Subject(s)
Lymph Node Excision/methods , Penile Neoplasms/surgery , Surgical Flaps , Testis/surgery , Aged , Aged, 80 and over , Humans , Inguinal Canal , Lymphatic Metastasis , MaleSubject(s)
Testis/injuries , Adult , Hernia, Inguinal/etiology , Humans , Male , Rupture , Transvestism , ViolenceABSTRACT
BACKGROUND: Tenckhoff catheter placement is well established to facilitate continuous ambulatory peritoneal dialysis (CAPD) in the treatment of end-stage renal failure. Complications of these catheters while in situ are well documented. However, little information is available concerning post-removal complications. Many centres, including our own remove these catheters by traction resulting in retained cuffs, rather than by formal dissection. We have evaluated the outcome of such removal over a 2-year period. METHODS: Sixty-two patients underwent Tenckhoff catheter removal by traction over a 2-year period at our unit. Patients were evaluated retrospectively using case notes and operation records. RESULTS: The catheters were sited for a mean of 23 months and were most commonly removed because of persistent peritonitis (48.4%). Sixty-one per cent of all patients had experienced at least one episode of CAPD peritonitis while the catheter was in situ, but this did not correlate with those who developed local sepsis. Fifteen patients (24.2%) subsequently developed local infective complications after a mean of 5.7 months (range 1-17 months). The subcutaneous cuff was involved in all cases and the peritoneal cuff was involved in six cases. Thirty patients were identified as being immunosuppressed, but this was not a risk factor in the development of retained cuff infections. CONCLUSIONS: There is a significant risk of local sepsis with retained cuffs resulting from removal by traction and our data suggests that these catheters should be removed by dissection and excision of both cuffs.
Subject(s)
Catheterization/adverse effects , Peritoneal Dialysis, Continuous Ambulatory/adverse effects , Adult , Aged , Female , Humans , Male , Middle Aged , Peritoneal Dialysis, Continuous Ambulatory/instrumentation , Peritonitis/etiology , Retrospective Studies , Time FactorsABSTRACT
PURPOSE: We evaluate the long-term outcome of the Gittes procedure for urinary stress incontinence. MATERIALS AND METHODS: A total of 87 women with proved genuine stress incontinence were treated with the Gittes procedure. The same urologist performed 95 consecutive operations during an 8-year period. Patients were evaluated by a postal questionnaire. RESULTS: Of the patients 52 (60%) (55 operations) responded to the questionnaire. Mean and median followup were 53 and 46 months, respectively (range 24 to 103). Twelve patients (23.1%) reported complete absence of postoperative urinary incontinence and were considered cured, 14 (26.9%) were significantly improved and a total of 30 (57.7%) benefited from the operation. The short-term results were initially encouraging but by 2 years only 20 patients were completely continent (38.5% cured). Of the 40 patients who were not cured 32 (80.0%) experienced incontinence within 2 years postoperatively. There were 26 who had complained of frequency and/or urgency preoperatively. There was a statistically significant subjective failure rate in this group (p = 0.007). CONCLUSIONS: The Gittes procedure is simple and has minimal complications. Although it provides continence in the early weeks and months following surgery, the long-term cure rate is disappointing, with most failures occurring within 2 years of surgery. Preoperative irritative symptoms, even when multichannel cystometry did not reveal instability, were associated with a poor subjective outcome. Our results suggest that the Gittes procedure is not satisfactory for the management of genuine stress incontinence in women.
