Joint venture surgery of a giant inguinoscrotal hernia in a patient suffering from trisomy 21 and Eisenmenger's syndrome.

A 44-year-old man with Trisomy 21 and Eisenmenger's syndrome underwent surgery due to a life-threatening scrotal hernia, containing the bladder, bilateral hydroceles and part of the sigmoid colon. Joint venture plastic and urologic surgery was performed with reposition of the bladder and sigmoid colon into the abdominal cavity, bilateral inguinal hernial mesh repair, left sided orchiectomy, excision of bilateral hydroceles and excision of a major part of the scrotum and recreation of the original anatomy of the penis and scrotum. This Case presents a successful outcome achieved as the patient after one-step-surgery was left to normal condition.

Urinary diversion in the treatment of refractory bladder pain syndrome.

Objectives: This study investigates the effect of urinary division in patients with bladder pain syndrome (BPS) refractory to conservative treatment. This study aimed to identify pre-operative predictive factors regarding the surgical outcome in patients undergoing urinary diversion with or without cystectomy (CX).Methods and patients: This study included 30 patients with BPS treated with a urinary diversion in the period from 2002-2017 at a single university hospital. The surgical procedure was selected on an individual basis, including both continent and non-continent diversions and primary procedure with or without concomitant CX. Pre- and post-operative data were registered retrospectively through medical chart review.Results: Eight patients were treated with primary CX and eight had secondary CX within a short time following urinary diversion (1.45 years in median), mainly due to persisting pain. However, more than half the patients were successfully treated with urinary diversion alone throughout the follow-up period (estimated 58% after 12 years). Nine patients were prior to surgery diagnosed with Hunner's lesions, and these had significantly greater pain relief compared to the remaining 21 patients (p = 0.02). The higher success rate of the bladder-preserving procedure was suggested in patients older than 48 years (p = 0.09) with less pain pre-operatively, estimated by less than three opioids prior to the procedure (p = 0.01).Conclusions: Surgical treatment with urinary diversion should be taken into consideration for refractory BPS, especially patients diagnosed with Hunner's lesions. These results support a bladder-preserving strategy unless the patient is young or has severe treatment refractory pain pre-operative.