Urethral disruption with urinary extravasation: a delayed complication of pancreatic transplantation.

PURPOSE: To describe the radiographic features and potential causes of urethral disruption in pancreas transplant recipients. MATERIALS AND METHODS: Eight episodes of urinary extravasation were depicted with retrograde urethrography in five male patients who had undergone pancreatic transplantation. The patients' medical records were reviewed to determine a cause of the extravasations. RESULTS: Four extravasations occurred at the proximal (deep) bulbar urethra, three at the bulbomembranous junction of the urethra, and one at the distal bulbar urethra. Four of eight cases of extravasation were preceded by recent cystoscopy or placement of a Foley catheter; one case was preceded by possible urethral injury due to a fall. CONCLUSION: Urethral disruption occurs as a complication of pancreatic transplantation. It has so far been seen only in male patients and occurs at the bulbar urethra or bulbomembranous junction. If the treating physician is unaware of this condition, diagnosis and institution of appropriate therapy may be delayed. Recent prior urinary tract instrumentation or trauma may be predisposing factors in urinary extravasation.

Shock-wave thrombus ablation, a new method for noninvasive mechanical thrombolysis.

Successful experimental and clinical experience with thrombus ablation has been attained with high-power acoustic energy delivered in a catheter. The goal of this study was to investigate the feasibility of noninvasive thrombus ablation by focused high-power acoustic energy. The source for high-power acoustic energy was a shock-wave generator in a water tank equipped with an acoustic lens with a fixed focal point at 22.5 cm. Thrombus was prepared in vitro, weighed (0.24 +/- 0.08 g), and inserted in excised human femoral artery segments. The arterial segments wer ligated, positioned at the focal point and then randomized into either test (n = 8) or control (n = 7). An x-ray system verified the 3-dimensional positioning of the arterial segment at the focal point. A 5 MHz ultrasound imaging system continuously visualized the arterial segment at the focal point before, during and after each experiment. The test segments were exposed to shock waves (1,000 shocks/24 kv). The arterial segment content was then flushed and the residual thrombus weighed. The arterial segment and thrombus were fixed and submitted to histologic examination. The test group achieved a significant ablation of thrombus mass (0.25 +/- 0.15 vs 0.07 +/- 0.003 g; p = 0.0001) after application of shock waves. Arterial segments showed no gross or microscopic damage. Ultrasound imaging revealed a localized (1.9 +/- 0.5 cm2), transient (744 +/- 733 ms), cavitation field at the focal point at the time of application of focused shock waves. Thus, focused high-power acoustic energy can effect noninvasive thrombus ablation without apparent damage to the arterial wall.(ABSTRACT TRUNCATED AT 250 WORDS)

Uroradiologic manifestations of portal hypertension.

In a retrospective review of 50 patients with known portal hypertension, uroradiologic abnormalities directly related to this entity were detected in 10 patients (20%). Unusual findings in three patients are stressed. One case of ileal conduit hemorrhage due to enterostomal varices secondary to portal hypertension, in which the imaging studies were noncontributory, is included in this discussion because of its important clinical and diagnostic implications.

The use of prophylactic low dose heparin in transurethral prostatectomy.

Low dose heparin prophylaxis has proved effective in reducing postoperative thromboembolic complications in a series combining multiple types of surgical procedures. Our series comfirms its safety for transurethral operations. We recommend its use in patients with predisposing factors to thromboembolic complications.