Biomedical subjects
Publications and source records attributed to L Jarolím.
A case of tumoriform endometriosis of urinary bladder immitating a tumor of the bladder during the first pregnancy of a 25-year-old patient was successfully treated by partial cystectomy allowing continuation of the pregnancy, a normal term delivery and after 5 months a second pregnancy with term delivery.
Sulcus nervi dorsalis penis/clitoridis is a groove on inferior ramus of pubis and ventral surface of the body of pubis, where dorsal nerve of penis in male and dorsal nerve and artery of clitoris in female run. Close relation of the dorsal nerve of penis/clitoris and pubis, represented by the course of sulcus nervi dorsalis penis/clitoridis has a major impact in surgical disciplines. Exact preparation of the dorsal nerve of penis is crucial in correct performance of conversion of genitalia in patients with transsexualism, in reconstruction of posterior urethra, in hypospadia, during performance of penile blockade during circumcision and in revascularization surgery of erectile dysfunction. The role of sulcus nervi dorsalis penis in the Alcock's syndrome is discussed. Similarly, it is advisable to take care of the dorsal nerve of clitoris inside sulcus nervi dorsalis clitoridis during reduction clitoridoplasty in patients with adrenogenital syndrome and during the insertion of transobturator vaginal tape. Injury of dorsal nerve of penis/clitoridis leads to hypestesia or anestesia of glans penis/clitoridis. The injury of dorsal artery of clitoris leads to hematoma. It is possible to use sulcus nervi dorsalis penis/clitoridis in sexing of isolated pubis from antropological or forensic purposes. Lateral border of sulcus nervi dorsalis penis/clitoridis corresponds to vertical ridge and lateral border of sulcus nervi dorsalis clitoridis to ventral arc--two parameters, which are part of the Phenice's method for sexing of isolated pubis.
OBJECTIVE: Case presentation of bladder endometriosis during 2nd trimester imitating urinary bladder tumour. SETTING: Mother and Child Care Institute, Prague. III. Medical School of Charles University, Prague. CASE REPORT: 25-years old patient, 2nd trimester of first pregnancy. TREATMENT: Partial bladder cystectomy. RESULT: Complete recovery succeded by term delivery. CONCLUSION: Tumouriform endometriosis of urinary bladder successfully treated by partial cystectomy allowing normal term delivery.
OBJECTIVE: To evaluate the role of BTA stat, BTA TRAK, UBC Rapid, UBC IRMA and voided urinary cytology in the detection of bladder transitional cell carcinoma (TCC). METHODS: The study included 78 patients with TCC of the bladder (group A), 62 patients with a history of bladder TCC without tumor recurrence at the time of examination (B, control group), 20 patients with other malignancy of the urinary tract (C), 38 patients with non-malignant urinary tract diseases (D), 10 patients with urinary tract infection (E) and 10 healthy volunteers (F). Except in group F, voided urine was collected before cystoscopy or cystectomy. RESULTS: The specificity and sensitivity in bladder cancer detection were 87.1 and 74.4%, respectively with BTA stat, 79.3 and 48.7%, respectively with UBC Rapid, 100 and 33.3%, respectively with cytology, 72.6 and 75.6%, respectively with BTA TRAK, 64.5 and 70.5%, respectively with UBC IRMA. CONCLUSIONS: The BTA stat and BTATRAK tests are superior to UBC Rapid, UBC IRMA and urinary cytology in detection of bladder TCC. In daily practice however cytology remains the best adjunct to cystoscopy because of its high sensitivity in Tis and 100% specificity. Cystoscopy cannot be replaced by any of evaluated methods.
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OBJECTIVE: To describe the techniques and outcome of genital and urethral reconstructive surgery during gender conversion as part of the treatment of transsexuals. PATIENTS AND METHODS: From 1992 to 1999, 82 patients were surgically converted after previous sexual and hormonal therapy. Using the male genital tissue to create new female genitalia, and vice versa, 30 male and 52 female transsexuals were converted. For male-to-female transsexuals, the technique of penile skin inversion was used 29 times and sigmoidocolpoplasty five times (in one patient primarily and in four patients to correct inadequate neovaginal size after penile skin inversion). In female-to-male transsexuals, 28 meta-idoioplasties and seven neophalloplasties were performed using the groin skin-flap technique, with 42 breast reductions also included as a part of the therapy. RESULTS: Surgical gender reassignment of the male transsexuals resulted in replicas of female genitalia which enabled coitus with orgasm. Depending on the technique used in the reverse conversion, the patient maintained the ability to attain orgasm, and in many cases had a satisfactory appearance of the neopenis, with the potential to void while standing. CONCLUSIONS: The morphological proportions of each patient vary, and the different shapes and sizes of the tissues can be used for plastic operations. Thus the modelling of each individual genital in transsexuals can be considered 'original'.
OBJECTIVES: Intact innervation of the female urethra is conditional for normal urination. In the past, urethrectomy was performed as part of cystectomy. After intense anatomical studies of the female pelvis, urethral-function-sparing cystectomy was developed. METHODS: Our clinical group consists of 41 female patients who were operated from 1993 to 1998 for bladder cancer, utilizing cystectomy with orthotopic bladder replacement. RESULTS: In 28 patients, complete daytime continence was restored and in 13 patients, daytime continence was socially satisfactory (1-2 pads were used due to mild stress incontinence). The drawback of orthotopic replacements in females is the frequent development of serious residual volume, which was seen in one third of the 41 patients. The functional results of orthotopic neobladders and therapy of residual urine volume were documented using urodynamic studies. CONCLUSIONS: Postvoiding residual volume may be caused by isolated dysfunction of the urethra and can be treated with clean intermittent self-catheterization or with alpha-blockers, which improve evacuation of the neobladder.
The standard diagnostic and staging evaluation of prostate cancer includes digital rectal examination, transrectal ultrasonography (TRUS), serum prostate-specific antigen (PSA) level measurement, abdominal pelvic CT and radionuclide bone scan. Magnetic resonance imaging (MRI) (especially endorectal magnetic resonance) opens new possibilities for diagnostic imaging of the prostate. It seems to be better for detecting seminal vesicle invasion. Unfortunately, sensitivity in evaluation of minor capsular and seminal penetration is low and differentiation between haemorrhage, chronic inflammatory, fibrotic changes and tumours is impossible.
BACKGROUND: The first extirpation of the urinary bladder on account of malignant papilomatosis was carried out by Karel Pawlik in 1889 as the first one in the world. At present cystectomy is indicated usually because of an infiltrating carcinoma of the urinary bladder. The objective of the present paper is, based on anatomical investigations, elaboration of a surgical technique of creating a orthotopic neovesica following cystectomy sparing a functional female urethra. METHODS AND RESULTS: In 1993-1998 32 women were operated within the age bracket of 32-72 years with a confirmed infiltration carcinoma of the urinary bladder. The authors describe in detail their own surgical technique. Day continence was achieved in 20 patients. Twelve patients suffer from stress incontinence. Eight patients have a post-micturition residue of 250-300 ml calling for a combination of medicamentous treatment and autocatheterization. The capacity of the neovesicle is the cause of nycturia: 21 patients must micturate once or twice during the night. Urodynamic studies did not reveal significant differences between patients with chronic post-miction residues and without residues. Also the mean functional length of the urethra was in both groups similar (27 mm in patients with a residue and 26.2 mm in patients without a residue). CONCLUSIONS: The elaborated surgical technique of cystectomy and creation of a neovesica makes a good quality of the patients' life possible.
Injury of the ureter is the most frequent trauma in urological practice. The most important deal concerning a patient's expectancy is early diagnosis and adequate treatment. During 1994-1998 the authors have treated 65 patients with diagnosis an injury of the ureter. The most frequent cause was the iatrogenic injury. Timing of surgery was 5-6 weeks. A percutaneous nephrostomy was the most frequent method of initial treatment (38 patients). Ureterorhaphy (32 patients), ureterocystoneostomy (12 patients) and Boari's flap operation (5 patients) was the most frequent definitive method of the treatment.
Surgical conversion of sex in transsexuals implies basically removal of the testes or uterus and creation of the opposite genital. At the Urological Clinic of the General Faculty Hospital and First Medical Faculty, Charles University in Prague during the period from 1992-1998 18 male and 29 female transsexuals were operated. In male transsexualism 17 times the technique of inversion of penile skin was used and in one instance sigmoideoplasty. In female transsexualism 17 metaidoioplasties were made, three plastic operations of the neophallus from inguinal skin flaps and 25 reducing mammaplasties.
OBJECTIVE: Orthotopic bladder replacement after cystoprostatectomy has long become the method of choice in the treatment of infiltrating bladder cancer in males. Very good quality of life in patients thus treated stimulated the work on a similar approach applicable to females. METHODS: Twelve females were treated by urethra-sparing cystectomy. The surgical technique preserves not just the urethra itself but also the pelvic floor and relevant innervation. RESULTS: Diurnal continence was achieved in 11 patients, 1 of whom had a so-called hypercontinence with a residual volume of 300 ml. The remaining patient suffered from stress incontinence. CONCLUSION: The described urethra-sparing radical cystectomy in female patients with a urothelial tumor, with normal pelvic floor and with a low risk of secondary affection of the urethra, permits reconstructing a continent orthotopic neobladder from a detubularized intestinal segment.
The changing etiology of ureteral lesions is associated with the expanding spectrum of ureteroscopic, gynaecological, coloproctological and vascular operations. During 1989-1995 the authors treated 60 women with a ureteral lesion, mostly in conjunction with gynaecological operations (37 patients). The assessment of the diagnosis was sometimes delayed. The most frequent initial treatment was the establishment of percutaneous puncture nephrostomy (in 47 instances before delayed reconstruction). The authors discuss the time interval between the development of the ureteral lesion and its reconstruction. The most frequent treatment was ureterorhaphy, ureterocystoneoanastomosis or Boari's flap.
The authors discuss treatment of vesicovaginal fistulae (VVF) in 36 patients and in six patients urethrovaginal fistulae treated in 1989-1995. The most frequent cause of VVF were iatrogenic lesions after hysterectomy. Occlusion of the fistula was performed 12x by the transvesical approach, nine times by a combined transperitoneal and vaginal approach, four times by a transvesical and transperitoneal approach, eight times by the vaginal route only and three times the authors had to make a continent derivation of urine of the sigma-rectum "pouch" type. Continence by primary operation was achieved in 86%, in urethrovaginal fistulae one reoperation was necessary. With the development of radical operations in the lesser pelvis in women the incidence of iatrogenic lesions is rising slightly, however when the technique of minimal invasive reconstruction urology is used, the prognosis of occlusion of fistulae is favourable.
The authors evaluated 165 radical retropubic prostatectomies, which have been performed at the Department of Urology of the 1st School of Medicine, the Charles University and the General Faculty Hospital in Prague, from January 1992 until half of April 1997. After more precise indication criteria have been implemented, even more per cent of patients are operated in clinical T1c stage (only in this year it was up to 45%). Out of all, in 56 patients PSA exceeded 20 ng/ml, in 46 patients, there was proved seminal vesicles invasion and in 29 patients, there have been disclosed regional lymph node involvement. The postoperative decline of PSA below the 4.0 ng/ml within three months was recorded in 80% of patients with seminal vesicles involvement, but only in 69.2% of patients with nodal invasion. It may indicate the worse prognosis of latter patients. Nowadays we perform the routine peroperative staging lymphadenectomy provided PSA exceeds 10 ng/ml preoperatively and in case of presence of cancerous cells in regional lymph nodes, we do not proceed in the operation and the patient is indicated to another therapeutical modality.
Urinary diversion following cystectomy on account of carcinoma of the bladder are pretentious surgical operations involving the risk of early and late complications. The authors made a retrospective analysis of 198 cases. Death during the early postoperative period was recorded in 3 patients (2x ileus and 1x pulmonary embolism). Other early complications were dehiscence of the intestinal anastomosis (3x), dehiscence of the skin would/3x) and pneumonia (3x). Clinically relevant late complications were ileus due to adhesions (4x), stenosis of the ureteroenteric anastomosis (21 ureteroenteric units and urolithiasis (6x). Metabolic acidosis was recorded frequently (19x). Complications were more frequent in patients with advanced disease and in a poor biological state.
BACKGROUND: The continent reservoir is an ideal urinary diversion in patients after cystectomy. The artificial closing mechanism construction in these reservoirs is rather complicated and the results are uncertain. The objective of the present work is to assess own experience with a relatively simple rectosigmoid reservoir created by a method described by M. Fisch. METHODS AND RESULTS: Since 1992 till 1995 the sigma-rectum detubularized reservoir was performed in 30 patients. The intricating bladder cancer was an indication for the operation in 27 patients and the other bladder diseases in 3 patients. The patients age ranged from 18 to 75 years. Diurnal continence was achieved in all 30 patients. 12 of them have to awake during the night to evacuate the reservoir 1 to 3 times. CONCLUSIONS: Sigma-rectum pouch is a good form of cintinent diversion in such patient, which are not suitable for orthoscopic neobladder because of oncologic limitation or bad general conditions. The patients tolerate the procedure very well, heal and adapt quickly to new evacuating mechanisms.
Since 1993 till 1995 cystectomy preserving the urethra in twelve female patients with infiltrating bladder cancer was performed. The patients age ranged form 32 to 72 years. The female urethra sparing radical cystectomy includes removal of the bladder together with the uterus and ovaries and resection of the anterior vaginal wall. The condition for preserving of the function of the urethra is its integrity including corresponding innervation and intact pelvic floor. The neobladder is made of a detubularized ileal segment and anastomosed with the urethra. Diurnal continence was achieved in 11 patients, one of them has so called hypercontinence with residual volume of 300 ml. One patient suffers from stress incontinence. The functional characteristics of the orthotopic neobladder in the operated females are very favourable. The risk of further affliction of the retained urethra with an urothelial tumor is possible to influence by a choice of selected patients for the overmentioned procedure.