ABSTRACT
We present the manifestations, their recognition, and treatment of urachal disorders, as well as report on 3 cases of urachal abscess in children. A review of the English literature is included.
Subject(s)
Abscess/epidemiology , Urachal Cyst/epidemiology , Urachus/abnormalities , Abscess/microbiology , Abscess/therapy , Child, Preschool , Combined Modality Therapy , Diagnostic Imaging , Female , Humans , Male , Staphylococcal Infections/diagnosis , Staphylococcal Infections/epidemiology , Staphylococcal Infections/therapy , Urachal Cyst/microbiology , Urachal Cyst/therapyABSTRACT
Long-term (10-year) results of kidney transplantation have been analyzed from this center with respect to several variables. In this report the influence of viral disease was added in studying the effect of cadaver versus living-related donor, recipient race, and compliance. Over all, 10-year actuarial patient and graft survival were 68% and 48%, respectively. Cytomegalovirus, hepatitis B and C, and HIV-1 were studied for their effects, and survival curves analyzed statistically. Although cadaver and living-related donor, recipient race, and compliance were 3 main variables influencing graft survival, these 4 viruses were not selective in their effects on any of them. Hepatitis B surface antigen positivity and hepatitis C antibody positivity did not influence overall mortality or graft survival. Only cytomegalovirus seronegative status was important (as opposed to seropositive status, which was not). Of seronegative patients only those receiving a kidney from a seropositive donor were adversely affected. The presence of HIV-1 antibody had an adverse effect on graft survival, but the question remains as to whether overall mortality in HIV seropositive patients is any worse than those receiving dialysis therapy.
Subject(s)
Kidney Transplantation , Virus Diseases/etiology , Cadaver , Cytomegalovirus Infections/etiology , Follow-Up Studies , Graft Survival , HIV Infections/etiology , Hepatitis B/etiology , Hepatitis C/etiology , Humans , Kidney Transplantation/adverse effects , Kidney Transplantation/mortality , Postoperative Complications/etiology , Survival Rate , Transplantation, HomologousABSTRACT
A total of 56 male spinal cord injury patients on condom catheter drainage was studied prospectively within 6 months of the injuries for 5 years. Low bladder pressures (filling maximum 35 cm. water and voiding maximum 70 cm. water) were ascertained with video-urodynamics. External sphincterotomy was performed when necessary for detrusor-sphincter dyssynergia. Yearly upper tract imaging, serum creatinine levels and urine cultures were obtained. All patients had colonized urine (asymptomatic) during the entire study period. No patient sustained deterioration of the urinary tract on imaging or by serum creatinine determinations during the 5-year interval. We conclude that asymptomatic bacteriuria is of no consequence to the integrity of the upper urinary tract when low pressures are operant.
Subject(s)
Bacteriuria/diagnosis , Spinal Cord Injuries/complications , Urinary Catheterization , Bacteriuria/physiopathology , Chronic Disease , Contraceptive Devices, Male , Fluoroscopy , Humans , Male , Prospective Studies , Spinal Cord Injuries/physiopathology , Television , Urinary Bladder/diagnostic imaging , Urinary Bladder, Neurogenic/physiopathology , Urinary Bladder, Neurogenic/therapy , Urinary Catheterization/instrumentation , Urodynamics/physiologyABSTRACT
Intermittent catheterization is used commonly to treat bladder dysfunction. We treated 10 patients who were experiencing difficulty with intermittent catheterization, 9 of whom had a false urethral passage. Of these patients 6 had previously undergone a bladder neck or urethral operation. Endoscopy was helpful to diagnose the condition. Treatment consisted of stenting in 3 patients, transurethral incision and stenting in 3, and fulguration and stenting in 4. An indwelling catheter was left in place for 2 to 3 weeks, after which intermittent catheterization was resumed with a softer catheter. Two patients again experienced severe difficulty with catheterization and they underwent a continent urinary diversion. When intermittent catheterization becomes difficult or impossible, the presence of a urethral false passage should be suspected as a possible cause.
Subject(s)
Urethra/injuries , Urinary Catheterization/adverse effects , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Male , Urethra/pathologyABSTRACT
Placement of the artificial urinary sphincter during augmentation enterocystoplasty may lead to infection, erosion and eventual removal of the device. To assess compatibility of artificial urinary sphincter implantation and enterocystoplasty we reviewed the records of 30 patients who had undergone enterocystoplasty and artificial urinary sphincter placement simultaneously (11), enterocystoplasty before artificial urinary sphincter placement (12) and artificial urinary sphincter placement before enterocystoplasty (7). The 19 male and 11 female patients were between 4 and 42 years old (median age 13.5 years). Followup in 28 patients ranged from 6 months to 8 years (average 17 months). Incontinence resulted from myelodysplasia in 16 patients, sacral agenesis in 3, spinal cord injury in 6, posterior urethral valves in 1, bilateral ectopic ureters in 1 and epispadias-exstrophy in 3. Erosion occurred in 2 patients (7 per cent): 1 female patient who underwent simultaneous sphincter implantation and enterocystoplasty and who had undergone previously many bladder neck reconstructive procedures, including polytetrafluoroethylene (Teflon) injection, and 1 female patient in whom the augmented bladder was entered at artificial urinary sphincter implantation. Mechanical failure occurred 4 times in 3 patients and the artificial urinary sphincter was improperly placed in 1. Over-all continence rate was 87 per cent (26 of 30 patients). Simultaneous placement of the artificial urinary sphincter and enterocystoplasty did not seem to affect the outcome of sphincter implantation if good bowel preparation, intravenous antibiotics and sterility of urine were accomplished preoperatively. Entering the augmented bladder during sphincter implantation may predispose to infection and erosion.
Subject(s)
Prostheses and Implants , Urinary Bladder/surgery , Urinary Incontinence/surgery , Adolescent , Adult , Child , Colon, Sigmoid/surgery , Female , Humans , Male , Postoperative Complications/etiology , Retrospective StudiesABSTRACT
The artificial urinary sphincter AS800 was implanted in 33 male and 13 female patients with congenital urinary tract incontinence. In 15 patients (32 per cent) previous operations to correct incontinence had failed. The sphincter was implanted around the bladder neck in 43 patients and around the bulbous urethra in 3. Mean patient age at the time of sphincter implantation was 13 years. In 40 patients (87 per cent) the sphincter functions well after a mean followup of 25 months and 39 patients (85 per cent) have satisfactory continence. In 6 patients the sphincter was removed because urethral, vulvar or scrotal erosions developed, all of whom had had previous surgical procedures in the area of the erosion. In 1 patient not operated upon previously erosion of the bulbous urethra developed. He did well after a new sphincter was implanted around the bladder neck. Five patients required an enterocystoplasty to achieve continence following the sphincter implantation. Nine patients required surgical revision of the sphincter for mechanical failure, technical errors, trauma and patient growth. We conclude that in patients with neurogenic sphincter failure implantation of an artificial sphincter around the bladder neck should be considered as the initial treatment of choice.
Subject(s)
Prostheses and Implants , Urinary Incontinence/congenital , Adolescent , Adult , Equipment Failure , Female , Follow-Up Studies , Humans , Male , Postoperative Complications/etiology , Reoperation , Time Factors , Urethra/surgery , Urinary Bladder/surgery , Urinary Bladder, Neurogenic/surgery , Urinary Incontinence/surgeryABSTRACT
We report a case of a male newborn with unilateral retroiliac ureter, ectopic left vas deferens, ectopic ureters and imperforate anus. A review of the urological literature has revealed only 2 other instances of an association of anomalies similar to that in our patient.
