Biomedical subjects
Publications and source records attributed to N Stomaci.
The authors report a case of locally recurrent renal carcinoma after partial nephrectomy, with bench surgery. Despite its interest, conservative surgery of renal carcinoma is limited by the risk of local tumor recurrence.
A series of 33 posterior urethral strictures in children is presented. The etiology was traumatic in 31 cases and iatrogenic in 2. Complex strictures were treated by a transpubic approach (20 cases) or by a posterior scroto-urethral inlay (1 case). Simple strictures were directly treated via the perineum: by a push-in technique (6 cases); by end-to-end anastomosis (3 cases); by a skin pedicled tube urethroplasty (1 case); by free skin graft (1 case), and by endoscopic urethrotomy (1 case). The use of omentum, employed in 19 cases, is considered a necessary step in transpubic urethroplasty. Favorable results were observed in 18 out of 20 transpubic procedures, in 8 out of 9 perineal urethroplasties and in 3 out of 4 other techniques, with an overall success rate of 87.8%.
Experience with treatment of 38 patients in an early phase with urethral trauma is presented. The site of injury was the penile urethra in three cases, the bulbous urethra in seven, and the prostatomembranous urethra in 28. Different surgical procedures were used, according to the site and the extent of urethral damage and the presence of associated lesions. All patients with penile and bulbous urethral trauma were cured and only one has diminished sexual potency, while in the posterior urethral group nine were cured, and 19 developed strictures requiring further surgical treatment. Total impotence developed in 17 and partial impotence in one patient. Another case presents urinary urge incontinence.
A new technique for the treatment of female stress urinary incontinence is described. It consists of colposuspension obtained by suprapubic placement of two double monofilament sutures in a spiral fashion on the lateral vaginal walls, which are fixed proximally to a Cooper's ligament and tied distally one to the other over the rectus fascia. This technique has been successfully employed in a preliminary series of 26 patients and it appears to be easy to perform and with a wide application range.
A new procedure with the use of a free skin patch graft for the surgical treatment of strictures located in the mid anterior urethra is described. To avoid the formation of a urethral diverticulum, the skin graft is sutured dorsally rather than ventrally and subsequently is fixed on the tunica albuginea of the corpora, which support the patch. We describe 4 different procedures according to the extent of the stenosis and the degree of involvement of the spongiosum tissue by the inflammatory process. The preliminary results obtained in a small series of 6 patients are presented.
The metabolism of antipyrine was studied in 13 patients with cancer and bladder papillomas and in 11 control subjects, matched for interfering factors like smoking, diet, age and sex. The mean antipyrine half-life was significantly longer in patients with urinary tract cancer (14.7 +/- 1.32 h SE) than in control subjects (11 +/- 0.55 h SE) (P less than 0.025); other clinical parameters did not vary.
Between January 1975 and December 1981 we treated 34 men with urinary incontinence with surgical intercavernous embedding of the bulboperineal urethra along its entire length. The etiology of incontinence was sphincteric damage following either prostatectomy (30 cases) or pelvic trauma (4 cases). All patients had complete neurologic integrity of the detrusor, 25 (75 per cent) had complete urinary continence, 5 (15 per cent) experienced considerable improvement, while 4 were failures. Followup ranged from 7 years to 4 months. Details of the surgical procedure are described, preoperative and postoperative management is emphasized and results are presented.
We report 2 cases of bladder hernia following repair of complex posterior urethral strictures by transpubic bulboprostatic anastomosis and omentoplasty. One patient was treated successfully by repair of the defect with a synthetic mesh. The presence of concomitant pubic diastasis is thought to be a contributing factor, as well as the use of omentum to fill the dead space.
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