Reimplanted ureter as an alternative to the catheterizable Mitrofanoff tube.

OBJECTIVE: We performed this study in dogs to investigate whether a ureter can be used as an alternative to the appendix without disrupting the uniformity of the gastrointestinal system. MATERIALS AND METHODS: This study comprised 10 adult healthy female mongrel dogs. The procedure was done in 2 stages: in the first stage, we performed a left-end cutaneous ureterostomy at the lower left quadrant just above the inguinal ligament. A second operation was performed 6 weeks later. The left ureter was divided and using Paquin's technique, the proximal end of the distal third of the left ureter was reimplanted in the anterolateral surface near the dome of the bladder. A high transureteroureterostomy with the remaining left proximal ureter to the opposite ureter completed the reconstruction. The bladder neck was ligated in order to create an experimental bladder outlet obstruction. At the time of creating the distal ureteral stoma, a feeding tube was left in the bladder, passing through the ureterostomy stoma and sutured to the skin. This catheter remained in place for 20 days, preventing the bladder form distending. Then in the following 6 months, intermittent catheterization was applied through the stoma at 3- to 4-hour intervals. Exploration was performed at the end of the 6th month. RESULTS: No animal died. The dogs were still continent. Intravenous urography, urea and creatinin values were normal. The ureteral stoma was viable in all 10 cases. Stenosis of the ureteral stoma developed in 1 dog and required surgical revision. Possible traumatic effects were investigated by histological sections, but no harmful effects were found at the ureteral endothelium. CONCLUSION: This method may be an alternative to the Mitrofanoff method, which uses the appendix.

Ureterocystoplasty in bilaterally functional kidneys.

OBJECTIVE: Traditional augmentation cystoplasty using gastrointestinal segments is known to be associated with metabolic abnormalities and alterations in the bladder causing potential carcinogenesis. In this respect alternative techniques have been searched preferably lined by urothelium. We performed ureterocystoplasty in 7 patients with a diagnosis of neurogenic bladder and investigated the clinical and functional aspects. PATIENTS AND METHODS: Between 1995 and 1999, ureterocystoplasty was performed using both ureters in 4 male and 3 female children with bilaterally functional kidneys. Patients' ages varied between 1 and 7 (mean 4.7) years. Before the operation all the children were incontinent, had a small-capacity noncompliant bladder, and high-grade (IV-V, International Classification System) reflux on voiding cystouretrography (VCU). Technetium-99m DTPA renal scintigraphy was also performed in all children to evaluate renal function before and after the operation. RESULTS: Before the operation the mean end-filling intravesical pressure was 45.6 (35-60) cm H(2)O which decreased to 18.9 cm H(2)O 3 months postoperatively. The mean bladder capacity 3 months after ureterocystoplasty was found to be 279.3 (250-330) ml. All the children were continent and VCU showed the absence of reflux. There was mild to moderate improvement in renal function after surgery in both kidneys on technetium-99m DTPA renal scintigraphy. Three (43%) patients could void spontaneously with abdominal straining, whereas 4 (57%) children could empty their bladders by clean intermittent catheterization. A double-J stent was inserted in 1 (14%) patient because of a rise in serum creatinine after the removal of the ureteral catheter. Patients were followed for a mean period of 30 (8-50) months and all the children remained continent. The bladder capacity and end-filling pressure measurements were also stable. CONCLUSION: Ureterocystoplasty was found to be an effective method for bladder augmentation in bilaterally functional kidneys with an acceptable complication rate

Is there significance of the choice of prone versus supine position in the treatment of proximal ureter stones with extracorporeal shock wave lithotripsy?

OBJECTIVE: To determine whether there is a significance of the choice of prone versus supine position in the treatment of proximal ureter stones with extracorporeal shock wave lithothripsy (ESWL). METHODS: Ninety-six patients with proximal ureter stones underwent ESWL. The procedure was performed in the supine position in 48 of them (group 1) and in the prone position in the other 48 patients (group 2). Stone-free rates, repeat ESWL rates, shocks per patient and shocks per session were compared in both groups. RESULTS: The mean session number per patients was 1.64+/-0.75 in group 1 and 1. 33+/-0.59 in group 2 (p = 0.224). The stone-free rates 3 months after ESWL were 88.3% in group 1 and 90.6% in group 2. The difference between the results was statistically insignificant (p<0.05). Therefore, these two parameters were similar in both groups. On the other hand, the number of shocks per session was 4,863.54+/-2, 114.85 in group 1 and 3,704.16+/-1,726.75 in group 2. This difference was statistically significant (p = 0.011). The patients tolerated the supine position better in general. Patients in the prone position experienced discomfort on inspiration and expiration and pain localized to the lumbar vertebrae. CONCLUSION: These results suggest that the supine position decreases the number of shocks per session in the treatment of proximal ureter stones with ESWL and this will be cost-effective.

[Isolated ureteropelvic junction laceration following blunt body trauma]. / Künt vücut travmalarini takiben izole üreteropel vik bileske (UPJ) yaralanmalari.

The purpose of the study is to investigate the radiologic and clinical treatment methods following the rarely seen UPJ laceration due to blunt body trauma. In this study there are eight patients with isolated UPJ laceration, admitted to Gülhane Military Medicine Academy, Firat University Medical Faculty Urology department, and Elazig Military Hospital Urology Service. They are one child (12 years old) and 7 adults (6 male, 1 female) ranged 18-61 years old. Abdominal USG(Ultrasonography), IVP(Intravenous Pyelography), abdominal CT(Computed Tomography), and retrograde-antegrade pyelography were used for diagnosis. They were treated with percutaneous nephrostomy, double J stent implantation and reconstructive open surgical procedures. All patient were cured with the culmination of urinary extravasation and ureteropelvic patency.

[Missed ureteral injuries following surgical exploration with percutaneous nephrostomy and drainage treatment]. / Cerrahi eksplorasyon sonrasi gözden kaçirilan üreter yaralanmalarinda perkütan nefrostomi ve drenaj ile tedavi yaklasimi.

Twelve patients with missed ureteral injury and urinoma due to gunshot are evaluated following surgical exploration. All 12 had underwent surgical exploration at the other hospitals on admission. Fever, malaise, shocking chills, leucocytosis due to urinoma formation are the findings in the late postoperative period and CT (computer tomography) scan revealed urinoma. Intravenous urograms are nondiagnostic in 6 of patients and hematuria is detected in 6(%50) Percutaneous nephrostomy is emphasized as the first step of management for these lately diagnosed ureteral fistulas. Additionally, Urinoma is drained percutaneously. Hence we save the patients from a second operation following severe gunshot trauma. The presence of shock, intraoperative bleeding, colonic injury and blast effect of high velocity missile with delayed tissue necrosis are the cause of missed ureteral injury. At 8 patients, nephrostomy was the solution and total cure is achieved. Mean follow-up period after nephrostomy is 3 months. At 2, we perform psoas-hitch and ureteroneocystostomy, at one psoas-hitch, boary- flep and ureteroneocystostomy and at one ureteroureterostomy due to long ureteral obstruction on urinary fistula. As a conclusion, when treating missed ureteral injuries with urinary fistula and urinoma formation following complicated surgical intervention, percutaneous nephrostomy application and percutaneous drainage of urinoma may be the first step for management. Late surgical reconstitution is the second step when needed.

Embolization therapy in two subtypes of priapism.

Two subtypes of priapism have been described based on the pathophysiologic mechanism. The more common type, termed stasis priapism, is characterized by a low flow state in which inadequate venous outflow creates an acidotic hypoxic environment leading to a painful prolonged erection. The other less common subtype, high flow priapism, is arteriogenic. We used embolization therapy in one case with long lasting stasis priapism and in the other with high flow priapism due to bilateral arteriosinusoidal fistulae in the penis. In both cases we used polyvinyl alcohol for embolization and sexual potency preservation. Priapism is the persistence of erection that does not result from sexual desire. Hauri et al. described two variants of priapism. In high flow priapism (non-ischaemic) there is unregulated arterial inflow to the lacunar spaces due to a lacerated cavernous artery associated with previous perineal and penile trauma. In stasis priapism, the second type, the basic abnormality could be due to a more pronounced or prolonged blood entrapment inside the vascular spaces of the corpora cavernosa sustained by an unknown cause. There are many treatment methods especially for low flow ischaemic variant. We report two different kinds of priapism and embolization therapy in both of them with polyvinyl alcohol.

External vacuum device therapy for spinal cord injured males with erectile dysfunction.

Neurogenic factors contributing to erectile dysfunction may be found in up to 20 per cent of organically impotent men. Although many options have been suggested for the treatment of some of these problems in male patients, most are invasive and have substantial morbidity. Our study group comprised 32 patients with spinal cord injury. These 32 patients with neurogenic impotence, who had been injured at least one year previously and had a regular sexual partner were evaluated. We selected external vacuum therapy as the treatment modality. During the initial phase of the study, six patients refused treatment due to negative cultural perception and they were excluded from the study group. Four patients discontinued treatment because of minor complications such as ecchymoses, petechiae and lack of motivation. Our data suggest that external vacuum therapy is a feasible, safe, noninvasive alternative and possibly a better initial treatment for the management of impotence secondary to spinal cord injury.

Surgical treatment of urethral diverticula in men.

Two 21-year-old men were treated for congenital diverticulum at the bulbous portion of the anterior urethra. One of the diverticula contained a stone. Acquired anterior urethral diverticulum with ventral displacement of the penile shaft following repair of hypospadias was treated in a 21-year-old man. Correction of the defect involved ventral paramedian vertical incision, excision of the diverticulum with closure at the urethra, and traction sutures for the ventral penile displacement.

A pseudotumour of the bladder. Case report.

A case of pseudotumour involving the bladder is presented. The differential diagnostic importance of the lesion is stressed.

Negative pressures in surgical drains.

Laboratory and clinical experiments were done to measure the pressure in tube drains. It was found that the fluid in drains connected to floor bags exerted a negative pressure equal to the height of the fluid column in the tube. There was no negative pressure when the drain opened into a urostomy bag at wound level. It is suggested that this negative pressure might tend to maintain a urinary fistula once a leak in the suture line has begun.