Penile injury and effect on male sexual function.

Penile injury is common as an emergency and should be accurately diagnosed and treated. We analysed 22 patients with penile injury admitted to the emergency unit of Dubrava University Hospital during a 4-year period. According to the American Association for the Surgery of Trauma five-grade classification of penile injuries, there were 14 grade I, 6 grade II and 2 grade III cases. Diagnosis was mainly based on clinical and ultrasonography findings, and in some cases on cavernosography. Nineteen patients underwent immediate surgery and three patients received conservative therapy. On outpatient follow up, sexual function was assessed by use of the 5-item International Index of Erectile Function (IIEF-5) test at 3 and 12 months of injury. At 3-month follow up, moderate, mild and no erectile dysfunction was recorded in 5, 6 and 11 patients respectively (mean IIEF-5: 19.62). At 12-month follow up, mild erectile dysfunction was found in only one patient (IIEF-5: 20), whereas all other patients were free from erectile dysfunction (mean IIEF-5: 23.75). The 12-month follow up yielded a higher statistical difference (P < 0.001) when compared with 3-month follow up. Study results indicated that appropriate treatment of penile injuries resulted in complete recovery of sexual function within 12 months.

Symptomatic physiologic hydronephrosis in pregnancy: incidence, complications and treatment.

OBJECTIVE: We present the incidence and results of treatment of symptomatic physiologic hydronephrosis in 3,400 pregnant women. METHODS: We analyzed 103 consecutive women who presented with clinical signs and symptoms related to the upper urinary system. Renal sonography, urinalysis, serum creatinine levels, white blood cell (WBC) count, and urine culture were done in all patients at first visit and repeated at least once a month until 1 month after delivery. In patients who manifested acute pyelonephritis, urinalysis, WBC count, erythrocyte sedimentation rate and C-reactive protein levels were repeated every 3 days until normalization, and urine culture as well as renal sonography were performed once a week until 1 month after delivery. Conservative measures (positioning, analgesia, antibiotics) were performed in all patients with symptomatic physiologic hydronephrosis. If the patient's condition was refractory to medical management, drainage of the ureter with a double pigtail stent was performed. RESULTS: Conservative measures were successful in 97 (94%) of 103 patients but 6 (6%) patients had ongoing signs and symptoms of acute pyelonephritis progressing to urosepsis. In all of them, antibiotics were continued and a double pigtail stent was placed resulting in fast regression of symptoms, curing of renal infection and progress of the pregnancies to the term with vaginal delivery. CONCLUSIONS: Symptomatic hydronephrosis in pregnancy can be treated conservatively. If the patient's condition is refractory to medical management, an internal drainage with double pigtail stent may be necessary.

Comparative analysis of bladder neck suspension using Raz, Burch and transvaginal Burch procedures. A 3-year randomized prospective study.

PURPOSE: Ever since Pereyra described needle suspension of the bladder neck for the treatment of stress urinary incontinence in women, numerous modifications have been presented. There were variations in the success reported by different authors. We report 3-year follow-up results in 146 women operated on for stress urinary incontinence using Raz, Burch and our own new procedures. MATERIALS AND METHODS: During a 5-year period, 146 women were operated on for genuine stress urinary incontinence. Using the method of Raz, and transvaginal Burch as well as the Burch retropubic urethropexy, a modified bladder neck suspension was performed in 46 (32%), 44 (30%) and 56 (38%) patients, respectively. In all patients a prior gynecological or urological operation for urinary incontinence and a clear neuropathic condition had been excluded before surgery. The routine diagnostic procedure consisted of multichannel cystometry, voiding cystourethrography, infusion urography and cystoscopy. A pressure-flow electromyography study was done in patients with a residual volume greater than 50 ml following voiding. The operations were performed by the same surgeon (I.G.). Initial follow-up was done after 12 months and then every year. RESULTS: Urodynamic testing did not reveal significant differences between Burch and Raz (p = 0.2652), Raz and transvaginal Burch (p = 0.5745) as well as between Burch and transvaginal Burch procedures (p = 0.7602; Fisher's exact test). Three years after surgery, 50 of 56 (89.3%; Burch procedure), 37 of 46 (80.4%; Raz modification) and 38 of 44 patients (86.4%; transvaginal Burch) were continent. CONCLUSIONS: There is no reason (except patient condition) to prefer any of the numerous modifications of bladder neck suspension. We believe that the success of the operation lies in adequate mobilization of the bladder neck and urethra as well as in a surgeon's familiarity with the procedure.

Urinary tract infection in acute appendicitis.

The effect of acute appendicitis (AA) on aerobic urinary tract infection was investigated. Abnormal urinalysis and urinary tract infection in patients with AA have seldom been reported previously. Appendectomy was performed in 84 patients with no previous urogenital, retroperitoneal, or pelvic disease, trauma or operation and AA was pathologically confirmed in 66 of them. Aerobic cultures of appendiceal tissue and mesenteriolum were done. Control groups included 25 patients with inguinal hernioplasty and 40 patients with varicocele repair. Urinalysis and urine culture were done prior to operation, and on days 1, 3, and 6 postoperatively. The "O" serogrouping identification of Escherichia coli (E. coli) was performed in the appendix, mesenteriolum and urine. Abnormal urinalysis was found in 48% of patients with AA before appendectomy, and in 12% on day 6 postoperatively (P < 0.05). Aerobes were isolated from urine in 32% of patients before appendectomy and in 24% on day 6 following surgery. E. coli was more often found in the appendix than in the mesenteriolum (P < 0.05). In seven out of 66 patients (11%) bacteriuria of more than 10(5) was found. All of them had identical aerobic strain isolated from the appendix, mesenteriolum and urine (E. coli in 4, Streptococcus faecalis in 2 and Corynebacterium species in one patient) according to antimicrobial susceptibility testing and "O" serogrouping of E. coli. Lower urinary tract infection was clinically manifested on day 3 postoperatively in 4 of them and in none from the control groups. Bacteria spreading from the appendix to the retroperitoneal space may invade the urinary tract and cause either symptomatic or asymptomatic urinary tract infection in patients with AA.

Urinalysis, ultrasound analysis, and renal dynamic scintigraphy in acute appendicitis.

OBJECTIVES: The influence of acute appendicitis (AA) on the right kidney and urinalysis was investigated. Permanent damage of the urinary tract and abnormal urinalysis have been previously reported in AA. METHODS: Appendectomy was performed in 84 patients with no previous urogenital, retroperitoneal, or pelvic disease, trauma, or operation. AA was confirmed in 66 of them. Control groups were the remaining 18 patients and 40 patients with varicocele repair. Renal sonography and urinalyses were done prior to operation, on days 1, 3, and 6 postoperatively. Pentetic acid renal scintigraphy was done on postoperative day 1 in patients with abnormal urinalysis. An obstructive radiographic curve indicated furosemide renography. RESULTS: Abnormal urinalysis was found in 48% of patients with AA before appendectomy and in 12% on day 6 postoperatively. Sonography showed pyelocaliceal dilation of the right kidney in 38% of patients with AA prior to appendectomy and in none on day 6 postoperatively. Patients with AA had pyelocaliceal dilation of the right kidney more frequently than those in the control groups (P < 0.001). It was more frequent in patients having abnormal urinalysis (P < 0.01). Scintigraphy confirmed pyelocaliceal dilation of the right kidney in 38% of patients with abnormal urinalysis. Furosemide renography excluded an obstruction in all of them. CONCLUSIONS: Inflammation is the major cause of abnormal urinalysis and transitory pyelocaliceal dilation in some patients with AA. Erythrocyturia, pyuria, proteinuria, and pyelocaliceal dilation detected by sonography or scintigraphy can frequently be found in patients with AA, but should not mislead the surgeon in the diagnosis of AA.

Prostatitis in benign prostatic hyperplasia: a histological, bacteriological and clinical study.

The paper deals with the incidence of prostatitis in benign prostatic hyperplasia (BPH) and its effect on the postoperative course in the patients subject to the transvesical prostatectomy. The samples of urine and expressed prostatic secretion were bacteriologically analysed before the operation, and samples of urine on three occasions following the operation. Specimens of BPH tissue obtained by surgery were subjected to pathohistological and microbiological examination. The incidence of prostatitis was found to be 90.3%. In the specimens of BPH tissue obtained by transversal prostatectomy, Gram-positive microorganisms were isolated in 32.8% of the tissue. In particular, Staphylococcus epidermidis was found in 26.6% of BPH tissue. Gram-negative microorganisms were isolated in 30.8% of BPH tissue, and fungi in 2.9%. In 27.9% of BPH tissue a microorganism could not be isolated although pathohistological examination evidenced prostatitis. Therefore, in these cases etiology remained unclear. Patients with Gram-negative prostatitis had the highest number of complications and the longest period of postoperative hospitalization. Preoperative and postoperative antibiotic therapy reduced the incidence of postoperative complications and shortened the period of hospitalization in the patients with significant Gram-negative bacteriuria before operation, that is, in the patients with Gram-negative prostatitis in BPH.