Urology
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A case in which sonography demonstrated that calculi may arise in female urethral diverticula is presented. The diagnosis of female urethral diverticula is reviewed.
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Injury to the rectum is a potentially serious complication of pelvic surgery. The management of rectal injury is controversial. We present a technique of using flaps of endopelvic fascia to reinforce the repair and isolate the injury site. We have utilized this approach in 4 men undergoing retropubic prostatectomy without complications.
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Several modes of urinary tract drainage exist for the spinal cord-injured (SCI) patient, but the use of an indwelling catheter is discouraged. We retrospectively reviewed the charts of our traumatic SCI patients followed twenty years or more since initial injury to compare urinary tract preservation and the incidence of urologic complications in patients with neurogenic bladders voiding spontaneously with those using long-term indwelling catheters. Eighty-one patients with long-term injuries were identified; 73 of them fit the study criteria. ⋯ Three of the 6 patients had indwelling catheters: in 1 patient TCC developed, in 1 adenocarcinoma, and in 1 squamous cell carcinoma. In 1 patient TCC developed in a defunctionalized bladder after ileal conduit formation. Based on this study, we can conclude that in select groups of SCI patients, the choice of an indwelling catheter may be made if other methods fail, provided patients undergo regular upper urinary tract imaging and cystoscopy.
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As with all surgical procedures, prevention and proper patient selection is the key to avoid complications. High-risk patients should be clearly identified from the outset. Properly maintained equipment, along with a thorough working knowledge of all instrumentation is essential. ⋯ A survey by Phillips et al. found the complication rate for physicians who had performed fewer than 100 laparoscopic procedures to be almost four times greater than surgeons with more experience. A survey of eight centers active in urologic laparoscopic surgery reported that 10-20 pelvic lymph node dissections were necessary before they felt comfortable and 25-50 cases before they were proficient with the procedure. Since the learning curve with laparoscopy is initially quite steep, urologists beginning to apply the technique should work closely with experienced laparoscopic surgeons.
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A total of 103 patients with pelvic fracture due to blunt trauma were evaluated by cystography and 10 cases of bladder rupture were identified. Risk factors associated with the likelihood of bladder rupture included gross hematuria, the number of fractured pubic rami, tachycardia, hypotension, and declining hematocrit. We conclude that since 90 percent of the patients do not have bladder rupture when a pelvic fracture is encountered, cystography may be safely reserved for those patients with pelvic fracture who are considered to be at high risk for such an injury.