Single-Layer Sutures in Abdominal Cavity Surgery.

The aim of our study was to evaluate of short-term outcomes of 4210 patients who underwent open abdominal surgery with used either single-layer, absorbable, or continuous sutures. Seromuscular anastomosis were presented (without mucosa). Fluid therapy: GDT and zero-balance GDT were also discussed. Anastomosis leakage developed in 6 patients. They were treated by creating a stoma. Simultaneously, septic shock was treated. Re-anastomoses were performed after some time and after sepsis was suppressed. Results of treatment with use of double-layer sutures, which was is use before 1978, were presented. Analysis of 536 patients treated at the same time was conducted and 53 patients with anastomosis leakage was identified. Out of this group, 2 patients survived. Based on the literature review, the methods for performing anastomosis. Attention was paid to the advantages of single layer over multi-layer sutures: effectiveness, simplicity and lower cost of treatment. The occurrence of mechanical ileus was less frequently observed since ceasing to employ peritoneoplasty, and preoperational preparation of gastrointestinal tract in patients had a beneficial influence on their postoperative course. Postoperative complications were discussed mainly based on additional examinations such as TC and MRI. The attention was focused on the importance of medical observation and clinical examination by an experienced surgeon in order to identify postoperative complications. Antibiotic treatment in cases of postoperative complications was presented, as well as fluid therapy: GDT, zero-balance GDT and the procedures employed in cases of complications such as: anastomosis leakage, mechanical ileus, inter-peritoneal abscess. Anastomotic stenosis was not observed in this group of patients.

Fournier's Gangrene: Clinical Presentation of 13 Cases.

BACKGROUND Fournier's gangrene (FG) is a fulminant form of infective, polymicrobial, necrotizing fasciitis of the perineal, genital, and perianal regions. It commonly affects men, but women and children may also develop this type of tissue necrosis. MATERIAL AND METHODS This study is a retrospective analysis of the management of 13 cases of Fournier's gangrene, diagnosed from among about 45 000 patients (men, women, and children) treated in the Department of General, Oncological, and Functional Urology (Medical University of Warsaw) from 1995 to 2013. All patients with Fournier's gangrene underwent adequate surgical debridement of the necrotic tissues. Additional procedures (suprapubic cystostomy and orchiectomy) were necessary in 10 out of 13 (77.0%) patients. Seven out of 13 (53.8%) patients required subsequent reconstructive surgery of the scrotum. RESULTS All 13 patients were males, with a median age of 59.6 years (range: 42-68 years). The average hospital stay was 31.9 days (range: 16-46 days). None of our patients died due to Fournier's gangrene. Bacteriological cultures of samples from the wounds showed polymicrobial flora, including the following genera of aerobes and anaerobes: Escherichia, Proteus, Klebsiella, Moraxella, Gemella, Enterococcus, Streptococcus, Staphylococcus, Bacteroides, Pseudoflavonifractor, Parabacteroides, Porphyromonas, Prevotella, Peptoniphilus, Peptostreptococcus, Actinomyces, Collinsella, and Lactobacillus. CONCLUSIONS Favorable outcome of FG treatment with low morbidity and no mortality can be achieved with rapid diagnosis, urgent surgical debridement of all necrotic tissues, and broad-spectrum empirical antimicrobial therapy, usually with combined antibiotics, against aerobic and anaerobic bacteria. Prevention of uroseptic shock by treating localized infection is compulsory.

Fournier's gangrene--current concepts.

Fournier's gangrene (FG) is a rapidly progressive form of infective necrotising fasciitis of the perineal, genital, or perianal regions, leading to thrombosis of the small subcutaneous vessels and necrosis of the overlying skin. It is believed that the occurrence of the disease in women is underreported and may be unrecognised by some clinicians. Fournier's gangrene is a life-threatening condition, constituting an urological emergency. Many patients with Fournier's gangrene have medical or surgical conditions, which are predisposing factors to this disease or its more severe or fatal course. These comprise diabetes mellitus, hypertension, alcoholism and advanced age. Recent reports in the literature point to changes in the epidemiology of FG, comprising an increasing age of patients. Several authors reported that the mean age of FG patients is at present 53-55 years. Prognosis in FG patients is based on FGSI (Fournier's gangrene severity index) score. Despite the progress in medical care for FG patients, the mortality rate reported in the literature remains high--most often 20-40%, but ranges from 4% to 80%. The most common isolates cultured from FG lesions are both Gram-positive and Gram-negative, as well as strictly anaerobic bacteria. Recently community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as an etiological agent of FG with severe clinical course and even fulminant sepsis. Rarely FG may have a fungal etiology, being caused by yeast-like fungi Candida spp. or by moulds. Antibiotics should be administered parenterally and in doses high enough to reach an effective concentration in the infected tissues.

Nested variant of urothelial carcinoma of renal pelvis - a case report.

We report a case of an 80-year-old woman with a very rare subtype of urothelial carcinoma - nested variant of urothelial carcinoma mimicking physiological von Brunn's nests. Optimal treatment of NVUC has not been determined due to the small number of cases, as well as the lack of randomized and follow-up studies. In our case the right retroperitoneal nephroureterectomy was chosen.

Lack of usefulness of ureteral reconstruction with free bladder mucosa flap in dogs confirmed by microangiography.

BACKGROUND: There is a paucity of data addressing the blood supply in the surgically reconstructed ureter, and complete lack of microangiographic studies of the reconstructed ureter with the use of a free bladder mucosa flap. The present study evaluated the blood supply in the reconstructed dog ureter after a 5-centimeter segment resection, supplemented by a tube constructed from a free bladder mucosa flap. MATERIAL AND METHODS: Female mongrel dogs (n=29) were used in this study. Under general anaesthesia, a 5-centimeter autologous free bladder mucosa flap was used to construct a tube, which was afterwards grafted to replace a 5-centimeter ureter resection. After a period of 3 months (n=2) and after 1 year (n=2), microangiography was performed to assess the revascularization of the grafted ureter. RESULTS: In our study, we observed the continuity of the ureter, but the grafted reconstruction was narrowed by the cicatrization in about 86% (n=25) of cases. This resulted in the development of hydronephrosis, as described in previous publications. The ureteral wall was covered by a normal urothelium, but consisted of fibrous connective tissue, which failed to restore a regular (normal) coat. The reconstructed segment showed no smooth muscle cells. A few smooth monocytes were found only at the border with intact portions of the ureter. The microangiography performed at the end of the experiments showed no vascularization of the restored segment of the ureter. CONCLUSIONS: The experiments showed a whole regeneration of urothelium in the transected and reanastomosed ureters. However, there was no regeneration of the muscular coat and a complete lack of revascularization.

[Epididymitis after prostatic adenomectomy--24-years observations]. / Zapalenie najadrzy po operacjach gruczolaka stercza--obserwacje 24-letnie.

MATERIAL AND METHODS: Authors have retrospectively reviewed records of 6811 patients with BPH treated during the last 24 years who underwent suprapubic and transurethral adenomectomy to evaluate the incidence of postoperative epididymitis. RESULTS: Only in 44 cases was diagnosed acute postoperative epididymitis (0.64%). Most commonly the postoperative epididymitis was noted following transvesical adenomectomies (1.53%), less commonly following retropubic (Millin's) surgery (1.09%), and most rarely following transurethral resection of the prostate (TURP) (0.11%). It was observed that the postoperative epididymitis was closely associated with urinary tract infections (UTI). The most common pathogen isolated in the postoperative epididymitis were Gram negative bacteria. No difference was noted between two groups (our patients without prophylactic vasectomy compared with the data from literature with prophylactic vasectomy) in the incidence of postoperative epididymitis. CONCLUSIONS: Incidence of postoperative epididymitis decreased significantly in the last two decades. Surgical techniques that allow for a shorter postoperative catheterization resulted in less frequent urinary tract infection which in turn led to decrease in the postoperative epididymitis. A course of suitable antibiotic therapy often permits to cure postoperative epididymitis without a need for surgery (70.45%). Vasectomy as the routine prophylactic intervention prior to prostatic surgery is no longer indicated.

[Adenomatoid tumors of the testis and epididymis]. / Guzy adenomatoidalne jadra i najadrza.

The authors report 8 adenomatoid tumors treated in the Urology Department of the Medical Academy of Warsaw by organ sparing surgery during 1985-2003. Microscopic and immuno-histochemic investigations confirmed their benign character and histiogenesis. Follow-up of 6 treated patients, over 5-15 years did not reveal recurrence of the neoplasm. Two patients were treated this year and are under medical observation.