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Biomedical subjects

T Sundin

Publications and source records attributed to T Sundin.

At least 19 recordsLinked to original sources
PubMed1995

Delayed management of posterior urethral disruption in children.

OBJECTIVE: To review the results of delayed operative treatment of total disruption of the posterior urethra in children. PATIENTS AND METHODS: Twelve boys (3-12 years, mean 7.5) with a suprapubic catheter were referred after primary management in other hospitals. All but one had been involved in road traffic accidents. In addition to their urethral injury, they all had pelvic fractures and the majority also had other major associated injuries. Six to 14 months after injury, abdominoperineal transpubic urethroplasty was performed in 11 patients according to Turner-Warwick. In one case a perineal anastomotic urethroplasty was performed. RESULTS: After the operation, voiding cysto-urethrography showed a wide anastomosis in all cases. After 3 to 45 months follow-up, there were no strictures. Eight boys were continent, two were totally incontinent, two had stress incontinence and one nocturnal enuresis. All patients with confirmed erections after injury also had erections after their operation. CONCLUSION: Primary suprapubic cystostomy and delayed repair can be used successfully for the treatment of posterior urethral disruption in children.

Accidents, Traffic↗
PubMed1995

Augmentation cystoplasty after cesarean hysterectomy for placenta previa-percreta.

We report a case of a 38-year old woman with placenta previa-percreta and urinary bladder invasion. Resection of the bladder wall during cesarean hysterectomy was complicated by a postoperative vesico-vaginal fistula and small-capacity bladder. A reconstructive augmentation cystoplasty utilizing the ileum was successful in improving the bladder capacity. To our knowledge, this is the first report of a placenta previa-percreta with bladder wall invasion which required reconstructive augmentation cystoplasty after cesarean hysterectomy. The obstetrician-gynecologist should be aware of reports of complications related to augmentation procedures, including late malignancy which may develop in the bowel segment used for cystoplasty.

Adult↗
PubMed1994

Ureteral injury secondary to laparoscopic CO2 laser.

A case of a 32-year-old nulligravida who underwent a carbon dioxide laser-laparoscopy for endometriosis is reported. Ureteral injury was complicated by a postoperative 'urinoma'. Injury occurred despite utilizing the hydrodissection technique destined to create a bed of water beneath the peritoneum to prevent laser beam penetration to adjacent normal tissue. This case illustrates that the hydrodissection technique may be less effective in the presence of severe endometriotic adhesions and fibrosis.

Adult↗
PubMed1993

The valved S-shaped rectosigmoid pouch for continent urinary diversion.

Continent urinary diversion to the valved S-shaped rectosigmoid pouch was performed in 9 female and 6 male patients 12 to 65 years old (mean age 51 years). The pouch was constructed by detubularization and S-shaped reconfiguration of 30 cm. of the intact rectum and sigmoid colon. The ureters were reimplanted into the pouch using antireflux techniques. Reflux of urine from the pouch to the proximal colon was prevented by fashioning an intussusception valve. The construction was protected by a transverse colostomy for 6 to 8 weeks. With a followup of 3 to 24 months (mean 11 months), all patients are continent during the day and also at night with evacuation intervals of 3 to 6 hours. There have been no cases of symptomatic urinary tract infection. Only 1 patient had mild hyperchloremic acidosis. No patient complained of abdominal distention or constipation. Contrast study via the anus (radiography of the pouch) showed that the intussusception valve was competent in all but 1 patient in whom reflux to the proximal colon was noted due to sliding of the nipple valve, which was revised successfully. Urodynamic studies (cystometry of the pouch) showed a capacity of 400 to 900 ml. (mean 600) with an intraluminal pressure of 22 cm. water (range 10 to 34) at maximal filling. The valved S-shaped rectosigmoid pouch is a faster and simpler surgical procedure compared with the modified rectal bladder (valved rectum augmented with ileum). It also results in a smooth postoperative course, since an intestinal anastomosis proximal to the colostomy is avoided.

Adolescent↗
PubMed1993

Placenta percreta with bladder invasion: report of three cases.

Three cases are reported of placenta percreta with urinary bladder wall invasion. All three patients had complete placenta previa and each had five previous cesarean sections. Placental invasion caused a giant vesicouterine fistula in the first case. The second patient had a cesarean hysterectomy and the placental portion that penetrated the bladder wall was left to absorb spontaneously. The third patient underwent a cesarean supracervical hysterectomy during which the bladder invasion was left undisturbed. She received intraoperative methotrexate, and pelvic packing and bilateral hypogastric ligation were helpful in hemorrhage control.

Adult↗
PubMed1992

Spontaneous bladder rupture after colocystoplasty. Case report.

An 18-year-old girl had bladder extrophy managed by sigmoid cystoplasty with clean intermittent catheterization. Spontaneous bladder rupture occurred 12 months after reconstructive surgery. The diagnosis was made by ultrasound with abdominal tapping and cystography under fluoroscopy. Management included intravenous antibiotics, laparotomy and closure of the perforation. The diagnosis was delayed and postoperative intraperitoneal abscess formation occurred.

Adolescent↗
PubMed1987

Balloon dilatation of bilharzial ureteric strictures.

Balloon dilatation was performed in nine patients with bilharzial ureteric strictures. In six patients a percutaneous, antegrade approach was used and in three a balloon catheter was introduced into the ureter via a cystoscope. In another four patients, negotiation of the strictured area with a guide wire failed. In all dilated patients, symptomatic and urographic relief of the obstruction was obtained during follow-up periods of 3 to 38 months (mean 19). One patient was re-dilated after 24 months and has remained symptom-free for a further 18 months. Balloon dilatation seems to be a promising method of treating this condition.

Adult↗
PubMed1986

Studies on renal damage from percutaneous nephrolitholapaxy.

To study in detail the effects of percutaneous nephrolitholapaxy on renal function, a consecutive series of 11 patients were investigated preoperatively by excretory urography, gamma camera renography for determination of individual renal function and computerized tomography of the kidneys. Postoperatively, gamma camera examination, computerized tomography, antegrade nephrostography, renal angiography and excretory urography were performed. With 2 exceptions, percutaneous nephrostomy, dilation of the tract and stone removal were done in 1 stage with the patient under continuous epidural anesthesia. Nephrostomy tract dilation was done with an Olbert type balloon catheter or Alken metallic dilators. Thickening of Gerota's fascia was demonstrated by computerized tomography in most cases, and small to moderate perirenal hematomas were found in several. At gamma camera examination decrease of renal function was noted regularly on postoperative day 1 and returned to near initial levels 2 weeks postoperatively in most cases. Angiography in 10 patients showed discrete parenchymal scarring in some and a peripheral arteriovenous fistula in 1. We conclude that percutaneous renal stone surgery usually is tolerated well by the kidney.

Adult↗
PubMed1986

Cardiovascular complications of estrogen therapy for nondisseminated prostatic carcinoma. A preliminary report from a randomized multicenter study.

In a prospective multicenter study, 244 men with highly or moderately differentiated prostatic cancer in stage I, II or III (VACURG) were consecutively randomized to three groups of treatment: Group A (77 patients) received polyestradiol phosphate (Estradurin, Leo) 80 mg i.m. every fourth week + ethinyl estradiol (Etivex, Leo) 150 micrograms daily, group B (72 patients) estramustine phosphate (Estracyt, Leo) 280 mg twice daily, and group C (76 patients) no therapy. Only men without current or previous other malignancy and without cardiovascular disease were admitted to the study. After 4 1/2 years 125 of the 244 patients had left the study, 9 because of cancer progression (stage IV, VACURG). The most serious complications were cardiovascular, including ischemic heart disease, cardiac decompensation, cerebral ischemia and venous thromboembolism, which occurred in 24 patients from group A and 9 from group B as compared to only one patient in group C. The subgroup superficial or deep venous thrombosis comprised 11 group A and 2 group B patients. Estrogens (E + e) offered as palliative treatment to patients with non-generalized prostatic carcinoma is burdened with a high incidence of serious cardiovascular complications.

Aged↗
PubMed1984

Supersensitivity to carbachol in the parasympathetically decentralized feline urinary bladder.

We investigated the concentration-response relations for carbachol, the morphological characteristics and the mechanical properties of feline detrusor strips from 1) normal cats, cats subjected to 2) parasympathetic sacral decentralization, 3) urinary diversion followed by parasympathetic sacral decentralization and 4) urinary diversion only. Hypertrophy of the detrusor and supersensitivity to carbachol (a decrease of EC50) were found only after parasympathetic decentralization. No hypertrophy developed and no change in the EC50-value for carbachol was found if urinary diversion preceded the parasympathetic decentralization. A decreased ability of force production per unit cross sectional smooth muscle area was found in the decentralized bladders compared to the controls. However, the total ability of force production and hence also pressure production of the decentralized bladders would be expected to be enhanced due to a 4 to 5-fold increase of bladder weight (mainly muscle mass). No differences in the active length-tension relations were found in the 4 groups. It is suggested that parasympathetic decentralization per se does not give rise to detrusor hypertrophy or increased sensitivity to carbachol. Provided that the situation in man is comparable to that in the cat, it might be that the supersensitivity test a.m. Lapides-Glahn reflects the presence of detrusor hypertrophy rather than the presence of a neurogenic lesion.

Animals↗
PubMed1984

Continent caecal reservoir in urinary diversion.

Construction of a continent urinary reservoir was attempted in 18 patients with carcinoma of the bladder. The caecum was used as the reservoir and an intussuscepted ileal nipple was created to provide continence. Fifteen patients are alive and have been observed for 7 to 68 months. The most common complication was malfunction of the nipple valve with urinary leakage and/or difficulty in catheterisation. Revision of the outlet was performed one or more times in 11 cases. The technique of nipple valve construction was successively evolved, with improvement in the functional results. Stricture of one uretero-intestinal anastomosis occurred in three patients. Construction of a continent caecal reservoir is a complex procedure and the problem of a stable, continence-ensuring mechanism in the outlet has not been conclusively solved. The enhanced quality of life offered by a successful continent reservoir nevertheless warrants continued clinical trials in selected patients.

Adult↗
PubMed1984

Renal function after urinary diversion. A study of continent caecal reservoir, ileal conduit and colonic conduit.

Total and separate renal function, renal parenchymal thickness and dilatation of the upper urinary tract were studied in 40 patients preoperatively and 24 to 67 months after urinary diversion, using 51Cr-EDTA clearance test, scintillation camera renography and urography. In ten patients a continent caecal reservoir was used for diversion. In the other patients, an ileal or a colonic conduit (15 patients with each method) was used, one ureter being implanted with an anti-reflux method and the other with direct technique. Renal function following urinary diversion showed little or no deterioration in most patients. The functional outcome was not related to the method of diversion or, in the conduit groups, to the mode of ureteral implantation. Serum creatinine tests and urography were not adequate for determining loss of renal function. Radionuclide studies proved to be valuable for assessing renal function after urinary diversion.

Adult↗
PubMed1983

Island patch urethroplasty: effects on urinary flow and ejaculation.

Seventeen patients had a single-stage operation for urethral stricture. To avoid recurrence (which occurred in 2 patients) the urethra should be opened not only through the stricture but well beyond the pathological cavernous tissue. In 3 patients it was not possible to reconstruct the bulbocavernosus muscle over the bulb. This resulted in urethral pouching which did not interfere with micturition, except for after-dribbling, but prevented forceful ejaculation and the semen leaked slowly for several minutes. Excision of the apex of the scrotal skin flap to the island patch seems to prevent marginal skin necrosis.

Adolescent↗