (range 1299 - 225). The mean age at presentation was 68.2 years (range 50 - 83 years). Duration of symptoms prior to presentation ranged between 1 - 118 months (mean 21.5 months). Following catheter insertion, all patients underwent TURP. Six of the 14 patients required...

[Urinary diversions : Which one one is right for which patient?]

Der Urologe. Ausg. A — Sun, 25 Jan 2009 05:00:00 +0100

Authors: Bader P, Westermann D, Frohneberg D Standardized operating techniques and surgeons' experiences have contributed to the development of complex urinary diversion systems over the last two decades. Patients' desires and comorbidity risks, such as kidney or bowel dysfunction, as well as their mental and manual abilities need to be taken into account. Careful preoperative decision making is essential if patients are to accept the chosen urinary diversion system and improve their quality of life.Ileal and ileocecal orthotopic neobladders have proven to be effective and comfortable for long-time use, thus stimulating decisions for orthotopic bladder substitution despite the risk of incontinence episodes, especially during the night. Catheterization of continent reservoirs connected ...

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Clinical pathway for tension-free vaginal mesh procedure: Evaluation in 300 patients with pelvic organ prolapse

International Journal of Urology — Thu, 22 Jan 2009 05:00:00 +0100

Conclusions: Patients generally accepted the pathway of discharge on postoperative day 3 in spite of the Japanese culture preferring a longer hospital stay. (Source: International Journal of Urology)

Hematocolpos causing severe urinary retention in an adolescent girl with imperforate hymen: an uncommon presentation

Archives of Gynecology and Obstetrics — Fri, 16 Jan 2009 12:46:55 +0100

Conclusion In case of acute severe urinary retention in an adolescent girl, the clinicians should keep in mind that imperforate hymen may be a causative factor and this condition may easily be treated surgically. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00404-009-0931-5Authors Adam Gyimadu, Hacettepe University Faculty of Medicine Department of Obstetrics and Gynecology Sihhiye Ankara TurkeyBerkan Sayal, Hacettepe University Faculty of Medicine Department of Obstetrics and Gynecology Sihhiye Ankara TurkeySuleyman Guven, Karadeniz Technical University Faculty of Medicine Department of Obstetrics and Gynecology Trabzon TurkeyG. Serdar Gunalp, Hacettepe University Faculty of Medicine Department of Obstetrics and Gynecology Sihhiye Ankara Turkey ...

[Prescribe clean intermittent self-catheterization.]

Presse Medicale — Fri, 16 Jan 2009 05:00:00 +0100

Authors: Bonniaud V, Leroy J, Kleinclauss F, Look PY, Bévalot J, Parratte B Clean intermittent self-catheterization is the recommended mode of voiding in patients with urinary retention. CISC is a non-sterile catheterization, done by the patient himself to insure complete emptying of the bladder several times per day. Its prescription rests on well-established recommendations with a sufficient frequency of self-catheterization (minimum 4), collected volumes less than 400 mL and a diuresis higher than 1.5 L. Clean intermittent self-catheterization allows a reduction in complications of infection, protects the upper urinary tract and provides urinary continence for the patient. Asymptomatic bacteriuria is very frequent in patients treated with intermittent catheterization and does n...

Acquired nonobstructive urinary bladder diverticulum: a case report

BioMed Central — Fri, 09 Jan 2009 05:00:00 +0100

Conclusion: Ultrasonographic examination of the urinary bladder is necessary to exclude such complication after a long-lasting catheterization as well as to maximally restrict the catheter's stay in the urinary bladder. (Source: BioMed Central)