A computational analysis of the effect of supporting organs on predicted vesical pressure in stress urinary incontinence.

Stress urinary incontinence (SUI) or urine leakage from urethra occurs due to an increase in abdominal pressure resulting from stress like a cough or jumping height. SUI is more frequent among post-menopausal women. In the absence of bladder contraction, vesical pressure exceeds urethral pressure leading to urine leakage. The main aim of this study is to utilize fluid-structure interaction techniques to model bladder and urethra computationally under an external pressure like sneezing. Both models have been developed with linear elastic properties for the bladder wall while the patient model has also been simulated utilizing the Mooney-Rivlin solid model. The results show a good agreement between the clinical data and the predicted values of the computational models, specifically the pressure at the center of the bladder. There is 1.3% difference between the predicted vesical pressure and the vesical pressure obtained from urodynamic tests. It can be concluded that the accuracy of the predicted pressure in the center of the bladder is significantly higher for the simulation assuming nonlinear material property (hyperelastic) for the bladder in comparison to the accuracy of the linear elastic model. The model is beneficial for exploring treatment solutions for SUI disorder. Graphical abstract 3D processing of bladder deformation during abdominal pressure of a the physiological model and b the pathological model (starting from left to right and up to down, consecutively).

Supradiaphragmatic Inferior Vena Caval Thrombectomy Without Cardiopulmonary Bypass: A Case Series at a Single Center.

INTRODUCTION: Inferior vena cava tumor thrombectomy in renal cell carcinoma patients is a challenging procedure, frequently requiring the vascular bypass technique for high-level thrombi with additional complications. Adopting a technique such as intrapericardial control in selected cases will circumvent these problems. Here, we present the results of our intrapericardial control technique during supradiaphragmatic inferior vena caval tumor thrombectomy. CASE PRESENTATION: The records of six patients with supradiaphragmatic tumor thrombi, who underwent radical nephrectomy and thrombectomy at our center with intrapericardial control between the years 2008 and 2015, were retrospectively reviewed. The patients' characteristics, intra- and postoperative data, histology, and follow-up records were gathered and compared. There were no immediate or 30-day postoperative deaths. The mean age of the patients was 61.3 years (range 46 - 75). The total mean duration of surgery was 315 minutes and the mean amount of transfused red blood cells was 4.33 units during surgery and 0.8 units in the postoperative period. The average hospitalization duration was 8 days (range 5 - 17). Tumor stage was T3 in four patients and T4 in two, due to ipsilateral adrenal involvement. The mean duration of follow-up was 33.5 months. Only one of the patients developed recurrences, first in the tumor bed and then at the site of the skin incision; these were excised with no apparent complications. CONCLUSIONS: Radical nephrectomy and tumor thrombectomy by intrapericardial control without cardiopulmonary bypass and hypothermic circulatory arrest is a safe and effective procedure that can avoid serious intra- and postoperative complications while providing acceptable cancer-control and mortality results.