Studer orthotopic ileal bladder substitute construction - surgical technique and complication management: one-center and 12-year experience.

PURPOSE: We have performed Studer neobladder creation in 61 patients (53 male and 8 female). The aims of this study were to evaluate the clinical outcomes, to review the surgical technique modification, postoperative complications management and metabolic disturbances. MATERIAL AND METHODS: All patients were retrospectively studied and followed-up. The follow-up: 12 years to 2 months. 44 patients (41 male and 3 female) returned for a control visit. All completed IIQ-7 questionnaire. Continence was analysed. Kidney ultrasound, post void residual and uroflowmetry, blood tests (electrolytes, kidney markers, acid-base balance) were performed. All patients were divided into two groups: I (with Zuber mineral water intake) and group II (without Zuber mineral water intake) for acid-base balance analysis. RESULTS: Early complications occurred in 13.1% (enterocolitis, neobladder-urethral anastomosis leakage, pyelonephritis, and lymphorrhoea). Late complications occurred in 14.0% (stricture of the neobladder-urethra anastomosis, urosepsis secondarily to bilateral hydronephrosis, stone formation, and pyonephrosis). In the follow-up 88.6% of patients revealed normal continence. The nocturnal incontinence, nocturia, and external or indwelling catheter were reported in 9, 6 and 5 patients, respectively). In IIQ-7 the mean negative impact of continence level on patients quality of life was 10.08% ± 14.47%. The mean Qmax., Qave., post void residual were 15.8 ± 4.9 ml/s, 7.9 ± 3.0 ml/s, and 151.2 ± 139.2 ml, respectively. Patients who regularly intake the Zuber present significant decrease of BE deficiency as compared to patient without Zuber usage. CONCLUSIONS: The Studer neobladder is the alternative urinary diversion. This is the difficult, skill demanding procedure, nevertheless gaining experience with self modifications resulted in decrease of complications. The Zuber mineral water intake ameliorates the base excess deficiency after Studer creation.

Functional, histological structure and mastocytes alterations in rat urinary bladders following acute and [corrected] chronic cyclophosphamide treatment.

Neurogenic inflammation is linked to urinary bladder overactivity development. Cyclophosphamide (CYP) damages all mucosal defence lines of urinary bladder and induces cystitis with overactivity. The aim of this study was to estimate the effect of CYP on rat urinary bladder function, histological structure and mastocytes numbers following acute and chronic CYP treatment. Fourty two female rats were divided into four groups: I (control), II (acute cystitis), III (chronic cystitis), IV (sham group). Acute and chronic cystitis were induced by CYP in single dose and four doses (1(st), 3(rd), 5(th), 7(th) day), respectively. In group I-III the cystometric evaluation was performed. Sections of the bladder were stained with HE and toluidine blue for the detection of mastocytes. The severity of inflammation was examined according to mucosal abrasion, haemorrhage, leukocyte infiltration and oedema. Acute and chronic CYP treatment caused inflammatory macroscopic and microscopic changes (mucosal abrasion, haemorrhage, oedema) and increased infiltration of inflammatory cells in urinary bladder. Acute treatment induced the infiltration of mastocytes within bladder wall contrary to chronic one decrement. Acute treatment caused more severe mucosal abrasion, whereas chronic one revealed more developed haemorrhage changes. Additionally, cystometric evaluation revealed urinary bladder overactivity development in both types of cystitis. Basal pressure and detrusor overactivity index after acute treatment increased considerably in comparison with the increase obtained after chronic one. Our results proved that acute model of CYP-induced cystitis in rats is more credible for further evaluation of neurogenic inflammation response in pathogenesis of overactive bladder as compared to chronic one.

Urodynamic effects of the bladder C-fiber afferent activity modulation in chronic model of overactive bladder in rats.

Previous studies have suggested that, different types of unmyelinated bladder afferent C-fibres, such as capsaicin-sensitive and capsaicin-resistant mediate the voiding reflex in overactive bladder (OAB). Considering its polymodal features, we explored the urodynamic effect of primary afferent neurons modulation on detrusor activity in normal and OAB rats. Experiments were performed on 48 female rats. OAB was induced by intraperitoneal administration of cyclophosphamide. All the surgical procedures and urodynamic studies were performed under urethane anaesthesia. Cystometry was done after a 1 h recovery period from the surgical procedure. All animals were randomly divided into six groups: control, chronic OAB, chronic OAB after capsaicin or lidocaine instillation, control capsaicin or lidocaine instillation. The measurements represent the average of five bladder micturition cycles. We analyzed: basal, threshold, micturition voiding pressure; intercontraction interval; compliance; functional bladder capacity; motility index; detrusor overactivity index. We used chronic cyclophosphamide OAB model for further investigations. In healthy rats, intravesical instillation of capsaicin caused complete inhibition of detrusor contractility preventing from proper voiding function of the bladder. Contrary, lidocaine has no influence on micturition cycles in intact animals. Also, intravesical instillation of capsaicin and lidocaine reduced the severity of detrusor overactivity of OAB rats leading to improvement of cystometric parameters.

Vesico-ileal fistula caused by a foreign body.

An enterovesical fistula due to an intestinal foreign body is presented and the therapeutic aspects of the lesion are discussed.

Spontaneous regression of hepatic metastases after nephrectomy and metastasectomy of renal cell carcinoma.

We report a case of clear cell carcinoma of the kidney with multifocal metastases to the lymph nodes, vagina and liver. Spontaneous regression of liver metastasis has been described after nephrectomy. Surgical management of primary and metastatic tumors should be considered in all patients with renal cell carcinoma.

[Functional evaluation of the prostatic urethra by means of transrectal ultrasound]. / Czynnosciowa ocena odcinka sterczowego cewki moczowej za pomoca ultrasonografii przezodbytniczej.

Transrectal ultrasound (TRUS) is the popular tool in the diagnostics of benign prostatic hyperplasia (BPH) mainly visualizing the static image of prostate with closed urethra. The aim of this study was to observe the changes of the shapes and dimensions of prostatic urethra during micturition using transrectal probe, with simultaneous uroflowmetry. 174 men were examined. 58 of them (aged 20-40 y.) non obstructed--control group, 57 (aged 41-60 y.) and 59 (aged 61-80 y.) with bladder outlet obstruction (BOO) symptoms. TRUS with videorecording in upright position was done. Simultaneously uroflowmetry was performed. Maximal dimensions of the cross-sections of the prostatic urethra in sagittal plane were taken on two levels. First at the bladder neck (S1, mm), second in the middle of the prostatic urethra (S2, mm). The relations between dimensions and uroflowmetry were analyzed using also the average of the sum od S1 and S2 (S3 mm). The average dimension of S1 and S2 decreased with age from 6.3 and 7.0 mm in control group, to 5.1 and 4.5 mm in patients over the age of 60. The average of S3 decreased from 13.3 to 9.5 mm. In all groups statistically significant relations between maximal flow rate (Qmax) and S1, S2 were noted (p < 0.001 and p < 0.05). Particularly strong relations between Qmax and S3 were stated (p < 0.0001). On the base of these results the nomograms were created which allow to calculate the approximate Qmax basing on the prostatic urethra cross dimension. The TRUS measurement of the prostatic urethra cross sections during micturition allows to calculate approximately the Qmax, especially on the base of S3. The observation of the changes of the shapes and dimensions of the prostatic urethra during micturition will make easier to localize and state the character of BOO. The low Qmax with simultaneous correct cross dimensions of the prostatic urethra can suggest the detrusor insufficiency.

[Latex allergy in health services workers]. / Alergia na lateks u pracowników sluzby zdrowia.

The studies were performed in 20 workers from the Health Service (13 women and 7 men in the age 25-57) suffering from hand urticaria (6 persons) and hand dermatitis (14 persons) suspected of the allergy to latex gloves. In all patients the familial and personal predispositions to allergy were evaluated by the anamnesis, the estimation of total IgE serum level and the skin prick tests (SPT) with inhalant allergens. The latex allergy was diagnosed by SPT and contact test with standardized extract of the natural latex allergen in the concentration 1000 PNU/ml (Nexter-Allergopharma) and by estimation of specific to latex IgE serum level. In addition to this, contact tests with glove's material as well European standard contact allergens (Hermal) were done and the one with antiseptic substances to which the patient was exposed at his work. The allergy type I to latex gloves was confirmed in all 6 cases with contact urticaria. The SPT with standard extract of the natural latex was more valuable than latex specific IgE in the serum. Contact allergy (type IV) to latex gloves was confirmed in 10 from 14 suspected cases. In the next 4 the allergy to antiseptic substances was the reasons of the illness. The allergy to latex gloves appears more often in women. No case showed the familial predisposition to allergy and only 4 patients additionally suffered from the allergy to pollen and mites. Moreover in both groups of patients we showed the presence of the additional contact allergy to different allergens (to metals and antiseptic substances).

[Functional evaluation of the internal urethral sphincter in transrectal USG]. / Czynnosciowa ocena zwieracza wewnetrznego cewki moczowej w USG transrektalnym.

One of urodynamic diagnostic methods is visualisation of the bladder neck opening which enables seeing the difference between internal and external urethral sphincter disfunction. Micturition video cysto-urethrography with X-rays makes possible to carry on such examinations, but it requires catheterisation which makes the method invasive. My purpose is to replace this examination by dynamic functional evaluation of the internal urethral sphincter during transrectal ultrasonography. During 10 routine transrectal ultrasound examinations of the prostate, patients were asked to urinate. During examination changes in configuration of the bladder neck and prostatic urethra were observed. Two patients could not urinate in horizontal position. In the rest of the patients very clear pictures showing changes in the shape and dimensions of the urethra during urination, were achieved. They were much more clear in comparison with X-ray video cystourethrography. Transrectal sonography is a perfect technique of the visualisation of the bladder neck and prostatic urethra during urination. The suggested method should be included into the urodynamic examinations.

[Urolithiasis]. / Kamica dróg moczowych.

Epidemiologic investigation did not show any special environmental combination causing urinary calculi creation. The disease concerns usually people between 25-50 year old. Most of the urinary calculi are compound of calcium oxalate and phosphate. In contaminated urine more often ammonia-magnesium phosphate. General constitutional factors having influence on urinary stones creation are specific gravidity, crystallization inhibiting factors concentration, hypercalcuria, urine acidity, hyperoxaluria and urinary tract infection. Unilateral, single urine stone is usually the effect of the local factors. Bilateral and multiple urinary stones are usually the effect of the local factors. Bilateral and multiple urinary stones usually are the effect of general constitutional and environmental factors. Complaints depend on the stone localisation, its dimensions and period of the disease. Nowadays most of the urinary calculi localised in the kidneys and ureters are treated with ESWL, PCNL and URS. Staghorn calculi are treated with the combination of PCNL and ESWL or operatively. Urinary stones localised in the bladder can be the consequence of descending ureteral stones, but usually they are created in the bladder as a consequence of the subvesical obstruction. The treatment is based on transurethral lithotripsy with simultaneous obstruction treatment by electrosurgery of the prostate or bladder neck or visual urethrotomy. Large and hard stones can be removed by cysto-lithotomy. Metafilaxis is the recurrences prevention, based first of all on diminution of crystalloid concentration and their solubility in the urine and providing crystallization inhibiting factors. Calculi composed of urine acid can be treated conservatively by their dilution.

[Index of the diaphyseal cortex and mechanical strength of the femur in experimental studies]. / Wskaznik korowo-trzonowy a wytrzymalosc mechaniczna kosci udowej w badaniach doswiadczalnych.

The mechanical strength at bending was examined in 26 femoral bones prepared from human corpses. The obtained data was compared with the cortical index (CI). The study demonstrates high correlation between CI and mechanical strength of the corpus as well as the collum of the examined bone, which means that CI is a good criterion in assessing biological age of the bone. Our study confirms previously made observations that revealed a considerable usefulness of CI determined in X-rays, for the estimation of osteoporosis advancement in long bones and their mechanical strength.

[Diagnostic difficulties in patients with primary lung cancer and pulmonary tuberculosis]. / Trudnosci diagnostyczne u chorych z pierwotnym rakiem oskrzela i gruzlica pluc.

An analysis of medical records of 774 patients treated at the Chest Hospital of the Ministry of Interior Affairs in Otwock during the years 1976-1985. 33 (4.3%) patients were selected for the study. All had a history of pulmonary tuberculosis. Only in 3 was the process active. In all development of lung cancer proved to be a grave diagnostical dilemma. In all cases a relapse of the pulmonary tuberculosis was suspected. The authors discuss six cases illustrating the diagnostical problems.

[Studies of the effect of ischemia of the legs on the degree of osteoporosis of the femur and tibia using the cortex-shaft index]. / Badania nad wplywem przewleklego niedokrwienia konczyn dolnych na stopien osteoporozy kosci udowych i piszczelowych przy uzyciu wskaznika korowo-trzonowego.

On the basis of arteriographs in 98 patients with chronic arterial ischemia of lower limbs, degree of osteoporosis was determined in symmetrical femoral and tibial bones using cortical index and statistical calculations. The study demonstrates similar level of mineralization of the examined bones in limbs with similar degree of ischemia. In patients with more pronounced unilateral osteoporotic changes more severe obliterations of the arteries was observed in the respective limb as compared with the opposite limb. The observed differences in cortical index values are statistically significant. Moreover chronic ischemia diminishes the correlation between cortical index and age. The study indicates, that chronic bone ischemia could play a role in the pathomechanism of local osteoporosis.