-
Cureus Apr 2021An H-section steel bar that had been set against the wall fell and hit the abdomen and then both legs of a 33-year-old Chinese man. As his vital signs were stable and...
An H-section steel bar that had been set against the wall fell and hit the abdomen and then both legs of a 33-year-old Chinese man. As his vital signs were stable and his chief complaint was leg pain, he was transferred to a local medical facility. After the confirmation of gross hematuria by an indwelling a bladder catheter there, he was transported to our hospital. On arrival, his vital signs were stable. His main complaint was foot pain. He had a scabbing injury at the scrotum and bilateral foot joint deformity. Whole-body computed tomography (CT) from head to toe revealed trabecular formation in the bladder and slight fluid collection in the rectovesical pouch, as well as bilateral fracture-dislocations at the ankles. The urinary tract injury and the fluid collection in the rectovesical pouch were managed conservatively, and the lower limbs were treated tentatively. Follow-up CT on day 3 revealed multiple free air pockets in the intra-abdominal cavity, which was considered to indicate perforation of the duodenal ulcer and treated conservatively. However, he showed abdominal pain on day 7, and repeated CT revealed increased fluid in the intra-abdominal cavity. Urgent laparoscopy showed intact bowels and perforation of the bladder that was closed by suturing. He ultimately obtained a survival outcome. This is the first case of transient trabecular formation in the bladder and delayed free air due to traumatic intraperitoneal bladder rupture. This unique case adds another radiological finding to the list of documented etiologies of traumatic bladder perforation.
PubMed: 34012733
DOI: 10.7759/cureus.14520 -
Biomaterials Research Nov 2022Wound closure in the complex body environment places higher requirements on suture's mechanical and biological performance. In the scenario of frequent mechanical...
BACKGROUND
Wound closure in the complex body environment places higher requirements on suture's mechanical and biological performance. In the scenario of frequent mechanical gastric motility and extremely low pH, single functional sutures have limitations in dealing with stomach bleeding trauma where the normal healing will get deteriorated in acid. It necessitates to advance suture, which can regulate wounds, resist acid and intelligently sense stomach pH.
METHODS
Based on fish swim bladder, a double-stranded drug-loaded suture was fabricated. Its cytotoxicity, histocompatibility, mechanical properties, acid resistance and multiple functions were verified. Also, suture's performance suturing gastric wounds and Achilles tendon was verified in an in vivo model.
RESULTS
By investigating the swim bladder's multi-scale structure, the aligned tough collagen fibrous membrane can resist high hydrostatic pressure. We report that the multi-functional sutures on the twisted and aligned collagen fibers have acid resistance and low tissue reaction. Working with an implantable "capsule robot", the smart suture can inhibit gastric acid secretion, curb the prolonged stomach bleeding and monitor real-time pH changes in rabbits and pigs. The suture can promote stomach healing and is strong enough to stitch the fractured Achilles tendon.
CONCLUSIONS
As a drug-loaded absorbable suture, the suture shows excellent performance and good application prospect in clinical work.
PubMed: 36348451
DOI: 10.1186/s40824-022-00306-1 -
The Pan African Medical Journal 2022While double J (DJ) stenting is common worldwide in the urological procedure, it may associate with severe and catastrophic complications. Penetration of the jejunum and... (Review)
Review
While double J (DJ) stenting is common worldwide in the urological procedure, it may associate with severe and catastrophic complications. Penetration of the jejunum and upward migration of double J (DJ) stents during cystoscopic DJ stent procedure are rare complications with few reported cases in the literature. We present a 65-year-old male presented with acute renal failure and peritonitis one week after failed cystoscopic removal of DJ stents. Radiographic investigations showed upward migration of the right DJ stent and a total displacement of the left DJ stent to the peritoneal cavity with peritonitis, bladder perforation, and jejunal injuries. The right DJ stent was removed via the ureteroscopic procedure. Then, open abdominal surgery was performed to remove the left DJ stent and repair the injured bladder wall and jejunal segment. In conclusion, synchronous upward DJ stent migration and peritoneal DJ stent malposition with jejunal and bladder injuries are rare and severe complications of the cystoscopic DJ stent procedure. The treatment should be performed depending on the time of diagnosis, nature of the injury, and general clinical conditions of the patient.
Topics: Aged; Humans; Intestinal Perforation; Male; Peritonitis; Stents; Ureter; Ureteroscopy; Urinary Bladder
PubMed: 35949457
DOI: 10.11604/pamj.2022.42.56.33727 -
International Journal of Critical... 2019Bladder necrosis and perforation is a rare and life-threatening medical emergency. Risk factors include trauma, malignancy, previous surgery and/or radiation therapy and...
Bladder necrosis and perforation is a rare and life-threatening medical emergency. Risk factors include trauma, malignancy, previous surgery and/or radiation therapy and diabetes mellitus. Signs, symptoms, and imaging findings are often obscure making the diagnosis difficult. Urinary tract infection is common in end-stage renal disease (ESRD) patients who have residual urine production and associated with increased complication and mortality rates. We describe the case of a 57-year-old female with a medical history of recurrent cystitis, type 2 diabetes mellitus and ESRD on hemodialysis that was admitted for septic shock and presumed ischemic colitis. Urine and blood microbiology studies were notable for . By the second day of hospital admission, her clinical condition significantly deteriorated and was later found to have bladder necrosis and rupture during laparotomy for suspected peritonitis. It is important that clinicians recognize bladder rupture as a potential complication of recurrent bacterial cystitis in ESRD patients on dialysis.
PubMed: 31334054
DOI: 10.4103/IJCIIS.IJCIIS_72_18 -
Indian Journal of Urology : IJU :... 2022The presence of urgency urinary incontinence (U/UUI) after sling surgery is a common reason for dissatisfaction and imposition on quality of life. We aimed to evaluate... (Review)
Review
The presence of urgency urinary incontinence (U/UUI) after sling surgery is a common reason for dissatisfaction and imposition on quality of life. We aimed to evaluate and analyze the pathophysiology, evaluation, and treatment of U/UUI after sling surgery. A MEDLINE review was performed for relevant, English-language articles relating to storage and emptying symptoms after sling surgery. U/UUI may persist, be improved, or worsen in women with preoperative mixed urinary incontinence and may appear de novo in those women originally presenting with pure stress urinary incontinence (SUI). While the exact mechanism is not clear, partial bladder outlet obstruction (BOO) should always be suspected, especially in those women with worsened or symptoms soon after sling surgery. Initial workup should elucidate the temporality, quality, and bother associated with symptoms and to evaluate the woman for urinary tract infection (UTI), pelvic organ prolapse (POP), or perforation of the lower urinary tract. The utility of urodynamics in attaining a definitive diagnosis of BOO is inconclusive. Treatment options include reevaluation of the patient after sling incision or after addressing UTI, POP, and perforation of the bladder or urethra. Women also typically undergo a multitiered approach to storage lower urinary tract symptoms outlined in the American Urological Association/Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction Overactive Bladder Guidelines. While improvement is typically seen with multimodality treatment, all women should be counseled regarding need for additional treatment for U/UUI, BOO, and SUI in the future.
PubMed: 36568453
DOI: 10.4103/iju.iju_147_22 -
Clinics and Practice Sep 2011Intraperitoneal rupture of the bladder is a rare cause of peritonitis. Intraperitoneal rupture of the bladder was diagnosed during an emergency laparotomy for suspected... (Review)
Review
Intraperitoneal rupture of the bladder is a rare cause of peritonitis. Intraperitoneal rupture of the bladder was diagnosed during an emergency laparotomy for suspected mesenteric ischemia. The patient had undergone iterative urinary catheterization after a vascular bypass. The perforation was excised and sutured and the patient was catheterized for urinary rest for 15 days. Urinary catheterization is a possible cause of intraperitoneal rupture of the bladder.
PubMed: 24765350
DOI: 10.4081/cp.2011.e109 -
Journal of Cancer Research and... Dec 2022To compare the clinical efficacy and safety of 2-micron laser and conventional trans-urethral resection of bladder tumor (TURBT) in the treatment of non-muscle-invasive... (Meta-Analysis)
Meta-Analysis
Efficacy and safety of 2-micron laser versus conventional trans-urethral resection of bladder tumor for non-muscle-invasive bladder tumor: A systematic review and meta-analysis.
AIM
To compare the clinical efficacy and safety of 2-micron laser and conventional trans-urethral resection of bladder tumor (TURBT) in the treatment of non-muscle-invasive bladder tumor (NMIBT), providing evidence-based evidence for clinical treatment.
MATERIALS AND METHODS
PubMed, Embase, Cochrane Library, CMB, CNKI, and WanFang databases were searched since their inception until December 2021 for all eligible randomized controlled trials (RCTs) related to 2-micron laser and TURBT for treating NMIBT. Two researchers independently screened the literature, extracted outcome indicators, and assessed the risk of bias according to the inclusion and exclusion criteria. Binary and continuous variables were calculated by relative risk (RR) and mean difference (MD) with 95% confidence interval (95%CI), respectively. RevMan 5.4 and Stata 15.0 software were used for all statistical analysis.
RESULTS
A total of ten RCTs involving 1,163 patients were included: 596 cases in the 2-micron laser group and 567 cases in the TURBT group. The results of the meta-analysis revealed that 2-micron laser has advantages over the TURBT in operative duration (MD = -2.94, 95% confidence interval (CI) [-8.55, 2.68], P = 0.31), operative blood loss (MD = -19.93, 95%CI [-33.26, -6.60], P = 0.003), length of hospital stay (MD = -0.94, 95%CI [-1.38, -0.50], P < 0.001), post-operative bladder irrigation time (MD = -28.60, 95%CI [-50.60, -6.59], P = 0.01), period of catheterization days (MD = -1.07, 95%CI [-1.73, -0.40], P = 0.002), obturator nerve reflex (RR = -0.06, 95%CI [0.02, 0.15], P < 0.001), bladder perforation (RR = 0.14, 95%CI [0.06, 0.35], P < 0.001), and bladder irritation (RR = 0.30, 95%CI [0.20, 0.46], P < 0.001). There was no significant difference between the two surgical methods in post-operative urethral stricture and short-term recurrence of NMIBT.
CONCLUSION
Compared with TURBT, 2-micron laser may be safer and more effective for NMIBT management. However, these conclusions need to be validated through more high-quality RCTs because of the quality limitations and publication bias of the included studies.
Topics: Humans; Urinary Bladder Neoplasms; Lasers; Urethra; Treatment Outcome; Length of Stay
PubMed: 36647947
DOI: 10.4103/jcrt.jcrt_608_22 -
Cureus Dec 2021Urinary bladder is the most common urologic organ exposed to iatrogenic injury. The bladder trauma is classified into extra-peritoneal, intra-peritoneal, or combined...
Urinary bladder is the most common urologic organ exposed to iatrogenic injury. The bladder trauma is classified into extra-peritoneal, intra-peritoneal, or combined trauma. Intra-peritoneal bladder injury is conventionally being treated with open surgical repair, mainly to explore the abdominal viscera for possible associated injuries and to insert peritoneal drain. One rare form of the iatrogenic bladder injury is catheter-related bladder injury which is very uncommon and only few cases were reported. It is mainly related to other associated medical conditions like cancer and chronic catheterization which might be causing subsequent bladder wall weakness. Therefore, it is important to collect more data about this rare type of bladder injury, particularly urethral catheterization which is one of the most common medical procedures. We present a 74-year-old male patient who developed acute kidney injury and was treated by urethral catheterization in the emergency department. The patient developed immediately severe abdominal pain. Non-contrast CT showed intra-peritoneal bladder perforation by the urethral catheter. The patient developed peritonitis and failed a trial of conservative management. Consequently, laparoscopic abdominal exploration and bladder repair was performed successfully.
PubMed: 35003952
DOI: 10.7759/cureus.20096 -
International Braz J Urol : Official... 2019The objective of bladder augmentation (BA) is to create a low-pressure reservoir with adequate capacity. Despite its benefits, the use of intestinal patches in bladder...
OBJECTIVE
The objective of bladder augmentation (BA) is to create a low-pressure reservoir with adequate capacity. Despite its benefits, the use of intestinal patches in bladder enlargement provides a high risk of developing complications and BA with demucosalised bowel represents a potential alternative. Therefore, this study evaluated urological parameters and long-term clinical follow-up of patients submitted to nonsecretory BA in a single center with 25 years of experience.
MATERIALS AND METHODS
Patients treated with BA underwent urological evaluation, which included history, physical examination and urodynamic study. The main urodynamic parameters (bladder capacity and bladder compliance) were assessed in the pre and postoperative moments, and compared by the Wilcoxon Signed Rank test. The main long-term complications were described.
RESULTS
269 patients (mean age 14±13 years, 47% male) underwent BA with the use of demucolised intestinal segments. Among the patients in the sample, 187 (69.52%) had neurogenic bladder, 68 (25.28%) had bladder exstrophy, nine had tuberculosis (3.34%), four had a posterior urethral valve (1.49%) and one with hypospadia (0.37%). After the surgical procedure, a significant increment in both urodynamic parameters was found, with a 222% increase in bladder capacity and 604% in bladder compliance (p < 0.001 in both analyzes). Mean follow-up time ranged from 2 to 358 months, with a median of 72 months (IQR 74-247). Among all patients, 5 presented spontaneous perforation.
CONCLUSION
The study showed statistically signifi cant increase in both compliance and bladder capacity after non-secretory BA, with a low rate of severe complications.
Topics: Adolescent; Adult; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Infant; Male; Middle Aged; Postoperative Period; Prospective Studies; Reproducibility of Results; Statistics, Nonparametric; Treatment Outcome; Urinary Bladder; Urinary Bladder Diseases; Urodynamics; Urologic Surgical Procedures; Young Adult
PubMed: 31184453
DOI: 10.1590/S1677-5538.IBJU.2018.0595 -
World Journal of Clinical Cases Oct 2020Spontaneous bladder rupture is relatively rare, and common causes of spontaneous bladder rupture include bladder diverticulum, neurogenic bladder dysfunction, gonorrhea...
BACKGROUND
Spontaneous bladder rupture is relatively rare, and common causes of spontaneous bladder rupture include bladder diverticulum, neurogenic bladder dysfunction, gonorrhea infection, pelvic radiotherapy, . Urinary bladder perforation caused by urinary catheterization mostly occurs during the intubation process.
CASE SUMMARY
Here, we describe an 83-year-old male who was admitted with 26 h of middle and upper abdominal pain and a history of long-term catheterization. Physical examination and computed tomography of the abdomen supported the diagnosis of diffuse peritonitis, most likely from a perforated digestive tract organ. Laparoscopic exploration revealed a possible digestive tract perforation. Finally, a perforation of approximately 5 mm in diameter was found in the bladder wall during laparotomy. After reviewing the patient's previous medical records, we found that 1 year prior the patient underwent an ultrasound examination showing that the end of the catheter was embedded into the mucosal layer of the bladder. Therefore, the bladder perforation in this patient may have been caused by the chronic compression of the urinary catheter against the bladder wall.
CONCLUSION
For patients with long-term indwelling catheters, there is a possibility of bladder perforation, which needs to be dealt with quickly.
PubMed: 33195672
DOI: 10.12998/wjcc.v8.i20.4993