Outcome of female urethral reconstruction: a 12-year experience.

INTRODUCTION AND HYPOTHESIS: To report our experience over 12 years in female urethral reconstruction with either anterior bladder tube (Tanagho) or labia minora pedicled tube. PATIENTS AND METHODS: This retrospective study included 16 patients with posttraumatic urethral loss. The patients were divided into two groups. Group I: included 6 patients managed with combined vaginal and abdominal approach using a proximally based anterior bladder tube (Tanagho) and Group II: included 10 patients underwent repair with labial fat pad flap with concomitant TOT sling. Outcomes included the success or failure of anatomical repair and continence, which was assessed during patient follow up by voiding diary, 24-h pad test and uroflowmetry. RESULTS: A total of 15 patients were followed for a mean of 42 months postoperatively, and only one patient was lost to follow up. Total continence was achieved in 10 patients (66.6 %) [4/6 patients (66.6 %) in group I and 6/9 patients (66.6 %) in group II]. Partial continence (i.e., one or two pad per day) was achieved in 2 patients (13.3 %). Failure occurs in 3 cases (20 %) [one case in group I and two cases in group II]. All our patients had a smooth postoperative course. In the labia pedicled tube, meatal stenosis was encountered in one patient and transient postoperative urine retention in 2 patients. Successful anatomical repair was achieved in all our patients. CONCLUSION: Both Bladder tube and labia minora pedicled tube with sling procedure have high success rate with only minor complications and are equally effective in the management of females with total urethral loss. Due to the small number of patients in this study, we still need to extend our study to verify our results.

Evaluation of outcome of transurethral needle ablation for treating symptomatic benign prostatic hyperplasia: A 10-year experience.

AIM: The aim of this study is to report our 10-year experience with transurethral needle ablation (TUNA) to evaluate its outcome on long-term basis. PATIENTS AND METHODS: A total of 351 patients' records who underwent TUNA procedure for the management of benign prostatic hyperplasia were reviewed. The International Prostate Symptom Score (IPSS) and peak urinary flow rate were evaluated before the procedure, at 3 and 6 months postoperatively, and then yearly for 10 years. For patients complaining of de novo erectile dysfunction, the International Index of Erectile Function-5 was evaluated. Postoperative complications, number of patients who required additional therapeutic modality/other TUNA sessions, or those dropped out during follow-up were all recorded. RESULTS: Three hundred and fifty-one patients who underwent TUNA with fulfillment of our selection criteria were included in the study. The yearly records of included patients showed that patients' baseline IPSS was significantly improved all over the follow-up years. Similarly, the maximum flow rate of the patients was significantly improved during the next 8 years. About 96.4% of patients who underwent TUNA did not require additional therapeutic modality/other TUNA sessions during the 1st-year follow-up. However, by 10 years, 26.4% of patients were offered another TUNA session and shifted to either medical therapy or other minimally invasive therapies. Mild hematuria was the most common complication (85.7%). Urinary retention, urethral stricture, and de novo erectile dysfunction were developed in 15.1%, 1.7%, and 6.8% of patients, respectively. There were no cases of retrograde ejaculation. CONCLUSION: TUNA can be considered as a relatively effective technique with a good safety profile. The current study demonstrated both significant subjective and objective improvements over 10 and 8 years of follow-up, respectively. It can be considered as a preferable option for patients who prefer surgical option with preservation of their sexual function and fertility.

Role of combined use of ketoconazole and tamsulosin in management of acute urinary retention due to benign prostatic obstruction (a randomized controlled trial).

BACKGROUND: Ketoconazole has the ability to lower serum testosterone to castrate level within 48 h. As the prostate is an androgen-dependent organ, we investigated the effect of the use of tamsulosin in combination with ketoconazole in cases of acute urinary retention (AUR) due to benign prostatic obstruction (BPO). METHODS: We recruited patients with AUR secondary to BPO but those with hepatic or renal impairment were excluded. Following urethral catheterization, the participants were randomized into two equal groups. The first group received tamsulosin (0.4 mg o.d.) and ketoconazole (200 mg t.d.s.) while the second one had tamsulosin and placebo. The drugs were maintained for 7 days and then the patients were put on trial without catheter (TWOC). The successful cases were assessed with peak flow rate (PFR) and the post-void residual urine volume (PVRV) was also estimated. RESULTS: We included 106 men with a mean age of 64.1±5.2 years and a mean prostate size of 61.6±14.6 g in the two groups. The received medications were well tolerated by all patients and none of them had discontinued the prescribed drugs. The incidence of the successful TWOC was significantly higher in the combined treatment group (77.35%) compared to the tamsulosin group (58.84%; P=0.01). Among those who had a successful TWOC, the PFR and the PVRV were also significantly better in the combined treatment group compared to the other one (P=0.001). CONCLUSIONS: Patients with AUR due to BPO can be treated safely with a combination of ketoconazole and tamsulosin to get a better success rate of TWOC.

Anaesthetic complications in surgical out-patients.

This study reports retrospectively the post-anaesthetic complications in surgical out-patients. We have studied the incidence and severity of these complications during the first five post-operative days in 500 female patients who underwent tubal ligation by laparoscopy. The report shows that post-anaesthetic complications in surgical out-patients are frequent but of mild severity. Although they produced some discomfort for the patients most of them were of the opinion that the advantages of having the operation as out-patients made up for the discomfort.

PIP: The safety of outpatient surgery depends mainly on patient selection, the type of operation, and the anesthetic technique. Subjects of this study were 500 women who as outpatients underwent tubal electrocoagulation through a laparoscope. After an interval of 1 week to 4 months postoperatively, each was sent a questionnaire regarding postanesthetic complications. The questionnaire was returned by 418 patients (83.6%). Several anesthetic agents had been used. Premedication was given only to very nervous patients (18%). Atropine .4 mg was given to all just before the operation. The trachae of all patients were untubated after a dose of succinylcholine and in 60% of cases 3-6 mg of D-tubocurare. There were no immediate anesthetic complications. Most patients were discharged within 3 hours. Postanesthetic complications were common. Muscle pains occurred in 45%, many lasting 2-5 days. Sore throat followed in 28.2% but was usually mild. Headache, nausea, vomiting, cough, and sputum were noted in 8-17%. A mild dizziness was sometimes a complaint. Inability to concentrate was experienced by 30% of patients for over 2 days. In 32.9 %, return to usual work took up to 48 hours; in 57.9%, it was 2-5 days w hile the others required over 5 days. 81% of the patients reported that they would accept the procedure again, while 16.7% would refuse. Return to preoperative mental status usually took several days and in a few over 5 days. Too early use of alcoholic beverages or driving an automob ile were warned against. Most patients considered that the advantage of having the operation as outpatients made up for the discomforts.

Alphadione (Althesin): a new induction agent.

The use of Althesin for induction of anaesthesia in 57 patients showed that it is a satisfactory induction agent. However, with the exception of rapid recovery with minimal after-effects, it has no major advantages over the commonly used barbiturates.

Epiglottitis and pulmonary oedema in children.

We have presented three patients with epiglottitis who developed pulmonary oedema during the course of treatment with nasotracheal intubation and antibiotics. The exact mechanism for the development of pulmonary oedema in these patients is not known. Possible mechnisms are changed in the physical factors controlling the movement of fluids across the capillary-alveolar membrane, transitory bacteraemia and endotoxinaemia, or myocardial depression by the antibiotics and the anaesthetic agent. The pulmonary oedema had a benign course and responded to mechanical ventilation and increased airway pressure.

Response to hypercapnia under ketamine anaesthesia.

The respiratory response to hypercapnia in dogs anaesthetized with ketamine was increased. This respiratory stimulation was most probably due to a direct effect of the drug on the medullary respiratory neurones. This effect was not modified by preanaesthetic medication pentobarbitone 5 mg/kg or morphine 0.1 mg/kg. Catecholamine response to hypercapnia was essentially the same as that reported by hypercapnic dogs anaesthetized with thiopentone.

Caudal anaesthesia in paediatric patients.

We have described our technique of caudal anaesthesia in children. This technique was used for relief of post-operative pain in 120 patients. Relief of pain was complete. Post-operative recovery was quiet and comfortable, with no side effects. The surgeons, the parents and recovery room personnel were satisfied. There were no surgical or anaesthetic complications.

[Clinical evaluation of the new anesthetic "Ethrane"]. / Evaluation clinique d'un nouvel agent anesthésique "l'éthrane"

Seventy-four patients aged 14 months to 71 years, classified as ASA I and II were anesthetised with Ethrane for surgical interventions of mean duration 117 minutes. With the exception of 5 patients who were directly anesthetised with Ethrane, the others received Ethrane after induction with Penthiobarbitone. Maintenance of anesthesia was ensured with 1 to 4p. 100 concentrations of Ethrane and 33p. 100 oxygen and 66p. 100 nitrous oxide. Tracheal intubation was facilitated by injection of 1 mg/kg of succinylcholine. Induction with enflurane is rapid with no phenomena of excitation or irritation of the ear passages. The cardiovascular apparatus is stable with no arrythmia but an increase in heart rate of 11 to 50p. 100 is noted and in 41p. 100 of the cases hypotension of 35p. 100 of the intitial value. During spontaneous ventilation, a type of rapid and superficial respiration is observed with a flow volume of 5.3 ml/kg for an average frequency of 25/min. The arterial blood gases show slight hypercapnia. Myorelaxation is significant and better than that obtained with halothane. Coming round poses few problems apart from agitation in adolescents. Response to simple orders appears at 13 minutes. Trembling and rigidity occur in 41p. 100 of the cases for 5 to 30 minutes. From the hepatic point of view, no lastin enzyme changes were noted and no renal toxicity was demonstrated. Ethrane appears to be a good anesthetic agent but the few advantages mentioned means that it does not fulfil ideal conditions.

Non-volitional assessment of skeletal muscle strength in patients with chronic obstructive pulmonary disease.

BACKGROUND: Although quadriceps weakness is well recognised in chronic obstructive pulmonary disease (COPD), the aetiology remains unknown. In disabled patients the quadriceps is a particularly underused muscle and may not reflect skeletal muscle function as a whole. Loss of muscle function is likely to be equally distributed if the underlying pathology is a systemic abnormality. Conversely, if deconditioning and disuse are the principal aetiological factors, weakness would be most marked in the lower limb muscles. METHODS: The non-volitional technique of supramaximal magnetic stimulation was used to assess twitch tensions of the adductor pollicis, quadriceps, and diaphragm muscles (TwAP, TwQ, and TwPdi) in 22 stable non-weight losing COPD patients and 18 elderly controls. RESULTS: Mean (SD) TwQ tension was reduced in the COPD patients (7.1 (2.2) kg v 10.0 (2.7) kg; 95% confidence intervals (CI) -4.4 to -1.4; p<0.001). Neither TwAP nor TwPdi (when corrected for lung volume) differed significantly between patients and controls (mean (SD) TwAP 6.52 (1.90) N for COPD patients and 6.80 (1.99) N for controls (95% CI -1.5 to 0.97, p=0.65; TwPdi 23.0 (5.6) cm H(2)O for COPD patients and 23.5 (5.2) cm H(2)O for controls (95% CI -4.5 to 3.5, p=0.81). CONCLUSIONS: The strength of the adductor pollicis muscle (and the diaphragm) is normal in patients with stable COPD whereas quadriceps strength is substantially reduced. Disuse may be the principal factor in the development of skeletal muscle weakness in COPD, but a systemic process preferentially affecting the proximal muscles cannot be excluded.