ABSTRACT
BACKGROUND: Prostatic stents offer a third clinical option for patients with bladder-outlet obstruction who are unfit for surgical relief and wish to avoid long-term catheterization. We report our experience with the Abbey-Moor Spanner temporary prostatic stent in patients with acute and chronic symptoms of bladder-outlet obstruction secondary to benign or malignant disease who were unfit for surgery because of age or cardiorespiratory disease. PATIENTS AND METHODS: A series of 43 consecutive patients stented March 2004 through November 2005 were reviewed retrospectively. Stents were removed and replaced every 3 months if tolerated. RESULTS: More than half of the patients (63%) had an unsatisfactory outcome, namely, immediate or delayed retention or elective removal because of unbearable symptoms. The remaining 37% of patients had a satisfactory outcome and either continue to have the stent in situ after a mean of five changes or are stent free after a successful voiding trial. CONCLUSION: Only 21% of the patients in whom stenting was indicated continued to have a stent in situ at the end of the study. We suggest that in such patients, a temporary stent such as the AbbeyMoor Spanner should be used for only 3 months as a trial of stenting followed by a trial of stent-free voiding, with the patient converted to permanent prostatic stenting if voiding is unsuccessful.
Subject(s)
Prostate/physiopathology , Stents , Urinary Bladder Neck Obstruction/therapy , Aged , Aged, 80 and over , Equipment Design , Equipment Failure , Humans , Male , Middle Aged , Models, Anatomic , Patient Satisfaction , Prostate/pathology , Prostatic Hyperplasia/complications , Prostatic Hyperplasia/therapy , Prostatic Neoplasms/complications , Prostatic Neoplasms/therapy , Retrospective Studies , Treatment OutcomeSubject(s)
Societies, Medical , Surgery, Plastic , Terminology as Topic , Female , Humans , Male , Public Opinion , Plastic Surgery ProceduresSubject(s)
Abdomen/physiopathology , Altitude , Kidney Pelvis/physiology , Pressure/adverse effects , Renal Insufficiency/etiology , Renal Insufficiency/physiopathology , Aircraft , Computer Simulation , Humans , Hypertension/complications , Hypertension/physiopathology , Male , Middle Aged , Models, Biological , Risk Assessment , Risk Factors , Rupture/etiology , Rupture/pathology , TravelABSTRACT
The British Association of Plastic Surgeons and British Orthopaedic Association estimate that 70% of Gustilo 3b tibial fractures require flap coverage. Prior to the introduction of vacuum-assisted closure (V.A.C.) in the late 1990s, options were limited for the treatment of such injuries in selected individuals with medical comorbidity or complex wounds. VAC has now become an important part of our algorithm for soft tissue reconstruction with excellent results, but its role has not yet been defined in common management pathways. The authors present 3 cases, all different in their mechanism of injury, type of injury, and subsequent management, but all had a successful outcome with VAC.
