Early fluoroscopic realignment for traumatic urethral injuries.

OBJECTIVES: There are a variety of open surgical and endoscopic approaches to the treatment of traumatic urethral injuries. The objective of our study was to evaluate the efficacy of early fluoroscopic realignment of the urethra following traumatic injury. METHODS: Seven patients with urethral rupture injuries (two anterior and five posterior urethral injuries) were treated. Follow-up ranged from 1 to 35 months. RESULTS: Six patients had successful early realignment of the urethra and catheter placement. Two of these required no further treatment, whereas 3 required another procedure or procedures following catheter removal. One patient is presently being treated. In 1 patient, realignment was unsuccessful and subsequent open urethroplasty was required. CONCLUSIONS: Early fluoroscopic realignment appears to be a safe and effective method of treatment for severe traumatic urethral injuries.

Postoperative pain following outpatient pediatric urologic surgery: a comparison of anesthetic techniques.

OBJECTIVES: To evaluate and compare the efficacy of caudal and local nerve blocks in preventing pain following outpatient pediatric urologic surgery. METHODS: Seventy-seven boys undergoing outpatient urologic surgery were randomized into one of three groups: general anesthesia alone, general anesthesia and caudal nerve block, or general anesthesia and local nerve block. Pain scores, frequency of medication, and total dosage of medication were recorded in the immediate postoperative period. Long-term pain and discomfort were measured using a 24-hour and 1-week questionnaire. RESULTS: The caudal and local groups had lower pain scores and significantly lower medication requirements than the control group in the short-term postoperative period. The caudal group had lower pain scores than the local group in all categories; however, the only significant difference was at 24 hours postoperatively. At 1 week postoperatively, the only difference among the three groups was a lower pain score in the caudal group compared with the control group. CONCLUSIONS: This study demonstrates that for outpatient pediatric urologic procedures, both caudal and local nerve blocks significantly reduce pain and medication given in the immediate postoperative period and indicates that caudal block may decrease pain for up to 1 week following surgery.

Hemorrhagic cystitis due to adenovirus infection following bone marrow transplantation.

Immunocompromised patients are at significant risk for infection with adenovirus. We report 3 cases of hemorrhagic cystitis in patients following bone marrow transplantation. Of the patients 2 had positive viral urine cultures and 1 had positive stool culture but negative urine culture and biopsy proved viral cystitis. Diagnosis of adenovirus should be considered when gross hematuria follows bone marrow transplantation even when urine culture is negative for adenovirus.