Risk continues: Very late manifestation of helicobacter pylori at gastric augmented bladder.

Helicobacter Pylori was previously demonstrated at gastric patch after gastrocystoplasty and a possible relationship with acid-haematuria syndrome was established after symptomatic relief by medical treatment. We present the long term outcome of a male bladder exstrophy patient after gastrocystoplasty. There was past history of bladder perforation, acid haematuria syndrome and treatment of HP and recurrent urinary tract infections, noncompliance on regular follow-up and cadaveric renal transplantation. At the preoperative evaluation for renal transplantation HP was present in the biopsy samples collected during gastroscopy and cystoscopy. The significance of persistant HP after gastrocystoplasty in the long term follow-up was discussed.

Long-Term Bleb-Related Infections After Trabeculectomy: Incidence, Risk Factors, and Influence of Bleb Revision.

PURPOSE: To report the incidence of late-onset bleb-related infections and to identify risk factors for bleb-related infections after trabeculectomy for the treatment of glaucoma. DESIGN: Retrospective case series. METHODS: Bleb-related infections were defined as blebitis, endophthalmitis, or blebitis with endophthalmitis. A total of 1959 eyes of 1423 patients who underwent trabeculectomy and who were followed for ≥1 year were included. RESULTS: Twenty-four eyes were diagnosed with bleb-related infections; 15 eyes were found to have blebitis and 9 eyes presented with endophthalmitis during the follow-up period of 5.4 ± 3.5 years (mean ± standard deviation). Among 15 eyes with blebitis, 2 eyes developed endophthalmitis under treatment. The Kaplan-Meier estimated incidence of bleb-related infections was 2.0% ± 0.5% (mean ± standard error) at 10 years. A Cox multivariate analysis showed the significant risk factors for a bleb-related infection to be diagnoses of pigmentary glaucoma or juvenile glaucoma, history of bleb leak, intraocular pressure sustained below the target pressure, chronic blepharitis, and the presence of punctal plugs. Surgical bleb revision demonstrated a protective effect against bleb-related infections (P < .01) when risk factors were present. CONCLUSIONS: This large case series with long-term follow-up demonstrates the incidence of bleb-related infections to be less than 2%, and describes the risk factors associated with bleb-related infections. A protective effect of surgical bleb revision was demonstrated. Clinicians should be constantly vigilant for, and patients made aware of, the possibility of bleb-related infections long after trabeculectomy, especially in the presence of identified risk factors.

The clinical, structural, and biological features of neovaginas: a comparison of the Frank and the McIndoe techniques.

OBJECTIVE: To compare two methods of neovagina construction, the Frank and McIndoe techniques, in terms of structural and biological aspects. STUDY DESIGN: A total of 55 subjects were included in this retrospective study: 43 underwent the Frank technique (FT) and 12 underwent the McIndoe technique (MT). A clinical evaluation and a comparison of the structural (color, shine, presence of hair, and histology) and biological (bacteriological, pH, and hormonal determinations) features were performed. Statistical analysis was performed using the Fisher and Mann-Whitney tests. RESULTS: The time to achieve a functional neovagina using the FT was longer than when using the MT (9.8±5.3 versus 5.8±2.9 months) (p=0.01). The neovaginal wall of the MT skin grafts was more rigid and drier, and it did not exhibit a shine in the way that the FT skin grafts did. The lining of the cavity formed by the FT in all subjects was similar to that of vaginal mucosa, whereas the lining formed by the MT persisted as a skin graft in 83.3% of the cases. The pH was lower for the FT (p<0.01), and Döderlein bacilli were present in 90% of the FT neovaginas but absent from the MT neovaginas. In the latter, flora with anaerobic bacteria was present. Hormonal cytology showed estrogen activity in 100% of the FT neovaginas, but there was no such activity in the MT neovaginas. CONCLUSIONS: Our data suggest that the FT may be clinically, structurally, and biologically superior to the MT for the creation of neovaginas and is also less costly.

Abiotrophia defectiva bleb-associated endophthalmitis confirmed with 16s ribosomal RNA sequencing.

One recognized complication of trabeculectomy with visually devastating potential is blebitis. We present a case of a 74-year-old woman with a culture and polymerase chain reaction-positive Abiotrophia defectiva bleb-associated endophthalmitis. Abiotrophia defectiva is a rare but possible cause of endophthalmitis secondary to blebitis and should be considered in culture-negative cases. Prompt identification, hence directed eradication, of the causative organism in such visually threatening cases may be facilitated by requesting polymerase chain reaction and 16S ribosomal RNA sequencing.

Functional and anatomic results after creation of a neovagina according to Wharton-Sheares-George in patients with Mayer-Rokitansky-Küster-Hauser syndrome-long-term follow-up.

OBJECTIVE: To evaluate the long-term outcomes and degree of satisfaction after neovaginoplasty according to Wharton-Sheares-George in women with Mayer-Rokitansky-Küster-Hauser syndrome. DESIGN: Open, monocentric follow-up study. SETTING: University hospital and referral center for pediatric and adolescent gynecology. PATIENT(S): Ten patients with Mayer-Rokitansky-Küster-Hauser syndrome with neovaginas created according to Wharton-Sheares-George 3 to 77 months ago. INTERVENTION(S): Gynecologic follow-up examination, including vaginal swab, bacterial culture, Papanicolaou smear, hybrid capture test for human papillomavirus typing, biopsy, pelvic ultrasound, and 2 questionnaires concerning global quality of life and degree of sexual satisfaction. MAIN OUTCOME MEASURE(S): Satisfaction with sexual function, quality of life, length and width of neovagina, structure of vaginal epithelium, and type of bacterial colonization. RESULT(S): Functional long-term follow-up results showed a high subjective degree of general well-being and sexual satisfaction in affected women. A satisfactory neovaginal length (mean, 8.3 ± 1.06 cm; range, 7-10 cm) and width (mean, 3.3 ± 0.5 cm; range, 2.5-4 cm) was obtained. As revealed by smears and biopsy, the neovagina resembled a natural vagina with regard to type of bacterial colonization and structure of epithelium. CONCLUSION(S): The goal of any method of creating a neovagina is to provide the patient the possibility to have satisfactory sexual intercourse and to enhance well-being and quality of life. These aims can be achieved by creating a neovagina according to Wharton-Sheares-George.

Interim clinical outcomes in the collaborative bleb-related infection incidence and treatment study.

PURPOSE: To introduce the Collaborative Bleb-related Infection Incidence and Treatment Study and to provide an interim, 2.5-year follow-up report of the findings. This prospective study sought to determine the incidence, severity, and prognosis of bleb-related infection and to investigate the efficacy of the antibacterial therapy in preventing it. DESIGN: Prospective cohort study. PARTICIPANTS: A total of 908 eyes of 908 glaucoma patients who had undergone mitomycin C-augmented trabeculectomy or trabeculectomy combined with phacoemulsification and intraocular lens implantation performed at 34 clinical centers. METHODS: Outcomes were measured at 6-month intervals, with special attention to bleb-related infections, and data for 2.5 years of follow-up result were summarized. MAIN OUTCOME MEASURES: The incidence and severity of bleb-related infection. RESULTS: Of the 908 eyes, 9 eyes developed a bleb-related infection. The Kaplan-Meier survival analysis revealed that the probability of development of bleb-related infection was 1.5±0.6% (cumulative probability ± standard error) at the 2.5-year follow in the trabeculectomy cases and 1.4±1.0% in the combined surgery cases. It was 1.5% in both cases with a limbal-based flap and in those with a fornix-based flap. It was significantly different between cases with bleb leakage and those without it (P = 0.037; log-rank test). CONCLUSIONS: The cumulative probability of bleb-related infection was prospectively determined to be 1.5±0.6% in eyes treated with mitomycin C-augmented trabeculectomy or trabeculectomy combined with phacoemulsification and intraocular lens implantation at the 2.5-year follow-up in the Collaborative Bleb-related Infection Incidence and Treatment Study.

Gemella species-associated late-onset endophthalmitis after trabeculectomy with adjunctive mitomycin C.

PURPOSE: To report 2 cases of delayed-onset, bleb-related endophthalmitis induced by Gemella species. METHODS: Interventional case report. RESULTS: Two patients developed bleb-related ocular infection attributable to Gemella haemolysans and Gemella morbillorum after trabeculectomy with adjunctive mitomycin C. Both patients had thin-walled cystic filtering blebs before ocular infection. One patient underwent urgent vitrectomy with intravitreal injection of ceftazidime and vancomycin. The other received an intraocular injection of vancomycin and ceftazidime. After surgical intervention, 2 cases were administered topical levofloxacin and sulfobenzylpenicillin, and intravenous cefpirome. The DNA from the microorganism was sequenced and identified as G. haemolysans and G. morbillorum. CONCLUSIONS: Gemella species should be added to the long list of organisms that may rarely cause bleb-associated endophthalmitis.

The relationship between Helicobacter pylori infection and acid-hematuria syndrome in pediatric patients with gastric augmentation-II.

BACKGROUND/PURPOSE: The acid-hematuria syndrome, which presents with dysuria, hematuria, and perineal pain still remains a problem in those patients who have undergone bladder augmentation using the gastrocystoplasty technique. Additionally, there is still a question regarding the explanation for postoperative metabolic problems such as metabolic alkalosis, hypocholoremia, hypergastrinemia, and various complications related to gastritis and peptic ulcer disease. The aim of this study was to investigate the relation of Helicobacter pylori (HP) infection in this patient group and the relationship between HP infection and the above-mentioned clinical problems and complications. METHODS: In this study, 10 children with a history of previous gastrocystoplasty (five girls, five boys; mean age, 6.75+/-2.53 years; range, 2.5 to 12 years) were evaluated. Blood samples for HP detection were analyzed by serological testing (ELISA technique). Histopathologic studies were performed for gastric tissue specimens, obtained by endoscopic procedures from the stomach and augmented bladder. Urine pH and serum gastrin levels were measured in all patients. RESULTS: Regarding the serological studies, four of ten patients had a positive ELISA test result (40%). The four patients with HP-positive serological test results, were the patients who had acid-hematuria syndrome. These patients also had low urine pH levels (mean, 4.5) when compared with those of HP-negative patients. HP-positive patients also had high serum gastrin levels in comparison with those of HP-negative patients. CONCLUSIONS: The relation between HP infection and problems such as hypergastrinemia, acid output, and ulcer disease is well known. Our study demonstrates a correlation between the HP-positive gastrocystoplasty patients and the above-mentioned symptoms and complications. Because of the potential risk of HP infection, we suggest that HP infection be investigated in patients with gastrocystoplasty or in candidates for a gastrocystoplasty operation. HP-positive patients should be treated, to reduce the risks of postoperative complications.