RESUMO
To ascertain the distribution, incidence, management, morbidity and mortality of posterior urethral valves (PUV) in Barbados and the islands of the Eastern Caribbean. The data were obtained through retrospective chart review of cases presenting to Queen Elizabeth Hospital during the years 1981 to 1990 inclusive. Information on 27 cases was available. The majority of these cases (70.37 percent), were from Barbados, but cases came from a total of six territories. From the results, an incidence of 98 per 100,000 in Barbados was estimated. The majority of cases (62.9 percent) were diagnosed after the first year of life. A significant number (33.2 percent) were diagnosed after the age of 10 years. There was no follow-up in 51.85 percent of cases. Of the remainder, overhalf (7/13) suffered complications of PUV or its treatment, and there was one death recorded secondary to the complications of PUV. There is a need for earlier diagnosis to avoid high morbidity and mortality. Closer attention must also be paid to follow-up in order to assess the success of treatment. This also will serve to reduce morbidity and mortality (AU)
Assuntos
Humanos , Uretra , Doenças Uretrais , BarbadosRESUMO
Road traffic, farm and forestry accidents result in numbers of patients with fractured pelvis and disrupted posterior urethra. These patients present a formidable challenge to the urological services. A simple repair of the disrupted posterior urethra is presented. It avoids any difficult extensive perineal dissection which can injure an already compromised sphincteric mechanism, requires no special instruments and is easily performed and taught to others. The technique is a modification of the Blandy-Leadbetter 2-page posterior urethroplasty and utilizes a novel, simple method of flap introduction and fixation. Five men had successful repair, in that they can control passage of urine and are free of drainage catheters. Two of the 5 have proceeded to successful second stage repair and control the passage of urine via the penis. One of the 2 is able to ejaculate normally (AU)
Assuntos
Humanos , Masculino , Uretra/cirurgia , Pelve/lesõesRESUMO
Attention is drawn to fibrotic stenosis of the bladder neck as a complication of inflammatory urethral stricture and ten cases with this complication in a series of 210 cases of urethral stricture are described. Descending cysto-urethrography is essential for the diagnosis and shows a narrow bladder neck instead of the normal funnel shape during the nicturition of the contrast medium. In addition, there is usually gross reflux of contrast medium into the prostatic glands and severe bladder diverticulosis. Ascending cysto-urethrography may show a "jet" effect as the contrast medium enters the bladder. Cases of stricture with bladder neck stenosis have a higher incidence of other complications than those which do not show bladder neck stenosis which suggests that the development of the stenosis may be related to the severity of the stricture. The stenosis is due to fibrosis secondary to chronic infection of the bladder neck tissues. The source of the infection is presumed to be due to the reflux of infected urine into the prostatic glands and this is always marked in cases with bladder neck stenosis. Treatment should consists of urethroplasty and resection of the bladder neck. (AU)
Assuntos
Humanos , Masculino , Bexiga Urinária/diagnóstico por imagem , Obstrução do Colo da Bexiga Urinária/diagnóstico por imagem , Uretra/diagnóstico por imagem , Estreitamento Uretral/complicações , Urografia , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/cirurgia , Uretra/cirurgiaRESUMO
A technique for performing urethograms is described, which is applicable in patients with severe urethral strictures complicated by fistulae. Escape of the dye into veins is discussed. Emphasis is placed on the importance of obtaining descending (or micturating) urethograms without which the urethra proximal to the stricture cannot be adequately outlined (AU)
Assuntos
Humanos , Masculino , Estreitamento Uretral/diagnóstico , Uretra/diagnóstico por imagemRESUMO
The pathology and treatment of 66 severe or complicated strictures of the urethra are reviewed. There is little evidence from this series that lymphogranuloma venereum is an important cause of urethral stricture and its complications. The importance of avoiding the formation of false passages with bougies is emphasized. Fistulous tracks fall into definite patterns. A study of these in association with the urethrograms will allow pre-operative assessment of the extent of the lesions, and therefore of the extent of resection likely to be required. The suggestion is made that when unilateral hydronephrosis is present, obstruction at the lower end of the affected ureter is sometimes the result of infection which spread from the prostate gland or which was initiated by the passage of a bougie outside the urethra posterior to the base of the bladder. Patients with long-standing cystitis in association with stricture of the urethra may develop a carcinoma which is usually squamous celled and situated away from the base of the bladder. Impassable strictures and those complicated by fistula and abscess formation are best treated by excision and anastomosis in one stage when short and situated in the bulbo-membranous urethra, and by two-stage excision and reconstruction when long, multiple or in the penile urethra. (Summary)
Assuntos
Humanos , Pessoa de Meia-Idade , Masculino , Estreitamento Uretral/patologia , Estreitamento Uretral/terapia , Jamaica , Estreitamento Uretral/complicações , Uretra/diagnóstico por imagem , Linfogranuloma Venéreo/etiologia , Testes de Fixação de Complemento , Fístula , Carcinoma , Gangrena , Derivação Urinária , Cirurgia Geral , Cuidados Pós-Operatórios , Cuidados Pré-OperatóriosRESUMO
A series of 8 urethral diverticula diagnosed at the Department of Obstetrics and Gynaecology of the University College of the West Indies in just over one year is described. A review of the literature is presented. Emphasis is made on the frequency with which this condition is overlooked in clinical practice. Investigation shows that most British medical schools do not include any mention of urethral diverticulum in their teaching programmes. Evidence is presented to show that urethral diverticulum is usually of congenital origin (AU)