Unusual lower GU tract gunshot injuries - abstract

With over 100 gunshot injuries seen at the University Hospital of the West Indies and the Kingston Public Hospital annually and with lower GU injuries occurring in approximately eight per cent of cases, it is not surprising that unusual trauma pathology will occur in this region. Described are four cases seen over a six-month period where the courses of the bullets almost defy an anatomical explanation. In two, the entry site was in the buttock with entry into the bladder through the posterior wall without causing bowel injury. In another, the entry wound was also lodge in the lumen of the bulbous urethra. In the other case, the skin entry wound was in the lower anterior abdominal wall with exit through the posterior inferior wall of the urinary bladder just above the mid trigone, again somehow avoiding bowel to finally lodge in the buttock. It is impossible to explain any of the above pathology if it is assumed that the bullets travelled on a straight course. Seemingly, their trajectories were altered, allowing the path of least resistance to be taken, thereby pushing structures with mobile walls out of their way. It is theoretically possible that the high pressure area that precedes a high velocity bullet pushes mobile structures out of harm's way (AU)

Splinter in the urine

A nine-year-old boy sustained a penetrating injury to the perineum. He later presented with urinary tract infections and a history of passing splinters in the urine. Investigation revealed a foreign body in the urinary bladder, and at suprapubic cystotomy splinters of wood and fragments of cloth were removed. (AU)

Bladder neck stenosis: the value of descending cysto-urethrography in the demonstration of this complication of inflammatory stricture

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)

The early management of the bladder in young male paraplegics - abstract

The cause of urinary problems in the management of paraplegia is infection. This infection is iatrogenic and is introduced via a catheter. For some years the Spinal Unit at the University Hospital of the West Indies has been treating paraplegics without the use of a catheter. The patient is put on a regime of manual decompression as soon as he is admitted to the Unit. A history and physical examination are done to exclude the possibility of urethral obstruction or damage. The chief objection to this method of treatment is that the intravescical pressure generated by manual decompression is enough to cause ureteric reflux and finally impaired renal function. The renal function of paraplegics of over three years who had been treated by manual decompression of the bladder was investigated. The blood urea of all patients treated by manual decompression was normal, whereas of those treated by prolonged catheterised had urinary infection but of those treated by manual decompression only one patient had urinary infection. The patients treated by manual decompression all had normal I.V.P.'s and in no case was ureteric reflux demonstrated on micturating cystograms. Manual decompression results in sterile urine and does not damage the urinay tract, urinary problems are caused by infection introduced by a catheter(AU)

Retropubic prostatectomy in patients with long standing suprapubic cystostomy

Sixteen patients with gross urinary sepsis and anaemia who had been treated previously by permanent suprapubic drainage that was in adequately managed were subjected to retopubic prostatesectomy. One patient died from a coronary thrombosis. Five patients developed urinary fistulae which healed within a week of catherer drainage. Even where facilities are poor, a condition which obtains in many of the hospitals in this area, a permanent suprapubic cystostomy is never justified as definitive treatment for benign prostatic hypertrophy. The majority of patients can withstand a second stage prostatectomy. The results are rewarding (AU)

Cervical pregnancy

A case of cervical pregnancy involving the scar of a previous Caesarean Section and invading the bladder is presented. Criteria dor diagnosis and alternative methods of treatment are reviewed. A reliable method of management which prevents haemorrhage in these cases could not be found in the available literature (AU)

Some problems of cystometry

Cystometry is performed to evaluate deranged bladder function. In paraplegics the results are not always consistent with their clinical progress, nor have the results of treatment based on such tests always been satisfactory. The methods used involve a catheter in the urethra connected to a water manometer or a pressure recording device (Band 1956). At the same time filling of the bladder is artificially carried out by running in saline through the same catheter. This introduces several possible errors, and to avoid some of these, Comarr has used the normal excretion of the kidneys to fill the bladder (Comarr 1959) whilst von Garrelts uses a fine polythene tube in the urethra, instead of a catheter (von Garrelts 1956). Preliminary experiments have been made to record the pressure changes via a suprapubic polythene tube, avoiding a urethral catheter altogether. In this way a record of detrusor function unaffected by abnormal reflexes initiated at the level of the sphincters can be obtained (AU)

Ureterocele: a case report

A case of a large ureterocele in an adult male is reported. The ureterocele was complicated by hydronephrosis and hydroureter and multiple ureteral calculi, and the patient presented with gross hematuria and retention of urine due to calculus obstruction of the urethra. Treatment was by ureterocelectomy and removal of the calculi. The literature was reviewed. (Summary)