Supernumerary kidneys: a clinical and radiological analysis of nine cases.

BACKGROUND: A supernumerary kidney (SK) is an additional kidney with its own capsule and blood supply that is not fused with the ipsilateral kidney (IK). Because individual case reports indicate a high morbidity rate, the aim of this retrospective study was a detailed analysis of this rare anatomical variant. METHODS: Our systematic imaging-based search for SKs, conducted in the period from 2000 and to 2017, yielded 9 cases in total (5 men, 4 women; mean age: 51.8 ± 22.8 years). RESULTS: The SKs were observed on the right in six and on the left side in three cases. In six subjects (66%) they were located caudal and in three cases (33%) cranial to the ipsilateral kidney. Calculi were found in three (33%) of the renal collecting systems. Five (56%) of the SKs had hydronephrosis grade IV and one SK had recurrent pyelonephritis (11%). Two of the ureters opened into the ipsilateral seminal vesicle (22%). Two (22%) SKs were functional but atrophic. Clinically relevant findings were made in 33% of the IKs: atrophy (n = 2), calculi (n = 1), and reflux with recurrent pyelonephritis (n = 1); another 33% had anatomical anomalies without functional impairment. The correct diagnosis of a SK is possible using CT imaging in all subjects. The prevalence of SK based on CT imaging can be estimated to be 1:26750. CONCLUSIONS: CT is the method of choice for visualizing SKs. The correct diagnosis is crucial in preventing dispensable surgical procedures and for providing optimal patient treatment and outcome.

Post-operative limb position can influence blood loss and range of motion after total knee arthroplasty: a systematic review.

PURPOSE: A consistent post-operative limb positioning regime could be an attractive, simple and cost-effective alternative to improve patient's outcomes after total knee arthroplasty (TKA). The aim of this study was to perform a systematic review of the available literature in order to understand whether a consistent post-operative limb positioning regime could affect blood loss and range of motion (ROM) after TKA. METHODS: A search was performed using the keywords "total knee replacement/knee prosthesis" in combination with "post-operative management", "blood loss", "range of motion", "leg position", "flexion", "extension" and "splinting" regardless of the year of publication. The scientific databases have been accessed in order to identify papers dealing with post-operative limb positioning regimes after TKA. RESULTS: Seven articles matching the inclusion criteria were selected. Blood loss and ROM were both investigated in all but one paper, in which only blood loss was evaluated. There were six randomized controlled trials and one prospective comparative study. A 48-72 h post-operative knee flexion protocol seems to be effective in reducing blood loss and increasing ROM following TKA. We did also find no benefit in using extension splints in the immediate post-operative period. CONCLUSIONS: Based on the studies undertaken to date, a 48-72 h post-operative knee flexion protocol should be implemented as an easy and inexpensive method of reducing blood loss and increasing ROM following TKA. Shorter flexion regimes failed to influence these parameters.

World record: Single AMS 800 artificial urinary sphincter functioning uninterrupted for 29 years in male paraplegic patient.

Lapides has revolutionized the treatment of neurogenic patients by introducing routine intermittent catheterization in 1971. This drastically lowered mortality from urosepsis. Scott introduced the artificial urinary sphincter (AUS) in 1972. This gave a completely new perspective for incontinent patients by dramatically increasing the quality of life. In patients with neurogenic urinary incontinence, the principles of care are preserving renal function, maintaining a low-pressure reservoir, allowing unobstructed urine flow and providing continence. We describe a male patient that received an AUS with a bladder neck cuff that functioned without revision for 29 years. After 30 years, AUS exchange proved successful.

Excessive fibrosis and non-function after ATOMS (adjustable transobturator male system): A case of capsular contracture?

The adjustable transobturator male system (ATOMS) treats post-prostatectomy urinary incontinence by compression of the proximal bulbous urethra. It reminds of the Kaufman prosthesis described in 1978. We describe a case where an excessive fibrotic reaction occurred around the cushion. Furthermore, the bulbous urethra underneath, developed severe atrophy devoid of any visible blood supply. We suspect ongoing shear forces around the cushion while sitting resulting in a chain reaction of acute through chronic inflammation and progressive fibrosis and encapsulation. Does the encapsulation lead to capsular contracture resulting in non-function?

Intrapelvic bulboprostatic repair after urethral distraction injury and failed bulbomembranous anastomosis.

A failed end-to-end anastomosis after membranous urethral distraction injury post-trauma is a surgical challenge. We present a case of a young man after complex pelvic injury. Revision urethroplasty was done utilizing nerve and vessel sparing techniques. Intrasphincteric dissection enabled bulbous urethral pull-through with intrapelvic anastomosis with good success. Low dose tadalafil was given to optimize penile rehabilitation.

Female urethral avulsion and bladder neck closure: What now? Trigonal tubularization with placement of an artificial urinary sphincter.

Bladder neck closure after severe polytrauma with an absent urethra poses a huge challenge for a young woman wanting to urinate normally. Considerations are reconstruction of a neourethra and operative means to gain continence. We describe a case of trigonal tubularization to function as a neourethra, together with the implantation of an artificial urinary sphincter. Eleven years after suffering from an open book pelvic rim fracture at 18 years, successful reconstruction of a trigonal neourethra enabled continence and residual-free spontaneous voiding at 29 years.

Urethro-cavernosal-spongiosal fistula after intralesional mitomycin C for recurrent urethral stricture disease.

Intralesional mitomycin C after direct visual internal urethrotomy for recurrent urethral stricture disease in patients suboptimal for open urethroplasty is an established option. We report a case of urethro-cavernosal-spongiosal fistula after intralesional mitomycin C into an area of previous dorsal inlay urethroplasty. The patient presented with pus draining from the urethral meatus ten days after treatment. Sterile abscesses developed within the corporal and spongious bodies, draining freely into the urethra. Complete spontaneous healing followed short-term transurethral catheterization and antibiotic prophylaxis.

Preservation of erectile function by artery sparing dilation of the corpora cavernosa in prolonged priapism.

Prolonged low-flow priapism causes structural impotence. We describe a case where potency has been preserved by off-centre corporal dilation to spare the cavernosal arteries. The patient suffered from idiopathic priapism lasting more than 72 hours before presentation. Corporoglanular shunts were performed thrice over a period of six days, twice also performing off-centre corporal dilation along the inside of the tunica. The idea was not to damage the central cavernosal arteries. Corporal blood supply spontaneously improved. Successful intercourse was possible after six months. Artery sparing cavernosal dilation techniques might improve spontaneous recovery in select cases.