Vesicovaginal fistula repair without intentional cystotomy using the laparoscopic robotic approach: a case report.
(1/10)
BACKGROUND AND OBJECTIVES: Fistulas inaccessible from the vagina may require abdominal repair; we sought to evaluate the robotic-assisted laparoscopic approach for this procedure. METHODS: A 41-year-old nulliparous woman presented with urinary incontinence following an abdominal hysterectomy, and office evaluation identified a vesicovaginal fistula. After discussion with the patient regarding the surgical options, the robotic approach was chosen to facilitate precise dissection, fine visualization, and suturing. A stent was placed from the bladder into the vagina, and no intentional cystotomy was made. The bladder was dissected away from the anterior vaginal wall at the fistula site, and the defects were closed independently with interposition of a fatty epiploica from the sigmoid colon. Total operative time was approximately 4 hours, and robotic time was about 2.5 hours. RESULTS: At 3 months after surgery, the patient had no recurrent symptoms. CONCLUSIONS: The robotic-assisted laparoscopic approach is a viable option for successful repair of a vesicovaginal fistula in a patient in whom a vaginal approach is not indicated. (+info)
Long term evaluation of functional and morphological bladder alterations on alloxan-induced diabetes and aging: experimental study in rats.
(2/10)
PURPOSE: to evaluate structural and functional effects of Alloxan- induced diabetes and aging on bladder of rats. METHODS: evaluations were performed in three groups: A--8 weeks of age, B--44 weeks of age, C--44 weeks of age with alloxan-induced diabetes. Muscle layer thickness, extracellular matrix fibrosis and collagen were quantified on digital images of bladder samples. Cystometric evaluations before surgical vesical denervation (SVD), included maximum cystometric capacity (MCC), maximum bladder pressure (MBP), bladder contraction frequency (VCF), duration of bladder contraction (DC), threshold pressure (TP) and bladder compliance (BC). After SVD, maximum cystometric capacity (MCC), BC and maximum urethral closing pressure (MUCP) were also measured. RESULTS: Reduced extracellular matrix fibrosis concentration and contraction strength were found in the bladders of group C. Before SVD, bladder compliance was not different between groups. Alterations were observed in MCC after SVD. CONCLUSIONS: We did not notice smooth muscle hypertrophy in Alloxan-induced diabetic rats after 44 weeks. There was alteration in the total and relative amount of fibrosis and collagen. The cystometric studies support the idea that this morphological alterations are important to determine the different bladder functional patterns found in the aging and the Alloxan-induced diabetic animals. (+info)
Intravesical foreign bodies: review and current management strategies.
(3/10)
INTRODUCTION: The aim of this study was to evaluate the cause, diagnosis, and management of intravesical foreign bodies in patients treated at our hospital and to review and update management of intravesical foreign bodies reported in the current literature. MATERIALS AND METHODS: Sixteen patients had been treated for intravesical foreign bodies at Nishtar Medical College Hospital, Multan, Pakistan during a 5-year period. Records of these patients were analyzed retrospectively for etiology, presentation, diagnosis, and management. RESULTS: The age of the patients ranged from 14 to 70 years and 10 of them were men. Seven patients (43.8%) had iatrogenic intravesical foreign bodies, 5 (31.3%) had migrated foreign bodies from the adjacent organs, and 4 (25.0%) had self-introduced foreign bodies into the bladder. The objects included copper wire, carrot, lead pencil, intrauterine device, surgical gauze, pieces of Foley catheter, and teflon beak of resectoscope sheath. The most common presenting symptoms were urinary frequency and dysuria. Endoscopic retrieval was possible in 8 (50.0%) patients, and the remaining underwent open cystostomy. CONCLUSION: Intravesical foreign bodies should be included in the differential diagnosis of patients with chronic lower urinary tract problems. Radiological evaluation is necessary to determine the exact size, number, and nature of them. The most suitable method for removal of intravesical foreign bodies depends on the nature of the foreign body, age of the patient, and available expertise and equipment. Most intravesical foreign bodies can be retrieved with minimally invasive techniques. (+info)
Retraction of an intrathecal baclofen infusion catheter following suprapubic cystotomy: a case report.
(4/10)
Ganglioneuroma in the urinary bladder of a dog.
(6/10)
An 11-year-old male Labrador retriever presented with chronic oliguria. Ultrasonography findings revealed a protruding mass at the neck of the urinary bladder. A cystotomy was performed, and the mass was removed by ligation with surgical sutures. Histopathological examination revealed conspicuous foci with a variable number of ganglion cells in the tumor and abundant interwoven bundles of schwannian cells with fine fibers. The ganglion cells were positive for neuron-specific enolase and neurofilament. The schwannian cells were positive for vimentin, S-100 protein, and glial fibrillary acidic protein. Thus, according to the classification of tumor with neuronal cell differentiation, the urinary tumor was diagnosed as a ganglioneuroma. (+info)
Brachytherapy after external beam radiotherapy and limited surgery preserves bladders for patients with solitary pT1-pT3 bladder tumors.
(7/10)
Unusual presentation of the urogenital myiasis caused by Luciliasericata (Diptera: Calliphoridae).
(8/10)
INTRODUCTION AND OBJECTIVE: The case report describes the unusual presentation of the urogenital myiasis caused by Luciliasericata in two Slovakian men. MATERIAL AND METHODS: The first patient, aged 66, who suffered from a locally advanced and inoperable urinary bladder dedifferentiated TCC with bilateral ureteral obstruction, chronic renal insufficiency and non-functioning left kidney. After surgical exploration the patient developed a malignant vesico-intestino-cutaneous fistula with stool leakage through the open wound. Because of very poor hygiene, and unsatisfactory attendance by staff, a fly deposited ova in the patient's necrotic wound. The patient died three months later of metastatic cancer disease. The second patient, a 43-year old homeless alcoholic male had gangrene of the scrotum and penis, urethro-cutaneous urinary fistula with numerous live and motile larvae on the surfaces. In both patients, some larvae were removed and sent to the lab for identification. The larvae were identified as maggots of the fly Luciliasericata. Antibiotic therapy, disinfection and debridement with sterile covering of the wound were used. RESULTS: For both patients, complex treatment of myiasis was successful and patient recovered without parasitic consequences. CONCLUSIONS: To our knowledge, this is the first report of the unusual presentation of the urogenital myiasis in Slovakian men with poor social habits and hygiene. (+info)