Development of a large bladder calculus on sutures used for pubic bone closure following extrophy repair.

Bladder exstrophy is a rare congenital condition that occurs in 1 to 30,000 live births. Primary bladder closure is usually performed in the first days of life in conjunction with an iliac osteotomy in order to achieve a more secure bladder closure. We report a case of a large bladder stone with secondary right-sided hydronephrosis in a 3-year-old child who underwent exstrophy repair at the age of 7 months. During the exstrophy repair a no. 1 braided, polyester, non-absorbable suture was used to close the pubic bones and served as a nidus for intravesical stone formation. This case substantiates the lithogenic nature of non-absorbable sutures in contact with urine as well as the need for close post-operative follow-up in these patients.

Posterior urethral disruption secondary to a penetrating gluteal injury.

We report a case of a complete posterior urethral injury secondary to a penetrating gluteal injury. Posterior urethral injury usually occurs in male patients with pelvic trauma. The reported incidence of urethral injury with pelvic fracture ranges from 1.6% to 25% (mean 10%), with 66% of them being complete posterior urethral ruptures. Causes of posterior urethral disruptions include blunt trauma, such as occur in road traffic accidents or falls from heights, and high velocity penetrating and crush injuries. Penetrating gluteal injuries that cause posterior urethral damage are extremely rare. This report presents the first case of a complete urethral injury due to a gluteal stab wound. Furthermore, this case demonstrates that any sign of injury to the lower urinary tract, regardless of the cause or weapon implicated, warrants an immediate evaluation.

Clinical significance of gross hematuria and its evaluation in patients receiving anticoagulant and aspirin treatment.

OBJECTIVES: To investigate the results of evaluations in patients presenting with gross hematuria while receiving anticoagulant or aspirin treatment and to compare the source of bleeding in these respective groups. METHODS: We retrospectively studied all patients admitted because of gross hematuria while receiving warfarin or aspirin treatment between 1990 and 1998. The degree of anticoagulation was evaluated in patients taking anticoagulation medication. Almost all patients were evaluated by cystoscopy and either excretory urography or ultrasound. RESULTS: Patients taking warfarin had a normal evaluation almost twice as often as those taking aspirin: 38% versus 22%, respectively. The leading pathologic findings in both groups were a bleeding benign prostate and a tumor in the urinary tract, in similar proportions. Overall, a tumor was diagnosed in one quarter of patients, and other treatable pathologic findings were diagnosed about half the time. In the 11 patients receiving excessive anticoagulation medication, two tumors were found (18%). Hemorrhagic cystitis was diagnosed in 12 patients. All 12 were taking aspirin. CONCLUSIONS: A normal evaluation was more prevalent in the warfarin group. A tumor was diagnosed in about one quarter of the patients. The prevalence of hemorrhagic cystitis in patients taking aspirin may point to a specific bleeding diathesis in the urothelium of these patients. In light of these findings, a full evaluation is warranted in patients receiving aspirin or warfarin therapy, and the presence of excessive anticoagulation should not impede a full evaluation.

Glide wires for delayed catheterization of severely obstructed ureters.

OBJECTIVE: Failure to retrogradely catheterize an obstructed ureter may require a nephrostomy. We describe an endoscopic technique to catheterize a severely obstructed ureter when the obstruction does not permit passage of a ureteral catheter over a wire. METHODS: Using a cystoscope, a wire is passed beyond the obstruction. When the attempt to insert a ureteral catheter over the wire fails, the wire is left in place, fixed externally to a Foley catheter. A second attempt to insert a ureteral catheter is carried out 24-48 h later. RESULTS: The procedure was performed in 5 patients. Ureteral catheterization, which was initially impossible, was performed successfully and without complications. CONCLUSIONS: Maintaining a wire in place over a short period of time facilitates a subsequent ureteral catheterization.

Vaginal evisceration resulting from a water-slide injury.

A case of vaginal evisceration resulting from sliding on a water chute is described. The treatment and mechanism of this rare injury are discussed.