Bladder cancer in the spinal cord-injured patient with long-term catheterization: a casual relationship?
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Biomedical subjects
Publications and source records attributed to C J Bennett.
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We describe a myelodysplastic woman with a Kock continent ileal reservoir who suffered parastomal herniation of the pouch following high dose infusion computerized tomography. Prophylactic indwelling catheterization in patients with continent diversion undergoing procedures that induce significant diuresis or involve prolonged distension of the reservoir is probably indicated.
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Transrectal electroejaculation was performed in 24 men who were anejaculatory from retroperitoneal lymphadenectomy. Of the men 23 had undergone retroperitoneal lymphadenectomy because of testis cancer. Seminal emission was achieved in all patients. In 21 patients greater than 10 x 10(6) progressively motile sperm with normal morphology were obtained. The average sperm count and motilities obtained were 289 x 10(6) and 18%, respectively, for the antegrade fractions, and 2,051 x 10(6) and 13%, respectively, for the retrograde fractions. Of the 3 azoospermic failures 2 had chemotherapy-induced testicular damage and 1 had carcinoma in situ of the remaining testis. A total of 19 couples underwent artificial insemination with electroejaculated sperm. There were 7 pregnancies achieved in 74 insemination cycles (36.8% of the couples conceived for a 9% cycle fecundity). Routine semen parameters could not predict which couples would be successful in achieving pregnancy. There were 2 first trimester spontaneous abortions. Five healthy children have been born. Electroejaculation is an excellent treatment for anejaculation that persists following retroperitoneal lymph node dissection.
Seven couples underwent combined electroejaculation and in vitro fertilization for anejaculatory infertility after a failed regimen of electroejaculation and intrauterine insemination. Two pregnancies resulted, one proceeding to a term vaginal delivery and one ending in a 6-week spontaneous abortion. Poor sperm binding and no fertilization were seen in two of the couples. Fertilization of the oocytes but no subsequent pregnancy were seen in the other three couples. Combined in vitro fertilization and gamete intrafallopian transfer was performed in four of the couples. The combination of electroejaculation and in vitro fertilization offers the opportunity to evaluate the female pelvis, observe the sperm-oocyte interaction, and achieve a pregnancy in couples with anejaculatory infertility.
Ten spinal-cord-injured males who exhibited autonomic dysreflexia during electroejaculation were given sublingual calcium channel blocker nifedipine pretreatment to prevent this complication. Nifedipine was successful in decreasing peak systolic, diastolic, and mean blood pressures during the procedure. The use of nifedipine resulted in fewer aborted trials and allowed higher energy delivery during the procedure.
Rectal probe electroejaculation was attempted in 48 spinal cord injury men and greater than 10 million sperm were obtained in 71%. Patient age and interval since injury had no effect on outcome. The best performance was seen in thoracic paraplegics and in those using intermittent catheterization for bladder management. Indwelling urethral catheters and high pressure reflex voiding had a negative impact on electroejaculation results.
This paper examines empathy as a practice component that is particularly significant in its relationship to self-determination in the discharge process in acute hospital settings. Empathy is also emphasized as an essential ingredient to a psychosocial assessment that leads to accurate problem formulation and preciseness in planning. Current theories on empathy are discussed in a literature review, while pertinent practice issues are presented in several case vignettes. Theory and practice confirm that empathic skills can develop on both sentient and cognitive levels over time. This development is enhanced by supervision that utilizes the worker's capacity for self-awareness.
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In summary, a vasectomy is a safe, simple, and effective method of male contraception without any known long-term health hazards. Because of its simplicity, it is performed in more than 500,000 patients per year, mainly in a physician's office, making it a very cost-effective contraceptive method. With the introduction of the microscope into the operating suite of the urologist, this procedure that was once considered permanent is amenable to reversal at a later date.
Semen obtained by electroejaculation was used to achieve pregnancies in the spouses of T5-6 and T4-5 paraplegics. Viable semen was recovered in both an antegrade and retrograde fashion. In both cases, the SPA test was positive. Semen recovered for AIH IUI was washed and swum up prior to insemination.
In July 1983 pubovaginal slings were used first at our university to treat incontinence in female patients with poor urethral function. From then until July 1, 1986, 82 such procedures were performed on a diverse group of patients, including a male patient. Initial success occurred postoperatively in 67 patients, with 15 failures. Of these failures 7 were related to urethral dysfunction. Another sling procedure was done in 2 patients and they are continent, while 3 were treated with medication: 2 became dry and 1 remains wet. A total of 8 patients suffered detrusor-related incontinence postoperatively (2 required augmentation cystoplasty for poor bladder compliance). To date 78 patients (95 per cent) are continent. Of the patients 2 required periodic intermittent catheterization for more than a year postoperatively and 12 are managed by chronic intermittent self-catheterization on a planned basis for neurogenic vesical dysfunction.
Electroejaculation with a rectal probe was used successfully for semen recovery 8 years after bilateral suprarenal hilar lymph node dissection for stage IIB embryonal cell cancer. An adequate ejaculate was obtained in relation to total sperm count, motility and normal morphology. Prior use of sympathomimetic drugs, including imipramine and ephedrine, was unsuccessful in producing an ejaculation. Electrostimulation via a rectal probe seems to be a useful technique for semen recovery in the patient with anejaculation after retroperitoneal lymph node dissection.
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