Der Urologe. Ausg. A
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Der Urologe. Ausg. A · Nov 1997
Clinical Trial[Tramadol infusion for pain therapy following bladder exstrophy surgery in pediatric wards].
We investigated in 17 children (mean 7.1 years) the continuous administration of tramadol following augmentation cystoplasty or exstrophy reconstruction. Mean duration of the tramadol administration on the pediatric ward was 3.8 +/- 1.1 days (initial dosage 0.25 mg/kg/per hour, dose adjustment by the nursing staff). Mean tramadol consumption was 0.21 mg/kg/h on day 1 and was reduced to 0.08 mg/kg/per hour on day 4. ⋯ Three patients (17.6%) suffered from nausea/vomiting on 3 of 64 treatment days (4.7%). Pruritus and extreme sedation did not occur. The continuous administration of tramadol is a simple and safe procedure following major urological surgery in children.
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Der Urologe. Ausg. A · Jul 1996
Case Reports[Left-sided flank pain in coincident infrarenal aortic aneurysm and left-sided nephropathy].
Two cases illustrating the difficult differential diagnosis of left-sided pain in the coincidence of nephropathy and aortic aneurysm are described. In both cases an aortic aneurysm was discovered, although the aneurysm caused the pain in the side in only one case. In particular, older men with recently occurring side or back pain must be examined with regard to aortic aneurysm. As the classic symptoms of a ruptured aneurysm are frequently disguised, aneurysm must always be considered as a cause of left-sided pain.
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Orthotopic reconstruction to the native urethra has revolutionized urinary diversion, allowing patients to void per the urethra. This form of urinary diversion was initially performed solely in male patients after cystectomy. More recently, however, with a better understanding of the female continence mechanism, including the urethral/vaginal support mechanism, and the ability to select appropriate female candidates properly for this type of surgery, orthotopic reconstruction has become a viable option in women. ⋯ Incontinence has never been a problem. The advent of orthotopic lower urinary reconstruction in women is a major achievement in the evolution of urinary diversion. With our increasing understanding of the continence mechanism in women and with increasing evidence that the female urethra can be safely preserved after cystectomy, orthotopic lower urinary tract reconstruction by the ileal neobladder can now be offered safely not only to males, but also to female patients undergoing cystectomy, and the functional results are superb.