British journal of urology
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A total of 86 consecutive patients who presented to the accident and emergency department with acute urinary retention due to prostatomegaly required catheterisation; 56 received suprapubic catheters and 30 were catheterised urethrally. Both groups were followed up for 3 years. Of the 30 patients catheterised urethrally, 12 (40%) developed urinary tract infections compared with 10 (18%) urinary tract infections in the 56 patients catheterised suprapubically. ⋯ None of the patients with suprapubic catheters developed these complications. Furthermore, 16 patients catheterised suprapubically underwent successful trial clamping of their catheter, whereas 7 patients required recatheterisation following removal of their urethral catheters. We recommend that the use of suprapubic catheters should become the preferred initial treatment for acute urinary retention.
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An increased long-term morbidity rate after transurethral compared with open prostatectomy has recently been claimed on the basis of retrospective studies of operations done up to 20 years ago. These studies have led to a demand for a prospective trial. Most reports show that peri-operative mortality following prostatectomy is virtually confined to unfit men over 80 years old. ⋯ There were no additional deaths in the first 12 months following surgery. Few of these patients would have been considered fit to undergo an open prostatectomy. Any proposed randomised trial would have to exclude such high risk patients until it can be shown that open prostatectomy is equally safe.
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The value of ultrasound in testicular trauma with haematocele has been questioned inasmuch as the injured testis should always be explored surgically. Ultrasonography, however, plays an important role in the diagnosis and follow-up of patients with blunt scrotal trauma without haematocele. ⋯ Seven patients presented with changes in the testicular or epididymal morphology at palpation and in 1 case the testes were not palpable. Ultrasonography was of great value, indicating surgery in 6 of these patients where physical examination alone was not sufficient to establish the need for surgical exploration.
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Penile strangulation is a rare injury that requires urgent management. Non-metallic, thin objects are easy to remove but can cause severe injury. ⋯ Penile ulceration and oedema in children may well indicate the presence of a strangulation object. We describe a new hammer and chisel method for removing such objects.
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Twelve patients with fracture of the penis have been treated in this department during the last 18 years. Their mean age was 41.5 years (range 25-55) and two-thirds of the injuries resulted from coitus. ⋯ One patient was treated conservatively and remains impotent. Immediate surgical treatment is recommended, since it avoids the formation of penile plaque, penile fibrosis and angulation and accelerates restoration of normal penile function.