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1.
Ann R Coll Surg Engl ; 102(2): e36-e38, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31530167

RESUMO

Penile calciphylaxis or calcific uremic arteriolopathy is a rare urological condition often associated with patients undergoing renal dialysis for end-stage renal disease. The majority of cases are associated with systemic calciphylaxis. The pathophysiology, diagnosis and management of penile calciphylaxis as an individual entity has brought little attention. The rates of comorbidity and mortality of these patients are often particularly high. Early diagnosis and a multidisciplinary approach are therefore essential. We report a case of penile calciphylaxis in a 59-year-old man with end-stage renal failure on haemodialysis who was successfully managed conservatively.


Assuntos
Angioplastia/métodos , Calciofilaxia/terapia , Tratamento Conservador/métodos , Doenças do Pênis/terapia , Inibidores da Agregação de Plaquetas/uso terapêutico , Bandagens , Calciofilaxia/diagnóstico , Calciofilaxia/etiologia , Artéria Femoral/cirurgia , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Doenças do Pênis/diagnóstico , Doenças do Pênis/etiologia , Pênis/irrigação sanguínea , Pênis/patologia , Diálise Renal/efeitos adversos , Resultado do Tratamento
2.
Spinal Cord ; 44(12): 729-33, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16446753

RESUMO

STUDY DESIGN: Retrospective review. OBJECTIVE: This retrospective review observes the evolution of bladder management by time and reports adult urological outcomes and complications in paediatric onset spinal cord injury (SCI). SETTING: Spinal Injuries Unit RNOH Stanmore. METHOD: In total, 10 traumatic SCI patients with mean age at injury of 13.6 years underwent treatment, for a mean period of 13.1 years. Characteristics of injury were noted. Two diagnostic subgroups, neurogenic detrusor overactivity (NDO), and acontractile detrusor were made. Complications, treatment changes, operative procedures with follow-up were noted. RESULTS: In group 1 (6/10 patients) with NDO, five had DSD. Initial bladder management was reflex/urge voiding (n=4), suprapubic catheterisation (SPC), (n=1) and self-intermittent catheterisation (SIC), (n=1). Two patients had multiple upper tract complications with decreased renal function, two recurrent symptomatic urinary infections and one; bladder calculus. In total, 12 operative procedures were performed to treat complications and change bladder management to, SIC+oxybutynin (n=3), ileal conduit (n=1), sacral anterior root stimulator implant (SARSI), (n=1), voiding on urge (n=1). In group 2 (4/10 patients) with a-contractile detrusor two had low compliance. Initial bladder management was SIC (n=3) and voiding on urge/straining (n=1). Two patients converted from SIC to permanent catheter drainage and reported complications. Incidental kidney stone was diagnosed in one. A total of four interventions were carried out with final management of SIC (n=2), voiding on urge/straining (n=1) and Mitrofanoff+ileocystoplasty (n=1). CONCLUSION: Bladder management in paediatric SCI is dependent on neurological level and type of injury; it changes with growth and is affected by changes in bladder management.


Assuntos
Traumatismos da Medula Espinal/complicações , Bexiga Urinaria Neurogênica/terapia , Adolescente , Adulto , Feminino , Humanos , Estudos Longitudinais , Masculino , Estudos Retrospectivos , Traumatismos da Medula Espinal/fisiopatologia , Resultado do Tratamento , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinaria Neurogênica/fisiopatologia , Cateterismo Urinário , Urodinâmica
3.
Hosp Med ; 66(6): 335-40, 2005 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15981341

RESUMO

Many new concepts were introduced in epidemiology, a etiopathology and treatment of stress urinary incontinence. This review gives a short account of these concepts and compares the results of commonly used treatment options with new ones recently introduced.


Assuntos
Incontinência Urinária por Estresse/etiologia , Feminino , Humanos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Incontinência Urinária por Estresse/tratamento farmacológico , Incontinência Urinária por Estresse/cirurgia
4.
Postgrad Med J ; 81(954): 232-5, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15811886

RESUMO

Autonomic dysreflexia is an important clinical diagnosis that requires prompt treatment to avoid devastating complications. The condition may present itself to all members of medical and surgical specialties, who may not be accustomed to treating it. It is the clinician's responsibility to have a basic understanding of the pathophysiology of the condition and the simple steps required to treat it.


Assuntos
Disreflexia Autonômica/terapia , Doença Aguda , Disreflexia Autonômica/diagnóstico , Disreflexia Autonômica/etiologia , Emergências , Tratamento de Emergência , Humanos
6.
Neurourol Urodyn ; 23(3): 241-5, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15098220

RESUMO

AIMS: The aim of this study was to resolve the paradox as to whether magnetic stimulation of sacral nerve roots results in contraction or suppression of the bladder, in both normal individuals and patients with spinal cord injury (SCI). MATERIALS AND METHODS: Seven males with complete SCI and neurogenic detrusor overactivity (NDO) and five normal males were investigated. Bladder capacity and maximum cystometric capacity were determined, respectively, in these groups. Magnetic stimulation was applied to sacral nerve roots using a multi-pulse magnetic stimulator and coil. Stimulation was applied at half capacity, near-full capacity, and during NDO or voiding (in normal individuals). Single and intermittent bursts of stimulation were applied. RESULTS: Neither single nor intermittent bursts of magnetic stimulation of the sacral nerve roots resulted in significant bladder pressure rises. Occasionally, following cessation of the magnetic stimulation bladder contractions were seen in patients with NDO. These contractions had an unpredictable and variable latency. As previously reported, magnetic stimulation suppressed NDO in patients with SCI, and suppressed voiding in normal individuals. CONCLUSIONS: Bladder contractions are occasionally observed in patients with NDO following withdrawal of stimulation. This phenomenon hypothetically arises as a result of removal of the bladder suppression provided by magnetic stimulation, rather than direct motor pathway stimulation (as has been reported by others). The ability of sacral magnetic stimulation to suppress detrusor contractions is reaffirmed.


Assuntos
Campos Eletromagnéticos , Músculo Liso Vascular/fisiologia , Raízes Nervosas Espinhais/fisiologia , Bexiga Urinária/fisiologia , Adulto , Humanos , Masculino , Contração Muscular/fisiologia , Pressão , Região Sacrococcígea , Traumatismos da Medula Espinal/fisiopatologia , Micção/fisiologia
7.
Acta Neurochir (Wien) ; 146(3): 313-6; discussion 316, 2004 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15015057

RESUMO

Case reports, by virtue of their simplicity, are ideal for the novice writer. The temptation is to write up anything that is remotely interesting in the hope that you get your name in print. One soon discovers that this is a self-defeating exercise when rejections of a mediocre manuscript come a plenty. Choosing an appropriate case is the difficult first step and getting started remains a challenge for the uninitiated. This article outlines our systematic approach for busy junior doctors to write high-quality and meaningful case reports with relative ease.


Assuntos
Jornalismo Médico , Registros Médicos , Redação , Humanos
8.
Spinal Cord ; 41(11): 643-4, 2003 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-14569266

RESUMO

STUDY DESIGN: A case report of the complications of a spinal cord injury (SCI) patient alternating between indwelling urethral catheter and a condom drainage system for bladder management. OBJECTIVE: To highlight the importance of penile care for bladder drainage following SCI. SETTING: Spinal Injuries Unit, Stanmore, UK. SUBJECT: A 39-year-old male who sustained a lumbar level SCI in December 2000. He presented acutely with leakage of urine around his condom drainage device. MAIN OUTCOME MEASURE: The examination revealed an eroded area on the ventral aspect of the proximal penile shaft, which corresponded to the site of condom attachment. An indwelling urethral catheter was inserted as a temporary measure before reconstruction. RESULT: At operation, in addition to the preoperatively observed area of erosion, the penile urethra was found to be cleaved for almost its entire length. CONCLUSIONS: The patient had suffered two complications from a combination of two types of bladder management, and surgery was successful in treating both the urethral cleavage and the skin erosion.


Assuntos
Doenças do Pênis/etiologia , Traumatismos da Medula Espinal/complicações , Obstrução Uretral/etiologia , Cateterismo Urinário/efeitos adversos , Adulto , Humanos , Masculino , Doenças do Pênis/cirurgia , Traumatismos da Medula Espinal/cirurgia , Obstrução Uretral/cirurgia , Cateterismo Urinário/métodos
9.
J Urol ; 170(2 Pt 1): 425-7, 2003 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-12853791

RESUMO

PURPOSE: Screening for bladder malignancy in patients with neuropathic bladder and a chronic indwelling catheter by cystoscopy and biopsy is commonly performed. Despite this practice the test has not been fully validated to date. We analyzed our experience with this screening test and explored its validity when applied to our patients. MATERIALS AND METHODS: We performed a retrospective analysis of screening biopsies in 36 patients with neuropathic bladder and a chronic indwelling catheter who had undergone yearly screening from 5 years after catheter insertion. Mean time since suprapubic catheter insertion was 12.1 years (range 8.7 to 23.8). RESULTS: No tumors were ever identified in our screened group. However, histological findings were frequently abnormal, of which the most common are active chronic cystitis and squamous metaplasia. CONCLUSIONS: Our study reinforces the increasing body of evidence suggesting that screening cystoscopy and biopsy in this group of patients is not valid. As a screening test, it fulfils few of the necessary criteria.


Assuntos
Biópsia por Agulha , Cateteres de Demora , Cistoscopia , Neoplasias da Bexiga Urinária/diagnóstico , Bexiga Urinaria Neurogênica/complicações , Cateterismo Urinário , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateteres de Demora/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/etiologia , Bexiga Urinaria Neurogênica/terapia , Cateterismo Urinário/efeitos adversos
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