Transvaginal urethrolysis for urethral obstruction after anti-incontinence surgery

PURPOSE: Urethral obstruction following a stress incontinence procedure occurs in 5 to 20% of patients. We examine the success of transvaginal urethrolysis in resolving voiding dysfunction. MATERIALS AND METHODS: A retrospective chart review was performed on 39 patients who had undergone transvaginal urethrolysis for urethral obstruction following an anti-incontinence procedure. Preoperatively, a history was taken, and pelvic examination and either video urodynamics or cystoscopy were done. RESULTS: All 39 patients complained of urge incontinence, 13% had urinary retention, 51% had incomplete bladder emptying and 36% voided to completion but had irritative voiding symptoms. Previous surgery included retropubic urethropexy in 41% of the cases, pubovaginal sling in 38% and bladder neck suspension in 21%. Mean length of followup after urethrolysis was 16 months. Of the 39 patients 33 (85%) had resolution of urge incontinence but 5 still required occasional intermittent catheterization. The remaining 6 patients had continued urge incontinence. An augmentation procedure was performed in 4 patients with improvement of symptoms. CONCLUSIONS: Our data support transvaginal urethrolysis for the treatment of iatrogenic urethral obstruction. It is a rapid, effective and minimally invasive technique that should be considered if voiding dysfunction does not resolve spontaneously.     

Congenital posterior urethral obstruction: the historical perspective

The currently accepted interpretation of urethral anatomy and pathology in boys is based on studies from the first half of this century, most notably from Hugh Hampton Young and his colleagues. The studies that led to Young's conclusions and the developments in the management allow for reinterpretation, particularly with the advent of prenatal diagnosis and video-endoscopic recording technology.     

Placement technique of a permanent urethral endoprosthesis

By taking into account the properties of this stent, which must eventually become completely epithelialized, it is important to clearly define its length so that its proximal and distal ends lie in healthy mucosa and the stricture must be dilated to allow maximum expansion of the stent. On the other hand, due to the severity of periurethral fibrosis, which can advance through the stent, this solution is contraindicated in the case of posttraumatic stricture or recurrence after urethroplasty. Apart from these contraindications, this is a rapid, sophisticated and effective procedure for which the current data of the literature are convincing.     

The use of urethral stents for the treatment of urethral strictures

Three types of urethral stents can be used in the treatment of recurrent strictures: Urolume/Wallstent is a self-expanding mesh which is incorporated into the urethral epithelium; the ASI Titanium stent is a short rigid mesh of Titanium wire which is also incorporated into the urethra; Nitinol is a flexible spring in one or two parts connected by a steel wire. It remains endoluminal. The Urolume/Wallstent has been used since 1987. It is indicated in iatrogenic strictures. No statistical results are presented. The ASI stent should be reserved for strictures of the prostatic and posterior urethra. The Niticol UroCoil system can be used at all levels of the urethra; two models are available: simple or twin. The author has inserted 65 stents in 56 patients. The stent was removed after one year in 41 patients. The use of these stents has considerably decreased the number of repeated dilatations and urethrotomies.     

Concentration of ionized calcium in plasma from cats with urethral obstruction

OBJECTIVE: To measure ionized calcium concentration in plasma from cats with urethral obstruction and to correlate these values with results of clinical biochemical analyses and physical examinations. DESIGN: Prospective study. ANIMALS: 24 male cats. PROCEDURE: Blood samples were obtained from each cat on admission, and PCV, pH, and concentrations of ionized calcium, total calcium, glucose, total solids, sodium, potassium, BUN, creatinine, chloride, magnesium, albumin, and phosphorus were determined. Mentation, tissue perfusion, and ECG recordings were also assessed. RESULTS: 18 (75%) cats had low ionized calcium concentrations (reference range, 2.4 to 2.8 mEq/L). Hypocalcemia was considered mild (2.0 to 2.36 mEq/L) in 9 (37.5%) cats, moderate (1.6 to 1.98 mEq/L) in 6 (25%), and severe (< 1.6 mEq/L) in 3 (12.5%). Significant positive correlations were found between ionized calcium concentration and heart rate, pH, and concentrations of sodium, chloride, and total calcium. Significant negative correlations were found between ionized calcium concentration and concentrations of potassium, BUN, creatinine, and phosphorus. CLINICAL IMPLICATIONS: Most cats with urethral obstruction had a low concentration of ionized calcium. This may contribute to cardiac electrical and mechanical dysfunction in some severely affected cats. Although effects of i.v. administration of calcium were not evaluated, results of this study strengthen the rationale for its use in cats with urethral obstruction.     

A simplified percutaneous hepatogastric drainage technique for malignant biliary obstruction

We describe a technique to bypass a malignant biliary obstruction by creating a direct connection between the left biliary tree and the stomach. First, adherence between the left liver parenchyma and the stomach is achieved by a Cope anchor system. Then, the left biliary tree and stomach are connected by Colapinto needle puncture of the stomach from a left biliary duct with the needle inserted through a 9 Fr transhepatic sheath. Over a stiff guidewire, a Ring drainage catheter is placed. Later, the Ring catheter is replaced by a metallic stent. Four patients with malignant biliary obstruction underwent this procedure. The mean survival time was 77 days with maximum follow-up of 171 days. Neither obstruction nor dislocation of the metallic stents occurred.     

Comparison of passive urethral resistance relation and urethral resistance factor in analysis of bladder outlet obstruction in patients with benign prostatic enlargement

Analysis of the pressure/flow relation renders objective and detailed information on bladder outlet obstruction. The benefit of pressure/flow analysis for clinical and fundamental research questions, however, cannot be acknowledged without comparison of the different methods that exist. We compared one parameter analysis (URA) with two parameter (PURR) analysis in 99 consecutive patients with benign prostatic enlargement. The normal (instantaneous intrapatient) variability of both the PURR parameter Pvoidmin (minimal pressure during voiding) and the URA is approximately 10-15 cm H2O. Within these limits agreement between the two methods of analysis in the quantification of (minimal) outlet obstruction was observed in about 50% of the cases. However, when Qmax is less than 6 ml/s (in 49.5% of the patients) the URA number exceeds the value Pvoidmin in 96% of the cases. Predominantly this is caused by the fact that in the majority of these cases the type of bladder outlet obstruction is more constrictive than the URA curve, based on Pdet at Qmax indicated. In patients with a low flow rate and/or a constrictive type of obstruction, the Pvoidmin resulting from PURR analysis indicates a lower minimal pressure during voiding compared to URA.     

The urethral closure pressure profile. A new technique using gas and simultaneous EMG-recording from the urethra

A new technique for recording of the urethral closure pressure profile using gas-inflation and simultaneous EMG-recording from the urethra is described. With the present technique, the parameters of the urethral closure pressure profile in healthy volunteers were in accordance with previous reports using water-infusion. The effect of alpha-adrenergic blockade on the pressure profile was studied in a series of patients. Half of the patients showed a marked reduction of the intraurethral pressure in the presphincteric part of the profile after alpha-adrenergic blockade. This indicated that sympathetic innervated smooth musculature gives a significant contribution to the total intraurethral pressure.     

The choice of radical operative technique in the surgery for tumor-related obstruction of the left half of the colon

The results of examination and surgical treatment of obturation ileus in 370 patients with the stenosing tumor of the left half of colon were analyzed. The primarily-radical operation conduction, forming decompressional colostomy without simultaneous restoration of intestinal continuity, permits to achieve the best immediate results.     

Effect of experimentally induced urethral obstruction and surgical decompression in utero on renal development and function in rabbits

To investigate the effect of urethral obstruction during late fetal life on renal development and function, we developed a rabbit fetal model of obstructive nephropathy to examine the pathological and biochemical consequences of urethral obstruction and beneficial effects of early surgical decompression. Animals were divided into four groups, i.e., obstructed, early decompressed, late decompressed, and control. Fetal renal development was evaluated by histological examination and counting the number of glomeruli in the four groups. The number of renal glomeruli correlated with gestational age in the normal fetus (r = 0.90, P < 0.0001). Urethral ligation on gestational day 25 (full-term, 31 days) resulted in thinning of the renal cortex and significantly decreased the number of renal glomeruli. The concentration of urinary microalbumin was higher when urethral obstruction was maintained for 3 days than 1 day after urethral obstruction, although urinary beta2- microglobulin, Na, Cl, and osmotic pressure did not change during this period. Decompression of urethral obstruction 1 day after induction of urethral obstruction resulted in improvement in the severity glomerular hypoplasia compared with late decompression (P < 0.01). Our results suggest that the rabbit fetal model simulates fetal urethral obstruction in humans, and indicates that early surgical decompression may be effective in restoration of normal renal function.     

The urethral sling and stress urinary incontinence

We report the case of a 40-year-old Filippino woman, with a 5-year history of a slowly spreading, painful skin lesion on her left foot. Histological examination showed a dermal, granulomatous infiltrate consisting of neutrophils, histiocytes and lymphocytes, with "sclerotic bodies" in the cytoplasm of phagocytic cells. Mycological culture revealed the presence of Phialophora verrucosa and confirmed the histopathological diagnosis of chromo-blastomycosis. Association of surgical curettage of the exuberant, infected tissue with systemic fluconazole administration gave good therapeutic results with no relevant side effects.     

Incomplete urethral obstruction associated with dilatation of the urethra, cystitis, and pyelonephritis in a Vietnamese pot-bellied pig

A sporadic case of trilateral retinoblastoma in a male child of 20 months is described using clinical and imaging approaches. Attempts were made to find out a tumour marker by analysing human chorionic gonadotrophin (hCG), alpha-feto protein (AFP), carcinoembryonic antigen (CEA), and lactic dehydrogenase (LDH) in blood and cerebrospinal fluid (CSF). Only LDH was elevated in CSF and the rest were normal. Retinoblastoma gene could not be isolated in this patient. It is proposed that LDH in CSF should be analysed in patients with bilateral retinoblastoma who had normal brain scan initially. If LDH level in CSF is elevated, the patient should be periodically monitored by non-invasive imaging of the brain to detect intracranial tumour at an early stage.     

Counteractive self-control in overcoming temptation.

How do anticipated short-term costs affect the likelihood of engaging in an activity that has long-term benefits. Five studies investigated the factors that determine (a) how anticipated short-term costs elicit self-control efforts and (b) how self-control efforts eventually diminish the influence of short-term costs on behavior. The studies manipulated short-term costs (e.g., painful medical procedures) and assessed a variety of self-control strategies (e.g., self-imposed penalties for failure to undergo a test). The results show that short-term costs elicit self-control strategies for self rather than others, before rather than after behavior, when long-term benefits are important rather than unimportant and when the costs are moderate rather than extremely small or large. The results also show that the self-control efforts help people act according to their long-term interests. (PsycINFO Database Record (c) 2011 APA, all rights reserved)