Retrospective study for risk factors for febrile UTI in spinal cord injury patients with routine concomitant intermittent catheterization in outpatient settings.

STUDY DESIGN: Retrospective study. OBJECTIVES: The objective of this study was to investigate the clinical risk factors for febrile urinary tract infection (UTI) in spinal cord injury-associated neurogenic bladder (NB) patients who perform routine clean intermittent catheterization (CIC). SETTING: Rehabilitation Hospital, Kobe, Japan. METHODS: Over a 3-year period, we retrospectively assessed the clinical risk factors for febrile UTI in 259 spinal cord injury patients diagnosed as NB and performing routine CIC with regard to the factors such as gender, the presence of pyuria and bacteriuria, and the categories of the American Spinal Injury Association (ASIA) impairment scale. RESULTS: A total of 67 patients had febrile UTI in the follow-up period, with 57 cases of pyelonephritis, 11 cases of epididymitis and 2 cases of prostatitis, including the patients with plural infectious diseases. The causative bacteria were ranked as follows: Escherichia coli (74 cases), Pseudomonas aeruginosa (17 cases), Enterococcus faecalis (14 cases) and Klebsiella pneumoniae (12 cases). Antibiotic-resistant E. coli were seen, with 10.5% instances of extended-spectrum ß-lactamase (ESBL) production and 23.8% of fluoroquinolone resistance. Multivariate analyses of clinical risk factors for febrile UTI showed that gender (male, P=0.0431), and ASIA impairment scale C or more severe (P=0.0266) were significantly associated with febrile UTI occurrence in NB patients with routine CIC. CONCLUSION: Our data demonstrated gender (male) and ASIA impairment scale C or more severe were significantly associated with febrile UTI occurrence in NB patients using routine CIC. Further prospective studies are necessary to define the full spectrum of possible risk factors for febrile UTI in these patients.

Severe hypospadias repair with meatal based paracoronal skin flap: the modified Koyanagi repair.

PURPOSE: Various techniques have been reported to repair severe hypospadias. The Koyanagi repair uses a meatal based foreskin flap. We modified this procedure and reviewed the outcome of the repair of severe hypospadias. MATERIALS AND METHODS: The modified Koyanagi repair was performed in 151 children 7 months to 15 years old (mean age 3 years) with severe hypospadias. The records of these patients were reviewed. In all cases the meatus was at or proximal to the penoscrotal junction. Followup was 6 months to 16 years (mean 6 years). Flap design is the same as in the Koyanagi repair, although our modified technique requires removal of the subcutaneous tissue of the distal portion of the flap, which acts as a full-thickness free skin graft. RESULTS: A fistula developed in 19 patients (12.6%), meatal stenosis in 3 (2%) required meatoplasty and infection in 2 (1.3%) resulted in a regressed meatal position. Good cosmetic results were achieved in all except the latter 2 cases. CONCLUSIONS: Our modified Koyanagi repair affords an excellent cosmetic appearance. The complication rate is relatively low and compares favorably with that of other techniques.

Spontaneous rupture of the urinary bladder is not a rare complication of radiotherapy for cervical cancer: report of six cases.

BACKGROUND: Spontaneous intraperitoneal rupture of the urinary bladder is an extremely rare event. It has been reported to be a rare complication of radiation therapy for cervical cancer, but no studies have ever reported the incidence of this life-threatening complication. MATERIALS AND METHODS: From August 1981 through December 1988, 143 patients with carcinoma of the uterine cervix were treated with high-dose-rate intracavitary brachytherapy combined with external beam therapy at Kobe City General Hospital. RESULTS: Of these patients, three (2.1%) suffered spontaneous intraperitoneal rupture of the urinary bladder as a late complication of radiation therapy between August 1995 and February 1998. Three other patients, treated with radiation therapy for cervical cancer at other hospitals, were also admitted to our hospital with this complication between August 1995 and February 1998. All six patients underwent laparotomy and repair of the perforation. However, rerupture of the bladder occurred in three of these patients. CONCLUSION: Spontaneous intraperitoneal rupture of the urinary bladder after radiation therapy for cervical cancer is less rare than previously expected, and urologists must consider the possibility of occurrence of this life-threatening event following radiation therapy.

[Retroperitoneal schwannoma: a case report].

A 67-year-old man was admitted for a complaint of lumbago. The patient had had the three operations for the schwannoma in spinal cord at the Neurosurgical Department of our hospital. Magnetic resonance imaging (MRI) revealed a right infrarenal tumor by chance. The tumor compressed the right kidney and measured 6 x 5 cm in size. On the tentative diagnosis of the retroperitoneal tumor, the patient was referred to the department of urology in our hospital and the tumor was excised. The histological diagnosis of the removed retroperitoneal tumor was schwannoma, and was thought to be heterotopic recurrent schwannoma.