Fibrin sealant for the management of genitourinary injuries, fistulas and surgical complications.

PURPOSE: We report our preliminary experience with the use of fibrin sealant to manage iatrogenic urinary tract injuries, complex urinary fistulas, and urological surgical complications. MATERIALS AND METHODS: Topical fibrin sealant was used in 19 patients for iatrogenic urinary tract injury during gynecological or general surgical procedures (7), complex urinary fistulas (5) or urological surgical complications (7). RESULTS: Successful resolution of the injury, fistula or complication was attained after a single application of fibrin sealant in the 18 patients (94.7%) in whom a direct injection technique was used. The only failure (formation of a vesicovaginal fistula) occurred with the air driven sprayed sealant delivery technique after sutured closure of iatrogenic cystotomy during vaginal hysterectomy. CONCLUSIONS: Liquid fibrin sealant appears to be safe and prudent for use in urological "damage control" from trauma, fistulas or surgical complications. Direct injection over a sutured urinary anastomosis appears to be highly effective in preventing urinary drainage. Additional study is needed to define further the role and best use of tissue adhesives in urology.

Prospective long-term results and quality-of-life assessment after Dura-II penile prosthesis placement.

OBJECTIVES: To evaluate prospectively the long-term device reliability and patient satisfaction after Dura-II malleable penile prosthesis implantation. METHODS: Between 1992 and 1996, 94 patients underwent Dura-II implantation for erectile dysfunction. Patients were prospectively examined and completed standardized questionnaires regarding sexual activity, prosthesis function, intercourse satisfaction, and overall quality of life. An independent statistician analyzed these data. RESULTS: The mean patient age was 63 years, and the mean patient follow-up was 5.7 years. Eighty-five patients were available for long-term evaluation. Fourteen patients died during the follow-up period. One patient was lost to follow-up, and eight prostheses (9%) were explanted; however, no mechanical defects were found in the explanted prostheses. Seventy-six percent and 87% of patients reported satisfactory rigidity and ease of concealing the device, respectively. Seventy-six percent of patients remained sexually active during the evaluation period, and 87% of patients reported that the prosthesis improved their overall quality of life. Eighty-five percent would undergo the implant surgery again, and 88% percent of patients would recommend the Dura-II prosthesis to a friend. CONCLUSIONS: The Dura-II malleable penile prosthesis provides good rigidity, ability to conceal the device, and mechanical reliability, as demonstrated by the results of this long-term study. Most patients stated they would have the prosthesis placed again and would recommend it to a friend.

Mechanical and antibiotic bowel preparation for urinary diversion surgery.

PURPOSE: We reviewed the existing scientific literature regarding the efficacy of preoperative mechanical and antibiotic bowel preparation for urinary diversion surgery. MATERIALS AND METHODS: We performed MEDLINE searches of the literature from 1966 through 2000 and obtained additional references through a review of the bibliographies of select articles. RESULTS: For urinary diversion surgery information regarding appropriate mechanical and antibiotic bowel preparation is scant. The colorectal surgery literature indicates that oral sodium phosphate appears to be better tolerated than polyethylene glycol and is as effective, although the latter is preferred in patients with compromised renal, cardiac or liver function. A combination of oral and parenteral antibiotics should be used for all urinary reconstructive surgeries involving gastrointestinal tract segments. A parenteral second generation cephalosporin antibiotic should be given within 1 hour of skin incision and repeated at an interval of twice the antibiotic serum half-life or when blood loss exceeds 1 l. CONCLUSIONS: For urinary diversion surgery contemporary methods of mechanical and antibiotic bowel preparation appear to be safe, effective and better tolerated than traditional bowel preparation methods.