ABSTRACT
STUDY DESIGN: A preliminary report. OBJECTIVES: Urinary stress incontinence following implantation of an anterior root stimulator and a posterior rhizotomy is a rare complication which is difficult to treat. It is seen in patients with an open bladder neck (T9-L2 lesion). An artificial urinary sphincter is a possible treatment for this condition but has a higher failure rate in patients with neurogenic bladder disease and could complicate micturition. SETTING: Ghent, Belgium. METHODS: A male paraplegic patient (T9, complete lesion) aged 36 was suffering from severe urinary incontinence due to detrusor hyperreflexia. Preoperatively the bladder neck was closed on cystography. Following implantation (6/95) of an intradural anterior root stimulator with posterior rhizotomy, severe urinary stress incontinence presented. Bilateral S3 foramen leads were implanted and connected to a pulse generator. RESULTS: The patient has been continent with continuous stimulation of both S3 roots for 4 years, and no fatigue of the levator muscles has been seen. Preoperative urodynamics are compared to results 3 years postoperatively. CONCLUSION: Bilateral S3 stimulation is a feasible and minimally invasive treatment of urinary stress incontinence following implantation of an anterior root stimulator.
Subject(s)
Electric Stimulation Therapy/methods , Postoperative Complications/therapy , Rhizotomy/adverse effects , Spinal Cord Injuries/complications , Spinal Nerve Roots/physiopathology , Urinary Incontinence, Stress/therapy , Adult , Electrodes, Implanted/adverse effects , Humans , Male , Spinal Nerve Roots/surgery , Treatment Outcome , Urinary Incontinence, Stress/etiology , UrinationABSTRACT
The authors report a rare case of renal arteriovenous malformation (rAVM) which was diagnosed by arteriography years after onset of intermittent haematuria. The rAVM of the cirsoid type was superselectively catheterized and embolized in toto with n-butyl 2-cyanoacrylate. Diagnostic imaging modalities and the technique of embolization are discussed.
Subject(s)
Arteriovenous Malformations/therapy , Embolization, Therapeutic/methods , Enbucrilate/therapeutic use , Kidney/blood supply , Tissue Adhesives/therapeutic use , Adult , Angiography , Arteriovenous Malformations/complications , Arteriovenous Malformations/diagnosis , Colic/etiology , Female , Follow-Up Studies , Hematuria/etiology , Humans , Kidney Diseases/etiology , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Ultrasonography, Doppler, Color , UrographyABSTRACT
A review of the literature of the last 5 years on retroperitoneal fibrosis is given. MRT seems to add to the exact extend of the disease and galliumscintigraphy can give new information on the activity of the process and the usefulness of medical therapy. The use of corticosteroid or other immunosuppressive drugs such a azathioprine, again is confirmed. Other drugs mentioned in the medical therapy are methotrexate, cyclophosfamide and penicillamine. A few cases responded well to tamoxifen, a drug which was already used in therapy of desmoid tumours. Medical treatment is anyhow superior to surgery alone.