PURPOSE: The usefulness of the pubovaginal sling procedure as primary treatment of stress incontinence associated with urethral hypermobility (type 2) or intrinsic sphincter deficiency (type 3) was determined. MATERIALS AND METHODS: A total of 60 consecutive cases of type 2 or 3 stress urinary incontinence was treated with a pubovaginal sling by 1 surgeon using a previously reported technique. Fluoroscopic urodynamic studies with leak point pressures were used to classify the type of incontinence. Of the 60 women 38 (63%) were diagnosed with type 2 and 22 (37%) with type 3 stress urinary incontience. Of these patients 24 had previously undergone 1 or more anti-incontinence procedures. RESULTS: At a mean followup of 25 months 57 of the 60 patients (95%) were completely continent. In addition, 69% of patients with urgency had resolution of the urgency symptoms following the sling procedure. Transient postoperative urinary retention (median duration 6.5 days) was present in 60% of the patients. However, all women subsequently voided spontaneously without requiring further intermittent or Foley catheterization. Other complications occurred infrequently, and included urinary tract infection (13% of cases), de novo urgency (12%) and persistent incisional pain (5%). CONCLUSIONS: These early results suggest that the pubovaginal sling is a safe and effective treatment for primary or recurrent type 2 or 3 stress incontinence. The most worrisome complication, urinary retention, occurred temporarily in more than half of the patients but eventually resolved in all cases, usually within 10 days.

Adult↗

PubMed1996

Cystic dysplasia of the testis: an unusual cause of a pediatric scrotal mass.

OBJECTIVES: To describe a case of cystic dysplasia of the testis (CDT), an uncommon cause of scrotal swelling in the pediatric patient. Clinical, radiographic, and pathologic findings are discussed and the 10 previously reported cases are reviewed. METHODS: A 4-year-old boy presented with asymptomatic scrotal swelling and was found to have a palpable mass in the upper pole of the right testicle with evidence of partial transillumination. A scrotal ultrasound revealed testicular enlargement with multiple cystic changes suggesting teratoma and operative exploration was recommended. RESULTS: Intraoperative findings included a multicystic mass in the right testicle with minimal normal testicular parenchyma. Subsequent inguinal orchiectomy was performed and pathologic examination revealed a benign, multilobulated configuration of cysts in the region of the rete testis with atrophy of the surrounding testicle. These findings were similar to those found in previously reported cases of CDT. Ipsilateral renal agenesis, a commonly associated anomaly, was also discovered in our patient. CONCLUSIONS: CDT is a rare cause of the pediatric scrotal mass that requires a high index of suspicion for diagnosis based on well-described clinical and sonographic findings. When feasible, a testicular-sparing approach should be considered and all patients should undergo evaluation for associated urologic anomalies.

Child, Preschool↗

PubMed1995

Neurourologic consequences of accidental intrathecal vincristine: a case report.

Inadvertent intrathecal administration of vincristine results in severe neurotoxicity. Motor and sensory bladder dysfunction have been reported but the long-term urologic consequences are unknown due to the associated high mortality. We report a case of accidental intrathecal vincristine administration with patient survival and follow-up of 24 months. The child developed a lower motor neuron neuropathic bladder requiring intermittent self-catheterization of the bladder. Urinary tract management of these children should be based on the urodynamic findings.

Child↗

PubMed1993

Enterocystoplasty in renal transplantation candidates: urodynamic evaluation and outcome.

In anticipation of renal transplantation 11 patients with end stage renal disease and small volume, poorly compliant bladders underwent enterocystoplasty. The etiology of bladder dysfunction included myelodysplasia in 4 patients, posterior urethral valves in 4 and vesicoureteral reflux in 3. Mean patient age at the time of bladder augmentation was 16.4 years (range 10 to 28). Detubularized bowel segments were used in all patients and included ileum in 7, ileocecal segment in 3 and sigmoid in 1. Urodynamic evaluation before and after enterocystoplasty demonstrated marked improvement in bladder capacity and compliance. These 11 patients have received 13 renal transplants with an 85% graft survival at a mean followup of 30.1 months. No bladder ruptures or other perioperative complications have occurred. All patients remain continent on clean intermittent catheterization. Our experience suggests that enterocystoplasty is a safe and effective method of restoring lower urinary tract function in the patient with end stage renal disease and a small, noncompliant bladder.

Adolescent↗

PubMed1992

Objective treatment response to endocrine therapy in metastatic prostate cancer.

A ten-year review of 198 patients with Stage D2 prostate cancer identified 13 patients (6.6%) who exhibited objective responses to hormonal treatment, as indicated by regression of a positive bone scan, CT scan, or chest x-ray film. Four patients had complete responses and 9 patients achieved partial responses as judged by the National Prostatic Cancer Project criteria. Median survival for those with objective treatment response has not yet been reached (> 44 months) compared with twenty-four months for the nonresponders (p = 0.00006). Although relatively uncommon, objective treatment response in Stage D2 prostate cancer is correlated with an improved prognosis.

Adenocarcinoma↗

PubMed1988

Elevated arterial blood pressure in survivors of liver transplantation treated with cyclosporine and corticosteroids.

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Adrenal Cortex Hormones↗