Treatment of contracted bladder from ketamine abuse with sigmoid cystoplasty / 中华泌尿外科杂志

Objective To discuss the surgical treatment of contracted bladder caused by ketamine abuse. Methods Twenty-five ketamine male abusers were included in this study.The ages were from 19 to 28 years old and mean age was 24 years old.AIl of them had abused ketamine history for 0.7 tO 4.0 years,and presented with severe lower urinary tract symptoms.including severe frequency,urgency,urge incontinence,and painful haematuria.Urine cultures were negative.Hepatic function and renal function were normal.B ultrasound examination of 23 cases demonstrated the presence of bilateral hydronephrosis,the separation of renal pelvic was(1.8±0.7)cm.B ultrasound examination of 22 cases demonstrated residual urine was 45-1 50 ml,mean 80 m1.Twenty-three IVU investigations demonstrated the presence of bilateral hydronephrosis with calyces renales minores cycloidal expansion and bladder contraction.All the patients took the urodynamies with bladder capacity was (89±34)ml,end filling detrusor pressure was(48±26)cm H2O,Qmax was(7.8±2.3)ml/s,residual urine volume was(82±47)m1.All patients had cystoscopies and random biopsies performed showed ulcerative cystitis only.All patients were required to withdraw the narcotics and the experimental medicines were given without symptoms alleviated.Sigmoid cystoplasty was performed in all the 25 patients. Results The mean follow up was 18 months(rang 6 to 36).Compared with that before operation, bladder capacity increased to (375 ±53)ml, end filling detrusor pressure reduced to( 13 ±9)cm H2O, Qmax increased to(17.6±5.8)ml/s, residual urine volume reduced to(20±10)ml.Compared with the preoperative, there were statistically significant differences.There was no complained of urinary incontinence, enuresis, frequency, urgency.Urine routine examination was normal.IVU showed the vesicoureteral reflux disappeared in all patients, and calyces renales no expansion or calyces renales minores light degree expansion.B ultrasound examination that the separation of renal collecting was(1.0 ±0.5)cm. Conclusions Sigmoidcystoplasty could increase bladder capacity and compliance, lower the intravesieal pressure.It could improve the patients' quality of life.

Dysfunctional Contracted Bladder in Renal Transplantation / 대한이식학회지

PURPOSE: This report presents our experience of the renal transplatation of a long term dysfunctional contracted bladder and its outcome. METHODS: Between March 1996 and May 2006, 425 cases of renal transplantation were performed in our medical center. We found 14 chronic renal failure patients having dysfunctional contracted bladder (DFCB) that was diagnosed through the preoperative voiding cystourethrogram. DFCB was defined as the maximal urinary bladder volume less than 100 mL. No surgical or medical preparation was done before and after renal transplantation. In 8 out of 14 cases, extravesical ureteroneocytostomy (EVUC) was conducted and the Lich's EVUC was done for the other 6 cases. Double J ureteral stent was not employed in any cases. RESULTS: The mean age of the recipients was 41.4 years. The mean capacity of these bladder was 72.1 mL (range 20 to 100 mL). Of the 14 cases, thirteen had living donor related transplantation and one received cadaveric kidney. Postoperative complication was occurred in one case, which was bleeding. There was no evidance of urinary tract complication. All patient excluding of one patient who had the episodesof chronic rejection were stable throughout the entire follow up period. CONCLUSION: DFCB in renal translpantation had no adverse effect on successful outcome in transplant operation deposite no preoperative preparation, especially cadaveric donor transplatation, it may, however, need a delicate surgical skills to perform EVUC.

Stented Ureteroureterostomy during a Living Donor Renal Transplantation in a Patient with Long-term Defunctionalized, Contracted Bladder: A Case Report / 대한이식학회지

Urinary reconstruction in a renal transplant recipient with a small contracted, long-term defunctionalized urinary bladder has been a major technical challenge because of high incidence of postoperative ureteral reflux, obstruction and urinary leakage. Several techniques (such as pre-operative augmentation cystoplasty, hydrostatic bladder dilatation, or urinary diversion) have been introduced to combat difficulties in these transplant recipients. However, these procedures were too complex or much complicated to reproduce good outcome. Herein, we report a case of successful stented ureteroureterostomy for urinary reconstruction in a recipient having a severely contracted bladder of less than 30 cc of capacity. Furthermore, postoperative cystographic and urodynamic evidence of successful restoration of bladder function is addressed.

Is Pretransplant Bladder Augmentation Using Hydrostatic Pressure of Contracted Bladder in Chronic Renal Failure Really Effective? / 대한이식학회지

PURPOSE: Kidney transplantation is definite treatment in chronic renal failure (CRF). But CRF patients have contracted bladder due to disuse atrophy and fibrosis of bladder mucosa and muscle. Contracted bladder results in CRF itself and failure of transplantation. And this causes many difficulties in ureteroneocystostomy. So many authors suggest that preoperative bladder augmentations of contracted bladder (cystoplasty) using intestine increase success rate in kidney transplantation. But these methods have been usually studied in pediatric transplantation. Preoperative hydrostatic bladder dilatation is nonoperative treatment usually used in interstitial cystitis and hemorrhagic bladder tumor. METHODS: Since January 1996, we newly attempted pretransplant bladder augmentation using hydrostatic pressure in 22 CRF patients who had contracted bladder diagnosed through preoperative voiding cystourethrogram (VCUG). RESULTS: Pre-augmented average bladder volume was 87.7 mL (60~100 mL) and post-augmented bladder volume was 210.5 mL (100~250 mL). There was no complication associated with pretransplant bladder augmentation itself, and there was no transplanted kidney loss. CONCLUSION: These results suggest that pretransplant bladder augmentation using hydrostatic pressure be useful in kidney transplantation of CRF patient who had contracted bladder.

The Long Term Results of Augmentation Cystoplasty in Contracted Bladder / 대한비뇨기과학회지

PURPOSE: In contracted bladder of various etiologies, if many of conservative managements fail, a surgical treatment seems to be the only therapeutic approach. We tried to evaluate the long term results of aug mentation cystoplasty including the postoperative complication and the degree of satisfaction in patients. MATERIALS AND METHODS: From 1989 to 1988, augmentation cystoplasties had been performed in 11 patients with contracted bladder of various etiologies. We reviewed the patients' medical records including the result of urodynamic examinations, retrospectively. Postoperative follow-up periods were 9 to 114months (mean:61months). Patients were interviewed by telephone. RESULTS: Urinary frequency, nocturia, dysuria and suprapubic pain were improved in all patients, but dysuria persisted in one patient with tuberculous cystitis. Clean intermittent catheterization (CIC) was done in there of 11 patients due to large volume of residual urine. The volume of residual urine was 200-300ml in one with hyperreflexic neurogenic bladder, and 100-200ml in two with interstitial cystitis. Self voiding was possible in 8 patients with residual urine volume less than 90ml. Almost all patients were very satisfied symptomatically in the telephone survey. There were no significant complications which required surgical revision. CONCLUSIONS: It is concluded that augmentation cystoplasty could be an excellent method of treatment for selective patients with contracted bladder, who have not improved symtomatically by medication or conservative management.

Augmentation Cystoplasty with Mainz Pouch in Tuberculous Contracted Bladder / 대한비뇨기과학회지

A variety of surgical techniques for augmentation cystoplasty have been developed. To evaluate the clinical availability of the augmentation cystoplasty using the Mainz pouch, We reviewed 8 patients with tuberculous contracted bladder who underwent construction of a Mainz pouch. Preoperative frequency was dramatically improved in all of 8 patients. Mean bladder capacity increased from 36 ml preoperatively to 534ml postoperatively. On the uroradiologic study, preoperative hydronephrosis was improved or stable in 9 of l0 renal units and was aggravated in 1 renal unit. Preoperative vesicoureteral reflux disappeared in all of 3 patients. Urodynamic study revealed mean residual urine of 70ml and maximal intravesical pressure during contraction of 65cmH2O after cystoplasty. There were no significant complications which required surgical revision.

Early experience of gastrocystoplasty for tuberculous contracted bladder / 대한비뇨기과학회지

Recently the stomach has been used with increasing frequency as an alternative to other bowel segments for auementing the bladder. The proposed advantages include decreased mucus production, reduced urinary infection due to an acid milieu, decreased metabolic abnormalities secondary to chloride excretion, and potential availability in patients with limited bowel length. The wedge gastrocystoplasty was performed in three patients of tuberculous contracted bladder, 2 females and 1 male, aged 22,51 and 57 years. On the excretory urogram, postoperative hydronephrosis was slightly improved as compared with preoperative one. Voiding cystogram showed no vesicoureteral reflux with reasonable capacity in all patients. Urgency, frequency, incontinence and voiding difficulty disappeared within 1 month postoperatively. When postoperative urodynamic studies were compared with the preoperative evaluation, it was noted that overall capacity was increased to an average of 235% (range 91 to 460%) at 2 months after surgery. Compliance has also improved dramatically after surgery. Three patients have been followed for at least 5 months, with the longest followup being 9 months. All patients reveal normal voiding patterns without gastric or urinary complications. We believe that a gastric segment is a suitable alternative to an intestinal segment especially in azotemic patient for reconstructine the urinary bladder. But the longterm effects of gastric augmentation remains to be determined.

Functional Analysis of Anti-Refluxing Augmentation Cystoplasty / 대한비뇨기과학회지

Augmentation cystoplasty using bowel is effective method for the functional enlargement of bladder capacity in contracted bladder due to various causes. Prevention of vesicoureteral reflux after augmentation cystoplasty is still controversial but generally accepted that prevention of reflux is essential for good long term result. Therefore, antireflux augmentation cystoplasty including the use of ileocecal valve and hemi-Kock intussuscepted ileal nipple valve has been used recently for this purpose. Herein, we report the result of 3 cases of ileocecal cystoplasty and 6 cases of hemi-Kock ileocystoplasty. Hemi-Kock ileocystoplasty is better than ileocecal cystoplasty in a viewpoint of reflux prevention and continence, but complication is more common and serious in hemi-Kock ileocystoplasty than ileocecal cystoplasty. It is considered that azotemia is not contraindication for these procedures, and renal function deterioration has not been observed postoperatively.

Surgical Management of Contracted Bladder Due to Tuberculosis / 대한비뇨기과학회지

Thirteen patients with contracted bladder due to tuberculosis who underwent surgical intervention were evaluated The most common agonizing symptom was frequency. Surgical management included augmentation cystoplasty in 8 patients and urinary diversion in 5 patients. In augmentation cystoplasty, the overall success rate of 87.5 % has been achieved in view of relief of symptom, improvement of bladder capacity and preservation of renal function. For the success of augmentation cystoplasty, creatinine clearance higher than 30 ml/min., no abnormality in selected intestinal segment, absence of uninhibited detrusor contraction or detrusor-sphincter-dyssynergia and no bladder outlet obstruction are inevitable. As an alternative, urinary diversion should be considered only in cases of severely deteriorated renal function, severely decreased bladder capacity, bladder outlet obstruction, neurogenic bladder and inapplicability of augmentation cystoplasty.

Complications of Ureteroileal Conduit: Review of 88 Cases / 대한비뇨기과학회지

Review of complications was made on 88 cases of the ileal conduit admitted to Dept. of Urology during the period of 13 years from August 1, 1970 through March 31, 1982. 1. There were 70 males and 18 females (ratio of 4:1) ranged in age from 7 to 72 years with peak incidence in the 6th decade. 2. The most common indication of this procedure was bladder tumor and other indication were renal tuberculosis with contracted bladder, neurogenic bladder, urethral rupture and urethral tumor. 3. 64% of patients with abnormal renal function preoperatively had some improvement postoperatively. 4. Operative mortality was 6.8%. The late mortality was 28%. The operative death rate in benign disease was 6.9% and the late death rate was 3.6%. The operative death rate in malignant disease was 6.9% and the late death rate was 42%. 5. Early complication rate in the benign disease was 17.2% and the late complication was 28.8%. Early complications included wound infection and dehiscence. diarrhea, prolonged ileus. and parastromal dermatitis. The late complications included intestinal obstruction, parastromal dermatitis, stromal stenosis and pyocystis.

Studies for Artificial Bladder Using Nobecutane-sprayed Paper on Tuberculous Contracted Bladder / 대한비뇨기과학회지

The authors carried out the cystoplasty by regeneration to a 24 year-old female of tuberculous contracted bladder with artificial bladder. The artificial bladder was prepared by using nobecutane-sprayed paper, which was designed by repetition of Nobecutane spraying and drying. The artificial bladder was subjected to a crucial incision on the dome and a No. 10 porous catheter was inserted from the urethra into the bladder. The artificial bladder was sutured with the original incised one with a margin of 1 Cm using 3-0 chromic catgut. The authors observed for 2 months postoperatively. The following results were obtained. 1. The artificial bladder fell off completely in the bladder in 34 days after the cystoplasty, which was extirpated transurethrally. 2. The bladder capacity was about 30 cc before the operation. Following the cystoplasty, it increased up to 180-220 cc by the 50th postoperative day, and the frequency of urination was 8 times in day and 3 times in night.

Ileocystoplasty for Contracted Bladder: A Case Report / 대한비뇨기과학회지

Contracture of the bladder resulting in diminished vesical capacity is not common and it demands correction as it leads to renal deterioration. Tuberculous infection, the most frequent type, is a chronic, cicatrizing inflammation of the bladder that is responsible for bladder contracture. Herein, the author describes an experience with a young male patient whose bladder capacity was less than 30cc. and left Kidney was non-functioning following anti-tuberculosis chemotherapy of irregular and random period for renal tuberculosis. Ileocystoplasty was performed at the Department of Urology, Presbyterian Medical Center, Taegu, Korea on the patient with good results; considerable relief of symptoms following surgery.

Surgical treatment of Contracted Bladder: Clinical observation of 30 cases of sigmoidocystoplasty / 대한비뇨기과학회지

Reconstruction of contracted bladder with a segment of small or large bowel has got a wide acceptance in the urological field today The use of a sigmoid colon segment isolated from the fecal stream appears to be most feasible for replacing or enlarging the bladder because the sigmoid colon with its proximity to the bladder would be the most logical donor organ. It might even be assumed so from a functional point of view. From January. 1961 to December 1962. in the Department of General Surgery. National Medical Center there has been performed 30 sigmoidocystoplasties for contracted bladder. The purpose of this paper is to present comparative clinical features of the reconstructed bladder and post-operative complications following closed loop and cup form sigmoidocystoplasty. Material: Of 30 cases of contracted bladder, 28 were contracted T. B bladder and 2 were non-specific cystitis. All 30 cases had previously undergone nephrectomy due either to non-functioning kidney, or extensive destruction. Seventeen cases were males and 13 cases were females. Agewas ranging from 12 to 67 years Two different techniques of sigmoidocystoplasty have been employed, namely closed loop (13 cases) and cup-form (17) sigmoiducyetoplasty, therefore, it has been possible to make a comparative study between two techniques. Clinical result and Conclusion: 1) Bladder reconstruction by means of an isolated sigmoid segment resulted in producing an efficaciously functioning artificial bladder as a urinary reservoir. No mortality 2) One case which was a complete failure was a case of contracted T. B. bladder with urinary incontinence, therefore, it should be emphasized that urinary incontinence is an absolute contraindication for sigmoidocystoplasty. 3)Bladder reconstructi with cup-form sigmoidocystoplasty was superior to closed loop sigmoidocystoplasty because of; A) Shape, position and Prevention of residual urine formation of the reconstructed bladder. B) Tidal volume as closed as total bladder volume. C) Very similar cystometry curve to the normal. D) Reduction of post-operative complication. 4) Production of mucus urine causes troublesome discomfort to the patient after bladder reconstruction, therefore, it would be ideal if we can prevent mucous urine. 5) Although the serum chloride has some tendency to increase after sigmoidocyetoplagty, however, no hyperchloremic acidosis was produced if the kidney function was normal. 6) All hyperchloremic acidosis cases in this series had irreversible hydronephrosis of the remaining kidney. This might give the impression that severe hydronephrosis is a contra-indication to sigmoidocystoplasty. However, as a contracted bladder gives not only miserable urinary symptoms but also shortens the life by progressive destruction of be kidney, the indication for reconstruction of a contracted bladder, even in the presence of severe hydronephrosis, should be discussed. A non-absorbable reconstructed bladder should be most ideal artificial bladder.

Treatment of Ureteral Stricture and Contacted Bladder Due to Tuberculosis / 대한비뇨기과학회지

Renal tuberculosis, if not treated surgically, usually runs a fatal course. In discussion as to whether a tuberculous kidney should be treated surgically or medically, most of the urologist, Dr. Wildolz. Rafin. Nesbit. agree with the opinion that nephrectomy is the radical treatment for tuberculosis of the kidney is early stage. Since those new drugs. PAS, and isoniazid including streptomycin, have been used for renal tuberculosis, the seriousness of renal tuberculosis is decreased compared with before. But the great tendency to scarring and contracture develops in the urinary pathway as a result of the disease or secondary to the healing of the tuberculous process. Cicatrization or scarring of the ureters, or the bladder exerts a serious influence on renal function, the death of the patient with renal tuberculosis is therefore frequently due to the sequelae of this infection rather than tuberculosis itself. I present seven patients seen in the short period of three years who, after nephrectomy and during medical therapy, suffered serious damage to the remaining normal kidney because of bladder or ureteral disease those were assumed that both kidneys would be damaged by tuberculosis in clinical investigation. In the treatment of those seven patients, I have observed tuberculous stricture of the ureter at any levels from the kidney to the bladder in five cases whose each remaining kidneys were found to be healthy and to become hydronephrotic due to stricture of the ureter, and other two were contracted bladder due to tuberculosis. In five patients of ureteral stricture, four cases restored normal renal function with reimplantation of the ureter into bladder and in one case uretero-ileocystoplasty as ileal replacement in three cases. one case was failed in ileal replacement. A patient with contracted bladder with very severe symptoms was markedly improved by constructing author's a new technique of two layer open-flap ileocystoplasty to enlarge the capacity of the bladder. The other patient was given a ringplastic ileocystoplasty, whose bladder symptoms were as much as before with significant residual urine in late period on five months after operation in spite of improvement in early period.