Surgical management of Skene's gland abscess/infection: a contemporary series.

INTRODUCTION AND HYPOTHESIS: We report our experience with surgical excision for treatment of Skene's gland abscess/infection after conservative measures have failed. METHODS: A retrospective review of patients that underwent surgical excision of Skene's gland abscess/infection by a single surgeon from 06/1995 to 09/2008 was performed. Patients were separated into groups based on indication for procedure. Recurrence rate and success rate were calculated. RESULTS: The final study group included 34 patients. After initial excision, 88.2% (30/34) of patients had resolution of symptoms. Recurrence of signs and symptoms that prompted further treatment occurred in 30% (9/30). In those that recurred, 88.8% (8/9) of patients had resolution of symptoms after further therapy. Overall success rate in complete resolution of symptoms after all treatment was 85.3%. Only patients to fail were in the urethral pain and recurrent UTI groups. CONCLUSION: Surgical excision is a safe and effective therapy for the treatment of Skene's gland abscess/infection after conservative measures have failed.

Outcomes of patients lost to followup after mid urethral synthetic slings--successes or failures?

PURPOSE: We classified patients lost to followup after mid urethral synthetic sling placement as examples of treatment success or failure based on the Patient Global Impression of Improvement, and compared the outcomes of those who followed up to the outcomes of those who did not. MATERIALS AND METHODS: We reviewed the charts of 217 patients who underwent mid urethral synthetic sling placement. Telephone interviews including the Patient Global Impression of Improvement and the Medical, Epidemiological, and Social Aspects of Aging questionnaires were conducted for patients lacking 3-month followup. RESULTS: Based on the Patient Global Impression of Improvement of the 48 patients who responded 13 (27.1%) were failures. The overall failure rate of patients with at least 3-month followup was 19% (23 of 124). CONCLUSIONS: In our study success rates for patients lost to followup were similar to the rates for those who had routine followup. However, it is uncertain if these data can be applied to other study populations, especially in a randomized controlled trial.

Migrated bullet in the bladder presenting 18 years after a gunshot wound.

Gunshot wounds to the genitourinary system are relatively rare, and it is even rarer a retained bullet migrates into the urinary tract. We describe a case where the bullet migrated into the bladder and formed a bladder stone eighteen years after the injury. This presentation is unique as it is one of the longest times from gunshot wound to presentation in the current literature.

Managing the urethra at transvaginal pelvic organ prolapse repair: a urodynamic approach.

PURPOSE: We evaluated the protocol that we use to determine whether a mid urethral synthetic sling will be placed at transvaginal pelvic organ prolapse repair. MATERIALS AND METHODS: A total of 140 patients underwent transvaginal repair for stage 2 to 4 pelvic organ prolapse, of whom 105 were treated according to the protocol and had a minimum 3 months of followup or required earlier intervention. Urodynamics were performed without prolapse reduction. When stress urinary incontinence was not identified, a pessary was placed and the study was repeated. Patients were designated as having urodynamic, occult or no stress urinary incontinence. Patients with urodynamic or occult stress urinary incontinence underwent a simultaneous mid urethral synthetic sling procedure, while those without urodynamic or occult stress urinary incontinence did not. Charts were reviewed to determine whether further intervention was required for stress urinary incontinence or obstruction. RESULTS: The risk of intervention due to obstruction after receiving a mid urethral synthetic sling was 8.5%. The risk of intervention for stress urinary incontinence in patients with no clinical, urodynamic or occult stress urinary incontinence and no mid urethral synthetic sling was 8.3%. The risk of intervention for stress urinary incontinence in patients with clinical stress urinary incontinence but no urodynamic or occult stress urinary incontinence and no mid urethral sling was 30%. CONCLUSIONS: Using our urodynamic protocol to manage the urethra at transvaginal pelvic organ prolapse repair the risk of intervention due to obstruction is essentially equal to the risk of intervention due to stress urinary incontinence when no clinical, urodynamic or occult stress urinary incontinence was present and no mid urethral synthetic sling was placed. In patients who report clinical stress urinary incontinence preoperatively despite no urodynamic or occult stress urinary incontinence there is a much higher rate of further intervention for stress urinary incontinence.

Patient-reported outcomes for tension-free vaginal tape-obturator in women treated with a previous anti-incontinence procedure.

Our purpose was to evaluate the outcome of a subset of patients that had a tension-free vaginal tape-obturator (TVT-O) placed following a previous anti-incontinence procedure. We performed a retrospective analysis of 27 consecutive women who had a TVT-O placed from January 2004 to December 2007. Patients were given the Patient Global Impression of Improvement (PGI-I) questionnaire starting at the 3-month follow-up. Of 174 women who had a TVT-O placed, 27 (15.5%) had a prior failed anti-incontinence procedure or surgery performed. The mean age was 63.8 years (range 43-87). Mean follow-up was 25.7 months (range 12-47 months). Based on the PGI-I, the overall success rate was 80% (20/25). In the properly selected patients with prior intervention for stress urinary incontinence (SUI), the success rate for TVT-O of 80% appears to be comparable to that of patients who never had a previous surgical or minimally invasive treatment for SUI.

Treatment of splenic injury during laparoscopic nephrectomy with BioGlue, a surgical adhesive.

Splenic laceration is a recognized complication of both open and laparoscopic renal surgery. Laparoscopic renal surgery continues to become the new standard of care, and this potentially problematic complication may be encountered during mobilization to gain access to the retroperitoneum. We present 2 cases of splenic injury managed with BioGlue, a new surgical adhesive, during one hand-assisted and one pure laparoscopic nephrectomy. Application of the BioGlue adhesive resulted in satisfactory hemostasis for both injuries without the need for further intervention. These preliminary observations suggest that BioGlue may be a useful addition to the urologic armamentarium to achieve hemostasis in laparoscopic surgery.

Development of cross-resistance between heat and cisplatin or hydroxyurea treatments in FaDu squamous carcinoma cells.

BACKGROUND: Induction of hyperthermia by radiofrequency ablation is gaining popularity in treating a variety of solid tumors. This study examined an impact of sublethal heat treatment interacted with chemotherapeutic drugs on the survival of head and neck squamous carcinoma cells using in vitro model. MATERIALS AND METHODS: FaDu cells were subjected to heat treatment at 42 degrees C or 45 degrees C for 15 min either before or after exposure to cisplatin or hydroxyurea. The survival of cells was determined by 3-(4,5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide assay. The RNA and protein levels of various heat shock proteins were examined by reverse transcription polymerase chain reaction and Western blot analysis, respectively. Cell cycle progression was analyzed by flow cytometry with propidium iodide staining. RESULTS: FaDu cells preheated to 45 degrees C exhibited an increased resistance to hydroxyurea but not to cisplatin. The heat treatment resulted in induction of HSP70 expression at transcript and protein levels, but there was no change in expression of HSP90beta and HSP27. After heat treatment, cells accumulated in S-phase at 3 h and proceeded to G(2)/M phase at 24 h. When cells pre-exposed to drugs for 24 h, the cisplatin-treated cells exhibited a higher thermotolerance than the hydroxyurea-treated cells at heat treatment of 45 degrees C. Cisplatin and hydroxyurea caused cells to accumulate in S-phase and increased the protein expression of HSP27 but not HSP90beta and HSP70. CONCLUSION: FaDu cells surviving the heat treatment expressed HSP70 and disrupted cell cycle progression, which resulted in developing a resistance to subsequent hydroxyurea treatment. However, the heat treatment did not have an effect on the sensitivity to cisplatin. In the reversed procedure, pre-exposure to hydroxyurea and cisplatin resulted in developing a thermotolerance.