Retrograde pyelography via ureteral stents.
Retrograde pyelography to establish ureteral patency prior to removal of ureteral stent can be done via the stent. A simple technique is described.
Catheters, Indwelling↗
Biomedical subjects
I J Fishman
Publications and source records attributed to I J Fishman.
Urinary undiversion and implantation of the artificial urinary sphincter in a 73-year-old man.
We report a case of successful urinary undiversion and implantation of an artificial urinary sphincter in a 73-year-old man, who had undergone ileal loop urinary diversion elsewhere for treatment of urinary incontinence secondary to transurethral prostatectomy. The rationale for our decision to perform undiversion is presented. Evaluation of patient history and physical examination are necessary, as well as delineation of the anatomy and function of the upper and lower tracts by laboratory, radiological and urodynamic examinations. Each undiversion case is unique. Treatment must be individualized and should be initiated only after meticulous weighing of the advantages and disadvantages of the different therapeutic alternatives. A complete explanation to the patient is important. Highly satisfying results can be expected in appropriately selected cases.
Aged↗
Use of fresh placental membranes for bladder reconstruction.
Several biodegradable and artificial materials have been used in the urinary tract for partial or total replacement of the bladder. Most of the graft materials have resulted in stone formation, collapse, rejection, or extrusion of the graft without adequate reconstruction of a functional bladder. In this paper, we present our assessment of the use of placental membranes as a feasible, economic, and acceptable organic agent for bladder reconstruction. Eight mongrel dogs were subjected to supratrigonal cystectomy, and then a 10 X 10 centimeter patch of human placental membrane was sutured to the remaining trigone in a watertight fashion. The dogs were sacrificed twelve weeks after surgery. Histologic examinations revealed evidence of regeneration of normal-appearing smooth muscle along the path of a retracting placental patch, and thus of reconstitution of a normal-appearing and functioning bladder. On the basis of this study, we believe that placental membranes, because of their low antigenic properties and easy availability, provide an excellent graft material for the urinary tract. Further studies concerning the application of this graft material in various pathological conditions are now in progress.
Amnion↗
The use of transrectal longitudinal real-time ultrasonography in urodynamics.
A total of 63 combined transrectal ultrasonographic and urodynamic studies was performed to evaluate the voiding dysfunction in 49 spinal cord injury patients and 7 other patients. Ultrasonography provided excellent real-time imaging of the bladder neck, prostatic urethra, prostate and external sphincter, and allowed for accurate diagnosis of detrusor-sphincter dyssynergia, detrusor-bladder neck dyssynergia, prostatic hypertrophy and bladder neck strictures. In addition to offering these capabilities, ultrasonography is less expensive than x-ray and it does not involve exposure of either the patient or examiner to radiation. However, it does not provide a means to detect vesicoureteral reflux.
Adult↗
Endourological reconstruction of posterior urethral disruption.
While conventional methods of urethroplasty for posterior urethral disruption usually are successful technically, they may be associated with complications and often require the expertise of a specialist. Therefore, the option of an endourological approach to the treatment of the obliterated posterior urethra would be highly desirable if a comparable surgical outcome could be achieved. We describe a closed controlled method of posterior urethral reconstruction following traumatic avulsion of the posterior urethra. Urethral continuity was re-established by endoscopic identification of the true prostatic outlet, its fixation with an angiography wire and a Goodwin sound, retrograde visual urethrotomy through the fibrotic segment and balloon dilation of the entire posterior channel. Postoperative anatomical and functional results were excellent, and were achieved with much less risk and cost to the patient than those of a perineal or transpubic urethroplasty.
Adult↗
Use of human amnion for microvascular interpositional grafts.
A major problem associated with vascular grafting employing an artificial graft is the inflammatory response provoked by the graft and subsequent complications of classical acute rejection phenomena when the graft is implanted subcutaneously into human volunteers. The favorable results obtained by a preliminary study of subcutaneous implantation of amnion in our laboratory have led us to a prospective study to determine its value as a vascular graft. Tubed conduits of glutaraldehyde-treated amnion were hand constructed of varying diameters and lengths. They were employed as segmental interpositional grafts in experimentally created femoral and aortic arterial defects in Sprague-Dawley rats. Patency rates varied from 60 to 90 percent, with all grafts showing remarkable reendothelialization within 3 to 4 weeks postoperatively. Morphology, antigenic reaction, blood flow, and patency of the different experimental amnion grafts were evaluated and compared to appropriate controls.
Amnion↗
Complicated implantations of inflatable penile prostheses.
In conclusion, implantation of an inflatable penile prosthesis into a normal penis is usually a relatively uncomplicated procedure, but the urologist should be aware of the possibility of complications described in this article. He must be familiar with the advantages and disadvantages of the various prostheses and the surgical techniques required to deal with the problems encountered in complicated as well as in routine prosthetic penile implants.
Erectile Dysfunction↗
Lower urinary tract dysfunction after radical hysterectomy for carcinoma of cervix.
The charts of 22 consecutive patients who had undergone radical hysterectomy for carcinoma of the cervix were reviewed retrospectively. Uroflowmetry, gas cystometry, and postvoid residual measurements were performed pre- and postoperatively, and a questionnaire to evaluate urinary problems experienced postoperatively was mailed to all patients. Twenty responses were received and followed up by a telephone interview with the urologist. The number and kind of problems suggest that the cause of urinary dysfunction commonly reported after radical hysterectomy is disruption of nerve supplies to both bladder and urethra. Data on retention suggest that the characteristics of this dysfunction change with time but generally are stabilized by the end of the first postoperative year. It is noted that recurrent urinary tract infection may occur asymptomatically because of loss of bladder sensation. Because of the diversity of presentation, urodynamics played an important role in individualization of treatment and monitoring of progress.
Adenocarcinoma↗
Evaluation of misoprostol cytoprotection of the bladder with cyclophosphamide (Cytoxan) therapy.
Cyclophosphamide is a well established cytotoxic drug used in the treatment of lymphoproliferative disorders, certain solid tumors, and nonneoplastic disorders such as nephrotic syndrome, systemic lupus erythematosus and rheumatoid arthritis. Hemorrhagic cystitis can be a complication of this drug varying between two and 40 per cent. Misoprostol, which is a synthetic prostaglandin E1 analog, was found to significantly decrease the histological damage to the bladder from cyclophosphamide. Male rats receiving misoprostol in conjunction with cyclophosphamide were found to have a reduction in ulceration, inflammation and edema of the bladder walls as compared to those treated with cyclophosphamide alone.
Alprostadil↗
The impact of the artificial urinary sphincter in the neurogenic bladder on the upper urinary tracts.
The charts and x-rays of 120 neurogenic bladder patients who underwent artificial sphincter implantation for treatment of urinary incontinence between 1973 and 1984 were reviewed retrospectively. Patients were followed for 3 to 130 months (average 36.8 months). The upper urinary tracts remained unchanged in 108 patients (90 per cent). Renal growth in children was undisturbed. Transient hydroureteronephrosis occurred in 8 patients (6.7 per cent) and progressive hydroureteronephrosis occurred in 4 (3.3 per cent). A total of 26 patients with vesicoureteral reflux (39 ureters) underwent ureteral reimplantation. Our results indicate that implantation of the artificial urinary sphincter in neurogenic bladder patients has minimal adverse impact on the upper urinary tracts, followup should be long-term and should include an IVP, outflow obstruction should be eliminated preoperatively by means of external sphincterotomy in male patients and bladder flap urethroplasty in female patients, similarly, adequate emptying of the bladder always must be assured during followup, if hydroureteronephrosis is detected early appropriate treatment can restore normal upper tracts, the presence of previously damaged upper tracts without evidence of obstruction is not a contraindication for artificial sphincter implantation and an antireflux operation in combination with artificial sphincter implantation is feasible.
Adolescent↗
Experience with the Hydroflex penile prosthesis.
Based on the author's experience, the Hydroflex penile prosthesis is an excellent addition to the urologist's armamentarium in the management of erectile impotence, where so indicated. As with all prostheses, it does have certain advantages and some limitations when compared with other types of penile prostheses. Simplicity of implantation and rigidity of the phallus is equivalent to that of a rigid type of device. Penile flaccidity and concealment is almost equivalent to that achievable with the IPP in the majority of patients. The quality of erection, ie, the length and girth of the penis, is somewhat less than that achieved with the IPP, but certainly better than with the rigid type of prosthesis. To date, the mechanical reliability of the Hydroflex has been excellent. When presenting the surgical prosthetic options to a patient, it is essential for the urologist to describe the advantages and disadvantages of each one of the various prostheses so that a rational decision can be made. However, it is also important to request the patient's permission for the surgeon to make the final decision at time of surgery, so that the optimal results can be attained.
Erectile Dysfunction↗
Experience with inflatable penile prosthesis.
Prosthesis surgery for management of erectile impotence has become an increasingly important aspect of urology. The inflatable penile prosthesis (IPP) provides the impotent patient with a controllable, natural-appearing and physiologically functional penis. Major modifications in the prosthesis and in the surgical implantation technique have been made since its initial introduction. In this article we present a histologic review of the IPP and our ten-year experience with it.
Adult↗
Prevention of urinary tract infection during intermittent catheterization.
We studied prospectively 40 patients with recent spinal cord injuries to determine the effectiveness of the combination of oral methenamine and an intravesicular acidifying agent for prevention of urinary tract infection during intermittent catheterization. The incidences of bacteriuria and symptomatic urinary tract infections were significantly less in the treated group. This combination appears to be a safe, effective means to reduce pyelonephritis in spinal cord injury patients on intermittent catheterization.
Bacteriuria↗
An inflatable penile prosthesis for treatment of diabetic impotence.
Surgical results have improved considerably since the first implantation of the inflatable penile prosthesis in 1973. The incidence of infection appears to be less than 2% and the overall success rate greater than 95%. With strict attention to details of preoperative preparation and to asepsis, the incidence of infection is probably no greater in the diabetic patient. Although there will always be mechanical problems with this more sophisticated device, the ease with which these problems can be corrected and the advantages of having natural erections, as well as flaccidity, makes the inflatable prosthesis the most desirable treatment for organic impotence.
Adult↗
Anterior urethral diverticulum and hydroureteronephrosis.
Explore the source record for details and available documents.
Adult↗
Management of penile zipper injury.
A penile problem that physicians are confronted with in the emergency room is entrapment of the foreskin by a zipper fastener. A case presentation and a simple technique for its management are described.
Child, Preschool↗
Preoperative irradiation and cystectomy in 135 cases of bladder cancer.
The updated experience of the McGill Teaching Hospitals in treating cancer of the bladder with short course, high-dose radiation and immediate cystectomy is presented. Five-year life table survival for the 135 patients so managed was 43.9 per cent. Survivorship at five years was 34.5 per cent in high-stage disease and 64.1 per cent in low-stage disease. It was concluded that preoperative radiation and surgery as outlined in selected cases remains an effective method of management.
Adult↗