-
Journal of Family Medicine and Primary... Sep 2020Urinary bladder is an adjacent viscus susceptible for intraoperative injury during cesarean section (CS). Prolonged labor, scarred uterus, intraabdominal adhesion,... (Review)
Review
Urinary bladder is an adjacent viscus susceptible for intraoperative injury during cesarean section (CS). Prolonged labor, scarred uterus, intraabdominal adhesion, emergency CS, advanced labor, cesarean hysterectomy etc., are the predisposing factors for bladder injury during CS. While operating on such conditions, one should be meticulous to explore the possibility of bladder injury. Family physician practicing community obstetrics should be aware of this and know how to tackle this. Usually the dome of the bladder is injured and the trigonal area remains away from the injury field by 6-10 cm. Bladder rent is repaired in two layers either by continuous simple or interrupted suture with 3-0 & 2-0 polyglycolic acid suture. Suprapubic cystostomy and transurethral catheter are kept for 10-14 days. While postoperative adhesion, CS during full dilatation of cervix, abnormal anatomy etc., may not proceed for negligence, bladder injury in normal patients and unrecognized intraoperative bladder injury may attract penalty from the consumer court.
PubMed: 33209757
DOI: 10.4103/jfmpc.jfmpc_586_20 -
World Journal of Gastroenterology Dec 2007Treatment of chronic pancreatitis has been exclusively surgical for a long time. Recently, endoscopic therapy has become widely used as a primary therapeutic option.... (Review)
Review
Treatment of chronic pancreatitis has been exclusively surgical for a long time. Recently, endoscopic therapy has become widely used as a primary therapeutic option. Initially performed for drainage of pancreatic cysts and pseudocysts, endoscopic treatments were adapted to biliary and pancreatic ducts stenosis. Pancreatic sphincterotomy which allows access to pancreatic ducts was firstly reported. Secondly, endoscopic methods of stenting, dilatation, and stones extraction of the bile ducts were applied to pancreatic ducts. Nevertheless, new improvements were necessary: failures of pancreatic stone extraction justified the development of extra-corporeal shock wave lithotripsy; dilatation of pancreatic stenosis was improved by forage with a new device; moreover endosonography allowed guidance for celiac block, gastro-cystostomy, duodeno-cystostomy and pancreatico-gastrostomy. Although endoscopic treatments are more and more frequently accepted, indications are still debated.
Topics: Dilatation; Drainage; Endoscopy, Gastrointestinal; Humans; Lithotripsy; Pancreatitis, Chronic; Sphincterotomy, Endoscopic; Stents
PubMed: 18069750
DOI: 10.3748/wjg.v13.i46.6127 -
Arab Journal of Urology Mar 2015Posterior urethroplasty is the most common strategy for the treatment of post-traumatic urethral injuries. Especially in younger patients, post-traumatic injuries are a... (Review)
Review
Posterior urethroplasty is the most common strategy for the treatment of post-traumatic urethral injuries. Especially in younger patients, post-traumatic injuries are a common reason for urethral strictures caused by road traffic accidents, with pelvic fracture or direct trauma to the perineum. In many cases early endoscopic realignment is the first attempt to restore the junction between proximal and distal urethra, but in some cases primary realignment is not possible or not enough to treat the urethral injury. In these cases suprapubic cystostomy alone and delayed repair by stricture excision and posterior urethroplasty is an alternative procedure to minimise the risk of stricture recurrence.
PubMed: 26019980
DOI: 10.1016/j.aju.2015.01.003 -
Asian Journal of Urology Jul 2018Posterior urethral injuries typically arise in the context of a pelvic fracture. Retrograde urethrography is the preferred diagnostic test in trauma patients with pelvic... (Review)
Review
Posterior urethral injuries typically arise in the context of a pelvic fracture. Retrograde urethrography is the preferred diagnostic test in trauma patients with pelvic fracture where a posterior urethral rupture is suspected. Pelvic fractures however preclude the adequate positioning of the patient on the X-ray table on admission and computed tomography scan with intravenous contrast and delayed films generally performed first. Suprapubic bladder catheter placement under ultrasound guidance should be performed whenever a posterior urethral disruption is suspected. Early diagnosis and proper acute management decrease the associated complications, such as strictures, urinary incontinence and erectile dysfunction. The correct and appropriate initial treatment of associated urethral rupture is critical to the proper healing of the injury. Placing of a suprapubic cystostomy on admission and delayed anastomotic urethroplasty after 3-6 months continues to be the gold standard of treatment. In this paper, we provide a comprehensive review of the literature with a special emphasis on the various treatments available: Open or endoscopic primary realignment, immediate or delayed urethroplasty after suprapubic cystostomy, and delayed optical urethrotomy.
PubMed: 29988844
DOI: 10.1016/j.ajur.2017.12.004 -
Journal of Indian Association of... 2022This study aimed to evaluate the outcome of perineal trauma in children and to a define protocol for their management.
AIMS
This study aimed to evaluate the outcome of perineal trauma in children and to a define protocol for their management.
METHODS
It is a retrospective study of children who presented with perineal injury between August 2012 and December 2020. The patients were classified into three groups: Group-1 included children with perineal and genitourinary injuries; Group-2 included patients with perineal and anorectal injuries; and Group-3 included patients with perineal, genitourinary, and anorectal injuries. All patients underwent primary repair. Those with full-thickness anorectal injury underwent an additional covering colostomy, while urethral disruption was initially managed by a diverting suprapubic cystostomy (SPC).
RESULTS
A total of 41 patients were studied. Impalement injury ( = 11; 27%) and sexual abuse ( = 11; 27%) were the most common mechanisms of injury. Twenty (49%) patients had anorectal injuries with 10 (24%) each of partial-thickness and full-thickness injury. There were 24 (59%) genital injuries and five (12%) urethral injuries. One patient each developed anal and vaginal stenosis, both were managed with dilatation. One patient developed a rectovaginal fistula repaired surgically at a later date.
CONCLUSION
Perineal injuries with resultant anorectal or genital damage require a careful primary survey. Following stabilization, an examination under anesthesia as a set protocol will help determine the treatment strategy. A colostomy is essential in the acute management of severe anorectal injuries to reduce local complications and preserve continence. Urethral injuries may warrant an initial diverting SPC in selected cases.
PubMed: 35261516
DOI: 10.4103/jiaps.JIAPS_322_20 -
Journal of Korean Neurosurgical Society May 2017To review recent advances in endoscopic techniques for treating intraventricular lesions via transcortical passage. Articles in PubMed published since 2000 were searched... (Review)
Review
To review recent advances in endoscopic techniques for treating intraventricular lesions via transcortical passage. Articles in PubMed published since 2000 were searched using the keywords 'endoscopy,' 'endoscopic,' and 'neuroendoscopic.' Of these articles, those describing intraventricular lesions were reviewed. Suprasellar arachnoid cysts (SACs) can be treated with ventriculo-cystostomy (VC) or ventriculo-cysto-cisternostomy (VCC). VCC showed better results compared to VC. Procedure type, fenestration size, stent placement, and aqueductal patency may affect SAC prognosis. Colloid cysts can be managed using a transforaminal approach (TA) or a transforaminal-transchoroidal approach (TTA). However, TTA may result in better exposure compared to TA. Intraventricular cysticercosis can be cured with an endoscopic procedure alone, but if pericystic inflammation and/or ependymal reaction are seen, third ventriculostomy may be recommended. Tumor biopsies have yielded successful diagnosis rates of up to 100%, but tumor location, total specimen size, endoscope type, and vigorous coagulation on the tumor surface may affect diagnostic accuracy. An ideal indication for tumor excision is a small tumor with friable consistency and little vascularity. Tumor size, composition, and vascularity may influence a complete resection. SACs and intraventricular cysticercosis can be treated successfully using endoscopic procedures. Endoscopic procedures may represent an alternative to surgical options for colloid cyst removal. Solid tumors can be safely biopsied using endoscopic techniques, but endoscopy for tumor resection still results in considerable challenges.
PubMed: 28490160
DOI: 10.3340/jkns.2017.0101.008 -
Clinics (Sao Paulo, Brazil) 2019Minimally invasive paracentetic suprapubic cystostomy is a technique that should be learned by all surgical trainees and residents. This study aimed to develop a... (Observational Study)
Observational Study
OBJECTIVES
Minimally invasive paracentetic suprapubic cystostomy is a technique that should be learned by all surgical trainees and residents. This study aimed to develop a self-made training model for paracentetic suprapubic cystostomy and placement of the suprapubic catheter and then to evaluate its effectiveness in training fourth-year medical students.
METHODS
Medical students were divided into an experimental group receiving comprehensive training involving literature, video, and model use and a control group receiving all the same training protocols as the experimental group except without hands-on practice using the model. Each student's performance was video-recorded, followed by subjective and objective evaluations by urology experts and statistical analysis.
RESULTS
All students completed the surgical procedures successfully. The experimental group's performance scores were significantly higher than those of the control group (median final performance scores of 91.0 vs. 86.8, respectively). Excellent scores were achieved by more students in the experimental group than in the control group (55% vs. 20%), and fewer poor scores were observed in the experimental group than in the control group (5% vs. 30%).
CONCLUSIONS
Based on its cost-effectiveness, reusability, and training effectiveness, this paracentetic suprapubic cystostomy training model is able to achieve goals in teaching practice quickly and easily. Use of the model should be encouraged for training senior medical students and resident physicians who may be expected to perform emergent suprapubic catheter insertion at some time.
Topics: Cost-Benefit Analysis; Cystostomy; Education, Medical, Undergraduate; Educational Measurement; Female; Humans; Male; Models, Anatomic; Paracentesis; Program Development; Prospective Studies; Random Allocation; Simulation Training; Urinary Catheterization; Video Recording
PubMed: 30994702
DOI: 10.6061/clinics/2019/e435 -
Frontiers in Pediatrics 2019Management of partial or complete traumatic urethral disruptions of the posterior urethra in children and adolescents, secondary to pelvic fracture poses a challenge.... (Review)
Review
Management of partial or complete traumatic urethral disruptions of the posterior urethra in children and adolescents, secondary to pelvic fracture poses a challenge. Controversy exists as to the correct acute treatment of posterior urethral injuries and delayed management of PFPUDDs. We reviewed the urological literature related to the treatment of traumatic posterior urethral injuries and delayed repair of these distraction defects in children and adolescents. There are few long-term outcomes studies of patients who underwent PFPUDDs repairs in childhood; most reports included few cases with short follow up. We excluded studies in which the cohort of patients was heterogeneous in terms of stricture disease, etiology and location. Primary cystostomy and delayed urethroplasty is the traditional management for PFPUIs. Immediate repair is rarely possible to perform. Realignment of posterior urethral rupture in children is indicated in special situations: (a) concomitant bladder neck tears, (b) associated rectal lacerations, (c) long disruptions of the urethral ends. Before delayed reconstruction ascending urethrography and micturating cystourethrogram along with retrograde and antegrade urethroscopy define site and length of the urethral gap. However, the most accurate evaluation of the characteristics of the distraction defect is made when surgical exposure reveals the complexity of the ruptured urethra. Partial ruptures may be managed with urethral stenting or suprapubic cystostomy, which may result in a patent urethra or a short stricture treated by optical urethrotomy. The gold standard treatment for PFPUDDs in children is deferred excision of pelvic fibrosis and bulbo-prostatic tension-free anastomosis, provided a healthy anterior urethra is present. Timing of delayed repair is at 3 to 4 months after trauma. Some urologists prefer either the perineal access or the transpubic approach to restore urethral continuity in children with PFPUDDs. Substitution urethroplasties are used in children with PFPUDDs, when anastomotic repair can't be achieved due to severe damage of the bulbar urethra. As evidenced in this review the progressive perineo-abdominal partial transpubic anastomotic repair has advantages over the isolated perineal anastomotic approach in patients with "complex" PFPUDD. This approach provides wider exposure and facilitates reconstruction of long or complicated posterior urethral distraction defects.
PubMed: 30838189
DOI: 10.3389/fped.2019.00024 -
Archivos Espanoles de Urologia Dec 2021There are different surgical techniques for reconstruction of the urinary tract in kidney transplant. However, urinary complications are frequent in the postoperative... (Review)
Review
There are different surgical techniques for reconstruction of the urinary tract in kidney transplant. However, urinary complications are frequent in the postoperative period, being the ureter the frequent location of these complications. This results in high health care costs, increasing patient morbimortality and sometimes graft loss. For this reason, prevention, correct diagnosis and treatment are important. The aim of this review is to describe the surgical techniques most commonly used in kidney transplant for ureteroneocystostomy. To analyze the advantages and disadvantages of each of them and to compare their complications. On the other hand, we summarize the recent literature on the four most frequent urinary complications in the postoperative period after transplantation. The possible causes and treatment of urine leak, ureteri cobstruction, hematuria and vesicoureteral reflux are presented.
Topics: Cystostomy; Humans; Kidney Transplantation; Postoperative Complications; Retrospective Studies; Ureter; Urinary Tract; Vesico-Ureteral Reflux
PubMed: 34851317
DOI: No ID Found -
Scientific Reports Jul 2022Magnetic compression technique (MCT) is a popular new anastomosis method. In this paper, we aimed to explore the feasibility of use of MCT for performing cystotomy in...
Magnetic compression technique (MCT) is a popular new anastomosis method. In this paper, we aimed to explore the feasibility of use of MCT for performing cystotomy in rabbits. The parent magnets and daughter magnets for rabbit cystostomy were designed and manufactured according to the anatomical characteristics of rabbit lower urinary tract. Twelve female New Zealand rabbits were used as animal models. After anesthesia, a daughter magnet was inserted into the bladder through the urethra, and the parent magnet was placed on the body surface projection of the bladder over the abdominal wall. The two magnets automatically attract each other. Postoperatively, the state of magnets was monitored daily, and the time when the magnets fell off was recorded. Cystostomy with MCT was successfully performed in all twelve rabbits. The mean operation time was 4.46 ± 0.75 min. The magnets fell off from the abdominal wall after a mean duration of 10.08 ± 1.62 days, resulting in the formation of bladder fistula. Macroscopic and microscopic examination showed that the fistula was well formed and unobstructed. The junction between bladder and abdominal wall was tight and smooth. We provide preliminary experimental evidence of the safety and feasibility of cystostomy based on MCT.
Topics: Animals; Cystostomy; Female; Magnetic Phenomena; Magnetics; Magnets; Pressure; Rabbits
PubMed: 35842556
DOI: 10.1038/s41598-022-16595-4