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Sample records for posterior urethral strictures

  1. Posterior Urethral Strictures

    PubMed Central

    Gelman, Joel; Wisenbaugh, Eric S.

    2015-01-01

    Pelvic fracture urethral injuries are typically partial and more often complete disruptions of the most proximal bulbar and distal membranous urethra. Emergency management includes suprapubic tube placement. Subsequent primary realignment to place a urethral catheter remains a controversial topic, but what is not controversial is that when there is the development of a stricture (which is usually obliterative with a distraction defect) after suprapubic tube placement or urethral catheter removal, the standard of care is delayed urethral reconstruction with excision and primary anastomosis. This paper reviews the management of patients who suffer pelvic fracture urethral injuries and the techniques of preoperative urethral imaging and subsequent posterior urethroplasty. PMID:26691883

  2. Urethral stricture

    MedlinePlus

    ... and not near the muscles that control the exit from the bladder, the stricture may be cut ... work, a urinary diversion called an appendicovesicostomy (Mitrofanoff procedure) may be done. This lets you drain your ...

  3. Treatment of Radiation-Induced Urethral Strictures.

    PubMed

    Hofer, Matthias D; Liu, Joceline S; Morey, Allen F

    2017-02-01

    Radiation therapy may result in urethral strictures from vascular damage. Most radiation-induced urethral strictures occur in the bulbomembranous junction, and urinary incontinence may result as a consequence of treatment. Radiation therapy may compromise reconstruction due to poor tissue healing and radionecrosis. Excision and primary anastomosis is the preferred urethroplasty technique for radiation-induced urethral stricture. Principles of posterior urethroplasty for trauma may be applied to the treatment of radiation-induced urethral strictures. Chronic management with suprapubic tube is an option based on patient comorbidities and preference.

  4. Advances in urethral stricture management.

    PubMed

    Gallegos, Maxx A; Santucci, Richard A

    2016-01-01

    Urethral stricture/stenosis is a narrowing of the urethral lumen. These conditions greatly impact the health and quality of life of patients. Management of urethral strictures/stenosis is complex and requires careful evaluation. The treatment options for urethral stricture vary in their success rates. Urethral dilation and internal urethrotomy are the most commonly performed procedures but carry the lowest chance for long-term success (0-9%). Urethroplasty has a much higher chance of success (85-90%) and is considered the gold-standard treatment. The most common urethroplasty techniques are excision and primary anastomosis and graft onlay urethroplasty. Anastomotic urethroplasty and graft urethroplasty have similar long-term success rates, although long-term data have yet to confirm equal efficacy. Anastomotic urethroplasty may have higher rates of sexual dysfunction. Posterior urethral stenosis is typically caused by previous urologic surgery. It is treated endoscopically with radial incisions. The use of mitomycin C may decrease recurrence. An exciting area of research is tissue engineering and scar modulation to augment stricture treatment. These include the use of acellular matrices or tissue-engineered buccal mucosa to produce grafting material for urethroplasty. Other experimental strategies aim to prevent scar formation altogether.

  5. Advances in urethral stricture management

    PubMed Central

    Gallegos, Maxx A.; Santucci, Richard A.

    2016-01-01

    Urethral stricture/stenosis is a narrowing of the urethral lumen. These conditions greatly impact the health and quality of life of patients. Management of urethral strictures/stenosis is complex and requires careful evaluation. The treatment options for urethral stricture vary in their success rates. Urethral dilation and internal urethrotomy are the most commonly performed procedures but carry the lowest chance for long-term success (0–9%). Urethroplasty has a much higher chance of success (85–90%) and is considered the gold-standard treatment. The most common urethroplasty techniques are excision and primary anastomosis and graft onlay urethroplasty. Anastomotic urethroplasty and graft urethroplasty have similar long-term success rates, although long-term data have yet to confirm equal efficacy. Anastomotic urethroplasty may have higher rates of sexual dysfunction. Posterior urethral stenosis is typically caused by previous urologic surgery. It is treated endoscopically with radial incisions. The use of mitomycin C may decrease recurrence. An exciting area of research is tissue engineering and scar modulation to augment stricture treatment. These include the use of acellular matrices or tissue-engineered buccal mucosa to produce grafting material for urethroplasty. Other experimental strategies aim to prevent scar formation altogether. PMID:28105329

  6. SIU/ICUD Consultation on Urethral Strictures: Posterior urethral stenosis after treatment of prostate cancer.

    PubMed

    Herschorn, Sender; Elliott, Sean; Coburn, Michael; Wessells, Hunter; Zinman, Leonard

    2014-03-01

    Posterior urethral stenosis can result from radical prostatectomy in approximately 5%-10% of patients (range 1.4%-29%). Similarly, 4%-9% of men after brachytherapy and 1%-13% after external beam radiotherapy will develop stenosis. The rate will be greater after combination therapy and can exceed 40% after salvage radical prostatectomy. Although postradical prostatectomy stenoses mostly develop within 2 years, postradiotherapy stenoses take longer to appear. Many result in storage and voiding symptoms and can be associated with incontinence. The evaluation consists of a workup similar to that for lower urinary tract symptoms, with additional testing to rule out recurrent or persistent prostate cancer. Treatment is usually initiated with an endoscopic approach commonly involving dilation, visual urethrotomy with or without laser treatment, and, possibly, UroLume stent placement. Open surgical urethroplasty has been reported, as well as urinary diversion for recalcitrant stenosis. A proposed algorithm illustrating a graded approach has been provided.

  7. Current management of urethral stricture disease

    PubMed Central

    Smith, Thomas G.

    2016-01-01

    Introduction: Broadly defined, urethral strictures are narrowing of the urethral lumen that is surrounded by corpus spongiosum, i.e., urethral meatus through the bulbar urethra. Urethral stenosis is narrowing of the posterior urethra, i.e., membranous urethra through bladder neck/prostate junction, which is not enveloped by corpus spongiosum. The disease has significant quality of life ramifications because many times younger patients are affected by this compared to many other urological diseases. Methods: A review of the scientific literature concerning urethral stricture, stenosis, treatment, and outcomes was performed using Medline and PubMed (U.S. National Library of Medicine and the National Institutes of Health). Abstracts from scientific meetings were included in this review. Results: There is level 3 evidence regarding the etiology and epidemiology of urethral strictures, stenoses, and pelvic fracture urethral injuries. Outcomes data from literature regarding intervention for urethral stricture are largely limited to level 3 evidence and expert opinion. There is a single level 1 study comparing urethral dilation and direct vision internal urethrotomy. Urethroplasty outcomes data are limited to level 3 case series. Conclusions: Progress is being made toward consistent terminology, and nomenclature which will, in turn, help to standardize treatment within the field of urology. Treatment for urethral stricture and stenosis remains inconsistent between reconstructive and nonreconstructive urologists due to varying treatment algorithms and approaches to disease management. Tissue engineering appears to be future for reconstructive urethral surgery with reports demonstrating feasibility in the use of different tissue substitutes and grafts. PMID:26941491

  8. Bipolar plasma vaporization using plasma-cutting and plasma-loop electrodes versus cold-knife transurethral incision for the treatment of posterior urethral stricture: a prospective, randomized study

    PubMed Central

    Cai, Wansong; Chen, Zhiyuan; Wen, Liping; Jiang, Xiangxin; Liu, Xiuheng

    2016-01-01

    OBJECTIVE: Evaluate the efficiency and safety of bipolar plasma vaporization using plasma-cutting and plasma-loop electrodes for the treatment of posterior urethral stricture. Compare the outcomes following bipolar plasma vaporization with conventional cold-knife urethrotomy. METHODS: A randomized trial was performed to compare patient outcomes from the bipolar and cold-knife groups. All patients were assessed at 6 and 12 months postoperatively via urethrography and uroflowmetry. At the end of the first postoperative year, ureteroscopy was performed to evaluate the efficacy of the procedure. The mean follow-up time was 13.9 months (range: 12 to 21 months). If re-stenosis was not identified by both urethrography and ureteroscopy, the procedure was considered “successful”. RESULTS: Fifty-three male patients with posterior urethral strictures were selected and randomly divided into two groups: bipolar group (n=27) or cold-knife group (n=26). Patients in the bipolar group experienced a shorter operative time compared to the cold-knife group (23.45±7.64 hours vs 33.45±5.45 hours, respectively). The 12-month postoperative Qmax was faster in the bipolar group than in the cold-knife group (15.54±2.78 ml/sec vs 18.25±2.12 ml/sec, respectively). In the bipolar group, the recurrence-free rate was 81.5% at a mean follow-up time of 13.9 months. In the cold-knife group, the recurrence-free rate was 53.8%. CONCLUSIONS: The application of bipolar plasma-cutting and plasma-loop electrodes for the management of urethral stricture disease is a safe and reliable method that minimizes the morbidity of urethral stricture resection. The advantages include a lower recurrence rate and shorter operative time compared to the cold-knife technique. PMID:26872076

  9. Adult urethral stricture: practice of Turkish urologists

    PubMed Central

    Akyuz, Mehmet; Sertkaya, Zulfu; Koca, Orhan; Calıskan, Selahattin; Kutluhan, Musab Ali; Karaman, Muhammet Ihsan

    2016-01-01

    ABSTRACT Objectives: To evaluate national practice patterns in the treatment of male anterior urethral strictures among Turkish urologists. Materials and Methods: A survey form including 12 questions prepared to determine active Turkish urologists' approach to diagnosis and treatment of the adult urethral stricture (US) were filled out. Based on the survey results, the institutions which 218 urologists work and their years of expertise, methods they used for diagnosis and treatment, whether or not they perform open urethroplasty and timing of open urethroplasty were investigated. Results: Optic internal urethrotomy and dilatation are the most commonly used minimal invasive procedures in treatment of US with the ratios of 93.5% and 63.3% respectively. On the other hand it was seen that urethroplasty was a less commonly used procedure, compared to minimal invasive techniques, with the ratio of 36.7%. Survey results showed us that the number of US cases observed and open urethroplasty procedures performed increases with increasing years of professional experience. Conclusions: As a method demanding special surgical experience and known as a time-consuming and challenging procedure, open urethroplasty will be able to take a greater part in current urological practice with the help of theoretical education and practical courses given by specific centers and experienced authors. PMID:27256189

  10. Approach to bulbar urethral strictures: Which technique and when?

    PubMed Central

    Joshi, Pankaj; Kaya, Cevdet; Kulkarni, Sanjay

    2016-01-01

    Bulbar urethra is the most common site of anterior urethral stricture and this stricture develops secondary to idiopathic (40%), iatrogenic (35%), inflammatory (10%), and traumatic (15%) causes. Various techniques and approaches with buccal mucosal graft have been described. We wanted to describe different techniques of repair with specific advantages. PMID:27274887

  11. SIU/ICUD Consultation On Urethral Strictures: Epidemiology, etiology, anatomy, and nomenclature of urethral stenoses, strictures, and pelvic fracture urethral disruption injuries.

    PubMed

    Latini, Jerilyn M; McAninch, Jack W; Brandes, Steven B; Chung, Jae Yong; Rosenstein, Daniel

    2014-03-01

    This committee reviewed and evaluated published data, and recommended standardized terminology relating to the epidemiology, etiology, anatomy, and nomenclature of urethral stenoses, urethral strictures, and pelvic fracture urethral disruption injuries, as well as their surgical management. A literature search using Medline, PubMed (U.S. National Library of Medicine and the National Institutes of Health), Embase, online acronym databases, and abstracts from scientific meetings was performed from 1980-2010. Articles were evaluated using the Levels of Evidence adapted by the International Consultation on Urological Diseases (ICUD) from the Oxford Centre for Evidence-Based Medicine. Recommendations were based on the level of evidence and discussed among the committee to reach a consensus. There is expert opinion to support standards regarding the epidemiology, anatomy, and nomenclature of urethral stenoses, urethral strictures, and pelvic fracture urethral disruption injuries. There is level 3 evidence regarding the epidemiology and etiology of urethral stenoses, urethral strictures, and pelvic fracture urethral injuries. The literature regarding the epidemiology, anatomy, and nomenclature of urethral stenoses, urethral strictures, and pelvic fracture urethral disruption injuries are sparse and generally of a low level of evidence. The proposed ICUD system does not readily apply to these areas. Further research is needed so that stronger levels of evidence can be developed leading to recommendations regarding the accuracy of the data. To improve future research and promote effective scientific progress and communication, a standardized nomenclature and anatomy regarding the urethra and urethral surgery is detailed herein.

  12. Evaluation and management of anterior urethral stricture disease

    PubMed Central

    Mangera, Altaf; Osman, Nadir; Chapple, Christopher

    2016-01-01

    Urethral stricture disease affects many men worldwide. Traditionally, the investigation of choice has been urethrography and the management of choice has been urethrotomy/dilatation. In this review, we discuss the evidence behind the use of ultrasonography in stricture assessment. We also discuss the factors a surgeon should consider when deciding the management options with each individual patient. Not all strictures are identical and surgeons should appreciate the poor long-term results of urethrotomy/dilatation for strictures longer than 2 cm, strictures in the penile urethra, recurrent strictures, and strictures secondary to lichen sclerosus. These patients may benefit from primary urethroplasty if they have many adverse features or secondary urethroplasty after the first recurrence. PMID:26918169

  13. Buccal mucosal graft in reconstructive urology: uses beyond urethral stricture.

    PubMed

    Pandey, Abhishek; Dican, Razvan; Beier, Jörn; Keller, Hansjörg

    2014-07-01

    The use of buccal mucosal grafts for the reconstruction of urethral strictures is an established procedure. Because of its robustness, the buccal mucosal graft could also potentially provide an alternative for other indications in reconstructive urology. We report here six consecutive patients who received a buccal mucosal graft for ureteral strictures, glans reconstruction and stoma stenosis. The follow up for all patients ranged from 26 to 50 months. The buccal mucosal graft showed excellent functional results for the ureteral strictures and stenosis from ureterocutaneostomy. For glans reconstructions, the buccal mucosal grafts delivered excellent cosmetic and functional results without causing meatal stenosis. We conclude the buccal mucosal graft can be used in reconstructive surgery beyond the reconstruction of urethral strictures.

  14. Posterior urethral polyp with type I posterior urethral valves: a rare association in a neonate.

    PubMed

    Kesan, Krushnakumar V; Gupta, Rahul Kumar; Kothari, Paras; Gupta, Abhaya; Mudkhedkar, Kedar; Kamble, Ravikiran; Dikshit, K Vishesh

    2014-06-01

    Urethral polyp is a rare cause of bladder outlet obstruction, voiding dysfunction, and hematuria in the pediatric age group. Urethral polyps are rarely associated with other congenital urinary tract anomalies. In this study, we report a case of solitary posterior urethral polyp with type I posterior urethral valve in a 7-day-old neonate presented with urinary retention and deranged renal function. The polyp was diagnosed on cystoscopy. Transurethral resection of the polyp with posterior urethral valve fulguration was performed. Pathologic assessment revealed a fibroepithelial lesion, which was consistent with congenital posterior urethral polyp.

  15. SIU/ICUD Consultation on Urethral Strictures: The management of anterior urethral stricture disease using substitution urethroplasty.

    PubMed

    Chapple, Christopher; Andrich, Daniela; Atala, Anthony; Barbagli, Guido; Cavalcanti, André; Kulkarni, Sanjay; Mangera, Altaf; Nakajima, Yosuke

    2014-03-01

    In this systematic review of the literature, a search of the PubMed database was conducted to identify articles dealing with augmentation/substitution urethral reconstruction of the anterior urethral stricture. The evidence was categorized by stricture site, surgical technique, and the type of tissue used. The committee appointed by the International Consultation on Urological Disease reviewed this data and produced a consensus statement relating to the augmentation and substitution of the anterior urethra. In this review article, the background pathophysiology is discussed. Most cases of urethral stricture disease in the anterior urethra are consequent on an ischemic spongiofibrosis. The choice of technique and the surgical approach are discussed along with the potential pros and cons of the use of a graft vs a flap. There is research potential for tissue engineering. The efficacy of the surgical approach to the urethra is reviewed. Whenever possible, a 1-stage approach is preferable from the patient's perspective. In some cases, with complex penile urethral strictures, a 2-stage procedure might be appropriate, and there is an important potential role for the use of a perineal urethrostomy in cases where there is an extensive anterior urethral stricture or where the patient does not wish to undergo complex surgery, or medical contraindications make this hazardous. It is important to have accurate outcome measures for the follow-up of patients, and in this context, a full account needs to be taken of patients' perspectives by the use of appropriate patient-reported outcome measures. The use of symptoms and a flow rate can be misleading. It is well established that with a normally functioning bladder, the flow rate does not diminish until the caliber of the urethra falls below 10F. The most accurate means of following up patients after stricture surgery are by the use of endoscopy or visualization by urethrography. Careful consideration needs to be made of the

  16. Use of Cutting Balloon in the Treatment of Urethral Stricture: A Novel Technique

    SciTech Connect

    Yildirim, Erkan; Cicek, Tufan; Istanbulluoglu, Okan; Ozturk, Bulent

    2009-05-15

    The peripheral cutting balloon has been used to treat various nonvascular strictures as well as vascular stenosis. In this article, we describe for the first time the use of the cutting balloon in the treatment of patients with urethral stricture. Four patients with bulbar urethral stricture were included in the study. All strictures were successfully dilated with the cutting balloon, and patients were free of symptoms at 6-month follow-up. Cutting-balloon dilatation is a safe, easy-to-perform, and effective treatment for patients with tight urethral strictures.

  17. In-vivo laser induced urethral stricture animal model for investigating the potential of LDR-brachytherapy

    NASA Astrophysics Data System (ADS)

    Sroka, Ronald; Lellig, Katja; Bader, Markus; Stief, Christian; Weidlich, Patrick; Wechsel, G.; Assmann, Walter; Becker, R.; Fedorova, O.; Khoder, Wael

    2015-02-01

    Purpose: Treatment of urethral strictures is a major challenge in urology. For investigation of different treatment methods an animal model was developed by reproducible induction of urethral strictures in rabbits to mimic the human clinical situation. By means of this model the potential of endoluminal LDR brachytherapy using β-irradiation as prophylaxis of recurrent urethral strictures investigated. Material and Methods: A circumferential urethral stricture was induced by energy deposition using laser light application (wavelength λ=1470 nm, 10 W, 10 s, applied energy 100 J) in the posterior urethra of anaesthetized New Zealand White male rabbits. The radial light emitting fiber was introduced by means of a children resectoscope (14F). The grade of urethral stricture was evaluated in 18 rabbits using videourethroscopy and urethrography at day 28 after stricture induction. An innovative catheter was developed based on a β-irradiation emitting foil containing 32P, which was wrapped around the application system. Two main groups (each n=18) were separated. The "internal urethrotomy group" received after 28days of stricture induction immediately after surgical urethrotomy of the stricture the radioactive catheter for one week in a randomized, controlled and blinded manner. There were 3 subgroups with 6 animals each receiving 0 Gy, 15 Gy and 30 Gy. In contrast animals from the "De Nuovo group" received directly after the stricture induction (day 0) the radioactive catheter also for the duration of one week divided into the same dose subgroups. In order to determine the radiation tolerance of the urethral mucosa, additional animals without any stricture induction received a radioactive catheter applying a total dose of 30 Gy (n=2) and 15 Gy (n=1). Cystourethrography and endoscopic examination of urethra were performed on all operation days for monitoring treatment progress. Based on these investigation a classification of the stricture size was performed and

  18. Urethral Strictures and Stenoses Caused by Prostate Therapy

    PubMed Central

    Chen, Mang L.; Correa, Andres F.; Santucci, Richard A.

    2016-01-01

    The number of patients with prostate cancer and benign prostatic hyperplasia is on the rise. As a result, the volume of prostate treatment and treatment-related complications is also increasing. Urethral strictures and stenoses are relatively common complications that require individualized management based on the length and location of the obstruction, and the patient’s overall health, and goals of care. In general, less invasive options such as dilation and urethrotomy are preferred as first-line therapy, followed by more invasive substitution, flap, and anastomotic urethroplasty. PMID:27601967

  19. High-pressure balloon dilation for male anterior urethral stricture: single-center experience*

    PubMed Central

    Yu, Shi-cheng; Wu, Hai-yang; Wang, Wei; Xu, Li-wei; Ding, Guo-qing; Zhang, Zhi-gen; Li, Gong-hui

    2016-01-01

    Objectives: We retrospectively reviewed the urethral stricture cases treated in our tertiary center, and assessed the safety and feasibility of the high-pressure balloon dilation (HPBD) technique for anterior urethral stricture. Methods: From January 2009 to December 2012, a total of 31 patients with anterior urethral strictures underwent HPBD at our center, while another 25 cases were treated by direct vision internal urethrotomy (DVIU). Patient demographics, stricture characteristics, surgical techniques, and operative outcomes were assessed and compared between the two groups. The Kaplan-Meier survival analysis was applied to evaluate the stricture-free rate for the two surgical techniques. Results: The operation time was much shorter for the HPBD procedure than for the DVIU ((13.19±2.68) min vs. (18.44±3.29) min, P<0.01). For the HPBD group, the major postoperative complications as urethral bleeding and urinary tract infection (UTI) were less frequently encountered than those in DVIU (urethral bleeding: 2/31 vs. 8/25, P=0.017; UTI: 1/31 vs. 6/25 P=0.037). The Kaplan-Meier survival analysis showed that there was no significant difference in stricture-free rate at 36 months between the two groups (P=0.21, hazard ratio (HR)=0.65, 95% confidence interval (CI): 0.34 to 1.26). However, there was a significantly higher stricture-free survival in the HPBD group at 12 months (P=0.02, HR=0.35, 95% CI: 0.14 to 0.87), which indicated that the stricture recurrence could be delayed by using the HPBD technique. Conclusions: HPBD was effective and safe and it could be considered as an alternative treatment modality for anterior urethral stricture disease. PMID:27604864

  20. The Use of Flaps and Grafts in the Treatment of Urethral Stricture Disease

    PubMed Central

    Wisenbaugh, Eric S.; Gelman, Joel

    2015-01-01

    The use of various grafts and flaps plays a critical role in the successful surgical management of urethral stricture disease. A thorough comprehension of relevant anatomy and principles of tissue transfer techniques are essential to understanding the appropriate use of grafts or flaps to optimize outcomes. We briefly review these principles and discuss which technique may be best suited for a given anterior urethral stricture, depending on the location and length of the stricture, the presence or absence of an intact corpus spongiosum, and the availability of adequate and healthy penile skin. PMID:26664357

  1. International prostate symptom score as a clinical outcome measure for Ethiopian patients with urethral stricture.

    PubMed

    Lemma, Be-ede; Taye, Mulat; Hawando, Tegene; Bakke, August

    2004-10-01

    Eighty-four urethral stricture patients and 73 controls were studied prospectively over a 6 months period in Tikur Anbessa Hospital from April to August 2000. The purpose of the study was to evaluate the use of International Prostate Symptom Score (IPSS) as an outcome measurement instrument for urethral stricture patients in Ethiopia. The Amharic translation of IPSS (IPSS Amh) was used in this study. Internal consistency was 0.91. Construct validity was 0.73. Test-retest reliability was 0.95. Sensitivity and specificity were 76% and 71% respectively. In conclusion the IPSS Amh was found to be valid for use in urethral stricture patients in Ethiopia. We recommend the wide use of this cheap and easily available clinical measurement instrument.

  2. Challenges in the Diagnosis and Management of Acquired Nontraumatic Urethral Strictures in Boys in Yaoundé, Cameroon

    PubMed Central

    Mouafo Tambo, F. F.; Fossi kamga, G.; Kamadjou, C.; Mbouche, L.; Nwaha Makon, A. S.; Birraux, J.; Andze, O. G.; Angwafo, F. F.; Mure, P. Y.

    2016-01-01

    Introduction. Urethral strictures in boys denote narrowing of the urethra which can be congenital or acquired. In case of acquired strictures, the etiology is iatrogenic or traumatic and rarely infectious or inflammatory. The aim of this study was to highlight the diagnostic and therapeutic difficulties of acquired nontraumatic urethral strictures in boys in Yaoundé, Cameroon. Methodology. The authors report five cases of nontraumatic urethral strictures managed at the Pediatric Surgery Department of the YGOPH over a two-year period (November 2012–November 2014). In order to confirm the diagnosis of urethral stricture, all patients were assessed with both cystourethrography and urethrocystoscopy. Results. In all the cases the urethra was inflammatory with either a single or multiple strictures. The surgical management included internal urethrotomy (n = 1), urethral dilatation (n = 1), vesicostomy (n = 2), and urethral catheterization (n = 3). With a median follow-up of 8.2 months (4–16 months) all patients remained symptoms-free. Conclusion. The authors report the difficulties encountered in the diagnosis and management of nontraumatic urethral strictures in boys at a tertiary hospital in Yaoundé, Cameroon. The existence of an inflammatory etiology of urethral strictures in boys deserves to be considered. PMID:27239364

  3. [Leiomyoma of the urethra - cause of an obstruction misdiagnosed as hereditary urethral stricture in a young man].

    PubMed

    Seseke, S; Schweyer, S; Reissig, K; Seseke, F

    2008-03-01

    Leiomyomas are benign neoplasms arising from smooth muscle cells. We describe the case of a 17-year-old boy admitted with progressive severe obstructive voiding symptoms. Retrograde urethrography showed a bulbous urethral stricture which was resected with primary urethral anastomosis. Histopathological examination confirmed the very rare case of a leiomyoma of the urethra. In patients with urethral stricture, leiomyoma should be included in the diagnostic considerations.

  4. Single stage: dorsolateral onlay buccal mucosal urethroplasty for long anterior urethral strictures using perineal route

    PubMed Central

    Prabha, Vikram; Devaraju, Shishir; Vernekar, Ritesh; Hiremath, Murigendra

    2016-01-01

    ABSTRACT Objective To assess the outcome of single stage dorsolateral onlay buccal mucosal urethroplasty for long anterior urethral strictures (>4cm long) using a perineal incision. Materials and Methods From August 2010 to August 2013, 20 patients underwent BMG urethroplasty. The cause of stricture was Lichen sclerosis in 12 cases (60%), Instrumentation in 5 cases (25%), and unknown in 3 cases (15%). Strictures were approached through a perineal skin incision and penis was invaginated into it to access the entire urethra. All the grafts were placed dorsolaterally, preserving the bulbospongiosus muscle, central tendon of perineum and one-sided attachement of corpus spongiosum. Procedure was considered to be failure if the patient required instrumentation postoperatively. Results Mean stricture length was 8.5cm (range 4 to 12cm). Mean follow-up was 22.7 months (range 12 to 36 months). Overall success rate was 85%. There were 3 failures (meatal stenosis in 1, proximal stricture in 1 and whole length recurrent stricture in 1). Other complications included wound infection, urethrocutaneous fistula, brownish discharge per urethra and scrotal oedema. Conclusion Dorsolateral buccal mucosal urethroplasty for long anterior urethral strictures using a single perineal incision is simple, safe and easily reproducible by urologists with a good outcome. PMID:27286122

  5. Docetaxel Inhibits Urethral Stricture Formation, an Initial Study in Rabbit Model

    PubMed Central

    Fu, Delai; Chong, Tie; Li, Hecheng; Zhang, Huibo; Wang, Ziming

    2014-01-01

    Introduction Urethral stricture, a frequent source of lower urinary tract disorders in men, is still a difficult problem for urologists. Based the anti-restenosis effect of paclitaxel on coronary artery, the role of docetaxel, a semi-synthetic analogue of paclitaxel, in limiting urethral stricture formation was studied. Methods Forty adult New Zealand male rabbits were involved in this study, which were randomly assigned into 3 groups, namely a high dose docetaxel (DH, 0.1 mg/d), a low dose docetaxel (DL, 0.01 mg/d) and a control (C) group, with 16, 16, 8 rabbits in each group, respectively. All animals underwent a 10 mm-long circumferential electrocoagulation of the bulbar urethra with a 13Fr pediatric resectoscope. Drugs were given by urethral irrigation daily and continuous for 28 days. Stricture formation was assessed by retrograde urethrography and videourethroscopy. Urethra pathology was evaluated by hematoxylin and eosin staining and Sirius red staining. Results At the end of this study, 15, 14 and 7 rabbits remained for evaluation in DH, DL and C group, respectively. Urethral diameters in DH, DL and C group were (7.17±1.63) mm, (6.55±0.62) mm, (3.23±1.36) mm, with a normal urethral diameter of (9.08±1.29) mm. Lumen reduction in DH, DL and C group were (36.93±11.58)%, (48.03±7.89)% and (84.66±14.95)%, respectively. Statistically difference could be found between every two groups (p<0.05) both in urethral diameters and in lumen reduction, except for compare of urethral diameters between DH and DL group. Histological examination confirmed mass fibrous tissue and collagen content at the stricture sit in C group, whereas less in docetaxel treated rabbits. Conclusions Docetaxel could limit urethral stricture formation, which may be due to inhibition of fibrous tissue and collagen expression. Docetaxel may become a new choice in the prevention of urethral stricture formation. PMID:25375859

  6. Visual Internal Urethrotomy for Adult Male Urethral Stricture Has Poor Long-Term Results

    PubMed Central

    Al Taweel, Waleed; Seyam, Raouf

    2015-01-01

    Objective. To determine the long-term stricture-free rate after visual internal urethrotomy following initial and follow-up urethrotomies. Methods. The records of all male patients who underwent direct visual internal urethrotomy for urethral stricture disease in our hospital between July 2004 and May 2012 were reviewed. The Kaplan-Meier method was used to analyze stricture-free probability after the first, second, third, fourth, and fifth urethrotomies. Results. A total of 301 patients were included. The overall stricture-free rate at the 36-month follow-up was 8.3% with a median time to recurrence of 10 months (95% CI of 9.5 to 10.5, range: 2–36). The stricture-free rate after one urethrotomy was 12.1% with a median time to recurrence of eight months (95% CI of 7.1–8.9). After the second urethrotomy, the stricture-free rate was 7.9% with a median time to recurrence of 10 months (95% CI of 9.3 to 10.6). After the third to fifth procedures, the stricture-free rate was 0%. There was no significant difference in the stricture-free rate between single and multiple procedures. Conclusion. The long-term stricture-free rate of visual internal urethrotomy is modest even after a single procedure. PMID:26494995

  7. Cost-effective Strategies for the Management and Treatment of Urethral Stricture Disease.

    PubMed

    Osterberg, E Charles; Murphy, Gregory; Harris, Catherine R; Breyer, Benjamin N

    2017-02-01

    Following failed endoscopic intervention, the most cost-effective strategy for recurrent urethral stricture disease (USD) is urethroplasty. Inpatient hospital costs associated with urethroplasty are driven by patient comorbidities and postoperative complications. Symptom-based surveillance for USD recurrence will reduce unnecessary diagnostic procedures and cost.

  8. Penile inversion through a penoscrotal incision for the treatment of penile urethral strictures

    PubMed Central

    Tracey, James M; Zhumkhawala, Ali A; Chan, Kevin G.; Lau, Clayton S.

    2016-01-01

    Purpose This article describes a novel technique for the repair of penile urethral strictures and establishes the safety, feasibility, and efficacy of this innovative surgical approach. Materials and Methods Patients with urethral strictures underwent a one-sided anterior dorsal oral mucosal graft urethroplasty through a penoscrotal inversion technique. The clinical outcome was considered a failure when any instrumentation was needed postoperatively, including dilatation. Results Five patients underwent the novel procedure. The patients' mean age was 58 years. The cause of stricture was instrumentation in 2 cases (40%), lichen sclerosis in 1 case (20%), and failed hypospadias repair in 2 cases (40%). The mean stricture length was 3 cm. The overall mean (range) follow-up was 6 months (range, 3–9 months). Of the 5 patients, 4 (80%) had a successful outcome and 1 (20%) had a failed outcome. The failure was successfully treated by use of a meatotomy. Conclusions The penile inversion technique through a penoscrotal incision is a viable option for the management of penile urethral strictures with several advantages to other techniques: namely, no penile skin incision, a single-stage operation, and supine positioning. PMID:26981596

  9. ‘Real-time sonoelastography’ in anterior urethral strictures: A novel technique for assessment of spongiofibrosis

    PubMed Central

    Yadav, Sher Singh; Tomar, Vinay; Agarwal, Neeraj; Jaipal, Usha; Priyadarshi, Shivam

    2016-01-01

    Introduction Spongiofibrosis assessment is critically important in the evaluation of anterior urethral strictures as its severity is directly proportional to stricture recurrence and thus affects management. Retrograde urethrography (RGU) is ineffective in the evaluation of spongiofibrosis. Sonourethrography (SUG) delineates it but does not accurately estimate its depth. Real-time elastography (RTE), a newer technique that not only attempts a qualitative but also quantitative estimation of spongiofibrosis (tissue stiffness) which results due to underlying pathological processes. Material and methods In the present study, various elastographic patterns and strain ratios in anterior urethral stricture patients were studied and compared to operative and histopathological findings. Sixty-three RGU diagnosed anterior urethral stricture cases were taken and re-evaluated by SUG and SE by another radiologist who was blinded to the findings of the RGU. Strain patterns and ratios of spongiofibrotic segments were documented and compared with operative findings as gold standard. Results Blue pattern on RTE showed 100% concordance with severe fibrosis as evaluated against histopathological findings whereas green pattern showed 87.5% concordance with moderate degree of fibrosis. Severe degree of fibrosis cases, confirmed on histopathology had a significantly higher mean strain ratio (10.51 ±2.297) as compared to moderate degree (6.33 ±2.353) (p <0.001 S). Conclusions Real time sonoelastography in the evaluation of spongiofibrosis not only assesses it qualitatively but also quantifies it. Strain ratios are statistically better indicators for estimating spongiofibrosis. PMID:28127461

  10. Early Experience with Hyaluronic Acid Instillation to Assist with Visual Internal Urethrotomy for Urethral Stricture

    PubMed Central

    Kim, Hak Min; Kang, Dong Il; Shim, Bong Suk

    2010-01-01

    Purpose The clinical usefulness of hyaluronic acid (HA) instillation during visual internal urethrotomy (VIU) for decreasing the incidence of recurrent urethral stricture was assessed. Materials and Methods Twenty-eight patients were treated by VIU with HA instillation between May 2007 and June 2009. After insertion of a Foley catheter following urethrotomy, HA was instilled via an 18-gauge tube catheter between the urethral lumen and Foley catheter. Seventeen cases were analyzed retrospectively 12 months postoperatively. We evaluated the success rate of this procedure by comparing retrograde urethrography (RGU) results, maximum flow rates, and postvoid residual urine volumes preoperatively and 3 and 12 months postoperatively. Success was defined as either a maximum flow rate of at least 15 ml/s or no visible urethral stricture on RGU at 12 months postoperatively. Results Total success rates were 76.5% (13/17) and 52.9% (9/17) at 3 and 12 months postoperatively, respectively. By etiology, success rates at 3 and 12 months postoperatively, respectively, were 66.7% and 33.3% for inflammation, 66.7% and 50.0% for trauma, and 83.3% and 66.7% for unknown causes. Success rates were 63.6% for strictures less than 10 mm in length and 33.3% for strictures of 10 mm or more in length at 12 months postoperatively. Success rates were 61.5% for single strictures and 25% for multiple strictures at 12 months postoperatively. Conclusions The success rate of VIU with HA instillation was not better than that observed in the literature for conventional VIU. PMID:21221206

  11. Comparison of sonoelastography with sonourethrography and retrograde urethrography in the evaluation of male anterior urethral strictures

    PubMed Central

    Talreja, Shyam Manoharlal; Tomar, Vinay; Yadav, Sher Singh; Jaipal, Usha; Priyadarshi, Shivam; Agarwal, Neeraj; Vyas, Nachiket

    2016-01-01

    Objective Retrograde urethrography (RUG) is the most common and preferred imaging modality for imaging of the anterior urethral strictures despite its well-known limitations and disadvantages. Sonourethrography (SUG) was introduced in 1988 to overcome the limitations of RUG and to provide more accurate results. As proper selection of imaging modality is very important for planning the treatment, various advances in this area are required. One of the major factors for recurrence of stricture disease is spongiofibrosis. Sonoelastography (SE) is a newer technique, tried in various other pathologies. In this study, we have used this technique for the first time to assess its efficacy in the evaluation of anterior urethral stricture disease by comparison with RUG and SUG. Material and methods Between August 2014 and May 2015, 77 patients with clinical features of anterior urethral stricture disease were included in the study and evaluated by RUG followed by SUG and SE for stricture location, length, depth of spongiofibrosis and periurethral pathologies. The results were then correlated with operative and histopathological findings. Results Overall diagnostic accuracy of SE, SUG, and RGU for the estimation of stricture location, and length were estimated 92.68% vs. 91.54%, 79% vs. 78.87% and 80.48% vs. 43.66%, respectively, while for depth of spongiofibrosis SE, and SUG had accuracy rates of 87.3%, 48%, respectively. The mean length measured on SE was nearest to the mean intra-operative stricture length (21.34+11.8 mm). SE findings significantly correlated with the colour of bladder mucosa on cystoscopic examination (p=0.003) whereas the association was non-significant (p=0.127) for difficulty in incision. While a nonsignificant correlation existed between SUG findings related both to the colour of the bladder mucosa and difficulty in incision on cystoscopy, SE findings had a significant association (p<0.001) with histopathology findings for severe degree of fibrosis

  12. Using transurethral Ho:YAG-laser resection to treat urethral stricture and bladder neck contracture

    NASA Astrophysics Data System (ADS)

    Bo, Juanjie; Dai, Shengguo; Huang, Xuyuan; Zhu, Jing; Zhang, Huiguo; Shi, Hongmin

    2005-07-01

    Objective: Ho:YAG laser had been used to treat the common diseases of urinary system such as bladder cancer and benign prostatic hyperplasia in our hospital. This study is to assess the efficacy and safety of transurethral Ho:YAG-laser resection to treat the urethral stricture and bladder neck contracture. Methods: From May 1997 to August 2004, 26 cases of urethral stricture and 33 cases of bladder neck contracture were treated by transurethral Ho:YAG-laser resection. These patients were followed up at regular intervals after operation. The uroflow rate of these patients was detected before and one-month after operation. The blood loss and the energy consumption of holmium-laser during the operation as well as the complications and curative effect after operation were observed. Results: The therapeutic effects were considered successful, with less bleeding and no severe complications. The Qmax of one month postoperation increased obviously than that of preoperation. Of the 59 cases, restenosis appeared in 11 cases (19%) with the symptoms of dysuria and weak urinary stream in 3-24 months respectively. Conclusions: The Ho:YAG-laser demonstrated good effect to treat the obstructive diseases of lower urinary tract such as urethral stricture and bladder neck contracture. It was safe, minimal invasive and easy to operate.

  13. Posterior urethral valves: long-term outcome.

    PubMed

    Caione, Paolo; Nappo, Simona Gerocarni

    2011-10-01

    Posterior urethral valves represent the most common cause of bladder outlet obstruction in infancy that impairs renal and bladder function. Long-term outcome of patients with previous PUV is evaluated. Patients over 18 years of age, treated from 1982 to 1995 before the age of 3 years were considered. Previous surgery, renal function, bladder activity, urinary incontinence, and fertility/sexual activity were evaluated. Clinical interview, creatinine clearance, uroflowmetry with ultrasound post-void urine residue, and self-administered questionnaire were recorded. Out of 45 identified records, 24 patients (53.3%) accepted to be enrolled (age 18-34 years, mean 23 years). The mean follow-up was 19.5 years (16-30 years). Out of the 21 excluded patients, 20 did not reply to the clinical interview and 1 died at age of 6 years. All the 24 patients had early endoscopic section of PUV; nine also received transient ureterocutaneostomy or vesicostomy. Ureteroneocystostomy was performed in five patients and ureterocystoplasty with unilateral nephrectomy in two. At follow-up chronic renal failure was detected in 13 patients (54.1%) and 9 (37.5%) had arterial hypertension. End-stage renal disease developed in five patients (20.8%): three had successful renal transplantation and two were in dialysis. Lower urinary tract symptoms were present in seven patients (29.1%). No significant fertility deficit and sexual dysfunction were observed in 23 patients, while 1 patient was azoospermic. No paternity was reported so far. Long-term outcome of patients with previously treated PUV is mandatory. Kidney, bladder, and sexual functions should be monitored till adulthood to verify any modified behaviour.

  14. Application of novel optical diffuser for urethral stricture treatment (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Nguyen, Trung Hau; Rhee, Yun-Hee; Ahn, Jin-Chul; Kang, Hyun Wook

    2016-02-01

    Optical fibers have frequently been used for photothermal laser therapy due to its efficiency to deliver laser energy directly to tissue. The aim of the current study was to develop a diffusing optical fiber to achieve radially uniform light irradiation for endoscopically treating urethral stricture. The optical diffuser was fabricated by micro-machining helical patterns on the fiber surface using CO2 laser light at 5 W. Visible light emission (632 nm) and spatial emissions (including polar, azimuthal, and longitudinal emissions) of the fiber tip were evaluated to validate the performance of the fabricated diffuser. Prior to tissue tests, numerical simulation on heat distribution was developed to estimate the degree of tissue coagulation depth during interstitial coagulation. Due to a high absorption coefficient by tissue water, 1470 nm laser was used for photothermal therapy treatment of urethral stricture to obtain a more precise depth profile. For in vitro tissue tests, porcine liver tissue was irradiated with three different power levels (3, 6, and 9 W) at various irradiation times. Porcine urethral tissue was also tested with the diffuser for 10 sec at 6 W to validate the feasibility of circumferential photothermal treatment. The treated tissue was stained with hematoxylin and eosin (H and E) and then imaged with an optical transmission microscope. The spatial emission characteristics of the diffusing optical fiber presented an almost uniform power distribution along the diffuser tip (less than 10% deviation) and around its circumference (less than 5% deviation). The peak temperature in simulation model at the tissue interface between the glass-cap and the tissue was 373 K that was higher than that at the distal end. The tissue tests showed that higher power levels resulted in lower coagulation thresholds (e.g., 1 sec at 9 W vs 8 sec at 3 W). Furthermore, the coagulation depth was approximately 20% thinner than the simulation results (p<0.001). The extent of

  15. Bilateral epididymitis in a child with undiagnosed posterior urethral valves.

    PubMed

    Kwong, Justin; Lorenzo, Armando J; DeMaria, Jorge; Braga, Luis H P

    2013-07-01

    Posterior urethral valves are most commonly detected in the early neonatal period, the diagnosis often antenatally suspected from ultrasound findings. Nevertheless, some cases might go undetected and become manifest later in life with lower urinary tract symptoms. We describe the unusual case of a 5-year-old boy with a 2-month history of bladder distension, urinary dribbling, and epididymitis. Cystourethrography revealed posterior urethral valves with reflux into the seminal vesicles, vas deferens, and epididymis, bilaterally. A review of the published data is provided in the context of this unusual presentation pattern.

  16. Update in urethral stents.

    PubMed

    Bahouth, Z; Meyer, G; Yildiz, G; Nativ, O; Moskovitz, B

    2016-10-01

    Urethral stents were first introduced in 1988, and since then, they have undergone significant improvements. However, they did not gain a wide popularity and their use is limited to a small number of centers around the world. Urethral stents can be used in the entire urethra and for various and diverse indications. In the anterior urethra, it can be used to treat urethral strictures. In the prostatic urethra, they can be used for the treatment of prostatic obstruction, including benign, malignant and iatrogenic prostatic obstruction. Moreover, although not widely used, it can be also applied for the treatment of posterior urethral stricture and bladder neck contracture, usually resulting in urinary incontinence and the need for subsequent procedures. Our main experience are with Allium urethral stents, and as such, we provide the latest updates in urethral stents with special emphasis on the various types of Allium urethral stents: bulbar, prostatic and bladder neck stents.

  17. [Urethroplasty with buccal mucosa graft or penile skin graft for anterior urethral stricture?].

    PubMed

    Rojas, Alejandro; Saavedra, Alvaro

    2015-06-04

    Currently the treatment for urethral stricture considers various techniques, including augmentation urethroplasty using tissue from different parts of the body. The more used are the buccal mucosa and penile skin, but are there any differences in success between both tissues? Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified one systematic review including 18 primary studies addressing this question, six of them prospective. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded there is uncertainty about the superiority of one technique over another because the certainty of the evidence is very low. A new systematic review is urgently needed on this topic as randomized studies have been published after the most recent review, which could provide greater certainty.

  18. Urethral Disorders

    MedlinePlus

    ... or injury. They include Urethral cancer - a rare cancer that happens more often in men Urethral stricture - a narrowing of the opening of the urethra Urethritis - inflammation of the urethra, sometimes caused by ...

  19. Congenital posterior urethral obstruction: re-do fulguration.

    PubMed

    Imaji, Reisuke; Dewan, Paddy A

    2002-09-01

    In patients with congenital posterior urethral obstruction, transurethral fulguration (TUF) is usually the treatment of choice if the patient is in a stable condition. However, few papers have described the proportion of patients who need further fulguration. We reviewed 83 boys with a congenital obstructive posterior urethral membrane (COPUM) to assess the role of re-do fulguration, as judged by prospective video recordings. Between December 1990 and March 2000, 83 boys (aged from newborn to 15 years) underwent cystourethroscopy for investigation of a urethral anomaly and were found to have a COPUM. TUF was performed endoscopically with a hook diathermy electrode. Two to 3 months later boys who had cauterisation had a further urethroscopy and diathermy as required. Of the 83 membranous lesions in the posterior urethra, 38 were considered severe, 20 moderate, and 21 minor. Four patients had inadequate data to be properly classified. Eighteen (47.4%) of the 38 patients who had a severe obstructive membrane equired further endoscopic intervention to obliterate residual membrane elements. As over 45% of patients who had a severe obstructing membrane needed further fulguration, it is important to follow patients carefully and to repeat the cystourethroscopy.

  20. A Giant Urethral Calculus.

    PubMed

    Sigdel, G; Agarwal, A; Keshaw, B W

    2014-01-01

    Urethral calculi are rare forms of urolithiasis. Majority of the calculi are migratory from urinary bladder or upper urinary tract. Primary urethral calculi usually occur in presence of urethral stricture or diverticulum. In this article we report a case of a giant posterior urethral calculus measuring 7x3x2 cm in a 47 years old male. Patient presented with acute retention of urine which was preceded by burning micturition and dribbling of urine for one week. The calculus was pushed in to the bladder through the cystoscope and was removed by suprapubic cystolithotomy.

  1. SIU/ICUD Consultation on Urethral Strictures: Anterior urethra-lichen sclerosus.

    PubMed

    Stewart, Laurence; McCammon, Kurt; Metro, Michael; Virasoro, Ramon

    2014-03-01

    We reviewed the current literature on lichen sclerosus as it related to urethral stricture disease using MEDLINE and PubMed (U.S. National Library of Medicine, National Institutes of Health) up to the current time. We identified 65 reports, 40 of which were considered relevant and form the basis of this review. Lichen sclerosus is now the accepted term, and balanitis xerotica obliterans is no longer acceptable. This common chronic inflammatory skin condition, mainly affecting the genitalia, remains an enigma, with uncertain etiology, varied presentation, and multiple treatments. In the early stages of the condition, a short course of steroids may be beneficial for some patients. If persistent, patients need long-term surveillance because of the potential development of squamous cell carcinoma. If diagnosed early, lichen sclerosus can be controlled, preventing progression. But once the disease has progressed, it is very difficult to treat. Surgical treatment by circumcision can be curative if the disease is treated early when still localized. Once progression to urethral involvement has occurred, treatment is much more difficult. Meatal stenosis alone is likely to require meatotomy or meatoplasty. Treatment of the involved urethra requires urethroplasty. Single-stage and multiple-stage procedures using oral mucosa have both been reported to give acceptable results, but the use of skin, genital or nongenital, is not recommended, because being skin, it remains prone to lichen sclerosus. With extensive disease, affecting the full length of the urethra, consideration should be given to perineal urethrostomy. A significant number of patients may prefer this simpler option.

  2. A simplified protocol for evaluating and monitoring urethral stricture patients minimizes cost without compromising patient outcome.

    PubMed

    Okorie, Chukwudi O; Pisters, Louis L; Ndasi, Henry T; Fekadu, Arega

    2010-07-01

    Uroflowmetry, urethrocystoscopy and urethrography are either not readily available or the cost is prohibitive for many patients in low-resource countries. This paper examines the use of clinical history in post-urethroplasty follow-up. We retrospectively reviewed the outcome of 54 post-urethroplasty patients. Preoperative diagnostic work-up included simple blood tests and a retrograde urethrography, and postoperatively we did not perform any immediate diagnostic work-up. Follow-up of these patients was done through mobile phone calls and personal contacts. Eighty-nine per cent of our patients reported acceptable voiding over a mean follow-up period of 48.4 months - 79.6% were followed using mobile phone contact. In the majority of the urethral strictures cases, diagnostic work up can be kept to a minimum, thereby reducing cost. Follow-up can be done via phone calls and personal contact in many African countries where compliance is frequently less than encouraging. The spread of mobile phone networks across the continent has been remarkable.

  3. Diversity of patient profile, urethral stricture, and other disease manifestations in a cohort of adult men with lichen sclerosus

    PubMed Central

    Kirk, Peter Stanford; Yi, Yooni; Hadj-Moussa, Miriam

    2016-01-01

    Purpose Lichen sclerosus (LS) in men is poorly understood. Though uncommon, it is often severe and leads to repeated surgical interventions and deterioration in quality of life. We highlight variability in disease presentation, diagnosis, and patient factors in male LS patients evaluated at a tertiary care center. Materials and Methods We retrospectively reviewed charts of male patients presenting to our reconstructive urology clinic with clinical or pathologic diagnosis of LS between 2004 and 2014. Relevant clinical and demographic information was abstracted and descriptive statistics calculated. Subgroup comparisons were made based on body mass index (BMI), urethral stricture, and pathologic confirmation of disease. Results We identified 94 patients with clinical diagnosis of LS. Seventy percent (70%) of patients in this cohort had BMI >30 kg/m2, and average age was 51.5 years. Lower BMI patients were more likely to suffer from urethral stricture disease compared to overweight counterparts (p=0.037). Patients presenting with stricture disease were more likely to be younger (p=0.003). Thirty percent (30%) of this cohort had a pathologic diagnosis of LS. Conclusions Urethral stricture is the most common presentation for men with LS. Many patients endure skin scarring and have numerous comorbidities. Patient profile is diverse, raising the concern that not all patients with clinical diagnosis of LS are suffering from identical disease processes. The rate of pathologic confirmation at a tertiary care institution is alarmingly low. Our findings support a role for increased focus on pathologic confirmation and further delineation of the subtype of disease based on location and clinical manifestations. PMID:27195319

  4. Vaginal-sparing ventral buccal mucosal graft urethroplasty for female urethral stricture: A novel modification of surgical technique

    PubMed Central

    Gani, Johan; Chee, Justin

    2016-01-01

    Purpose To present a novel modification of surgical technique to treat female urethral stricture (FUS) by a vaginal-sparing ventral buccal mucosal urethroplasty. Recurrent FUS represents an uncommon, though difficult clinical scenario to manage definitively. A variety of surgical techniques have been described to date, yet a lack of consensus on the optimal procedure persists. Materials and Methods We present a 51-year-old female with urethral stricture involving the entire urethra. Suspected etiology was iatrogenic from cystoscopy 17 years prior. Since then, the patient had undergone at least 25 formal urethral dilations and periods of self-dilation. In lithotomy position, the urethra was dilated to accommodate forceps, and ventral urethrotomy carried out sharply, exposing a bed of periurethral tissue. Buccal mucosa was harvested, and a ventral inlay technique facilitated by a nasal speculum, was used to place the graft from the proximal urethra/bladder neck to urethral meatus without a vaginal incision. Graft was sutured into place, and urethral Foley catheter inserted. Results The vaginal-sparing ventral buccal mucosal graft urethroplasty was deemed successful as of last follow-up. Flexible cystoscopy demonstrated patency of the repair at 6 months. At 10 months of follow-up, the patient was voiding well, with no urinary incontinence. No further interventions have been required. Conclusions This case describes a novel modification of surgical technique for performing buccal mucosal urethroplasty for FUS. By avoiding incision of the vaginal mucosa, benefits may include reduced: morbidity, urinary incontinence, and wound complications including urethro-vaginal fistula. PMID:27437540

  5. A comparative study of lingual mucosal graft urethroplasty with buccal mucosal graft urethroplasty in urethral stricture disease: An institutional experience

    PubMed Central

    Pal, Dilip Kumar; Gupta, Depak Kumar; Ghosh, Bastab; Bera, Malay Kumar

    2016-01-01

    Aims: A prospective study to compare the outcomes of lingual versus buccal mucosal graft urethroplasty in patients with long segment anterior urethral strictures disease. Materials and Methods: The study included 30 patients for buccal mucosal graft urethroplasty (group I) and 30 patients for lingual mucosal graft urethroplasty (group II) for treatment of long segment (>3 cm) incomplete anterior urethral stricture disease using single-stage dorsal onlay free oral mucosal graft urethroplasty by Barbagli's technique between February 2013 to September 2014. All patients underwent complete evaluation of the stricture including inspection of the oral cavity. Results: The results of urethroplasty in between two group were not significant (P > 0.05) in terms of Qmax (P = 0.63), mean postoperative AUA symptom score (P = 0.83), operative time (P = 0.302) intra operative blood loss (P = 0.708), duration of postoperative hospitalization (P = 0.83), but slurring of speech complications was seen in group II, but not in group I. Long-term complications of salivary disturbance, tightness of the mouth, persistent pain at graft site, perioral numbness, seen only in group I (BMGU). Conclusion: LMG urethroplasty is an excellent alternative to BMG urethroplasty with comparable results of urethroplasty and minimal donor site complications. PMID:27141184

  6. Long-term consequences of posterior urethral valves.

    PubMed

    Lopez Pereira, Pedro; Martinez Urrutia, M J; Espinosa, L; Jaureguizar, E

    2013-10-01

    Posterior urethral valves (PUV) are the most common congenital cause of bladder outlet obstruction in infancy, and it is the effect of this obstruction on the bladder and the kidneys that will decide a patient's prognosis. With the improvements in diagnosis and treatments, what was previously a poor prognosis for boys with PUV has improved, and more patients will encounter the long-term sequelae of PUV during puberty and adulthood. In these patients the long-term prognosis in terms of renal and bladder function and fertility, as well as the risk of malignancy in those whose bladders were augmented with gastrointestinal segments, is still a matter of great concern and all of these topics will be discussed in this article.

  7. Urethral stricture vaporization with the KTP laser provides evidence for a favorable impact of laser surgery on wound healing

    NASA Astrophysics Data System (ADS)

    Schmidlin, Franz R.; Venzi, Giordano; Jichlinski, Patrice; Oswald, Michael; Delacretaz, Guy P.; Gabbiani, Giulio; Leisinger, Hans-Juerg; Graber, Peter

    1997-12-01

    The objective of this study was to evaluate and compare the safety and efficacy of the KTP 532 laser to direct vision internal urethrotomy (DVIU) in the management of urethral strictures. A total of 32 patients were randomized prospectively in this study, 14 DVIU and 18 KTP 532 laser. Patients were evaluated postoperatively with flowmetry and in the case of recurrence with cystourethrography at 3, 12, 24 weeks. With the KTP 532 laser complete symptomatic and uredynamic success was achieved in 15 (83%) patients at 12 and 24 weeks. Success rate was lower in the DVIU group with 9 (64%) patients at 12 weeks and 8 (57%) patients at 24 weeks. Mean preoperative peak-flow was improved from 6 cc/s to 20 cc/s at 3, 12 and 24 weeks with the KTP laser. With DVIU mean preoperative peak-flow was improved from 5.5 cc/s to 20 cc/s at 3 weeks followed by a steady decrease to 13 cc/s at 12 weeks and to 12 cc/s 24 weeks. No complication was observed in either group of patients. Our results confirm that stricture vaporization with the KTP 532 laser is a safe and efficient procedure. The better results after laser surgery make it also a valuable alternative in the endoscopic treatment of urethral strictures. These findings suggest a favorable influence of laser surgery on wound healing with less wound contraction and scarring. The lack of contraction of laser wounds might be related to the absence and the lack of organization of myofibroblasts in laser induced lesions.

  8. Urinary tract infections in children with posterior urethral valves after kidney transplantation.

    PubMed

    Mochon, M; Kaiser, B A; Dunn, S; Palmer, J; Polinsky, M S; Schulman, S L; Flynn, J T; Baluarte, H J

    1992-12-01

    The records of 14 boys with posterior urethral valves who had renal failure and subsequently underwent renal transplantation were reviewed to determine the postoperative incidence of urinary tract infection relative to that of 29 male transplant children without valves, who served as controls. There were no significant differences between the posterior urethral valve patients and controls with regard to age, donor source, immunosuppression, followup after transplantation or mean calculated creatinine clearance. Vesicoureteral reflux was found in 1 child with posterior urethral valves and 3 of the children in the control group (p not significant). A total of 15 urinary tract infections occurred in 5 children (36%) with posterior urethral valves, for a rate of 1 per 30 patient-months of followup, and 6 urinary tract infections occurred in 2 controls (7%), for a rate of 1 per 216 patient-months of followup (p < 0.05). However, only 1 of 26 controls (4%) without vesicoureteral reflux had urinary tract infection, for a rate 1 per 1,144 patient-months (p < 0.01). Conversely, the rate of urinary tract infections in controls with vesicoureteral reflux was similar to that of children with posterior urethral valves. Of the 5 children with posterior urethral valves 4 had the initial urinary tract infection within 2 months of transplantation and 10 of 15 episodes occurred within the first 4 months. Antimicrobial prophylaxis did not appear to decrease the rate of infection in children with posterior urethral valves. A history of posterior urethral valves increases the frequency of urinary tract infection after renal transplantation but the usefulness of antimicrobial prophylaxis and the relationship to long-term graft function remain to be determined. Urinary tract infection rarely develops in other transplanted boys without vesicoureteral reflux.

  9. Upper-tract changes after treatment of posterior urethral valves.

    PubMed

    Lal, R; Bhatnagar, V; Mitra, D K

    1998-07-01

    This paper discusses the long-term sequelae in the upper urinary tract with respect to hydroureteronephrosis (HUN), vesicoureteral reflux (VUR), renal parenchymal disease, and their correlation with renal function in 84 boys with posterior urethral valves followed for 1 to 21 years. Thirty-one boys (39.3%) were adolescents or older at the time of review. The incidence of high-grade VUR (grade III or more) was 47.6% at presentation, and resolution following decompression of the lower urinary tract occurred in 38.7% of refluxing units. VUR was associated with a high incidence of chronic renal failure (CRF) (30%) on long-term follow up; however, 16% of non-refluxing patients also progressed to CRF. The incidences of renal parenchymal disease and persistent upper-tract dilatation in the non-refluxing group were 25% and 50% of renal units respectively. Gross HUN persisted in 12.3% of patients despite decompression and reconstructive surgery, with vesicoureteral junction (VUJ) obstruction being documented in 1 patient only. Moderate and mild upper-tract dilatation persisted in 31.6% and 43.9% of patients, respectively. Persistent gross HUN was associated with a very high incidence of CRF (92.3%), while 88.4% of those with persistent mild/moderate dilatation maintained normal renal function over a follow-up period ranging from 1 to 21 years. This study emphasizes the need for systematic evaluation to exclude VUJ obstruction and abnormal urodynamics as a cause of persistent HUN so that effective therapy can be instituted early to relieve back-pressure and to provide a low-pressure reservoir with effective emptying. In the absence of either of these causes, persistent ureterectasis after treatment is presumably due to secondary peristaltic failure as a consequence of ureteral fibrosis, ureteral tortuosity, or developmental dysplasia.

  10. Penile Circular Fasciocutaneous (McAninch) Flap as an Option for Complex Anterior Urethral Stricture in Case of Non-Viable Buccal Mucosal Graft

    PubMed Central

    Vijayganapathy, Sundaramoorthy; Mallya, Ashwin; Sreenivas, Jayaram

    2016-01-01

    The penile circular fasciocutaneous flap (FCF) is employed in the successful single stage reconstruction of long segment complex anterior urethral strictures especially when buccal mucosa is unavailable due to various reasons. A 65-year-old gentleman, chronic smoker and tobacco chewer, hypertensive on treatment, presented with obstructive lower urinary tract symptoms for 8 months. He had no prior urethral catheterization. On examination, he had circumcised penis, with stenosis of the external urethral meatus. Glans had no changes suggesting balanitis xerotica obliterans. Suprapubic cystostomy was done as he developed acute urinary retention during evaluation. Retrograde urethrogram (RGU) showed pan-anterior urethral stricture. He was planned for substitution urethroplasty. On oral cavity examination, he had moderate trismus with oral submucous fibrosis. As buccal mucosal graft was unavailable, he was planned for FCF. A ventral onlay tubularization FCF urethroplasty from meatus to bulbar urethra based on dartos dorsal pedicle was done. His postoperative recovery was uneventful. Pericatheter RGU did not show extravastion and he voided well with Qmax 14 ml/second. He is doing well at follow-up. PMID:27630900

  11. [Success of internal urethrotomy as the 1st operation in male urethral stricture].

    PubMed

    Esch, W; Latal, D

    1983-11-01

    A follow-up examination was possible on 179 out of 226 patients operated on for urethrostenosis using sight urethrotomy according to Sachse. The results are classification according to the observation period, ranging from 3 months to 3 years. The most important criteria of a successful operation were lack of discomfort and a rise in uroflow to over 10 ml. Relapses occur more frequently than average in patients who had recidive infections of the urinary tract before the operation. Where the operation was successful the urinary tract infection almost always subsided. Recidive strictures occurred frequently in patients over 70 years. However, internal urethrotomy is often the only suitable method of operation at that age. Long prior bouginage makes prognosis worse. In terms of aetiology, iatrogenic stenoses give the worst results, bulbar ring stenoses, the best. In cases of long stenoses, particularly in the penile part of the urethra, the results of the operation are clearly worse than average, so that another method of operation should be considered, especially if the patients are young.

  12. Penile necrosis in a diabetic with renal disease and clean intermittent catheterization for recurrent urethral stricture. Case report.

    PubMed

    Cormio, L; Taskinen, S; Perttilä, I; Ruutu, M

    1994-06-01

    In a patient with diabetic microangiopathy and renal disease, penile necrosis occurred in connection with clean intermittent catheterization. Microangiopathy of the urethral and penile arteries presumably lowered the local defences, so that the catheterization initiated penile necrotic changes by introducing bacteria and traumatizing the poorly vascularized urethral epithelium.

  13. Spontaneous Rupture of Kidney Due to Posterior Urethral Valve–Diagnostic Difficulties

    PubMed Central

    Kiliś-Pstrusińska, Katarzyna; Pukajło-Marczyk, Agnieszka; Patkowski, Dariusz; Zalewska-Dorobisz, Urszula; Zwolińska, Danuta

    2013-01-01

    Background Spontaneous kidney rupture could develop in the course of posterior urethral valve (PUV), the most common cause of outflow urinary tract obstruction in male infants. However, urinary extravasation is a rare complication among this group of children. Case Presentation Our case report presents diagnostic difficulties connected with spontaneous kidney rupture due to PUV in a 6 week-old infant. Due to not equivocal images, thundery course of disease and rapid deterioration in the infant's condition, the patient required an urgent laparatomy. Conclusion This case showed that the investigation of renal abnormalities during early neonatal period, is very important specifically in PUV that can lead to kidney rupture. PMID:23795264

  14. Efficacy of holmium laser urethrotomy and intralesional injection of Santosh PGI tetra-inject (Triamcinolone, Mitomycin C, Hyaluronidase and N-acetyl cysteine) on the outcome of urethral strictures

    PubMed Central

    Kishore, Lalit; Sharma, Aditya Prakash; Garg, Nitin; Singh, Shrawan Kumar

    2015-01-01

    Introduction To study the efficacy of holmium laser urethrotomy with intralesional injection of Santosh PGI tetra-inject (Triamcinolone, Mitomycin C, Hyaluronidase and N-acetyl cysteine) in the treatment of urethral strictures. Material and methods A total of 50 patients with symptomatic urethral stricture were evaluated by clinical history, physical examination, uroflowmetry and retrograde urethrogram preoperatively. All patients were treated with holmium laser urethrotomy, followed by injection of tetra-inject at the urethrotomy site. Tetra-inject was prepared by diluting acombination of 40 mg Triamcinolone, 2 mg Mitomycin, 3000 UHyaluronidase and 600 mg N-acetyl cysteine in 5–10 ml of saline, according to the stricture length. An indwelling 18 Fr silicone catheter was left in place for 7–10 days.All patients were followed-up for 6-18 months postoperatively by history, uroflowmetry, and if required, retrograde urethrogram and micturating urethrogram every 3 months. Results 41 (82%) patients had asuccessful outcome,whereas 9 (18%) had recurrences during a follow-up ranging from 6–18 months. In <1 cm length strictures, the success rate was 100%, while in 1–3 cm and >3 cm lengthsthe success rates were 81.2% and 66.7% respectively. This modality, thus, has an encouraging success rate, especially in those with short segment urethral strictures (<3 cm). Conclusions Holmium laser urethrotomy with intralesional injection ofSantosh PGI tetra-inject (Triamcinolone, Mitomycin C, Hyaluronidase, N-acetyl cysteine) is a safe and effective minimally-invasive therapeutic modality for short segment urethral strictures. PMID:26855803

  15. Outcome of buccal mucosa and lingual mucosa graft urethroplasty in the management of urethral strictures: A comparative study

    PubMed Central

    Chauhan, Sharad; Yadav, Sher Singh; Tomar, Vinay

    2016-01-01

    Objective: The objective of the study was to compare the outcome of buccal and lingual mucosa graft (LMG) augmentation urethroplasty along with donor sites morbidities in anterior urethra stricture. Subjects and Methods: From September 2010 to January 2014, 125 patients underwent single stage augmentation urethroplasty. They were randomly divided into two groups to receive either buccal mucosa graft (BMG) or LMG. The patients were prospectively followed for complications and outcome. Results: Baseline characteristics such as mean age, etiology, stricture length, and location were comparable in both groups. Overall success rate for Group 1 and Group 2 were 69.2% and 80%, respectively. Mean follow-up periods were 28.2 and 25 months in Group 1 and Group 2, respectively. Conclusions: LMG provides the better outcome with fewer immediate and delayed complications as compared to BMG. The length of stricture and width of graft were main factors affecting the outcome. PMID:26834399

  16. Pelvic-fracture urethral injury in children

    PubMed Central

    Hagedorn, Judith C.; Voelzke, Bryan B.

    2015-01-01

    Objective To review paediatric posterior urethral injuries and the current potential management options; because urethral injury due to pelvic fracture in children is rare and has a low incidence, the management of this type of trauma and its complications remains controversial. Methods We reviewed previous reports identified by searching the PubMed Medline electronic database for clinically relevant articles published in the past 25 years. The search was limited to the keywords ‘pediatric’, ‘pelvic fracture’, ‘urethral injury’, ‘stricture’, ‘trauma’ and ‘reconstruction’. Results Most paediatric urethral injuries are a result of pelvic fractures after high-impact blunt trauma. After the diagnosis, immediate bladder drainage via a suprapubic cystotomy, or urethral realignment, are the initial management options, except for a possible immediate primary repair in girls. The common complications of pelvic fracture-associated urethral injury include urethral stricture formation, incontinence and erectile dysfunction. Excellent results can be achieved with delayed urethroplasty for pelvic fracture-associated urethral injuries. Conclusion Traumatic injury to the paediatric urethra is rare and calls for an immediate diagnosis and management. These devastating injuries have a high complication rate and therefore a close follow-up is warranted to assure adequate delayed repair by a reconstructive urologist. PMID:26019977

  17. Gene locus ambiguity in posterior urethral valves/prune-belly syndrome.

    PubMed

    Weber, Stefanie; Mir, Sevgi; Schlingmann, Karl Peter; Nürnberg, Gudrun; Becker, Christian; Kara, Pelin E; Ozkayin, Nese; Konrad, Martin; Nürnberg, Peter; Schaefer, Franz

    2005-08-01

    Lower urinary tract obstruction by posterior urethral valves (PUV) is an important cause of congenital renal failure in male infants. Though population-based studies point to a role of genetic factors in the etiology of PUV, no clear evidence for a specific gene defect for PUV has been observed so far. Here we present a consanguineous family with four male descendants affected by PUV and a healthy girl, suggestive of autosomal recessive inheritance. One boy presented with prune-belly syndrome (PBS) in addition to PUV. Using a DNA chip-based genome-wide linkage analysis, we identified a region of homozygosity for the affected boys in an interval of 35 cM on chromosome 1q41-44 with a maximum multipoint LOD score of Z(max) = 3.134 at theta = 0 for single nucleotide polymorphisms (SNPs) rs158724-rs720163. By applying a second genetic model based on the assumption of a male-limited phenotype and the girl being carrier of the genetic defect without expressing the phenotype, a second alternative locus of 9 cM on chromosome 11p11 was identified with a LOD score of Z(max) = 3.61 at theta = 0. Equal significance for both loci with a LOD score of Z(max) = 3.01 at theta = 0 was obtained after the affection status of the female descendant was set "unknown". We suppose that most probably, only one of the two identified loci harbours the disease-causing gene. As the interpretation of the girl's status remains uncertain, we are not able to exclude one of the two loci. Analyses of additional informative families will be important to exclude one of the two loci and to restrict the critical interval.

  18. New frontiers in urethral reconstruction: injectables and alternative grafts

    PubMed Central

    2015-01-01

    Contemporary management of anterior urethral strictures requires both endoscopic as well as complex substitution urethroplasty, depending on the nature of the urethral stricture. Recent clinical and experimental studies have explored the possibility of augmenting traditional endoscopic urethral stricture management with anti-fibrotic injectable medications. Additionally, although buccal mucosa remains the gold standard graft for substitution urethroplasty, alternative grafts are necessary for reconstructing particularly complex urethral strictures in which there is insufficient buccal mucosa or in cases where it may be contraindicated. This review summarizes the data of the most promising injectable adjuncts to endoscopic stricture management and explores the alternative grafts available for reconstructing the most challenging urethral strictures. Further research is needed to define which injectable medications and alternative grafts may be best suited for urethral reconstruction in the future. PMID:26813260

  19. Fetal urinary peptides to predict postnatal outcome of renal disease in fetuses with posterior urethral valves (PUV).

    PubMed

    Klein, Julie; Lacroix, Chrystelle; Caubet, Cécile; Siwy, Justyna; Zürbig, Petra; Dakna, Mohammed; Muller, Françoise; Breuil, Benjamin; Stalmach, Angelique; Mullen, William; Mischak, Harald; Bandin, Flavio; Monsarrat, Bernard; Bascands, Jean-Loup; Decramer, Stéphane; Schanstra, Joost P

    2013-08-14

    Bilateral congenital abnormalities of the kidney and urinary tract (CAKUT), although are individually rare diseases, remain the main cause of chronic kidney disease in infants worldwide. Bilateral CAKUT display a wide spectrum of pre- and postnatal outcomes ranging from death in utero to normal postnatal renal function. Methods to predict these outcomes in utero are controversial and, in several cases, lead to unjustified termination of pregnancy. Using capillary electrophoresis coupled with mass spectrometry, we have analyzed the urinary proteome of fetuses with posterior urethral valves (PUV), the prototypic bilateral CAKUT, for the presence of biomarkers predicting postnatal renal function. Among more than 4000 fetal urinary peptide candidates, 26 peptides were identified that were specifically associated with PUV in 13 patients with early end-stage renal disease (ESRD) compared to 15 patients with absence of ESRD before the age of 2. A classifier based on these peptides correctly predicted postnatal renal function with 88% sensitivity and 95% specificity in an independent blinded validation cohort of 38 PUV patients, outperforming classical methods, including fetal urine biochemistry and fetal ultrasound. This study demonstrates that fetal urine is an important pool of peptides that can predict postnatal renal function and thus be used to make clinical decisions regarding pregnancy.

  20. Effect of Bladder Neck Preservation and Posterior Urethral Reconstruction during Robot-Assisted Laparoscopic Radical Prostatectomy for Urinary Continence

    PubMed Central

    You, Youn Chul; Kim, Tae Hyo

    2012-01-01

    Purpose To report our results on urinary continence after bladder neck preservation (BNP) and posterior urethral reconstruction (PUR) during robot-assisted laparoscopic radical prostatectomy (RALP). Materials and Methods Data from 107 patients who underwent RALP were compared on the basis of whether the patients underwent BNP and PUR, BNP only, or the standard technique (ST). In group A (n=31 patients), ST was performed by using Ven velthoven continuous suturing for urethrovesical anastomosis. In group B (n=28 patients), ST with only PUR was performed. In group C (n=48 patients), both the BNP and PUR techniques were used. "Recovery of continence" was defined as the use of 1 pad (50 ml) or less within 24 hours. Results The three groups were comparable in terms of patient demographics. The mean operative time and the mean blood loss decreased significantly from group A to group C (p=0.021 for mean operative time and p=0.004 for the mean blood loss). Mean catheterization time was 8.9, 7.8, and 7.1 days in each group (p=0.047). Early return of urinary continence at 3 months was observed in group B (89.2%) and group C (90.6%) compared with group A (71%). However, continence at 6 months was comparable in the 3 groups (87.5% in group A, 92.8% in group B, and 92.3% in group C). Rates of positive surgical margins decreased from 30.2% in group A to 20% in group B and 12% in group C. Conclusions BNP and PUR during RALP showed a favorable impact on the early postoperative recovery of continence while not affecting positive surgical margins. PMID:22323971

  1. Posterior Urethral Valves in Children: Pattern of Presentation and Outcome of Initial Treatment in Ile-Ife, Nigeria

    PubMed Central

    Talabi, Ademola Olusegun; Sowande, Oludayo Adedapo; Etonyeaku, Amarachukwu Chiduziem; Salako, Abdulkadir A; Adejuyigbe, Olusanya

    2015-01-01

    Background: The management of posterior urethral valves (PUV) and its sequelae is still a challenge to most pediatric surgeons in our environment due to late presentation and inadequate facilities for long-term evaluation and treatment. Despite initial successful treatment about 40% would develop chronic renal failure. The aim is to describe the presentation, management and outcome of the initial treatment in boys with PUV. Materials and Methods: It is a retrospective analysis of PUV in boys 8 years and below over a 17 years period. Demographic characteristics, clinical features, investigations, and treatment outcome were reviewed. Results: Thirty-seven cases were analyzed. The median age was 5 months (range from birth to 8 years). Three (8.1%) patients had prenatal ultrasound diagnosis. The most common presentation was voiding dysfunction 37 (100%). Part of the preoperative investigation included micturating cystourethrogram (n = 31: 83.8%) and abdomino-pelvic ultrasonography (n = 37:(100%). The mean serum creatinine value of those who presented within the first 30 days of life and those who presented afterwards were 325 (±251) µmol/L and 141 (±100) µmol/L respectively, P = 0.003. Surgical interventions included trans-vesical excision of valves (n = 9: 28.1%), valvotomy (n = 10: 31.3%), balloon avulsion (n = 8: 25.0%), vesicostomy (n = 4: 12.5%) and endoscopic valve avulsion (n = 1: 3.1%). Seventeen (56.7%) patients had serum creatinine >70.4 µmol/L after 1-month of valve excision. Five (13.5%) patients had postrelief complications and 5 (13.5%) died on admission. Ninety percentage (27/30) of patients had poor prognostic indices. Conclusions: The initial treatment outcome was good but most had poor prognostic factors. PMID:26425072

  2. Male urethral diverticulum uncommon entity: Our experience

    PubMed Central

    Thakur, Naveen; Sabale, Vilas Pandurang; Mane, Deepak; Mullay, Abhirudra

    2016-01-01

    Out pouching of the urethral wall could be congenital or acquired. Male urethral diverticulum (UD) is a rare entity. We present 2 cases of acquired and 1 case of congenital male UD. Case 1A: 40 year male presented with SPC and dribbling urine. Clinically he had hard perineal swelling. RGU revealed large diverticulum in proximal bulbar, irregular narrow distal urethra and stricture just beyond diverticulum. Managed with perineal exploration, stone removal, diverticulum repair and urethroplasty using excess diverticular wall. Case 2A: 30 year male with obstructive lower urinary tract symptoms (LUTS). Retrograde urethrogram (RGU) revealed bulbar urethral diverticulum akin to anterior urethral valve, managed endoscopically. 1 year follow up urine stream satisfactory. Case 3A: 27 year male previously operated large proximal bulbar urethral stone with incontinence. RGU large proximal bulbar UD with wide open sphincter. Treated with excision of excess diverticular wall and penile clamp with pelvic exercises for incontinence. Congenital UD develops due to imperfect closure of urethral fold, Acquired UDs occurs secondary to stricture, infection, trauma, long standing impacted urethral stones or scrotal / skin flap urethroplasties. RGU and MCU are the best diagnostic technique to confirm and characterize the UD. Urethral diverticulectomy with urethral reconstruction is the recommended treatment for UD. UD is a rare entity. Especially in males, congenital are even more rare. Management should be individualized. Surgery can involve innovation and/or surgical modifications. We used excess diverticular flap for stricture urethroplasty in one case. PMID:28057997

  3. The stone formation in the Memotherm urethral stent implantation area: Is it a rare complication?

    PubMed Central

    Karakose, Ayhan; Atesci, Yusuf Ziya; Aydogdu, Ozgu

    2014-01-01

    Recurrent urethral stricture is one of the biggest problems in urology. Urethral stents as an alternative treatment has been used since 1985. The stone formation in the Memotherm (Angiomed) urethral stent implantation area is a rare complication. We report the case of a 67-year-old man who had a stone in the Memotherm urethral stent implantation area 6 years after his urethral stent surgery. PMID:24678370

  4. Catheter-induced urethral trauma in cats with urethral obstruction.

    PubMed

    Corgozinho, Katia B; de Souza, Heloisa J M; Pereira, Adriana N; Belchior, Cristiane; da Silva, Michel A; Martins, Marina C L; Damico, Cristiane B

    2007-12-01

    Fifteen cats were evaluated with urethral obstruction. Penile trauma by catheterization was the major indication for perineal urethrostomy. Ten cats had developed a urethral stricture and five had rupture of the urethra following medical management. All cats had abnormalities in penis and/or prepuce and/or scrotal sacs including hyperemia or swelling. Perineal urethrostomy was performed in all cases and they were evaluated for 6 months after surgery. Few complications were noted. Urinary tract infection was the most frequent complication observed. The clients considered their cats to have a good quality of life following surgery.

  5. Acute urinary retention. Comparison of suprapubic and urethral catheterisation.

    PubMed

    Horgan, A F; Prasad, B; Waldron, D J; O'Sullivan, D C

    1992-08-01

    A total of 86 consecutive patients who presented to the accident and emergency department with acute urinary retention due to prostatomegaly required catheterisation; 56 received suprapubic catheters and 30 were catheterised urethrally. Both groups were followed up for 3 years. Of the 30 patients catheterised urethrally, 12 (40%) developed urinary tract infections compared with 10 (18%) urinary tract infections in the 56 patients catheterised suprapubically. Five patients (17%) in the urethral group developed urethral strictures with no strictures in the suprapubic group. Two patients catheterised urethrally developed epididymo-orchitis and 1 developed septicaemia. None of the patients with suprapubic catheters developed these complications. Furthermore, 16 patients catheterised suprapubically underwent successful trial clamping of their catheter, whereas 7 patients required recatheterisation following removal of their urethral catheters. We recommend that the use of suprapubic catheters should become the preferred initial treatment for acute urinary retention.

  6. [First experience of Ho:YAG laser urethrotomy in the treatment of strictures in patients with prostate cancer].

    PubMed

    Lebedinets, A A; Shkol'nik, M I; Timofeev, D A

    2014-01-01

    Strictures of vesicourethral anastomosis (VUA), urethral strictures, and bladder neck obliteration are frequent complications occurring after treatment for prostate cancer and dramatically reducing the quality of life of the patients. To date, there is no single standard treatment of urethral strictures. One of the promising methods is laser optical urethrotomy using a solid-state Ho:YAG- laser. Since 2012, we treated 12 patients with strictures of VUA, urethral strictures, and bladder neck obliteration. According urethrography, the maximum length of stricture was 4.5 cm. Treatment efficacy was assessed at 6 months after surgery objectively according urethrography, uroflowmetry, and ultrasound of the bladder with the definition of residual urine; and subjectively--by IPSS questionnaire and QoL questionnaire. After removal of the urethral catheter, all patients had recovered independent urination, decreased IPSS scores by 59.5%, IPSS-QoL score by 45.87%, decreased residual urine volume by 89.92%, and increased maximum urinary flow rate by 78.19%. Intraoperative complications and early postoperative complications were not observed. Ho:YAG laser is a minimally invasive and safe tool for urethrotomy of strictures of VUA, urethral strictures, and bladder neck obliteration arising after treatment for prostate cancer. Definitive conclusions about the effectiveness of this method should be based on long-term results of comparative trials.

  7. An unusual urethral foreign body☆

    PubMed Central

    Naidu, Krishanth; Chung, Amanda; Mulcahy, Maurice

    2013-01-01

    INTRODUCTION Lower urinary tract foreign body insertions have a low incidence. The motives for insertion of a variety of objects are difficult to comprehend. This case warrants discussion given the great management challenge faced by the oddity and infrequency with which a fork is encountered in the penile urethra. PRESENTATION OF CASE A 70-year-old man presents to the Emergency Department with a bleeding urethral meatus following self-insertion of a fork into the urethra to achieve sexual gratification. Multiple retrieval methods were contemplated with success achieved via forceps traction and copious lubrication. DISCUSSION The presentation of urethral foreign bodies can vary widely, as can the type of object inserted. The most prevalent motivation for self-insertion of urethral foreign bodies is autoerotism. Motivations ought to be explored in light of possible underlying psychological or psychiatric conditions. The most appropriate surgical extraction technique can be guided by physical examination and imaging. Endoscopic removal is often successful, depending on the object's physical attributes and morphology. It is important to arrange appropriate follow-up, as late complications can occur such as urethral strictures. CONCLUSION Psychological and surgical arms encompass the management plan. Foreign body retrieval is determined by its physical attributes and morphology with the aim to minimise urothelial trauma and preserve erectile function. Essentially, endourological extraction serves the primary means of retrieval. Cystourethoscopy is important to diagnose urothelial injuries and to ensure complete removal of foreign bodies following extraction. PMID:24055017

  8. Crosstalk between TGF-β1 and CXCR3 signaling during urethral fibrosis.

    PubMed

    Xie, Hong; Feng, Chao; Fu, Qiang; Sa, Ying-Long; Xu, Yue-Min

    2014-09-01

    Urethral fibrosis is an important pathological feature of urethral stricture. TGF-β1 and CXC chemokine receptor 3 (CXCR3) signaling have been reported as the critical pathways involved in the pathology of fibrosis. Here, we collected the urine samples from the patients with recurring urethral stricture, recurring stricture treated by cystostomy, and age- and gender-matched healthy people. ELISA detection revealed that TGF-β1 level was significantly up-regulated for the urethral stricture patients. By contrast, flow cytometry, real-time PCR detection, and immunofluoresecent staining showed that urethral stricture resulted in decreased expression of CXCR3. TGF-β1 treatment could increase cell proliferation and migration ability of urethra fibroblasts, whereas IP-10/CXCR3 signaling showed the opposite effect. Further, we found a crosstalk between TGF-β1 and CXCR3 signaling in the regulation of urethral fibrosis. Thus, pharmacological intervention of TGF-β1 or CXCR3 signaling has a potential as the therapeutic target for the prevention of urethral fibrosis.

  9. Management of Long-Segment and Panurethral Stricture Disease

    PubMed Central

    Martins, Francisco E.; Kulkarni, Sanjay B.; Joshi, Pankaj; Warner, Jonathan; Martins, Natalia

    2015-01-01

    Long-segment urethral stricture or panurethral stricture disease, involving the different anatomic segments of anterior urethra, is a relatively less common lesion of the anterior urethra compared to bulbar stricture. However, it is a particularly difficult surgical challenge for the reconstructive urologist. The etiology varies according to age and geographic location, lichen sclerosus being the most prevalent in some regions of the globe. Other common and significant causes are previous endoscopic urethral manipulations (urethral catheterization, cystourethroscopy, and transurethral resection), previous urethral surgery, trauma, inflammation, and idiopathic. The iatrogenic causes are the most predominant in the Western or industrialized countries, and lichen sclerosus is the most common in India. Several surgical procedures and their modifications, including those performed in one or more stages and with the use of adjunct tissue transfer maneuvers, have been developed and used worldwide, with varying long-term success. A one-stage, minimally invasive technique approached through a single perineal incision has gained widespread popularity for its effectiveness and reproducibility. Nonetheless, for a successful result, the reconstructive urologist should be experienced and familiar with the different treatment modalities currently available and select the best procedure for the individual patient. PMID:26779259

  10. Medical management of urethral and colonic perforation associated with urinary catheterization in a kitten.

    PubMed

    Whittemore, Jacqueline C; Zucca, Lynda

    2003-09-15

    A 6-week-old male kitten was evaluated because of stranguria and possible urethral blockage; a urinary catheter placed during general anesthesia penetrated the urethral and colonic walls and entered the colon. Treatment was conservative, with fluids administered i.v., administration of piperacillin, and supportive care. The kitten never became febrile or clinically ill and continued to thrive. There was no development of clinical signs consistent with stricture, diverticulum, or fistula formation. Complications from urethral perforation include infection and urethral stricture. Reconstructive surgery is considered the treatment of choice for traumatic urethral-colonic perforation. However, surgery may not be feasible or may be cost-prohibitive in certain situations. In such instances, medical management may provide a reasonable alternative to euthanasia.

  11. Esophageal stricture - benign

    MedlinePlus

    ... esophagus. These may include household cleaners, lye, disc batteries, or battery acid. Treatment of esophageal varices Symptoms Symptoms may ... Prognosis) The stricture may come back in the future. This would require a repeat dilation. Possible Complications ...

  12. Management of the devastated posterior urethra and bladder neck: refractory incontinence and stenosis.

    PubMed

    Anderson, Kirk M; Higuchi, Ty T; Flynn, Brian J

    2015-02-01

    Stricture of the proximal urethra following treatment for prostate cancer occurs in an estimated 1-8% of patients. Following prostatectomy, urethral reconstruction is feasible in many patients. However, in those patients with prior radiation therapy (RT), failed reconstruction, refractory incontinence or multiple comorbidities, reconstruction may not be feasible. The purpose of this article is to review the evaluation and management options for patients who are not candidates for reconstruction of the posterior urethra and require urinary diversion. Patient evaluation should result in the decision whether reconstruction is feasible. In our experience, risk factors for failed reconstruction include prior radiation and multiple failed endoscopic treatments. Pre-operative cystoscopy is an essential part of the evaluations to identify tissue necrosis, dystrophic calcification, or tumor in the urethra, prostate and/or bladder. If urethral reconstruction is not feasible it is imperative to discuss options for urine diversion with the patient. Treatment options include simple catheter diversion, urethral ligation, and both bladder preserving and non-preserving diversion. Surgical management should address both the bladder and the bladder outlet. This can be accomplished from a perineal, abdominal or abdomino-perineal approach. The devastated bladder outlet is a challenging problem to treat. Typically, patients undergo multiple procedures in an attempt to restore urethral continuity and continence. For the small subset who fails reconstruction, urinary diversion provides a definitive, "end-stage" treatment resulting in improved quality of life.

  13. Electrospun Poly(l-lactide)/Poly(ethylene glycol) Scaffolds Seeded with Human Amniotic Mesenchymal Stem Cells for Urethral Epithelium Repair

    PubMed Central

    Lv, Xiaokui; Guo, Qianping; Han, Fengxuan; Chen, Chunyang; Ling, Christopher; Chen, Weiguo; Li, Bin

    2016-01-01

    Tissue engineering-based urethral replacement holds potential for repairing large segmental urethral defects, which remains a great challenge at present. This study aims to explore the potential of combining biodegradable poly(l-lactide) (PLLA)/poly(ethylene glycol) (PEG) scaffolds and human amniotic mesenchymal cells (hAMSCs) for repairing urethral defects. PLLA/PEG fibrous scaffolds with various PEG fractions were fabricated via electrospinning. The scaffolds were then seeded with hAMSCs prior to implantation in New Zealand male rabbits that had 2.0 cm-long defects in the urethras. The rabbits were randomly divided into three groups. In group A, hAMSCs were grown on PLLA/PEG scaffolds for two days and then implanted to the urethral defects. In group B, only the PLLA/PEG scaffolds were used to rebuild the rabbit urethral defect. In group C, the urethral defect was reconstructed using a regular urethral reparation technique. The repair efficacy was compared among the three groups by examining the urethral morphology, tissue reconstruction, luminal patency, and complication incidence (including calculus formation, urinary fistula, and urethral stricture) using histological evaluation and urethral radiography methods. Findings from this study indicate that hAMSCs-loaded PLLA/PEG scaffolds resulted in the best urethral defect repair in rabbits, which predicts the promising application of a tissue engineering approach for urethral repair. PMID:27517902

  14. Penile urethral reconstruction: concepts and concerns.

    PubMed

    Barbagli, Guido; Palminteri, Enzo; Bracka, Aivar; Caparrós Sariol, Joan

    2003-06-01

    Reconstruction of the penile urethra is a challenging exercise, and for many surgeons an ungratifying experience. The past three decades have seen us move from predominantly 2-staged surgery, through foreskin grafts, and then single stage flap reconstructions, and now in the 3rd millennium, for some situations 2-stage repair has again become the favoured option. Satisfying short-term solutions have sometimes resulted in poor long-term outcomes when reviewed 10 years later. Clearly there are still problems to be resolved, hence the need for continuing evolution in our surgical management. Lessons have been learned from the treatment of Lichen Sclerosus, from strictures following hypospadias repair, and strictures associated with severe spongiofibrosis. Management of these problems has traditionally been associated with not only a high incidence of restricture and fistula formation, but also with poor cosmetic results, something that men today find increasingly difficult to accept. Several considerations are fundamental to achieving the best functional and aesthetic results. These include the presence or absence of Lichen Sclerosus, the extent of urethral disease and its grade (i.e. mucosal disease or with accompanying spongiofibrosis); furthermore the use of non-genital grafts for urethral reconstruction when the local penile tissues are deficient or unhealthy. In arriving at our present strategy, a collaborative approach that integrates established urological practice with the different perspectives of a plastic surgeon (A.B.) has proved constructive and beneficial.

  15. Direct visual internal urethrotomy for isolated, post-urethroplasty strictures: a retrospective analysis

    PubMed Central

    Brown, Elizabeth Timbrook; Mock, Stephen; Dmochowski, Roger; Reynolds, W. Stuart; Milam, Douglas; Kaufman, Melissa R.

    2016-01-01

    Background: Urethroplasty is often successful for the treatment of male urethral stricture disease, but limited data exists on recurrence management. Our goal was to evaluate direct visual internal urethrotomy (DVIU) as a treatment option for isolated, recurrent strictures after urethroplasty. Methods: We retrospectively identified male patients who underwent urethroplasty from 1999 to 2013 and developed an isolated, recurrent stricture at the urethroplasty site treated with DVIU. Success was defined as lack of symptomatology and no subsequent intervention. Comparative analysis identified characteristics and stricture properties associated with success. Results: A total of 436 urethroplasties were performed in 401 patients at our institution between 1999 and 2013. Stricture recurrence was noted in 64 (16%) patients. Of these, 47 (73%) underwent a DVIU. A total of 37 patients met inclusion criteria and underwent 50 DVIU procedures at the urethroplasty site. A single DVIU was successful in 13 of 37 patients (35%). A total of 4 of 6 patients required a second DVIU (67%). Overall, 17 of 43 (40%) of the total DVIUs were successful after urethroplasty. Success did not differ by age, stricture length or location, surgical technique, radiation history, prior urethroplasty or DVIU, time to failure, or etiology. Conclusions: Post-urethroplasty DVIU for isolated, recurrent strictures may be offered as a minimally invasive treatment option. Approximately 40% of patients were spared further intervention. PMID:28203286

  16. Effect of adipose tissue-derived stem cell injection in a rat model of urethral fibrosis

    PubMed Central

    Sangkum, Premsant; Yafi, Faysal A.; Kim, Hogyoung; Bouljihad, Mostafa; Ranjan, Manish; Datta, Amrita; Mandava, Sree Harsha; Sikka, Suresh C; Abdel-Mageed, Asim B.; Hellstrom, Wayne J.G.

    2016-01-01

    Introduction: We sought to evaluate the therapeutic effect of adi-pose tissue-derived stem cells (ADSCs) in a rat model of urethral fibrosis. Methods: Eighteen (18) male Sprague-Dawley rats (300‒350 g) were divided into three groups: (1) sham (saline injection); (2) urethral fibrosis group (10 μg transforming growth factor beta 1 (TGF-β1) injection); and (3) ADSCs group (10 μg TGF-β1 injection plus 2 × 105 ADSCs). Rat ADSCs were harvested from rat inguinal fat pads. All study animals were euthanized at two weeks after urethral injection. Following euthanasia, rat urethral tissue was harvested for histologic evaluation. Type I and III collagen levels were quantitated by Western blot analysis. Results: TGF-β1 injection induced significant urethral fibrosis and increased collagen type I and III expression (p<0.05). Significant decrease in submucosal fibrosis and collagen type I and III expression were noted in the ADSCs group compared with the urethral fibrosis group (p<0.05). TGF-β1 induced fibrotic changes were ameliorated by injection of ADSCs. Conclusions: Local injection of ADSCs in a rat model of urethral fibrosis significantly decreased collagen type I and III. These findings suggest that ADSC injection may prevent scar formation and potentially serve as an adjunct treatment to increase the success rate of primary treatment for urethral stricture disease. Further animal and clinical studies are needed to confirm these results. PMID:27790299

  17. Urethral healing in rabbits.

    PubMed

    Scherz, H C; Kaplan, G W; Boychuk, D I; Landa, H M; Haghighi, P

    1992-08-01

    We studied urethral healing in New Zealand white rabbits by histological examination after insult (urethral catheter) or injury (urethrotomy) specifically for acute and chronic inflammation, fibrosis, fistulas, squamous metaplasia, foreign body giant cells and urethral dilatation. Urethral catheterization resulted in increased inflammation and fibrosis compared to noncatheterized animals. Skin closure techniques and materials resulted in an inflammatory response that may extend to and involve the urethra. Minor differences in suture size were not an important variable but the persistence of suture material may have a role in the degree of inflammation and the formation of foreign body giant cells. Transepithelial closure techniques drag epithelial cells into subcutaneous tissues and may predispose to fistula formation.

  18. Management of Urethral Recurrences: Urothelial and Nonurothelial.

    PubMed

    Zargar-Shoshtari, Kamran; Sexton, Wade J; Poch, Michael A

    2016-11-01

    This article discusses the diagnostic and therapeutic options in the management of urethral cancer recurrence in patients treated with urethral sparing cystectomy as well as those who had urethral preservation following primary urethral carcinoma.

  19. [Anatomy of the urethral sphincteric vesico-prostatic complex].

    PubMed

    Gadda, F; Carmignani, L; Favini, P; Acquati, P; Avogadro, A; Rocco, F

    2001-09-01

    As 27 different names have been proposed for the components of the urethral sphincter, it is difficult to build a clear anatomical model of it. Starting from a review of the literature and from some personal observations of surgical anatomy, our aim is to draw a vision as much organic as possible of the anatomy of the urethral sphincter. The components of the urethral sphincter are: the bladder neck (preprostatic sphincter), the smooth muscle urethral sphincter, the rhabdosphincter and levator ani muscle. Recently the rhabdosphincter has been proposed as a vertical structure that extends from the pelvic cavity (bladder base) to the perineal cavity. It can be round-shaped or omega-shaped. The anterior insertions are along the anterolateral aspect of the prostate (superiorly) and on the perineal fascia (inferiorly). The posterior insertions are on the Denonvilliers fascia and posterior aspect of the prostatic apex (superiorly) and on the central perineal tendon (inferiorly). The rhabdosphincter has strong means of fixations: anteriorly it is fixed to the pubis by the pubo-urethral ligaments, posteriorly it is supported by the medial fibrous raphe of the perineum. The anteromedial fibres of levator ani muscle are involved in the continence mechanism by their strong relation with the rhabdosphincter and the prostate.

  20. Laser lithotripsy of a urethral calculus via ischial urethrotomy in a steer.

    PubMed

    Streeter, R N; Washburn, K E; Higbee, R G; Bartels, K E

    2001-09-01

    A steer examined because of obstructive urolithiasis and urethral rupture underwent laser lithotripsy, using a chromium-thulium-holmium:yttrium-aluminum-garnet (Ho:YAG) laser inserted through an ischial urethrotomy. Procedures were performed with caudal epidural anesthesia. Six months after surgery, the urethra was patent with no clinical evidence of urethral stricture or fistula. Ischial urethrotomy provided rapid access to the bladder for catheterization and to the obstructive urolith for lithotripsy. Laser lithotripsy was a rapid and effective means of urolith removal in this steer.

  1. Single stage circumferential lingual mucosal graft urethroplasty in near obliterative bulbar urethra stricture: A novel technique

    PubMed Central

    Sharma, Umesh; Yadav, Sher Singh; Tomar, Vinay; Garg, Amit

    2016-01-01

    Aims: This is a prospective study of the use and efficacy of a novel technique of circumferential tubularised lingual mucosal graft (LMG) in obliterative and near obliterative bulbar urethral stricture of >2 cm where excisional and augmented anastomotic urethroplasty are not feasible. Materials and Methods: The stenotic urethral segment was opened dorsally in midline and fibrosed urethra was excised taking care to preserve the healthy spongiosum tissue. LMG (av. Length 3 cm) was placed from one end of corporal body towards spongy tissue in a circumferential manner. Another LMG was placed in similar manner to deal with longer stricture. The urethra was tubularised over 14 Fr silicone catheter. Results: A total of 12 men, of mean age 47 years underwent this procedure. The mean follow up period was 11 months starting from July 2014 till manuscript submission. Follow up included voiding cystourethrogram at 3 weeks, cystoscopy at 3 months (one patient didn’t turned up) and subsequent follow up. Mean stricture length was 4.66 cm (range, 3–8.5 cm) and mean operative time was 195 min. (range, 160 to 200 min.). The technique was successful (normal voiding with no need for any post-operative procedure) in 11(91.6%) patients. One patient developed early recurrence at 4 month of surgery and had anastomotic stricture which was successfully managed by direct visual internal urethrotomy. Conclusion: Single stage circumferential tubularised graft urethroplasty is an excellent technique for strictures that include segments of obliterative and near obliterative diseased urethra. It provide a wider neourethra than patch graft urethroplasty. PMID:27141182

  2. Erbium: YAG Laser Incision of Urethral Structures for Treatment of Urinary Incontinence After Prostate Cancer Spray

    DTIC Science & Technology

    2006-02-01

    devoted to in vivo animal studies comparing the wound healingafter Erbium and Holmium laser incision of the urethra and bladder neck. Further...urinary incontinence. Conventional treatments for stricture (including balloon dilation, cold knife incision, electrocautery, and Holmium laser incision...urethral tissue with a thermal damage zone of only 10-20 µm. This thermal damage zone was much less than that of the Holmium laser which produced 300 µm of

  3. [Female urethral obstruction and bladder neck stenosis - fact or myth - how to proceed].

    PubMed

    Gunnemann, A; Liedl, B; Palma, P C R; Yoshimura, Y; Muctar, S

    2015-09-01

    The female urethra is probably the most neglected organ in women. Female urethral stricture and primary bladder neck obstruction are rare clinical entities. Traditional and new surgical techniques have been described for the treatment of female urethral stricture. However, they are based on limited data. There is no consensus on best management. The techniques of urethroplasty all have a higher mean success rate (80-94%) than urethral dilatation (< 50%), albeit with shorter mean follow-up. Urethroplasty performed by experienced surgeons appears to be a feasible option in women who have failed urethral dilatation, although there is a lack of high-level evidence to recommend one technique over another.Primary bladder neck obstruction (PBNO) is a condition in which the bladder neck fails to open adequately during voiding. This leads to increased striated sphincter activity or obstruction of urinary flow without another anatomic cause being present, for example an obstruction caused by genitourinary prolapse in women. Watchful waiting, pharmacotherapy and surgical intervention are possible treatments.

  4. Artificial urinary sphincter urethral erosions: Temporal patterns, management, and incidence of preventable erosions

    PubMed Central

    Agarwal, Deepak K.; Linder, Brian J.; Elliott, Daniel S.

    2017-01-01

    Introduction: The artificial urinary sphincter (AUS) is the mainstay of surgical treatment for male stress urinary incontinence. Although urethral erosions are a known complication, their temporal distribution and optimal management have not been well characterized. We seek to evaluate the timing, etiologies, and management of urethral erosions in primary AUS implantations. Materials and Methods: 1802 male patients underwent AUS procedure at Mayo Clinic (Rochester) from 1983 to 2011, including 1082 primary placements. Of primary placements, 63 had a urethral erosion of their device requiring explanation and were included in our analysis. All cases of urethral erosion were confirmed at the time of explantation through cystoscopy and direct visualization. At our institution, explantation is typically performed without primary urethral repair. Results: There were 63 cases (5.8%) of urethral erosions of primary AUS devices during the study time frame. The median age at AUS implantation was 74 years (interquartile range [IQR] 68–77 years) and median time to explantation was 21 months (IQR 5–59 months). The temporal trend of AUS erosions demonstrates a peak in the 1st year, with a gradual tapering of cases thereafter, persisting beyond 10 years. Three of 36 (8.3%) patients with follow-up developed a urethral stricture. Overall, 32/63 patients (51%) underwent salvage AUS reimplantation at a median of 7.1 months (IQR 3.1–12.9 months). Conclusions: Urethral erosions tend to occur early (within 1–2 years), with gradual tapering over time. However, continued vigilance is needed after AUS placement to decrease late erosions. These data can be used for counseling and to help guide follow-up care of patients with AUS. PMID:28197026

  5. Primary tuberculosis of urethra presenting as stricture urethra and watering can perineum: A rarity

    PubMed Central

    Prakash, Gaurav; Singh, Vishwajeet; Sinha, Rahul Janak; Babu, Suresh; Jhanwar, Ankur; Mehrotra, C. N.

    2016-01-01

    A young man presented with irritative lower urinary tract symptoms and multiple fistulae (watering can) in the perineum since 6 months. Micturating cystourethrogram and retrograde urethrogram was performed after 12 weeks following suprapubic cystostomy which showed bulbar urethral stricture with multiple urethrocutaneous fistulae. He underwent anastomotic urethroplasty and excision of the urethrocutaneous fistulae. Histopathology of the excised fistulous tract showed granulomatous pathology suggestive of tuberculosis. Antitubercular treatment was given for 9 months. The patient is voiding well at 12 months follow-up. PMID:28058001

  6. The dose-dependence biological effect of laser fluence on rabbit fibroblasts derived from urethral scar.

    PubMed

    Yang, Yong; Yu, Bo; Sun, Dongchong; Wu, Yuanyi; Xiao, Yi

    2015-04-01

    Two-micrometer laser vaporization resection has been used in clinic for years, but some patients received the treatment are still faced with excessive and abnormal wound repair which leads to the recurrent of urethral stricture eventually. Fibroblasts play a key role in the processes of "narrow-expansion/operation-restenosis" recurring problems. Here, we investigated the effect of laser fluence biomodulation on urethral scar fibroblasts as well as the underlying mechanism. Urethral scar fibroblasts were isolated and cultured, and laser irradiation (2 μm) was applied at different laser fluence or doses (0, 0.125, 0.5, 2, 8, 32 J/cm(2)) with a single exposure in 1 day. The effect of 2-μm laser irradiation on cell proliferation, viability, and expression of scar formation related genes were investigated. Two-micrometer laser irradiation with intermediate dose (8 J/cm(2)) promoted scar fibroblasts proliferation and reactive oxygen species (ROS) production, while higher doses of 32 J/cm(2) are suppressive as it decreased the survival rate, viability, and proliferation of fibroblasts. In addition, qRT-PCR and Western blotting results both proven that collagen type I, collagen IV, MMP9, and CTGF display significant increase, yet the TGF-β1 expression was severely reduced at intermediate dose (8 J/cm(2)) group when compared with the others groups. Our findings suggest the scar formation-related genes are sensitive to intermediate laser irradiation dose, the most in scar fibroblasts. We revealed the bioeffect and molecular mechanism of 2-μm laser irradiation on rabbit urethral scar fibroblasts. Our study provides new insights into the mechanisms which involved in the excessive and abnormal wound repair of 2-μm laser vaporization resection. These results could potentially contribute to further study on biological effects and application of 2-μm laser irradiation in urethral stricture therapy.

  7. Aluminum phosphide-induced esophageal strictures: a new cause of benign esophageal strictures.

    PubMed

    Misra, Sri Prakash; Dwivedi, Manisha

    2009-01-01

    Fifteen consecutive patients presenting with dysphagia due to aluminum phosphide (AP)-induced esophageal strictures were studied retrospectively to elucidate the natural history of AP-induced esophageal strictures and to evaluate the efficacy of bougie dilation. The median time lag between consumption of AP and occurrence of dysphagia was 3 weeks. All patients had a single stricture and could be dilated using a bougie dilator. Thirteen patients were relieved of dysphagia on a mean (SD) follow-up of 18 (7.3) months. Two patients had recalcitrant strictures and needed needle-knife incision of the stricture followed by balloon dilation. The strictures opened up well in both the patients and they were relieved of dysphagia. AP-induced esophageal stricture is a new cause of benign esophageal stricture. Most patients present with dysphagia around 3 weeks after consumption of AP tablets. A single esophageal stricture is found in these patients. Most strictures respond very well to bougie dilation. However, some of the strictures may be recalcitrant and may require needle-knife incision and balloon dilation.

  8. Common controversies in management of biliary strictures

    PubMed Central

    Parsi, Mansour A

    2017-01-01

    Biliary strictures are caused by a heterogeneous group of benign and malignant conditions, each requiring a specific treatment approach. Management of biliary strictures often involves endoscopy either for definite treatment, as a bridge to surgery or for palliative purposes. Endoscopic treatment of various types of biliary strictures is not standardized and there are multiple areas of controversy regarding the best treatment options. These controversies are mainly due to lack of well-designed comparative studies to support a specific therapy. This paper reviews three common areas of controversy in the endoscopic management of biliary strictures. The areas discussed in this editorial include the role of biliary drainage in resectable malignant strictures and whether such drainage should be performed routinely prior to surgery, the best endoscopic palliation for unresectable hilar strictures and whether unilateral or bilateral stenting should be attempted, and the optimal endoscopic management for dominant strictures in patients with primary sclerosing cholangitis. The goal of this editorial is twofold. The first is to review the current literature on management of the aforementioned strictures and offer recommendations based on available evidence. The second goal is to highlight the gaps in our knowledge which in turn can encourage future research on these topics. PMID:28275292

  9. Ruptured urinary bladder attributable to urethral compression by a haematoma after vertebral fracture in a bull

    PubMed Central

    2014-01-01

    Background In male cattle, rupture of the urinary bladder is usually associated with urethral obstruction by uroliths. Less common causes include urethral compression or stricture. This case report describes the findings in a young Limousion breeding bull with rupture of the urinary bladder because of urethral compression by a haematoma after coccygeal fracture. Case presentation The bull had been introduced into a 40-head Red-Holstein herd one week before being injured. One week after introduction to the herd, the bull had an acute onset of anorexia and he was referred to the clinic. There was marked abdominal distension, reduced skin turgor and enophthalmus. The serum concentration of urea and creatinine was increased. Ultrasonographic examination revealed severe ascites and abdominocentesis yielded clear yellow fluid with high urea and creatinine concentrations, which supported a diagnosis of uroperitoneum. The bull was euthanatized because of a poor prognosis. Postmortem examination revealed a comminuted fracture of the first two coccygeal vertebrae associated with a massive haematoma that obstructed entire pelvic cavity. The haematoma compressed the urethra thereby preventing outflow of urine, which resulted in a 5-cm tear ventrally at the neck of the bladder. It was assumed that the newly-introduced bull had sustained the vertebral fractures when he was mounted by a cow. Conclusions The present case study serves to expand the differential diagnosis of urinary bladder rupture. Therefore, in addition to obstructive urolithiasis, compression and stricture of the urethra might be considered in male cattle with uroperitoneum. PMID:24666697

  10. Management of Benign Biliary Strictures

    SciTech Connect

    Laasch, Hans-Ulrich; Martin, Derrick F.

    2002-12-15

    Benign biliary strictures are most commonly a consequence of injury at laparoscopic cholecystectomy or fibrosis after biliary-enteric anastomosis. These strictures are notoriously difficult to treat and traditionally are managed by resection and fashioning of acholedocho- or hepato-jejunostomy. Promising results are being achieved with newer minimally invasive techniques using endoscopic or percutaneous dilatation and/or stenting and these are likely to play an increasing role in the management. Even low-grade biliary obstruction carries the risks of stone formation, ascending cholangitis and hepatic cirrhosis and it is important to identify and treat this group of patients. There is currently no consensus on which patient should have what type of procedure, and the full range of techniques may not be available in all hospitals. Careful assessment of the risks and likely benefits have to be made on an individual basis. This article reviews the current literature and discusses the options available. The techniques of endoscopic and percutaneous dilatation and stenting are described with evaluation of the likely success and complication rates and compared to the gold standard of biliary-enteric anastomosis.

  11. Detailed urethral dosimetry in the evaluation of prostate brachytherapy-related urinary morbidity

    SciTech Connect

    Allen, Zachariah A.; Merrick, Gregory S. . E-mail: gmerrick@wheelinghospital.com; Butler, Wayne M.; Wallner, Kent E.; Kurko, Brian; Anderson, Richard L.; Murray, Brian C.; Galbreath, Robert W.

    2005-07-15

    Purpose: To evaluate the relationship between urinary morbidity after prostate brachytherapy and urethral doses calculated at the base, midprostate, apex, and urogenital diaphragm. Methods and Materials: From February 1998 through July 2002, 186 consecutive patients without a prior history of a transurethral resection underwent monotherapeutic brachytherapy (no supplemental external beam radiation therapy or androgen deprivation therapy) with urethral-sparing techniques (average urethral dose 100%-140% minimum peripheral dose) for clinical T1c-T2b (2002 AJCC) prostate cancer. The median follow-up was 45.5 months. Urinary morbidity was defined by time to International Prostate Symptom Score (IPSS) resolution, maximum increase in IPSS, catheter dependency, and the need for postimplant surgical intervention. An alpha blocker was initiated approximately 2 weeks before implantation and continued at least until the IPSS returned to baseline. Evaluated parameters included overall urethral dose (average and maximum), doses to the base, midprostate, apex, and urogenital diaphragm, patient age, clinical T stage, preimplant IPSS, ultrasound volume, isotope, and D90 and V100/150/200. Results: Of the 186 patients, 176 (94.6%) had the urinary catheter permanently removed on the day of implantation with only 1 patient requiring a urinary catheter >5 days. No patient had a urethral stricture and only 2 patients (1.1%) required a postbrachytherapy transurethral resection of the prostate (TURP). For the entire cohort, IPSS on average peaked 2 weeks after implantation with a mean and median time to IPSS resolution of 14 and 3 weeks, respectively. For the entire cohort, only isotope predicted for IPSS resolution, while neither overall average prostatic urethra nor segmental urethral dose predicted for IPSS resolution. The maximum postimplant IPSS increase was best predicted by preimplant IPSS and the maximum apical urethral dose. Conclusions: With the routine use of prophylactic alpha

  12. Percutaneous management of postoperative anastomotic biliary strictures.

    PubMed

    Saad, Wael E A

    2008-06-01

    Postoperative anastomotic biliary strictures can occur after surgery in bile ducts belonging to transplanted or native (nontransplanted) livers. The majority of postoperative anastomotic strictures encountered by interventional radiologists are most likely in liver transplant recipients due to the large and growing liver transplant recipient population worldwide compared with patients with native livers and biliary enteric anastomoses. They occur after 2.5 to 13% of liver transplantations and they represent at least one-half of biliary strictures encountered after liver transplantation. Anastomotic biliary strictures are considered technical in nature, accentuated by fibrosis and scarring that may be secondary to, if not exacerbated by, graft ischemia. There are numerous variables in the percutaneous transhepatic balloon dilation protocols applied to treat anastomotic biliary strictures. These include (1) types of balloons, (2) how long balloons are inflated, (3) how frequently patients return for additional dilation sessions, and (4) the interval(s) at which they return. No alteration in these variables has proven to improve long-term patency. In addition, new technology such as cutting balloons and stents has not been fully evaluated to determine their effect on long-term patency. The current article describes the overall theme of balloon dilation protocols for the management of anastomotic biliary strictures and discusses possible future management of such strictures.

  13. A giant dumbbell shaped vesico-prostatic urethral calculus: a case report and review of literature.

    PubMed

    Prabhuswamy, Vinod Kumar; Tiwari, Rahul; Krishnamoorthy, Ramakrishnan

    2013-01-01

    Calculi in the urethra are an uncommon entity. Giant calculi in prostatic urethra are extremely rare. The decision about treatment strategy of calculi depends upon the size, shape, and position of the calculus and the status of the urethra. If the stone is large and immovable, it may be extracted via the perineal or the suprapubic approach. In most of the previous reported cases, giant calculi were extracted via the transvesical approach and external urethrotomy. A 38-year-old male patient presented with complaints of lower urinary tract symptoms. Further investigations showed a giant urethral calculus secondary to stricture of bulbo-membranous part of the urethra. Surgical removal of calculus was done via transvesical approach. Two calculi were found and extracted. One was a huge dumbbell calculus and the other was a smaller round calculus. This case was reported because of the rare size and the dumbbell nature of the stone. Giant urethral calculi are better managed by open surgery.

  14. Ileocecocolic strictures in two captive cheetahs (Acinonyx jubatus jubatus).

    PubMed

    Travis, Erika K; Duncan, Mary; Weber, Martha; Adkesson, Michael J; Junge, Randall E

    2007-12-01

    Intestinal strictures were diagnosed in two captive cheetahs (Acinonyx jubatus jubatus). The cheetahs presented with lethargy, anorexia, diarrhea, and weight loss. The first cheetah had a stricture of the ileocecocolic junction diagnosed at necropsy. The second had an ileocecocolic stricture causing obstruction that was diagnosed at surgery. After resection and anastomosis, the cheetah recovered well. The etiology of the strictures remains undetermined. Intestinal stricture, particularly of the ileocecocolic junction, should be considered as a differential diagnosis for cheetahs with nonspecific gastrointestinal signs.

  15. Urethral Stone Disease Leading to Retention After Hair-bearing Neophalloplasty

    PubMed Central

    Viviano, Robert; Morganstern, Bradley A.; O'Toole, Adam

    2014-01-01

    A 35-year-old male patient with a past history of traumatic penile amputation and subsequent penile reconstruction with a radial artery free flap phalloplasty presented to the urology clinic for urinary retention and complaint of a firm penile mass. The patient had been lost to follow-up for 2 years before this presentation. Patient had a suprapubic tube in place from initial surgery, with imaging showing 2 large uroliths encrusted around the end. Urethral stricture was suspected in the patient. On cystoscopy, an additional obstructing urolith was found in penile urethra, appearing to have formed in situ. PMID:26955545

  16. Isolated urethral tuberculosis in a middle-aged man: a case report

    PubMed Central

    2013-01-01

    Introduction Urogenital tuberculosis is a frequent disease in endemic countries. It is characterized by clinical polymorphism. The isolated urethral form is exceptional, even in countries with endemic tuberculosis. We present a rare case of urogenital tuberculosis in a man revealed by urethral narrowing and multiple urethro-scrotal fistulas. Case presentation The patient, a Moroccan man, was 40 years old. He visited our hospital for a urology consultation and presented with dysuria, purulent discharge and a meatic penoscrotal fistula. A retrograde and voiding urethrocystography was performed and revealed an extended narrowing of the whole anterior urethra associated with multiple fistulous portions toward the scrotum and perineum. At this stage, we reached a diagnosis of nonspecific sclero-inflammatory urethral stricture with complicating fistulas. We decided to perform a urethroplasty enlargement to clear the narrowing urethral sinus tracts. The evolution was marked by delayed wound healing associated with the persistence of fistulas extending into the corpus cavernosum with purulent discharge. It was at this point in the treatment that we suspected tuberculosis. Multiple biopsies were then performed on the periurethral tissue and fistula tracts. The histological examination confirmed urethral tuberculosis and showed the presence of giant cell epithelial lesions with caseous necrosis characteristic of tuberculosis. The treatment for tuberculosis was immediately established and the evolution was marked by a localized, rapid and significant improvement. A second-stage urethroplasty was scheduled for two months after the start of his antituberculous treatment. Conclusions Urogenital tuberculosis is common, but isolated urethral involvement is very rare even in countries with endemic tuberculosis. We urge practitioners, and especially urologists, to consider the disease in their investigation whenever given clinical signs are declared. PMID:23566379

  17. Anterior Urethral Valves: Not Such a Benign Condition…

    PubMed Central

    Cruz-Diaz, Omar; Salomon, Anahi; Rosenberg, Eran; Moldes, Juan Manuel; de Badiola, Francisco; Labbie, Andrew Scott; Gosalbez, Rafael; Castellan, Miguel Alfredo

    2013-01-01

    Purpose: Anterior urethral valves (AUVs) is an unusual cause of congenital obstruction of the male urethra, being 15–30 times less common than posterior urethral valves (PUVs). It has been suggested that patients with congenital anterior urethral obstruction have a better prognosis than those with PUV, with less hydronephrosis, and a lower incidence of chronic renal insufficiency (5 vs. 30%). The long-term prognosis of AUVs is not clear in the literature. In this report we describe our experience and long-term follow up of patients with anterior urethral valve. Materials and Methods: We retrospectively identified 13 patients who presented with the diagnosis of AUVs in our institutions between January 1994 and June 2012. Two patients were excluded: one patient had no follow up after intervention; the other had a follow up <1 year. From the 11 patients included, we evaluated the gestational age, prenatal and postnatal ultrasound findings, voiding cystourethrogram findings, age upon valve ablation, micturition pattern, creatinine, and clinical follow up. Results: Between 1994 and 2012 we evaluated 150 patients with the diagnosis of urethral valves. Of this group, 11 patients (7.3%) had AUVs and an adequate follow up. Mean follow up is 6.3 years (2.5–12 years). Five (45.4%) patients had prenatal diagnosis of AUV. The most common prenatal ultrasonographic finding was bilateral hydronephrosis and distended bladder. One patient showed a large perineal cystic mass, which was confirmed to be a dilated anterior urethra. The mean gestational age was 37.6 weeks (27–40 WGA). Postnatally, 90% had trabeculated bladder, 80% hydronephrosis, and 40% renal dysplasia. The most common clinical presentation was urinary tract infection in five patients (45.4%), followed by weak urinary stream found in four patients (36.3%). The age at initial surgical intervention ranged between 7 days and 13 years. Seven (63.6%) patients had primary transurethral valve resection or

  18. Cell-Seeded Tubularized Scaffolds for Reconstruction of Long Urethral Defects: A Preclinical Study

    PubMed Central

    Orabi, Hazem; AbouShwareb, Tamer; Zhang, Yuanyuan; Yoo, James J.; Atala, Anthony

    2012-01-01

    Background The treatment options for patients requiring repair of a long segment of the urethra are limited by the availability of autologous tissues. We previously reported that acellular collagen-based tubularized constructs seeded with cells are able to repair small urethral defects in a rabbit model. Objective We explored the feasibility of engineering clinically relevant long urethras for surgical reconstruction in a canine preclinical model. Design, setting, and participants Autologous bladder epithelial and smooth muscle cells from 15 male dogs were grown and seeded onto preconfigured collagen-based tubular matrices (6 cm in length). The perineal urethral segment was removed in 21 male dogs. Urethroplasties were performed with tubularized collagen scaffolds seeded with cells in 15 animals. Tubularized constructs without cells were implanted in six animals. Serial urethrography and three-dimensional computed tomography (CT) scans were performed pre- and postoperatively at 1, 3, 6, and 12 mo. The animals were euthanized at their predetermined time points (three animals at 1 mo, and four at 3, 6, and 12 mo) for analyses. Outcome measurements and statistical analysis Statistical analysis of CT imaging and histology was not needed. Results and limitations CT urethrograms showed wide-caliber urethras without strictures in animals implanted with cell-seeded matrices. The urethral segments replaced with acellular scaffolds collapsed. Gross examination of the urethral implants seeded with cells showed normal-appearing tissue without evidence of fibrosis. Histologically, an epithelial cell layer surrounded by muscle fiber bundles was observed on the cell-seeded constructs, and cellular organization increased over time. The epithelial and smooth muscle phenotypes were confirmed using antibodies to pancytokeratins AE1/AE3 and smooth muscle–specific desmin. Formation of an epithelial cell layer occurred in the unseeded constructs, but few muscle fibers formed

  19. Long-term urethral catheterisation.

    PubMed

    Turner, Bruce; Dickens, Nicola

    This article discusses long-term urethral catheterisation, focusing on the relevant anatomy and physiology, indications for the procedure, catheter selection and catheter care. It is important that nurses have a good working knowledge of long-term catheterisation as the need for this intervention will increase with the rise in chronic health conditions and the ageing population.

  20. Eosinophilic cholecystitis with common bile duct stricture: a rare disease.

    PubMed

    Mehanna, Daniel; Naseem, Zainab; Mustaev, Muslim

    2016-05-24

    Although the most common cause of cholecystitis is gallstones, other conditions may present as acute cholecystitis. We describe a case of eosinophilic cholecystitis with common bile duct stricture. A 36-year-old woman initially had generalised abdominal pain and peripheral eosinophilia. Diagnostic laparoscopy showed eosinophilic ascites and necrotic nodules on the posterior abdominal wall. She was treated with anthelminthics on presumption of toxacara infection based on borderline positivity of serological tests. She later presented with acute cholecystitis and had a cholecystectomy and choledocotomy. Day 9 T-tube cholangiogram showed irregular narrowing of the distal common bile duct. The patient's symptoms were improved with steroids and the T-tube was subsequently removed.

  1. Eosinophilic esophagitis: strictures, impactions, dysphagia.

    PubMed

    Khan, Seema; Orenstein, Susan R; Di Lorenzo, Carlo; Kocoshis, Samuel A; Putnam, Philip E; Sigurdsson, Luther; Shalaby, Theresa M

    2003-01-01

    Eosinophilic esophagitis, long known to be a feature of acid reflux, has recently been described in patients with food allergies and macroscopically furrowed esophagus. The pathophysiology and optimal management of patients with eosinophilic esophagitis is unclear. We describe our clinical experience related to eosinophilic esophagitis and obstructive symptoms in children and propose etiopathogenesis and management guidelines. Twelve children with obstructive esophageal symptoms (11 male), median age 5 years, and identified to have eosinophilic esophagitis with > 5 eosinophils per high-power field (eos/hpf) are reported. Of these, four had strictures, six had impactions, and two had only dysphagia. A diagnostic evaluation included esophagogastroduodenoscopy with biopsies in all and upper gastrointestinal series, IgE, radioallergosorbent tests, and skin tests for food allergies in some cases. Esophageal histology specimens were independently analyzed for eosinophil density by two authors. Four of five children with > 20 eos/hpf responded to elimination diets/steroids. The fifth child responded to a fundoplication. Seven children had 5-20 eos/hpf and three of them with no known food allergies responded to antireflux therapy alone. Three others in this group with positive food allergies responded to treatment with elimination diets and/or steroids. The seventh patient in this group was lost to follow-up. In conclusion, on the basis of response to therapy, eosinophilic esophagitis can be subdivided into two groups: those with likely gastroesophageal reflux disease if < 20 eos/hpf and no food allergies, and others with allergic eosinophilic esophagitis associated with food allergies and often with > 20 eos/hpf.

  2. Urethral obstruction of 6 hours or less causes bacteriuria, bacteremia, and pyelonephritis in mice challenged with "nonuropathogenic" Escherichia coli.

    PubMed Central

    Johnson, D E; Russell, R G; Lockatell, C V; Zulty, J C; Warren, J W

    1993-01-01

    Urethral obstruction may be caused by prostatic hypertrophy, urethral stricture, or encrustation of a urethral-catheter lumen. Bacteriuria often complicates these obstructions. The sequelae include fever, acute pyelonephritis, chronic renal inflammation, and death. We hypothesized that even brief obstruction of the urinary tract containing a nonvirulent bacterium would result in these complications. Mice challenged transurethrally with Escherichia coli FN414, which is rapidly eliminated from normal mice without causing bacteriuria, bacteremia, or renal pathology, were subjected to reversible urethral obstruction by coating the urethral meatus with collodion for 1, 3, or 6 h. The majority of mice obstructed for 1 h demonstrated parenchymal renal inflammation 48 h later. At the end of 3 h of obstruction, 9 of 10 mice were bacteremic; some bacteremias were present at 48 h after removal of the obstruction. At that time, more severe renal inflammation was seen in these mice. As little as 6 h of obstruction resulted not only in the acute changes described above but also in chronic renal inflammation and fibrosis in the majority of animals sacrificed 3 and 6 weeks later. Additional studies demonstrated that urethral obstruction enhanced the uropathogenicity of another nonpathogenic E. coli strain (K-12 strain HB101) and caused more severe renal lesions in mice challenged with E. coli CFT073, isolated from a patient with symptoms of pyelonephritis. These findings demonstrate that brief urethral obstruction may (i) induce organisms which are cleared rapidly from the normal urinary tract to cause bacteriuria, bacteremia, and pyelonephritis and (ii) intensify the renal lesions caused by a uropathogen. Images PMID:8335372

  3. [Choice of an optimal free graft for replacement urethroplasty in extensive urethral strictures].

    PubMed

    Loran, O B; Veliev, E I; Kotov, S V; Belomyttsev, S V

    2011-01-01

    Irrespective of the type and properties of a free graft in urethroplasty, survival of the graft depends on blood circulation in the nutrient bed. We made an experimental trial to study engraftment of free grafts of buccal and lingual mucosa on different types of the nutrient bed. Free flaps (78 buccal and 86 lingual mucosa samples) were taken from 52 male Wistar rats (300 to 470 body mass). Grafting was made on different types of nutrient bed - skeletal muscle, subcutaneous fat and penile tunica albuginea. Histological examination of the grafts was made 2, 4, 7 and 14 days after transplantation. The process of engraftment followed all the stages of nonspecific inflammation. The alteration stage (48 hours) is characterized by marked epithelial atrophy, necrosis of most of the cross-striate muscular fibers of the graft, necrotic alterations of the nutrient bed, primarily in the suture area. Excudation and emigration (2-4 days)--by continued necrotic changes with infiltration of the graft with neutrophilic leukocytes, edema of the upper layer stroma and infiltrate extention on the nutrient bed. Proliferation (day 7)--by attenuation of necroinflammatory processes, decline of leukocyte infiltration, formation of blood vessels in the subepithelial base of the graft. Regeneration (day7-14)--by recovery of the epithelial graft layer, development of granulation tissue in the submucosal base. The best engraftment was registered on transplantation on penile tunica albuginea (buccal graft--93.4%, lingual one--88.9%). Successful implantation on the muscle occurred in 90.7% for buccal and 87.9% for lingual grafts. On fat tissue buccal transplant failed in 19, lingua--in 23.89% transplantations. Thus, staging in interaction between different grafts and types of nutrient bed do not depend on characteristics of the bed and graft. Necroinflammatory changes in the buccal graft change for proliferative processes earlier than in the lingual one. Proliferative and regenerative processes develop earlier on penile tunica albuginea. Alteration and exudation are more pronounced on subcutaneous fat.

  4. Erbium: YAG Laser Incision of Urethral Strictures for Treatment of Urinary Incontinence After Prostate Cancer Surgery

    DTIC Science & Technology

    2005-02-01

    trunk fiber (Infrared Fiber Systems, Silver Spring, MD) with a 1-cm-length low -OH silica fiber tip. The trunk/tip fiber-core diameters measured 250/365...resulting in poor laser transmission 10 and low damage thresholds (Figure 1b). The major limitation of the PET tubing was its wall thickness (12.5...diameters need to match more precisely than with PTFE. However, PET has some advantages: its low shrink temperature eliminates melting of the

  5. Esophageal stricture in a cougar (Puma concolor).

    PubMed

    Desmarchelier, Marion; Lair, Stéphane; Defarges, Alice; Lécuyer, Manon; Langlois, Isabelle

    2009-06-01

    A 7-mo-old female cougar (Puma concolor) was presented with a 2-wk history of anorexia and a 1-wk history of regurgitation. Barium contrast esophagogram and gastroesophagoscopy revealed the presence of a segmental intraluminal esophageal stricture in the middle third of the esophagus. The stricture was potentially secondary to a previous anesthetic episode. Three endoscopic balloon dilations allowed increasing the luminal diameter to a size that enabled the cougar to eat food softened with water without any signs of discomfort or regurgitation. Two months after being discharged, the cougar was doing well, had gained weight and was eating horsemeat softened with water.

  6. Biliary strictures: endoscopic assessment and management

    PubMed Central

    Paranandi, Bharat; Oppong, Kofi W

    2017-01-01

    The diagnosis of biliary strictures can be challenging. Endoscopy has an established role in the diagnosis and therapy of biliary strictures. However, the diagnostic yield from conventional endoscopic retrograde cholangiopancreatography tissue sampling is modest. Improvements in existing technologies as well as the implementation of novel technologies and techniques have the potential to improve the diagnostic performance of endoscopy and expand its therapeutic role. Recent studies have enabled greater clarity about the role of preoperative biliary drainage and the choice of stents in this setting as well as the utility of metal stents in benign and malignant disease. PMID:28261440

  7. A comparison of surgical outcomes of perineal urethrostomy plus penile resection and perineal urethrostomy in twelve calves with perineal or prescrotal urethral dilatation

    PubMed Central

    Marzok, M.A.; El-khodery, S.A.

    2013-01-01

    The clinical diagnosis, ultrasonographic findings, surgical management, outcome, and survival rate of perineal or prescrotal urethral dilatation in 12 male calves are described. All calves were crossbred and intact males. The most noticeable clinical presentations were perineal (n= 10) or prescrotal (n= 2) swellings and micturition problems. The main ultrasonographic findings were oval shaped dilatation of the urethra in all animals with dimensions of 40-75 X 30-62 mm. The calves with perineal urethral dilatation were treated by perineal urethrostomy (n= 4) and partial penile transection including the dilated urethra and urethral fistulation (n= 6). Prescrotal urethral dilatations were treated by penile transection proximal to the dilatation site (n= 2). Cystitis and stricture of the urethra were recorded postoperatively for two of the calves that underwent perineal urethrostomy. Nine animals were slaughtered at normal body weight approximately 6-8 months after the surgical treatment. Three animals were slaughtered after approximately three to four months, two of them having gained insufficient body weight. Our study shows that ultrasonography is a useful tool for the diagnosis of urethral dilatation in bovine calves. Our study also shows that the partial penile transection may be a suitable and satisfactory choice of surgical treatment for correcting the urethral dilatation in bovine calves. PMID:26623322

  8. Urethral hemangioma in a prepubertal female patient

    PubMed Central

    Li, Chiao-Ching; Li, Chiao-Zhu; Yen, Ching-Heng; Tsai, Wen-Chuan; Wu, Sheng-Tang; Cha, Tai-Lung; Meng, En

    2017-01-01

    Abstract Rationale: Urethral hemangiomas commonly occur in men or elderly women. We presented a rare case of urethral hemangioma in a prepubertal female patient. Patients concerns: An 8-year-old girl had the complaints of bloody staining of clothing, a foul perineal odor, and urethral pain. She was brought to our genitourinary outpatient department for survey and a single, 1-cm compressible reddish nodule at the 10-2 o’clock position in the distal urethra was found. Diagnoses: Urethral hemangioma in a prepubertal girl was diagnosed after excision of the urethral nodule. Interventions: Excision with 8 “stay” sutures in the protruding urethral mucosa was performed. Outcomes: Normal micturition without symptom recurrence was noted at the 3-month follow-up. Lessons: Urethral hemangioma is also found in prepubertal female patient. Increased physician awareness and early recognition of a urethral hemangioma can avoid unnecessary examinations and patient anxiety. The procedure of excision with 8 “stay” sutures in the protruding urethral mucosa facilitates mobilization from the distal urethra and provides a good surgical view of abnormal proliferative blood vessels. Therefore, the lesion can be removed as clean as possible. PMID:28353601

  9. Urethral hyperthermia: an alternative to urethrectomy.

    PubMed

    Cooper, T P; Tremann, J A

    1975-09-01

    Nine male dogs were subjected to cystoprostatectomy, ileal loop diversion, and urethral hyperthermia. Five of the 9 dogs survived six weeks. Three of the 5 surviving dogs had complete destruction of the urethral epithelium, and the other 2 dogs had 95 per cent and 50 per cent destruction with the proximal urethral end incompletely destroyed. Complete urethral destruction may have been obtained with resection of the proximal urethra postirrigation. The irrigation added no extra time to the surgical procedure and was accompanied by few complications. Complications may have been averted with a dorsal slit and meatotomy.

  10. The glucose breath test: a diagnostic test for small bowel stricture(s) in Crohn's disease.

    PubMed

    Mishkin, Daniel; Boston, Francis M; Blank, David; Yalovsky, Morty; Mishkin, Seymour

    2002-03-01

    The aim of this study was to determine whether an indirect noninvasive indicator of proximal bacterial overgrowth, the glucose breath test, was of diagnostic value in inflammatory bowel disease. Twenty four of 71 Crohn's disease patients tested had a positive glucose breath test. No statistical conclusions could be drawn between the Crohn's disease activity index and glucose breath test status. Of patients with radiologic evidence of small bowel stricture(s), 96.0% had a positive glucose breath test, while only one of 46 negative glucose breath test patients had a stricture. The positive and negative predictive values for a positive glucose breath test as an indicator of stricture formation were 96.0% and 97.8%, respectively. This correlation was not altered in Crohn's disease patients with fistulae or status postresection of the terminal ileum. The data in ulcerative colitis were nondiagnostic. In conclusion, the glucose breath test appears to be an accurate noninvasive inexpensive diagnostic test for small bowel stricture(s) and secondary bacterial overgrowth in Crohn's disease.

  11. Erectile function after anastomotic urethroplasty for pelvic fracture urethral injuries.

    PubMed

    El-Assmy, A; Harraz, A M; Benhassan, M; Nabeeh, A; Ibrahiem, El Hi

    2016-07-01

    There is an established association between ED and pelvic fracture urethral injuries (PFUIs). However, ED can occur after the injury and/or the urethral repair. To our knowledge, only one study of erectile function (EF) after urethroplasty for PFUIs used a validated questionnaire. This study was carried out to determine the impact of anastomotic posterior urethroplasty for PFUIs on EF. We retrospectively reviewed the computerized surgical records to identify patients who underwent anastomotic urethroplasty for PFUIs from 1998 to 2014. Those patients were contacted by phone or mail and were re-evaluated in the outpatient clinic by International Index of Erectile Function questionnaire; in unmarried men, the single-question self-report of ED was used for evaluation of EF, clinical examination and penile color Doppler ultrasonography (CDU) for men with ED. Overall, 58 patients were included in the study among whom 36 (62%) men were sexually active and the remaining 22 (38%) were single. The incidence of ED among our group is 72%. All patients developed ED after initial pelvic trauma and none of our patients had impaired EF after urethroplasty. The incidence of ED increased proportionally with severity of pelvic trauma. All patients with type-C pelvic fracture, associated symphysis pubis diastasis, sacroiliac joints diastasis and bilateral pubic ramus fractures had ED. Men with PFUIs had worse EF than men in other series with pelvic fractures without urethral injury. The majority (88%) of men with ED showed veno-occlusive dysfunction on penile CDU. So we concluded that men with PFUIs had a high incidence of ED up to 72%. Anastomotic posterior urethroplasty had no negative impact on EF and the development of ED after PFUIs was related to the severity of the original pelvic trauma. Veno-occlusive dysfunction is the commonest etiology of ED on penile CDU.

  12. Urethral and penile war injuries: The experience from civil violence in Iraq

    PubMed Central

    Al-Azzawi, Issam S.; Koraitim, Mamdouh M.

    2014-01-01

    Objective To determine the incidence, mechanism of injury, wounding pattern and surgical management of urethral and penile injuries sustained in civil violence during the Iraq war. Patients and methods In all, 2800 casualties with penetrating trauma to the abdomen and pelvis were received at the Al-Yarmouk Hospital, Baghdad, from January 2004 to June 2008. Of these casualties 504 (18%) had genitourinary trauma, including 45 (8.9%) with urethral and/or penile injuries. Results Of 45 patients, 29 (64%) were civilians and 16 (36%) were Iraqi military personnel. The injury was caused by an improvised explosive device (IED) in 25 (56%) patients and by individual firearms in 20 (44%). Of the patients, 24 had penile injuries, 15 had an injury to the bulbar urethra and six had an injury to the posterior urethra. Anterior urethral injuries were managed by primary repair, while posterior urethral injuries were managed by primary realignment in five patients and by a suprapubic cystostomy alone in one. An associated injury to major blood vessels was the cause of death in eight of nine patients who died soon after surgery (P < 0.001). Conclusion Urethral and penile injuries were caused by IEDs and individual firearms with a similar frequency. Most of the casualties were civilians and a minority were military personnel. Injuries to the anterior urethra can be managed by primary repair, while injuries to the posterior urethra can be managed by primary realignment. An associated trauma to major blood vessels was the leading cause of death in these casualties. PMID:26019940

  13. Jejunal Epiphany: Diverticulae, Enteroliths and Strictures

    PubMed Central

    Rehmani, Babar; Kumar, Navin

    2016-01-01

    Multiple jejunal diverticulae represent a rare entity and are usually asymptomatic. This case report is about one such jejunal diverticulae along with multiple enteroliths and jejunal strictures. All these three different findings in a short segment of jejunum is a very rare finding with all three variants seen in a segment of jejunum. We herein present a case of a 45-year-old male, who presented with vague abdominal pain for one and half years associated with nausea and vomiting and altered bowel habits. Laparotomy revealed multiple large jejunal diverticulae compressing the bowel with multiple enteroliths and two strictures in a short segment of jejunum leading to intestinal obstruction. Patient underwent resection of the involved jejunal segment and then repair by anastomosis. Post-operative period was uneventful. PMID:28208925

  14. Cologastric strictures: What is the best treatment?

    PubMed Central

    Lu, Richard; Brown, Kimberly; Okereke, Ikenna

    2017-01-01

    A 31-year-old gentleman who had undergone an emergent esophagectomy and reconstruction with a colon interposition graft, presented with a long-standing cologastric stricture. He had undergone multiple attempts at endoscopic dilation over multiple decades with little symptomatic relief. He underwent a resection and reconstruction of the anastomosis entirely through an abdominal approach. He did well from surgery and experienced complete symptomatic relief immediately. Complications of colon interposition grafts can occasionally be treated using an abdominal incision only. PMID:28069881

  15. Management issues in post living donor liver transplant biliary strictures

    PubMed Central

    Wadhawan, Manav; Kumar, Ajay

    2016-01-01

    Biliary complications are common after living donor liver transplant (LDLT) although with advancements in surgical understanding and techniques, the incidence is decreasing. Biliary strictures are more common than leaks. Endoscopic retrograde cholangiopancreatography (ERCP) is the first line modality of treatment of post LDLT biliary strictures with a technical success rate of 75%-80%. Most of ERCP failures are successfully treated by percutaneous transhepatic biliary drainage (PTBD) and rendezvous technique. A minority of patients may require surgical correction. ERCP for these strictures is technically more challenging than routine as well post deceased donor strictures. Biliary strictures may increase the morbidity of a liver transplant recipient, but the mortality is similar to those with or without strictures. Post transplant strictures are short segment and soft, requiring only a few session of ERCP before complete dilatation. Long-term outcome of patients with biliary stricture is similar to those without stricture. With the introduction of new generation cholangioscopes, ERCP success rate may increase, obviating the need for PTBD and surgery in these patients. PMID:27057304

  16. Urethritis

    MedlinePlus

    ... from the urethra. The discharge is often yellowish green and thick when the gonococcal organism is involved ... a global healthcare leader working to help the world be well. From developing new therapies that treat ...

  17. Urethritis

    MedlinePlus

    ... swelling in penis Enlarged lymph nodes in the groin area Pain with intercourse or ejaculation In women: Abdominal pain ... and chills Frequent or urgent urination Pelvic pain Pain with intercourse Vaginal discharge

  18. Refractory strictures despite steroid injection after esophageal endoscopic resection

    PubMed Central

    Hanaoka, Noboru; Ishihara, Ryu; Uedo, Noriya; Takeuchi, Yoji; Higashino, Koji; Akasaka, Tomofumi; Kanesaka, Takashi; Matsuura, Noriko; Yamasaki, Yasushi; Hamada, Kenta; Iishi, Hiroyasu

    2016-01-01

    Background: Although steroid injection prevents stricture after esophageal endoscopic submucosal dissection (ESD), some patients require repeated sessions of endoscopic balloon dilation (EBD). We investigated the risk for refractory stricture despite the administration of steroid injections to prevent stricture in patients undergoing esophageal ESD. Refractory stricture was defined as the requirement for more than three sessions of EBD to resolve the stricture. In addition, the safety of steroid injections was assessed based on the rate of complications. Patients and methods: We analyzed data from 127 consecutive patients who underwent esophageal ESD and had mucosal defects with a circumferential extent greater than three-quarters of the esophagus. To prevent stricture, steroid injection was performed. EBD was performed whenever a patient had symptoms of dysphagia. Results: The percentage of patients with a tumor circumferential extent greater than 75 % was significantly higher in those with refractory stricture than in those without stricture (P = 0.001). Multivariate analysis adjusted for age, sex, history of radiation therapy, tumor location, and tumor diameter showed that a tumor circumferential extent greater than 75 % was an independent risk factor for refractory stricture (adjusted odds ratio [OR] 5.49 [95 %CI 1.91 – 15.84], P = 0.002). Major adverse events occurred in 3 patients (2.4 %): perforation during EBD in 2 patients and delayed perforation after EBD in 1 patient. The patient with delayed perforation underwent esophagectomy because of mediastinitis. Conclusions: A tumor circumferential extent greater than 75 % is an independent risk factor for refractory stricture despite steroid injections. The development of more extensive interventions is warranted to prevent refractory stricture. PMID:27004256

  19. Endoscopic palliation of malignant biliary strictures

    PubMed Central

    Salgado, Sanjay M; Gaidhane, Monica; Kahaleh, Michel

    2016-01-01

    Malignant biliary strictures often present late after the window for curative resection has elapsed. In such patients, the goal of therapy is typically focused on palliation. While historically, palliative measures were performed surgically, the advent of endoscopic intervention offers minimally invasive options to provide relief of symptoms, improve quality of life, and in some cases, increase survival of these patients. Some of these therapies, such as endoscopic biliary decompression, have become mainstays of treatment for decades, whereas newer modalities, including radiofrequency ablation, and photodynamic therapy offer additional options for patients with incurable biliary malignancies. PMID:26989459

  20. Prophylactic stenting for esophageal stricture prevention after endoscopic submucosal dissection

    PubMed Central

    Shi, Ke-Da; Ji, Feng

    2017-01-01

    Endoscopic submucosal dissection (ESD) of superficial esophageal cancer has been increasingly used as an alternative to surgery because it is minimally invasive and has a high rate of en bloc resection. However, a high rate of esophageal stricture is observed after ESD for large lesions, which can dramatically decrease the patient’s quality of life. Stricture prevention is necessary to allow for endoscopic therapy to expand. We, herein, review the most recent evidence and discuss the role of the metallic self-expandable stent and the biodegradable stent in esophageal stricture prevention. Limited studies suggested that prophylactic stenting could reduce the stricture rate without increasing the number of complications. In addition, the number of bougie dilation procedures was significantly lower with stent placement. Esophageal stenting is a promising option for post-ESD stricture prevention. However, current evidence is too preliminary to formulate practice standards. Future studies are needed to further validate the efficacy and safety of prophylactic stenting and determine the best strategy for stricture prevention. Stent migration is the most common complication. A new stent that has advantages of a low migration rate and minimal tissue reaction will need to be developed. Therefore, randomized controlled trials with long-term follow-up periods are required before prophylactic stenting could be considered a valid option to prevent post-ESD stricture. PMID:28246466

  1. Advanced endoscopic imaging of indeterminate biliary strictures

    PubMed Central

    Tabibian, James H; Visrodia, Kavel H; Levy, Michael J; Gostout, Christopher J

    2015-01-01

    Endoscopic evaluation of indeterminate biliary strictures (IDBSs) has evolved considerably since the development of flexible fiberoptic endoscopes over 50 years ago. Endoscopic retrograde cholangiography pancreatography (ERCP) was introduced nearly a decade later and has since become the mainstay of therapy for relieving obstruction of the biliary tract. However, longstanding methods of ERCP-guided tissue acquisition (i.e., biliary brushings for cytology and intraductal forceps biopsy for histology) have demonstrated disappointing performance characteristics in distinguishing malignant from benign etiologies of IDBSs. The limitations of these methods have thus helped drive the search for novel techniques to enhance the evaluation of IDBSs and thereby improve diagnosis and clinical care. These modalities include, but are not limited to, endoscopic ultrasound, intraductal ultrasound, cholangioscopy, confocal endomicroscopy, and optical coherence tomography. In this review, we discuss established and emerging options in the evaluation of IDBSs. PMID:26675379

  2. Magnetic resonance imaging of female urethral and periurethral disorders.

    PubMed

    Surabhi, Venkateswar Rao; Menias, Christine O; George, Verghese; Siegel, Cary Lynn; Prasad, Srinivasa R

    2013-11-01

    This article reviews the normal anatomy of the female urethra, magnetic resonance (MR) imaging techniques, and the role of MR imaging in the evaluation of diverse urethral and periurethral diseases. Salient MR imaging findings of common and uncommon cystic urethral lesions (urethral diverticulum, Skene cyst, and vaginal cysts), and masses (urethral carcinoma, leiomyoma, melanoma, fibroepithelial polyp, caruncle, and mucosal prolapse) are presented. The evolving role of dynamic MR in the evaluation of stress urinary incontinence is reviewed.

  3. 21 CFR 876.4590 - Interlocking urethral sound.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Interlocking urethral sound. 876.4590 Section 876...) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4590 Interlocking urethral sound. (a) Identification. An interlocking urethral sound is a device that consists of two metal...

  4. 21 CFR 876.4590 - Interlocking urethral sound.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Interlocking urethral sound. 876.4590 Section 876...) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4590 Interlocking urethral sound. (a) Identification. An interlocking urethral sound is a device that consists of two metal...

  5. 21 CFR 876.4590 - Interlocking urethral sound.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Interlocking urethral sound. 876.4590 Section 876...) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4590 Interlocking urethral sound. (a) Identification. An interlocking urethral sound is a device that consists of two metal...

  6. 21 CFR 876.4590 - Interlocking urethral sound.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Interlocking urethral sound. 876.4590 Section 876...) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4590 Interlocking urethral sound. (a) Identification. An interlocking urethral sound is a device that consists of two metal...

  7. 21 CFR 876.4590 - Interlocking urethral sound.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Interlocking urethral sound. 876.4590 Section 876...) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4590 Interlocking urethral sound. (a) Identification. An interlocking urethral sound is a device that consists of two metal...

  8. Contemporary Management of Primary Distal Urethral Cancer.

    PubMed

    Traboulsi, Samer L; Witjes, Johannes Alfred; Kassouf, Wassim

    2016-11-01

    Primary urethral cancer is one of the rare urologic tumors. Distal urethral tumors are usually less advanced at diagnosis compared with proximal tumors and have a good prognosis if treated appropriately. Low-stage distal tumors can be managed successfully with a surgical approach in men or radiation therapy in women. There are no clear-cut indications for the choice of the most appropriate treatment modality. Organ-preserving modalities have shown effective and should be used whenever they do not compromise the oncological safety to decrease the physical and psychological trauma of dismemberment or loss of sexual/urinary function.

  9. Bladder neck incompetence at posterior urethroplasty

    PubMed Central

    Koraitim, Mamdouh M.

    2015-01-01

    The finding of an incompetent bladder neck (BN) at the time of posterior urethroplasty will necessarily exacerbate the already difficult situation. In such cases the aim of the treatment is not only to restore urethral continuity by end-to-end urethral anastomosis, but also to restore the function of the BN to maintain urinary continence. Fortunately, the incidence of incompetence of the BN at posterior urethroplasty is uncommon, usually ≈4.5%. It seems that pelvic fracture-related BN injuries, in contrast to urethral injuries which result from a shearing force, are due to direct injury by the sharp edge of the fractured and displaced pubic bone. The risk of injuries to the BN is greater in children, in patients with a fracture involving both superior and inferior pubic rami on the same side, and in those managed initially by primary realignment. An incompetent BN is suspected by finding an open rectangular BN on cystography, and a fixedly open BN on suprapubic cystoscopy. An incompetent BN can be treated either subsequent to or concomitant with the urethral repair, according to whether a perineal or a perineo-abdominal urethroplasty is used, respectively. Several options have been reported to treat pelvic fracture-related BN incompetence, including reconstructing the BN, forming a new sphincter by tubularisation of a rectangular flap of the anterior bladder wall, and mechanical occlusion by an artificial sphincter or collagen injection. Reconstruction of the BN by the Young-Dees-Leadbetter∗∗ procedure probably provides the most successful results. PMID:26019982

  10. Characterizing intestinal strictures with acoustic resolution photoacoustic microscopy

    NASA Astrophysics Data System (ADS)

    Lei, Hao; Xu, Guan; Liu, Shengchun; Johnson, Laura A.; Moons, David S.; Higgins, Peter D. R.; Rice, Michael D.; Ni, Jun; Wang, Xueding

    2016-03-01

    Crohn's disease (CD) is an autoimmune disease, which may cause obstructing intestinal strictures due to inflammation, fibrosis (deposition of collagen), or a combination of both. Identifying the different stages of the disease progression is still challenging. In this work, we indicated the feasibility of non-invasively characterizing intestinal strictures using photoacoustic imaging (PAI), utilizing the uniquely optical absorption of hemoglobin and collagen. Surgically removed human intestinal stricture specimens were investigated with a prototype PAI system. 2D PA images with acoustic resolution at wavelength 532, 1210 and 1310 nm were formulated, and furthermore, the PA histochemical components images which show the microscopic distributions of histochemical components were solved. Imaging experiments on surgically removed human intestinal specimens has demonstrated the solved PA images were significantly different associated with the presence of fibrosis, which could be applied to characterize the intestinal strictures for given specimens.

  11. Current status of minimally invasive endoscopic management of ureteric strictures

    PubMed Central

    Kachrilas, Stefanos; Karaolides, Theocharis; Nikitopoulou, Stavroula; Papadopoulos, George; Buchholz, Noor; Masood, Junaid

    2013-01-01

    Endourological techniques are used more often nowadays in the treatment of ureteric strictures of various etiologies. Advances in technology have provided new tools to the armamentarium of the endoscopic urological surgeon. Numerous studies exist that investigate the efficiency and safety of each of the therapeutic modalities available. In this review, we attempt to demonstrate the available and contemporary evidence supporting each minimally invasive modality in the management of ureteric strictures. PMID:24294293

  12. Advanced Cytologic Techniques for the Detection of Malignant Pancreatobiliary Strictures

    PubMed Central

    Moreno Luna, Laura E.; Kipp, Benjamin; Halling, Kevin C.; Sebo, Thomas J.; Kremers., Walter K.; Roberts, Lewis R.; Barr Fritcher, Emily G.; Levy, Michael J.; Gores, Gregory J.

    2006-01-01

    Background & Aims Two advanced cytologic techniques for detecting aneuploidy, digital image analysis (DIA) and fluorescence in situ hybridization (FISH) have recently been developed to help identify malignant pancreatobiliary strictures. The aim of this study was to assess the clinical utility of cytology, DIA, and FISH for the identification of malignant pancreatobiliary strictures. Methods Brush cytologic specimens from 233 consecutive patients undergoing ERCP for pancreatobiliary strictures were examined by all three techniques. Strictures were stratified as proximal (n=33) or distal (n=114) based on whether they occurred above or below the cystic duct, respectively. Strictures in patients with PSC (n=86) were analyzed separately. Results Despite the stratification, the performances of the tests were similar. Routine cytology has a low sensitivity (5–20%) but 100% specificity. Because of the high specificity for cytology, we assessed the performance of the other tests when routine cytology was negative. In this clinical context, FISH had an increased sensitivity (35–60%) when assessing for chromosomal gains (polysomy) while preserving the specificity of cytology. The sensitivity and specificity of DIA was intermediate as compared to routine cytology and FISH, but was additive to FISH values demonstrating only trisomy of chromosome 7 or chromosome 3. Conclusions These findings suggest that FISH and DIA increase the sensitivity for the diagnosis of malignant pancreatobiliary tract strictures over that obtained by conventional cytology while maintaining an acceptable specificity. PMID:17030177

  13. Eosinophilic Cholangitis—A Challenging Diagnosis of Benign Biliary Stricture

    PubMed Central

    Fragulidis, Georgios Panagiotis; Vezakis, Antonios I.; Kontis, Elissaios A.; Pantiora, Eirini V.; Stefanidis, Gerasimos G.; Politi, Aikaterini N.; Koutoulidis, Vasilios K.; Mela, Maria K.; Polydorou, Andreas A.

    2016-01-01

    Abstract When confronting a biliary stricture, both benign and malignant etiologies must be carefully considered as a variety of benign biliary strictures can masquerade as hilar cholangiocarcinoma (CCA). Therefore, patients could undergo a major surgery despite the possibility of a benign biliary disease. Approximately 15% to 24% of patients undergoing surgical resection for suspected biliary malignancy will have benign pathology. Eosinophilic cholangitis (EC) is a rare benign disorder of the biliary tract, which can cause obstructive jaundice and can pose a difficult diagnostic task. We present a rare case of a young woman who was referred to our hospital with obstructive painless jaundice due to a biliary stricture at the confluence of the hepatic bile ducts, with a provisional diagnosis of cholangiocarcinoma. Though, during her work up she was found to have EC, an extremely rare benign cause of biliary stricture, which is characterized by a dense eosinophilic infiltration of the biliary tree causing stricturing, fibrosis, and obstruction and which is reversible with short-term high-dose steroids. Despite its rarity, EC should be taken into consideration when imaging modalities demonstrate a biliary stricture, especially if preoperative diagnosis of malignancy cannot be made, in the setting of peripheral eosinophilia and the absence of cardinal symptoms of malignancy. PMID:26735539

  14. 21 CFR 876.5520 - Urethral dilator.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Urethral dilator. 876.5520 Section 876.5520 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL... flexibilities. The device may include a mechanism to expand the portion of the device in the urethra...

  15. 21 CFR 876.5520 - Urethral dilator.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Urethral dilator. 876.5520 Section 876.5520 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL... flexibilities. The device may include a mechanism to expand the portion of the device in the urethra...

  16. 21 CFR 876.5520 - Urethral dilator.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Urethral dilator. 876.5520 Section 876.5520 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL... flexibilities. The device may include a mechanism to expand the portion of the device in the urethra...

  17. 21 CFR 876.5520 - Urethral dilator.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Urethral dilator. 876.5520 Section 876.5520 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL... flexibilities. The device may include a mechanism to expand the portion of the device in the urethra...

  18. Esophageal Stricture Prevention after Endoscopic Submucosal Dissection

    PubMed Central

    Jain, Deepanshu; Singhal, Shashideep

    2016-01-01

    Advances in diagnostic modalities and improvement in surveillance programs for Barrett esophagus has resulted in an increase in the incidence of superficial esophageal cancers (SECs). SEC, due to their limited metastatic potential, are amenable to non-invasive treatment modalities. Endoscopic ultrasound, endoscopic mucosal resection, and endoscopic submucosal dissection (ESD) are some of the new modalities that gastroenterologists have used over the last decade to diagnose and treat SEC. However, esophageal stricture (ES) is a very common complication and a major cause of morbidity post-ESD. In the past few years, there has been a tremendous effort to reduce the incidence of ES among patients undergoing ESD. Steroids have shown the most consistent results over time with minimal complications although the preferred mode of delivery is debatable, with both systemic and local therapy having pros and cons for specific subgroups of patients. Newer modalities such as esophageal stents, autologous cell sheet transplantation, polyglycolic acid, and tranilast have shown promising results but the depth of experience with these methods is still limited. We have summarized case reports, prospective single center studies, and randomized controlled trials describing the various methods intended to reduce the incidence of ES after ESD. Indications, techniques, outcomes, limitations, and reported complications are discussed. PMID:26949124

  19. Management of non-gonococcal urethritis.

    PubMed

    Moi, Harald; Blee, Karla; Horner, Patrick J

    2015-07-29

    Non-gonococcal urethritis (NGU), or inflammation of the urethra, is the most common treatable sexually transmitted syndrome in men, with approximately 20-50 % of cases being due to infection with Chlamydia trachomatis and 10-30 % Mycoplasma genitalium. Other causes are Ureaplasma urealyticum, Trichomonas vaginalis, anaerobes, Herpes simplex virus (HSV) and adenovirus. Up to half of the cases are non-specific. Urethritis is characterized by discharge, dysuria and/or urethral discomfort but may be asymptomatic. The diagnosis of urethritis is confirmed by demonstrating an excess of polymorpho-nuclear leucocytes (PMNLs) in a stained smear. An excess of mononuclear leucocytes in the smear indicates a viral etiology. In patients presenting with symptoms of urethritis, the diagnosis should be confirmed by microscopy of a stained smear, ruling out gonorrhea. Nucleid acid amplifications tests (NAAT) for Neisseria gonorrhoeae, C. trachomatis and for M. genitalium. If viral or protozoan aetiology is suspected, NAAT for HSV, adenovirus and T. vaginalis, if available. If marked symptoms and urethritis is confirmed, syndromic treatment should be given at the first appointment without waiting for the laboratory results. Treatment options are doxycycline 100 mg x 2 for one week or azithromycin 1 gram single dose or 1,5 gram distributed in five days. However, azithromycin as first line treatment without test of cure for M. genitalium and subsequent Moxifloxacin treatment of macrolide resistant strains will select and increase the macrolide resistant strains in the population. If positive for M. genitalium, test of cure samples should be collected no earlier than three weeks after start of treatment. If positive in test of cure, moxifloxacin 400 mg 7-14 days is indicated. Current partner(s) should be tested and treated with the same regimen. They should abstain from intercourse until both have completed treatment. Persistent or recurrent NGU must be confirmed with microscopy

  20. Urethral sensation: basic mechanisms and clinical expressions.

    PubMed

    Birder, Lori A; de Wachter, Stefan; Gillespie, James; Wyndaele, Jean Jacques

    2014-04-01

    A prerequisite for conscious bladder control is adequate sensory input to the central nervous system, and it is well established that changes in sensory mechanisms can give rise to disturbances in bladder function. Impulses related to the desire to void are believed to course through the pelvic nerves, and those for sensation of a full bladder course through the pudendal nerves. The sense of imminent micturition most probably resides in the urethra, and the desire to void comes from stretching the bladder wall. In addition, a variety of structures play an important role in terms of urethral closure (such as the urethral epithelium, vasculature and smooth muscle) that are necessary to maintain continence. This overview will discuss mechanisms related in part to the urethra involved in activation of bladder reflexes and sensation with a discussion on the mucosa (urothelium and underlying lamina propria) and underlying cellular structures.

  1. Urethral anatomy and semen flow during ejaculation

    NASA Astrophysics Data System (ADS)

    Kelly, Diane

    2016-11-01

    Ejaculation is critical for reproductive success in many animals, but little is known about its hydrodynamics. In mammals, ejaculation pushes semen along the length of the penis through the urethra. Although the urethra also carries urine during micturition, the flow dynamics of micturition and ejaculation differ: semen is more viscous than urine, and the pressure that drives its flow is derived primarily from the rhythmic contractions of muscles at the base of the penis, which produce pulsatile rather than steady flow. In contrast, Johnston et al. (2014) describe a steady flow of semen through the crocodilian urethral groove during ejaculation. Anatomical differences of tissues associated with mammalian and crocodilian urethral structures may underlie these differences in flow behavior.

  2. Sexually transmitted diseases syndromic approach: urethral discharge.

    PubMed

    Di Carlo, A

    2012-08-01

    Urethral discharge (UD) in men is one of the most identifiable sexually transmitted infections (STI)-associated syndromes. UD performs very well, giving the possibility of an accurate diagnosis, a treatment at first encounter, a rapid cure with effective drugs, a modification of the risk behavior. Furthermore the patient is informed about the infectious nature of STDs, the transmission through sexual intercourse, the increased risks of infertility and other complications and, finally, the importance of completing treatment, even after improvement. Applying the syndromic approach to UD has resulted in effective case management of urethritis, as shown in different studies. Thus, there are numerous reasons why treatment of gonorrhea should include a regimen with complete in vivo activity against both N. gonorrhoeae and C. trachomatis.

  3. Management of Recurrent Stricture Formation after Transverse Vaginal Septum Excision

    PubMed Central

    Gupta, Ridhima; Bozzay, Joseph D.; Williams, David L.; DePond, Robert T.; Gantt, Pickens A.

    2015-01-01

    Background. A transverse vaginal septum (TVS) is a rare obstructing anomaly, caused due to improper fusion of Müllerian ducts and urogenital sinus during embryogenesis. Case. A 15-year-old girl presented with primary amenorrhea. She had multiple congenital anomalies. Initial examination and imaging investigation revealed the presence of a unicornuate uterus and a TVS. The TVS was excised; however the patient was unable to perform vaginal dilation postoperatively leading to recurrent stricture formation. She underwent multiple surgeries for excision of the stricture. The patient was eventually evaluated every day in the clinic until she was able to demonstrate successful vaginal dilatation in the presence of a clinician. Summary and Conclusion. Properly guided regular and intensive vaginal dilation after TVS excision may decrease the need of reoperations due to recurrent stricture formation. PMID:26078895

  4. [Clinical practice guideline. Traumatic urethral stenosis in males].

    PubMed

    Serrano-Brambila, Eduardo Alonso; Moreno-Alcázar, Othón Martino; Neri-Páez, Edgar; Sánchez-Martínez, Luis Carlos; Hernández-Ordóñez, Octavio Francisco; Morales-Morales, Arturo; Basavilvazo-Rodríguez, M Antonia; Torres-Arreola, Laura del Pilar; Valenzuela-Flores, Adriana Abigail; Hernández-Valencia, Marcelino

    2013-01-01

    The incidence of urethral stenosis in Mexico had not been documented. At the Centro Médico Nacional La Raza, during the year 2010, 629 patients with urethral stenosis were attended as outpatient consultation: 85 % with previous urethral stenosis and 15 % with urethral treatment complication. Urethral stenosis is a chronic illness, with multiple etiological origins and the handling is controversial. It has a great negative impact for the patients and the recurrence reaches 85 %. The treatment consisted of an invasive approach (urethral dilations, endoscopy procedure) and open surgery (urethroplasty). The World Health Organization and World Alliance take the world challenge about the urinary tract infections associated with the attention of patients, focused on urethral stenosis. The objective of the following clinical guide is to offer to the health professional a clinical tool for making decisions in the handling of the hardship or masculine urethral stenosis, based on the best available evidence, carrying out in systematized form with bibliographical research using validated terms of the MeSH: urethral structures, in the databases Trip database, PubMed, Guideline Clearinghouse, Cochrane Library and Ovid.

  5. Obstructive jaundice due to radiation-induced hepatic duct stricture

    SciTech Connect

    Chandrasekhara, K.L.; Iyer, S.K.

    1984-10-01

    A case of obstructive jaundice due to radiation-induced hepatic duct stricture is reported. The patient received postoperative radiation for left adrenal carcinoma, seven years prior to this admission. The sequelae of hepatobiliary radiation and their management are discussed briefly.

  6. Crohn’s disease complicated by strictures: a systematic review

    PubMed Central

    Rieder, Florian; Zimmermann, Ellen M; Remzi, Feza H; Sandborn, William J

    2016-01-01

    The occurrence of strictures as a complication of Crohn’s disease is a significant clinical problem. No specific antifibrotic therapies are available. This systematic review comprehensively addresses the pathogenesis, epidemiology, prediction, diagnosis and therapy of this disease complication. We also provide specific recommendations for clinical practice and summarise areas that require future investigation. PMID:23626373

  7. Gonococcal Conjunctivitis Despite Successful Treatment of Male Urethritis Syndrome.

    PubMed

    Peters, Remco P H; Verweij, Stephan P; McIntyre, James A; Schaftenaar, Erik

    2016-02-01

    We report a case of progressive, cephalosporin-susceptible, Neisseria gonorrhoeae conjunctivitis despite successful treatment of male urethritis syndrome. We hypothesize that conjunctival infection progressed due to insufficient penetration of cefixime and azithromycin and point out that extragenital infection and male urethritis may not be cured simultaneously in settings where the syndromic approach is used.

  8. Role of metallic stents in benign esophageal stricture

    NASA Astrophysics Data System (ADS)

    Shim, Chan Sup

    2012-10-01

    Simple esophageal strictures, which are focal, straight, and large in diameter, usually require 1 - 3 dilation sessions to relieve symptoms. However, complex strictures, which are long, tortuous, or associated with a severely compromised luminal diameter, are usually more difficult to treat with conventional bougie or balloon dilation techniques, and often have high recurrence rates. Although the permanent placement of self-expandable metal stents (SEMS) has been used to manage refractory benign esophageal strictures, this procedure is associated with additional problems, such as stricture from tissue hyperplasia, stent migration, and fistula formation. Thus, several new types of stents have been developed, including temporary SEMS, self-expandable plastic stents (SEPS), and biodegradable stents. The use of these new products has produced varied results. Temporary SEMS that have been used to relieve benign esophageal conditions have caused granulation tissue at both ends of the stent because of contact between the mucosa and the exposed metal components of the stent, thus hindering stent removal. We examined the tissue response to two new types of SEMS, a flange-type and a straighttype, each coated with a silicone membrane on the outside of the metal mesh. These two SEMS were evaluated individually and compared with a conventional control stent in animal experiments. Although the newly designed stents resulted in reduced tissue hyperplasia, and were thus more easily separated from the esophageal tissue, some degree of tissue hyperplasia did occur. We suggest that newly designed DES (drug-eluting stents) may provide an alternative tool to manage refractory benign esophageal stricture.

  9. Trichomonas vaginalis as a cause of urethritis in Malawian men.

    PubMed

    Hobbs, M M; Kazembe, P; Reed, A W; Miller, W C; Nkata, E; Zimba, D; Daly, C C; Chakraborty, H; Cohen, M S; Hoffman, I

    1999-08-01

    This study was conducted to determine the prevalence of trichomoniasis in Malawian men, to evaluate a polymerase chain reaction (PCR) detection assay for T. vaginalis in urethral swab samples, and to examine the effect of T. vaginalis infection on HIV excretion in the semen. There were 206 men with symptomatic urethritis in STD clinic and 127 asymptomatic men in the Dermatology Clinic who were enrolled from January to March 1996. Results, according to a wet-mount microscopy and urethral swabs culture combination, showed that, of 293 men, only 38 (13%) men were positive for T. vaginalis. The estimated prevalence among symptomatic and asymptomatic cases was 15.7% and 8.7%, respectively. The PCR yielded a sensitivity of 0.82 (95% CI: 0.66-0.92) and specificity of 0.95 (95% CI: 0.91-0.97); these were compared to the wet-mount microscopy and culture combination. Overall HIV seroprevalence of men was 51%, because gonococcal urethritis was shown to significantly increase seminal HIV RNA levels. The median HIV RNA concentration in seminal plasma from men with symptomatic urethritis plus T. vaginalis infection was significantly higher than in seminal plasma from HIV-positive men with symptomatic urethritis only. Since this study has several important limitations, a randomized clinical trial would be useful for determining whether urethritis cure rates can be significantly improved.

  10. Urethral reconstruction with a 3D porous bacterial cellulose scaffold seeded with lingual keratinocytes in a rabbit model.

    PubMed

    Huang, Jian-Wen; Lv, Xiang-Guo; Li, Zhe; Song, Lu-Jie; Feng, Chao; Xie, Min-Kai; Li, Chao; Li, Hong-Bin; Wang, Ji-Hong; Zhu, Wei-Dong; Chen, Shi-Yan; Wang, Hua-Ping; Xu, Yue-Min

    2015-09-11

    The goal of this study was to evaluate the effects of urethral reconstruction with a three-dimensional (3D) porous bacterial cellulose (BC) scaffold seeded with lingual keratinocytes in a rabbit model. A novel 3D porous BC scaffold was prepared by gelatin sponge interfering in the BC fermentation process. Rabbit lingual keratinocytes were isolated, expanded, and seeded onto 3D porous BC. BC alone (group 1, N  =  10), 3D porous BC alone (group 2, N  =  10), and 3D porous BC seeded with lingual keratinocytes (group 3, N  =  10) were used to repair rabbit ventral urethral defects (2.0   ×   0.8 cm). Scanning electron microscopy revealed that BC consisted of a compact laminate while 3D porous BC was composed of a porous sheet buttressed by a dense outer layer. The average pore diameter and porosity of the 3D porous BC were 4.23   ±   1.14 μm and 67.00   ±   6.80%, respectively. At 3 months postoperatively, macroscopic examinations and retrograde urethrograms of urethras revealed that all urethras maintained wide calibers in group 3. Strictures were found in all rabbits in groups 1 and 2. Histologically, at 1 month postoperatively, intact epithelium occurred in group 3, and discontinued epithelium was found in groups 1 and 2. However, groups 2 and 3 exhibited similar epithelial regeneration, which was superior to that of group 1 at 3 months (p  <  0.05). Comparisons of smooth muscle content and endothelia density among the three groups revealed a significant increase at each time point (p  <  0.05). Our results demonstrated that 3D porous BC seeded with lingual keratinocytes enhanced urethral tissue regeneration. 3D porous BC could potentially be used as an optimized scaffold for urethral reconstruction.

  11. Metallic stents in the management of ureteric strictures

    PubMed Central

    Kulkarni, Ravi

    2014-01-01

    Management of ureteric strictures is a challenging task. Subtle presentation, silent progression and complex aetiology may delay diagnosis. A wide range of available treatment options combined with the lack of adequate randomised trials has led to the introduction of personal bias in the management of this difficult group of patients. Metallic ureteric stents offer an alternative to the conventional treatment modalities. A review of the currently available metallic stents and their role in the long-term management of ureteric strictures is presented. Materials used in the manufacture of indwelling urological devices are evolving all the time. Improved endo-urological techniques combined with new devices made from better compounds will continue to improve patient experience. PMID:24497686

  12. Role of stents and laser therapy in biliary strictures

    NASA Astrophysics Data System (ADS)

    Chennupati, Raja S.; Trowers, Eugene A.

    2001-05-01

    The most frequent primary cancers causing malignant obstructive jaundice were pancreatic cancer (57%), hilar biliary cancer (19% including metastatic disease), nonhilar biliary cancer (14%) and papillary cancer (10%). Endoscopic stenting has widely replaced palliative surgery for malignant biliary obstruction because of its lower risk and cost. Self-expandable metal stents are the preferred mode of palliation for hilar malignancies. Plastic stents have a major role in benign biliary strictures. Major complications and disadvantages associated with metallic stents include high cost, cholangitis. malposition, migration, unextractability, and breakage of the stents, pancreatitis and stent dysfunction. Dysfunction due to tumor ingrowth can be relieved by thermal methods (argon plasma coagulator therapy). We present a concise review of the efficacy of metallic stents for palliation of malignant strictures.

  13. Urethral Duplication with Two Hypospadic Meati—An Unusual Variant

    PubMed Central

    Davidson, Joseph Rutherford; Wright, Naomi Jane; Garriboli, Massimo

    2016-01-01

    Duplication of the urethra is a rare congenital anomaly, with approximately 300 cases reported in the literature. We report a unique case of this condition in a male infant. This case differs from the classical Effman type II-A2 duplication because of the presence of two hypospadic urethral meati, as opposed to a ventral or dorsal accessory meatus with a normally positioned distal urethra. The patient underwent a single-stage repair consisting of a proximal urethra-urethral anastomosis and distal urethral tubularization at 21 months of age with excellent results in terms of both function and cosmesis. PMID:28018807

  14. Incidental adenocarcinoma in patients undergoing surgery for stricturing Crohn's disease

    PubMed Central

    Kristo, Ivan; Riss, Stefan; Argeny, Stanislaus; Maschke, Svenja; Chitsabesan, Praminthra; Stift, Anton

    2017-01-01

    AIM To evaluate frequency and clinical course of incidental adenocarcinoma in patients with stricturing Crohn's disease (CD). METHODS In this study, consecutive patients, who were operated on for stricturing CD between 1997-2012, were included at an academic tertiary referral center. Demographic data and clinical course were obtained by an institutional database and individual chart review. Besides baseline characteristics, intraoperative findings and CD related history were also recorded. Colorectal cancer was classified and staged according to the Union for International Cancer Control (UICC). RESULTS During the study period 484 patients underwent resections due to stricturing CD. Incidental adenocarcinoma was histologically confirmed in 6 (1.2%) patients (4 males, 2 females). Patients diagnosed with colorectal cancer had a median age of 43 (27-66) years and a median history of CD of 16 (7-36) years. Malignant lesions were found in the rectum (n = 4, 66.7%), descending colon (n = 1, 16.7%) and ileocolon (n = 1, 16.7%). According to the UICC classification two patients were stages as I (33.3%), whereas the other patients were classified as stage IIA (16.7%), stage IIIB (16.7%), stage IIIC (16.7%) and stage IV (16.7%), respectively. After a median follow-up of 2 (0.03-8) years only 1 patient is still alive. CONCLUSION The frequency of incidental colorectal cancer in patients, who undergo surgery for stenotic CD, is low but associated with poor prognosis. However, surgeons need to be aware about the possibility of malignancy in stricturing CD, especially if localized in the rectum. PMID:28210083

  15. Fasciocutaneous flap in esophageal stricture with ventriculoperitoneal shunt.

    PubMed

    Seong, Yong Won; Kang, Chang Hyun; Chang, Hak; Park, In Kyu; Kim, Young Tae

    2014-01-01

    Abdominal surgery in a patient with ventriculoperitoneal shunt may increase the risk of shunt malfunction and infection. We present a successful case of resection and reconstruction of the cervical esophagus by rolled lateral thoracic artery fasciocutaneous flap in a patient with corrosive esophageal stricture and preexisting ventriculoperitoneal shunt. Follow-up esophagogastroscopy after 3 months revealed wide patent graft. Rolled fasciocutaneous flap may be a safe alternative treatment without risk of shunt-associated complications in a patient with ventriculoperitoneal shunt.

  16. Transperineal ultrasonography in stress urinary incontinence: The significance of urethral rotation angles

    PubMed Central

    Al-Saadi, Wasan Ismail

    2015-01-01

    Objective To assess, using transperineal ultrasonography (TPUS), the numerical value of the rotation of the bladder neck [represented by the difference in the anterior (α angle) and posterior urethral angles (β angle)] at rest and straining, in continent women and women with stress urinary incontinence (SUI), to ascertain if there are significant differences in the angles of rotation (Rα and Rβ) between the groups. Patients, subjects and methods In all, 30 women with SUI (SUI group) and 30 continent women (control group) were included. TPUS was performed at rest and straining (Valsalva manoeuver), and the threshold value for the urethral angles (α and β angles) for each group were estimated. The degree of rotation for each angle was calculated and was considered as the angle of rotation. Results Both the α and β angles were significantly different between the groups at rest and straining, and there was a significant difference in the mean increment in the value of each angle. Higher values of increment (higher rotation angles) were reported in the SUI group for both the α and β angles compared with those of the control group [mean (SD) Rα SUI group 19.43 (12.76) vs controls 10.53 (2.98) °; Rβ SUI group 28.30 (12.96) vs controls 16.33 (10.8) °; P < 0.001]. Conclusion Urethral rotation angles may assist in the assessment and diagnosis of patients with SUI, which may in turn reduce the need for more sophisticated urodynamic studies. PMID:26966596

  17. [Pathogen spectrum of non-gonorrhea urethritis].

    PubMed

    Schmidt, U; Hartmann, M; Pfützner, H

    1988-05-01

    By cultural investigations in 333 males with non-gonorrhoical urethritis (NGU) and 158 control probands it was demonstrated that Chlamydia trachomatis is the main germ of this disease also in the GDR with a frequency of 40% of the cases. A chlamydia-negative NGU was caused in 15% by Ureaplasma urealyticum in a number of greater than or equal to 10(4) germs/ml urine and in 5% by Trichomonas vaginalis, respectively. Candida albicans occurred significant more frequently in the patient group (21%) than in the control group (4%). Other optional pathogenic bacterias were the cause of NGU in single cases. The diagnosis and therapy of NGU should be considered this germ spectrum and the sexual partner also.

  18. Pharyngoesophageal stricture and fistula. Treatment by free jejunal graft.

    PubMed Central

    Hester, T R; McConnel, F; Nahai, F; Cunningham, S J; Jurkiewicz, M J

    1984-01-01

    Fifty-five patients with disorders of the pharynx or cervical esophagus requiring extensive ablative therapy were reconstructed by heterotopic autotransplantation of a segment of jejunum. Of these 55 patients, the overwhelming majority were treated for squamous cell carcinoma or the complications of combined radiation and operative therapy. There were six graft failures in the entire group of 55 patients for a transfer reliability of 90%. Three patients died in the perioperative period (5%). The purpose of this paper is to report on the treatment of a subset of these patients in whom fixed cicatricial stenosis of the gullet was the problem or in whom a radionecrotic cutaneous fistula existed. Fourteen such patients were treated, ten with stricture and four with fistula. Both patch grafts of on-lay segments and more routine circumferentially intact tubed segments of jejunum were used depending upon the nature of the defect. The youngest patient in this group was a 3-year-old juvenile diabetic with caustic stricture and the oldest was a 75-year-old man with fixed stricture following operation and radiation for cancer. Nine of ten and four of four anatomic reconstructions were successful in the stricture and fistula patients, respectively. All of these 13 patients with a neo- gullet of jejunum were able to handle secretions and liquids satisfactorily. Eleven patients were on a regular diet and had no discernible physiological impairment in alimentation. One patient had mild dysphagia and used a blenderized diet. One patient was able to swallow liquids only. In this patient the resection for tumor was so high and so extensive that the physiologic act of deglutition itself was impaired. There were no perioperative deaths, although one patient has succumbed to recurrent and metastatic carcinoma. When conventional treatment for stricture or fistula in the cervical alimentary tract has failed, reconstruction can be accomplished safely by free revascularized jejunal graft

  19. Neurovascular sparing vas clipping: last option for recurrent epididymo-orchitis in urethrovasal reflux due to urethral injury.

    PubMed

    Khorramirouz, Reza; Mozafarpour, Sarah; Mohseni, Mohammad Javad; Kajbafzadeh, Abdol-Mohammad

    2014-05-01

    Acute scrotum is a critical clinical entity in children. This report presents a 12-year-old boy presented with recurrent epididymo-orchitis (EO) with a history of pelvic trauma and urethral disruption 10 years ago. Antegrade and retrograde studies confirmed urethrovasal reflux. The patient did not respond to prophylactic antibiotics, clean intermittent catheterization and endoscopic injection of bulking agent at the junction of the ejaculatory duct and posterior urethra. As the last option, neurovascular sparing vas clipping was performed and the patient made a full recovery. This is the first report of this technique in the treatment for recurrent EO caused by traumatic injury.

  20. Predictive factors and clinical practice profile for strictures post-necrotising enterocolitis

    PubMed Central

    Zhang, Han; Chen, Jiaping; Wang, Yan; Deng, Chun; Li, Lei; Guo, Chunbao

    2017-01-01

    Abstract Intestinal stricture is a severe and common complication of necrotizing enterocolitis (NEC), causing severe and prolonged morbidity. Our goal was to investigate the clinical predictors for strictures developing after NEC and evaluate the management outcome of the post-NEC strictures to better orient their medicosurgical care. A total of 188 patients diagnosed with NEC with identical treatment protocols throughout the period under study were retrospectively reviewed from 4 academic neonatal centers between from January 1, 2011, and October 31, 2016. Clinical predictive factors and clinical outcomes, including demographic information, clinical management, laboratory data, histopathology of resected bowel segment, and discharge summaries, were evaluated on the basis of with post-NEC strictures or not. Of the involved variables examined, the late-onset NEC [risk ratio (RR), 0.56; 95% confidence interval (95% CI), 0.41–0.92; P < 0.001], cesarean delivery (RR, 1.42; 95% CI, 0.98–2.29; P = 0.026), and first procalcitonin (PCT) (onset of symptoms) (RR, 1.82; 95% CI, 0.98–3.15; P = 0.009) were the independent predictive factors for the post-NEC strictures. C-reactive protein (CRP), white blood cell (WBC), and plateletcrit levels were markedly higher on infants with stricture and elevated levels were maintained until the stricture was healed. Infants with intestinal stricture had significantly longer times to beginning enteral feeds (23.9 ± 12.1), than infants without intestinal stricture (18.6 ± 8.8) (P = 0.023). The median age at discharge was also significantly higher in the group with stricture (P = 0.014). This retrospective and multicenter study demonstrates that the early-onset NEC and cesarean delivery conferred protection over the post-NEC stricture. Infants with post-NEC stricture need prolonged hospitalization. PMID:28272242

  1. Wire-guided balloon coloplasty--a new treatment for colorectal strictures?

    PubMed Central

    Banerjee, A K; Walters, T K; Wilkins, R; Burke, M

    1991-01-01

    A new technique for dilatation of colorectal anastomotic strictures--wire-guided balloon coloplasty--is described. It is suitable for high strictures, may be performed without general anaesthetic and is repeatable. It does not require endoscopy and may be used to relieve obstructive symptoms in both benign and malignant strictures so avoiding the need for a defunctioning colostomy. Images Figure 1. Figure 2. Figure 3. PMID:2013892

  2. Male urethral sarcoma: a case report and literature review

    PubMed Central

    Nogueira, Magno Almeida; dos Santos, Guilherme Campelo Lopes; Lopes, Roberto Iglesias; Campos, Octavio Henrique Arcos; Dall’Oglio, Marcos Francisco; Sant’Anna, Alexandre Crippa

    2016-01-01

    ABSTRACT Urethral tumors are rare and aggressive. They usually affect men (2:1) and occur more commonly in white (85% of cases). Soft tissue sarcomas are a heterogeneous group of tumors that arise from embryonic mesoderm. It represents 1% of all cases of urinary tract malignancies and rarely primary affect the ureter. We report a case of male urethral sarcoma. To date, only two similar cases have been published in literature. PMID:26398363

  3. Benign Post-Radiation Rectal Stricture Treated with Endoscopic Balloon Dilation and Intralesional Triamcinolone Injection

    PubMed Central

    Karanikas, Michael; Touzopoulos, Panagiotis; Mitrakas, Alexandros; Zezos, Petros; Zarogoulidis, Paul; Machairiotis, Nikolaos; Efremidou, Eleni; Liratzopoulos, Nikolaos; Polychronidis, Alexandros; Kouklakis, George

    2012-01-01

    Post-radiation stricture is a rare complication after pelvis irradiation, but must be in the mind of the clinician evaluating a lower gastrointestinal obstruction. Endoscopy has gained an important role in chronic radiation proctitis with several therapeutic options for management of intestinal strictures. The treatment of rectal strictures has been limited to surgery with high morbidity and mortality. Therefore, a less invasive therapeutic approach for benign rectal strictures, endoscopic balloon dilation with or without intralesional steroid injection, has become a common treatment modality. We present a case of benign post-radiation rectal stricture treated successfully with balloon dilation and adjuvant intralesional triamcinolone injection. A 70-year-old woman presented to the emergency room complaining for 2 weeks of diarrhea and meteorism, 11 years after radiation of the pelvis due to adenocarcinoma of the uterus. Colonoscopy revealed a stricture at the rectum and multiple endoscopic biopsies were obtained from the stricture. The stricture was treated with endoscopic balloon dilation and intralesional triamcinolone injection. The procedure appears to have a high success rate and a very low complication rate. Histologic examination of the biopsies revealed non-specific inflammatory changes of the rectal mucosa and no specific changes of the mucosa due to radiation. All biopsies were negative for malignancy. The patient is stricture-free 12 months post-treatment. PMID:23271987

  4. The Cost of Surveillance After Urethroplasty

    PubMed Central

    Zaid, Uwais B.; Hawkins, Mitchel; Wilson, Leslie; Ting, Jie; Harris, Catherine; Alwaal, Amjad; Zhao, Lee C.; Morey, Allen F.; Breyer, Benjamin N.

    2015-01-01

    Objectives To determine variability in urethral stricture surveillance. Urethral strictures impact quality of life and exact a large economic burden. Although urethroplasty is the gold standard for durable treatment, strictures recur in 8–18%. There are no universally accepted guidelines for post-urethroplasty surveillance. We performed a literature search to evaluate variability in surveillance protocols, analyzed costs, and reviewed performance of each commonly employed modality. Methods Medline search was performed using the keywords: “urethroplasty,” “urethral stricture,” “stricture recurrence” to ascertain commonly used surveillance strategies for stricture recurrence. We included English language manuscripts from the past 10 years with at least 10 patients, and age greater than 18. Cost data was calculated based on standard 2013 Centers for Medicare and Medicaid Services physician’s fees. Results Surveillance methods included retrograde urethrogram/voiding cystourethrogram (RUG/VCUG), cystourethroscopy, urethral ultrasound, AUA-Symptom Score, and post void residual (PVR) and urine flowmetry (UF) measurement. Most protocols call for a RUG/VCUG at time of catheter removal. Following this, UF/PVR, cystoscopy, urine culture, or a combination of UF and AUA-SS were performed at variable intervals. The first year follow-up cost of anterior urethral surgery ranged from $205 to $1,784. For posterior urethral surgery, follow-up cost for the first year ranged from $404 to $961. Conclusions Practice variability for surveillance of urethral stricture recurrence after urethroplasty leads to significant differences in cost. PMID:25819624

  5. Female urethral diverticulum: cases report and literature

    PubMed Central

    2014-01-01

    Introduction A female urethral diverticulum is an uncommon pathologic entity. It can manifest with a variety of symptoms involving the lower urinary tract. Our objective is to describe the various aspects of the diverticulum of the female urethra such as etiology, diagnosis and treatment. Cases presentation We report five female patients, without prior medical history. They had different symptoms: dysuria in four cases, recurrent urinary tract infection in three cases, stress incontinence in two cases and hematuria in two cases. All patients had dyspareunia. The physical exams found renitent mass located in the endovaginal side of urethra which drained pus in two cases. Urethrocystography found a diverticulum of urethra in all cases. Our five patients underwent diverticulotomy by endovaginal approach. The course after surgical treatment was favorable. The urinary catheter was withdrawn after ten days. Some recurrent symptoms were reported. Conclusion Evaluation of recurrent urinary complaints in young women can lead to the finding of a diverticulum of urethra. Urethrocystography can reveal this entity. Diverticulectomy by endovaginal approach is the best choice for treatment. PMID:24528809

  6. Management of pelvic fracture-associated urethral injuries: A survey of Canadian urologists

    PubMed Central

    Wong, Nathan Colin; Allard, Christopher B.; Dason, Shawn; Farrugia, Patricia; Bhandari, Mohit; Davies, Timothy O.

    2017-01-01

    Introduction The management of pelvic fracture-associated urethral injuries (PFUI) is not standardized and optimal management is controversial. We surveyed Canadian urologists about their experiences and opinions regarding optimal management of PFUI. Methods Canadian urologists were surveyed via an anonymous, bilingual, web-based, 12-item questionnaire. A total of 735 Canadian urologists were invited to participate via email distributed by the Canadian Urological Association. Results Of the 146 urologists who participated (19.9% response rate), the majority practice at a trauma centre (53.2%), but manage only 1–5 PFUI/year (71.5%). Most participants (82.6%) favour primary realignment compared to suprapubic (SP) tube with delayed repair (15.3%) and immediate reconstruction (2.1%). Compared to SP diversion and delayed repair, the majority of participants believe primary realignment is associated with equivocal incontinence (61.2%) and erectile dysfunction rates (75.8%), but has lower stricture rates (73.0%). Among respondents who perform primary realignment, 45.4% concurrently place a SP tube, while 54.6% do not. While 91% believe SP tubes do not increase the risk of pelvic hardware infections, 31.6% report that orthopedic surgeons alter their management of pelvic fractures in the presence of a SP tube. Conclusions Most Canadian urologist respondents — even those practicing at trauma centres — manage very few PFUIs/year. There is reasonable consensus among respondents that primary realignment is favourable to delayed or immediate reconstruction, but discordance on whether or not to place concurrent SP tubes. The urological and orthopedic consequences of SP tubes in the management of traumatic urological injuries warrant further investigation. PMID:28360950

  7. Application of Wnt Pathway Inhibitor Delivering Scaffold for Inhibiting Fibrosis in Urethra Strictures: In Vitro and in Vivo Study

    PubMed Central

    Zhang, Kaile; Guo, Xuran; Zhao, Weixin; Niu, Guoguang; Mo, Xiumei; Fu, Qiang

    2015-01-01

    Objective: To evaluate the mechanical property and biocompatibility of the Wnt pathway inhibitor (ICG-001) delivering collagen/poly(l-lactide-co-caprolactone) (P(LLA-CL)) scaffold for urethroplasty, and also the feasibility of inhibiting the extracellular matrix (ECM) expression in vitro and in vivo. Methods: ICG-001 (1 mg (2 mM)) was loaded into a (P(LLA-CL)) scaffold with the co-axial electrospinning technique. The characteristics of the mechanical property and drug release fashion of scaffolds were tested with a mechanical testing machine (Instron) and high-performance liquid chromatography (HPLC). Rabbit bladder epithelial cells and the dermal fibroblasts were isolated by enzymatic digestion method. (3-(4,5-Dimethylthiazol-2-yl)-2,5-Diphenyltetrazolium Bromide (MTT) assay) and scanning electron microscopy (SEM) were used to evaluate the viability and proliferation of the cells on the scaffolds. Fibrolasts treated with TGF-β1 and ICG-001 released medium from scaffolds were used to evaluate the anti-fibrosis effect through immunofluorescence, real time PCR and western blot. Urethrography and histology were used to evaluate the efficacy of urethral implantation. Results: The scaffold delivering ICG-001 was fabricated, the fiber diameter and mechanical strength of scaffolds with inhibitor were comparable with the non-drug scaffold. The SEM and MTT assay showed no toxic effect of ICG-001 to the proliferation of epithelial cells on the collagen/P(LLA-CL) scaffold with ICG-001. After treatment with culture medium released from the drug-delivering scaffold, the expression of Collagen type 1, 3 and fibronectin of fibroblasts could be inhibited significantly at the mRNA and protein levels. In the results of urethrography, urethral strictures and fistulas were found in the rabbits treated with non-ICG-001 delivering scaffolds, but all the rabbits treated with ICG-001-delivering scaffolds showed wide caliber in urethras. Histology results showed less collagen but more

  8. The Accordion Sign in the Transplant Ureter: Ramifications During Balloon Dilation of Strictures

    SciTech Connect

    Kriegshauser, J. Scott Naidu, Sailen G.; Chang, Yu-Hui H.; Huettl, Eric A.

    2015-04-15

    PurposeThis study was designed to demonstrate the accordion sign within the transplant ureter and evaluate its ramifications during balloon dilation of strictures.MethodsA retrospective electronic chart and imaging review included demographic characteristics, procedure reports, and complications of 28 renal transplant patients having ureteral strictures treated with percutaneous balloon dilation reported in our transplant nephrology database during an 8-year period. The accordion sign was deemed present or absent on the basis of an imaging review and was defined as present when a tortuous ureter became kinked and irregular when foreshortened after placement of a wire or a catheter. Procedure-related urine leaks were categorized as occurring at the stricture if within 2 cm; otherwise, they were considered away from the stricture.ResultsThe accordion sign was associated with a significantly greater occurrence of leaks away from the stricture (P = 0.001) but not at the stricture (P = 0.34).ConclusionsThe accordion sign is an important consideration when performing balloon dilation procedures on transplant ureteral strictures, given the increased risk of leak away from the stricture. Its presence should prompt additional care during wire and catheter manipulations.

  9. Biliary strictures and hepatic artery flow abnormalities in split liver transplants.

    PubMed

    O'Loughlin, Edward V; Stormon, Michael O; Shun, Albert; Verran, Deborah; Jermyn, Vicki; Wong, Christopher; Lord, David

    2010-02-01

    The aim of this study was to examine the role of HA flow abnormalities in the development of biliary strictures following split liver transplants. Data was obtained from a prospective data base of all patients undergoing split liver transplants from 2000-2008 with a follow up time of at least six months. Forty-six transplants were performed in 44 patients. Fourteen of 46 developed strictures of whom four were intrahepatic and 10 anastomotic. Nine of 14 with strictures had either hepatic artery thromobosis (HAT, four) or abnormalities of HA flow identified by routine Doppler ultrasound (5) compared with two of 32 without strictures (p < 0.02, (one temporary loss of flow and one HA aneurysm). There were no differences between the stricture and non stricture group with regard to age or weight at transplant, donor age, cold and warm ischemia times or intraoperative portal vein flow though there was a significant decrease in intraoperative HA flow in the stricture group. In conclusion, both HAT and hepatic artery flow abnormalities are associated with biliary strictures in the majority of split liver transplants. However, unrecognised abnormalities in HA flow and or other factors are likely to contribute.

  10. Self-Expandable Metal Stenting of Refractory Upper Gut Corrosive Strictures: A New Role for Endoscopy?

    PubMed Central

    Manta, Raffaele; Conigliaro, Rita; Bertani, Helga; Manno, Mauro; Soliman, Ahmed; Fedeli, Paolo; Bassotti, Gabrio

    2011-01-01

    Caustic strictures of the gastrointestinal tract are often difficult to treat, since relapses are frequent after medical or endoscopic treatment. Thus, novel approaches are needed. We report here our experience with self-expandable metallic stents (SEMS) as a new endoscopic approach in three patients with corrosive strictures of the upper gastrointestinal tract. PMID:22606415

  11. Urethral duplication: a rare cause of urinary incontinence in a female child

    PubMed Central

    Gupta, Sanjay; Tiwari, Rajesh; Kumar, Vijoy; Singh, Mahendra

    2012-01-01

    Female urethral duplication is a rare congenital anomaly. We report a case of complete urethral duplication along with horseshoe kidney in a four-years-old female child presenting with incontinence since childhood. PMID:24578937

  12. Mitomycin-C: 'a ray of hope' in refractory corrosive esophageal strictures.

    PubMed

    Nagaich, N; Nijhawan, S; Katiyar, P; Sharma, R; Rathore, M

    2014-04-01

    Increasingly frequent dilation may become a self-defeating cycle in refractory stricture as recurrent trauma enhance, scar formation, and ultimately recurrence and potential worsening of the stricture. In 12 patients of caustic induced esophageal stricture, who failed to respond despite rigorous dilatation regimen for more than one year, a trial of topical mitomycin-C application to improve dilatation results was undertaken, considering the recently reported efficacy and safety of this agent. Mitomycin-C was applied for 2-3 minutes at the strictured esophageal segment after dilation with wire-guided Savary-Gilliard dilator. Patient was kept nil by mouth for 2-3 hours. After 4-6 sessions of mitomycin-C treatment, resolution of symptoms and significant improvement in dysphagia score and periodic dilatation index was seen in all 12 patients. Mitomycin-C topical application may be a useful strategy in refractory corrosive esophageal strictures and salvage patients from surgery.

  13. Self-Expanding Metal Stenting in the Management of a Benign Colonic Stricture

    PubMed Central

    Jessamy, Kegan; Ozden, Nuri; Simon, Howard M.; Kobrossi, Semaan; Ubagharaji, Ezinnaya

    2016-01-01

    Colonic postanastomotic strictures occur in 1.5–8% of patients following colorectal surgery. Traditionally, colonic strictures were treated by multiple modalities including endoscopic dilatation. Self-expanding metal stents (SEMS) have been indicated in the management of benign colonic strictures; however, there are limited available data with regard to their efficacy. We present the case of a 68-year-old male who had perforated sigmoid diverticulitis followed by Hartmann's procedure with eventual reanastomosis 6 months later. He subsequently developed benign colonic stricture, which was treated with a metal stent. SEMS are associated with a low mortality rate and are appropriate in treating acute colonic obstruction as a result of benign stricture in the setting of postanastomosis. PMID:27403114

  14. Treatment of colonic anastomotic strictures with 'through the scope' balloon dilators.

    PubMed Central

    Dinneen, M D; Motson, R W

    1991-01-01

    Stricture occurs in 1.2-4.2% of colonic anastomoses. Symptomatic strictures have previously been treated by resection and re-anastomosis and more recently by radiographically guided dilatation by a modified Seldinger technique. This paper describes the endoscopic balloon dilatation of five symptomatic cases and three asymptomatic cases. Eight patients underwent balloon dilatation of colonic anastomotic strictures. Four patients had no symptoms post dilatation and the strictures remained patient on follow-up endoscopy. All the remaining patients required re-dilatation at approximately 2 months. One of these patients underwent dilatation but remained symptomatic, the dilatation was repeated and a colonic perforation occurred at this time. Of the other three, two continue to be followed up, and are well and one patient died of disseminated malignancy. Balloon dilatation with 'through the scope' dilators is a simpler technique than radiologically guided dilatation. These early results suggest that endoscopic dilatation may avoid further surgery in some patients with anastomotic stricture. PMID:2041001

  15. Serum Proteome Profiles in Stricturing Crohn’s Disease: A pilot study.

    SciTech Connect

    Townsend, Peter; Zhang, Qibin; Shapiro, Jason; Webb-Robertson, Bobbie-Jo M.; Bramer, Lisa M.; Schepmoes, Athena A.; Weitz, Karl K.; Mallette, Meaghan; Moniz, Heather; Bright, Renee; Merrick, Marjorie; Shah, Samir A.; Sands, Bruce E.; Leleiko, Neal

    2015-08-01

    Background: Crohn’s disease (CD) is a form of inflammatory bowel disease (IBD) with different described behaviors, including stricture. At present, there are no laboratory studies that can differentiate stricturing CD from other phenotypes of IBD. We performed a pilot study to examine differences in the proteome among patients with stricturing Crohn’s disease, non-stricturing Crohn’s disease, and ulcerative colitis (UC). Methods: Serum samples were selected from the Ocean State Crohn’s and Colitis Area Registry (OSCCAR), an established cohort of patients with IBD. Crohn’s disease patients with surgically-resected stricture were matched with similar patients with Crohn’s disease without known stricture, and with UC. Serum samples from each patient were digested and analyzed using liquid chromatography-mass spectrometry to characterize the proteome. Statistical analyses were performed to identify peptides and proteins that can differentiate CD with stricture. Results: Samples from 9 patients in each group (27 total patients) were analyzed. Baseline demographic characteristics were similar among the three groups. We quantified 7668 peptides and 897 proteins for analysis. ROC analysis identified a subset of peptides with an area under the curve greater than 0.9, indicating greater separation potential. Partial least squares discriminant analysis was able to distinguish among the three groups with up to 70% accuracy by peptides, and up to 80% accuracy by proteins. We identified the significantly different proteins and peptides, and determined their function based on previously published literature. Conclusions: The serum of patients with stricturing CD, non-stricturing CD, and UC are distinguishable via proteomic analysis. Some of the proteins that differentiate the stricturing phenotype have been implicated in complement activation, fibrinolytic pathways, and lymphocyte adhesion.

  16. Neisseria meningitidis ST11 Complex Isolates Associated with Nongonococcal Urethritis, Indiana, USA, 2015–2016

    PubMed Central

    Toh, Evelyn; Gangaiah, Dharanesh; Batteiger, Byron E.; Williams, James A.; Arno, Janet N.; Tai, Albert; Batteiger, Teresa A.

    2017-01-01

    At a clinic in Indianapolis, Indiana, USA, we observed an increase in Neisseria gonorrhoeae–negative men with suspected gonococcal urethritis who had urethral cultures positive for N. meningitidis. We describe genomes of 2 of these N. meningitidis sequence type 11 complex urethritis isolates. Clinical evidence suggests these isolates may represent an emerging urethrotropic clade. PMID:28098538

  17. [Urethritis caused by Trichomonas vaginalis in men. Epidemiology].

    PubMed

    Hernanz, J M; Clavo, I; Menendez, B; Jareño, M; Moya, D; Jover, J

    1987-01-01

    The interviews of sexually transmitted diseases (STD) done in the Dispensario "Martínez Anido" of Madrid in the period understood between September of 1984 and September of 1985 are revised. Among all of the 1,370 surveys, the trichomonal urethritis in the male, represents 2.2% of all of the urethritis and 4.6% of the nongonococcal urethritis in the male. Mean age of patients was 35 years, the social-economic level was inferior than those which we observed in others STD, all of the cases were heterosexual and the source of contamination was in 100% a prostitute of a low level. The answer to the treatment with metronidazole of the only doses of 2 gr. was satisfactory in all cases.

  18. [Laser hair removal for urethral hair after hypospadias repair].

    PubMed

    Kaneko, Tomoyuki; Nishimatsu, Hiroaki; Ogushi, Tetsuo; Sugimoto, Masayuki; Asakage, Yasuyuki; Kitamura, Tadaichi

    2008-01-01

    A 56-year-old male was admitted for induration of ventral side of the penile shaft. Computed tomography showed a large urethral calculus in the distal urethra. About 50 years previously, he had undergone multi-staged urethroplasty for hypospadias. He had also suffered from recurrent urethral calculi managed by urethrolithotomy 5 and 2 years before the admission. Urethrolithotomy revealed hair-bearing urethral calculus. Instillation of depilating agent containing thioglycolate into the neourethra for preventing hair regrowth was ineffective. Transurethral laser hair removal of neourethra was subsequently performed. All the neourethral follicles were ablated with GaAlAs diode laser (wave length 810 nm; at a power of 15W for 2 seconds) through a side-firing laser fiber. Another three operations were performed for a few regrown hairs at a power of 20-30W. Convalescence was uneventful. The patient is free of hair regrowth except for a hair at five months of follow-up.

  19. Urethral hemangioma: case report and review of the literature.

    PubMed

    Regragui, Souhail; Slaoui, Amine; Karmouni, Tarik; El Khader, Khalid; Koutani, Abdelatif; Attya, Ahmed Ibn

    2016-01-01

    Hemangiomas are benign vascular tumors. They are the prerogative of the liver and skin. And genitourinary localizations are rare and have only been rarely reported in the prostat, bladder, ureter or the perineum. In the light of published cases, urethral hemangiomas are mostly found in males. Few cases of hemangioma in the female urethra were reported. We report a cavernous hemangioma of the urethra in a 61 years old patient who presented bleeding from the urethra and micturition disorders. Physical examination revealed a tumor 3 cm x 2 polyploid arising from the terminal urethra (urethral hemangioma). We performed surgical resection of the tumor, along with bladder drainage. The postoperative course was simple. We update through a review of the literature aspects of the diagnostic and therapeutic care of the urethral hemangioma.

  20. Urethral Reconstruction Using Mesothelial Cell-Seeded Autogenous Granulation Tissue Tube: An Experimental Study in Male Rabbits

    PubMed Central

    Jiang, Shiwei; Xu, Zhonghua; Zhao, Yuanyuan; Yan, Lei; Zhou, Zunlin

    2017-01-01

    Objective. This study was to evaluate the utility of the compound graft for tubularized urethroplasty by seeding mesothelial cells onto autogenous granulation tissue. Methods. Silastic tubes were implanted subcutaneously in 18 male rabbits, of which nine underwent omentum biopsies simultaneously for in vitro expansion of mesothelial cells. The granulation tissue covering the tubes was harvested 2 weeks after operation. Mesothelial cells were seeded onto and cocultured with the tissue for 7 days. A pendulous urethral segment of 1.5 cm was totally excised. Urethroplasty was performed with mesothelial cell-seeded tissue tubes in an end-to-end fashion in nine rabbits and with unseeded grafts in others as controls. Serial urethrograms were performed at 1, 2, and 6 months postoperatively. Meanwhile, the neourethra was harvested and analyzed grossly and histologically. Results. Urethrograms showed cell-seeded grafts maintained wide at each time point, while strictures formation was found in unseeded grafts. Histologically, layers of urothelium surrounded by increasingly organized smooth muscles were observed in seeded grafts. In contrast, myofibroblasts accumulation and extensive scarring occurred in unseeded grafts. Conclusions. Mesothelial cell-seeded granulation tissue tube can be successfully used for tubularized urethroplasty in male rabbits. PMID:28337443

  1. Pro: endoscopic realignment for pelvic fracture urethral injuries

    PubMed Central

    Stein, Daniel M.

    2015-01-01

    Patients with pelvic fracture urethral distraction injuries may benefit from early endoscopic realignment. Realignment is associated with a low risk of immediate complications and has a high success rate for achieving catheter placement. Review of over thirty studies assessing for subsequent urethral stenosis, including at least a dozen that directly compare realignment to suprapubic diversion along, conclude that there is a benefit averaging at least 35% in favor of realignment. Furthermore, realignment may result in easier subsequent urethroplasty and possibly shorter stenoses. PMID:26816813

  2. A bulbar artery pseudoaneurysm following traumatic urethral catheterization

    PubMed Central

    Bettez, Mathieu; Aubé, Melanie; Sherbiny, Mohamed El; Cabrera, Tatiana; Jednak, Roman

    2017-01-01

    Traumatic urethral catheterization may result in a number of serious complications. A rare occurrence is the development of a urethral pseudoaneurysm. We report the case of a 13-year-old male who required placement of a Foley catheter for an orthopedic surgical procedure. The Foley was misplaced in the bulbourethra, resulting in the development of a bulbar artery pseudoaneurysm. Profuse bleeding via the urethra was noted after removal of the catheter, and the patient experienced severe intermittent hematuria during the postoperative period. Cystoscopy revealed a pulsatile mass within the bulbourethra. Angiography confirmed a bulbar artery pseudoaneurysm, which was successfully embolized with resolution of bleeding. PMID:28163815

  3. Percutaneous Posterior Calcaneal Osteotomy.

    PubMed

    Lui, Tun Hing

    2015-01-01

    Different types of posterior calcaneal osteotomy are used for calcaneal realignment in the management of hindfoot deformity. We describe a percutaneous technique of posterior calcaneal osteotomy that can be either a Dwyer-type closing wedge osteotomy or displacement osteotomy.

  4. A case report on buccal mucosa graft for upper ureteral stricture repair

    PubMed Central

    Sabale, Vilas Pandurang; Thakur, Naveen; Kankalia, Sharad Kumar; Satav, Vikram Pramod

    2016-01-01

    Management of ureteric stricture especially long length upper one-third poses a challenging job for most urologists. With the successful use of buccal mucosa graft (BMG) for stricture urethra leads the foundation for its use in ureteric stricture also. A 35-year-old male diagnosedcase of left upper ureteric stricture, postureteroscopy with left percutaneous nephrostomy (PCN) in situ. Cysto-retrograde pyelography and nephrostogram done simultaneously suggestive of left upper ureteric stricture of 3 cm at L3 level. On exploration, diseased ureteral segment exposed, BMG harvested and sutured as onlay patch graft with supportive omental wrap. The treatment choice for upper ureteric long length stricture is inferior nephropexy, autotransplantation, or bowel interposition. With PCN in situ, inferior nephropexy becomes technically difficult, other two are morbid procedures. Use of BMG in this situation is technically better choice with all the advantages of buccal mucosa. Onlay BMG for ureteral stricture is technically easy, less morbid procedure and can be important choice in future. PMID:28057996

  5. Balloon Dilatation of Salivary Duct Strictures: Report on 36 Treated Glands

    SciTech Connect

    Drage, Nicholas A.; Brown, Jackie E.; Escudier, Michael P.; Wilson, Ron F.; McGurk, Mark

    2002-10-15

    Purpose: This paper describes the technique for balloon dilatation of salivary duct strictures and evaluates the clinical and radiographic findings in a consecutive series of 36 affected glands. Methods: Thirty-four patients (36 glands) had balloon dilatation of their salivary duct strictures performed under fluoroscopic control. They were evaluated immediately afterwards and at review by sialography. Results: In 36 cases attempted, 33 (92%) strictures were dilated. The immediate post-treatment sialogram was available in 28 cases, of which 23 (82%) demonstrated complete and four (14%) partial elimination of stricture. In one case the appearance was unchanged(4%). Review data (mean 6.8 months) were available on 25 glands: 12 were asymptomatic (48%), 12 (48%) had reduced symptoms and one (4%)failed to improve. Sialographic data were available on 21 glands: in 10(48%) the duct remained patent, in one (5%) the stricture was partially eliminated, in seven (33%) the strictures had returned and in the remaining three (14%) cases there was complete obstruction. Conclusions: Balloon dilatation is an effective treatment of salivary duct stenosis. In half the cases the stricture recurred but symptomatic improvement was achieved and maintained in the majority of cases.

  6. Atypical abdominal pain: post-traumatic transverse colon stricture.

    PubMed

    Rotar, Raluca; Uwechue, Raphael; Sasapu, Kishore Kumar

    2013-08-23

    A driver presented to the emergency department 1 day after an accident driving his excavator with abdominal pain and vomiting. He was admitted to the surgical ward 2 days later, after reattending. A CT scan revealed wall thickening and oedema in the transverse colon. This was supported by a subsequent CT virtual colonoscopy which raised the suspicion of neoplasia. A follow-up colonoscopy was not carried further than the transverse colon due to an indurated, tight stricture. Biopsies from that area showed ulceration and inflammatory changes non-specific for ischaemia, drug-induced changes or inflammatory bowel disease. As a consequence of the subocclusive symptoms and the possibility of a neoplastic diagnosis, a laparoscopic-assisted transverse colectomy was performed. The histology of the resected segment revealed post-traumatic inflammation and fibrosis with no evidence of neoplasia.

  7. Clinical profile and outcome of aluminum phosphide-induced esophageal strictures.

    PubMed

    Kochhar, Rakesh; Dutta, Usha; Poornachandra, Kuchhangi Sureshchandra; Vaiphei, Kim; Bhagat, Suraj; Nagi, Birinder; Singh, Kartar

    2010-09-01

    Aluminum phosphide (AlP) is a lethal solid fumigant pesticide which has been recently linked to esophageal stricture formation. This paper aims to study the clinical profile and response to treatment of AlP-induced esophageal strictures. Data on all patients of AlP-induced strictures seen between January 2004 and June 2008 were retrieved and analyzed for clinical parameters and response to endoscopic dilation. Each patient underwent barium swallow to define the site and length of stricture and then was dilated endoscopically. Twelve patients of AlP-induced esophageal stricture (seven males) with a mean age of 26.83+/-8.43 years were evaluated. They had consumed one to three AlP tablets, 4-156 weeks before reporting to us. They had onset of dysphagia within 2 to 8 weeks of ingestion of AlP. Of 14 strictures in 12 patients, seven were in upper third, two in middle third, and five in lower third of esophagus with a mean length of 1.96+/-0.75 cm. Nine patients responded to dilation requiring 5.56+/-2.65 dilations. Four patients were given intralesional steroids to augment the effect of dilation. Three patients failed and were operated upon. All patients remained symptom free over a follow-up of 3-30 (15.67+/-9.41) months. AlP-induced esophageal strictures can be dilated endoscopically in a majority of patients; however, 25% of them require surgical intervention. AlP-induced esophageal strictures, thus, behave like caustic-induced strictures.

  8. Classification of Esophageal Strictures following Esophageal Atresia Repair.

    PubMed

    Macchini, Francesco; Parente, Giovanni; Morandi, Anna; Farris, Giorgio; Gentilino, Valerio; Leva, Ernesto

    2017-03-06

    Introduction The aim of this study was to stratify anastomotic strictures (AS) following esophageal atresia (EA) repair and to establish predictors for the need of dilations. Material and Methods A retrospective study on children operated on for EA between 2004 and 2014 was conducted. The stricture index (SI) was measured both radiologically (SIXR) and endoscopically (SIEND). A correlation analysis between the SI and the number of dilations was performed using Spearman's test and linear regression analysis. Results In this study, 40 patients were included: 35 (87.5%) presented with Gross's type C EA, 3 (7.5%) type A, 1 (2.5%) type B, and 1 (2.5%) type D. The mean follow-up time was 101 ± 71.1 months (range: 7.8-232.5, median: 97.6). The mean SIXR was 0.56 ± 0.16 (range: 0.15-0.86). The mean SIEND was 0.45 ± 0.22 (range: 0.15-0.85). Twenty-four patients (60%) underwent a mean of 2 endoscopic dilations (range: 1-9). The number of dilations was poorly correlated with SIXR, while significantly correlated with SIEND. Patients who did not need dilations had a SIEND < 0.33, patients who needed only one dilation had 0.33 ≤ SIEND < 0.44, and those with SIEND ≥ 0.44 needed two or more dilations. No significant association with other clinical variables was found. All patients were asymptomatic at the time of the first endoscopy. Conclusion SIEND is a useful tool to classify AS and can represent a predictor of the need for endoscopic dilation. The role of the SIEND becomes even more important as clinical characteristics have a low predictive value for the development of an AS and the need for subsequent endoscopic esophageal dilatations.

  9. Congenital urethral stenosis in a male miniature piglet

    PubMed Central

    Pouleur-Larrat, Bénédicte; Maccolini, Edouard; Carmel, Eric Norman; Hélie, Pierre

    2014-01-01

    A 2-month-old male miniature pig showed progressive abdominal pain, pollakiuria, and stranguria that progressed to complete urinary obstruction. Postmortem examination revealed idiopathic urethral stenosis at the level of the recess, of probable congenital origin. Urinary tract malformations should be included in the differential diagnosis of miniature piglets with urinary disorders. PMID:24891635

  10. Urethral Dilatation in Women: Urologists' Practice Patterns in the UK

    PubMed Central

    Masarani, M; Willis, RG

    2006-01-01

    INTRODUCTION Review of the literature reveals little evidence to prove the efficacy of urethral dilatation for adult women with various lower urinary tract complaints. We conducted a postal survey to ascertain the actual practice of urethral dilatation among urologists in the UK. MATERIALS AND METHODS A questionnaire was mailed to 428 consultant urologists listed as full members of the British Association of Urological Surgeons. The questionnaire consisted of 8 items about urologists' perception of indications, efficacy, and the need for repeated dilatation and anaesthesia. RESULTS The questionnaire response rate was 42%. Although urethral stenosis was the most common indication (97%), the majority of urologists (69%) indicated that fewer than 25% of patients had evidence of stenosis. Overall, 61% of urologists performed dilatation 7 times or more during the last year and 55% believed that less than half of the patients experienced long-term improvement. CONCLUSIONS Despite the lack of strong evidence to support the use of urethral dilatation in women, many urologists continue to find it a useful tool in approaching women with lower urinary tract complaints. PMID:17002859

  11. Neonatal urethral polyps associated with Beckwith-Wiedemann syndrome.

    PubMed

    Anzai, Yuko; Koshida, Shigeki; Yanagi, Takahide; Johnin, Kazuyoshi; Takeuchi, Yoshihiro

    2013-10-01

    We report the first case of Beckwith-Wiedemann syndrome without urinary obstruction, but with a congenital urethral polyp as a tumor protruding from the external urinary meatus. The present case suggests a possible relation between Beckwith-Wiedemann and the onset of fibroepithelial polyps in the reno-urinary system during the neonatal period.

  12. A Method for Recording Urethral Pressure Profiles in Female Rats

    PubMed Central

    Xu, Shengfei; Li, Xiaohui; Xu, Lei; Chen, Biao; Tan, Huibing; Du, Guanghui

    2015-01-01

    Aims Urethral pressure profile (UPP) and leak-point pressure (LPP) measurements as well as external urethral sphincter (EUS) electromyography (EMG) and videourodynamic analyses are the primary methods for evaluating urethral function in humans. However, UPP recording in female rats, a widely used animal model, is challenging due to their small body sizes. This study reports a novel method for recording UPP in female rats. Materials and Methods Seventeen anesthetized female rats were studied. LPP data for 14 rats were included. The other 3 rats were excluded because of death or abnormal urogenital organs. UPP curves were recorded using a modified water-perfusion catheter system, with the lateral hole facing the 3-, 6-, 9-, and 12-o’clock positions in a randomized sequence. LPP, functional urethral length (FUL) and maximum urethral closure pressure (MUCP) were analyzed. Results The mean LPP was 64.39 ± 20.29 cm H2O. The mean FUL and MUCP values at the 3-, 6-, 9-, and 12-o’clock positions were 12.90 ± 1.20, 16.70 ± 1.95, 13.90 ± 2.42, and 11.60 ± 0.97 mm, respectively, and 38.70 ± 11.85, 33.90 ± 11.82, 37.40 ± 11.95, and 71.90 ± 23.01 cm H2O, respectively. The FUL at the 6-o’clock position and MUCP at the 12-o’clock position were significantly greater than those at the other 3 positions. The FUL and MUCP of repeated UPP recordings were not significantly different than those of the first recordings. Conclusions UPP recording using a modified method based on a water-perfusion catheter system is feasible and replicable in female rats. It produces UPP curves that sensitively and appreciably reflect detailed pressure changes at different points within the urethra and thus provides opportunity to evaluate urethral structures, especially the urethral sphincter, in detail. These results may enhance the utility of female rat models in research of urinary sphincter mechanisms. PMID:26502072

  13. High grade anorectal stricture complicating Crohn's disease: endoscopic treatment using insulated-tip knife

    PubMed Central

    Chon, Hyung Ku; Shin, Ik Sang; Kim, Sang Wook

    2016-01-01

    Endoscopic treatments have emerged as an alternative to surgery, in the treatment of benign colorectal stricture. Unlike endoscopic balloon dilatation, there is limited data on endoscopic electrocautery incision therapy for benign colorectal stricture, especially with regards to safety and long-term patency. We present a case of a 29-year-old female with Crohn's disease who had difficulty in defecation and passing thin stools. A pelvic magnetic resonance imaging scan, gastrograffin enema, and sigmoidoscopy showed a high-grade anorectal stricture. An endoscopic insulated-tip knife incision was successfully performed to resolve the problem. From our experience, we suggest that endoscopic insulated-tip knife treatment may be a feasible and effective modality for patients with short-segment, very rigid, fibrotic anorectal stricture. PMID:27433152

  14. Can esophageal dilation be avoided in the treatment of severe esophageal stricture caused by eosinophilic esophagitis?

    PubMed

    Silva, D; Santos, F; Piedade, S; Morais-Almeida, M

    2015-07-01

    Eosinophilic esophagitis (EoE) is an inflammatory immune-mediated disease with predominant eosinophilic inflammation characterized by the presence of esophageal dysfunction symptoms. Treatment delay can be associated with disease complications, like esophageal strictures, that can justify the use of invasive procedures which are not deprived of side effects. We present a case report of a 14 year old child with severe esophageal stricture secondary to EoE, that was treated with topical and systemic corticosteroid before any invasive procedure was considered. After 26 weeks of medical treatment, significant improvement of esophageal dysfunction occurred with histological remission and stricture resolution. In patients with severe esophageal strictures secondary to EoE, the need for esophageal dilation procedures should be considered only after anti-inflammatory treatment.

  15. Inflammatory stricture of the right ureter following perforated appendicitis: The first Indian report

    PubMed Central

    Rajkumar, Janavikula Sankaran; Ganesh, Deepa; Rajkumar, Anirudh

    2016-01-01

    Perforated appendicitis leading to inflammatory stricture of the right ureter is a rarity. We present this fairly uncommon case of a patient who developed a stricture of the right ureter secondary to an ongoing inflammatory process in the peritoneum and retroperitoneum. A perforated appendicitis was operated upon, and on follow-up the mild hydronephrosis had worsened. Stenting of the right ureter completely solved the problem. PMID:27251819

  16. B Cell Acute Lymphocytic Leukemia Presenting as a Bile Duct Stricture Diagnosed With Cholangioscopy

    PubMed Central

    Bartel, Michael J.; Jiang, Liuyan; Lukens, Frank

    2016-01-01

    Indeterminate biliary strictures represent a diagnostic challenge requiring further work-up, which encompasses a variety of diagnostic modalities. We report a very rare case of B-cell acute lymphocytic leukemia presenting as a biliary stricture following remission of acute myeloid leukemia, which was initially treated with allogenic stem cell transplant. After multiple diagnostic modalities were implemented with no success, the use of cholangioscopy-guided biopsies was the key for the final diagnosis. PMID:27807569

  17. Current diagnosis and treatment of benign biliary strictures after living donor liver transplantation

    PubMed Central

    Chang, Jae Hyuck; Lee, Inseok; Choi, Myung-Gyu; Han, Sok Won

    2016-01-01

    Despite advances in surgical techniques, benign biliary strictures after living donor liver transplantation (LDLT) remain a significant biliary complication and play an important role in graft and patient survival. Benign biliary strictures after transplantation are classified into anastomotic or non-anastomotic strictures. These two types differ in presentation, outcome, and response to therapy. The leading causes of biliary strictures include impaired blood supply, technical errors during surgery, and biliary anomalies. Because patients usually have non-specific symptoms, a high index of suspicion should be maintained. Magnetic resonance cholangiography has gained widespread acceptance as a reliable noninvasive tool for detecting biliary complications. Endoscopy has played an increasingly prominent role in the diagnosis and treatment of biliary strictures after LDLT. Endoscopic management in LDLT recipients may be more challenging than in deceased donor liver transplantation patients because of the complex nature of the duct-to-duct reconstruction. Repeated aggressive endoscopic treatment with dilation and the placement of multiple plastic stents is considered the first-line treatment for biliary strictures. Percutaneous and surgical treatments are now reserved for patients for whom endoscopic management fails and for those with multiple, inaccessible intrahepatic strictures or Roux-en-Y anastomoses. Recent advances in enteroscopy enable treatment, even in these latter cases. Direct cholangioscopy, another advanced form of endoscopy, allows direct visualization of the inner wall of the biliary tree and is expected to facilitate stenting or stone extraction. Rendezvous techniques can be a good option when the endoscopic approach to the biliary stricture is unfeasible. These developments have resulted in almost all patients being managed by the endoscopic approach. PMID:26819525

  18. Vaginal Swab Test Compared With the Urethral Q-tip Test for Urethral Mobility Measurement: A Randomized Controlled Trial

    PubMed Central

    Meyer, Isuzu; Szychowski, Jeff M; Illston, Jana D; Parden, Alison M; Richter, Holly E

    2015-01-01

    Objective To assess whether a vaginal cotton-tipped swab is equivalent to the standard Q-tip test regarding urethral mobility. Secondarily, to examine whether both tests agree in hypermobility diagnosis, discomfort level, and patients' preference. Methods In this randomized cross-over trial, women with stress urinary incontinence without prolapse beyond the hymen were randomized to undergo either a vaginal or urethral mobility test first followed by the alternate approach. The primary outcome was the difference in rotation angle, from resting to maximum strain, between tests. The equivalence margin was ±10°. The secondary outcome was agreement in hypermobility diagnosis using two definitions, #1 maximum straining angle of ≥30° from the horizontal plane, #2 rotation angle ≥30°. Discomfort was assessed using 0-10 visual analog scale. Using 90% power assuming a standard deviation of 20°, 36 and 139 patients were needed for 10° and 5° equivalence margins, respectively. Results From January 2014 to March 2015, 140 women were randomized. The mean difference between the two tests was 5.1° (95% confidence interval 3.2-6.9°), meeting the predefined equivalence criteria. In the hypermobility diagnosis, the urethral and vaginal tests had no disagreement using the definition #1 (p=0.23) whereas the two tests disagreed using definition #2 (p=0.03). The urethral approach had a higher discomfort level (p<0.001). The majority preferred the vaginal test (68% preferred vaginal, 32% no preference). Conclusion The vaginal swab test is equivalent to the standard Q-tip test in measuring urethral mobility with less discomfort and is preferred by patients. PMID:26942364

  19. Usefulness of biodegradable polydioxanone stents in the treatment of postsurgical colorectal strictures and fistulas.

    PubMed

    Pérez Roldán, F; González Carro, P; Villafáñez García, M C; Aoufi Rabih, S; Legaz Huidobro, M L; Sánchez-Manjavacas Múñoz, N; Roncero García-Escribano, O; Ynfante Ferrús, M; Bernardos Martín, E; Ruiz Carrillo, F

    2012-03-01

    Benign colonic strictures and fistulas are a growing problem presenting most commonly after bowel resection. Standard treatment is with endoscopic bougies or, more usually, balloon dilation. When these approaches are not successful, other solutions are available and different endoscopic and surgical approaches have been used to treat fistulas. We present an additional option--biodegradable stents--for the treatment of colonic strictures and fistulas that have proven refractory to other endoscopic interventions. We analyzed the results from 10 patients with either a postsurgical colorectal stricture (n =7) or rectocutaneous fistula (n =3) treated with the biodegradable SX-ELLA esophageal stent (covered or uncovered). Stents were successfully placed in nine patients, although early migration subsequently occurred in one. Placement was impossible in one patient due to deformity of the area and the fact that the stricture was approximately 30cm from the anus. The fistulas were successfully closed in all patients, although symptoms reappeared in one patient. In the six patients who received stents for strictures, symptoms resolved in five; in the remaining patient, the stent migrated shortly after the endoscopy. Treatment of colonic strictures and rectocutaneous fistulas with biodegradable stents is an effective alternative in the short-to-medium term. The stent does not have to be removed and is subject to very few complications. The drawbacks of this approach are the need to repeat the procedure in some patients and the lack of published series on efficacy.

  20. Meta-Analysis of the Long Term Success Rate of Different Interventions in Benign Biliary Strictures

    PubMed Central

    Huszár, Orsolya; Kokas, Bálint; Mátrai, Péter; Hegyi, Péter; Pétervári, Erika; Vincze, Áron; Pár, Gabriella; Sarlós, Patrícia; Bajor, Judit; Czimmer, József; Mosztbacher, Dóra; Márta, Katalin; Zsiborás, Csaba; Varjú, Péter; Szücs, Ákos

    2017-01-01

    Background Benign biliary stricture is a rare condition and the majority of the cases are caused by operative trauma or chronic inflammation based on various etiology. Although the initial results of endoscopic, percutaneous and surgical treatment are impressive, no comparison about long term stricture resolution is available. Aims The goal of this study was to compare the long term disease free survival in benign biliary strictures with various etiology after surgery, percutaneous transhepatic—and endoscopic treatment. Methods PubMed, Embase, and Cochrane Library were searched by computer and manually for published studies. The investigators selected the publications according to the inclusion and exclusion criteria, processed the data and assessed the quality of the selected studies. Meta-analysis of data of 24 publications was performed to compare long term disease free survival of different treatment groups. Results Compared the subgroups surgery resulted in the highest long term stricture resolution rate, followed by the percutaneous transhepatic treatment, the multiple plastic stent insertion and covered self-expanding metal stents (SEMS), however the difference was not significant. All compared methods are significantly superior to the single plastic stent placement. Long term stricture resolution rate irrespectively of any therapy is still not more than 84%. Conclusions In summary, the use of single plastic stent is not recommended. Further randomized studies and innovative technical development are required for improving the treatment of benign biliary strictures. PMID:28076371

  1. Urethral closure mechanisms during sneezing-induced stress in anesthetized female cats.

    PubMed

    Julia-Guilloteau, V; Denys, P; Bernabé, J; Mevel, K; Chartier-Kastler, E; Alexandre, L; Giuliano, F

    2007-09-01

    During stress-induced increase in abdominal pressure, urinary continence is maintained by urethral closure mechanisms. Active urethral response has been studied in dogs and rats. Such an active urethral response is also believed to occur in humans during stress events. We aimed to investigate urethral closure mechanisms during sneezing in cats. Urethral pressures along the urethra (UP1-UP4), with microtip transducer catheters with UP4 positioned in the distal urethra where the external urethral sphincter (EUS) is located, and intravesical pressure were measured, and abdominal wall, anal sphincter (AS), levator ani (LA), and EUS electromyograms (EMGs) were recorded during sneezing under closed-abdomen and open-abdomen conditions in eight anesthetized adult female cats. Proximal and middle urethral response induced by sneezing was not different from bladder response. Distal urethral response was greater compared with proximal and middle urethral and bladder response. In the open-abdomen bladder, proximal and middle urethral responses were similarly decreased and distal urethral response was unchanged compared with the closed-abdomen bladder. Bladder and urethral responses were positively correlated to sneeze strength. EUS, LA, and AS EMGs increased during sneezing. No urine leakage was observed, regardless of the strength of sneeze. In cats urethral closure mechanisms are partly passive in the proximal and middle urethra and involve an active component in the distal urethra that is believed to result from EUS and possibly LA contractions. Because central serotonin exerts similar effects on the lower urinary tract in cats and humans, the cat may represent a relevant model for pharmacological studies on continence mechanisms.

  2. Palliative Treatment of Malignant Colorectal Strictures with Metallic Stents

    SciTech Connect

    Paul Diaz, Laura; Pinto Pabon, Isabel; Fernandez Lobato, Rosa; Montes Lopez, Carmen

    1999-01-15

    Purpose: To assess the effectiveness and safety of self-expanding metallic stents as a primary palliative treatment for inoperable malignant colorectal strictures. Methods: Under radiological guidance 20 self-expanding metallic Wallstents were implanted in 16 consecutive patients with colorectal stenoses caused by malignant neoplasms, when surgical treatment of the condition had been ruled out. The patients were followed up clinically for 1-44 months, until death or termination of this study. Results: The stents were successfully implanted in all cases and resolved the clinical obstruction in all the patients except one, who underwent subsequent colostomy. During follow-up of the remaining 15 patients, clinical complications arising from the procedure were pain (two patients), minor rectal bleeding (one patient), and severe rectal bleeding (one patient) (26%). There were three cases of stent migration and three cases of stent occlusion, and reintervention by us was necessary in 20% of cases (3/15). The mean life span following the procedure was 130 days, and none of the patients exhibited clinical symptoms of obstruction at the time of death (12 patients) or termination of the study (3 patients). Conclusion: Deployment of metallic stents under radiologic guidance is an effective alternative as a primary palliative measure in malignant colorectal obstruction, though the possible clinical complications and need for repeat intervention during follow-up should be taken into account.

  3. Percutaneous Management of Biliary Strictures After Pediatric Liver Transplantation

    SciTech Connect

    Miraglia, Roberto Maruzzelli, Luigi; Caruso, Settimo; Riva, Silvia; Spada, Marco; Luca, Angelo; Gridelli, Bruno

    2008-09-15

    We analyze our experience with the management of biliary strictures (BSs) in 27 pediatric patients who underwent liver transplantation with the diagnosis of BS. Mean recipient age was 38 months (range, 2.5-182 months). In all patients percutaneous transhepatic cholangiography, biliary catheter placement, and bilioplasty were performed. In 20 patients the stenoses were judged resolved by percutaneous balloon dilatation and the catheters removed. Mean number of balloon dilatations performed was 4.1 (range, 3-6). No major complications occurred. All 20 patients are symptom-free with respect to BS at a mean follow-up of 13 months (range, 2-46 months). In 15 of 20 patients (75%) one course of percutaneous stenting and bilioplasty was performed, with no evidence of recurrence of BS at a mean follow-up of 15 months (range, 2-46 months). In 4 of 20 patients (20%) two courses of percutaneous stenting and bilioplasty were performed; the mean time to recurrence was 9.8 months (range, 2.4-24 months). There was no evidence of recurrence of BS at a mean follow-up of 12 months (range, 2-16 months). In 1 of 20 patients (5%) three courses of percutaneous stenting and bilioplasty were performed; there was no evidence of recurrence of BS at a mean follow-up of 10 months. In conclusion, BS is a major problem following pediatric liver transplantation. Radiological percutaneous treatment is safe and effective, avoiding, in most cases, surgical revision of the anastomosis.

  4. Recovery of normal esophageal function in a kitten with diffuse megaesophagus and an occult lower esophageal stricture.

    PubMed

    Schneider, Jaycie; Ames, Marisa; DiCicco, Michael; Savage, Mason; Atkins, Clarke; Wood, Michael; Gookin, Jody L

    2015-06-01

    An 8-week-old male domestic shorthair was presented to the Internal Medicine Service at North Carolina State University for regurgitation. Radiographic diagnosis of generalized esophageal dilation and failure of esophageal peristalsis were compatible with diagnosis of congenital megaesophagus. Endoscopic examination of the esophagus revealed a fibrous stricture just orad to the lower esophageal sphincter. Conservative management to increase the body condition and size of the kitten consisted of feeding through a gastrostomy tube, during which time the esophagus regained normal peristaltic function, the stricture orifice widened in size and successful balloon dilatation of the stricture was performed. Esophageal endoscopy should be considered to rule out a stricture near the lower esophageal sphincter in kittens with radiographic findings suggestive of congenital megaesophagus. Management of such kittens by means of gastrostomy tube feeding may be associated with a return of normal esophageal motility and widening of the esophageal stricture, and facilitate subsequent success of interventional dilation of the esophageal stricture.

  5. Rapid presumptive diagnosis of gonococcal urethritis in men by the limulus lysate test.

    PubMed Central

    Spagna, V A; Prior, R B; Perkins, R L

    1979-01-01

    In an evaluation of the limulus assay as a method for detecting endotoxin in urethral exudates, positive results of urethral samples at a 1/200 dilution were obtained from 73 out of 73 patients with culture-positive gonococcal urethritis while negative results were obtained from 26 out of 27 patients with cuture-negative urethral specimens. A specimen from one patient, which gave negative results on Gram stain and culture, gave positive results to the limulus test. The overall accuracy of the limulus test for predicting culture results was 99% (p less than 0.001). Thus, in preliminary studies of otherwise healthy men, the results of the limulus assay correlated with those of biological methods for diagnosing urethral gonorrhoea; the test may, therefore, be of use in identifying cases of nongonococcal urethritis. PMID:466383

  6. Condylomata acuminata of external urethral meatus causing infravesical obstruction.

    PubMed

    Kilciler, Mete; Bedir, Selahattin; Erdemir, Fikret; Coban, Hidayet; Erten, Koray; Ors, Onder; Ozgok, Yasar

    2007-01-01

    Condyloma acuminata is one of the most common virally transmitted diseases. The most common sites for condyloma in males are the balanopreputial sulcus, frenulum and the glans' mucosa. Condylomata in the urethra is rarely seen occur and most often situated in the distal part of the urethra. A 24-year-male admitted to our clinic with complaint of papillary lesion at the urethral meatus and urinary retention. Physical examination revealed that multiple papillary lesions along the anterior urethra until 1 cm distance from the urethral meatus. Under the clinical diagnosis of condyloma acuminata, he was treated conservatively with radical local excision of the lesion and condyloma acuminatum was verified by histopathological examination. Four months after surgery, there has been no local or remote recurrence.

  7. Dysuria associated with urethral caruncle in the dog.

    PubMed

    Bradshaw, J M; Brown, P J; Pearson, G R; Holt, P E

    1996-07-01

    Three cases of urethral caruncle were recognized in bitches with a history of chronic dysuria. Clinical and radiological examinations revealed the presence of inoperable lesions involving much of the urethra in all three cases. At post-mortem examination of Case 1, an oval swelling, 1.5 x 1.0 cm, was detected within the wall of the urethra close to the vagino-urethral orifice. In Case 2, firm, mottled yellow, white and red tissue formed a thickening between the urethra and vagina. In Case 3, a cylindrical cream mass, 8 cm long and 3 cm in diameter, surrounded the urethra and impinged on the wall of the vagina. Histologically, glandular structures lined by a single layer of epithelial cells and a mixed granulomatous inflammatory reaction were present in the wall of the urethra of all three cases.

  8. Cholinergic urethral brush cells are widespread throughout placental mammals.

    PubMed

    Deckmann, Klaus; Krasteva-Christ, Gabriela; Rafiq, Amir; Herden, Christine; Wichmann, Judy; Knauf, Sascha; Nassenstein, Christina; Grevelding, Christoph G; Dorresteijn, Adriaan; Chubanov, Vladimir; Gudermann, Thomas; Bschleipfer, Thomas; Kummer, Wolfgang

    2015-11-01

    We previously identified a population of cholinergic epithelial cells in murine, human and rat urethrae that exhibits a structural marker of brush cells (villin) and expresses components of the canonical taste transduction signaling cascade (α-gustducin, phospholipase Cβ2 (PLCβ2), transient receptor potential cation channel melanostatin 5 (TRPM5)). These cells serve as sentinels, monitoring the chemical composition of the luminal content for potentially hazardous compounds such as bacteria, and initiate protective reflexes counteracting further ingression. In order to elucidate cross-species conservation of the urethral chemosensory pathway we investigated the occurrence and molecular make-up of urethral brush cells in placental mammals. We screened 11 additional species, at least one in each of the five mammalian taxonomic units primates, carnivora, perissodactyla, artiodactyla and rodentia, for immunohistochemical labeling of the acetylcholine synthesizing enzyme, choline acetyltransferase (ChAT), villin, and taste cascade components (α-gustducin, PLCβ2, TRPM5). Corresponding to findings in previously investigated species, urethral epithelial cells with brush cell shape were immunolabeled in all 11 mammals. In 8 species, immunoreactivities against all marker proteins and ChAT were observed, and double-labeling immunofluorescence confirmed the cholinergic nature of villin-positive and chemosensory (TRPM5-positive) cells. In cat and horse, these cells were not labeled by the ChAT antiserum used in this study, and unspecific reactions of the secondary antiserum precluded conclusions about ChAT-expression in the bovine epithelium. These data indicate that urethral brush cells are widespread throughout the mammalian kingdom and evolved not later than about 64.5millionyears ago.

  9. A Case of Strangulated Urethral Prolapse in a Premenopausal Adult Female

    PubMed Central

    Jessop, Morris L.; Al-Omar, Osama

    2016-01-01

    Urethral prolapse in a premenopausal adult female is exceedingly rare. This paper describes a case of strangulated urethral prolapse presenting as a urethral mass in an unusual demographic and reviews the literature on etiology and management. Only a few cases have occurred in women of reproductive age. The etiology is likely multifactorial. Treatment with surgical excision provides good results in the majority of cases. PMID:27413572

  10. Flexible Distributed Pressure Sensing Strip for a Urethral Catheter1

    PubMed Central

    Ahmadi, Mahdi; Rajamani, Rajesh; Timm, Gerald; Sezen, A.S.

    2015-01-01

    A multi-sensor flexible strip is developed for a urethral catheter to measure distributed pressure in a human urethra. The developed sensor strip has important clinical applications in urodynamic testing for analyzing the causes of urinary incontinence in patients. There are two major challenges in the development of the sensor. First, a highly sensitive sensor strip that is flexible enough for urethral insertion into a human body is required and second, the sensor has to work reliably in a liquid in-vivo environment in the human body. Capacitive force sensors are designed and micro-fabricated using polyimide/PDMS substrates and copper electrodes. To remove the parasitic influence of urethral tissues which create fringe capacitance that can lead to significant errors, a reference fringe capacitance measurement sensor is incorporated on the strip. The sensing strip is embedded on a catheter and experimental in-vitro evaluation is presented using a bench-top pressure chamber. The sensors on the strip are able to provide the required sensitivity and range. Preliminary experimental results also show promise that by using measurements from the reference parasitic sensor on the strip, the influence of parasitics from human tissue on the pressure measurements can be removed. PMID:27065719

  11. Somatomotor and sensory urethral control of micturition in female rats.

    PubMed

    Cruz, Yolanda; Pastelín, César; Balog, Brian M; Zaszczurynski, Paul J; Damaser, Margot S

    2014-12-01

    In rats, axons of external urethral sphincter (EUS) motoneurons travel through the anastomotic branch of the pudendal nerve (ABPD) and anastomotic branch of the lumbosacral trunk (ABLT) and converge in the motor branch of the sacral plexus (MBSP). The aim of the present study was to determine in female rats the contribution of these somatomotor pathways and urethral sensory innervation from the dorsal nerve of the clitoris on urinary continence and voiding. EUS electromyographic (EMG) activity during cystometry, leak point pressure (LPP), and voiding efficiency (VE) were assessed in anesthetized virgin Sprague-Dawley female rats before and after transection of the above nerve branches. Transection of the MBSP eliminated EUS EMG, decreased LPP by 50%, and significantly reduced bladder contraction duration, peak pressure, intercontraction interval, and VE. Transection of the ABPD or ABLT decreased EUS EMG discharge and LPP by 25% but did not affect VE. Transection of the dorsal nerve of the clitoris did not affect LPP but reduced contraction duration, peak pressure, intercontraction interval, and VE. We conclude that somatomotor control of micturition is provided by the MBSP with axons travelling through the ABPD and ABLT. Partial somatomotor urethral denervation induces mild urinary incontinence, whereas partial afferent denervation induces voiding dysfunction. ABPD and ABLT pathways could represent a safeguard ensuring innervation to the EUS in case of upper nerve damage. Detailed knowledge of neuroanatomy and functional innervation of the urethra will enable more accurate animal models of neural development, disease, and dysfunction in the future.

  12. Somatomotor and sensory urethral control of micturition in female rats

    PubMed Central

    Cruz, Yolanda; Pastelín, César; Balog, Brian M.; Zaszczurynski, Paul J.

    2014-01-01

    In rats, axons of external urethral sphincter (EUS) motoneurons travel through the anastomotic branch of the pudendal nerve (ABPD) and anastomotic branch of the lumbosacral trunk (ABLT) and converge in the motor branch of the sacral plexus (MBSP). The aim of the present study was to determine in female rats the contribution of these somatomotor pathways and urethral sensory innervation from the dorsal nerve of the clitoris on urinary continence and voiding. EUS electromyographic (EMG) activity during cystometry, leak point pressure (LPP), and voiding efficiency (VE) were assessed in anesthetized virgin Sprague-Dawley female rats before and after transection of the above nerve branches. Transection of the MBSP eliminated EUS EMG, decreased LPP by 50%, and significantly reduced bladder contraction duration, peak pressure, intercontraction interval, and VE. Transection of the ABPD or ABLT decreased EUS EMG discharge and LPP by 25% but did not affect VE. Transection of the dorsal nerve of the clitoris did not affect LPP but reduced contraction duration, peak pressure, intercontraction interval, and VE. We conclude that somatomotor control of micturition is provided by the MBSP with axons travelling through the ABPD and ABLT. Partial somatomotor urethral denervation induces mild urinary incontinence, whereas partial afferent denervation induces voiding dysfunction. ABPD and ABLT pathways could represent a safeguard ensuring innervation to the EUS in case of upper nerve damage. Detailed knowledge of neuroanatomy and functional innervation of the urethra will enable more accurate animal models of neural development, disease, and dysfunction in the future. PMID:25339694

  13. The thermal effect of urethral warming during cryosurgery.

    PubMed

    Rabin, Yoed; Stahovich, Thomas F

    2002-01-01

    The heating effect of urethral warming during cryosurgery has been investigated theoretically, via heat transfer simulations. Two warmer configurations have been considered: (i). the clinically available urethral warmer, which has a configuration of a counter flow fluid heat exchanger; (ii). a newly designed urethral warmer, based on a temperature controlled electrical heater, termed a "cryoheater". A dramatic effect of thermal resistance to heat transfer through the heat exchanger wall has been identified, which is absent in the cryoheater. It follows that the cryoheater is expected to be more efficient in generating an unfrozen region around the urethra. It is shown that the conventional heat exchanger may fail to prevent freezing around the urethra in a significant number of prostate cases, depending on the layout of cryoprobes around the urethra. On the other hand, clinical reports exist which suggest that the heat exchanger improves in many cases the outcome of cryosurgery, in terms of long term complications. It is speculated in the current report that the cryoheater can further improve the outcome of cryosurgery, by providing protection from freezing in a wider range of cases. It is suggested that a future study be conducted to examine the correlation between the layout of cryoprobes and surgical outcome.

  14. Urethral recurrence after cystectomy: current preventative measures, diagnosis and management.

    PubMed

    Chan, Yvonne; Fisher, Patrick; Tilki, Derya; Evans, Christopher P

    2016-04-01

    To summarise the current literature on the diagnosis and management of urethral recurrence (UR) after radical cystectomy (RC), as UR after RC is rare but associated with high mortality. With the recently increased use of orthotopic bladder substitution and the questionable benefit of prophylactic urethrectomy, identification of patients at high risk of UR, management of the remnant urethra, and treatment of UR become critical questions. A review of the PubMed database from 1980 to 2014 was performed to identify studies evaluating recurrent urothelial cancer of the urethra after RC. The search terms used included 'urethral recurrence', 'cystectomy' or 'cystoprostatectomy'. Selected studies provided information on the type of urinary diversion performed, the incidence of UR, and the time to UR. Incidence of UR after RC ranges from 1% to 8% with most recurrences occurring within the first 2 years after surgery. Increased risk of UR is associated with involvement of the prostate, tumour multifocality, bladder neck involvement, and cutaneous diversion. The median overall survival after UR ranges from 6 to 54 months and the 5-year disease-specific survival after UR is reported to be between zero and 83%. UR remains a relatively rare event. Current literature suggests that urethral wash cytology may be useful in patients with intermediate- to high-risk of recurrence to enable early detection of non-invasive disease, which may be amenable to conservative therapy before urethrectomy.

  15. Topical mitomycin C can effectively alleviate dysphagia in children with long-segment caustic esophageal strictures.

    PubMed

    El-Asmar, K M; Hassan, M A; Abdelkader, H M; Hamza, A F

    2015-07-01

    Caustic ingestion in children and the resulting long esophageal strictures are usually difficult to be managed, and eventually, esophageal replacement was required for cases refractory to frequent dilatation sessions. Topical mitomycin C (MMC) application has been used recently to improve the results of endoscopic dilatation for short esophageal strictures. The study aims to assess the role of MMC application in management of long-segment caustic esophageal strictures. From January 2009 to June December 2013, patients presented with long caustic esophageal stricture (>3 cm in length) were included in this study and subjected to topical MMC application after endoscopic esophageal dilatation on multiple sessions. Regular follow-up and re-evaluation were done. A dysphagia score was used for close follow-up clinically; verification was done radiologically and endoscopically. During the specified follow-up period, 21 patients with long caustic esophageal stricture were subjected to topical MMC application sessions. Clinical, radiological, and endoscopic resolution of strictures occurred in 18 patients (85.7% cure rate). Number of dilatation sessions to achieve resolution of dysphagia was (n = 14.3 ± 5.7) with application of mitomycin two to six times. There was no recurrence in short- and mid-term follow-up. No complications were encountered related to topical MMC application. MMC is a promising agent in management of long-segment caustic esophageal strictures. Long-term follow-up is needed to prove its efficacy and to evaluate potential long-term side-effects of MMC application.

  16. Hybrid therapy with locoregional steroid injection and polyglycolic acid sheets to prevent stricture after esophageal endoscopic submucosal dissection

    PubMed Central

    Nagami, Yasuaki; Shiba, Masatsugu; Tominaga, Kazunari; Ominami, Masaki; Fukunaga, Shusei; Sugimori, Satoshi; Tanaka, Fumio; Kamata, Noriko; Tanigawa, Tetsuya; Yamagami, Hirokazu; Watanabe, Toshio; Fujiwara, Yasuhiro; Arakawa, Tetsuo

    2016-01-01

    Background and study aim: The incidence of stricture formation caused by endoscopic submucosal dissection (ESD) for widespread lesions is high, and stricture formation can reduce quality of life. We evaluated the prophylactic efficacy of hybrid therapy using a locoregional steroid injection and polyglycolic acid (PGA) sheets with fibrin glue to prevent stricture formation after esophageal ESD in high risk patients in whom we predicted stricture formation would be difficult to prevent with a single prophylactic steroid injection. Methods: Ten patients who underwent esophageal ESD were enrolled (entire-circumference: n = 6; sub-circumference, more than 5/6 of the circumference: n = 4). A single locoregional steroid injection and PGA sheets with fibrin glue were used after ESD. We evaluated the incidence of stricture formation, the number of endoscopic balloon dilation (EBD) procedures needed to treat the stricture formation, and adverse events of the therapy. Results: Esophageal stricture formation occurred in 50.0 % of patients (5/10) (median EBD sessions 0.5, range 0 – 16). Subanalysis showed that stricture formation occurred in 37.5 % of patients (3/8) excluded the lesions located near a previous scar from ESD or surgical anastomosis site (median EBD sessions 0, range 0 – 4). Conclusion: Hybrid therapy using a locoregional steroid injection and PGA sheets with fibrin glue may have the potential to prevent esophageal stricture formation after esophageal ESD in high risk patients. PMID:27652294

  17. Female urethral diverticulum presenting with acute urinary retention: Reporting the largest diverticulum with review of literature.

    PubMed

    Pradhan, Manas Ranjan; Ranjan, Priyadarshi; Kapoor, Rakesh

    2012-04-01

    Female urethral diverticulum is a rare entity with diverse spectrum of clinical manifestations. It is a very rare cause of bladder outlet obstruction and should be considered as a differential diagnosis in females presenting with acute urinary retention associated with a vaginal mass. Strong clinical suspicion combined with thorough physical examination and focused radiological investigations are vital for its diagnosis. Herein we report a case of giant urethral diverticulum presenting with acute urinary retention in a young female. It was managed by excision and urethral closure, and is the largest urethral diverticulum reported till date in the literature.

  18. Treatment of Ureterointestinal Anastomotic Strictures by Diathermal or Cryoplastic Dilatation

    SciTech Connect

    Orsi, Franco; Penco, Silvia Matei, Victor; Bonomo, Guido; Vigna, Paolo Della; Monfardini, Lorenzo; Cobelli, Ottavio De

    2007-09-15

    Background. Ureterointestinal anastomotic strictures (UAS) complicate 10-15% of surgeries for urinary diversion and are the main cause of deterioration in renal function. Treatments are surgical revision, management with autostatic stent, balloon dilatation, endoscopic incision, and percutaneous transrenal diathermy (Acucise). A new option is cryoplastic dilatation (Polar-Cath). Purpose. To assess the feasibility, complications, and preliminary results of UAS treatment using the Acucise and Polar-Cath systems. Methods. Nineteen UAS, diagnosed by ultrasonography or computed tomography and sequential renal scintigraphy, occurred in 15 cancer patients after radical cystectomy and urinary diversion. Fifteen were managed with balloon diathermy and 4 by balloon cryoplasty in a three-stage procedure-percutaneous nephrostomy, diathermal or cryoplastic dilatation, and transnephrostomic control with nephrostomy removal-each separated by 15 days. All patients gave written informed consent. Results. Dilatations were successful in all cases. The procedure is simple and rapid (about 45 min) under fluoroscopic control and sedation. Procedural complications occurred in 1 (5%) patient with UAS after Wallace II uretero-ileocutaneostomy: a common iliac artery lesion was induced by diathermal dilatation, evident subsequently, and required surgical repair. Patency with balloon diathermy was good, with two restenoses developing over 12 months (range 1-22) of follow-up. With balloon cryoplastic dilatation, one restenosis developed in the short term; follow-up is too brief to assess the long-term efficacy. Conclusion. Our short-term results with diathermal and cryoplastic dilatation to resolve UAS are good. If supported by longer follow-up, the techniques may be considered as first-choice approaches to UAS. Surgery should be reserved for cases in which this minimally invasive technique fails.

  19. An animal model of photodynamic-therapy-induced esophageal stricture: preliminary report

    NASA Astrophysics Data System (ADS)

    Perry, Yaron; Epperly, Michael W.; Finkelstein, Sydney; Klein, Edwin; Greenberger, Joel; Luketich, James

    2003-06-01

    Photodynamic Therapy (PDT) using Photofrin has been recently approved by the FDA for the treatment of esophageal cancer and Barrett's esophagus. A major limitation of PDT for Barrett's esophagus is the development of esophageal stricture in up to 53% of patients. Mechanisms of PDT stricture formation have not been elucidated. The major difficulty is the lack of an animal model for PDT-induced stricture. We have used a pig model in which the esophagus is very similar to that of the human esophagus. Two (Scrofa) domestic pigs were injected with Photofrin at dosage of 2 mg/kg 48 hours prior to photoactivation with 630 nm light. Following anesthesia, a laser probe (2.5 cm in length) was passed through the oral cavity to approximately the mid-point of the esophagus via an endoscope. Light energy (400 Joules (J)/cm) was delivered as a single dose in one pig or repeated at 72 hours in the second pig. In this pig model, upper endoscopy, Barium swallow and pathological studies confirmed stricture formation following esophageal PDT exposure of 400 J as one or two fractions. We believe that this is the first animal model created to study esophageal strictures resulting from PDT.

  20. Posterior Cruciate Ligament Injury

    MedlinePlus

    ... ACL connect your thighbone (femur) to your shinbone (tibia). If either ligament is torn, it might cause ... ligaments connect the thighbone (femur) to the shinbone (tibia). The anterior and posterior cruciate ligaments form an " ...

  1. Posterior ankle impingement syndrome.

    PubMed

    Maquirriain, Javier

    2005-10-01

    Posterior ankle impingement syndrome is a clinical disorder characterized by posterior ankle pain that occurs in forced plantar flexion. The pain may be acute as a result of trauma or chronic from repetitive stress. Pathology of the os trigonum-talar process is the most common cause of this syndrome, but it also may result from flexor hallucis longus tenosynovitis, ankle osteochondritis, subtalar joint disease, and fracture. Patients usually report chronic or recurrent posterior ankle pain caused or exacerbated by forced plantar flexion or push-off maneuvers, such as may occur during dancing, kicking, or downhill running. Diagnosis of posterior ankle impingement syndrome is based primarily on clinical history and physical examination. Radiography, scintigraphy, computed tomography, and magnetic resonance imaging depict associated bone and soft-tissue abnormalities. Symptoms typically improve with nonsurgical management, but surgery may be required in refractory cases.

  2. Segmental Urethral Dosimetry and Urinary Toxicity in Patients With No Urinary Symptoms Before Permanent Prostate Brachytherapy

    SciTech Connect

    Thomas, Carys; Keyes, Mira Liu, Mitchell; Moravan, Veronika

    2008-10-01

    Purpose: To determine whether segmental urethral dosimetry is predictive for the degree of urinary morbidity after prostate brachytherapy in patients with no urinary symptoms before prostate brachytherapy. Methods and Materials: Between May 2000 and November 2005, 1,107 patients underwent iodine-125 monotherapy with urethral sparing techniques. A total of 166 patients fulfilled the selection criteria: baseline (International Prostate Symptom Score) IPSS {<=}5, no androgen deprivation therapy, and prostate ultrasound planning volumes (PUTV) <45 mL. The median follow-up was 44 months. Urinary morbidity was defined by maximum increase in IPSS, time to IPSS resolution, maximum Radiation Therapy Oncology Group (RTOG) score, time to RTOG resolution, and urinary retention. Surrogate deviated urethra was contoured and doses calculated at the base, mid-prostate, apex, and urogenital diaphragm. Univariate and multivariate analysis was used to evaluate urethral and prostate dosimetry, age, PUTV, and number of needles for their association with urinary morbidity. Results: Urethral dose was fairly constant in all urethra segments except prostate base, where the variation in does was large. On multivariate analysis, higher urethral base D50, V100, and larger PUTV were predictive for higher maximum increase in IPSS. Higher urethral base V100 and larger PUTV predicted for prolonged IPSS resolution. Higher urethral base D50 and larger needle number predicted for longer RTOG resolution. Higher urethral base V100 predicted for RTOG {>=}2 toxicity. Conclusions: Radiation dose to the urethral base, larger PUTV, and needle number, predicted for increased urinary toxicity after prostate brachytherapy. Correlation between urinary morbidity and urethral base dosimetry may reflect a large variation in urethral dose observed at the prostate base.

  3. Severe endobronchitis and airway stricture caused by inhalation of cosmetic talc.

    PubMed

    Ong, Thun How; Takano, Angela

    2012-08-01

    Pulmonary disease caused by talc is well described, but previous reports mainly describe lung parenchymal involvement. We describe what is, to our knowledge, the first case in which inhalation of cosmetic talc led to intense endobronchitis and airway stricture. A 70-year-old woman presented with new-onset wheezing and was found to have right upper lobe collapse on chest radiography. CT imaging of the thorax showed right upper lobe collapse with occlusion of the right upper lobe. Bronchoscopy showed severe endobronchitis with thickened mucosa throughout the right and left main stem bronchi and a fibrotic stricture occluding the right upper lobe. Bronchial biopsy specimens showed foreign-body granulomatosis encasing birefringent crystalline material. Spectral analysis confirmed the crystals to be consistent with cosmetic talc used by the patient. We hypothesize that the patient inhaled a large amount of talc, which was trapped in the larger airways and resulted in intense foreign-body granulomatosis, leading to an airway stricture.

  4. [Dilatation of anastomotic stricture by Nd:YAG laser beam under endoscopy].

    PubMed

    Lu, Z C; Chen, L G; Zhang, Y Y

    1994-11-01

    Anastomotic stricture has become a common complication following surgical treatment of upper gastrointestinal cancers. A technique was devised to alleviate the stricture with Nd. YAG laser beam under endoscopy. The laser beam was applied at 3-4 different points near the anastomotic stoma. The thermal effect of the beam would cut the scar tissues in and underneath the mucosa, leading to dilatation of the stoma. A total of 48 patients with cancer of the esophagus (n = 21), gastric cardia (n = 20), body of stomach (n = 6) and gastric stump (n = 1) with postoperative anastomotic stricture was so treated. According to the degree of dilatation, the result of treatment upon longterm follow-up was good (the anastomotic stoma was enlarged more than 6 mm) in 41 (85.4%), fair (the stoma enlarged 4-5 mm) in 5 (10.4%) and poor in the remaining 2. Due precautions should be made to avoid bleeding and perforation.

  5. Side to Side Esophagogastrojejunoplasty in Post-corrosive Stricture of Distal Esophagus and Proximal Stomach.

    PubMed

    Sharma, Praveen; Pancholi, Mukesh; Patel, Gulab; Sharma, Anju

    2015-12-01

    A four years old female child presented after 2 months of ingestion of battery fluid (sulfuric acid) accidently with stricture of the distal esophagus, esophagogastric junction, and fundus as well as proximal portion of the body of the stomach. Corrosive stricture involving the distal esophagus with the proximal stomach is not a frequently encountered condition. Side to side esophagogastrojejunostomy without removal of the strictured esophagus or stomach (side to side esophagogastrojejunoplasty) can be done in such patient hence preserving the stomach which is important physiologically as a reservoir and for the secretion of gastric juices. In review of literature in search engines like MD Consult, PubMed, Cochrane Library, and Embase and standard textbooks of surgery, we could not find such procedure had been performed till date, so that it is the innovative approach with support of literature and surgical principles.

  6. Dilation of benign strictures in the esophagus and colon with the polyflex stent: a case series study.

    PubMed

    García-Cano, Jesús

    2008-02-01

    Polyflex, a new self-expanding plastic stent (SEPS), is increasingly used to treat obstructions in the gastrointestinal tract. The majority of reports on Polyflex come from tertiary referral centers. This retrospective study describes the efficacy and safety of this new SEPS for the treatment of benign strictures in esophagus and colon and its use in a community hospital. Seven patients were treated from August 2003 through December 2006. All of them presented with severe strictures, and were treated with Polyflex insertion. Four patients had esophageal obstructions (three peptic, one postoperative) and the remaining three patients had postoperative strictures in the rectosigmoid. One patient had a coexisting fistula. Two strictures (one esophageal and another colonic, both postoperative) received the Polyflex as the first line of treatment, without previous sessions of dilation. Esophageal strictures were solved after several consecutive SEPS insertions. Migrated stents were easily extracted from the stomach. On the other hand, colonic strictures achieved permanent dilation with a single stent. The patient with coexisting stricture and fistula became asymptomatic and still had the SEPS in place after four months. The one complication was mild pain after insertion. Polyflex seems to be a useful tool in the dilation of severe benign strictures in esophagus and rectosigmoid and, as in large centers, good results are achieved in a community hospital.

  7. Laparoscopic transgastric endoscopic retrograde cholangiopancreatography for benign common bile duct stricture after Roux-en-Y gastric bypass.

    PubMed

    Peters, M; Papasavas, P K; Caushaj, P F; Kania, R J; Gagné, D J

    2002-07-01

    Access to the gastric remnant and duodenum is lost after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Traditionally, a percutaneous transhepatic access to the common bile duct has been used to manage choledocholithiasis and duct strictures. We present a novel method of laparoscopic transgastric endoscopic retrograde cholangiopancreatography for managing a benign biliary stricture after a Roux-en-Y gastric bypass.

  8. Outcomes of urethral calculi patients in an endemic region and an undiagnosed primary fossa navicularis calculus.

    PubMed

    Verit, Ayhan; Savas, Murat; Ciftci, Halil; Unal, Dogan; Yeni, Ercan; Kaya, Mete

    2006-02-01

    Urethral calculus is a rare form of urolithiasis with an incidence lower than 0.3%. We determined the outcomes of 15 patients with urethral stone, of which 8 were pediatric, including an undiagnosed primary fossa navicularis calculus. Fifteen consecutive male patients, of whom eight were children, with urethral calculi were assessed between 2000 and 2005 with a mean of 19 months' follow-up. All stones were fusiform in shape and solitary. Acute urinary retention, interrupted or weak stream, pain (penile, urethral, perineal) and gross hematuria were the main presenting symptoms in 7 (46.7%), 4 (26.7%), 3 (20%) and 1 (6.6%) patient, respectively. Six of them had accompanying urethral pathologies such as stenosis (primary or with hypospadias) and diverticulum. Two patients were associated with upper urinary tract calculi but none of them secondary to bladder calculi. A 50-year-old patient with a primary urethral stone disease had urethral meatal stenosis accompanied by lifelong lower urinary tract symptoms. Unlike the past reports, urethral stones secondary to bladder calculi were decreasing, especially in the pediatric population. However, the pediatric patients in their first decade are still under risk secondary to the upper urinary tract calculi or the primary ones.

  9. Etiology of urethral discharge in West Africa: the role of Mycoplasma genitalium and Trichomonas vaginalis.

    PubMed Central

    Pépin, J.; Sobéla, F.; Deslandes, S.; Alary, M.; Wegner, K.; Khonde, N.; Kintin, F.; Kamuragiye, A.; Sylla, M.; Zerbo, P. J.; Baganizi, E.; Koné, A.; Kane, F.; Mâsse, B.; Viens, P.; Frost, E.

    2001-01-01

    OBJECTIVE: To determine the etiological role of pathogens other than Neisseria gonorrhoeae and Chlamydia trachomatis in urethral discharge in West African men. METHODS: Urethral swabs were obtained from 659 male patients presenting with urethral discharge in 72 primary health care facilities in seven West African countries, and in 339 controls presenting for complaints unrelated to the genitourinary tract. Polymerase chain reaction analysis was used to detect the presence of N. gonorrhoeae, C. trachomatis, Trichomonas vaginalis, Mycoplasma genitalium, and Ureaplasma urealyticum. FINDINGS: N. gonorrhoeae, T. vaginalis, C. trachomatis, and M. genitalium--but not U. urealyticum--were found more frequently in men with urethral discharge than in asymptomatic controls, being present in 61.9%, 13.8%, 13.4% and 10.0%, respectively, of cases of urethral discharge. Multiple infections were common. Among patients with gonococcal infection, T. vaginalis was as frequent a coinfection as C. trachomatis. M. genitalium, T. vaginalis, and C. trachomatis caused a similar clinical syndrome to that associated with gonococcal infection, but with a less severe urethral discharge. CONCLUSIONS: M. genitalium and T. vaginalis are important etiological agents of urethral discharge in West Africa. The frequent occurrence of multiple infections with any combination of four pathogens strongly supports the syndromic approach. The optimal use of metronidazole in flowcharts for the syndromic management of urethral discharge needs to be explored in therapeutic trials. PMID:11242818

  10. Impact Assessment of Urethral Meatus Morphology and Penile Biometry in Transurethral Prostate and Bladder Surgery

    PubMed Central

    Vieiralves, Rodrigo Ribeiro; Conte, Paulo Henrique Pereira; Felici, Eduardo Medina; Rodrigues, Nádia Cristina Pinheiro; de souza, Tomás Accioly; Sampaio, Francisco J. B.

    2017-01-01

    Objective. To analyze the penile and urethral meatus biometry and its correlation with meatoplasty during endoscopic resections. We also propose a new classification for urethral meatus morphology. Materials and Methods. We prospectively studied 105 patients who underwent prostate and bladder transurethral resections. We performed standardized measurement of penile and urethral meatus biometry followed by penile photo in the front position. The need to perform meatoplasty or dilatation during resectoscope introduction was registered. Data were analyzed comparing the correlation between two groups: without intervention (Group A) and with intervention (Group B). Results. We observed in Group A and Group B, respectively, the average length of urethral meatus of 1.07 cm versus 0.75 cm (p < 0.001) and average width of urethral meatus of 0.59 cm versus 0.38 cm (p < 0.001). Considering the morphology of the urethral meatus, we propose a new classification, in the following groups: (a) typical; (b) slit; (c) point-like; (d) horseshoe; and (e) megameatus. The point-like meatus was the one that most needed intervention, followed by the slit and the typical meatus (p < 0.001). Conclusions. Point-like and slit-shaped urethral meatus, as well as reduced length and width of the urethral meatus, are the determining factors. PMID:28298923

  11. Prepackaged therapy for urethritis: the "MSTOP" experience in Cameroon

    PubMed Central

    Crabbe, F.; Tchupo, J. P.; Manchester, T.; Gruber-Tapsoba, T.; Mugrditchian, D.; Timyan, J.; Goodridge, G.; Cheta, C.; Laga, M.; Dallabetta, G.

    1998-01-01

    RATIONALE: The social marketing of STD treatment may be a strategy to increase the availability of effective therapy for urethritis in male patients. OBJECTIVE: To evaluate a pilot project of social marketing of urethritis treatment packages. The project, initially designed for over the counter sale in private pharmacies, was finally restricted by national health authorities to primary healthcare settings in Yaounde and Douala, Cameroon. METHODS: Monthly sales of packages containing antibiotics, condoms, partner referral cards, and written information on STDs were monitored by the social marketing agency. Structured interviews were conducted with a sample of traceable patients who had consulted for urethritis. Structured interviews completed by focus group discussions were conducted among healthcare providers. Interview findings were further validated by a "mystery patient" survey, using surrogate patients. Lastly, 15 key informants among the decision markers involved in the project were interviewed in depth. Local independent consultants carried out the whole evaluation. RESULTS: A total of 1392 treatment packages were sold in 10 months. Patients who had purchased the package reported high compliance with the treatment, with 99% taking the single dose of cefuroxime-axetil and 83% completing the course of doxycycline. 76% notified all or some partners, and 84% of those who had sex during treatment used condoms. In contrast, only 27% of trained healthcare providers prescribed "MSTOP". They questioned the omission of laboratory diagnosis, the selection of antibiotics, and the duration of therapy. Public health authorities were also sceptical about the choice of antibiotics and viewed the initial project as an overt encouragement of self medication. CONCLUSIONS: Although the MSTOP project was not implemented in the way it had initially been designed, it highlighted the patients' interest in the product. Public health authorities in Cameroon should have been made aware

  12. Urethral duplication with unusual cause of bladder outlet obstruction

    PubMed Central

    Venkatramani, Vivek; George, Arun Jacob Philip; Chandrasingh, J.; Panda, Arabind; Devasia, Antony

    2016-01-01

    A 12-year-old boy presented with poor flow and recurrent urinary tract infections following hypospadias repair at the age of 3 years. The evaluation revealed urethral duplication with a hypoplastic dorsal urethra and patent ventral urethra. He also had duplication of the bladder neck, and on voiding cystourethrogram the ventral bladder neck appeared hypoplastic and compressed by the dorsal bladder neck during voiding. The possibility of functional obstruction of the ventral urethra by the occluded dorsal urethra was suspected, and he underwent a successful urethro-urethrostomy. PMID:27127361

  13. Urethral duplication with unusual cause of bladder outlet obstruction.

    PubMed

    Venkatramani, Vivek; George, Arun Jacob Philip; Chandrasingh, J; Panda, Arabind; Devasia, Antony

    2016-01-01

    A 12-year-old boy presented with poor flow and recurrent urinary tract infections following hypospadias repair at the age of 3 years. The evaluation revealed urethral duplication with a hypoplastic dorsal urethra and patent ventral urethra. He also had duplication of the bladder neck, and on voiding cystourethrogram the ventral bladder neck appeared hypoplastic and compressed by the dorsal bladder neck during voiding. The possibility of functional obstruction of the ventral urethra by the occluded dorsal urethra was suspected, and he underwent a successful urethro-urethrostomy.

  14. [Urethral cancer is rare and difficult to diagnose].

    PubMed

    Klemann, Nina; Toft, Birgitte Grønkjær; Thind, Peter

    2014-01-20

    Primary cancer of the urethra is a rare condition with symptoms ranging from haematuria, urethral obstruction and pelvic pain to urethrocutaneous fistula and abscess. Magnetic resonance imaging (MRI) is considered first choice of diagnostic imaging, but experience with treatment is scarce. We present a case of a 69-year-old woman with a one-year history of urinary obstruction. MRI revealed a tumour surrounding the urethra, and biopsies showed adenocarcinoma in situ. Surgery with removal of the bladder, urethra, internal genitals and lymph nodes revealed a periurethral cyst with both adenocarcinoma in situ and focal adenocarcinoma.

  15. Evaluation of risk factors and treatment options in patients with ureteral stricture disease at a single institution

    PubMed Central

    Tran, Henry; Arsovska, Olga; Paterson, Ryan F.; Chew, Ben H.

    2015-01-01

    Introduction: Ureteral strictures are a significant cause of morbidity and mortality, resulting in potential kidney damage requiring several surgical procedures. Non-malignant causes include radiation, trauma from calculi impaction, pelvic surgery, or ureteroscopy (URS). We identified risk factors in our patients with ureteral strictures and the success of their treatment outcomes. Methods: A retrospective chart review of 25 patients with 29 ureteral strictures was performed to determine the success of their treatment. Results: Twenty-five (25) patients with 29 benign ureteral strictures were identified. Most cases (60%) were caused by impacted stones where the median stone size was 1.15 cm (0.37–1.8 cm). Intervention for stones prior to stricture development included shockwave lithotripsy, URS, and percutaneous nephrolithotomy. Five patients with strictures from impacted stones had ureteric complications during stone treatment including perforation +/− urinoma (n=3), fractured guidewire left in situ (n=1), and ureteric orifice resection (n=1). Other stricture etiologies included radiation (28%) and endometriosis (4%). Treatment modalities used included ureteroureterostomy (n=2), ureteral re-implant (n=3), urinary diversion (n=3), autotrasplant (n=1), laser endoureterotomy +/− balloon dilation (n=8), nephrectomy (n=2), balloon dilation +/− stent (n=3), ureterovesical junction (UVJ) resection + stent (n=1), chronic stent changes (n=4), or surveillance (n=3). Conclusions: Our evaluation highlights important principles. Patients with complicated ureteroscopies or severely impacted calculi warrant close followup with imaging after stone treatment due to possibility of rapid renal deterioration from stricture formation. Radiation-induced strictures are difficult to manage, possibly requiring subsequent urinary diversion. Finally, endoscopic management of benign ureteral strictures via balloon dilation and laser endoureterotomy is an excellent choice in properly

  16. The tibialis posterior tendon.

    PubMed

    Lhoste-Trouilloud, A

    2012-02-01

    The tibialis posterior tendon is the largest and anteriormost tendon in the medial ankle. It produces plantar flexion and supination of the ankle and stabilizes the plantar vault. Sonographic assessment of this tendon is done with high-frequency, linear-array transducers; an optimal examination requires transverse retromalleolar, longitudinal retromalleolar, and distal longitudinal scans, as well as dynamic studies. Disorders of the posterior tibial tendon include chronic tendinopathy with progressive rupture, tenosynovitis, acute rupture, dislocation and instability, enthesopathies. The most common lesion is a progressive "chewing gum" lesion that develops in a setting of chronic tendinopathy; it is usually seen in overweight women over 50 years of age with valgus flat feet. Medial ankle pain must also be carefully investigated, and the presence of instability assessed with dynamic maneuvers (forced inversion, or dorsiflexion) of the foot. Sonography plays an important role in the investigation of disorders involving the posterior tibial tendon.

  17. Posterior Fossa Tumors.

    PubMed

    Brandão, Lara A; Young Poussaint, Tina

    2017-02-01

    Pediatric brain tumors are the leading cause of death from solid tumors in childhood. The most common posterior fossa tumors in children are medulloblastoma, atypical teratoid/rhabdoid tumor, cerebellar pilocytic astrocytoma, ependymoma, and brainstem glioma. Location, and imaging findings on computed tomography (CT) and conventional MR (cMR) imaging may provide important clues to the most likely diagnosis. Moreover, information obtained from advanced MR imaging techniques increase diagnostic confidence and help distinguish between different histologic tumor types. Here we discuss the most common posterior fossa tumors in children, including typical imaging findings on CT, cMR imaging, and advanced MR imaging studies.

  18. Posterior crossbites in children.

    PubMed

    Zhu, J F; Crevoisier, R; King, D L; Henry, R; Mills, C M

    1996-11-01

    Posterior crossbite, the most common malocclusion in young children, can be caused by a variety of skeletal, muscular, or dental factors. This condition produces insufficient maxillary arch width and is frequently associated with various oral sucking and postural habits. If left untreated, this problem can result in adverse skeletal growth changes. Various mechanical treatment modalities designed to expand the posterior maxillary arch width are available to correct this problem. The appropriate treatment method depends on the patient's age and level of cooperation as well as the determined etiology of the constriction.

  19. Tibialis Posterior Tendon Entrapment Within Posterior Malleolar Fracture Fragment.

    PubMed

    Fantry, Amanda; Lareau, Craig; Vopat, Bryan; Blankenhorn, Brad

    2016-01-01

    Management of posterior malleolus fractures continues to be controversial, with respect to both need for fixation and fixation methods. Fixation methods include an open posterior approach to the ankle as well as percutaneous reduction and fixation with or without arthroscopy for visualization of the articular surface. Plain radiographs are unreliable in identifying fracture pattern and intraoperative reduction, making arthroscopy a valuable adjunct to posterior malleolus fracture management. In this article, we report a case of tibialis posterior tendon entrapment within a posterior malleolus fracture, as identified by arthroscopy and managed with open reduction. Tibialis posterior tendon entrapment within a posterior malleolus has not been previously reported. Ankle arthroscopy for posterior malleolus fractures provides an opportunity to identify soft-tissue or tendinous entrapment, articular surface reduction, and articular cartilage injuries unlikely to be identified with fluoroscopy alone and should be considered in reduction and fixation of posterior malleolus fractures.

  20. Chlamydia trachomatis in cervicitis and urethritis in women.

    PubMed

    Paavonen, J; Vesterinen, E

    1982-01-01

    In the Scandinavian countries today, Chlamydia trachomatis seems to be the most important cause of sexually transmitted diseases. Although C. trachomatis is most prevalent in symptomatic women and in persons visiting venereal disease clinics, the asymptomatic carrier rate, particularly in young women, appears to be surprisingly high. In addition to young age and level of sexual activity, the use of oral contraceptives and the presence of cervical ectopy are important risk factors for chlamydial infection. Chlamydial cervicitis often is characterized by a hypertrophic follicular appearance, with severe edema, erythema, friability, and endocervical mucopurulent discharge. On colposcopy, an atypical transformation zone is frequently observed. Papanicolaou smears taken from C. trachomatis culture-positive patients often reveal benign atypias and dyskaryotic changes. C. trachomatis, therefore, being a venereally transmitted intracellular organism, may well play a role in the development of cervical intraepithelial neoplasia (CIN). Future studies on patients with cytological atypias, therefore, also should include tests for C. trachomatis. Prospective studies are needed to determine the natural history and outcome of C. trachomatis-associated atypias and their behavior after adequate therapy. A large proportion of C. trachomatis-infected women also are culture-positive from the urethra. The demonstration that C. trachomatis is a common causative agent of acute urethral syndrome (also called abacterial urethritis, dysuria-pyuria syndrome) in women has been a valuable contribution. The diagnosis of pyuria in a patient with abacterial dysuria is of critical importance, since it suggests a chlamydial etiology and thus is a potentially treatable condition.

  1. Study on acupuncture and moxibustion therapy for female urethral syndrome.

    PubMed

    Zheng, H; Wang, S; Shang, J; Chen, G; Huang, C; Hong, H; Chen, S

    1998-06-01

    Among 180 patients with female urethral syndrome, 128 were treated by acupuncture and moxibustion and 52 by western medicine as controls. The short-term effective rate in the acupuncture and moxibustion group was 90.6% and the long-term effective rate, 80.4%; whereas the short-term effective rate of the control group was 26.9% (P < 0.01). The maximal uroflow rate increased by an average of 4.6 ml/s, after acupuncture and moxibustion treatment (P < 0.001) and the mean uroflow rate increased by an average of 3.1 ml/s (P < 0.001); on the contrary, no changes were found in the control group (P > 0.05). Sixty-nine cases from the acupuncture and moxibustion group and 39 from the control group were subjected before and after treatment to determinations of the maximal bladder pressure, maximal abdominal pressure, bladder-neck pressure, and maximal urethral closure pressure during urination. All these indexes were decreased remarkably in the acupuncture and moxibustion group, while no changes were observed in the control group.

  2. Antibiotics on urethral catheter withdrawal: a hit and miss affair.

    PubMed

    Wazait, H D; van der Meullen, J; Patel, H R H; Brown, C T; Gadgil, S; Miller, R A; Kelsey, M C; Emberton, M

    2004-12-01

    Globally, millions of patients undergo urethral catheterization every year. Our objective was to study the current use of prophylactic antibiotics on urinary catheter withdrawal. A questionnaire (N = 300) was sent to healthcare professionals involved in the management of patients with urinary catheters (consultant microbiologists, infection control nurses, consultant urologists, specialist nurses in urology, continence advisers and consultants in the care of older people). The questionnaire asked about their use of prophylactic antibiotics on the withdrawal of a urethral catheter. Sixty percent of healthcare professionals advocated the use of antibiotics for either all or selected groups of patients. The remainder did not. The use of prophylactic antibiotics varied among different groups. Of the healthcare professionals who used antibiotics, the majority cited more than one reason for their use (prevent bacteraemia, avoid an infection in a prosthesis or urinary tract infection). The course and type of antibiotic used varied. Our study has shown diversity in practice that is of concern. At present, just over one-half of patients with urinary catheters are being given antibiotics, although there is no evidence to suggest that such an intervention confers any benefit. If benefits do not exist, these patients are being exposed to the harm of antibiotics and providers are incurring costs unnecessarily. A formal trial to address this issue is urgently needed.

  3. Urethral dysfunction in female mice with estrogen receptor β deficiency.

    PubMed

    Chen, Yung-Hsiang; Chen, Chao-Jung; Yeh, Shuyuan; Lin, Yu-Ning; Wu, Yang-Chang; Hsieh, Wen-Tsong; Wu, Bor-Tsang; Ma, Wen-Lung; Chen, Wen-Chi; Chang, Chawnshang; Chen, Huey-Yi

    2014-01-01

    Estrogen has various regulatory functions in the growth, development, and differentiation of the female urogenital system. This study investigated the roles of ERβ in stress urinary incontinence (SUI). Wild-type (ERβ(+/+)) and knockout (ERβ(-/-)) female mice were generated (aged 6-8 weeks, n = 6) and urethral function and protein expression were measured. Leak point pressures (LPP) and maximum urethral closure pressure (MUCP) were assessed in mice under urethane anesthesia. After the measurements, the urethras were removed for proteomic analysis using label-free quantitative proteomics by nano-liquid chromatography-mass spectrometry (LC-MS/MS) analysis. The interaction between these proteins was further analysed using MetaCore. Lastly, Western blot was used to confirm the candidate proteins. Compared with the ERβ(+/+) group, the LPP and MUCP values of the ERβ(-/-) group were significantly decreased. Additionally, we identified 85 differentially expressed proteins in the urethra of ERβ(-/-) female mice; 57 proteins were up-regulated and 28 were down-regulated. The majority of the ERβ knockout-modified proteins were involved in cell-matrix adhesion, metabolism, immune response, signal transduction, nuclear receptor translational regelation, and muscle contraction and development. Western blot confirmed the up-regulation of myosin and collagen in urethra. By contrast, elastin was down-regulated in the ERβ(-/-) mice. This study is the first study to estimate protein expression changes in urethras from ERβ(-/-) female mice. These changes could be related to the molecular mechanism of ERβ in SUI.

  4. Role of endoscopic retrograde cholangiopancreatography in the management of benign biliary strictures: What’s new?

    PubMed Central

    Ferreira, Rosa; Loureiro, Rui; Nunes, Nuno; Santos, António Alberto; Maio, Rui; Cravo, Marília; Duarte, Maria Antónia

    2016-01-01

    Benign biliary strictures comprise a heterogeneous group of diseases. The most common strictures amenable to endoscopic treatment are post-cholecystectomy, post-liver transplantation, related to primary sclerosing cholangitis and to chronic pancreatitis. Endoscopic treatment of benign biliary strictures is widely used as first line therapy, since it is effective, safe, noninvasive and repeatable. Endoscopic techniques currently used are dilation, multiple plastic stents insertion and fully covered self-expandable metal stents. The main indication for dilation alone is primary sclerosing cholangitis related strictures. In the vast majority of the remaining cases, temporary placement of multiple plastic stents with/without dilation is considered the treatment of choice. Although this approach is effective, it requires multiple endoscopic sessions due to the short duration of stent patency. Fully covered self-expandable metal stents appear as a good alternative to plastic stents, since they have an increased radial diameter, longer stent patency, easier insertion technique and similar efficacy. Recent advances in endoscopic technique and various devices have allowed successful treatment in most cases. The development of novel endoscopic techniques and devices is still ongoing. PMID:26962404

  5. Photodynamic therapy for Barrett's esophagus: effect of steroid therapy on stricture formation

    NASA Astrophysics Data System (ADS)

    Panjehpour, Masoud; Overholt, Bergein F.; Haydek, John M.; Lee, Sharon G.

    1999-07-01

    The primary goal of this study was to investigate whether the use of oral steroids would reduce the incidence of stricture formation after balloon photodynamic therapy in patients with dysplasia and early caner in Barrett's esophagus. The effect of other treatment parameters such as light dose and multiple treatments were also investigated.

  6. Probe-Based Confocal Laser Endomicroscopy for Indeterminate Biliary Strictures: Refinement of the Image Interpretation Classification

    PubMed Central

    Giovannini, Marc; Jamidar, Priya; Gan, S. Ian; Cesaro, Paola; Caillol, Fabrice; Filoche, Bernard; Karia, Kunal; Smith, Ioana; Slivka, Adam

    2015-01-01

    Background. Accurate diagnosis and clinical management of indeterminate biliary strictures are often a challenge. Tissue confirmation modalities during Endoscopic Retrograde Cholangiopancreatography (ERCP) suffer from low sensitivity and poor diagnostic accuracy. Probe-based confocal laser endomicroscopy (pCLE) has been shown to be sensitive for malignant strictures characterization (98%) but lacks specificity (67%) due to inflammatory conditions inducing false positives. Methods. Six pCLE experts validated the Paris Classification, designed for diagnosing inflammatory biliary strictures, using a set of 40 pCLE sequences obtained during the prospective registry (19 inflammatory, 6 benign, and 15 malignant). The 4 criteria used included (1) multiple thin white bands, (2) dark granular pattern with scales, (3) increased space between scales, and (4) thickened reticular structures. Interobserver agreement was further calculated on a separate set of 18 pCLE sequences. Results. Overall accuracy was 82.5% (n = 40 retrospectively diagnosed) versus 81% (n = 89 prospectively collected) for the registry, resulting in a sensitivity of 81.2% (versus 98% for the prospective study) and a specificity of 83.3% (versus 67% for the prospective study). The corresponding interobserver agreement for 18 pCLE clips was fair (k = 0.37). Conclusion. Specificity of pCLE using the Paris Classification for the characterization of indeterminate bile duct stricture was increased, without impacting the overall accuracy. PMID:25866506

  7. Successful salvage of kidney allografts threatened by ureteral stricture using pyelovesical bypass.

    PubMed

    Azhar, R A; Hassanain, M; Aljiffry, M; Aldousari, S; Cabrera, T; Andonian, S; Metrakos, P; Anidjar, M; Paraskevas, S

    2010-06-01

    Ureteral stricture is the most common urologic complication after renal transplantation. When endourologic management fails, open ureteral reconstruction remains the standard treatment. The complexity of some of these procedures makes it necessary to explore other means of repair. This study evaluated the intermediate-term outcome of subcutaneous pyelovesical bypass graft (SPBG) on renal transplant recipients. We reviewed 8 patients (6 male and 2 female; mean age 52 years) with refractory ureteral strictures postrenal transplantation, who received SPBG as salvage therapy. All patients failed endourologic management and half failed open management of their strictures. After a mean follow-up of 19.4 months, 7 out of 8 renal grafts have good function with mean GFR of 58.5 mL/min/1.73 m(2), without evidence of obstruction or infection. One patient lost his graft due to persistent infection of the SPBG and one patient developed a recurrent urinary tract infection managed with long-term antibiotics. SPBG offers a last resort in the treatment of ureteral stricture after renal transplantation refractory to conventional therapy.

  8. Isolated Ileal Stricture Secondary to Antigen-Negative GI Histoplasmosis in a Patient on Immunosuppressive Therapy

    PubMed Central

    Green, Michael; Nehme, Fredy; Tofteland, Nathan

    2017-01-01

    We present a case of antigen-negative disseminated histoplasmosis manifesting as an isolated ileal stricture in a patient on chronic infliximab and methotrexate. Diagnosis can be challenging due to imperfect tests, and this condition should remain in the differential, even with negative testing. Mortality of untreated disseminated histoplasmosis can be as high as 80%. PMID:28144615

  9. Prophylactic steroid administration for strictures after endoscopic resection of large superficial esophageal squamous cell carcinoma

    PubMed Central

    Kadota, Tomohiro; Yano, Tomonori; Kato, Tomoji; Imajoh, Maomi; Noguchi, Masaaki; Morimoto, Hiroyuki; Osera, Shozo; Yoda, Yusuke; Oono, Yasuhiro; Ikematsu, Hiroaki; Ohtsu, Atsushi; Kaneko, Kazuhiro

    2016-01-01

    Background and study aims: One of the major complications after endoscopic resection (ER) for large superficial esophageal squamous cell carcinoma (ESCC) is benign esophageal stricture, which can reduce quality of life even if ESCC achieves a cure without organ resection. Recently, steroid administration has been reported as a prophylactic treatment to prevent esophageal strictures. This retrospective study evaluated the stricture rate according to the different width of mucosal defects due to ER and compared it to that seen with prophylactic steroid administration. Patients and methods: Between June 2007 and December 2013, we enrolled patients with ESCC who had 3/4 or larger circumferential mucosal defects due to ER. In December 2009, steroid injections (triamcinolone acetonide 50 mg) into the ulcer bed due to ER were introduced. Beginning in November 2012, we commenced oral steroid administration (prednisolone 30 mg/day, tapered gradually for 8 weeks) in addition to steroid injection. Patients were classified into 3 groups according to the width of mucosal defect after ER (Group A, ≥ 3/4 and < 7/8; Group B, ≥ 7/8 and less than the entire circumference; and Group C, the entire circumference). We retrospectively evaluated the stricture rate by comparing no treatment, steroid injection, or steroid injection followed by oral steroid according to the width of mucosal defect. Results: A total of 115 patients met the selection criteria. In Group B, no treatment had a significantly higher stricture rate (100 %, vs. steroid injection: 56 % P = 0.015; vs steroid injection followed by oral steroid: 20 % P < 0.001). Conversely, in Group C, the stricture rate was high, regardless of treatment (no treatment: 100 %; steroid injection: 100 %; steroid injection followed by oral steroid: 71 %). Conclusions: Although prophylactic steroid administration is effective to prevent strictures for 7/8 circumference or larger mucosal defects, it is

  10. Acquired urinary incontinence in the bitch: update and perspectives from human medicine. Part 2: The urethral component, pathophysiology and medical treatment.

    PubMed

    Noël, Stéphanie; Claeys, Stéphanie; Hamaide, Annick

    2010-10-01

    Various pathologies can affect the bladder and/or urethral contractility causing signs of urinary incontinence. In this second part of a three-part review, the pathophysiology of impaired urethral contractility (including urethral hyper- and hypotonicity) in the bitch and in women is discussed. Urethral sphincter mechanism incompetence (USMI) is the most common form of acquired urinary incontinence in bitches and is characterized by a decreased urethral tone. The pathophysiology and current recommended medical treatment options for USMI and cases of modified urethral tonicity due to a neurological disorder or functional outlet obstruction are discussed. Treatment options in human medicine in cases of impaired urethral contractility are described.

  11. Benign esophageal stricture after thermal injury treated with esophagectomy and ileocolon interposition

    PubMed Central

    Kitajima, Toshihiro; Momose, Kota; Lee, Seigi; Haruta, Shusuke; Shinohara, Hisashi; Ueno, Masaki; Fujii, Takeshi; Udagawa, Harushi

    2014-01-01

    Thermal injuries of the esophagus are rare causes of benign esophageal stricture, and all published cases were successfully treated with conservative management. A 28-year-old Japanese man with a thermal esophageal injury caused by drinking a cup of hot coffee six months earlier was referred to our hospital. The hot coffee was consumed in a single gulp at a party. Although the patient had been treated conservatively at another hospital, his symptoms of dysphagia gradually worsened after discharge. An upper gastrointestinal endoscopy and computed tomography revealed a pin-hole like area of stricture located 19 cm distally from the incisors to the esophagogastric junction, as well as circumferential stenosis with notable wall thickness at the same site. The patient underwent a thoracoscopic esophageal resection with reconstruction using ileocolon interposition. The pathological findings revealed wall thickening along the entire length of the esophagus, with massive fibrosis extending to the muscularis propria and adventitia at almost all levels. Treatment with balloon dilation for long areas of stricture is generally difficult, and stent placement in patients with benign esophageal stricture, particularly young patients, is not yet widely accepted due to the incidence of late adverse events. Considering the curability and quality-of-life associated with a long expected prognosis, we determined that surgery was the best treatment option for this young patient. In this case, we decided to perform an esophagectomy and reconstruction with ileocolon interposition in order to preserve the reservoir function of the stomach and to avoid any problems related to the reflux of gastric contents. In conclusion, resection of the esophagus is a treatment option in patients with benign esophageal injury, especially in cases involving young patients with refractory esophageal stricture. In addition, ileocolon interposition may help to improve the quality-of-life of patients. PMID

  12. The role of stents in the treatment of Crohn’s disease strictures

    PubMed Central

    Loras Alastruey, Carme; Andújar Murcia, Xavier; Esteve Comas, Maria

    2016-01-01

    Background and aims: Stenosis is one of the most frequent local complications in Crohn’s disease (CD). Surgery is not the ideal treatment because of the high rate of postoperative recurrence. Endoscopic balloon dilation (EBD) currently is the current treatment of choice for short strictures amenable to the procedure. However, it is not applicable or effective in all the cases, and it is not without related complications. Our goal was to summarize the published information regarding the use and the role of the stents in the treatment of CD stricture. A Medline search was performed on the terms “stricture,” “stenosis,” “stent” and “Crohn’s disease.” Results: a total of 19 publications met our search criteria for an overall number of 65 patients. Placing a self-expanding metal stent (SEMS) may be a safe and effective alternative to EBD and/or surgical intervention in the treatment of short stenosis in patients with CD. Indications are the same as those for EBD. In addition, SEMS may be useful in stenosis refractory to EBD and may be suitable in the treatment of longer or more complex strictures that cannot be treated by EBD. With the current information, it seems that the best treatment option is the placement of a fully covered stent for a mean time of 4 weeks. Regarding the use of biodegradable stents, the information is limited and showing poor results. Conclusions: the use of stents in the treatment of strictures in CD should be taken into account either as a first endoscopic therapy or in case of EBD failure. PMID:27014743

  13. Amniotic Membrane Grafts for the Prevention of Esophageal Stricture after Circumferential Endoscopic Submucosal Dissection

    PubMed Central

    Barret, Maximilien; Pratico, Carlos Alberto; Camus, Marine; Beuvon, Frédéric; Jarraya, Mohamed; Nicco, Carole; Mangialavori, Luigi; Chaussade, Stanislas; Batteux, Frédéric; Prat, Frédéric

    2014-01-01

    Background and Aims The prevention of esophageal strictures following circumferential mucosal resection remains a major clinical challenge. Human amniotic membrane (AM) is an easily available material, which is widely used in ophthalmology due to its wound healing, anti-inflammatory and anti-fibrotic properties. We studied the effect of AM grafts in the prevention of esophageal stricture after endoscopic submucosal dissection (ESD) in a swine model. Animals and Methods In this prospective, randomized controlled trial, 20 swine underwent a 5 cm-long circumferential ESD of the lower esophagus. In the AM Group (n = 10), amniotic membrane grafts were placed on esophageal stents; a subgroup of 5 swine (AM 1 group) was sacrificed on day 14, whereas the other 5 animals (AM 2 group) were kept alive. The esophageal stent (ES) group (n = 5) had ES placement alone after ESD. Another 5 animals served as a control group with only ESD. Results The prevalence of symptomatic strictures at day 14 was significantly reduced in the AM group and ES groups vs. the control group (33%, 40% and 100%, respectively, p = 0.03); mean esophageal diameter was 5.8±3.6 mm, 6.8±3.3 mm, and 2.6±1.7 mm for AM, ES, and control groups, respectively. Median (range) esophageal fibrosis thickness was 0.87 mm (0.78–1.72), 1.19 mm (0.28–1.95), and 1.65 mm (0.7–1.79) for AM 1, ES, and control groups, respectively. All animals had developed esophageal strictures by day 35. Conclusions The anti-fibrotic effect of AM on esophageal wound healing after ESD delayed the development of esophageal stricture in our model. However, this benefit was of limited duration in the conditions of our study. PMID:24992335

  14. Newly designed “pieced” stent in a rabbit model of benign esophageal stricture

    PubMed Central

    Liu, Jin; Shang, Liang; Liu, Ji-Yong; Qin, Cheng-Yong

    2015-01-01

    AIM: To investigate a newly designed stent and its dilatation effect in a rabbit model of benign esophageal stricture. METHODS: Thirty-four New Zealand white rabbits underwent a corrosive injury in the middle esophagus for esophageal stricture formation. Thirty rabbits with a successful formation of esophageal strictures were randomly allocated into two groups. The control group (n = 15) was implanted with a conventional stent, and the study group (n = 15) was implanted with a detachable “pieced” stent. The study stent (30 mm in length, 10 mm in diameter) was composed of three covered metallic pieces connected by surgical suture lines. The stent was collapsed by pulling the suture lines out of the mesh. Two weeks after stricture formation, endoscopic placement of a conventional stent or the new stent was performed. Endoscopic extraction was carried out four weeks later. The extraction rate, ease of extraction, migration, complications, and survival were evaluated. RESULTS: Stent migration occurred in 3/15 (20%) animals in the control group and 2/15 (13%) animals in the study group; the difference between the two groups was not statistically significant. At the end of four weeks, the remaining stents were successfully extracted with the endoscope in 100% (11/11) of the animals in the study group, and 60% (6/10) of the animals in the control group; this difference was statistically significant (P < 0.05). There was no difference in the mean number of follow-up days between the control and study groups (25.33 vs 25.85). Minor bleeding was reported in five cases in the study group and four in the control group. There were no severe complications directly associated with stent implantation or extraction in either of the two groups. CONCLUSION: In this experimental protocol of benign esophageal strictures, the novel “pieced” stent demonstrated a superior removal rate with a similar migration rate compared to a conventional stent. PMID:26229404

  15. Diabetes and elevated urea level predict for uretero-ileal stricture after radical cystectomy and ileal conduit formation

    PubMed Central

    Hoag, Nathan; Papa, Nathan; Beharry, Bhawanie Koonj; Lawrentschuk, Nathan; Chiu, Danny; Sengupta, Shomik; Bolton, Damien

    2017-01-01

    Introduction Benign uretero-ileal anastomotic stricture is a significant complication following radical cystectomy and ileal conduit urinary diversion after radical cystectomy. We examined risk factors for stricture formation to predict those at greatest stricture risk. Methods A retrospective chart review was conducted for patients undergoing radical cystectomy and ileal conduit diversion between 2002 and 2012. Demographic data and patient variables were analyzed to determine risk factors for uretero-ileal stricture using multivariate logistic regression. Results Over the study period, 133 patients underwent cystectomy and ileal conduit formation, with 14 (10.5%) developing uretero-ileal anastomotic stricture. Diabetes and elevated serum urea level (defined as >7.1 mmol/L) were associated with increased risk for development of uretero-ileal stricture (odds ratio 4.31 and 4.28, respectively; p<0.05 for each). Conclusions In this patient cohort, diabetes and elevated serum urea level were predictive for the development of uretero-ileal anastomotic stricture. Further prospective study with larger patient samples is required. PMID:28360953

  16. The influence of membranous stretched urethral length and urethral circumference on postoperative recovery of continence after radical prostatectomy: A pilot study

    PubMed Central

    Cho, Dae Sung; Lee, Eun Ju; Kim, Se Joong; Kim, Sun Il

    2015-01-01

    Introduction: We investigate the influence of stretched membranous urethral length (SUL) and urethral circumference (UC) on postoperative recovery of continence after radical prostatectomy (RP). Methods: To evaluate the distal continence zone intraoperatively, we individually measured and recorded stretched membranous urethral length (distance between the urogenital diaphragm and the prostate apex with cephalad retraction, SUL) and urethral circumference (UC) after exposure of the urethra. We analyzed the association between magnetic resonance imaging-measured membranous urethral length (MRIL) and urethral diameter (MRID) and intraoperative SUL and UC and influence on return to continence. Results: The mean patient age, SUL and UC were 66.5 ± 6.0 years, 24.2 ± 3.3 mm, and 27.5 ± 4.4 mm, respectively. MRIL and MRID were 11.3 ± 1.6 mm and 10.6 ± 1.9mm, respectively. In the bivariate correlation analysis, there was no statistically significant correlation between SUL and MRIL (p = 0.201) and between UC and MRID (p = 0.124). In the Kaplan-Meier curve analysis, cumulative continence rates between the two groups dichotomized at the median value according to age (p = 0.0519), SUL (p = 0.6583), UC (p = 0.4031), MRIL (p = 0.4042), and MRID (p = 0.8191) were not significantly different. High SUL-to-MRIL ratio (>2.2) was the only significant predictor of lower cumulative continence rate (p = 0.0457). Conclusions: MRIL measured during surgery was not associated with postoperative continence recovery after RP. We observed that an excessively long membranous urethra compared to the urethral length on preoperative MRI is predictive of poorer postoperative continence recovery. However, small sample size and potential confounding surgical factors limit the significance of this study. PMID:26029292

  17. Suprapubic Cystostomy for the Management of Urethral Injuries During Penile Prosthesis Implantation

    PubMed Central

    Anele, Uzoma A; Le, Brian V; Burnett, Arthur L

    2014-01-01

    Introduction Urethral injury is an uncommon surgical complication of penile prosthesis (PP) surgery. Conventional dogma requires abortion of the procedure if the adjacent corporal body is involved or delayed implantation to avert device infection associated with urinary extravasation. Besides the setback of the aborted surgery, this management approach also presents the possible difficulty of encountering corporal fibrosis at the time of reoperation. Aim We report an approach using primary urethral repair and temporary suprapubic cystostomy for the management of incidental urethral injuries in a cohort of patients allowing for successful completion of unaborted PP implantation. Materials and Methods We performed a retrospective analysis of all patients receiving PPs from 1990 to 2014 in which incidental urethral injuries were repaired and PP implantation was completed with suprapubic cystostomy (suprapubic tube [SPT] insertion). After allowing for urethral healing and urinary diversion via SPT for 4–8 weeks, the PP was activated. Main Outcome Measures Successful management was determined by the absence of perioperative complications within 6 months of implantation. Results We identified four cases, all receiving inflatable PPs, managed with temporary suprapubic cystostomy. These patients sustained urethral injuries during corporal dissection (one patient), corporal dilation (one patient), and penile straightening (two patients). All patients were managed safely and successfully. Conclusion Primary urethral repair followed by temporary suprapubic cystostomy offers a surgical approach to complete PP implantation successfully in patients who sustain urethral injury complications, particularly for complex PP surgeries. Anele UA, Le BV, and Burnett AL. Suprapubic cystostomy for the management of urethral injuries during penile prosthesis implantation. PMID:25548649

  18. Risk Factors for Urethral Condyloma among Heterosexual Young Male Patients with Condyloma Acuminatum of Penile Skin

    PubMed Central

    2016-01-01

    To our knowledge, this is the first study that focuses on risk factor of urethral condyloma (UC). The subjects of our study included genital warts patients who had been diagnosed as having condyloma acuminatum of penile skin (CAPS) with/without UC. Relationship with UC of number of life time female partners, co-infection with urethritis, circumcision status, number of CAPS and wart diameter were studied by use of multivariate analysis. Co-infection with urethritis, circumcision status were risk factors of UC in heterosexual young male patients with CAPS. This information will be helpful for providing more professional counseling to patients with genital warts. PMID:27659432

  19. An investigation of the effects from a urethral warming system on temperature distributions during cryoablation treatment of the prostate: a phantom study.

    PubMed

    Favazza, C P; Gorny, K R; King, D M; Rossman, P J; Felmlee, J P; Woodrum, D A; Mynderse, L A

    2014-08-01

    Introduction of urethral warmers to aid cryosurgery in the prostate has significantly reduced the incidence of urethral sloughing; however, the incidence rate still remains as high as 15%. Furthermore, urethral warmers have been associated with an increase of cancer recurrence rates. Here, we report results from our phantom-based investigation to determine the impact of a urethral warmer on temperature distributions around cryoneedles during cryosurgery. Cryoablation treatments were simulated in a tissue mimicking phantom containing a urethral warming catheter. Four different configurations of cryoneedles relative to urethral warming catheter were investigated. For each configuration, the freeze-thaw cycles were repeated with and without the urethral warming system activated. Temperature histories were recorded at various pre-arranged positions relative to the cryoneedles and urethral warming catheter. In all configurations, the urethral warming system was effective at maintaining sub-lethal temperatures at the simulated surface of the urethra. The warmer action, however, was additionally demonstrated to potentially negatively impact treatment lethality in the target zone by elevating minimal temperatures to sub-lethal levels. In all needle configurations, rates of freezing and thawing were not significantly affected by the use of the urethral warmer. The results indicate that the urethral warming system can protect urethral tissue during cryoablation therapy with cryoneedles placed as close as 5mm to the surface of the urethra. Using a urethral warming system and placing multiple cryoneedles within 1cm of each other delivers lethal cooling at least 5mm from the urethral surface while sparing urethral tissue.

  20. Posterior Circulation Ischemic Stroke.

    PubMed

    Go, Steven

    2015-01-01

    Approximately 20-25% of all acute strokes occur in the posterior circulation. These strokes can be rather difficult to diagnose because they present in such diverse ways, and can easily be mistaken for more benign entities. A fastidious history, physical exam, high clinical suspicion, and appropriate use of imaging are essential for the emergency physician to properly diagnose and treat these patients. Expert stroke neurologist consultation should be utilized liberally.

  1. Urethral masturbation and sexual disinhibition in dementia: a case report.

    PubMed

    Rosenthal, Michal; Berkman, Pinhas; Shapira, Adi; Gil, Israel; Abramovitz, Jancu

    2003-01-01

    Urethral masturbation and sexual disinhibition as manifestations of behavioral and psychological symptoms of dementia (BPSD) are described in a 90-year-old patient who repeatedly self-inserted foreign bodies into his urethra. A diagnosis was made of late onset sexual disinhibition and hypersexuality in a patient with Dementia of the Alzheimer Type. Significant reduction of his sexual behavior was achieved with low doses of haloperidol. Similar symptoms are noted in Pick's disease, other fronto-temporal lesions, mania and following a seizure or treatment of Parkinson's disease, and have been described as Kluver-Busy-type. Clinicians should consider this diagnosis when investigating dysuria, cystitis, haematuria and urinary tract infections even in the very old.

  2. Urethral Dysfunction in Female Mice with Estrogen Receptor β Deficiency

    PubMed Central

    Chen, Yung-Hsiang; Chen, Chao-Jung; Yeh, Shuyuan; Lin, Yu-Ning; Wu, Yang-Chang; Hsieh, Wen-Tsong; Wu, Bor-Tsang; Ma, Wen-Lung; Chen, Wen-Chi; Chang, Chawnshang; Chen, Huey-Yi

    2014-01-01

    Estrogen has various regulatory functions in the growth, development, and differentiation of the female urogenital system. This study investigated the roles of ERβ in stress urinary incontinence (SUI). Wild-type (ERβ+/+) and knockout (ERβ−/−) female mice were generated (aged 6–8 weeks, n = 6) and urethral function and protein expression were measured. Leak point pressures (LPP) and maximum urethral closure pressure (MUCP) were assessed in mice under urethane anesthesia. After the measurements, the urethras were removed for proteomic analysis using label-free quantitative proteomics by nano-liquid chromatography–mass spectrometry (LC-MS/MS) analysis. The interaction between these proteins was further analysed using MetaCore. Lastly, Western blot was used to confirm the candidate proteins. Compared with the ERβ+/+ group, the LPP and MUCP values of the ERβ−/− group were significantly decreased. Additionally, we identified 85 differentially expressed proteins in the urethra of ERβ−/− female mice; 57 proteins were up-regulated and 28 were down-regulated. The majority of the ERβ knockout-modified proteins were involved in cell-matrix adhesion, metabolism, immune response, signal transduction, nuclear receptor translational regelation, and muscle contraction and development. Western blot confirmed the up-regulation of myosin and collagen in urethra. By contrast, elastin was down-regulated in the ERβ−/− mice. This study is the first study to estimate protein expression changes in urethras from ERβ−/− female mice. These changes could be related to the molecular mechanism of ERβ in SUI. PMID:25275480

  3. Remote discovery of an asymptomatic bowel perforation by a mid-urethral sling.

    PubMed

    Elliott, Jason E; Maslow, Ken D

    2012-02-01

    Bowel perforation is a rare complication of mid-urethral sling procedures and is usually reported shortly after the surgery. We report a remotely discovered asymptomatic bowel injury found at the time of subsequent surgery. The patient with a history of several prior pelvic surgeries underwent an uneventful retropubic mid-urethral sling placement. Five years later, during an abdominal sacrocolpopexy procedure, mesh from the mid-urethral sling was found perforating the wall of the cecum and fixating it to the right pelvic sidewall. Cecal wedge resection was performed to excise the sling mesh. Asymptomatic bowel perforation by mid-urethral sling mesh has not been previously reported. Pelvic and abdominal surgeons should be aware of the possibility of finding this injury in patients with prior sling surgeries.

  4. Male urethritis in King County, Washington, 1974-75: II. Diagnosis and treatment.

    PubMed Central

    Hinds, M W; Gale, J L

    1978-01-01

    Methods of diagnosing and treating male urethritis in King County. Washington in 1974-1975 were examined by a retrospective postal survey, records review, and prospective surveillance. A Gram-stained smear of urethral discharge was used by 86 per cent of private physicians and urethral culture by 56 per cent. Only 5 per cent made a diagnosis without laboratory aid. U.S. Public thealth Service gonorrhea treatment regimens were used by 54-81 per cent of private physicians. Over 90 per cent of physicians not in private practice (emergency room and housestaff) used smear, cultures, and recommended treatment regimens. The Gram-stained smear appeared to be under-utilized and the urethral culture overutilized. There is a significant need for physician education regarding recommended treatment for male gonorrhea. PMID:623359

  5. ’TRIC AGENT’ URETHRITIS: A REPORT OF THE SEROLOGICAL FLUORESCENT ANTIBODY AND ASSOCIATED FINDINGS

    DTIC Science & Technology

    a much larger percentage of ’NSU’ cases than previously thought. There appears to be a definite interrelationship between TRIC urethritis and epididymitis in young adults, and possibly with Reiter’s Syndrome. (Author)

  6. False-positive prostate cancer markers in a man with symptomatic urethral Chlamydia trachomatis infection.

    PubMed

    Smelov, V; Novikov, A; Brown, L J; Eklund, C; Strokova, L; Ouburg, S; Morre, S A; Dillner, J

    2013-06-01

    Symptomatic male urethral Chlamydia trachomatis infection resulted in inflammation of the prostate, with associated increases in both prostate-specific (PSA) and prostate cancer-specific (PCA3) markers with prostate biopsies showing no evidence of malignancy.

  7. Endoscopic characteristics and usefulness of endoscopic dilatation of anastomotic stricture following pancreaticojejunostomy: case series and a review of the literature

    PubMed Central

    Kida, Akihiko; Shirota, Yukihiro; Houdo, Yuji; Wakabayashi, Tokio

    2016-01-01

    The incidence of pancreatitis induced by anastomotic stricture following pancreaticodigestive tract anastomosis as a late-onset adverse event has been reported to be 3% or lower, but some cases repeatedly relapse and are difficult to treat. Endoscopic identification and treatment of the anastomotic site are considered to be difficult, and only a small number of cases have been reported. We present three cases with recurrent pancreatitis induced by anastomotic stricture following pancreaticojejunostomy applied after pancreaticoduodenectomy. We successfully identified the anastomotic site and performed endoscopic dilatation of the anastomotic stricture, and pancreatitis has not recurred. We characterized endoscopic features of the anastomotic site, understanding of which is essential to identify the site, and investigated useful techniques to identify the site and perform cannulation for pancreatography. Furthermore, we showed the safety and usefulness of endoscopic dilatation for anastomotic stricture following pancreaticojejunostomy according to our three cases and a review of the literature. PMID:27803744

  8. Hemorrhagic urethritis in female-to-male transsexual. Possible androgen-related phenomena.

    PubMed

    Cohen, M S; Sanchez, R L

    1987-12-01

    This article describes a case of hematuria and urethritis related to androgen stimulation in a female-to-male transsexual receiving testosterone cypionate. Biopsy of the affected urethral tissue revealed periurethral glands which demonstrated a strong positive reaction with immunoperoxidase staining for prostatic specific antigen. When the androgen stimulus was reduced, the patient's symptoms resolved. This report gives evidence for possible androgen-induced pathology in the female urethra.

  9. Improved Accuracy of Percutaneous Biopsy Using “Cross and Push” Technique for Patients Suspected with Malignant Biliary Strictures

    SciTech Connect

    Patel, Prashant; Rangarajan, Balaji; Mangat, Kamarjit E-mail: kamarjit.mangat@nhs.net

    2015-08-15

    PurposeVarious methods have been used to sample biliary strictures, including percutaneous fine-needle aspiration biopsy, intraluminal biliary washings, and cytological analysis of drained bile. However, none of these methods has proven to be particularly sensitive in the diagnosis of biliary tract malignancy. We report improved diagnostic accuracy using a modified technique for percutaneous transluminal biopsy in patients with this disease.Materials and MethodsFifty-two patients with obstructive jaundice due to a biliary stricture underwent transluminal forceps biopsy with a modified “cross and push” technique with the use of a flexible biopsy forceps kit commonly used for cardiac biopsies. The modification entailed crossing the stricture with a 0.038-in. wire leading all the way down into the duodenum. A standard or long sheath was subsequently advanced up to the stricture over the wire. A Cook 5.2-Fr biopsy forceps was introduced alongside the wire and the cup was opened upon exiting the sheath. With the biopsy forceps open, within the stricture the sheath was used to push and advance the biopsy cup into the stricture before the cup was closed and the sample obtained. The data were analysed retrospectively.ResultsWe report the outcomes of this modified technique used on 52 consecutive patients with obstructive jaundice secondary to a biliary stricture. The sensitivity and accuracy were 93.3 and 94.2 %, respectively. There was one procedure-related late complication.ConclusionWe propose that the modified “cross and push” technique is a feasible, safe, and more accurate option over the standard technique for sampling strictures of the biliary tree.

  10. Management of cervical esophageal strictures with self-expanding metalic stents.

    PubMed

    Cindoruk, Mehmet; Karakan, Tarkan

    2006-12-01

    Esophageal strictures due to malignant diseases are treated with self-expanding metalicic stents. However, experience is limited with these metalic stents in the cervical esophagus. Due to technical difficulties and procedure-related complications, the cervical esophagus has been assigned as a risky area for stenting procedures. Another encountered problem is patient discomfort after the procedure. In this case report, we present three patients with cervical esophageal strictures who were successfully treated with self-expandable metalic stents. Two of these patients had inoperable esophageal carcinoma and the third had benign stenosis due to radiotherapy of larynx carcinoma. The two patients with malignant disease survived four and six months, respectively, after the procedure. The last patient with benign disease is still alive and has been without dysphagia symptom for six months.

  11. Posterior interosseous neuropathy

    PubMed Central

    Kele, Henrich; Xia, Annie; Weiler, Markus; Schwarz, Daniel; Bendszus, Martin; Pham, Mirko

    2016-01-01

    Objective: To investigate the spatial pattern of lesion dispersion in posterior interosseous neuropathy syndrome (PINS) by high-resolution magnetic resonance neurography. Methods: This prospective study was approved by the local ethics committee and written informed consent was obtained from all patients. In 19 patients with PINS and 20 healthy controls, a standardized magnetic resonance neurography protocol at 3-tesla was performed with coverage of the upper arm and elbow (T2-weighted fat-saturated: echo time/repetition time 52/7,020 milliseconds, in-plane resolution 0.27 × 0.27 mm2). Lesion classification of the radial nerve trunk and its deep branch (which becomes the posterior interosseous nerve) was performed by visual rating and additional quantitative analysis of normalized T2 signal of radial nerve voxels. Results: Of 19 patients with PINS, only 3 (16%) had a focal neuropathy at the entry of the radial nerve deep branch into the supinator muscle at elbow/forearm level. The other 16 (84%) had proximal radial nerve lesions at the upper arm level with a predominant lesion focus 8.3 ± 4.6 cm proximal to the humeroradial joint. Most of these lesions (75%) followed a specific somatotopic pattern, involving only those fascicles that would form the posterior interosseous nerve more distally. Conclusions: PINS is not necessarily caused by focal compression at the supinator muscle but is instead frequently a consequence of partial fascicular lesions of the radial nerve trunk at the upper arm level. Neuroimaging should be considered as a complementary diagnostic method in PINS. PMID:27683851

  12. Efficacy of multiple biliary stenting for refractory benign biliary strictures due to chronic calcifying pancreatitis

    PubMed Central

    Ohyama, Hiroshi; Mikata, Rintaro; Ishihara, Takeshi; Sakai, Yuji; Sugiyama, Harutoshi; Yasui, Shin; Tsuyuguchi, Toshio

    2017-01-01

    AIM To investigate endoscopic therapy efficacy for refractory benign biliary strictures (BBS) with multiple biliary stenting and clarify predictors. METHODS Ten consecutive patients with stones in the pancreatic head and BBS due to chronic pancreatitis who underwent endoscopic therapy were evaluated. Endoscopic insertion of a single stent failed in all patients. We used plastic stents (7F, 8.5F, and 10F) and increased stents at intervals of 2 or 3 mo. Stents were removed approximately 1 year after initial stenting. BBS and common bile duct (CBD) diameter were evaluated using cholangiography. Patients were followed for ≥ 6 mo after therapy, interviewed for cholestasis symptoms, and underwent liver function testing every visit. Patients with complete and incomplete stricture dilations were compared. RESULTS Endoscopic therapy was completed in 8 (80%) patients, whereas 2 (20%) patients could not continue therapy because of severe acute cholangitis and abdominal abscess, respectively. The mean number of stents was 4.1 ± 1.2. In two (20%) patients, BBS did not improve; thus, a biliary stent was inserted. BBS improved in six (60%) patients. CBD diameter improved more significantly in the complete group than in the incomplete group (6.1 ± 1.8 mm vs 13.7 ± 2.2 mm, respectively, P = 0.010). Stricture length was significantly associated with complete stricture dilation (complete group; 20.5 ± 3.0 mm, incomplete group; 29.0 ± 5.1 mm, P = 0.011). Acute cholangitis did not recur during the mean follow-up period of 20.6 ± 7.3 mo. CONCLUSION Sequential endoscopic insertion of multiple stents is effective for refractory BBS caused by chronic calcifying pancreatitis. BBS length calculation can improve patient selection procedure for therapy. PMID:28101303

  13. Gall bladder emptying in patients with corrosive-induced esophageal strictures.

    PubMed

    Khan, Bilal A; Kochhar, Rakesh; Nagi, Birender; Raja, Kaiser; Singh, Kartar

    2005-01-01

    Ingestion of corrosive substances can lead to strictures of the esophagus and stomach. Cicatrization of the lower part of the esophagus can entrap vagal fibers in the process of fibrosis. The aim of the present study was to evaluate gallbladder dysfunction as a sequel to vagal damage in patients with corrosive-induced esophageal strictures. The cephalic phase of gallbladder emptying was stimulated by modified sham feeding according to the chew-and-spit method. Gallbladder volume was measured by ultrasonography using the ellipsoid method after an overnight fast and every 15 min for a period of 90 min after sham feeding in 22 patients and 10 controls. Mean fasting gallbladder volume was significantly greater in patients than in controls (22.09 +/- 9.78 vs. 14.61 +/- 4.42 ml; P = 0.025). After sham feeding the gallbladder ejection fraction was significantly lower in patients than in controls (32.86 +/- 17.21 vs. 49.40 +/- 7.86%; P = 0.007). Patients with cicatrization in the distal one-third of the esophagus had a greater basal gallbladder volume (24.57 +/- 9.2 ml) and significantly lower ejection fraction (20.47 +/- 8.9%) than patients with strictures at other sites (gallbladder volume, 18.50 +/- 10.69 ml; ejection fraction, 47.48 +/- 13.3%; P = 0.001). In conclusion, patients with corrosive-induced esophageal strictures, especially those in the distal one-third, had an increased fasting gallbladder volume and decreased cephalic phase of gallbladder emptying, pointing to impaired vagal cholinergic transmission, possibly due to vagal entrapment in the cicatrization process.

  14. Symptomatic posterior mediastinal angioleiomyoma.

    PubMed

    I, Hoseok; Jeong, Yeon Joo; Choi, Kyung Un; Kim, Yeong-Dae

    2008-08-30

    We report a case of a symptomatic angioleiomyoma in the left posterior mediastinum. A 66-year-old woman presented with left back and flank pain for 6 months. Chest computed tomography (CT) and magnetic resonance imaging (MRI) revealed a well-circumscribed 4.3 cm round mass. The mass was initially diagnosed as nerve sheath tumor, because of her symptoms and its close location to the sympathetic trunk and intercostal nerve. It was uneventfully removed through video-assisted thoracoscopic surgery. The pathology revealed an angioleiomyoma.

  15. Posterior Reversible Encephalopathy Syndrome and Fatal Cryptococcal Meningitis After Immunosuppression in a Patient With Elderly Onset Inflammatory Bowel Disease

    PubMed Central

    Vasant, Dipesh H.; Limdi, Jimmy K.; Borg-Bartolo, Simon P.; Bonington, Alec

    2016-01-01

    Advanced age and associated comorbidities are-recognized predictors of life-threatening adverse outcomes, such as opportunistic infection following immunosuppressive therapy. We describe the case of an elderly patient with stricturing colonic Crohn’s disease and significant clinical comorbidities, initially controlled with corticosteroid induction followed by infliximab, whose course was complicated by fatal disseminated cryptococcal infection and posterior reversible encephalopathy syndrome. Our patient’s case highlights rare, but serious, complications of immunosuppression. In applying modern treatment paradigms to the elderly, the clinician must consider the potential for more pronounced adverse effects in this potentially vulnerable group, maximizing benefit and minimizing harm. PMID:27807560

  16. Normal anatomic relationship between urethral sphincter complex and zones of prostrate in young Chinese males on MRI

    PubMed Central

    Wang, Xiangdong; Liu, Tieyan; Zhao, Jing; Sun, Jingyi; Chen, Yuefeng; Sun, Pengyu; Wang, Xuesong; Liu, Sheng

    2015-01-01

    Objective In this research, the normal anatomic relationship between urethral sphincter complex and zones of prostrate in young Chinese males has been studied. Methods: The sagittal, coronal, and axial T2-weighted non-fat suppressed fast spin-echo images of pelvic cavities of 86 Chinese young males were studied. Result: Urethral sphincter complex threaded through the prostate and divided it into 2 parts: transition zone (TZ), periurethral glands internal to the urethral sphincter and peripheral zone (PZ), central zone (CZ), anterior fibromuscular stroma (AFS) zone external to the urethral sphincter. The length of urethral striated sphincter is 12.26-20.94 mm (mean 16.59 mm) at membranous urethra. Conclusions: In this paper, we summarized the normal anatomic relationship between urethral sphincter complex and zones of prostrate in young Chinese males with no urinary control problems. PMID:26629244

  17. Efficacy of Retrievable Metallic Stent with Fixation String for Benign Stricture after Upper Gastrointestinal Surgery

    PubMed Central

    Kim, Jeong-Eun; Lee, Myungsu; Hur, Saebeom; Kim, Minuk; Lee, Sang Hwan; Cho, Soo Buem; Kim, Chan Sun; Han, Joon Koo

    2016-01-01

    Objective To determine the efficacy of retrievable metallic stent with fixation string for benign anastomotic stricture after upper gastrointestinal (UGI) surgery. Materials and Methods From June 2009 to May 2015, a total of 56 retrievable metallic stents with fixation string were placed under fluoroscopy guidance in 42 patients who were diagnosed with benign anastomotic stricture after UGI surgery. Clinical success was defined as achieving normal regular diet (NRD). Results The clinical success rate after the first stent placement was 57.1% (24/42). After repeated stent placement and/or balloon dilation, the clinical success rate was increased to 83.3% (35/42). Six (14.3%) patients required surgical revision to achieve NRD. One (2.4%) patient failed to achieve NRD. Stent migration occurred in 60.7% (34/56) of patients. Successful rate of removing the stent using fixation string and angiocatheter was 94.6% (53/56). Distal migration occurred in 12 stents. Of the 12 stents, 10 (83.3%) were successfully removed whereas 2 could not be removed. No complication occurred regarding distal migration. Conclusion Using retrievable metallic stent with a fixation string is a feasible option for managing early benign anastomotic stricture after UGI surgery. It can reduce complications caused by distal migration of the stent. PMID:27833405

  18. Palliation of Postoperative Gastrointestinal Anastomotic Malignant Strictures with Flexible Covered Metallic Stents: Preliminary Results

    SciTech Connect

    Lee, Jeong-Min; Han, Young Min; Lee, Sang Yong; Kim, Chong Soo; Yang, Doo Hyun; Lee, Seung Ok

    2001-01-15

    Purpose: To evaluate the efficacy of the placement of covered metallic stents for palliation of gastrointestinal anastomotic strictures secondary to recurrent gastric cancer.Methods: Under fluoroscopic guidance, placement of one or two self-expandable covered metallic stents was attempted perorally in 11 patents (aged 48-76 years) with anastomotic stenoses due to recurrent gastric malignancies. The strictures involved both the afferent and efferent loops in three patients. All patients had poor peroral food intake with severe nausea and vomiting after ingestion. The technical and clinical success was evaluated.Results: Placement of the covered stent was technically successful in 13 of 15 (87%) attempts in ten patients. After the procedure, 9 of 11 (82%) patients overall were able to ingest at least a liquid diet and had markedly decreased incidence of vomiting. During the follow-up of 2-31 weeks (mean 8.5 weeks) there were no major complications.Conclusion: These preliminary results suggest that flexible, covered stents may provide effective palliation of malignant anastomotic stricture secondary to recurrent gastric cancer.

  19. Development of a Swine Benign Biliary Stricture Model Using Endoscopic Biliary Radiofrequency Ablation

    PubMed Central

    2016-01-01

    The large animal model with benign biliary stricture (BBS) is essential to undergo experiment on developing new devices and endoscopic treatment. This study conducted to establish a clinically relevant porcine BBS model by means of endobiliary radiofrequency ablation (RFA). Endoscopic retrograde cholangiography (ERC) was performed on 12 swine. The animals were allocated to three groups (60, 80, and 100 W) according to the electrical power level of RFA electrode. Endobiliary RFA was applied to the common bile duct for 60 seconds using an RFA catheter that was endoscopically inserted. ERC was repeated two and four weeks, respectively, after the RFA to identify BBS. After the strictures were identified, histologic evaluations were performed. On the follow-up ERC two weeks after the procedure, a segmental bile duct stricture was observed in all animals. On microscopic examination, severe periductal fibrosis and luminal obliteration with transmural inflammation were demonstrated. Bile duct perforations occurred in two pigs (100 W, n = 1; 80 W, n = 1) but there were no major complications in the 60 W group. The application of endobiliary RFA with 60 W electrical power resulted in a safe and reproducible swine model of BBS. PMID:27510388

  20. Endoscopic and retrograde cholangiographic appearance of hepaticojejunostomy strictures: A practical classification

    PubMed Central

    Mönkemüller, Klaus; Jovanovic, Ivan

    2011-01-01

    AIM: To study the endoscopic and radiological characteristics of patients with hepaticojejunostomy (HJ) and propose a practical HJ stricture classification. METHODS: In a retrospective observational study, a balloon-assisted enteroscopy (BAE)-endoscopic retrograde cholangiography was performed 44 times in 32 patients with surgically-altered gastrointestinal (GI) anatomy. BAE-endoscopic retrograde cholangio pancreatography (ERCP) was performed 23 times in 18 patients with HJ. The HJ was carefully studied with the endoscope and using cholangiography. RESULTS: The authors observed that the hepaticojejunostomies have characteristics that may allow these to be classified based on endoscopic and cholangiographic appearances: the HJ orifice aspect may appear as small (type A) or large (type B) and the stricture may be short (type 1), long (type 2) and type 3, intrahepatic biliary strictures not associated with anastomotic stenosis. In total, 7 patients had type A1, 4 patients A2, one patient had B1, one patient had B (large orifice without stenosis) and one patient had type B3. CONCLUSION: This practical classification allows for an accurate initial assessment of the HJ, thus potentially allowing for adequate therapeutic planning, as the shape, length and complexity of the HJ and biliary tree choice may mandate the type of diagnostic and therapeutic accessories to be used. Of additional importance, a standardized classification may allow for better comparison of studies of patients undergoing BAE-ERCP in the setting of altered upper GI anatomy. PMID:22110837

  1. Useful strategies to prevent severe stricture after endoscopic submucosal dissection for superficial esophageal neoplasm

    PubMed Central

    Uno, Kaname; Iijima, Katsunori; Koike, Tomoyuki; Shimosegawa, Tooru

    2015-01-01

    The minimal invasiveness of endoscopic submucosal dissection (ESD) prompted us to apply this technique to large-size early esophageal squamous cell carcinoma and Barrett’s adenocarcinoma, despite the limitations in the study population and surveillance duration. A post-ESD ulceration of greater than three-fourths of esophageal circumference was advocated as an important risk factor for refractory strictures that require several sessions of dilation therapy. Most of the preoperative conditions are asymptomatic, but dilatation treatment for dysphagia associated with the stricture has potential risks of severe complications and a worsening of quality of life. Possible mechanisms of dysphasia were demonstrated based on dysmotility and pathological abnormalities at the site: (1) delayed mucosal healing; (2) severe inflammation and disorganized fibrosis with abundant extracellular matrices in the submucosa; and (3) atrophy in the muscularis proper. However, reports on the administration of anti-scarring agents, preventive dilation therapies, and regenerative medicine demonstrated limited success in stricture prevention, and there were discrepancies in the study designs and protocols of these reports. The development and consequent long-term assessments of new prophylactic technologies on the promotion of wound healing and control of the inflammatory/tumor microenvironment will require collaboration among various research fields because of the limited accuracy of preoperative staging and high-risk of local recurrence. PMID:26109798

  2. Posterior Cortical Atrophy

    PubMed Central

    Crutch, Sebastian J; Lehmann, Manja; Schott, Jonathan M; Rabinovici, Gil D; Rossor, Martin N; Fox, Nick C

    2013-01-01

    Posterior cortical atrophy (PCA) is a neurodegenerative syndrome that is characterized by a progressive decline in visuospatial, visuoperceptual, literacy and praxic skills. The progressive neurodegeneration affecting parietal, occipital and occipito-temporal cortices which underlies PCA is attributable to Alzheimer's disease (AD) in the majority of patients. However, alternative underlying aetiologies including Dementia with Lewy Bodies (DLB), corticobasal degeneration (CBD) and prion disease have also been identified, and not all PCA patients have atrophy on clinical imaging. This heterogeneity has led to diagnostic and terminological inconsistencies, caused difficulty comparing studies from different centres, and limited the generalizability of clinical trials and investigations of factors driving phenotypic variability. Significant challenges remain in identifying the factors associated with both the selective vulnerability of posterior cortical regions and the young age of onset seen in PCA. Greater awareness of the syndrome and agreement over the correspondence between syndrome-and disease-level classifications are required in order to improve diagnostic accuracy, research study design and clinical management. PMID:22265212

  3. Posterior Fossa Meningioma

    PubMed Central

    Saleh, Essam A.; Taibah, Abdel Kader; Achilli, Vittorio; Aristegui, Miguel; Mazzoni, Antonio; Sanna, Mario

    1994-01-01

    Posterior fossa meningioma is the second most common tumor in the cerebellopontine angle. It has a higher rate of postoperative morbidity and mortality compared to acoustic neuroma. Forty posterior fossa meningioma patients managed in our centers were reviewed. Thirty-nine patients were managed surgically with 42 surgical procedures. The approaches used were the translabyrinthine approach in 18 patients (43%), the modified transcochlear in 11 cases (26%), the petro-occipital transsigmoid in 5 cases (12%), the suboccipital in 4 cases (10%), the petro-occipital trassigmoid transcervical in 2 cases (5%), the petro-occipital transsigmoid transtentorial in 1 case (2%), and a subtemporal transtentorial for another case (2%). Facial nerve anatomical integrity was preserved in 87% of procedures but was interrupted in 5 cases, with 4 of the latter subsequently repaired. Total tumor removal was accomplished in 38 cases. A second-stage total tumor removal is planned for the remaining case. There was only one case of perioperative death and no cases of radiological recurrence so far. ImagesFigure 1Figure 2Figure 3Figure 4p206-bFigure 5p207-bFigure 5 PMID:17171173

  4. Main Bile Duct Stricture Occurring After Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma

    SciTech Connect

    Miyayama, Shiro Yamashiro, Masashi; Okuda, Miho; Yoshie, Yuichi; Nakashima, Yoshiko; Ikeno, Hiroshi; Orito, Nobuaki; Notsumata, Kazuo; Watanabe, Hiroyuki; Toya, Daisyu; Tanaka, Nobuyoshi; Matsui, Osamu

    2010-12-15

    The purpose of this study was to evaluate the clinical course of main bile duct stricture at the hepatic hilum after transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). Among 446 consecutive patients with HCC treated by TACE, main bile duct stricture developed in 18 (4.0%). All imaging and laboratory data, treatment course, and outcomes were retrospectively analyzed. All patients had 1 to 2 tumors measuring 10 to 100 mm in diameter (mean {+-} SD 24.5 {+-} 5.4 mm) near the hepatic hilum fed by the caudate arterial branch (A1) and/or medial segmental artery (A4) of the liver. During the TACE procedure that caused bile duct injury, A1 was embolized in 8, A4 was embolized in 5, and both were embolized in 5 patients. Nine patients (50.0%) had a history of TACE in either A1 or A4. Iodized oil accumulation in the bile duct wall was seen in all patients on computed tomography obtained 1 week later. Bile duct dilatation caused by main bile duct stricture developed in both lobes (n = 9), in the right lobe (n = 3), in the left lobe (n = 4), in segment (S) 2 (n = 1), and in S3 (n = 1). Serum levels of alkaline phosphatase and {gamma}-glutamyltranspeptidase increased in 13 patients. Biloma requiring drainage developed in 2 patients; jaundice developed in 4 patients; and metallic stents were placed in 3 patients. Complications after additional TACE sessions, including biloma (n = 3) and/or jaundice (n = 5), occurred in 7 patients and were treated by additional intervention, including metallic stent placement in 2 patients. After initial TACE of A1 and/or A4, 8 patients (44.4%), including 5 with uncontrollable jaundice or cholangitis, died at 37.9 {+-} 34.9 months after TACE, and 10 (55.6%) have survived for 38.4 {+-} 37.9 months. Selective TACE of A1 and/or A4 carries a risk of main bile duct stricture at the hepatic hilum. Biloma and jaundice are serious complications associated with bile duct strictures.

  5. A Challenging Surgical Approach to Locally Advanced Primary Urethral Carcinoma

    PubMed Central

    Lucarelli, Giuseppe; Spilotros, Marco; Vavallo, Antonio; Palazzo, Silvano; Miacola, Carlos; Forte, Saverio; Matera, Matteo; Campagna, Marcello; Colamonico, Ottavio; Schiralli, Francesco; Sebastiani, Francesco; Di Cosmo, Federica; Bettocchi, Carlo; Di Lorenzo, Giuseppe; Buonerba, Carlo; Vincenti, Leonardo; Ludovico, Giuseppe; Ditonno, Pasquale; Battaglia, Michele

    2016-01-01

    Abstract Primary urethral carcinoma (PUC) is a rare and aggressive cancer, often underdetected and consequently unsatisfactorily treated. We report a case of advanced PUC, surgically treated with combined approaches. A 47-year-old man underwent transurethral resection of a urethral lesion with histological evidence of a poorly differentiated squamous cancer of the bulbomembranous urethra. Computed tomography (CT) and bone scans excluded metastatic spread of the disease but showed involvement of both corpora cavernosa (cT3N0M0). A radical surgical approach was advised, but the patient refused this and opted for chemotherapy. After 17 months the patient was referred to our department due to the evidence of a fistula in the scrotal area. CT scan showed bilateral metastatic disease in the inguinal, external iliac, and obturator lymph nodes as well as the involvement of both corpora cavernosa. Additionally, a fistula originating from the right corpus cavernosum extended to the scrotal skin. At this stage, the patient accepted the surgical treatment, consisting of different phases. Phase I: Radical extraperitoneal cystoprostatectomy with iliac-obturator lymph nodes dissection. Phase II: Creation of a urinary diversion through a Bricker ileal conduit. Phase III: Repositioning of the patient in lithotomic position for an overturned Y skin incision, total penectomy, fistula excision, and “en bloc” removal of surgical specimens including the bladder, through the perineal breach. Phase IV: Right inguinal lymphadenectomy. The procedure lasted 9-and-a-half hours, was complication-free, and intraoperative blood loss was 600 mL. The patient was discharged 8 days after surgery. Pathological examination documented a T4N2M0 tumor. The clinical situation was stable during the first 3 months postoperatively but then metastatic spread occurred, not responsive to adjuvant chemotherapy, which led to the patient's death 6 months after surgery. Patients with advanced stage tumors of

  6. Noninvasive evaluation of active pan-ulcerative colitis with multiple strictures using Fluorine-18-Fluorodeoxyglucose positron emission tomography/computed tomography.

    PubMed

    Santhosh, Sampath; Bhattacharya, Anish; Rana, Surinder Singh; Bhasin, Deepak Kumar; Gupta, Rajesh; Mittal, Bhagwant Rai

    2016-01-01

    Ulcerative colitis (UC) is an inflammatory bowel disease characterized by waxing and waning inflammation that changes in severity and extent and may progress to neoplasia, especially in the presence of strictures. When patients have nonnegotiable strictures or severe inflammation with ulcers, colonoscopy is difficult and carries the risk of perforation. The authors present a patient with pan-UC with multiple strictures, in whom fluorodeoxyglucose positron emission tomography/computed tomography was used to noninvasively evaluate the extent and severity of the disease.

  7. Dynamics of the sensory response to urethral flow over multiple time scales in rat

    PubMed Central

    Danziger, Zachary C; Grill, Warren M

    2015-01-01

    The pudendal nerve carries sensory information from the urethra that controls spinal reflexes necessary to maintain continence and achieve efficient micturition. Despite the key role urethral sensory feedback plays in regulation of the lower urinary tract, there is little information about the characteristics of urethral sensory responses to physiological stimuli, and the quantitative relationship between physiological stimuli and the evoked sensory activation is unknown. Such a relation is critical to understanding the neural control of the lower urinary tract and how dysfunction arises in disease states. We systematically quantified pudendal afferent responses to fluid flow in the urethra in vivo in the rat. We characterized the sensory response across a range of stimuli, and describe a previously unreported long-term neural accommodation phenomenon. We developed and validated a compact mechanistic mathematical model capable of reproducing the pudendal sensory activity in response to arbitrary profiles of urethral flows. These results describe the properties and function of urethral afferents that are necessary to understand how sensory disruption manifests in lower urinary tract pathophysiology. Key points Sensory information from the urethra is essential to maintain continence and to achieve efficient micturition and when compromised by disease or injury can lead to substantial loss of function. Despite the key role urethral sensory information plays in the lower urinary tract, the relationship between physiological urethral stimuli, such as fluid flow, and the neural sensory response is poorly understood. This work systematically quantifies pudendal afferent responses to a range of fluid flows in the urethra in vivo and describes a previously unknown long-term neural accommodation phenomenon in these afferents. We present a compact mechanistic mathematical model that reproduces the pudendal sensory activity in response to urethral flow. These results have

  8. Novel posterior fixation keratoprosthesis

    NASA Astrophysics Data System (ADS)

    Lacombe, Emmanuel

    1992-08-01

    The keratoprosthesis is the last solution for corneally blind patients that cannot benefit from corneal transplants. Keratoprostheses that have been designed to be affixed anteriorly usually necessitate multi-step surgical procedures and are continuously subjected to the extrusion forces generated by the positive intraocular pressure; therefore, clinical results in patients prove inconsistent. We proposed a novel keratoprosthesis concept that utilizes posterior corneal fixation which `a priori' minimizes the risk of aqueous leakage and expulsion. This prosthesis is implanted in a single procedure thereby reducing the number of surgical complications normally associated with anterior fixation devices. In addition, its novel design makes this keratoprosthesis implantable in phakic eyes. With an average follow-up of 13 months (range 3 to 25 months), our results on 21 cases are encouraging. Half of the keratoprostheses were implanted in severe burn cases, with the remainder in cases of pseudo- pemphigus. Good visual results and cosmetic appearance were obtained in 14 of 21 eyes.

  9. Posterior pole tumor update.

    PubMed

    Ou, Judy I; Wheeler, Sharon M; O'Brien, Joan M

    2002-12-01

    This chapter focuses on the diagnosis and management of choroidal melanoma in light of recent findings from the COMS. Retinoblastoma is emphasized to describe recent trends in primary treatment away from EBRT and toward chemoreduction with local therapy. In addition, vascular and glial tumors of the retina and tumors of the retinal pigment epithelium are described because of the association between these lesions and systemic disease. Recent advances in treatment and genetic testing for these diseases are discussed. Finally, ocular metastasis, intraocular lymphoid tumors, and intraocular leukemia are included because of their importance in determining systemic treatment and prognosis. The chapter gives an overview of important posterior pole tumors and highlights recent developments in the management of each intraocular disease process.

  10. Salvage therapy using self-expandable metal stents for recalcitrant anastomotic strictures after living-donor liver transplantation

    PubMed Central

    Jang, Sung Ill; Sung, Se Yong; Park, Hyunsung; Lee, Kwang-Hun; Joo, Seung-Moon; Lee, Dong Ki

    2017-01-01

    Background: Recently, there has been an increase in clinical success rates using nonsurgical methods to resolve anastomotic biliary strictures (ABSs) that develop after liver transplantation (LT). However, some strictures are particularly refractory and cannot be completely resolved by an endoscopic or percutaneous procedure. Consequently, the aim of this study was to examine the feasibility and efficacy of using a newly designed fully covered self-expandable metal stent (FCSEMS) to resolve refractory ABS. Methods: A total of 35 patients with an ABS that developed after LT, but could not be resolved by an endoscopic or percutaneous procedure, were included in this study. FCSEMSs were positioned endoscopically and removed after 2–3 months. After stent removal, the patients were followed to assess complications, including re-stenosis. Results: The mean period from LT to stricture was 13.7 months, and the mean duration of the stricture was 31.8 months. The type and mean number of procedures previously attempted were endoscopic retrograde cholangiopancreatography (ERCP) (9.1 ± 5.1) in 19 patients and percutaneous transhepatic biliary drainage (9.2 ± 4.8) in 16 patients. All patients had successful FCSEMS insertions and removals; the mean stent indwelling time was 3.2 months. The mean follow-up period was 18.7 months (range: 6.4–37.8 months). Stricture recurrence was observed in 6 of 29 patients (recurrence rate: 20.7%). The anastomotic stricture resolved with the FCSEMS insertion in 29 of 35 patients (clinical success rate: 82.9%). Conclusions: The newly designed FCSEMS is a potentially feasible and effective treatment for anastomotic strictures that develop after LT but are not amenable to treatment by conventional procedures. PMID:28246547

  11. Intestinal and cloacal strictures in free-ranging and aquarium-maintained green sea turtles (Chelonia mydas).

    PubMed

    Erlacher-Reid, Claire D; Norton, Terry M; Harms, Craig A; Thompson, Rachel; Reese, David J; Walsh, Michael T; Stamper, M Andrew

    2013-06-01

    Intestinal or cloacal strictures that resulted in intestinal obstruction were diagnosed in six green sea turtles (Chelonia mydas) from three rehabilitation facilities and two zoologic parks. The etiologies of the strictures were unknown in these cases. It is likely that anatomic adaptations of the gastrointestinal tract unique to the green sea turtle's herbivorous diet, paired with causes of reduced intestinal motility, may predispose the species to intestinal damage and subsequent obstructive intestinal disease. In aquarium-maintained green sea turtles, obesity, diet, reduced physical activity, chronic intestinal disease, and inappropriate or inadequate antibiotics might also be potential contributing factors. Clinical, radiographic, and hematologic abnormalities common among most of these sea turtles include the following: positive buoyancy; lethargy; inappetence; regurgitation; obstipation; dilated bowel and accumulation of oral contrast material; anemia; hypoglycemia; hypoalbuminemia; hypocalcemia; and elevated creatine kinase, aspartate aminotransferase, and blood urea nitrogen. Although these abnormalities are nonspecific with many possible contributing factors, intestinal disease, including strictures, should be considered a differential in green sea turtles that demonstrate all or a combination of these clinical findings. Although diagnostic imaging, including radiographs, computed tomography, or magnetic resonance imaging, are important in determining a cause for suspected gastrointestinal disease and identifying an anatomic location of obstruction, intestinal strictures were not successfully identified when using these imaging modalities. Lower gastrointestinal contrast radiography, paired with the use of oral contrast, was useful in identifying the suspected site of intestinal obstruction in two cases. Colonoscopy was instrumental in visually diagnosing intestinal stricture in one case. Therefore, lower gastrointestinal contrast radiography and

  12. Norfloxacin-releasing urethral catheter for long-term catheterization.

    PubMed

    Park, Jae Hyung; Cho, Yong Woo; Cho, Yong-Hyun; Choi, Joong Myung; Shin, Hee Jong; Bae, You Han; Chung, Hesson; Jeong, Seo Young; Kwon, Ick Chan

    2003-01-01

    Norfloxacin-releasing urethral catheters were prepared for the purpose of preventing urinary tract infections during long-term catheterization. The outer and inner surfaces of the catheters were coated with poly(ethylene-co-vinyl acetate) (EVA) and an amphiphilic multiblock co-polymer (PEO2kPDMS), composed of poly(ethylene oxide) and poly(dimethyl siloxane). Norfloxacin, a fluoroquinolone synthetic antibiotic, was impregnated into a coating layer. The in vitro drug release behavior was monitored for 30 days, the surface topography was investigated using scanning electron microscopy (SEM) and the antibacterial activity against different bacteria implicated in urinary tract infection was evaluated by the in vitro inhibition zone test. All the coated catheters showed continuous delivery of norfloxacin for up to 30 days owing to hydrophobic natures of norfloxacin and EVA. PEO2kPDMS incorporated in a coating layer produced a smooth and uniform surface. The coated catheters created considerable inhibition zones for 10 days against Escherichia coli. Klebsiella pneumoniae and Proteus vulgaris, indicating the continuous release of norfloxacin. Overall, it was evident that the catheters coated with EVA/PEO2kPDMS blends containing norfloxacin have a promising potential for the clinical use in patients undergoing long-term catheterization.

  13. Urethral Pain Among Prostate Cancer Survivors 1 to 14 Years After Radiation Therapy

    SciTech Connect

    Pettersson, Niclas; Olsson, Caroline; Tucker, Susan L.; Alsadius, David; Wilderaeng, Ulrica; Johansson, Karl-Axel; Steineck, Gunnar

    2013-01-01

    Purpose: To investigate how treatment-related and non-treatment-related factors impact urethral pain among long-term prostate cancer survivors. Methods and Materials: Men treated for prostate cancer with radiation therapy at the Sahlgrenska University Hospital in Goeteborg, Sweden from 1993 to 2006 were approached with a study-specific postal questionnaire addressing symptoms after treatment, including urethral burning pain during urination (n=985). The men had received primary or salvage external-beam radiation therapy (EBRT) or EBRT in combination with brachytherapy (BT). Prescribed doses were commonly 70 Gy in 2.0-Gy fractions for primary and salvage EBRT and 50 Gy plus 2 Multiplication-Sign 10.0 Gy for EBRT + BT. Prostatic urethral doses were assessed from treatment records. We also recruited 350 non-pelvic-irradiated, population-based controls matched for age and residency to provide symptom background rates. Results: Of the treated men, 16% (137 of 863) reported urethral pain, compared with 11% (27 of 242) of the controls. The median time to follow-up was 5.2 years (range, 1.1-14.3 years). Prostatic urethral doses were similar to prescription doses for EBRT and 100% to 115% for BT. Fractionation-corrected dose and time to follow-up affected the occurrence of the symptom. For a follow-up {>=}3 years, 19% of men (52 of 268) within the 70-Gy EBRT + BT group reported pain, compared with 10% of men (23 of 222) treated with 70 Gy primary EBRT (prevalence ratio 1.9; 95% confidence interval 1.2-3.0). Of the men treated with salvage EBRT, 10% (20 of 197) reported urethral pain. Conclusions: Survivors treated with EBRT + BT had a higher risk for urethral pain compared with those treated with EBRT. The symptom prevalence decreased with longer time to follow-up. We found a relationship between fractionation-corrected urethral dose and pain. Among long-term prostate cancer survivors, the occurrence of pain was not increased above the background rate for prostatic urethral

  14. Bacterial Vaginosis–Associated Bacteria in Men: Association of Leptotrichia/Sneathia spp. With Nongonococcal Urethritis

    PubMed Central

    Manhart, Lisa E.; Khosropour, Christine M.; Liu, Congzhu; Gillespie, Catherine W.; Depner, Kevin; Fiedler, Tina; Marrazzo, Jeanne M.; Fredricks, David N.

    2014-01-01

    Background Approximately 45% of nongonococcal urethritis cases have no identified etiology. Novel bacteria recently associated with bacterial vaginosis (BV) in women may be involved. We evaluated the association of idiopathic nongonococcal urethritis and 5 newly described BV-associated bacteria (BVAB). Methods Heterosexual men 16 years or older attending a sexually transmitted disease clinic in Seattle, Washington, from May 2007 to July 2011 and negative for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma genitalium, and Ureaplasma urealyticum–biovar2 were eligible. Cases had urethral discharge or 5 or more polymorphonuclear leukocytes per high-power field in urethral exudates. Controls had no urethral discharge and less than 5 polymorphonuclear leukocytes per high-power field. Urine was tested for Atopobium spp., BVAB-2, BVAB-3, Megasphaera spp., and Leptotrichia/Sneathia spp. using quantitative taxon-directed polymerase chain reaction. Results Cases (n = 157) and controls (n = 102) were of similar age, education, and income, and most were white. Leptotrichia/Sneathia spp. was significantly associated with urethritis (24/157 [15.3%] vs. 6/102 [5.9%], P = 0.03). BVAB-2 was more common in cases than in controls (7/157 [4.5%] vs. 1/102 [1.0%], P = 0.15), and BVAB-3 (n = 2) and Megasphaera spp. (n = 1) were only detected in men with urethritis, but these bacteria were found only in men who also had Leptotrichia/Sneathia spp. Atopobium spp. was not associated with urethritis. The quantity of bacteria did not differ between cases and controls. Among treated cases, doxycycline was more effective than azithromycin for clinical cure of men with Leptotrichia/Sneathia spp. (9/10 vs. 7/12, P = 0.16) and BVAB-2 (3/3 vs. 0/3, P = 0.10). Conclusions Leptotrichia/Sneathia spp. may be urethral pathogens or contribute to a pathogenic microbiota that can also include BVAB-2, BVAB-3, and Megasphaera spp. Doxycycline may be more effective than

  15. PCR for diagnosis of male Trichomonas vaginalis infection with chronic prostatitis and urethritis.

    PubMed

    Lee, Jong Jin; Moon, Hong Sang; Lee, Tchun Yong; Hwang, Hwan Sik; Ahn, Myoung-Hee; Ryu, Jae-Sook

    2012-06-01

    The aim of this study was to assess the usefulness of PCR for diagnosis of Trichomonas vaginalis infection among male patients with chronic recurrent prostatitis and urethritis. Between June 2001 and December 2003, a total of 33 patients visited the Department of Urology, Hanyang University Guri Hospital and were examined for T. vaginalis infection by PCR and culture in TYM medium. For the PCR, we used primers based on a repetitive sequence cloned from T. vaginalis (TV-E650). Voided bladder urine (VB1 and VB3) was sampled from 33 men with symptoms of lower urinary tract infection (urethral charge, residual urine sensation, and frequency). Culture failed to detect any T. vaginalis infection whereas PCR identified 7 cases of trichomoniasis (21.2%). Five of the 7 cases had been diagnosed with prostatitis and 2 with urethritis. PCR for the 5 prostatitis cases yielded a positive 330 bp band from bothVB1 and VB3, whereas positive results were only obtained from VB1 for the 2 urethritis patients. We showed that the PCR method could detect T. vaginalis when there was only 1 T. vaginalis cell per PCR mixture. Our results strongly support the usefulness of PCR on urine samples for detecting T. vaginalis in chronic prostatitis and urethritis patients.

  16. Prostate Histotripsy: Evaluation of Prostatic Urethral Treatment Parameters in a Canine Model

    PubMed Central

    Schade, George R.; Styn, Nicholas R.; Ives, Kimberly A.; Hall, Timothy L.; Roberts, William W.

    2013-01-01

    Objective - To assess the impact of histotripsy treatment parameters (pulse number and pulse-repetition frequency [PRF]) on the efficiency of histotripsy induced homogenization of the prostatic urethra. Material and Methods - A total of 34 transabdominal prostate histotripsy treatments were applied along a perpendicular plane traversing the prostatic urethra of 21 canine subjects. - Prostate histotripsy was applied with 1) escalating pulse number with fixed PRF or 2) at fixed pulse number with varying PRFs. - The development of urethral homognization within 14 days of histotripsy was evaluated endoscopically and confirmed histologically. Results - Within 14 days of histotripsy 50%, 83%, 83%, and 100% of subjects receiving 12.5k, 25k, 50k, and 100k pulses per mm of treatment path (delivered at 500Hz PRF), respectively developed prostatic urethral disintegration. - Delivery of 100k pulses per mm was required to achieve urethral disintegration in all subjects within 24 hours of histotripsy treatment. - Increasing histotripsy PRF from 50Hz to 500Hz to 2,000Hz while applying a constant dose of 25k pulses per mm treatment was associated with increased rate of urethral disintegration (50% vs 75% vs 100% at 14 days, respectively). Conclusions - Increasing the number of histotripsy pulses and/or increasing the PRF of histotripsy treatment applied to the urethra may improve the rate and efficiency of prostatic urethral disintegration in the canine model. - This understanding will aid in the development of treatment strategies for prostate histotripsy for BPH in human trials. PMID:24176120

  17. Ureteroiliac Artery Fistula Caused by a Metallic Memokath Ureteral Stent in a Radiation-Induced Ureteral Stricture

    PubMed Central

    Das, Krishanu; Ordones, Flavio; Welikumbura, Sumudu

    2016-01-01

    Abstract Background: Memokath 051™ stents are increasingly used for management of benign and malignant ureteral strictures refractory to management with single or tandem polymeric Double-J ureteral stents. Migration, encrustation, and difficulty in extraction during stent exchange are the chief problems reported so far with these thermoexpandable metallic stents. We report an unusual complication of ureteroexternal iliac artery fistula (UEAF) caused by Memokath stent inserted for radiation-induced ureteral stricture. Case Presentation: A 71-year-old male with history of colorectal cancer (underwent extirpative surgery + chemoradiotherapy) and subsequently radiation-induced ureteral stricture had bilateral Memokath ureteral stents inserted. Three months later, he presented with sepsis and hemodynamic instability secondary to UEAF, confirmed on angiography. A covered vascular stent was inserted as an immediate management. Conclusion: Memokath stent insertion in radiation-induced ureteral strictures may be associated with an increased risk of erosion and the rare potential complication of UEAF. This potential risk needs to be considered in the overall setting of such strictures and the difficulty in treating them. Prompt imaging (angiography) and placement of an endovascular stent are the ideal immediate options in such cases. PMID:27785465

  18. Posterior Reversible Encephalopathy Syndrome

    PubMed Central

    Algahtani, Abdulhadi; Aldarmahi, Ahmad; Hmoud, Mohammed; Marzuk, Yousef; Shirah, Bader

    2016-01-01

    Objectives: Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome characterized by headache, altered mental status, seizures, or loss of vision. In this study, we report the largest series of PRES coming from Saudi Arabia and explore the etiology, clinical presentation, and outcome. We also report new imaging findings associated with this condition. Methods: We performed a retrospective study of all cases of PRES admitted to King Abdulaziz Medical City, Jeddah, Saudi Arabia, between the years 2005 and 2015. A neurologist reviewed all charts and analyzed the clinical presentations, etiological factors, and outcomes, and a neuroradiologist reviewed the imaging studies. Only patients with clinical and imaging features consistent with PRES were included in the study. Results: We collected 31 patients who had clinical and radiological features consistent with PRES. Females were more affected than males (18 females and 13 males), and patients’ age ranged from 6 to 95 years, with a mean of 38.3 years. Patients were treated by removing the precipitating causes and treating the underlying conditions. Resolution of neurologic signs occurred within 2 to 3 weeks in all patients. Conclusion: In our opinion, PRES itself is usually a benign condition with complete recovery if the condition is recognized early and managed appropriately. Although clinical signs are nonspecific, the constellation of symptoms including headache, visual problems, seizures, and altered level of consciousness should suggest the possibility of PRES, especially in high-risk group. Abnormalities on magnetic resonance imaging are often characteristic and may be the first clue to the diagnosis. PMID:28042366

  19. Intraluminal Radioactive Stent Compared with Covered Stent Alone for the Treatment of Malignant Esophageal Stricture

    SciTech Connect

    Wang Zhongmin; Huang Xunbo; Cao Jun; Huang Gang; Chen Kemin LIu Yu; Liu Fenju

    2012-04-15

    Objective: This study was designed to compare the clinical effectiveness of intraluminal radioactive stent loaded with iodine-125 seeds implantation versus covered stent alone insertion in patients with malignant esophageal stricture. Methods: We studied two groups of patients with malignant esophageal stricture. Group A comprised 28 patients (19 men and 9 women) who underwent intraluminal radioactive stent loaded with iodine-125 seeds implantation and were followed prospectively. Group B comprised 30 patients (18 men and 12 women) who had previously received covered stent alone insertion; these patients were evaluated retrospectively. There was no crossover between the two groups during follow-up. Informed consent was obtained from each patient, and our institutional review board approved the study. The dysphagia score, overall survival rates, complication rates, and reintervention rates were compared in the two groups. Results: There were no significant differences between the two groups in terms of baseline characteristics. Stent placement was technically successful and well tolerated in all patients. The dysphagia score was improved in both groups after stent placement. The median survival was significantly longer in group A than in group B: 11 versus 4.9 months, respectively (P < 0.001). The complications of chest pain, esophageal reflux, and stent migration was more frequent in group B, but this difference did not reach statistical significance. There was no statistical difference in reintervention between two groups. Conclusions: Intraluminal radioactive stent loaded with iodine-125 seeds implantation was a feasible and practical management in treating malignant esophageal stricture and was superior to covered stent alone insertion, as measured by survival.

  20. Cell Sheet Transplantation for Esophageal Stricture Prevention after Endoscopic Submucosal Dissection in a Porcine Model

    PubMed Central

    Pidial, Laetitia; Camilleri, Sophie; Bellucci, Alexandre; Casanova, Amaury; Viel, Thomas; Tavitian, Bertrand; Cellier, Christophe; Clement, Olivier

    2016-01-01

    Background & Aims Extended esophageal endoscopic submucosal dissection (ESD) is highly responsible for esophageal stricture. We conducted a comparative study in a porcine model to evaluate the effectiveness of adipose tissue-derived stromal cell (ADSC) double cell sheet transplantation. Methods Twelve female pigs were treated with 5 cm long hemi-circumferential ESD and randomized in two groups. ADSC group (n = 6) received 4 double cell sheets of allogenic ADSC on a paper support membrane and control group (n = 6) received 4 paper support membranes. ADSC were labelled with PKH-67 fluorophore to allow probe-based confocal laser endomicroscopie (pCLE) monitoring. After 28 days follow-up, animals were sacrificed. At days 3, 14 and 28, endoscopic evaluation with pCLE and esophagography were performed. Results One animal from the control group was excluded (anesthetic complication). Animals from ADSC group showed less frequent alimentary trouble (17% vs 80%; P = 0.08) and higher gain weight on day 28. pCLE demonstrated a compatible cell signal in 4 animals of the ADSC group at day 3. In ADSC group, endoscopy showed that 1 out of 6(17%) animals developed a severe esophageal stricture comparatively to 100% (5/5) in the control group; P = 0.015. Esophagography demonstrated a decreased degree of stricture in the ADSC group on day 14 (44% vs 81%; P = 0.017) and day 28 (46% vs 90%; P = 0.035). Histological analysis showed a decreased fibrosis development in the ADSC group, in terms of surface (9.7 vs 26.1 mm²; P = 0.017) and maximal depth (1.6 vs 3.2 mm; P = 0.052). Conclusion In this model, transplantation of allogenic ADSC organized in double cell sheets after extended esophegeal ESD is strongly associated with a lower esophageal stricture’s rate. PMID:26930409

  1. Double-Layered PTFE-Covered Nitinol Stents: Experience in 32 Patients with Malignant Esophageal Strictures

    SciTech Connect

    Park, Jung Gu; Jung, Gyoo-Sik Oh, Kyung Seung; Park, Seon-Ja

    2010-08-15

    We evaluated the effectiveness of a double-layered polytetrafluoroethylene (PTFE)-covered nitinol stent in the palliative treatment of malignant esophageal strictures. A double-layered PTFE-covered nitinol stent was designed to reduce the propensity to migration of conventional covered stent. The stent consists of an inner PTFE-covered stent and an outer uncovered nitinol stent tube. With fluoroscopic guidance, the stent was placed in 32 consecutive patients with malignant esophageal strictures. During the follow-up period, the technical and clinical success rates, complications, and cumulative patient survival and stent patency were evaluated. Stent placement was technically successful in all patients, and no procedural complications occurred. After stent placement, the symptoms of 30 patients (94%) showed improvement. During the mean follow-up of 103 days (range, 9-348 days), 11 (34%) of 32 patients developed recurrent symptoms due to tumor overgrowth in five patients (16%), tumor ingrowth owing to detachment of the covering material (PTFE) apart from the stent wire in 3 (9%), mucosal hyperplasia in 2 (6%), and stent migration in 1 (3%). Ten of these 11 patients were treated by means of placing a second covered stent. Thirty patients died, 29 as a result of disease progression and 1 from aspiration pneumonia. The median survival period was 92 days. The median period of primary stent patency was 190 days. The double-layered PTFE-covered nitinol stent seems to be effective for the palliative treatment of malignant esophageal strictures. We believe that the double-layer configuration of this stent can contribute to decreasing the stent's migration rate.

  2. Treatment of a Ruptured Anastomotic Esophageal Stricture Following Bougienage with a Dacron-Covered Nitinol Stent

    SciTech Connect

    Heindel, Walter; Gossmann, Axel; Fischbach, Roman; Michel, Olaf; Lackner, Klaus

    1996-11-15

    A patient suffering from esophagorespiratory fistula after bougienage of a benign stricture at the site of the anastomosis between a jejunal interposition and the esophagus was referred for interventional treatment. A prototype nitinol stent centrally covered with Dacron was implanted under regional anesthesia and fluoroscopic guidance. The self-expanding prosthesis dilated the stenosis completely and closed the fistula, with consequent improvement in respiratory and nutritional status and thus the general quality of life. The patient was able to eat and drink normally until death 3 months later due to progression of his underlying malignant disease.

  3. Pharyngeal Neisseria gonorrhoeae detection in oral-throat wash specimens of male patients with urethritis.

    PubMed

    Takahashi, Satoshi; Kurimura, Yuichiro; Hashimoto, Jiro; Takeyama, Koh; Koroku, Mikio; Tanda, Hitoshi; Nishimura, Masahiro; Tsukamoto, Taiji

    2008-12-01

    Detection of Neisseria gonorrhoeae and Chlamydia trachomatis in the pharynx has been highlighted in the prevention of the unexpected spread of sexually transmitted diseases. We tried to clarify the detection rate of Neisseria gonorrhoeae in the pharynx and the clinical relevance of oral-throat wash specimens to detect the organism in heterosexual men with gonococcal and nongonococcal urethritis. In our cohort of 79 male patients with urethritis, oral throat wash specimens were collected after they had gargled with normal saline for approximately 30 to 60 s. Positive pharyngeal N. gonorrhoeae was defined as a positive result on the strand displacement amplification test for the specimen from the oral-throat wash. N. gonorrhoeae was detected in the oral-throat wash specimens of 13 (31.7%) of the 41 male patients with gonococcal urethritis. Oral-throat wash with a nucleic acid amplification test can detect pharyngeal N. gonorrhoeae easily and efficiently.

  4. [Can bladder catheterization in pediatrics cause complications? The case of a urethral dysuria cystograph].

    PubMed

    Alcázar García, A; Daviu Llorens, E; Daza Laguna, A; Durán Feliubadalo, C; Pons Torrents, X

    2009-10-01

    A urethral dysuria cystograph (CUMS (Cistografia Ureteral Miccional Seriada)) is the first diagnostic procedure, by means of x-rays, to evaluate bladder-urethral reflux. It consists of a bladder catheter to administer a radiopaque contrast dye through the ureter. To use the aforementioned technique without any asepsis measures and without knowledge about it can lead to possible complications. By means of a retrospective study using a sample of 181 patients, the authors have evaluated the incidence of possible complications and/or subsequent discomfort due to a urethral dysuria cystograph (CUMS). As final results, by means of an after test telephone call, the authors observed that 96.7% of the children who underwent this technique did not manifest any type of complication nor urinary discomfort.

  5. Photodynamic therapy of urethral condylomata acuminata using topically 5-aminolevulinic acid

    NASA Astrophysics Data System (ADS)

    Wang, Xiuli; Wang, Hongwei; Wang, Haishan; Xu, Shizheng; Liao, Kanghuang; Hillemanns, Peter

    2005-07-01

    Background Electrocoagulation and laser evaporation for urethral condylomata acuminata have high recurrence rates and can be associated with urethral malformations. Objective To investigate the effect of photodynamic therapy (PDT) with topical 5-aminolevulinic acid (ALA) on urethral condylomata acuminata and to examine the histological changes in lesions of condylomata acuminata after ALA-PDT. Methods One hundred and sixty-four urethral condylomata patients were given topical ALA followed by intraurethral PDT through a cylindrical fiber. Among the cases, 16 penile and vulval condylomatous lesions in 11 patients were treated with topical ALA-PDT at same time. After the treatment, biopsy specimens were collected from the 16 penile and vulval lesions. The histological changes were then evaluated by light microscope and electron microscope. Results The complete response rate for urethral condylomata by topical ALA-PDT was 95.12% and the recurrence rate was 5.13% after 6 to 24 months follow-up. Keratinocytes in middle and upper layers of the epidermis with marked vacuolation and some necrocytosis were detected one and three hours after PDT. Necrosis in all layers of the epidermis was noted five hours after PDT by microscopy. In electron microscopy of kerationcytes, distinct ultrastructural abnormalities of mitochondrion, endoplasmic reticulum and membrane damage were observed. Apoptotic bodies were detected three hours after PDT and a large number of the keratinocytes exhibited necrosis five hours after PDT by electron microscope. Conclusions Results suggests that topical ALA-PDT is a simple, effective, relatively safe, less recurrent and comparatively well tolerated treatment for urethral condylomata acuminata. The mechanisms might be that ALA-PDT could trigger apoptotic process and necrosis in the HPV infected keratinocytes. Key words:

  6. Advances in Surgical Reconstructive Techniques in the Management of Penile, Urethral, and Scrotal Cancer.

    PubMed

    Bickell, Michael; Beilan, Jonathan; Wallen, Jared; Wiegand, Lucas; Carrion, Rafael

    2016-11-01

    This article reviews the most up-to-date surgical treatment options for the reconstructive management of patients with penile, urethral, and scrotal cancer. Each organ system is examined individually. Techniques and discussion for penile cancer reconstruction include Mohs surgery, glans resurfacing, partial and total glansectomy, and phalloplasty. Included in the penile cancer reconstruction section is the use of penile prosthesis in phalloplasty patients after penectomy, tissue engineering in phallic regeneration, and penile transplantation. Reconstruction following treatment of primary urethral carcinoma and current techniques for scrotal cancer reconstruction using split-thickness skin grafts and flaps are described.

  7. Acute urinary retention secondary to urethral involvement of granulomatosis with polyangiitis

    PubMed Central

    Anderson, Patrick T.; Gottheil, Stephanie; Gabril, Manal; Barra, Lillian; Power, Nicholas

    2017-01-01

    Granulomatosis with polyangiitis (GPA, formerly Wegener’s granulomatosis) is a systemic necrotizing vasculitis of small- and medium-sized blood vessels, primarily affecting the upper and lower respiratory tracts, as well as the kidneys. Urogenital manifestations of GPA are exceedingly rare and usually respond well to systemic immunosuppressive therapy. Here, we present a case of a 36-year-old female presenting with acute urinary obstruction secondary to urethral GPA involvement in the immediate postpartum period. Special consideration should be given to ruling out malignancy in all patients with a history of GPA and urethral lesions, especially when there is a history of cyclophosphamide treatment. PMID:28163812

  8. Anterior Urethrectomy for Primary Carcinoma of the Female Urethra Mimicking a Urethral Caruncle

    PubMed Central

    Shim, Ji Sung; Oh, Mi Mi; Lee, Jeong Gu

    2013-01-01

    Here we report a case of primary carcinoma of the female urethra. A 52-year-old woman presented with a palpable urethral mass associated with intermittent pain that she first experienced a few months prior. Clinical examination showed a urethral mass that appeared to be a caruncle; therefore, simple carunclectomy was performed. However, on histological examination, the mass was revealed to be a squamous cell carcinoma; therefore, anterior urethrectomy was performed. During a 4-year follow-up period, the patient has been well with no dysuria, dyspareunia, or incontinence. PMID:24466468

  9. Anterior urethrectomy for primary carcinoma of the female urethra mimicking a urethral caruncle.

    PubMed

    Shim, Ji Sung; Oh, Mi Mi; Lee, Jeong Gu; Bae, Jae Hyun

    2013-12-01

    Here we report a case of primary carcinoma of the female urethra. A 52-year-old woman presented with a palpable urethral mass associated with intermittent pain that she first experienced a few months prior. Clinical examination showed a urethral mass that appeared to be a caruncle; therefore, simple carunclectomy was performed. However, on histological examination, the mass was revealed to be a squamous cell carcinoma; therefore, anterior urethrectomy was performed. During a 4-year follow-up period, the patient has been well with no dysuria, dyspareunia, or incontinence.

  10. Three-dimensional structure of a parameatal urethral cyst by scanning electron microscopy.

    PubMed

    Yamada, Nanako; Yoshida, Yuichi; Ito, Ayako; Morino, Shinichi; Yamamoto, Osamu

    2013-05-01

    We report scanning electron microscopy (SEM) for a case of parameatal urethral cyst. A 6-year-old Japanese boy presented with a cyst on the right lateral side of the urethral meatus. Histological examination revealed a cyst lined with columnar epithelium. An immunohistochemical study showed positive staining for CK7, CK13, and CEA, and negative for CK20 in luminal cells. On SEM examination, the inner surface of the cyst showed ridges arranged in a gyrus-like manner at lower magnification. Higher magnification revealed luminal cells with short microvillus projections. Some cells showed apocrine, merocrine, and possibly holocrine-type secretions.

  11. Posterior sampling with improved efficiency

    SciTech Connect

    Hanson, K.M.; Cunningham, G.S.

    1998-12-01

    The Markov Chain Monte Carlo (MCMC) technique provides a means to generate a random sequence of model realizations that sample the posterior probability distribution of a Bayesian analysis. That sequence may be used to make inferences about the model uncertainties that derive from measurement uncertainties. This paper presents an approach to improving the efficiency of the Metropolis approach to MCMC by incorporating an approximation to the covariance matrix of the posterior distribution. The covariance matrix is approximated using the update formula from the BFGS quasi-Newton optimization algorithm. Examples are given for uncorrelated and correlated multidimensional Gaussian posterior distributions.

  12. Topical application of mitomycin C in the treatment of esophageal and tracheobronchial stricture: a report of 2 cases.

    PubMed

    Daher, Paul; Riachy, Edward; Georges, Beyrouthy; Georges, Dabar; Adib, Moukarzel

    2007-09-01

    We present 2 cases of successful treatment of recurrent anastomotic strictures using a topical application of mitomycin C. In the first case, a 4-year-old boy had a cervical cyst excised, which appeared to be an ectopic gastric mucosa. He consequently presented severe stenosis at the origin of the cervical esophagus that needed repeated balloon dilatations. The second case is about a 12-year-old girl who presented a traumatic complete rupture of the right mainstem bronchus managed by primary repair, with subsequent anastomotic stricture. Both patients were successfully managed with topical application of mitomycin C (1 mg/mL), and needed no more dilatations.

  13. [THE TREATMENT OF POSTOPERATIVE STRICTURE OF BILIARY DUCTS: A 15-YEARS EXPERIENCE AND OBSERVATIONS FROM THE PRACTICE].

    PubMed

    Tishchenko, A M; Boyko, V V; Smachilo, R M; Skoriy, D I

    2015-09-01

    Experience of performance of 160 operations for injuries and stricture of biliary ducts, was analyzed. In 36 patients before admittance to hospital there were performed interventions, which provide correction of injuries or their consequences. In majority (141) of patients hepaticojejunoanastomosis in accordance to Roux method or its reconstruction were performed. Other interventions (right-sided hemihepatectomy) were rarely performed. The procedure of anastomosis formation, permitting to connect the mucosae of joining organs in precision, was proposed. Clinical observations of correction of the biliary ducts stricture were presented.

  14. Treatment of Complete Anal Stricture after Diverting Colostomy for Fournier's Gangrene

    PubMed Central

    Kubota, Tadao; Lefor, Alan Kawarai; Mizokami, Ken

    2017-01-01

    Background. Anal stenosis is a rare but serious complication of anorectal surgery. Severe anal stenosis is a challenging condition. Case Presentation. A 70-year-old Japanese man presented with a ten-hour history of continuous anal pain due to incarcerated hemorrhoids. He had a history of reducible internal hemorrhoids and was followed for 10 years. He had a fever and nonreducible internal hemorrhoids surrounding necrotic soft tissues. He was diagnosed as Fournier's gangrene and treated with debridement and diverting colostomy. He needed temporary continuous renal replacement therapy and was discharged on postoperative day 39. After four months, severe anal stenosis was found on physical examination, and total colonoscopy showed a complete anal stricture. The patient was brought to the operating room and underwent colostomy closure and anoplasty. He recovered without any complications. Conclusion. We present a first patient with a complete anal stricture after diverting colostomy treated with anoplasty and stoma closure. This case reminds us of the assessment of distal bowel conduit and might suggest that anoplasty might be considered in the success of the colostomy closure. PMID:28255493

  15. A systematic review of animal and clinical studies on the use of scaffolds for urethral repair.

    PubMed

    Qi, Na; Li, Wen-jiao; Tian, Hong

    2016-02-01

    Replacing urethral tissue with functional scaffolds has been one of the challenging problems in the field of urethra reconstruction or repair over the last several decades. Various scaffold materials have been used in animal studies, but clinical studies on use of scaffolds for urethral repair are scarce. The aim of this study was to review recent animal and clinical studies on the use of different scaffolds for urethral repair, and to evaluate these scaffolds based on the evidence from these studies. PubMed and OVID databases were searched to identify relevant studies, in conjunction with further manual search. Studies that met the inclusion criteria were systematically evaluated. Of 555 identified studies, 38 were included for analysis. It was found that in both animal and clinical studies, scaffolds seeded with cells were used for repair of large segmental defects of the urethra, such as in tubular urethroplasty. When the defect area was small, cell-free scaffolds were more likely to be applied. A lot of pre-clinical and limited clinical evidence showed that natural or artificial materials could be used as scaffolds for urethral repair. Urinary tissue engineering is still in the immature stage, and the safety, efficacy, cost-effectiveness of the scaffolds are needed for further study.

  16. Comparison of Perineal Sonographically Measured and Functional Urodynamic Urethral Length in Female Urinary Incontinence

    PubMed Central

    Janetzki, Nadine; Kennes, Lieven; Stickeler, Elmar; Serno, Julia; Behrendt, Julia

    2016-01-01

    Objectives. To detect the anatomical insufficiency of the urethra and to propose perineal ultrasound as a useful, noninvasive tool for the evaluation of incontinence, we compared the anatomical length of the urethra with the urodynamic functional urethral length. We also compared the urethral length between continent and incontinent females. Methods. 149 female patients were enrolled and divided into four groups (stress, urge, or mixed incontinence; control). Sonographically measured urethral length (SUL) and urodynamic functional urethral length (FUL) were analyzed statistically. Standardized and internationally validated incontinence questionnaire ICIQ-SF results were compared between each patient group. Results. Perineal SUL was significantly longer in incontinent compared to continent patients (p < 0.0001). Pairwise comparison of each incontinent type (stress, urge, or mixed incontinence) with the control group showed also a significant difference (p < 0.05). FUL was significantly shorter in incontinent patients than in the control group (p = 0.0112). But pairwise comparison showed only a significant difference for the stress incontinence group compared with the control group (p = 0.0084) and not for the urge or mixed incontinent group. No clear correlation between SUL, FUL, and ICIQ-SF score was found. Conclusions. SUL measured by noninvasive perineal ultrasound is a suitable parameter in the assessment of female incontinence, since incontinent women show a significantly elongated urethra as a sign of tissue insufficiency, independent of the type of incontinence. PMID:27819004

  17. Urethro-urethral fistula: A rare cause of post-TURP incontinence

    PubMed Central

    Moorthy, H. Krishna; Pillai, Biju S.

    2014-01-01

    Prostatic abscess rarely follows acute prostatitis and can sometimes lead to a fistula by breaking into the prostatic urethra, peri-rectal tissues, the perineum, or the rectum. We report a case of a prostatic abscess tracking into the bulbar urethra after a transurethral resection of the prostate. This created a fistula, mimicking a urethral duplication and leading to urinary incontinence. PMID:25553167

  18. Retrospective study to characterize post-obstructive diuresis in cats with urethral obstruction.

    PubMed

    Francis, Brenda J; Wells, Raegan J; Rao, Sangeeta; Hackett, Timothy B

    2010-08-01

    Urethral obstruction is a common medical emergency in cats. Frequency of post-obstruction diuresis in cats following resolution of urethral obstruction is unknown. The objective of this study was to document frequency and associated clinical features of post-obstruction diuresis in cats. The records of 32 cats undergoing 33 admissions to the Colorado State University Veterinary Hospital for urethral obstruction were reviewed. Signalment, admission blood values, fluid therapy, and urine output were recorded. Diuresis was defined as urine output greater than 2ml/kg/h. Post-obstructive diuresis occurred in 46% (13/28) of cats within the first 6h of treatment. Occurrence of post-obstructive diuresis was statistically more likely in cats with venous pH<7.35 on admission. Urine production following resolution of urethral obstruction should be monitored so that fluid therapy can be adjusted to the individual patient, as many cats will have a higher fluid requirement secondary to post-obstruction diuresis.

  19. Characterization of bulbospongiosus muscle reflexes activated by urethral distension in male rats.

    PubMed

    Tanahashi, Masayuki; Karicheti, Venkateswarlu; Thor, Karl B; Marson, Lesley

    2012-10-01

    The urethrogenital reflex (UGR) is used as a surrogate model of the autonomic and somatic nerve and muscle activity that accompanies ejaculation. The UGR is evoked by distension of the urethra and activation of penile afferents. The current study compares two methods of elevating urethral intraluminal pressure in spinalized, anesthetized male Sprague-Dawley rats (n = 60). The first method, penile extension UGR, involves extracting the penis from the foreskin, so that urethral pressure rises due to a natural anatomical flexure in the penis. The second method, penile clamping UGR, involves penile extension UGR with the addition of clamping of the glans penis. Groups of animals were prepared that either received no additional treatment, surgical shams, or received bilateral nerve cuts (4 nerve cut groups): either the pudendal sensory nerve branch (SbPN), the pelvic nerves, the hypogastric nerves, or all three nerves. Penile clamping UGR was characterized by multiple bursts, monitored by electromyography (EMG) of the bulbospongiosus muscle (BSM) accompanied by elevations in urethral pressure. The penile clamping UGR activity declined across multiple trials and eventually resulted in only a single BSM burst, indicating desensitization. In contrast, the penile extension UGR, without penile clamping, evoked only a single BSM EMG burst that showed no desensitization. Thus, the UGR is composed of two BSM patterns: an initial single burst, termed urethrobulbospongiosus (UBS) reflex and a subsequent multiple bursting pattern (termed ejaculation-like response, ELR) that was only induced with penile clamping urethral occlusion. Transection of the SbPN eliminated the ELR in the penile clamping model, but the single UBS reflex remained in both the clamping and extension models. Pelvic nerve (PelN) transection increased the threshold for inducing BSM activation with both methods of occlusion but actually unmasked an ELR in the penile extension method. Hypogastric nerve (HgN) cuts

  20. Percutaneous Transhepatic Use of a Cutting Balloon in the Treatment of a Benign Common Bile Duct Stricture

    SciTech Connect

    Kakani, Nirmal K.; Puckett, Mark; Cooper, Martin; Watkinson, Anthony

    2006-06-15

    Benign biliary strictures (BBS) are difficult to treat. The majority of them are treated either endoscopically or using percutaneous techniques either with stents or conventional angioplasty balloons. To our knowledge we present the first case of use of a cutting balloon in the treatment of BBS through a percutaneous approach.

  1. Role of noradrenergic pathways in sneeze-induced urethral continence reflex in rats.

    PubMed

    Kaiho, Yasuhiro; Kamo, Izumi; Chancellor, Michael B; Arai, Yoichi; de Groat, William C; Yoshimura, Naoki

    2007-02-01

    To clarify the role of noradrenergic pathways in preventing stress urinary incontinence (SUI) during sneezing, we investigated the effect of the norepinephrine reuptake inhibitor nisoxetine and alpha-adrenoceptor antagonists phentolamine (nonspecific blocker) and prazosin (alpha(1)-receptor-selective blocker) on the neurally evoked urethral continence reflex induced by sneezing in rats. The amplitude of urethral pressure responses during sneezing (A-URS), urethral baseline pressure (UBP) at the midurethra, and sneeze-induced leak point pressure (S-LPP) were measured in normal female adult rats and rats with SUI induced by vaginal distention (VD). In normal rats, intrathecal (it) phentolamine (0.02 nmol) and prazosin (0.02 nmol) decreased A-URS by 11.9 and 15.7%, respectively, without affecting UBP. In both normal and VD rats, intravenous (iv) application of nisoxetine (1 mg/kg) increased A-URS by 17.2 and 18.3% and UBP by 23.7 and 32.7%, respectively. Phentolamine or prazosin (both it) eliminated nisoxetine-induced increases in A-URS, but not the increases in UBP, which were, however, suppressed by iv phentolamine (5 mg/kg) or prazosin (1 mg/kg). Sneezing induced fluid leakage from the urethral orifice in VD rats, but not in normal rats. In VD rats, S-LPP was increased by 30.2% by iv nisoxetine. Application of phentolamine and prazosin (both it) decreased S-LPP by 15.7 and 20.6%, respectively, and nisoxetine induced increases in S-LPP to 13.2 and 12.3%, respectively. These results indicate that activation of the noradrenergic system by a norepinephrine reuptake inhibitor can prevent SUI via alpha(1-)adrenoceptors by enhancing the sneeze-induced active urethral closure mechanism at the spinal level and augmenting UBP at the periphery.

  2. An Indwelling Urethral Catheter Knotted Around a Double-J Ureteral Stent: An Unusual Complication after Kidney Transplantation

    PubMed Central

    Warmerdam, E. G.; Toorop, R. J.; Abrahams, A. C.; Berger, P.

    2011-01-01

    Urethral catheterization is a common procedure with a relatively low complication rate. Knotting of an indwelling urethral catheter is a very rare complication, and there are only a few case reports on knotted catheters, most of them concerning children. We report an especially rare case where a urethral catheter formed a knot around a double-J ureteral stent after a kidney transplantation. We will discuss the various risk factors for knotting of a catheter and the methods to untangle a knot. PMID:24533194

  3. Eosinophils and IL-33 perpetuate chronic inflammation and fibrosis in a pediatric population with stricturing Crohn’s ileitis

    PubMed Central

    Masterson, Joanne C.; Capocelli, Kelley E.; Hosford, Lindsay; Biette, Kathryn; McNamee, Eóin N.; de Zoeten, Edwin F; Harris, Rachel; Fernando, Shahan D.; Jedlicka, Paul; Protheroe, Cheryl; Lee, James J.; Furuta, Glenn T.

    2015-01-01

    Background Fibrostenosis and stricture are well-recognized endpoints in Crohn’s disease (CD). We hypothesized that stricturing-CD is characterized by eosinophilia and epithelial-IL-33. We proposed that eosinophil exposure to IL-33 would perpetuate inflammatory chronicity and subsequent fibrostenosis. Methods We performed a retrospective study of 74 children with inflammatory and stricturing ileal-CD comparing clinicopathological features to immunohistochemical measures of eosinophilia and IL-33. To scrutinize eosinophil patterns we developed a novel eosinophil-peroxidase (EPX)-score encompassing number, distribution and degranulation. Human eosinophils and intestinal fibroblasts were cultured with IL-33 and IL-13 and inflammatory and remodeling parameters were assessed. Anti-eosinophil therapy was also administered to the Crohn’s-like ileitis model (SAMP1/SkuSlc). Results Our novel EPX-score was more sensitive than H&E-staining, revealing significant differences in eosinophil patterns, comparing inflammatory and stricturing pediatric CD. A significant relationship between ileal-eosinophilia and complicated clinical/histopathological phenotype including fibrosis was determined. IL-33 induced significant eosinophil EPX-secretion and IL-13 production. Exposure to eosinophils in the presence of IL-33, ‘primed’ fibroblasts to increase pro-inflammatory cytokines (TNF-α, IL-1β, IL-6), eosinophil-associated chemokines (CCL24, CCL26) and IL-13Rα2 production. Production of fibrogenic molecules (collagen 1A2, fibronectin and periostin) increased following exposure of ‘primed’-fibroblasts to IL-13. Epithelial-IL-33 was increased in pediatric Crohn’s-ileitis and strongly associated with clinical and histopathological activity, ileal eosinophilia and complicated, fibrostenotic disease. SAMP1/SkuSlc eosinophil-targeted treatment resulted in significant improvements in inflammation and remodeling. Conclusions Our study of specimens from pediatric patients with

  4. Feasibility of CEUS and strain elastography in one case of ileum Crohn stricture and literature review.

    PubMed

    Giannetti, Andrea; Biscontri, Marco; Matergi, Marco; Stumpo, Michela; Minacci, Chiara

    2016-09-01

    Contrast-enhanced ultrasonography (CEUS) and strain elastography (SE) are diagnostic imaging methods, which are still not routinely used in the clinical management of inflammatory bowel diseases. However, there are studies in the literature reporting on the use of both CEUS and SE in patients with bowel obstruction due to Crohn's disease, documenting the usefulness of these two methods in the differentiation between inflammation and fibrosis affecting the bowel wall. The aim of this case report is to evaluate the usefulness of CEUS and SE performed in a patient with Crohn's disease, who was admitted to hospital with bowel obstruction due to terminal ileal stricture and submitted to ileocecal resection. CEUS and SE identified and to some extent also characterized the inflammatory and fibrotic processes affecting the bowel wall. Macroscopic and microscopic examinations of the surgical specimen confirmed the presence of inflammatory phenomena (exudates, ulcers, and fistulas) and fibrosis as suggested by ultrasound (US) imaging methods.

  5. Complications after treating esophageal strictures with prostheses and stents – 20 years’ experience

    PubMed Central

    Brzeziński, Daniel; Rębowski, Marek; Kozak, Józef

    2016-01-01

    Introduction Over 80% of patients with esophageal cancer are qualified only for palliative treatment. The main goal of the therapy is to eliminate symptoms of dysphagia. Aim To analyze complications after insertion of prostheses and stents in patients with inoperable cancer of the esophagus/cardia. Material and methods From 1996 to 2015 prostheses of the esophagus were implanted in 1309 patients. In the strictures of the lower part of the esophagus, Barbin-Mousseau prostheses (102 cases) and Häring prostheses (324 cases) were placed. In the strictures of the upper and middle part of the esophagus, Wilson-Cook prostheses (65 cases) and Sumi prostheses (51 cases) were implanted using rigid oesophagoscopy. Since 2001, 867 esophageal stents have been implanted. Results Complications occurred in 146 (11%) patients, including 7 (0.6%) cases of death. The most common complication was the recurrence of swallowing disorders (74 patients). In 51 patients, tumor overgrowth over the stent/prosthesis was responsible for that symptom, and in 23 patients its clogging. A fistula (22 cases) and the passage of the prosthesis/stent (25 cases) were the second most common group of complications. Compression of the trachea, bleeding, and dehiscence of wounds occurred in a total of 18 patients. Complications were mostly treated through the repositioning of the prosthesis/stent or the insertion of an additional one. Conclusions The most common complications after esophageal prosthetics are the recurrence of dysphagia, a fistula and the displacement of the prosthesis/stent. The basic treatment of complications is the repositioning or insertion of an additional prosthesis. PMID:28194251

  6. Rethinking "posterior" tongue-tie.

    PubMed

    Douglas, Pamela Sylvia

    2013-12-01

    Currently, many clinicians who help with breastfeeding problems are diagnosing "posterior" tongue-tie in infants and performing or referring for frenotomy. In this "Speaking Out" article, I argue that the diagnosis of "posterior" tongue-tie has successfully raised awareness of the importance of impaired tongue function in breastfeeding difficulty. However, the diagnosis of "posterior" tongue-tie also applies a reductionist, medicalized theoretical frame to the complex problem of impaired tongue function, risking unintended outcomes. Impaired tongue function arises out of multiple interacting and co-evolving factors, including the interplay between social behaviors concerning breastfeeding and mother-infant biology. Consideration of theoretical frames is vital if we are to build an evidence base through efficient use of the scarce resources available for clinical breastfeeding research and minimize unintended outcomes.

  7. Noninvasive evaluation of active pan-ulcerative colitis with multiple strictures using Fluorine-18-Fluorodeoxyglucose positron emission tomography/computed tomography

    PubMed Central

    Santhosh, Sampath; Bhattacharya, Anish; Rana, Surinder Singh; Bhasin, Deepak Kumar; Gupta, Rajesh; Mittal, Bhagwant Rai

    2016-01-01

    Ulcerative colitis (UC) is an inflammatory bowel disease characterized by waxing and waning inflammation that changes in severity and extent and may progress to neoplasia, especially in the presence of strictures. When patients have nonnegotiable strictures or severe inflammation with ulcers, colonoscopy is difficult and carries the risk of perforation. The authors present a patient with pan-UC with multiple strictures, in whom fluorodeoxyglucose positron emission tomography/computed tomography was used to noninvasively evaluate the extent and severity of the disease. PMID:26917901

  8. [A new generation of urethral stents--Allium in the therapy of symptomatic prostatic enlargement of various etiology].

    PubMed

    Marković, B B; Marković, Z; Yachia, D; Hadzi, Djokić J

    2007-01-01

    A number of urethral stents made of different materials, with different time of indwelling and different designs, primarily based on the vascular stent concept, have been applied in the clinical practice so far. According to the published studies, urethral stents have justified their clinical application, however with certain limitations. Within an attempt to overcome the limitations, a covered, temporary urethral stent was initially designed by Daniel Yachie and Ijko Markovi in Allium corporation from Israel. With its triangular shape, the stent is a replica of the obstructive prostatic urethral lumen. In has been applied in a series of 14 patients with lower urinary tract symptoms caused by the obstruction at the level of the prostatic urethra. The subjects were averagely aged 77.4 +/- 5.1 years. Allium prostatic stent remained in place in the patients for 4.93 +/- 3.17 months, at the average.

  9. Trichomonas vaginalis infection: How significant is it in men presenting with recurrent or persistent symptoms of urethritis?

    PubMed

    Ng, Andrea; Ross, Jonathan D C

    2016-01-01

    Persistent or recurrent non-gonococcal urethritis has been reported to affect up to 10-20% of men attending sexual health clinics. An audit was undertaken to review the management of persistent or recurrent non-gonococcal urethritis in men presenting at Whittall Street Clinic, Birmingham, UK. Detection of Trichomonas vaginalis infection was with the newly-introduced nucleic acid amplification test. A total of 43 (8%) of 533 men treated for urethritis re-attended within three months with persistent or recurrent symptoms. Chlamydia trachomatis infection was identified in 13/40 (33%), T. vaginalis in 1/27 (4%) and Mycoplasma genitalium in 6/12 (50%). These findings suggest that the prevalence of T. vaginalis infection remains low in our clinic population and may not contribute significantly to persistent or recurrent non-gonococcal urethritis.

  10. Effects of different alpha-1 adrenoceptor blockers on proximal urethral function using in vivo isovolumetric pressure changes.

    PubMed

    Yamaguchi, Takanori; Nagano, Masashi; Osada, Yukio

    2005-10-01

    The effects of different alpha-1 adrenoceptor blockers on the urethra and the cardiovascular system were evaluated using an in vivo isovolumetric intra-urethral pressure model in New Zealand white rabbits. The urethra of anesthetized male rabbits was cannulated through the bladder and secured at the vesico-urethral junction. The distal side of urethra under the pubic bone was also closed to allow measurement of the intra-urethral pressure. Both the intra-urethral pressure and the femoral arterial pressure were monitored. The effects of five different alpha-1 adrenoceptor blockers on the increases in both the intra-urethral pressure and blood pressure induced by phenylephrine were then examined. The inhibition rate of the alpha-1 adrenoceptor blockers prazosin, bunazosin, terazosin, alfuzosin and tamsulosin on the increase in intra-urethral pressure caused as a result of contraction by phenylephrine was 87.5 +/- 4.5% (mean +/- S.E.), 88.0 +/- 7.2%, 86.2 +/- 6.2%, 81.4 +/- 4.8% and 92.5 +/- 5.0% respectively. The potency ranking of these alpha-1 adrenoceptor blockers was tamsulosin > bunazosin > prazosin > terazosin > alfuzosin. Their inhibition rate of the arterial pressure increase induced by phenylephrine was 81.9 +/- 5.0%, 86.2 +/- 5.9%, 76.0 +/- 6.0%, 63.6 +/- 5.7% and 58.0 +/- 5.2% respectively, with a potency ranking of bunazosin > prazosin > terazosin > alfuzosin > tamsulosin. We therefore conclude that the alpha-1 adrenoceptor blockers bunazosin and prazosin have a more potent action on both the urethra and the vascular system. However, tamsulosin and alfuzosin displayed a marked blockade of the increased urethral pressure induced by phenylephrine, with much less of a blockade of arterial pressure. In the present study, tamsulosin has been shown to be the most sensitive and powerful of the alpha-1 adrenoceptor blockers on urethral smooth muscle.

  11. Penile necrosis requiring penectomy complicating recto-urethral fistula post prostate cancer external beam radiation and brachytherapy.

    PubMed

    Kinahan, John; Pai, Howard; Martens, Mildred; Gray, Jason; Biberdorf, Darren; Mihailovic, Alex; McAuley, Iain

    2014-01-01

    Radiation therapy is a well-recognized treatment for unfavourable risk localized prostate cancer. Radiation induced recto-urethral fistulae are known rare complications particularly from brachytherapy. We report a case of a recto-urethral fistula 7 years post-external beam radiation and I-125 brachytherapy, which was complicated by a severe polymicrobial soft tissue infection. This infection required penectomy and pelvic exenteration with diverting colostomy, Indiana pouch urinary diversion and gracilis myo-cutaneuos flap closure of the perineum.

  12. Children's Understanding of Posterior Probability

    ERIC Educational Resources Information Center

    Girotto, Vittorio; Gonzalez, Michael

    2008-01-01

    Do young children have a basic intuition of posterior probability? Do they update their decisions and judgments in the light of new evidence? We hypothesized that they can do so extensionally, by considering and counting the various ways in which an event may or may not occur. The results reported in this paper showed that from the age of five,…

  13. Stereolithography for Posterior Fossa Cranioplasty

    PubMed Central

    Agner, Celso; Dujovny, Manuel; Evenhouse, Raymond; Charbel, Fady T.; Sadler, Lewis

    1998-01-01

    Posterior fossa cranioplasty has been suggested for improvement of neurological symptoms following craniectomy. However, there is no particular recommendation in the literature about techniques for prosthesis manufacture and implantation. We report our experience using rapid prototyping technology and stereolithography for pre-surgical implant design and production of cranioplasties. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5 PMID:17171056

  14. Endoscopic balloon dilatation of Crohn’s-associated intestinal strictures: High patient satisfaction and long-term efficacy

    PubMed Central

    Rueda Guzmán, Anna; Wehkamp, Jan; Kirschniak, Andreas; Naumann, Aline; Malek, Nisar P.

    2016-01-01

    Introduction Stricture formation is a common long-term complication of Crohn’s disease. Endoscopic balloon dilatation offers a bowel-sparing treatment option, but long-term outcome and its association with patient-, stricture-, and procedure-related factors is only poorly understood. Patient satisfaction with endoscopic balloon dilatation is largely unknown. Methods We performed a retrospective review of all endoscopic balloon dilatation for Crohn’s disease-related strictures between January 2005 and January 2013. Long-term outcome, complication rates and predictive factors were evaluated. Patient satisfaction was assessed using a questionnaire and telephone interviews. Results A total of 118 balloon dilatations were performed for 69 strictures in 46 patients. One patient was excluded from further analysis due to malignancy. Median time from diagnosis of Crohn’s disease to symptomatic stricture formation was 19 years. Technical success, defined as passage of the endoscope after dilatation, was reportedly obtained in 95 of 106 procedures (89.6%). Two perforations occurred, one of which could be managed conservatively. No episodes of severe bleeding were recorded (procedure-related complication rate: 2/118; 1.7%). During a median follow-up of 4.8 years (range 0.4–8.7), 55.6% (25/45) of patients were able to avoid surgery. Of the patients, 35.6% (16/45) did not need any further intervention, 40.0% (18/45) underwent more than one dilatation, and 24.4% (11/45) were operated after the first dilatation. The percentage of patients who were satisfied with the procedure and would again opt for balloon dilation as first line therapy was 83.3% (35/42). None of the risk factors examined in this study correlated with the necessity for subsequent surgery. Discussion Endoscopic balloon dilatation is a safe and effective first line therapy for Crohn’s disease-related strictures. No technical, stenosis-, or patient-related factor reliably predicted sustained dilatation

  15. [Antibiotherapy applied to uncomplicated urethritis and cervicitis. French Agency for Health Product Safety].

    PubMed

    2006-01-01

    In sexually transmitted infections and more precisely in uncomplicated urethritis and cervicitis, the two infectious agents most commonly identified in France are Neisseria gonorrhoeae (gonococci) and Chlamydia trachomatis, alone or associated. The resistance of N. gonorrhoeae to ciprofloxacin has reached over 20 % in France. A new national strategy for the therapeutic management of probabilistic treatment applied to uncomplicated urethritis and cervicitis is required. Bacteriological sampling before treatment is mandatory. Anti-gonococcal probabilistic treatment is a monodose using one of the following molecules: third generation cephalosporin: ceftriaxone (intra-muscular or intra-venous), cefixime (oral); aminoside: spectinomycin (intra- muscular); fluoroquinolone (bacteriologically controlled): ciprofloxacin (oral); An oral anti-Chlamydia treatment must be associated: azithromycin (monodose); or doxycycline (standard treatment). Blood tests (screening for syphilis, HIV infection, hepatitis B, hepatitis C) must be performed taking into account the delay for sero-conversion. Hepatitis B vaccination must be offered to any non-immunized patient. Protected intercourse (using condoms) must be recommended.

  16. Anterior urethral valves without diverticulae: a report of two cases and a review of the literature.

    PubMed

    Singh, Dig Vijay; Taneja, Rajesh

    2014-05-01

    Two unusual cases of anterior urethral valves (AUV) without diverticulae are presented. The first case is a male child born with prenatal diagnosis of bilateral hydronephrosis. On cystoscopy, iris-like diaphragm valves were encountered about 3 mm distal to the skeletal sphincter. In the second case, an 18-month-old male child was investigated for recurrent febrile urinary tract infections and obstructed urinary symptoms. Cystoscopy confirmed the presence of slit-like valves 5 mm distal to the skeletal sphincter. Fulguration of the AUVs was performed in both cases. It may be worthwhile to review all cases of anterior urethral obstruction collectively and re-categorize them appropriately to include the unusual AUVs without diverticulum in that classification.

  17. Ejaculatory ducts opening into accessory urethral channel with hypospadias and absent verumontanum: a rare association.

    PubMed

    Ravi Kumar, Valkodai Ramanthan; Duraisami, Vijayagiri

    2013-12-01

    Ejaculatory ducts draining into accessory urethral channel opening into perineum is rare. This is a case report of a 27-year-old male who had hypospadias surgery at 3 years of age, presenting with discharge of semen through the perineal opening from adolescence. Cystoscopy and dye study showed that it was a short channel communicating with both ejaculatory ducts. Cystoscopy of the native urethra revealed that the vermontanum had not developed. The mucous lined accessory urethra was anastomosed to the bulbar urethra. Urethrogram done after one year showed that the accessory urethra was draining well into the bulbar urethra. Such type of accessory urethral channel communicating with ejaculatory ducts and associated with hypospadias and absent vermontanum has not been reported so far.

  18. [Urethral injuries secondary to implantation of penile prosthesis. Analysis of the causes, prevention and treatment].

    PubMed

    Vitarelli, Antonio; Divenuto, Lucia; Palminteri, Enzo; Lorusso, Giovanni; Pagliarulo, Arcangelo

    2014-01-01

    Urethral injuries due to penile prosthesis implant represent a rare complication of the intervention to position penile prosthesis, but unfortunately scientific literature about this is poor. This rare complication may occur during surgery and in the postoperative period, both early and late. It recognizes a variety of causes that may include anatomical or functional conditions, for example cavernosal fibrosis or outcomes of inflammations or previous urethral lesions and pathological sensibility due to diabetic neuropathy or other forms of neuropathy including those from spinal cord injury or myelopathy. This review evaluates the possible predisposing conditions, the clinical presentations, and the devices in the surgical procedures to use to minimize the risk of onset of this lesions and the measures to take if they occur.

  19. Differential association of ureaplasma species with non-gonococcal urethritis in heterosexual men

    PubMed Central

    Ondondo, Raphael O; Whittington, William L H; Astete, Sabina G; Totten, Patricia A

    2015-01-01

    Objective To assess the role of Ureaplasma urealyticum and Ureaplasma parvum in patients with non-gonococcal urethritis (NGU) using specimens from a previously reported study of NGU. Methods Species-specific PCR assays for U urealyticum and U parvum were used to detect these organisms in specimens from men enrolled in a case–control study based in a Seattle STD clinic in order to evaluate their association with NGU. Urethritis was defined by clinical examination and the presence of inflammation on Gram stained smear. Controls had normal examination findings and no evidence of inflammation on Gram stain smear or by the leucocyte esterase test. Results U urealyticum was detected in 26% (31/119) of cases and 16% (19/117) of controls, resulting in an association with NGU (adjusted odds ratio (aOR)=2.3, 95% CI 1.04 to 4.9) after adjusting for age, race, history of prior urethritis and other NGU pathogens (Chlamydia trachomatis, Mycoplasma genitalium). The association of U urealyticum and NGU was strongest in white men <28 years of age (OR=5.4, 95% CI 1.3 to 22.2). U parvum was detected in 14% (17/119) cases and 31% (36/117 controls) and thus was negatively associated with NGU (aOR=0.4, 95% CI 0.2 to 0.8). The prevalence of U urealyticum (16%) in controls was higher than that of C trachomatis (3.4%) or M genitalium (4.3%, p<0.05, each comparison). Conclusions Unlike U parvum, U urealyticum was associated with urethritis. The strong effect in younger white men and high rates in controls may suggest variability in virulence among U urealyticum strains or in host innate or acquired immunity. PMID:20460265

  20. Adenovirus urethritis and concurrent conjunctivitis: a case series and review of the literature.

    PubMed

    Liddle, Olivia Louise; Samuel, Mannampallil Itty; Sudhanva, Malur; Ellis, Joanna; Taylor, Chris

    2015-03-01

    We present eight cases and review the literature of concurrent urethritis and conjunctivitis where adenovirus was identified as the causative pathogen. The focus of this review concerns the identification of specific sexual practices, symptoms, signs and any serotypes that seem more commonly associated with such adenovirus infections. We discuss the seasonality of adenovirus infection and provide practical advice for clinicians to give to the patient.

  1. Congenital anterior urethral diverticulum presenting as a scrotal mass in a two-year-old child

    PubMed Central

    Gürağaç, Ali; Irkilata, Hasan Cem; Yunusov, Nahit; Demirer, Zafer

    2016-01-01

    Here, we describe a case of congenital anterior urethral diverticulum (CAUD) in a two-year-old boy, who presented with right inguinoscrotal swelling that mimicked a spermatic cord cyst or hydrocele. Accurate diagnosis was made intraoperatively by retrograde urethrography. Open diverticulectomy and primary urethroplasty were performed for its management. The clinical presentation, diagnosis, and the management of this rare condition is discussed. PMID:28096926

  2. [Urethritis syndrome and atypical germ flora of the exterior female genitalia (author's transl)].

    PubMed

    Hofstetter, A; Schmiedt, E; Weissenbacher, E R; Frank, S

    1976-10-29

    A positive microbiological evidence could be obtained 54 times from the smear of the exterior genitals of 80 women suffering from complaints that were caused by urethritis, criteria of the examinations being sterile catheter specimen, negative cystoscopical findings, and missing indications to anatomical changes in the urethral region. Cytological examinations of these cases with regard to the vaginal epithelium had the following results:Group I:6 times; group II: 37 times; group IIW:8 times; group IIId: once; group IVa:twice. The cytological tests were carried out according to the method of papanicolaou as modified by Soost. Furthermore, we could state the following degrees of purity: Degree I: 8 times; degree II:16 times; degree III: 30 times. The cytological examinations of the urethral epithelium demonstrated, in 52 cases, an increased appearance of "nude" completely exposed epithelial cell nuclei--a fact corresponding to a degenerative autolysis (according to Wied). In the 26 women with missing atypical germ flora within the region of the exterior genitals, exclusively groups I (according to Papanicolaou and Soost) and degrees of purity I were stated. These persons also demonstrated remarkably grave psychical disturbances, especially in the intimate regions. In the cases of positive microbiological evidence, the following measures have proved satisfactory: Vaginal hygienization combined with a directly aimed antibacterial therapy, and the prescription of preparations containing lactic acid. A transitory discontinuation of contraceptives is being discussed. Our examination results are emphasizing the necessity of an analysis of the germ flora in cases of complaints arising from urethritis. Also psychical disturbances must be taken into consideration in cases of missing urological and gynaecological criteria of evidence.

  3. A Case of Embryonal Rhabdomyosarcoma Presenting as a Lobulated Protrusion From the Urethral Meatus at Birth.

    PubMed

    Bethell, George S; Johal, Navroop S; Cuckow, Peter M

    2015-10-01

    This is the first reported case of rhabdomyosarcoma presenting as a mass protruding from the urethral meatus present at birth. A male neonate was transferred to a tertiary pediatric urology center on day 4 of life where the mass was surgically excised. Histology confirmed an embryonal rhabdomyosarcoma and chemotherapy commenced. The patient completed chemotherapy at the age of 8 months. The child is now 3.5 years old and well with no recurrence of disease.

  4. Novel Bioceramic Urethral Bulking Agents Elicit Improved Host Tissue Responses in a Rat Model

    PubMed Central

    Mann-Gow, Travis K.; King, Benjamin J.; El-Ghannam, Ahmed; Knabe-Ducheyne, Christine; Kida, Masatoshi; Dall, Ole M.; Krhut, Jan

    2016-01-01

    Objectives. To test the physical properties and host response to the bioceramic particles, silica-calcium phosphate (SCPC10) and Cristobalite, in a rat animal model and compare their biocompatibility to the current clinically utilized urethral bulking materials. Material and Methods. The novel bulking materials, SCPC10 and Cristobalite, were suspended in hyaluronic acid sodium salt and injected into the mid urethra of a rat. Additional animals were injected with bulking materials currently in clinical use. Physiological response was assessed using voiding trials, and host tissue response was evaluated using hard tissue histology and immunohistochemical analysis. Distant organs were evaluated for the presence of particles or their components. Results. Histological analysis of the urethral tissue five months after injection showed that both SCPC10 and Cristobalite induced a more robust fibroblastic and histiocytic reaction, promoting integration and encapsulation of the particle aggregates, leading to a larger bulking effect. Concentrations of Ca, Na, Si, and P ions in the experimental groups were comparable to control animals. Conclusions. This side-by-side examination of urethral bulking agents using a rat animal model and hard tissue histology techniques compared two newly developed bioactive ceramic particles to three of the currently used bulking agents. The local host tissue response and bulking effects of bioceramic particles were superior while also possessing a comparable safety profile. PMID:27688751

  5. Hypothesis That Urethral Bulb (Corpus Spongiosum) Plays an Active Role in Male Urinary Continence

    PubMed Central

    Rehder, Peter; Staudacher, Nina M.; Schachtner, Joerg; Berger, Maria E.; Schillfahrt, Florian; Hauser, Verena; Mueller, Raphael; Skradski, Viktor; Horninger, Wolfgang; Glodny, Bernhard

    2016-01-01

    The proximal urethral bulb in men is enlarged, surrounds the bulbous urethra, and extends dorsally towards the perineum. During intercourse engorgement takes place due to increased blood flow through the corpus spongiosum. Antegrade ejaculation is facilitated by contraction of the bulbospongiosus muscles during climax. Micturition during sexual stimulation is functionally inhibited. Supporting the bulb may indirectly facilitate continence in a certain subset of patients with postprostatectomy incontinence. During physical activity with increased abdominal pressure, reflex contraction of the pelvic floor muscles as well as the bulbospongiosus muscles occurs to support sphincter function and limit urinary incontinence. Operations to the prostate may weaken urinary sphincter function. It is hypothesized that the distal urinary sphincter may be supported indirectly by placing a hammock underneath the urethral bulb. During moments of physical stress the “cushion” of blood within the supported corpus spongiosum helps to increase the zone of coaptation within the sphincteric (membranous) urethra. This may lead to urinary continence in patients treated by a transobturator repositioning sling in patients with postprostatectomy incontinence. This paper describes the possible role of the urethral bulb in male urinary continence, including its function after retroluminal sling placement (AdVance, AdVance XP® Male Sling System, Minnetonka, USA). PMID:27022393

  6. Novel Bioceramic Urethral Bulking Agents Elicit Improved Host Tissue Responses in a Rat Model.

    PubMed

    Mann-Gow, Travis K; King, Benjamin J; El-Ghannam, Ahmed; Knabe-Ducheyne, Christine; Kida, Masatoshi; Dall, Ole M; Krhut, Jan; Zvara, Peter

    2016-01-01

    Objectives. To test the physical properties and host response to the bioceramic particles, silica-calcium phosphate (SCPC10) and Cristobalite, in a rat animal model and compare their biocompatibility to the current clinically utilized urethral bulking materials. Material and Methods. The novel bulking materials, SCPC10 and Cristobalite, were suspended in hyaluronic acid sodium salt and injected into the mid urethra of a rat. Additional animals were injected with bulking materials currently in clinical use. Physiological response was assessed using voiding trials, and host tissue response was evaluated using hard tissue histology and immunohistochemical analysis. Distant organs were evaluated for the presence of particles or their components. Results. Histological analysis of the urethral tissue five months after injection showed that both SCPC10 and Cristobalite induced a more robust fibroblastic and histiocytic reaction, promoting integration and encapsulation of the particle aggregates, leading to a larger bulking effect. Concentrations of Ca, Na, Si, and P ions in the experimental groups were comparable to control animals. Conclusions. This side-by-side examination of urethral bulking agents using a rat animal model and hard tissue histology techniques compared two newly developed bioactive ceramic particles to three of the currently used bulking agents. The local host tissue response and bulking effects of bioceramic particles were superior while also possessing a comparable safety profile.

  7. Differentiation of Inflammatory from Fibrotic Ileal Strictures among Patients with Crohn's Disease through Analysis of Time-Intensity Curves Obtained after Microbubble Contrast Agent Injection.

    PubMed

    Quaia, Emilio; Gennari, Antonio Giulio; van Beek, Edwin J R

    2017-04-03

    The aim of the study described here was to assess whether the analysis of time-intensity curves obtained after microbubble contrast agent injection could differentiate inflammatory from fibrotic ileal strictures among patients with Crohn's disease. Sixty-five consecutive patients (40 male and 25 female; mean age ± SD, 42.2 ± 12.22 y) with stricture of the terminal ileal loop from Crohn's disease were scanned after microbubble injection. Time-intensity curves were obtained from quantitative analysis, and peak enhancement, rise time, time to peak, area under the time-intensity curve (AUC), AUC during wash-in (AUCWI) and AUC during wash-out (AUCWO) were compared between patients with inflammatory strictures and patients with fibrotic strictures. Inflammatory (n = 40) and fibrotic (n = 25) strictures differed (p < 0.05) in peak enhancement, wash-in rate, wash-in perfusion index, AUC, AUCWI and AUCWO. The quantitative analysis of small bowel wall contrast enhancement after microbubble contrast agent injection may differentiate inflammatory from fibrotic ileal strictures in patients with Crohn's disease.

  8. Transplantation of tissue-engineered cell sheets for stricture prevention after endoscopic submucosal dissection of the oesophagus

    PubMed Central

    Sjöqvist, Sebastian; Elbe, Peter; Kanai, Nobuo; Enger, Jenny; Haas, Stephan L; Mohkles-Barakat, Ammar; Okano, Teruo; Takagi, Ryo; Ohki, Takeshi; Yamamoto, Masakazu; Kondo, Makoto; Markland, Katrin; Lim, Mei Ling; Yamato, Masayuki; Nilsson, Magnus; Permert, Johan; Blomberg, Pontus; Löhr, J-Matthias

    2016-01-01

    Background and objective Endoscopic mucosal dissection (ESD) is a treatment option for oesophagus tumours localized to the mucosa enabling en bloc removal of large lesions. The resulting larger mucosal defects have resulted in an increase in the occurrence of post-treatment strictures. Transplantation of autologous cell sheets, cultured from oral mucosa, has been shown to prevent post-ESD strictures. The aim of the study was to assess the efficacy and safety of cell sheet transplantation after oesophageal ESD in a Western patient population where reflux-associated pre-malignant and malignant conditions predominate. Methods Patients with Barrett’s oesophagus associated high-grade dysplasia or early adenocarcinoma where ESD entailed a resection >3 cm in length and ≥75% of the circumference were eligible for treatment under hospital exemption. Cell sheets were cultured from buccal mucosa according to Good Manufacturing Practice and were endoscopically applied to the post-ESD defect directly after resection. Patients were followed with weekly endoscopy examinations, including confocal laser microscopy, for a total of four weeks. Results Five patients were treated. ESD was extensive with resections being circumferential in three patients and 9–10 cm in length in two. The number of transplanted cell sheets ranged from two to six. Three patients developed strictures requiring two to five dilatation sessions. Conclusions Cell sheet transplantation shows to be safe and feasible in a Western population. Results suggest that transplantation has a protective effect on the mucosal defect after ESD, decreasing both the risk for and extent of stricture formation.

  9. Distortions of posterior visual space.

    PubMed

    Phillips, Flip; Voshell, Martin G

    2009-01-01

    The study of spatial vision is a long and well traveled road (which, of course, converges to a vanishing point at the horizon). Its various distortions have been widely investigated empirically, and most concentrate, pragmatically, on the space anterior to the observer. The visual world behind the observer has received relatively less attention and it is this perspective the current experiments address. Our results show systematic perceptual distortions in the posterior visual world when viewed statically. Under static viewing conditions, observer's perceptual representation was consistently 'spread' in a hyperbolic fashion. Directions to distant, peripheral locations were consistently overestimated by about 11 degrees from the ground truth and this variability increased as the target was moved toward the center of the observer's back. The perceptual representation of posterior visual space is, no doubt, secondary to the more immediate needs of the anterior visual world. Still, it is important in some domains including certain sports, such as rowing, and in vehicular navigation.

  10. Single vs. double layer suturing method repair of the urethral plate in the rabbit model of hypospadias

    PubMed Central

    Shirazi, Mehdi; Rahimi, Mohammad

    2016-01-01

    Introduction There are different methods of urethroplasty in hypospadias. The present study aimed to compare the repair of the urethral plate by single vs. double layer suturing. Material and methods Fifteen male rabbits were assigned to the control, single layer, and double layer urethral plate suturing groups (n = 5). Experimental hypospadias was induced in the second and third groups and the urethral plates were sutured. After two weeks, the penis was dissected out and underwent histopathological processing. Stereological studies were applied to obtain quantitative histological data regarding the structure of the urethra and the related part of the corpus spongiosum. Results Volume density of the urethral epithelium (the fraction of unit volume of the urethra occupied by its epithelium) was higher in the single layer suturing group when compared to the double layer or control groups (p <0.01). Additionally, the volume density of the urethral lumen (the fraction of the corpus spongiosum that is occupied by the urethral lumen) in the single versus the double layer suturing groups was respectively 2.4 and 2 folds higher than that in the control group (p <0.01). Besides, the volume density of the lumen was significantly higher in the single layer suturing when compared to the double layer suturing group (p <0.01). However, no significant difference was observed among the study groups regarding the volume density of the collagen and vessels in the incised site of the penis which implied that the fraction of the urethra and surrounding corpus spongiosum was occupied by collagen and vessels. Conclusions Urethral plate repair by the single layer suturing method could be accompanied by higher epithelialization and wider lumen in the rabbit model of hypospadias. PMID:28127462

  11. Expandable polyester silicon-covered stent for malignant esophageal strictures before neoadjuvant chemoradiation: a pilot study.

    PubMed

    Siddiqui, Ali A; Loren, David; Dudnick, Robert; Kowalski, Thomas

    2007-03-01

    Patients with resectable esophageal cancer often require placement of a surgical jejunostomy tube prior to receiving chemoradiation so as to maintain adequate nutrition due to their inability to swallow and eat. This study reports a single institutional experience with the Polyflex self-expanding silicone stent (Riisch; Kernen. Germany) in patients with malignant stenosis receiving chemoradiation prior to esophagectomy. This was a retrospective, nonrandomized study of 6 patients who underwent Polyflex esophageal stent placement across a malignant stricture prior to receiving neoadjuvant chemoradiation. The study assessed procedural success, restoration of oral nutrition, migration, and removal of the Polyflex stent. The outcomes measured were the efficacy of treatment, stent-related complications, and changes in the nutritional status of the patient after stent placement. Stent placement was successful in 5 of 6 patients (83%). Restoration of oral nutrition after stent placement occurred in 5 of 5 patients (100%). Migration of the stent into the stomach occurred in 3 patients (60%) without occurrence of gastric outlet obstruction; there was no proximal migration. Stents were successfully removed endoscopically or at the time of esophagectomy. This early experience suggests that the removable silicone Polyflex stent is an effective alternative to a surgical jejunostomy tube for the management of malignant esophageal stenosis in patients for whom neoadjuvant chemoradiation is planned prior to esophagectomy.

  12. Percutaneous “Y” biliary stent placement in palliative treatment of type 4 malignant hilar stricture

    PubMed Central

    Centore, Luca; Soreca, Emilio; Corvino, Antonio; Farbo, Vincenzo; Bencivenga, Alfonso

    2016-01-01

    Background This study evaluated the technical and clinical efficacy of percutaneous bilateral biliary stent-in-stent (SIS) deployment technique with a “Y” configuration using open-cell-design stents in type 4 Klatskin tumor patients. Methods Retrospective evaluation ten patients with type IV Bismuth malignant hilar stricture (MHS) treated with percutaneous bilateral “Y” SIS deployment technique placement followed in our institution between March of 2012 and November of 2014. Results Bilateral SIS deployment was technically successful in all patients. One patient (10%) had major complications (episode of cholangitis); one patient (10%) had minor complications, including self-limiting hemobilia. Successful internal drainage was achieved in nine (90%) patients. Stent occlusion by tumor overgrowth and sludge formation occurred in two patient (20%). The median survival and stent patency time were 298 and 315 days respectively. Conclusions Percutaneous bilateral metal stenting using a Y-stent is a valid option for the palliative treatment of type 4 Bismuth MHS, improving quality patient’ life. PMID:27034794

  13. Should plastic stents be avoided in all unresectable malignant perihilar biliary strictures?

    PubMed

    Kawashima, Hiroki; Itoh, Akihiro; Ohno, Eizaburo; Goto, Hidemi; Hirooka, Yoshiki

    2013-05-01

    Clinical guidelines of the European Society of Gastrointestinal Endoscopy recommend the insertion of self-expandable metallic stents (SEMS) as opposed to plastic stents (PS) in patients with unresectable malignant perihilar stricture (MHS). However, PS are cheaper and easier to insert into the biliary duct compared to SEMS. Furthermore, PS are removable and easy to move into subsequent drainage procedures. We conducted the present retrospective single-center study to elucidate the predictive factors associated with stent patency period duration in patients with unresectable MHS who would benefit from a long patency period after PS placement. This study included 56 consecutive patients with unresectable MHS who were drained using PS. PS failure occurred in 26 (46.4%) patients. The median patency period was 72 days (95% confidence interval: 29.8-114). The only significant predictive factor associated with the length of the stent patency period was history of previous endoscopic sphincterotomy (EST). Median patency periods with and without previous EST were 28 and 109 days, respectively (P = 0.016). In conclusion, we suggest that conventional biliary drainage with PS is still a suitable option for the treatment of unresectable MHS in patients without previous EST.

  14. Posterior commissure of the human larynx revisited.

    PubMed

    Tucker, John A; Tucker, Sean T

    2010-05-01

    The existence of the posterior commissure (PC) of the human larynx has been disputed (Hirano M, Sato K, et al. The posterior glottis. Trans Am Laryngol Assoc. 1986;107:70-75). "The term posterior commissure has no relevance to anatomical structure. The term commissure means a joining together. The bilateral vocal folds never join at their posterior ends. The posterior aspect of the glottis is a wall. The posterior lateral aspect of the posterior glottis is also the lateral wall of the posterior glottis" (Hirano M, Sato K, et al. The posterior glottis. Trans Am Laryngol Assoc. 1986;107:70-75). This study is intended to clarify the development of anatomical and morphological aspects of the PC in conjunction with a clinical classification of the larynx in sagittal view. This study uses human embryo and fetal laryngeal sections from the Carnegie Collection of Human Embryos (the world standard) and whole organ laryngeal sections from the Tucker Laryngeal Fetal Collection. Correlation of histologic and gross anatomical structure is made with the Hirano et al atlas, the Vidić Photographic Atlas of the Human Body, and the O'Rahilly Embryonic Atlas. Embryologic data clearly describe and illustrate the posterior union of the cricoid cartilage with formation of the PC. The anatomical functional aspects of the posterior lateral cricoid lamina as the supporting buttress of the articulating arytenoid cartilages are illustrated.

  15. Isolated posterior cruciate ligament calcification

    PubMed Central

    Koukoulias, Nikolaos E; Papastergiou, Stergios G

    2011-01-01

    The authors present a case of calcified posterior cruciate ligament (PCL). A 61-year-old female presented in our department reporting 12 months history of knee pain that was getting worse during the night. The patient was under medication for epileptic seizure, osteoporosis and hyperthyroidism. X-rays demonstrated calcification of the PCL. CT and MRI excluded any other intra-articular and extra-articular pathology. Arthroscopic debridement of the calcium deposits was performed and the symptoms resolved immediately, while the postoperative x-rays were normal. Histological examination confirmed the calcium nature of the lesion. Two years postoperatively the patient remains asymptomatic. PMID:22669889

  16. Relationships between diagnoses of sexually transmitted infections and urinary tract infections among male service members diagnosed with urethritis, active component, U.S. Armed Forces, 2000-2013.

    PubMed

    2014-07-01

    A previous MSMR report found that 42.8% of all incident (first-time) urinary tract infections (UTIs) in males, but only 0.4% of such UTIs in females, were diagnosed as "urethritis, unspecified" (ICD-9: 597.80). This study explored the possibility that many of the diagnoses of urethritis in males represented sexually transmitted infections (STIs), even though ICD-9: 597.80 is explicitly reserved for cases of urethritis that are deemed to not be sexually transmitted. Examined were relationships between diagnoses of urethritis, diagnoses of STIs, and recurrent diagnoses of UTIs. Male service members who received a diagnosis of "urethritis, unspecified" (ICD-9: 597.80) had an increased risk of a subsequent UTI diagnosis, especially of "urethritis, unspecified," compared to all male service members. Most service members who were diagnosed with "urethritis, unspecified" had no documented diagnoses of an STI in their Military Health System health records; however, recurrent UTIs were more common among service members who did have documented STIs. The most commonly diagnosed STIs in this study were "other non-gonococcal urethritis" (which includes that caused by Chlamydia trachomatis) and gonorrhea.

  17. Huge interparietal posterior fontanel meningohydroencephalocele

    PubMed Central

    Dos Santos, Manuel Filipe Dias; de Santa Barbara, Rita de Cassia

    2015-01-01

    Congenital encephalocele is a neural tube defect characterized by a sac-like protrusion of the brain, meninges, and other intracranial structures through the skull, which is caused by an embryonic development abnormality. The most common location is at the occipital bone, and its incidence varies according to different world regions. We report a case of an 1-month and 7-day-old male child with a huge interparietal-posterior fontanel meningohydroencephalocele, a rare occurrence. Physical examination and volumetric computed tomography were diagnostic. The encephalocele was surgically resected. Intradural and extradural approaches were performed; the bone defect was not primarily closed. Two days after surgery, the patient developed hydrocephaly requiring ventriculoperitoneal shunting. The surgical treatment of the meningohydroencephalocele of the interparietal-posterior fontanel may be accompanied by technical challenges and followed by complications due to the presence of large blood vessels under the overlying skin. In these cases, huge sacs herniate through large bone defects including meninges, brain, and blood vessels. The latter present communication with the superior sagittal sinus and ventricular system. A favorable surgical outcome generally follows an accurate strategy taking into account individual features of the lesion. PMID:26484324

  18. Longevity of Posterior Composite Restorations

    PubMed Central

    Opdam, N.J.M.; van de Sande, F.H.; Bronkhorst, E.; Cenci, M.S.; Bottenberg, P.; Pallesen, U.; Gaengler, P.; Lindberg, A.; Huysmans, M.C.D.N.J.M.; van Dijken, J.W.

    2014-01-01

    The aim of this meta-analysis, based on individual participant data from several studies, was to investigate the influence of patient-, materials-, and tooth-related variables on the survival of posterior resin composite restorations. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a search resulting in 12 longitudinal studies of direct posterior resin composite restorations with at least 5 years’ follow-up. Original datasets were still available, including placement/failure/censoring of restorations, restored surfaces, materials used, reasons for clinical failure, and caries-risk status. A database including all restorations was constructed, and a multivariate Cox regression method was used to analyze variables of interest [patient (age; gender; caries-risk status), jaw (upper; lower), number of restored surfaces, resin composite and adhesive materials, and use of glass-ionomer cement as base/liner (present or absent)]. The hazard ratios with respective 95% confidence intervals were determined, and annual failure rates were calculated for subgroups. Of all restorations, 2,816 (2,585 Class II and 231 Class I) were included in the analysis, of which 569 failed during the observation period. Main reasons for failure were caries and fracture. The regression analyses showed a significantly higher risk of failure for restorations in high-caries-risk individuals and those with a higher number of restored surfaces. PMID:25048250

  19. Eosinophilic cholangitis is a potentially underdiagnosed etiology in indeterminate biliary stricture

    PubMed Central

    Walter, Dirk; Hartmann, Sylvia; Herrmann, Eva; Peveling-Oberhag, Jan; Bechstein, Wolf O; Zeuzem, Stefan; Hansmann, Martin-Leo; Friedrich-Rust, Mireen; Albert, Jörg G

    2017-01-01

    AIM To investigate presence and extent of eosinophilic cholangitis (EC) as well as IgG4-related disease in patients with indeterminate biliary stricture (IBS). METHODS All patients with diagnosis of sclerosing cholangitis (SC) and histopathological samples such as biopsies or surgical specimens at University Hospital Frankfurt from 2005-2015 were included. Histopathological diagnoses as well as further clinical course were reviewed. Tissue samples of patients without definite diagnosis after complete diagnostic work-up were reviewed regarding presence of eosinophilic infiltration and IgG4 positive plasma cells. Eosinophilic infiltration was as well assessed in a control group of liver transplant donors and patients with primary sclerosing cholangitis. RESULTS one hundred and thirty-five patients with SC were included. In 10/135 (13.5%) patients, no potential cause of IBS could be identified after complete diagnostic work-up and further clinical course. After histopathological review, a post-hoc diagnosis of EC was established in three patients resulting in a prevalence of 2.2% (3/135) of all patients with SC as well as 30% (3/10) of patients, where no cause of IBS was identified. 2/3 patients with post-hoc diagnosis of EC underwent surgical resection with suspicion for malignancy. Diagnosis of IgG4-related cholangitis was observed in 7/135 patients (5.1%), whereas 3 cases were discovered in post-hoc analysis. 6/7 cases with IgG4-related cholangitis (85.7%) presented with eosinophilic infiltration in addition to IgG4 positive plasma cells. There was no patient with eosinophilic infiltration in the control group of liver transplant donors (n = 27) and patients with primary sclerosing cholangitis (n = 14). CONCLUSION EC is an underdiagnosed benign etiology of SC and IBS, which has to be considered in differential diagnosis of IBS. PMID:28246478

  20. Basic investigation of laser therapy for the ureteral stricture using ultraviolet argon laser and multifiber catheter

    NASA Astrophysics Data System (ADS)

    Daidoh, Yuichiro; Arai, Tsunenori; Murai, Masaru; Suda, Akira; Kikuchi, Makoto; Nakamura, Hiroshi; Komime, Yukikuni; Utsumi, Atsushi

    1992-06-01

    In order to develop new, easy, and safe treatment for urinary tract stricture, we investigated the laser plasty using a combination of an uv Ar laser for ablation and a novel multi-fiber catheter for laser delivery. To investigate the characteristics of the uv Ar laser ablation to ureteral tissue, the experiment in vitro was performed. The ureter was clearly ablated with sufficient thin coagulation layer. The proper laser power for the tissue ablation was about 0.5 W for 0.4 mm core-diameter fiber. The multi-fiber catheter (1.6 mm in outer diameter) consisted of 13 pixels of silica glass fibers (0.2 mm in core diameter) for laser delivery and a through lumen (0.9 mm in inner diameter) for guidewire. The catheter was inserted into a canine ureter under the general anesthesia. The ureter and urinary tract were irradiated using about 0.6 W of laser power at the catheter tip with 40s duration. The irradiated urinary tract tissues were histologically investigated. The ureter was ablated up to the submucosa layer. The urinary tract endotherium was eliminated by the laser ablation without the carbonization. No perforation was found at various irradiation conditions. To investigate the ureteral tissue damage of the uv Ar laser irradiation, the serosa temperature was measured by a thermocouple. The temperature elevation of the serosa could be restricted up to 60 degree(s)C, at which the protein was not coagulated. We concluded that the combination of uv Ra laser and multi-fiber catheter offered easy, reliable therapy for coronary structure.

  1. Biliary strictures after liver transplantation: risk factors and prevention by donor treatment with epoprostenol.

    PubMed

    Pirenne, J; Monbaliu, D; Aerts, R; Desschans, B; Liu, Q; Cassiman, D; Laleman, W; Verslype, C; Magdy, M; Van Steenbergen, W; Nevens, F

    2009-10-01

    Biliary strictures (BS), a major complication after orthotopic liver transplantation (OLT), cause morbidity, mortality, graft loss, and increased costs. The virtually unchanged incidence of BS (approximately 10%-25%) suggests that they are not simply "technical" in origin, but probably represent a mucosa ischemic injury inherent in the transplantation procedure. To study risk factors for BS, we analyzed 403 OLTs performed between January 1, 1997 and December 31, 2006, at a single center, excluding cases of regraft or death within 1 month. The average time to the diagnosis of the BS was 253 days (range, 7-1002 days). Upon univariate analysis, the absence of flushing of donor bile ducts, an imported versus a locally procured liver, and rejection were risk factors for BS. In contrast, the following factors were protective: donor cardiac arrest followed by resuscitation (suggesting an ischemic preconditioning effect) as well as addition of epoprostenol to and pressurization of the preservation solution. Patients with higher postoperative peak values of transaminases, bilirubin, alkaline phosphatase, and gamma glutamyl transpeptidase were at greater risk for later development of BS. Donor hypotension, donor age, donor intensive care unit (ICU) stay, type of preservation, positive cross-match, cold and warm ischemia times, sequential versus simultaneous portal/arterial reperfusion, as well as cytomegalovirus (CMV) infection were not risk factors for BS. Upon multivariate analysis, only epoprostenol and pressurization offered protection from BS. In conclusion, this study 2 novel points: (1) patients with high(er) transaminase values and cholestasis early postoperatively are at greater risk to develop later BS and require close monitoring and (2) donor maneuvers for better flushing and preserving peribiliary vascular plexus and biliary mucosa (epoprostenol and pressurization of preservation solution) offer protection from BS.

  2. Clinical evaluation of a single daily dose of phenylpropanolamine in the treatment of urethral sphincter mechanism incompetence in the bitch.

    PubMed

    Claeys, Stéphanie; Rustichelli, Frederico; Noël, Stéphanie; Hamaide, Annick

    2011-05-01

    The objective of this retrospective study was to determine the efficacy of a single daily oral dose of phenylpropanolamine (PPA) in the treatment of urethral sphincter mechanism incompetence (USMI) in bitches. Nine bitches diagnosed with USMI were treated with a single daily dose [1.5 mg/kg body weight (BW)] of PPA for at least 1 month. Urethral pressure profiles (UPP) were performed in 7 dogs before treatment and repeated in 4 of them after treatment. Treatment with PPA resulted in long-term continence in 8/9 bitches. One dog did not respond to PPA and was treated surgically later. Recheck UPPs showed a significant increase in maximal urethral closure pressure in the 4 bitches after treatment with PPA compared to before treatment. In conclusion, long-term continence can be achieved in bitches affected with USMI after administration of a single daily dose of PPA (1.5 mg/kg BW).

  3. Female urethral diverticulum containing a giant calculus: a CARE-compliant case report.

    PubMed

    Dong, ZhiLong; Wang, Hanzhang; Zuo, LinJun; Hou, MingLi

    2015-05-01

    Urethral diverticula with calculi have a low incidence as reported in the literature. Diverticulum of female urethra is rare, often discovered due to associated complications. We report a case of diverticulum of the female urethra containing giant calculi in a 62-year-old multiparous woman. She consulted with our office due to dysuria and a hard, painful periurethral mass in the anterior vagina wall. The diverticulum was approached surgically by a vaginal route, and local extraction of the calculi and subsequent diverticulectomy successfully treated the condition.Diagnosis of a complicated diverticulum can be easily achieved if one possesses a high degree of clinical symptoms.

  4. Surgical treatment of urethral obstruction due to urolithiasis in male cattle: a review of 85 cases.

    PubMed

    Gasthuys, F; Steenhaut, M; De Moor, A; Sercu, K

    1993-11-20

    Eighty-five male cattle with urethral obstruction due to urolithiasis were treated by surgery. In most cases local anaesthetic techniques combined with sedation were applied to the dorsally recumbent animals. The penis was transected and transposed in animals with a ruptured urethra. A ruptured bladder was repaired by a paramedian abdominal approach. The bladder was fistulated through the ventral abdominal wall when no alternative treatment was possible. Complications related to the different surgical interventions are described. Only 35.3 per cent of the animals recovered satisfactorily.

  5. Unilateral renal agenesis and urethral atresia associated with ergotamine intake during pregnancy.

    PubMed

    Demirel, Gamze; Oguz, Serife Suna; Erdeve, Omer; Dilmen, Ugur

    2012-01-01

    Ergotamine, an ergot alkaloid, used for the treatment and prevention of migraine attacks, is considered as a teratogenic drug and, therefore, should be avoided in pregnancy. Here, we report a newborn infant with unilateral renal agenesis, urethral atresia, and pulmonary hypoplasia associated with the use of ergotamine for the treatment of migraine attacks at early pregnancy. Genitourinary anomalies in association with ergotamine usage were rarely reported and this was the third case of renal agenesia in association with ergotamine usage in literature. We suggest that ergotamine teratogenicity may be dose dependent and should be avoided in pregnancy for the possibility of genitourinary anomalies.

  6. Management of urethral sphincter mechanism incompetence in a male dog with laparoscopic-guided deferentopexy.

    PubMed

    Salomon, J F; Cotard, J P; Viguier, E

    2002-11-01

    Urethral sphincter mechanism incompetence is uncommon in the male dog. Diagnosis is made on the basis of the history (full bladder intermittent incontinence with persistence of normal micturitions), clinical examination and by exclusion of other causes of incontinence, such as prostatic disease, lower urinary tract abnormalities and cystitis. This report describes a case in an 11-year-old male poodle in which positive contrast urethrocystography showed no anatomical abnormalities. Surgical treatment by fixation of both ductus deferens to the abdominal wall under laparoscopic guidance with cranial displacement of the urinary bladder improved the incontinence.

  7. Peri-meatal PeIN and urethral SCC: a case report.

    PubMed

    Doiron, P R; du P Menage, H; Freeman, A; Muneer, A; Bunker, C B

    2017-03-10

    A 55-year-old man presented with an asymptomatic lesion adjacent to the urethral meatus of one year's duration (Fig. 1). His medical history was significant for quiescent lung sarcoidosis (treatment never required), asthma and irritable bowel syndrome. His only medication was a budesonide/formoterol inhaler. The plaque had slowly been increasing in size, had not ulcerated or bled and had not impacted sexual or urinary function. Examination did not reveal extension into the urethra. Biopsy revealed undifferentiated penile intraepithelial neoplasia (PeIN) III/carcinoma in situ. This article is protected by copyright. All rights reserved.

  8. Management of Proximal Primary Urethral Cancer: Should Multidisciplinary Therapy Be the Gold Standard?

    PubMed

    Zinman, Leonard N; Vanni, Alex J

    2016-11-01

    Primary urethral cancer (PUC) is a rare, but devastating genitourinary tumor that affects men and women. Although most PUC are localized, proximal PUC frequently presents with locally advanced disease, with 30% to 40% having lymph node metastasis. Single modality surgical or radiation therapy has dismal results. Multimodal therapy with cisplatin-based chemotherapy and consolidation surgery has greatly improved the local recurrence and overall survival rates for this aggressive disease. In locally advanced squamous cell carcinoma of the urethra, radiotherapy combined with radiosensitizing chemotherapy is an option for genital preservation. Prospective, multi-institutional studies are required to further define the optimal multidisciplinary treatment strategy for this destructive disease.

  9. [Usefulness of urethral endoprosthesis in the management of urinary retention after brachytherapy for localized prostate cancer].

    PubMed

    Kerkeni, W; Chahwan, C; Lenormand, C; Dubray, B; Benyoucef, A; Pfister, C

    2014-03-01

    Brachytherapy is a possible treatment for localized low risk prostate cancer. Although this option is minimally invasive, some side effects may occur. Acute retention of urine (ARU) has been observed in 5% to 22% of cases and can be prevented in most cases by alpha-blocker treatment. Several alternatives have been reported in the literature for the management of ARU following brachytherapy: prolonged suprapubic catheterization, transurethral resection of the prostate and also intermittent self-catheterization. The authors report an original endoscopic approach, using urethral endoprosthesis, with a satisfactory voiding status.

  10. Percutaneous Balloon Dilatation for the Treatment of Early and Late Ureteral Strictures After Renal Transplantation: Long-Term Follow-Up

    SciTech Connect

    Bachar, Gil N. Mor, E.; Bartal, G.; Atar, Eli; Goldberg, N.; Belenky, A.

    2004-08-15

    We report our experience with percutaneous balloon dilatation (PBD) for the treatment of ureteral strictures in patients with renal allografts. Of the 422 consecutive patients after renal transplantation in our center 10 patients had ureteral strictures. An additional 11 patients were referred from other centers. The 21 patients included 15 men and 6 women aged 16 to 67 years. Strictures were confirmed by sonography and scintigraphy in all cases. Patients underwent 2 to 4 PBDs at 7-10-day intervals. Clinical success was defined as resolution of the stenosis and hydronephrosis on sequential ultrasound and normalization of creatinine levels. Patients were divided into two groups: those who underwent transplantation more than 3 months previously and those who underwent transplantation less than 3 months previously. PBD was successful in 13 of the 21 patients (62%). There was no statistically significant difference in success rate between the patients with early (n 12) and those with late (n = 9) obstruction: 58.4% and 66%, respectively. No major complications were documented. PBD is a safe and simple tool for treating ureteral strictures and procedure-related morbidity is low. It can serve as an initial treatment in patients with early or late ureteral strictures after renal transplantation.

  11. Prevention of esophageal stricture after endoscopic submucosal dissection using RNA-based silencing of carbohydrate sulfotransferase 15 in a porcine model.

    PubMed

    Sato, Hiroki; Sagara, Seiji; Nakajima, Nao; Akimoto, Teppei; Suzuki, Kenji; Yoneyama, Hiroyuki; Terai, Shuji; Yahagi, Naohisa

    2017-03-06

    Background and study aims Endoscopic submucosal dissection (ESD) for esophageal carcinoma frequently causes fibrotic strictures that require treatment. A possible preventive effect of small interfering RNA (siRNA) targeting carbohydrate sulfotransferase 15 (CHST15) on esophageal stricture formation after ESD was investigated in 3 pigs. Materials and methods Two half-circumferential ESD ulcers were created in the oral and anal ends of the esophagus. CHST15 siRNA was injected submucosally in one of the two ESD ulcers. Endoscopic, macroscopic, histological, and polymerase chain reaction analyses were performed. Results On post-operative day 14, the non-treated ulcers were found to show histological fibrosis and increased expression of the CHST15 messenger RNA. A single endoscopic injection of CHST15 siRNA alleviated stricture development in post-ESD ulcers with significant reduction in the mucosal contraction rate. The deposition of collagen and accumulation of fibroblasts and myofibroblasts were diminished in ulcers treated with CHST15 siRNA, where significant suppression of CHST15, transforming growth factor-beta (TGF-β), and collagen-1 messenger RNAs was also seen. Conclusion CHST15 siRNA alleviated esophageal post-ESD stricture formation via repression of fibrosis, revealing a novel therapeutic role for antifibrotic agents in the prevention of post-ESD strictures.

  12. STD/HIV control in Malawi and the search for affordable and effective urethritis therapy: a first field evaluation.

    PubMed Central

    Lule, G; Behets, F M; Hoffman, I F; Dallabetta, G; Hamilton, H A; Moeng, S; Liomba, G; Cohen, M S

    1994-01-01

    OBJECTIVES--To evaluate gonococcal (GU) and nongonococcal urethritis (NGU), chlamydia antigen, and serostatus for syphilis and human immunodeficiency virus (HIV) among males attending a Malawian STD clinic with complaints of urethral discharge and/or dysuria. To collect demographic and behavioural data and to determine the effectiveness of five treatments for urethritis. METHODS--Urethritis was diagnosed using microscopy and culture for Neisseria gonorrhoeae. Sera were screened with rapid plasma reagin (RPR) and if reactive, with microhaemagglutination for Treponema pallidum (MHA-TP). HIV antibodies and chlamydia antigen were detected using enzyme immunoassay. Patients were randomised for treatment, cure was assessed 8-10 days later. RESULTS--At enrolment, GU was diagnosed in 415 (80.3%) and NGU in 59 (11.2%) of 517 males. Chlamydia antigen was found in 26 (5.2%) of 497 specimens tested. Syphilis seropositivity rate (RPR and MHA-TP reactive) was 10.7%. Overall HIV seroprevalence was 44.2%; 71.7% of men with reactive syphilis serology were HIV(+) compared with 40.9% of syphilis seronegatives (OR: 3.6, p < 0.001). Trimethoprim 320 mg/sulphamethoxazole 1600 mg by mouth for 2 days (TMPSMX), or the combination of amoxicillin 3 gm, probenicid 1 gm, and clavulanate 125 mg by mouth once (APC), failed to cure gonorrhoea effectively. Amoxicillin 3 gm, probenicid 1 gm, and clavulanate 125 mg, by mouth once with doxycycline 100 mg BID for 7 days (APC-D), gentamicin 240 mg IM once (GENT), ciprofloxacin 250 mg by mouth once (CIPRO) cured 92.9% to 95% of gonorrhoea. APC-D treatment did not generate less NGU at follow-up. HIV serostatus did not affect cure of urethritis. CONCLUSION--All patients presenting with urethritis should be treated syndromically using a simple algorithm and screened for syphilis seroreactivity for appropriate treatment and counselling. PMID:7705854

  13. A severe case of esophageal ulcer causing a tight stricture despite long-term D-penicillamine treatment.

    PubMed

    Yapali, Suna; Turan, Ilker; Ozutemiz, Omer; Tekesin, Oktay

    2014-12-01

    D-penicillamine has long been used in the management of rheumatic diseases due to the effects on inhibition of collagen synthesis. Herein, we report a severe case of esophageal ulcer causing a tight stricture extending through the distal esophagus despite the long-term D-penicillamine treatment in a patient with Wilson's disease. D-penicillamine would theoretically be expected to contribute to the healing of an esophageal ulcer. However, the drug failed to have a favorable outcome, which is notable and worth reporting.

  14. Imaging of the Posterior Skull Base.

    PubMed

    Job, Joici; Branstetter, Barton F

    2017-01-01

    The posterior skull base can be involved by a variety of pathologic processes. They can be broadly classified as: traumatic, neoplastic, vascular, and inflammatory. Pathology in the posterior skull base usually involves the lower cranial nerves, either as a source of pathology or a secondary source of symptoms. This review will categorize pathology arising in the posterior skull base and describe how it affects the skull base itself and surrounding structures.

  15. Posterior peritoneal recesses: assessment using CT

    SciTech Connect

    Rubenstein, W.A.; Auh, Y.H.; Zirinsky, K.; Kneeland, J.B.; Whalen, J.P.; Kazam, E.

    1985-08-01

    Intraperitoneal compartments may extend posteriorly to the level of known retroperitoneal structures at several locations within the abdomen. These locations include the posterior subhepatic or hepatorenal space, the splenorenal space, the retropancreatic recess, the paracolic gutters, and the pararectal fossae. Because of their posterior location, fluid collections within these compartments may be mistaken radiologically for retroperitoneal masses. The sectional anatomy of these spaces and particularly their appearance on computed tomographic scans, are illustrated in this paper.

  16. Posterior ankle impingement in the dancer.

    PubMed

    Moser, Brad R

    2011-01-01

    Dancers spend a lot of time in the relevé position in demi-pointe and en pointe in their training and their careers. Pain from both osseous and soft tissue causes may start to occur in the posterior aspect of their ankle. This article reviews the potential causes of posterior ankle impingement in dancers. It will discuss the clinical evaluation of a dancer and the appropriate workup and radiographic studies needed to further evaluate a dancer with suspected posterior ankle impingement.

  17. The Urethral Rhabdosphincter, Levator Ani Muscle, and Perineal Membrane: A Review

    PubMed Central

    Hinata, Nobuyuki; Murakami, Gen

    2014-01-01

    Detailed knowledge of the anatomy of the rhabdosphincter and adjacent tissues is mandatory during urologic surgery to ensure reliable oncologic and functional outcomes. To characterize the levator ani (LA) function for the urethral sphincter, we described connective tissue morphology between the LA and urethral rhabdosphincter. The interface tissue between the LA and rhabdosphincter area in males contained abundant irregularly arrayed elastic fibers and smooth muscles. The male rhabdosphincter was positioned alongside the LA to divide the elevation force and not in-series along the axis of LA contraction. The male perineal membrane was thin but solid and extends along the inferior margin or bottom of the rhabdosphincter area. In contrast, the female rhabdosphincter, including the compressor urethrae and urethrovaginal sphincter muscles, was embedded in the elastic fiber mesh that is continuous with the thick, multilaminar perineal membrane. The inferomedial edge of the female LA was attached to the upper surface of the perineal membrane and not directly attached to the rhabdosphincter. We presented new diagrams showing the gender differences in topographical anatomy of the LA and rhabdosphincter. PMID:24877147

  18. Neural control of the female urethral and anal rhabdosphincters and pelvic floor muscles

    PubMed Central

    de Groat, William C.

    2010-01-01

    The urethral rhabdosphincter and pelvic floor muscles are important in maintenance of urinary continence and in preventing descent of pelvic organs [i.e., pelvic organ prolapse (POP)]. Despite its clinical importance and complexity, a comprehensive review of neural control of the rhabdosphincter and pelvic floor muscles is lacking. The present review places historical and recent basic science findings on neural control into the context of functional anatomy of the pelvic muscles and their coordination with visceral function and correlates basic science findings with clinical findings when possible. This review briefly describes the striated muscles of the pelvis and then provides details on the peripheral innervation and, in particular, the contributions of the pudendal and levator ani nerves to the function of the various pelvic muscles. The locations and unique phenotypic characteristics of rhabdosphincter motor neurons located in Onuf's nucleus, and levator ani motor neurons located diffusely in the sacral ventral horn, are provided along with the locations and phenotypes of primary afferent neurons that convey sensory information from these muscles. Spinal and supraspinal pathways mediating excitatory and inhibitory inputs to the motor neurons are described; the relative contributions of the nerves to urethral function and their involvement in POP and incontinence are discussed. Finally, a detailed summary of the neurochemical anatomy of Onuf's nucleus and the pharmacological control of the rhabdosphincter are provided. PMID:20484700

  19. Bitter triggers acetylcholine release from polymodal urethral chemosensory cells and bladder reflexes

    PubMed Central

    Deckmann, Klaus; Filipski, Katharina; Krasteva-Christ, Gabriela; Fronius, Martin; Althaus, Mike; Rafiq, Amir; Papadakis, Tamara; Renno, Liane; Jurastow, Innokentij; Wessels, Lars; Wolff, Miriam; Schütz, Burkhard; Weihe, Eberhard; Chubanov, Vladimir; Gudermann, Thomas; Klein, Jochen; Bschleipfer, Thomas; Kummer, Wolfgang

    2014-01-01

    Chemosensory cells in the mucosal surface of the respiratory tract (“brush cells”) use the canonical taste transduction cascade to detect potentially hazardous content and trigger local protective and aversive respiratory reflexes on stimulation. So far, the urogenital tract has been considered to lack this cell type. Here we report the presence of a previously unidentified cholinergic, polymodal chemosensory cell in the mammalian urethra, the potential portal of entry for bacteria and harmful substances into the urogenital system, but not in further centrally located parts of the urinary tract, such as the bladder, ureter, and renal pelvis. Urethral brush cells express bitter and umami taste receptors and downstream components of the taste transduction cascade; respond to stimulation with bitter (denatonium), umami (monosodium glutamate), and uropathogenic Escherichia coli; and release acetylcholine to communicate with other cells. They are approached by sensory nerve fibers expressing nicotinic acetylcholine receptors, and intraurethral application of denatonium reflexively increases activity of the bladder detrusor muscle in anesthetized rats. We propose a concept of urinary bladder control involving a previously unidentified cholinergic chemosensory cell monitoring the chemical composition of the urethral luminal microenvironment for potential hazardous content. PMID:24843119

  20. The enigma of non-gonococcal urethritis: role for Bacteroides ureolyticus.

    PubMed Central

    Hawkins, D A; Fontaine, E A; Thomas, B J; Boustouller, Y L; Taylor-Robinson, D

    1988-01-01

    Although up to about half the cases of acute non-gonococcal urethritis (NGU) are caused by Chlamydia trachomatis organisms (chlamydiae) and a smaller, ill-defined, proportion probably by Ureaplasma urealyticum organisms (ureaplasmas), the aetiology of all cases is not understood. Clarification of the role of the anaerobe, Bacteroides ureolyticus, was sought in the current study. Seventy five chlamydia negative patients with NGU were treated on a double blind placebo controlled basis with metronidazole. After seven days more of the 35 patients given this drug tended to improve clinically than the 40 given the placebo, but the difference was not significant. Of 23 chlamydia negative but anaerobe positive men, however, 78% (7/9) receiving metronidazole responded clinically, but only 7% (1/14) receiving placebo responded (p less than 0.001). Furthermore, whereas 78% of the anaerobe positive men given metronidazole recovered, only 23% (6/26) of the anaerobe negative men did so (p less than 0.02). No further evidence for the role of ureaplasmas in the aetiology of NGU was obtained, but the data suggest that B ureolyticus organisms, and perhaps other anaerobes, have an important role in a small proportion of cases and that the beneficial effects of metronidazole given on an empirical basis will be confined to anaerobe positive urethritis. PMID:3278969

  1. Comparison of terazosin and prazosin for treatment of vesico-urethral reflex dyssynergia in dogs.

    PubMed

    Haagsman, A N; Kummeling, A; Moes, M E; Mesu, S J; Kirpensteijn, J

    2013-07-13

    Nineteen dogs with vesico-urethral reflex dyssynergia (VURD) were treated with prazosin or terazosin 0.5 mg/kg twice daily to compare efficacy and side effects. Dogs were referred because of signs of (partial) urethral obstruction. Physical examination, abdominal ultrasonography, urinalysis and a radiographic contrast study of bladder and urethra (urethrocystography) were routinely performed. If no mechanical causes of obstruction or disease of the distal urinary tract were observed, the diagnosis VURD was presumed and the dogs were included in our study. Follow-up information was obtained from owners or referring veterinarians. Significantly more side effects were seen in the dogs treated with terazosin (n=14; 93 per cent) compared with the dogs treated with prazosin (n=5; 20 per cent; P=0.002). Effects of the treatment were comparable between prazosin and terazosin. Labradors and dogs that were castrated surgically had a significant better survival (P<0.01) compared with other breeds and animals that were castrated chemically. There was a moderate to good effect in 60 per cent of the dogs treated with prazosin, and in 64 per cent of the dogs treated with terazosin.

  2. [Urethral Fistula and Scrotal Abscess Associated with Colovesical Fistula Due to the Sigmoid Colon Cancer].

    PubMed

    Nakazawa, Shigeaki; Uemura, Motohide; Miyagawa, Yasushi; Tsujimura, Akira; Nonomura, Norio

    2015-09-01

    We report here a rare case of urethral fistula and scrotal abscess associated with colovesical fistula due to sigmoid colon cancer. An 84-year-old male was referred to our hospital complaining of macrohematuria, fecaluria, pneumaturia and micturitional pain. Computed tomography (CT) showed colovesical fistula. Other examinations, including colonoscopy and cystoscopy, did not reveal a clear cause for the colovesical fistula. Only an elevated serum level of the tumor marker CA19-9 suggested the possibility of sigmoid colon cancer. Eleven days after hospitalization, bilateral scrotal contents had swollen rapidly to the size of a goose egg. CT suggested urethral fistula with scrotal abscess formation. Drainage of scrotal abscess and colostomy were performed. Intraoperatively, the fistula of the bulbar urethra was revealed. Because increased serum CA19-9 suggested a diagnosis of sigmoid colon cancer, cystectomy and sigmoid colectomy with right nephrectomy were performed. Pathological examination revealed adenocarcinoma of sigmoid colon with bladder invasion. His condition was improved with rehabilitation 6 months after operation.

  3. Injectable biomaterials for the treatment of stress urinary incontinence: their potential and pitfalls as urethral bulking agents.

    PubMed

    Davis, Niall F; Kheradmand, F; Creagh, T

    2013-06-01

    Injectable urethral bulking agents composed of synthetic and biological biomaterials are minimally invasive treatment options for stress urinary incontinence (SUI). The development of an ideal urethral bulking agent remains challenging because of clinical concerns over biocompatibility and durability. Herein, the mechanical and biological features of injectable urethral biomaterials are investigated, with particular emphasis on their future potential as primary and secondary treatment options for SUI. A literature search for English language publications using the two online databases was performed. Keywords included "stress urinary incontinence", "urethral bulking agent" and "injectable biomaterial". A total of 98 articles were analysed, of which 45 were suitable for review based on clinical relevance and importance of content. Injectable biomaterials are associated with a lower cure rate and fewer postoperative complications than open surgery for SUI. They are frequently reserved as secondary treatment options for patients unwilling or medically unfit to undergo surgery. Glutaraldehyde cross-linked bovine collagen remains the most commonly injected biomaterial and has a cure rate of up to 53 %. Important clinical features of an injectable biomaterial are durability, biocompatibility and ease of administration, but achieving these requirements is challenging. In carefully selected patients, injectable biomaterials are feasible alternatives to open surgical procedures as primary and secondary treatment options for SUI. In future, higher cure rates may be feasible as researchers investigate alternative biomaterials and more targeted injection techniques for treating SUI.

  4. Comparison of methylene blue/gentian violet stain to Gram's stain for the rapid diagnosis of gonococcal urethritis in men.

    PubMed

    Taylor, Stephanie N; DiCarlo, Richard P; Martin, David H

    2011-11-01

    We compared a simple, one-step staining procedure using a mixture of methylene blue and gentian violet to Gram stain for the detection of gonococcal urethritis. The sensitivity and specificity of both Gram stain and methylene blue/gentian violet stain were 97.3% and 99.6%, respectively. There was a 100% correlation between the 2 methods.

  5. Prevention of urethral blockage following semen collection in two species of lemur, Varecia variegata variegata and Lemur catta.

    PubMed

    Chatfield, Jenifer; Penfold, Linda

    2007-06-01

    Lemurs are a diverse group of primates comprised of five families, all of which are found only on Madagascar and the Comoro Islands. Of the 60 known species, 17 are endangered and 5 of these are considered critically endangered. The effects of inbreeding on population health and viability have been well described; though negative inbreeding effects can be ameliorated through the introduction of new genetic material. Introduction of new individuals into a population can be extremely challenging because of the highly social nature of lemurs. Semen collection in lemur species is notoriously challenging, as the ejaculate forms a coagulum. During normal breeding, the coagulum forms a copulatory plug in the female. However, this coagulum can present a life-threatening situation when retained in the urethra abnormally following electroejaculation. This study investigates the use of ascorbic acid in preventing urethral blockage in two lemur species during semen collection, demonstrates successful collection of semen by electroejaculation from two species of lemur during the breeding season, and discusses removal of urethral plugs subsequent to semen collection. Semen was collected successfully from all animals. Urethral plugs formed during each collection and were abnormally retained in 2/11 collections. Both plugs were successfully and immediately removed with the use of retropulsion through a urethral catheter. Although the results of this study are encouraging, more investigation is required to establish whether or not this procedure can be safely performed in the field.

  6. Posterior repair and sexual function

    PubMed Central

    Komesu, Yuko M.; Rogers, Rebecca G.; Kammerer-Doak, Dorothy N.; Barber, Matthew D.; Olsen, Ambre L.

    2011-01-01

    OBJECTIVE The purpose of this study was to determine the effect of posterior repair (PR) on sexual function in patients who have undergone incontinence and/or pelvic reconstructive surgery. STUDY DESIGN A cohort study of women who underwent incontinence and/or prolapse surgery was performed. Participants completed the pelvic organ prolapse urinary incontinence sexual questionnaire (PISQ) before and after the operation. PISQ scores were compared between women who underwent PR and women who did not. RESULTS Of 73 study participants, 30 women underwent PR; 43 women did not (no PR). Although there was no difference in dyspareunia between groups pre-op, dyspareunia prevalence post-op was significantly lower in the no PR group. Preoperative PISQ scores were similar between groups. After the operation, both groups significantly improved their PISQ scores, without a difference between groups. CONCLUSION Although the incidence of dyspareunia differed between PR and no PR groups, overall improvement in sexual function was reflected in improved total PISQ scores that occurred irrespective of PR performance. PMID:17618777

  7. Effect of duloxetine, a norepinephrine and serotonin reuptake inhibitor, on sneeze-induced urethral continence reflex in rats.

    PubMed

    Miyazato, Minoru; Kaiho, Yasuhiro; Kamo, Izumi; Chancellor, Michael B; Sugaya, Kimio; de Groat, William C; Yoshimura, Naoki

    2008-07-01

    We investigated the effect of duloxetine, a norepinephrine (NE) and serotonin (5-HT) reuptake inhibitor, on the neurally evoked urethral continence reflex induced by sneezing in rats. To clarify the role of noradrenergic and serotonergic mechanisms in preventing stress urinary incontinence (SUI) during sneezing, we examined the effect of duloxetine followed by intrathecal (it) methiothepin maleate (5-HT receptor and alpha1-adrenoceptor antagonist) or terazosin or idazoxan (selective alpha1- and alpha2-adrenoceptor antagonists, respectively). Amplitude of urethral pressure responses during sneezing (A-URS), urethral baseline pressure (UBP) at the midurethra, and sneeze-induced leak point pressure (S-LPP) were measured in normal adult female rats and rats with SUI induced by vaginal distension (VD). In normal and VD rats, intravenous application of duloxetine (1 mg/kg) increased A-URS by 35% and 34% and UBP by 21% and 34%, respectively. Sneezing-induced fluid leakage from the urethral orifice was observed in VD rats but not in normal rats. S-LPP was increased from 39.1 to 92.2 cmH2O by intravenous duloxetine in incontinent VD rats. Duloxetine-mediated enhancement of A-URS was inhibited by terazosin but not methiothepin maleate (it). In addition, simultaneous intrathecal application of methiothepin and terazosin induced a reduction in A-URS during sneezing, which was not increased by intravenous duloxetine. However, the reduced A-URS after intrathecal application of methiothepin and terazosin returned to the control level when duloxetine (iv) was applied after intrathecal idazoxan administration. These results indicate that duloxetine can prevent SUI by facilitating noradrenergic and serotonergic systems in the spinal cord to enhance the sneeze-induced active urethral closure mechanism.

  8. Notes from the Field: Increase in Neisseria meningitidis-Associated Urethritis Among Men at Two Sentinel Clinics - Columbus, Ohio, and Oakland County, Michigan, 2015.

    PubMed

    Bazan, Jose A; Peterson, Amy S; Kirkcaldy, Robert D; Briere, Elizabeth C; Maierhofer, Courtney; Turner, Abigail Norris; Licon, Denisse B; Parker, Nicole; Dennison, Amanda; Ervin, Melissa; Johnson, Laura; Weberman, Barbara; Hackert, Pamela; Wang, Xin; Kretz, Cecilia B; Abrams, A Jeanine; Trees, David L; Del Rio, Carlos; Stephens, David S; Tzeng, Yih-Ling; DiOrio, Mary; Roberts, Mysheika Williams

    2016-06-03

    Neisseria meningitidis (Nm) urogenital infections, although less common than infections caused by Neisseria gonorrhoeae (Ng), have been associated with urethritis, cervicitis, proctitis, and pelvic inflammatory disease. Nm can appear similar to Ng on Gram stain analysis (gram-negative intracellular diplococci) (1-5). Because Nm colonizes the nasopharynx, men who receive oral sex (fellatio) can acquire urethral Nm infections (1,3,5). This report describes an increase in Nm-associated urethritis in men attending sexual health clinics in Columbus, Ohio, and Oakland County, Michigan.

  9. Role of spinal serotonergic pathways in sneeze-induced urethral continence reflex in rats.

    PubMed

    Miyazato, Minoru; Kaiho, Yasuhiro; Kamo, Izumi; Kitta, Takeya; Chancellor, Michael B; Sugaya, Kimio; Arai, Yoichi; de Groat, William C; Yoshimura, Naoki

    2009-10-01

    To clarify the role of spinal serotonergic mechanisms in preventing stress urinary incontinence (SUI) during sneezing, we investigated the effect of intrathecal (it) application of 8-OH-DPAT (a 5-HT(1A) agonist), mCPP (a 5-HT(2B/2C) agonist), and fluoxetine (a serotonin reuptake inhibitor) using a rat model that can examine the neurally evoked continence reflex during sneezing. Amplitudes of urethral pressure responses during sneezing (A-URS), urethral baseline pressure (UBP) at the midurethra, and sneeze-induced leak point pressure (S-LPP) were measured in normal female adult rats and rats with SUI induced by vaginal distention (VD). In normal rats, 8-OH-DPAT decreased A-URS by 48.9%, whereas mCPP increased A-URS by 33.6%. However, A-URS was not changed after fluoxetine. 8-OH-DPAT, mCPP, or fluoxetine did not alter UBP. The effect of 8-OH-DPAT and mCPP was antagonized by WAY-100635 (it), a selective 5-HT(1A) antagonist, and RS-102221 (it), a selective 5-HT(2C) antagonist, respectively. Fluoxetine in the presence of WAY-100635 did not change either A-URS or UBP, but fluoxetine in the presence of RS-102221 decreased A-URS. In VD rats, S-LPP was decreased by 14.6 cmH2O after 8-OH-DPAT, whereas it was increased by 12.8 cmH2O after mCPP. However, S-LPP was not changed after fluoxetine. These results indicate that activation of 5-HT(2C) receptors enhances the active urethral closure reflex during sneezing at the spinal level, whereas 5-HT(1A) inhibits it and that no apparent changes in the sneeze-induced continence reflex after fluoxetine treatment are due to coactivation of excitatory 5-HT(2C) receptors and inhibitory 5-HT receptors other than the 5-HT(1A) subtype. Thus, activation of excitatory 5-HT receptor subtypes such as 5-HT(2C) could be effective for the treatment of SUI.

  10. [Urethral recurrence of invasive carcinoma following BCG treatment for bladder Ca in situ].

    PubMed

    Ruoppolo, M; Gozo, M; Milesi, R; Spina, R; Fragapane, G

    2010-01-01

    CIS is a flat, high-grade, non-invasive microscopic urothelial carcinoma. It is considered a precursor of invasive bladder cancer. CIS is classified as primary, secondary or concurrent, when occurred as isolated CIS without cuncurrent papillary tumors, or detected during the follow-up of patients with a previous papillary tumor, or finally in the presence of bladder neoplasm. BCG is widely established as the treatment of choice for CIS with a success rate of approximately 70%. BCG reduces the risk of progression of CIS into invasive carcinoma in 30 to 50% of cases. Direct and prolonged contact between the urothelium and BCG is a prerequisite for successful therapy. Discovery of CIS in the prostatic or membranous urethra represents an ominous sign. CIS may be present only in the epithelial lining of the prostatic urethra or in the ducts, or in the worst case it may be found in the prostatic tissue stroma. Urethral involvement by CIS is at high risk of tumor progression and development of metastases due to reduced thickness of lamina propria and absence of muscolaris mucosa. 83 patients, enrolled from 1/1996 to 12/2005 at our urological department with CIS: primary (focal and multifocal) in 25, secondary in 7 and cuncurrent in 51 (associated with T1bG3 cancer in 37 cases), and urethral CIS in 5 and conservatively treated by TUR and intravescical instillations of BCG, 4 developed afterwords only invasive cancer of the urethra in the absence of bladder involvement. In 2 cases cancer arised from the prostatic fossa after TURP, in 1 from membranous urethra and in the last from prostatic ducts. Among the 4 patients, 3 were treated by cystoprostatourethrectomy and Platinum-based chemotherapy, 1 refused surgical treatment. Two patients died for disseminated disease. 1 patient is alive at 60-month's follow-up. In the last patient cancer relapsed at 36-month's follow-up. We conclude that prostatic/urethral involvement during follow-up after successful intravesical treatment

  11. Urethral Injuries

    MedlinePlus

    ... and Related Injuries (Video) Rotator Cuff Injury (News) Violent Video Games May Not 'Desensitize' Players, Brain Scans ... Comfort Am I Correct? More Videos News HealthDay Violent Video Games May Not 'Desensitize' Players, Brain Scans ...

  12. Treatment implications of posterior fossa ependymoma subgroups.

    PubMed

    Ramaswamy, Vijay; Taylor, Michael D

    2016-11-15

    Posterior fossa ependymoma comprises two distinct molecular entities, ependymoma_posterior fossa A (EPN_PFA) and ependymoma_posterior fossa B (EPN_PFB), with differentiable gene expression profiles. As yet, the response of the two entities to treatment is unclear. To determine the relationship between the two molecular subgroups of posterior fossa ependymoma and treatment, we studied a cohort of 820 patients with molecularly profiled, clinically annotated posterior fossa ependymomas. We found that the strongest predictor of poor outcome in patients with posterior fossa ependymoma across the entire age spectrum was molecular subgroup EPN_PFA, which was recently reported in the paper entitled "Therapeutic impact of cytoreductive surgery and irradiation of posterior fossa ependymoma in the molecular era: a retrospective multicohort analysis" in the Journal of Clinical Oncology. Patients with incompletely resected EPN_PFA tumors had a very poor outcome despite receiving adjuvant radiation therapy, whereas a substantial proportion of patients with EPN_PFB tumors can be cured with surgery alone.

  13. Congenital basis of posterior fossa anomalies

    PubMed Central

    Cotes, Claudia; Bonfante, Eliana; Lazor, Jillian; Jadhav, Siddharth; Caldas, Maria; Swischuk, Leonard

    2015-01-01

    The classification of posterior fossa congenital anomalies has been a controversial topic. Advances in genetics and imaging have allowed a better understanding of the embryologic development of these abnormalities. A new classification schema correlates the embryologic, morphologic, and genetic bases of these anomalies in order to better distinguish and describe them. Although they provide a better understanding of the clinical aspects and genetics of these disorders, it is crucial for the radiologist to be able to diagnose the congenital posterior fossa anomalies based on their morphology, since neuroimaging is usually the initial step when these disorders are suspected. We divide the most common posterior fossa congenital anomalies into two groups: 1) hindbrain malformations, including diseases with cerebellar or vermian agenesis, aplasia or hypoplasia and cystic posterior fossa anomalies; and 2) cranial vault malformations. In addition, we will review the embryologic development of the posterior fossa and, from the perspective of embryonic development, will describe the imaging appearance of congenital posterior fossa anomalies. Knowledge of the developmental bases of these malformations facilitates detection of the morphological changes identified on imaging, allowing accurate differentiation and diagnosis of congenital posterior fossa anomalies. PMID:26246090

  14. Recurrent posterior shoulder instability. Diagnosis and treatment.

    PubMed

    Pollock, R G; Bigliani, L U

    1993-06-01

    Recurrent posterior glenohumeral instability is regarded as a difficult problem to diagnose and treat. A careful history and physical examination are the most helpful tools in making this diagnosis. A positive posterior stress test, demonstrable posterior subluxation, and a sulcus sign are frequently present on examination. Special roentgenographic studies, such as the computerized arthrotomography (arthro-CT) scan, may be used in cases in which plain roentgenographs suggest bony glenoid abnormalities. When conservative therapy fails, there is no consensus on the operative treatment. Procedures that address the soft tissues, such as capsulorrhaphy and posterior labral repair, as well as those that alter the bony geometry of the joint, such as posterior bone blocks and glenoid or humeral osteotomies, have been described. Capsular laxity is the most common pathologic finding in the authors' experience, and they favor the use of a posterior-inferior capsular shift procedure to correct this problem. Augmentation of the repair with a posterior bone block is reserved for unusual cases, such as when glenoid hypoplasia is present or in certain revision situations.

  15. Posterior labral injury in contact athletes.

    PubMed

    Mair, S D; Zarzour, R H; Speer, K P

    1998-01-01

    Nine athletes (seven football offensive linemen, one defensive lineman, and one lacrosse player) were found at arthroscopy to have posterior labral detachment from the glenoid. In our series, this lesion is specific to contact athletes who engage their opponents with arms in front of the body. All patients had pain with bench pressing and while participating in their sport, diminishing their ability to play effectively. Conservative measures were ineffective in relieving their symptoms. Examination under anesthesia revealed symmetric glenohumeral translation bilaterally, without evidence of posterior instability. Treatment consisted of glenoid rim abradement and posterior labral repair with a bioabsorbable tack. All patients returned to complete at least one full season of contact sports and weightlifting without pain (minimum follow-up, > or = 2 years). Although many injuries leading to subluxation of the glenohumeral joint occur when an unanticipated force is applied, contact athletes ready their shoulder muscles in anticipation of impact with opponents. This leads to a compressive force at the glenohumeral joint. We hypothesize that, in combination with a posteriorly directed force at impact, the resultant vector is a shearing force to the posterior labrum and articular surface. Repeated exposure leads to posterior labral detachment without capsular injury. Posterior labral reattachment provides consistently good results, allowing the athlete to return to competition.

  16. Long-Term Results of Percutaneous Bilioenteric Anastomotic Stricture Treatment in Liver-Transplanted Children

    SciTech Connect

    Moreira, Airton Mota Carnevale, Francisco Cesar; Tannuri, Uenis; Suzuki, Lisa; Gibelli, Nelson; Maksoud, Joao Gilberto; Cerri, Giovanni Guido

    2010-02-15

    was 10 months. The primary patency rate was 61.2%, and the recurrence rate was 34.3% (group I). Seven patients (7 of 35; 20%) had their stricture treated with a second treatment session (group II). The average drainage time in group II was 24 months. During a period >20 months, 4 patients (4 of 35; 11.4%) required 1 additional treatment session (group III), and 1 patient (1 of 35; 2.9%) had a catheter placed at the end of the study period (group IV). Drainage time in group I was significantly shorter than those in groups II, III, and IV (p < 0.05). There was no statistically significant relation between therapeutic response and the selected risk factors (p > 0.05). The majority of complications, such as catheter displacement and leakage, were classified as minor; however, 2 patients (5.7%) with hemobilia were noted. Complications increased according to the need for reintervention. In conclusion, balloon dilation and percutaneous drainage placement is safe and effective, and it has long-term patency for children with BAS after liver transplantation. Because of prolonged treatment time, reintervention may be necessary, thereby increasing the complication rate. Balloon dilation and percutaneous drainage placement should be considered as the first treatment option because of its minimally invasive nature.

  17. Anatomy-shaped design of a fully-covered, biliary, self-expandable metal stent for treatment of benign distal biliary strictures

    PubMed Central

    Weigt, Jochen; Kandulski, Arne; Malfertheiner, Peter

    2016-01-01

    Background and study aims: The treatment success of benign biliary strictures with fully covered metal stents (CSEMS) is altered by high stent dislocation rates. We aimed to evaluate a new stent design to prevent dislocation. Patients and methods: Patients with benign biliary strictures were treated with a newly designed double-coned stent (dcSEMS). Mechanical analysis of the new stent was performed and it was compared with a cylindrical stent. Results: A total of 13 dcCSEMS were implanted in 11 patients (2 female, 9 male, median age 47, range 33 – 71). All patients had distal biliary strictures due to chronic pancreatitis. No stent migration occurred. In all but one patient the stents were removed. One patient refused stent extraction and was lost to follow up. Stent occlusion occurred twice leading to cholangitis in both cases. The duration of stent treatment was 170 days (range 61 – 254). After extraction only one patient had early recurrent stricture and received the same stent again. Three stents showed minimal tissue granulation at the papilla. One stent presented ingrowth at the proximal end and was removed after implantation of a second fully covered stent. Mechanical examination revealed significantly lower radial expansion force of the new stent as compared to the cylindrical stent. Conclusions: The new stent design has a low rate of migration. Biomechanical properties may explain this effect. PMID:26793789

  18. Modeling the Biomechanical Influence of Epilaryngeal Stricture on the Vocal Folds: A Low-Dimensional Model of Vocal-Ventricular Fold Coupling

    ERIC Educational Resources Information Center

    Moisik, Scott R.; Esling, John H.

    2014-01-01

    Purpose: Physiological and phonetic studies suggest that, at moderate levels of epilaryngeal stricture, the ventricular folds impinge upon the vocal folds and influence their dynamical behavior, which is thought to be responsible for constricted laryngeal sounds. In this work, the authors examine this hypothesis through biomechanical modeling.…

  19. Stricture Rate after Laparoscopic Roux-en-Y Gastric Bypass with a 21-mm Circular Stapler versus a 25-mm Linear Stapler

    PubMed Central

    Vunnamadala, Kalyan; Sakharpe, Aniket; Wilhelm, B. Jakub; Aksade, Artun

    2015-01-01

    Background: Obesity is estimated to affect more than one and a half billion adults. Laparoscopic Roux-en-Y gastric bypass (LRYGB) has become one of the preferred weight loss procedures. However, complications can occur. Strictures at the gastrojejunal anastomosis lead to clinical symptoms such as vomiting, dysphagia, and patient discomfort. The stricture rate has been correlated with the size and type of stapler used. Methods: A retrospective review of the clinical records of patients who underwent LRYGB was performed between 2003 and 2010. A comparison was made between a 21-mm circular stapler technique and a 25-mm linear stapler technique. Results: The stricture rate for the 21-mm circular stapler group was 7.12% and comparable to the national average. Using the 25-mm linear stapler, this complication rate significantly decreased to 1.09% (p<0.0004; odds ratio 6.5; [95% confidence interval 1.96–33.83]). Conclusions: Stricture after LRYGB is a serious complication. This study found that with a change in technique, this complication can be decreased considerably. PMID:25830078

  20. Trans-urethral ultrasound (TUUS) imaging for visualization and analysis of the prostate and associated tissues

    NASA Astrophysics Data System (ADS)

    Holmes, David R., III; Robb, Richard A.

    2000-04-01

    Accurate assessment of pathological conditions in the prostate is difficult. Screening methods include palpation if the prostate gland, blood chemical testing, and diagnostic imaging. Trans-rectal Ultrasound (TRUS) is commonly used for the assessment of pathological conditions, however, TRUS is severely constrained by the relative distal location of the imaging probe. Trans-urethral Ultrasound (TUUS) may overcome some limitations of TRUS. A TUUS catheter was used to image the prostate, rectum, bladder, ureter, neuro-vascular bundles, arteries, and surrounding tissue. In addition, 360 degrees rotational scans were recorded for reconstruction into 3D volumes. Segmentation was challenging, however, new techniques such as active contour methods show potential. 3D visualizations, including both volume and surface rendering, were provided to clinicians off-line. On-line 3D visualization techniques are currently being developed. Potential applications of TUUS include: prostate cancer diagnosis and staging as well as image guided biopsy and therapy.

  1. Prostatic urethral lift: A minimally invasive treatment for benign prostatic hyperplasia

    PubMed Central

    Garcia, Cindy; Chin, Peter; Rashid, Prem; Woo, Henry H.

    2015-01-01

    Prostatic urethral lift (PUL) is a minimally invasive procedure for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia. The procedure may be performed under local, spinal, or general anesthesia. The PUL procedure involves the delivery of implants that retract obstructing prostate lobes. Unlike other benign prostatic hyperplasia treatment options including pharmacological therapy, and the current invasive gold-standard transurethral resection of the prostate, the PUL procedure achieves quantifiable improvements in functional outcomes and quality of life, in the absence of major adverse events. Furthermore, improvement in LUTS may be attained while preserving erectile and ejaculatory function. Adverse effects associated with the PUL procedure are mild to moderate, and are transient in nature. The PUL procedure provides an alternative for men seeking treatment for bothersome LUTS, with fewer side-effects. PMID:26157759

  2. Prostatic urethral lift: A minimally invasive treatment for benign prostatic hyperplasia.

    PubMed

    Garcia, Cindy; Chin, Peter; Rashid, Prem; Woo, Henry H

    2015-03-01

    Prostatic urethral lift (PUL) is a minimally invasive procedure for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia. The procedure may be performed under local, spinal, or general anesthesia. The PUL procedure involves the delivery of implants that retract obstructing prostate lobes. Unlike other benign prostatic hyperplasia treatment options including pharmacological therapy, and the current invasive gold-standard transurethral resection of the prostate, the PUL procedure achieves quantifiable improvements in functional outcomes and quality of life, in the absence of major adverse events. Furthermore, improvement in LUTS may be attained while preserving erectile and ejaculatory function. Adverse effects associated with the PUL procedure are mild to moderate, and are transient in nature. The PUL procedure provides an alternative for men seeking treatment for bothersome LUTS, with fewer side-effects.

  3. Outcomes of Percutaneous Management of Anastomotic Ureteral Strictures in Renal Transplantation: Chronic Nephroureteral Stent Placement with and without Balloon Dilatation

    SciTech Connect

    Uflacker, A. Sheeran, D. Khaja, M.

    2015-06-15

    PurposeThis study was designed o evaluate outcomes of percutaneous management of anastomotic ureteral strictures in renal transplants using nephroureteral stents with or without balloon dilatation.MethodsA retrospective audit of 1,029 consecutive renal transplants was performed. Anastomotic ureteral strictures were divided into two groups: nephroureteral stent only (NUS) and NUS+PTA (nephroureteral stent plus percutaneous transluminal angioplasty), with each cohort subdivided into early versus late presentation (obstructive uropathy occurring <90 day or >90 days from transplant, respectively). Overall and 6-month technical success were defined as removal of NUS any time with <30 % residual stenosis (any time lapse less or more than 6 months) and at >6 months, respectively. Patency was evaluated from NUS removal to last follow-up for both groups and compared.ResultsSixty-seven transplant patients with 70 ureteric anastomotic strictures (6.8 %, n = 70/1,029) underwent 72 percutaneous treatments. 34 % were late (>90 days, n = 24/70), and 66 % were early (<90 days, n = 46/70). Overall technical success was 82 % (n = 59/72) and 6-month success was 58 % (n = 42/72). Major and minor complications were 2.8 % (n = 2/72), and 12.5 % (n = 9/72). NUS+PTA did not improve graft survival (p = 0.354) or patency (p = 0.9) compared with NUS alone. There was no difference in graft survival between treated and nontreated groups (p = 0.74).ConclusionsThere is no advantage to PTA in addition to placement of NUS, although PTA did not negatively impact graft survival or long-term patency and both interventions were safe and effective. Neither the late or early groups benefited from PTA in addition to NUS. Earlier obstructions showed greater improvement in serum creatinine than later obstructions.

  4. The Trial of Mid-Urethral Slings (TOMUS): Design and Methodology

    PubMed Central

    2013-01-01

    Objective Mid-urethral slings (MUS) are increasingly common surgical procedures for the treatment of stress urinary incontinence (SUI) in women. There are currently no adequately powered trials with sufficient length of follow-up comparing the efficacy or safety of the transobturator and retropubic MUS. As a result, no selection criteria are available to guide surgeons or patients. This article describes the methodology and rationale for the Trial Of Mid-Urethral Slings (TOMUS). Patients and Methods The primary aims of this randomized controlled trial is to compare subjective and objective success rates for urinary incontinence (UI) at 12 and 24 months following retropubic and transobturator MUS procedures. Secondary aims are to compare the resolution of overall and stress-specific UI, morbidity, the time to adequate voiding, satisfaction, and quality of life in the two groups. TOMUS will also assess the clinical utility of pre-operative urodynamics in women undergoing MUS procedures. The primary outcome will be obtained at 12 months and 24 months. The definition of treatment success is two-fold. Objective treatment success is defined by a negative stress test, a negative 24-hour pad test and no retreatment for SUI. Subjective treatment success is defined by no self-reported leakage on 3-day diary and no self-reported SUI symptoms. Enrollment began April 2006 and is expected to be complete in 2 years. Conclusions The TOMUS trial is designed to provide outcome and safety information to pelvic surgeons and their patients on the two most commonly performed MUS techniques. PMID:24772006

  5. A de-epithelialised 'turnover dartos flap' in the repair of urethral fistula.

    PubMed

    Ahuja, Rajeev B

    2009-03-01

    We report our experience in the management of urethrocutaneous fistulae following hypospadias repair by using a turnover, de-epithelialiszed dartos flap. From May 2003 to June 2007 we operated on 10 patients with urethral fistulae following hypospadias repair. Their ages ranged from 4 to 25 years (mean: 7 years). Four of these patients had their urethroplasty done elsewhere and reported for fistula repair alone. These four patients had no record of the urethroplasty procedure that was used. A solitary fistula was located at the corona in two patients, on the mid-shaft in three patients, and proximal penile in one patient. Two patients had multiple fistulae on the shaft, one patient had two fistulae on the shaft, and one patient had a long fistula from the proximal penile to peno-scrotal region. The technique involves using a circumscribing incision around the fistula and closing the inner skin edges by an inverting subcuticular stitch to form the urethral layer. A flap is marked on the skin adjacent to the circumscribing incision and de-epithelialised. It is raised with underlying dartos fascia/muscle and turned over the first layer of closure and secured. The vascular supply to the flap is based on a hinge of tissue around the defect. A long skin flap developed from shaft or the scrotum is approximated over this layer to complete the repair. Alternatively, the skin is closed in a 'pants over vest' technique. An indwelling catheter is placed for 3-4 days. Nine patients healed without complications, and one patient with multiple fistulae on the shaft had a residual tiny pin-point fistula which closed spontaneously. Thus, the success rate with this technique was 100%. Although dartos flaps have been used for many years as a waterproofing layer in urethroplasties or while repairing urethrocutaneous fistulae, their use as a 'de-epithelialised turnover flap' provides another reliable tool in the surgical repertoire.

  6. Urethral catheters and medical malpractice: a legal database review from 1965 to 2015

    PubMed Central

    Osterberg, E. Charles; Chang, Helena; Gaither, Thomas W.; Alwaal, Amjad; Fox, Ryan; Breyer, Benjamin N.

    2016-01-01

    Background Urethral catheters (UCs) are commonly used in medicine and are associated with complications such as urinary tract infections (UTIs) and trauma. Given UC complications and their ubiquitous usage in healthcare, there is a potential for liability risk. We aim to explore litigation involving UC-related complications. Methods The LexisNexis legal database was queried for all state and federal cases from January 1965 through October 2015 using the terms “urethral catheter” or “Foley catheter” in combination with “medical malpractice”, “negligence”, “medical error”, and “trauma”. Each case was reviewed for reported medical characteristics and legal aspects, including the outcome of the case. Results Our search yielded 29 cases. Urologists were the most common providers cited as defendants (21%), all of whom were successful in their defense. The most common malpractice claim was for traumatic insertion (48%). Pain was the most common type of damage claimed by plaintiffs (28%), followed by UTI (24%). Nineteen (66%) cases favored defendants, while 10 (34%) cases favored the plaintiffs, of which 2 (7%) were settled out of the court. In settled cases, the mean settlement received by plaintiffs was $55,750 (range, $25,000–$86,500). The mean award to plaintiffs for cases determined by the court was $112,991 (range, $4,000–$325,000). Conclusions Despite widespread usage of UC over a 50-year period, lawsuits centered on UC misuse are rare at the state and federal court levels. Of litigated cases, urologists are commonly involved yet have successful defenses. PMID:27785434

  7. Correction: Prospective pilot study of fully covered self-expandable metal stents for refractory benign pancreatic duct strictures: long-term outcomes

    PubMed Central

    Matsubara, Saburo; Sasahira, Naoki; Isayama, Hiroyuki; Takahara, Naminatsu; Mizuno, Suguru; Kogure, Hirofumi; Yamamoto, Natsuyo; Nakai, Yousuke; Tada, Minoru; Koike, Kazuhiko

    2016-01-01

    Background and study aims: Background and study aims: Temporary placement of a fully covered self-expandable metal stent (FCSEMS) has recently emerged as a treatment option for pancreatic duct strictures due to chronic pancreatitis refractory to conventional plastic stenting. However, there are no data about long-term outcomes with this therapeutic option. The aims of the current study were to estimate the feasibility, safety, efficacy, and long-term outcomes of temporary FCSEMS placement for refractory pancreatic duct strictures. Patients and methods: This was a prospective, single-center feasibility study. Ten patients with refractory pancreatic duct strictures due to chronic pancreatitis underwent FCSEMS placement for 3 months. We evaluated the rate of recurrent symptoms after stent removal during long-term follow-up, as well as adverse events (AEs). Results: Two patients required early (within 1 week) stent removal because of intolerable pain or pancreatitis. In the remaining 8 patients, the recurrence rate of any symptoms after FCSEMS removal was 63% during 35 months of follow up. The causes of recurrent symptoms were as follows: recurrence of stricture in 2; stent-induced stricture in 1; impaction of pancreatic stones in 1; and development of a pseudocyst in 1. When limited to stricture, the recurrence rate was 38%. Additional endoscopic treatments were required in 4 patients: a second FCSEMS placement in 1; plastic stent (PS) placement in 1; stone extraction in 1; and endoscopic ultrasound–guided pseudocyst drainage in 1. Asymptomatic stent migration occurred in 2 patients. Suppurative pancreatic ductitis due to food impaction in the FCSEMS occurred in 2 patients, and endoscopic pancreatic duct drainage was performed. Stent-induced ductal changes developed in 2 patients and PS treatment was required in 1 patient for pain relief. Conclusion: The FCSEMS appears to be a feasible and potentially effective option for the management of refractory pancreatic duct

  8. Posterior Hip Pain in an Athletic Population

    PubMed Central

    Frank, Rachel M.; Slabaugh, Mark A.; Grumet, Robert C.; Virkus, Walter W.; Bush-Joseph, Charles A.; Nho, Shane J.

    2010-01-01

    Context: Posterior hip pain is a relatively uncommon but increasingly recognized complaint in the orthopaedic community. Patient complaints and presentations are often vague or nonspecific, making diagnosis and subsequent treatment decisions difficult. The purposes of this article are to review the anatomy and pathophysiology related to posterior hip pain in the athletic patient population. Evidence Acquisition: Data were collected through a thorough review of the literature via a MEDLINE search of all relevant articles between 1980 and 2010. Results: Many patients who complain of posterior hip pain actually have pain referred from another part of the body—notably, the lumbar spine or sacroiliac joint. Treatment options for posterior hip pain are typically nonoperative; however, surgery is warranted in some cases. Conclusions: Recent advancements in the understanding of hip anatomy, pathophysiology, and treatment options have enabled physicians to better diagnosis athletic hip injuries and select patients for appropriate treatment. PMID:23015944

  9. Posterior cruciate ligament (PCL) injury - aftercare

    MedlinePlus

    Adib F, Curtis C, Bienkowski P Micheli LJ. Posterior cruciate ligament sprain. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, ...

  10. [Morphogenesis of connective tissue in patients with hydronephrosis caused by stricture of ureteric-pelvic segment of various etiology].

    PubMed

    Savenkov, V I

    2015-02-01

    In patients, suffering hydronephrosis stages II-III, caused by the ureteric-pelvic segment (UPS) obstruction due to inborn failures of urinary system, the collagen types I and III ratio reduction, and in acquired obstruction--its enhancement, are noted in interstitium, renal parenchyma vessels and the UPS walls. While obstruction in patients due to inborn failures in vascular basal membranes a deficiency of collagen type IV and appearance of nontypical for vascular basal membranes intersticial collagen type Il are observed. In the acquired UPS, obstruction the, enhancement of content of collagen type IV is revealed only. These disorders are mostly pronounced in patients with the disease recurrence. There was proposed diagnostic coefficient of ratio between collagens types I and III in patients, suffering hydronephrosis, caused by obstruction of various etiology. In hydronephrosis, caused by the UPS stricture, the cytokines disbalance occurs, impacting processes of collagen formation.

  11. Gibbs Sampling for Marginal Posterior Expectations

    DTIC Science & Technology

    1991-11-19

    Achcar and Smith (1989) shows that performance of the Laplace method is often very sensitive to parametrization. Morris (1988) offers expansions based on...Berkeley Symp. 1, 453-468. Lindley, D.V. (1980). "Approximate Bayesian Methods" in Bayesian Statistics, J.M. Bernardo, M.H. DeGroot , D.V. Lindley...A.F.M. Smith, University Press, Valencia, Spain. Morris , C. "Approximating Posterior Distributions and Posterior Moments" In: Bayesian Statistics 3, J.M

  12. [Posterior cortical atrophy (Benson-syndrome)].

    PubMed

    Rózsa, Anikó; Szilvássy, Ildikó; Kovács, Krisztina; Boór, Krisztina; Gács, Gyula

    2010-01-30

    We present the characteristics of posterior cortical atrophy--a very rare cortical dementia--in a 69 year old woman's case. Our patient's symptoms began with a visual problem which was initially explained by ophthalmological disorder. After neurological exam visual agnosia was diagnosed apart from other cognitive disorder (alexia without agraphia, acalculia, prosopagnosia, constructional disorder, clock-time recognition disorder, dressing apraxia, visuospatial disorientation). The brain MRI showed bilateral asymmetric parieto-occipital atrophy which is characteristic of posterior cortical atrophy.

  13. Posterior Wnts Have Distinct Roles in Specification and Patterning of the Planarian Posterior Region.

    PubMed

    Sureda-Gómez, Miquel; Pascual-Carreras, Eudald; Adell, Teresa

    2015-11-05

    The wnt signaling pathway is an intercellular communication mechanism essential in cell-fate specification, tissue patterning and regional-identity specification. A βcatenin-dependent signal specifies the AP (Anteroposterior) axis of planarians, both during regeneration of new tissues and during normal homeostasis. Accordingly, four wnts (posterior wnts) are expressed in a nested manner in central and posterior regions of planarians. We have analyzed the specific role of each posterior wnt and the possible cooperation between them in specifying and patterning planarian central and posterior regions. We show that each posterior wnt exerts a distinct role during re-specification and maintenance of the central and posterior planarian regions, and that the integration of the different wnt signals (βcatenin dependent and independent) underlies the patterning of the AP axis from the central region to the tip of the tail. Based on these findings and data from the literature, we propose a model for patterning the planarian AP axis.

  14. Vertigo due to posterior circulation stroke.

    PubMed

    Kim, Ji Soo; Lee, Hyung

    2013-07-01

    Stroke in the distribution of the posterior circulation may present as acute onset spontaneous vertigo and imbalance. Although vertigo due to posterior circulation stroke is usually associated with other neurologic symptoms or signs, small infarcts in the cerebellum or brainstem can present with vertigo without other localizing symptoms. Approximately 17% of patients with isolated posterior inferior cerebellar artery territory infarction presented with isolated vertigo, nystagmus, and postural unsteadiness. A head impulse test can differentiate acute isolated vertigo associated with cerebellar stroke from more benign disorders involving the inner ear. Sometimes acute isolated audiovestibular loss can be the initial symptom of impending posterior circulation ischemic stroke (particularly within the territory of the anterior inferior cerebellar artery). In this case, evaluation of isolated audiovestibular loss may prevent the progression of acute vertigo and hearing loss into more widespread areas of infarction in the posterior circulation. In this article, the clinical syndromes and signs of acute vestibular syndrome due to posterior circulation stroke involving the brainstem and cerebellum are summarized.

  15. 5α-Dihydrotestosterone negatively regulates cell proliferation of the periurethral ventral mesenchyme during urethral tube formation in the murine male genital tubercle.

    PubMed

    Suzuki, H; Matsushita, S; Suzuki, K; Yamada, G

    2017-01-01

    Androgen is an essential factor involved in masculinization of external genitalia. Failure of the exposure to 5α-dihydrotestosterone (DHT) causes a hypoplastic penile size and urethral abnormality. The main pathology of hypospadias is defective urethral closure on the ventral side of the penis. Hormone-dependent genes are suggested as the causative factors. However, the detailed mechanisms of DHT functions on urethral tube formation remain unknown. Androgen is both a positive and negative regulator of cell proliferation. The roles of locally converted DHT in cell proliferation at the periurethral mesenchyme have not been elucidated. We revealed the expression pattern of 5α-reductase type 2 mRNA (Srd5a2) and local DHT distribution by direct measurement in this study. We also analyzed periurethral mesenchymal cell proliferation status using systematic three-dimensional (3D) reconstruction analyses. A prominent Srd5a2 expression and localized DHT distribution on the ventral side of the genital tubercle were detected. Cell proliferation was reduced in this mesenchymal region during urethral formation. The current results suggest the presence of the possible negative regulation of cell proliferation by DHT. Moreover, cell proliferation related to urethral tube formation was revealed to be DHT dose dependent. These data are expected to contribute to the understanding of the mode of regulation of cell proliferation related to urethral tube formation by DHT. These findings may also offer insight into the understanding of human hypospadias and related hormone-dependent factors.

  16. Topographic distribution of serotonin-immunoreactive urethral endocrine cells and their relationship with calcitonin gene-related peptide-immunoreactive nerves in male rats.

    PubMed

    Yokoyama, Takuya; Saino, Tomoyuki; Nakamuta, Nobuaki; Yamamoto, Yoshio

    2017-01-01

    We investigated the topographic distribution and morphology of serotonin (5-HT)-immunoreactive endocrine cells in the urethra of male rats, and focused on their relationship with peptidergic nerve fibers immunoreactive for calcitonin gene-related peptide (CGRP). Urethral endocrine cells immunoreactive for 5-HT were densely distributed in the epithelial layers of the prostatic part, but were sparsely distributed in the membranous and spongy parts of urethra. Distribution of urethral endocrine cells with 5-HT immunoreactivity in the prostatic part was restricted from the internal urethral orifice to the region of seminal colliculus. 5-HT-immunoreactive endocrine cells were also observed in the ductal epithelial layers of coagulating glands, prostatic glands, and seminal vesicles. 5-HT-immunoreactive endocrine cells were triangular or flask in shape and possessed an apical projection extending toward the urethral lumen, and basal or lateral protrusions intruding between other epithelial cells were also detected in some cells. Double immunolabeling for 5-HT and CGRP revealed that CGRP-immunoreactive nerve fibers attached to urethral endocrine cells with 5-HT immunoreactivity in the prostatic part. These results suggest that urethral endocrine cells may release 5-HT in response to luminal stimuli, and that these cells and CGRP-immunoreactive nerves may regulate each other by an axon reflex mechanism.

  17. A surface swab method for culturing Foley catheters assays the pericatheter (urethral) but not the urine (luminal) microbial population.

    PubMed

    Johnson, J R; Dykstra, D; Brown, J J; Kringstad, B; Pryor, J L

    1997-07-01

    Assessment of the urethral flora in patients with indwelling bladder catheters is problematic in the presence of urinary tract infection (UTI). A new surface swab method that samples the external catheter surface without interference from contaminated luminal contents is described. In vitro, recovery of adherent bacteria from the external catheter surface by the surface swab method was proportional to the bacterial density as measured by a comparison scrape method. In a prospective longitudinal assessment of three chronically catheterized subjects with polymicrobial catheter-associated UTI, a conventional roll plate catheter culture method suggested substantial overlap between the urethral and urine microbial populations, possibly a result of contamination of catheter cultures by infected urine. In contrast, the surface swab method revealed little overlap between these floras, evidence suggesting a predominantly luminal (rather than meatal) route of UTI acquisition. The new surface swab method should prove useful in future studies of the pathogenesis and prevention of catheter-associated UTI.

  18. [Proximal urethra portion perforation during TVT-O in a patient with urethral deviation secondary to previous failed Burch surgery].

    PubMed

    Ricci Arriola, Paolo; Solà Dalenz, Vicente; Pardo Schanz, Jack

    2009-03-01

    A 59 years old woman with laparoscopic Burch made during 2003 in another hospital. During 2006, the patient is evaluating in our center for a persistent urinary incontinence, the urodynamic study demonstrated stress urinary incontinence type II and overactive bladder without obstruction evidences. A TVT-O (tension-free vaginal tape obturador in-out route) was made, nevertheless when the right branch was passed blood was observed in the Foley catheter. A cystoscopy showed an important deviation of urethra and the tape through urethra in the proximal portion. The right branch went again inserted taking the necessary precautions. Two days after surgery the Foley catheter was removed and the stress urinary incontinence symptoms disappeared. The urge incontinence symptoms disappeared with the pharmacalogical treatment (Tolterodine 2 mg/day). We believe that the urethral deviation caused by a technically deficient laparoscopic Burch was the reason for the urethral perforation during the TVT-O.

  19. [Combined Chemotherapy with Radiation was Tolerable and Effective Treatment in Female Octogenarian Patients with Urethral Cancer -Two Case Reports].

    PubMed

    Tachibana, Takashi; Matsumoto, Kazumasa; Nagi, Shoji; Hagiwara, Masahiro; Kobayashi, Kentaro; Tsumura, Hideyasu; Yoshida, Kazunari; Iwamura, Masatsugu

    2016-07-01

    We report two octogenarian patients with primary urethral cancer treated with chemotherapy and external beam radiation therapy. An 85-year-old female presented with perineal bleeding. Magnetic resonance imaging (MRI) showed a locally advanced tumor in the urethra. Biopsy was performed and pathologic findings demonstrated squamous cell carcinoma. After receiving one cycle of a half dose of gemcitabine and nedaplatin, the patient received external beam radiation therapy with gemcitabine and nedaplatin treatment followed by two more cycles of chemotherapy. Complete response was achieved. An 87-year-old female presented with vaginal bleeding. MRIrevealed locally advanced urethral tumor with bilateral inguinal lymph node metastases. Scratch and urine cytology of tumor demonstrated squamous cell carcinoma. After the same treatment as in case 1, primary cancer and lymph node metastases were significantly decreased. There have been no signs of recurrence or progression after treatment, and no severe adverse events in either patient during 53 and 26 months'follow up, respectively.

  20. Genital lichen sclerosus developing around 'ectopic' urethral orifices supports the role of occlusion and urine in its pathogenesis.

    PubMed

    Gupta, Vishal; Gupta, Somesh

    2017-01-01

    Several factors such as genetic susceptibility, autoimmunity, hormones, infections, local trauma, urine, and occlusion have been speculated to play a role in the pathogenesis of lichen sclerosus. We report two male patients with lichen sclerosus around 'ectopic' urethral openings and the opposing surfaces of the penile shaft and scrotum, providing further evidence in support of urine and occlusion as contributing factors in the development of lichen sclerosus.

  1. Spinal stimulation of the upper lumbar spinal cord modulates urethral sphincter activity in rats after spinal cord injury.

    PubMed

    Abud, Edsel M; Ichiyama, Ronaldo M; Havton, Leif A; Chang, Huiyi H

    2015-05-01

    After spinal cord injury (SCI), the neurogenic bladder is observed to develop asynchronous bladder and external urethral sphincter (EUS) contractions in a condition known as detrusor-sphincter dyssnergia (DSD). Activation of the EUS spinal controlling center located at the upper lumbar spinal cord may contribute to reduce EUS dyssynergic contractions and decrease urethral resistance during voiding. However, this mechanism has not been well studied. This study aimed at evaluating the effects of epidural stimulation (EpS) over the spinal EUS controlling center (L3) in combination with a serotonergic receptor agonist on EUS relaxation in naive rats and chronic (6-8 wk) T8 SCI rats. Cystometrogram and EUS electromyography (EMG) were obtained before and after the intravenous administration of 5HT-1A receptor agonist and antagonist. The latency, duration, frequency, amplitude, and area under curve of EpS-evoked EUS EMG responses were analyzed. EpS on L3 evoked an inhibition of EUS tonic contraction and an excitation of EUS intermittent bursting/relaxation correlating with urine expulsion in intact rats. Combined with a 5HT-1A receptor agonist, EpS on L3 evoked a similar effect in chronic T8 SCI rats to reduce urethral contraction (resistance). This study examined the effect of facilitating the EUS spinal controlling center to switch between urine storage and voiding phases by using EpS and a serotonergic receptor agonist. This novel approach of applying EpS on the EUS controlling center modulates EUS contraction and relaxation as well as reduces urethral resistance during voiding in chronic SCI rats with DSD.

  2. Seeding cell approach for tissue-engineered urethral reconstruction in animal study: A systematic review and meta-analysis

    PubMed Central

    Xue, Jing-Dong; Gao, Jing; Fu, Qiang; Feng, Chao

    2016-01-01

    We systematically reviewed published preclinical studies to evaluate the effectiveness of cell-seeded tissue engineering approach for urethral reconstruction in an animal model. The outcomes were summarized by success factors in the animal experiments, which evaluate the possibility and feasibility of a clinical application in the future. Preclinical studies of tissue engineering approaches for urethral reconstruction were identified through a systematic search in PubMed, Embase, and Biosis Previews (web of science SP) databases for studies published from 1 January 1980 to 23 November 2014. Primary studies were included if urethral reconstruction was performed using a tissue-engineered biomaterial in any animal species (with the experiment group being a cell-seeded scaffold and the control group being a cell-free scaffold) with histology and urethrography as the outcome measure. A total of 15 preclinical studies were included in our meta-analysis. The histology and urethrography outcome between the experimental and control groups were considered to be the most clinically relevant. Through this systematic approach, our outcomes suggested that applying the cell-seeded biomaterial in creating a neo-urethra was stable and effective. And multi-type cells including epithelial cells as well as smooth muscle cells or fibroblasts seemed to be a better strategy. Stem cells, especially after epithelial differentiation, could be a promising choice for future researches. PMID:27022134

  3. Seeding cell approach for tissue-engineered urethral reconstruction in animal study: A systematic review and meta-analysis.

    PubMed

    Xue, Jing-Dong; Gao, Jing; Fu, Qiang; Feng, Chao; Xie, Hong

    2016-07-01

    We systematically reviewed published preclinical studies to evaluate the effectiveness of cell-seeded tissue engineering approach for urethral reconstruction in an animal model. The outcomes were summarized by success factors in the animal experiments, which evaluate the possibility and feasibility of a clinical application in the future. Preclinical studies of tissue engineering approaches for urethral reconstruction were identified through a systematic search in PubMed, Embase, and Biosis Previews (web of science SP) databases for studies published from 1 January 1980 to 23 November 2014. Primary studies were included if urethral reconstruction was performed using a tissue-engineered biomaterial in any animal species (with the experiment group being a cell-seeded scaffold and the control group being a cell-free scaffold) with histology and urethrography as the outcome measure. A total of 15 preclinical studies were included in our meta-analysis. The histology and urethrography outcome between the experimental and control groups were considered to be the most clinically relevant. Through this systematic approach, our outcomes suggested that applying the cell-seeded biomaterial in creating a neo-urethra was stable and effective. And multi-type cells including epithelial cells as well as smooth muscle cells or fibroblasts seemed to be a better strategy. Stem cells, especially after epithelial differentiation, could be a promising choice for future researches.

  4. Development of a CFD urethral model to study flow-generated vortices under different conditions of prostatic obstruction.

    PubMed

    Pel, Johan J M; van Mastrigt, Ron

    2007-01-01

    A novel, non-invasive method to diagnose bladder outlet obstruction involves the recording of noise with a contact microphone pressed against the perineum (between anus and scrotum). This noise results from flow-generated vortices caused by prostatic obstruction. We developed a computational fluid dynamic (CFD) urethral model including urethral geometry to study the relation between generated noise and the degree of obstruction. This model comprised a bladder, bladder neck, prostate and urethra. Calculations were carried out at four bladder pressures, five degrees of obstruction and three obstruction shapes. For each of the sixty simulations, the velocity and pressure distributions along the urethra were calculated including wall shear stresses to localize flow transition from disturbed to normal. Negative pressures at the obstruction outlet induced recirculation of flow. The location of transition was independent of the applied bladder pressure, but it depended primarily on the degree and secondarily on the shape of the obstruction. Based on the presented results, we hypothesize that the location of the maximum amplitude of perineal noise mainly depends on the degree and shape of the prostatic obstruction. Our future aim is to test our hypothesis in male patients and to extend the presented model to 3D with a viscoelastic urethral wall to calculate the fluid-wall interaction.

  5. The effect of oral and intraurethral trimetazidine use on urethral healing

    PubMed Central

    Ayyildiz, Ali; Ayyildiz, Sema Nur; Benli, Erdal; Erdem, Havva; Cirrik, Selma; Noyan, Tevfik; Germiyanoglu, R. Cankon; Çirakoglu, Abdullah

    2016-01-01

    Objective(s): We aimed to study the effect of trimetazidine (TMZ) on urethral wound repair. Materials and Methods: A total of 52 male rats were used; 8 groups were formed: 1-week and 3-week control (C1, C3), sham (S1, S3), oral (OT1, OT3), and intraurethral TMZ (IUT1, IUT3) groups. Serum and urine total antioxidant capacity (TAC), total oxidant capacity (TOC), and 8-hydroxy-deoxy-guanosine (8-OHdG) were studied. Hematoxyline-Eosin was used for the histopathological study. In addition, tumor necrosis factor alpha (TNF- α), interleukin 1α, and β levels were compared across groups by an immunohistochemical method. Results: There were significant differences between C3 and IUT3, OT3 and IUT3 with respect to serum TAC in 3-week groups (P=0.013; P =0.001). Serum TOC levels were significantly different between C3 and IUT3; S3 and OT3; and OT3 and IUT3 groups (P =0.024; P =0.019; P =0.000, respectively). Serum 8-OHdG levels were significantly different between C3 and OT3 groups (P=0.033). In the immunohistochemical examination, C1 and OT1; C1 and IUT1; and S1, S3, OT1, OT3, IUT1 groups were significantly different with respect to IL-1β staining (P=0.007; P =0.000; P=0.009), while there was a significant difference between C3 and S3 with respect to IL-1β (P =0.000). Conclusion: TMZ increased urinary total oxidant level; while increasing serum TAC levels in the long-term. It also reduced serum TAC levels in urethral use and caused an increase in serum TOC levels with minimal effects on DNA injury and repair. No effect was detected on IL1 α and TNF, but partially reduced the effect on IL-1 β levels. PMID:27803779

  6. A Challenging Surgical Approach to Locally Advanced Primary Urethral Carcinoma: A Case Report and Literature Review.

    PubMed

    Lucarelli, Giuseppe; Spilotros, Marco; Vavallo, Antonio; Palazzo, Silvano; Miacola, Carlos; Forte, Saverio; Matera, Matteo; Campagna, Marcello; Colamonico, Ottavio; Schiralli, Francesco; Sebastiani, Francesco; Di Cosmo, Federica; Bettocchi, Carlo; Di Lorenzo, Giuseppe; Buonerba, Carlo; Vincenti, Leonardo; Ludovico, Giuseppe; Ditonno, Pasquale; Battaglia, Michele

    2016-05-01

    Primary urethral carcinoma (PUC) is a rare and aggressive cancer, often underdetected and consequently unsatisfactorily treated. We report a case of advanced PUC, surgically treated with combined approaches.A 47-year-old man underwent transurethral resection of a urethral lesion with histological evidence of a poorly differentiated squamous cancer of the bulbomembranous urethra. Computed tomography (CT) and bone scans excluded metastatic spread of the disease but showed involvement of both corpora cavernosa (cT3N0M0). A radical surgical approach was advised, but the patient refused this and opted for chemotherapy. After 17 months the patient was referred to our department due to the evidence of a fistula in the scrotal area. CT scan showed bilateral metastatic disease in the inguinal, external iliac, and obturator lymph nodes as well as the involvement of both corpora cavernosa. Additionally, a fistula originating from the right corpus cavernosum extended to the scrotal skin. At this stage, the patient accepted the surgical treatment, consisting of different phases. Phase I: Radical extraperitoneal cystoprostatectomy with iliac-obturator lymph nodes dissection. Phase II: Creation of a urinary diversion through a Bricker ileal conduit. Phase III: Repositioning of the patient in lithotomic position for an overturned Y skin incision, total penectomy, fistula excision, and "en bloc" removal of surgical specimens including the bladder, through the perineal breach. Phase IV: Right inguinal lymphadenectomy.The procedure lasted 9-and-a-half hours, was complication-free, and intraoperative blood loss was 600 mL. The patient was discharged 8 days after surgery. Pathological examination documented a T4N2M0 tumor. The clinical situation was stable during the first 3 months postoperatively but then metastatic spread occurred, not responsive to adjuvant chemotherapy, which led to the patient's death 6 months after surgery.Patients with advanced stage tumors of the

  7. Posterior cruciate ligament removal contributes to abnormal knee motion during posterior stabilized total knee arthroplasty.

    PubMed

    Cromie, Melinda J; Siston, Robert A; Giori, Nicholas J; Delp, Scott L

    2008-11-01

    Abnormal anterior translation of the femur on the tibia has been observed in mid flexion (20-60 degrees ) following posterior stabilized total knee arthroplasty. The underlying biomechanical causes of this abnormal motion remain unknown. The purpose of this study was to isolate the effects of posterior cruciate ligament removal on knee motion after total knee arthroplasty. We posed two questions: Does removing the posterior cruciate ligament introduce abnormal anterior femoral translation? Does implanting a posterior stabilized prosthesis change the kinematics from the cruciate deficient case? Using a navigation system, we measured passive knee kinematics of ten male osteoarthritic patients during surgery after initial exposure, after removing the anterior cruciate ligament, after removing the posterior cruciate ligament, and after implanting the prosthesis. Passively flexing and extending the knee, we calculated anterior femoral translation and the flexion angle at which femoral rollback began. Removing the posterior cruciate ligament doubled anterior translation (from 5.1 +/- 4.3 mm to 10.4 +/- 5.1 mm) and increased the flexion angle at which femoral rollback began (from 31.2 +/- 9.6 degrees to 49.3 +/- 7.3 degrees). Implanting the prosthesis increased the amount of anterior translation (to 16.1 +/- 4.4 mm), and did not change the flexion angle at which femoral rollback began. Abnormal anterior translation was observed in low and mid flexion (0-60 degrees) after removing the posterior cruciate ligament, and normal motion was not restored by the posterior stabilized prosthesis.

  8. Fundus autofluorescence imaging in posterior uveitis.

    PubMed

    Durrani, Khayyam; Foster, C Stephen

    2012-01-01

    Although the phenomenon of fundus autofluorescence has been known for decades, it has only recently been recognized as a measure of retinal pigment epithelial function and health. Characteristic fundus autofluorescence patterns have been described in eyes affected by inflammation of the posterior segment, and these patterns have provided insights into the pathogenesis of posterior uveitis entities. In addition, preliminary data indicate that fundus autofluorescence characteristics may serve as markers of disease activity, allow prediction of visual prognosis, and may help determine the adequacy of therapy. We provide an overview of the current state of fundus autofluorescence imaging technology and review our current knowledge of fundus autoflourescence findings and their clinical use in the posterior uveitis entities.

  9. Reversible cortical blindness: posterior reversible encephalopathy syndrome.

    PubMed

    Bandyopadhyay, Sabyasachi; Mondal, Kanchan Kumar; Das, Somnath; Gupta, Anindya; Biswas, Jaya; Bhattacharyya, Subir Kumar; Biswas, Gautam

    2010-11-01

    Cortical blindness is defined as visual failure with preserved pupillary reflexes in structurally intact eyes due to bilateral lesions affecting occipital cortex. Bilateral oedema and infarction of the posterior and middle cerebral arterial territory, trauma, glioma and meningioma of the occipital cortex are the main causes of cortical blindness. Posterior reversible encephalopathy syndrome (PRES) refers to the reversible subtype of cortical blindness and is usually associated with hypertension, diabetes, immunosuppression, puerperium with or without eclampsia. Here, 3 cases of PRES with complete or partial visual recovery following treatment in 6-month follow-up are reported.

  10. Posterior cortical atrophy: a brief review.

    PubMed

    Kirshner, Howard S; Lavin, Patrick J M

    2006-11-01

    Posterior cortical atrophy is a striking clinical syndrome in which a dementing illness begins with visual symptoms. Initially, the problem may seem to be loss of elementary vision, but over time the patient develops features of visual agnosia, topographical difficulty, optic ataxia, simultanagnosia, ocular apraxia (Balint's syndrome), alexia, acalculia, right-left confusion, and agraphia (Gerstmann's syndrome), and later a more generalized dementia. Occasional patients have visual hallucinations and signs of Parkinson's disease or Lewy body dementia. A number of different neuropathologic disorders are associated with posterior cortical atrophy.

  11. Instrumented urethral catheter and its ex vivo validation in a sheep urethra

    NASA Astrophysics Data System (ADS)

    Ahmadi, Mahdi; Rajamani, Rajesh; Timm, Gerald; Sezen, Serdar

    2017-03-01

    This paper designs and fabricates an instrumented catheter for instantaneous measurement of distributed urethral pressure profiles. Since the catheter enables a new type of urological measurement, a process for accurate ex vivo validation of the catheter is developed. A flexible sensor strip is first fabricated with nine pressure sensors and integrated electronic pads for an associated sensor IC chip. The flexible sensor strip and associated IC chip are assembled on a 7 Fr Foley catheter. A sheep bladder and urethra are extracted and used in an ex vivo set up for verification of the developed instrumented catheter. The bladder-urethra are suspended in a test rig and pressure cuffs placed to apply known static and dynamic pressures around the urethra. A significant challenge in the performance of the sensor system is the presence of parasitics that introduce large bias and drift errors in the capacitive sensor signals. An algorithm based on use of reference parasitic transducers is used to compensate for the parasitics. Extensive experimental results verify that the developed compensation method works effectively. Results on pressure variation profiles circumferentially around the urethra and longitudinally along the urethra are presented. The developed instrumented catheter will be useful in improved urodynamics to more accurately diagnose the source of urinary incontinence in patients.

  12. Clinical Trials of a Urethral Dose Measurement System in Brachytherapy Using Scintillation Detectors

    SciTech Connect

    Suchowerska, Natalka; Jackson, Michael; Lambert, Jamil; Yin, Yong Bai; Hruby, George; McKenzie, David R.

    2011-02-01

    Purpose: To report on the clinical feasibility of a novel scintillation detector system with fiberoptic readout that measures the urethral dose during high-dose-rate brachytherapy treatment of the prostate. Methods and Materials: The clinical trial enrolled 24 patients receiving high-dose-rate brachytherapy treatment to the prostate. After the first 14 patients, three improvements were made to the dosimeter system design to improve clinical reliability: a dosimeter self-checking facility; a radiopaque marker to determine the position of the dosimeter, and a more robust optical extension fiber. Results: Improvements to the system design allowed for accurate dose measurements to be made in vivo. A maximum measured dose departure of 9% from the calculated dose was observed after dosimeter design improvements. Conclusions: Departures of the measured from the calculated dose, after improvements to the dosimetry system, arise primarily from small changes in patient anatomy. Therefore, we recommend that patient response be correlated with the measured in vivo dose rather than with the calculated dose.

  13. MRI micturating urethrography for improved urethral delineation in prostate radiotherapy planning: a case study

    NASA Astrophysics Data System (ADS)

    Rai, Robba; Sidhom, Mark; Lim, Karen; Ohanessian, Lucy; Liney, Gary P.

    2017-04-01

    Stereotactic ablative body radiotherapy is used in prostate cancer to deliver a high dose of radiation to the tumour over a small number of treatments. This involves the simulation of the patient using both CT and MRI. Current practice is to insert an indwelling catheter (IDC) during CT to assist with visualisation of the urethra and subsequently minimise dose to this highly critical structure. However, this procedure is invasive and has an associated risk of infection. This is a case study, which demonstrates our initial experience of using a real-time non-invasive MRI technique to replace the use of IDC for prostate cancer patients. The patient was scanned on a dedicated 3T MRI and was instructed to micturate in their own time whereupon a sagittal T2 weighted HASTE sequence was acquired every 5 s. This was subsequently followed by T2 weighted axial imaging at the level of mid prostate to provide improved urethral definition. Acquired images showed bladder voidance in real-time and an increase in signal intensity in the proximal urethra post voiding allowing for delineation of the urethra. The dimension and shape of the proximal urethra was well visualised and accumulation time of urine in the urethra was sufficient to enable optimum timing of the scanning technique. We have presented for the first time a micturating urethography technique using MRI, which has allowed us to visualise the urethra without contrast and with minimal invasiveness to the patient.

  14. Trans-urethral ultrasound (TUUS) imaging for visualization and analysis of the prostate and associated tissues.

    PubMed

    Holmes, D R; Robb, R

    2000-01-01

    The incidence of prostate disease is high. However, accurate assessment of pathological conditions is still difficult. Although CT, MRI, and TRUS imaging methods provide useful information, each has specific drawbacks. Our work examines the potential and utility of 3D trans-urethral ultrasound (TUUS) for improved imaging of the prostate. Four normal canines were examined with TUUS. The catheter was placed in the urethra and used to image the prostate, rectum, bladder, ureter, neuro-vascular bundles, arteries, and surrounding tissue. 2D and 3D datasets were acquired and digitized. The 2D data provides useful visualization of the tissue. The clinician was also able to watch urine enter the bladder and perform a digital rectal exam in real-time. 3D data visualization required torodial reconstruction. The algorithm was optimized to provide very fast 3D reconstructions of the prostate. Segmentation of the data proved challenging, but 3D visualization, including volume rendered data and surface rendered data, were well accepted by clinicians. Clinicians and researchers determined a number of potential applications of these new techniques, including: prostate cancer diagnosis and staging, assessment of Benign Nodular Enlargement, assessment of physiologic function of the bladder, evaluation of morphologic properties of the prostate, and image guided biopsy and therapy.

  15. Fetoscopic laser surgery to decompress distal urethral obstruction caused by prolapsed ureterocele.

    PubMed

    Torres Montebruno, X; Martinez, J M; Eixarch, E; Gómez, O; García Aparicio, L; Castañón, M; Gratacos, E

    2015-11-01

    We report on the successful use of fetoscopic surgery to treat a case of prolapsed ureterocele in a female fetus. At 21 weeks' gestation, a double renal system with an intravesical ureterocele obstructing the bladder outlet was diagnosed, causing severe megacystis, bilateral hydronephrosis and progressive oligohydramnios. Ultrasound evaluation following referral to our center confirmed severe bilateral hydronephrosis with pelvic and calyceal dilatation, but amniotic fluid volume was normal and the ureterocele was not visualized in the bladder. Instead, a cystic mass within the external genitalia was observed, suggestive of a prolapsed ureterocele, causing intermittently severe obstruction of the urethra. The parents were counseled about the uncertain prognosis and fetal surgery to decompress the urinary system was proposed. The procedure involved firing a contact diode laser until perforation of the ureterocele was achieved. Following laser surgery, resolution of megacystis, reduction of hydronephrosis and normalization of amniotic fluid volume were observed. Our report demonstrates that fetoscopic decompression of a distal urethral obstruction is feasible in the rare event of congenital prolapsed ureterocele.

  16. Survival Outcomes and Predictive Factors for Female Urethral Cancer: Long-term Experience with Korean Patients.

    PubMed

    Kang, Minyong; Jeong, Chang Wook; Kwak, Cheol; Kim, Hyeon Hoe; Ku, Ja Hyeon

    2015-08-01

    The aim of this study was to evaluate female urethral cancer (UCa) patients treated and followed-up during a time period spanning more than 20 yr at single institution in Korea. We reviewed medical records of 21 consecutive patients diagnosed with female UCa at our institution between 1991 and 2012. After exclusion of two patients due to undefined histology, we examined clinicopathological variables, as well as survival outcomes of 19 patients with female UCa. A Cox proportional hazards ratio model was used to identify significant predictors of prognosis according to variables. The median age at diagnosis was 59 yr, and the median follow-up duration was 87.0 months. The most common initial symptoms were voiding symptoms and blood spotting. The median tumor size was 3.4 cm, and 55% of patients had lesions involving the entire urethra. The most common histologic type was adenocarcinoma, and the second most common type was urothelial carcinoma. Fourteen patients underwent surgery, and 7 of these patients received adjuvant radiation or systemic chemotherapy. Eleven patients experienced tumor recurrence after primary therapy. Patients with high stage disease, advanced T stage (≥T3), and positive lymph nodes had worse survival outcomes compared to their counterparts. Particularly, lymph node positivity and advanced T stage were significant predictive factors for all survival outcomes. Tumor location was the only significant predictor for recurrence-free survival. Although our study included a small number of patients, it conveys valuable information about this rare female urologic malignancy in a Korean population.

  17. Newly Designed Y-configured Single-Catheter Stenting for the Treatment of Hilar-Type Nonanastomotic Biliary Strictures After Orthotopic Liver Transplantation

    SciTech Connect

    Wang Changming; Li Xuan; Song Shibing; Lv Xianjun; Luan Jingyuan; Dong Guoxiang

    2012-02-15

    Purpose: This study was designed to introduce our novel technique of percutaneous single catheter placement into the hilar bile ducts strictures while fulfilling the purpose of bilateral biliary drainage and stenting. We investigated the efficacy and safety of the technique for the treatment of hilar nonanastomotic biliary strictures. Methods: Ten patients who were post-orthotopic liver transplantation between July 2000 and July 2010 were enrolled in this study. Percutaneous Y-configured single-catheter stenting for bilateral bile ducts combined with balloon dilation was designed as the main treatment approach. Technical success rate, clinical indicators, complications, and recurrent rate were analyzed. Results: Technical success rate was 100%. Nine of the ten patients had biochemical normalization, cholangiographic improvement, and clinical symptoms relief. None of them experienced recurrence in a median follow-up of 26 months after completion of therapy and removal of all catheters. Complications were minor and limited to two patients. The one treatment failure underwent a second liver transplantation but died of multiple system organ failure. Conclusions: Percutaneous transhepatic Y-configured single-catheter stenting into the hilar bile ducts is technically feasible. The preliminary trial of this technique combined with traditional PTCD or choledochoscopy for the treatment of hilar biliary strictures after orthotopic liver transplantation appeared to be effective and safe. Yet, further investigation is needed.

  18. Transplantation of epidermal cell sheets by endoscopic balloon dilatation to avoid esophageal re-strictures: initial experience in a porcine model

    PubMed Central

    Kobayashi, Shinichiro; Kanai, Nobuo; Tanaka, Nobuyuki; Maeda, Masanori; Hosoi, Takahiro; Fukai, Fumio; Eguchi, Susumu; Yamato, Masayuki

    2016-01-01

    Background and study aims: Epidermal cell sheet (ECS) transplantation immediately after aggressive endoscopic submucosal dissection (ESD) has been shown to be safe and effective in the prevention of esophageal strictures. This study evaluated the feasibility of ECS transplantation after endoscopic balloon dilation (EBD) in a porcine model. Methods: Six pigs underwent circumferential esophageal ESD under general anesthesia. Two weeks later, two pigs underwent EBD and transplantation of an autologous ECS, two underwent EBD alone, and two underwent endoscopic observation only (control). Results: The two pigs in the transplantation group underwent six ECS transplants after EBD with five of the six (83 %) being successful, as shown by engraftment of transplanted ECSs after 7 days. No adverse events were observed. Stricture rates were lower in the two transplanted pigs (55 % and 60 %) than in the control (92.2 % and 87.7 %) and EBD-treated (71.7 % and 78.2 %) pigs. Infiltration of inflammatory cells was significantly lower in the transplanted pigs than in the control and EBD-treated pigs. Conclusion: Preliminary results indicate the stability of the ECS transplantation procedure and the engraftment of transplanted ECS in the tears after EBD. This proof-of-concept study suggests that covering tears with ECSs after EBD may avoid re-strictures. PMID:27853736

  19. Esophageal stricture secondary to drug-induced toxic epidermal necrolysis presenting in an adult: an unusual complication of a rare disease.

    PubMed

    Njei, Basile; Schoenfeld, Adam; Vaziri, Haleh

    2013-10-01

    Toxic epidermal necrolysis (TEN) is an idiosyncratic, potentially life-threatening skin disease characterized by widespread inflammation and necrosis of the epidermis and mucous membranes. It may result in narrowing of the esophageal lumen through fibrosis and esophageal stricture in rare situations, mostly encountered in children. To the best of our knowledge, we report the first case of esophageal stricture secondary to allopurinol-induced TEN in an adult patient. A 70-year-old male presented to our clinic with severe dysphagia secondary to allopurinol-induced TEN involving his mouth and esophagus. At the time of presentation the patient had a percutaneous endoscopic gastrostomy feeding tube and was unable to handle his oral secretions. Endoscopy revealed near complete proximal esophageal stricture. A bidirectional esophageal dilatation procedure via the mouth and percutaneous endoscopic gastrostomy site was successfully performed over a guidewire for treatment of this patient. The patient tolerated the procedure well. Esophagogastroduodenoscopy with dilation was performed in a regular anterograde fashion five times over the next three months. Triamcinolone acetonide was injected using Carr-Locke injection needle from ultrasound endoscopy during the last three sessions. He currently tolerates a regular diet without difficulty.

  20. Treatment rationale of fractured posterior teeth.

    PubMed

    Silvestri, A R; Singh, I

    1978-11-01

    The four types of fractures most frequently encountered in posterior teeth--obliquely directed complete fractures, vertically directed complete fractures, obliquely directed incomplete fractures, and vertically directed incomplete fractures--have been described. A detailed treatment approach for each type has been presented.

  1. Posterior Predictive Model Checking in Bayesian Networks

    ERIC Educational Resources Information Center

    Crawford, Aaron

    2014-01-01

    This simulation study compared the utility of various discrepancy measures within a posterior predictive model checking (PPMC) framework for detecting different types of data-model misfit in multidimensional Bayesian network (BN) models. The investigated conditions were motivated by an applied research program utilizing an operational complex…

  2. Posterior Probabilities for a Consensus Ordering.

    ERIC Educational Resources Information Center

    Fligner, Michael A.; Verducci, Joseph S.

    1990-01-01

    The concept of consensus ordering is defined, and formulas for exact and approximate posterior probabilities for consensus ordering are developed under the assumption of a generalized Mallows' model with a diffuse conjugate prior. These methods are applied to a data set concerning 98 college students. (SLD)

  3. Complicated posterior capsulorhexis: aetiology, management, and outcome

    PubMed Central

    Van Cauwenberge, F.; Rakic, J.; Galand, A.

    1997-01-01

    BACKGROUND—A 1 year retrospective analysis of 650 patients, who underwent a posterior capsulorhexis on their intact capsules, was performed to examine the incidence of complications, their aetiologies, and the outcome.
METHODS—Data were analysed on 32 patients with complicated capsulorhexis for type of surgery, preoperative and postoperative factors, and relative risk factors for vitreous issue.
RESULTS—There were six patients with vitreous loss. The posterior capsulorhexis was uncontrolled in 14 cases and difficult to perform in 12 cases. Implantation into the capsular bag was possible in all cases. Systemic vascular hazard and old age (over 80 years) were found to be statistically significant risk factors for vitreous loss (p=0.002 and p=0.03 respectively). The mean follow up was 13.5 months (range 4-25 months). One patient developed a retinal detachment and two had a transient clinical cystoid macular oedema. Visual acuity of ≥ 20/40 was obtained in 93% of the patients.
CONCLUSION—Loss of control of the posterior capsulorhexis has a low incidence but can lead to serious problems during surgery. A good knowledge of the technique is necessary to complete the procedure with a posterior capsulorhexis of the optimum size without vitreous loss.

 PMID:9135382

  4. Subspecialization in the human posterior medial cortex

    PubMed Central

    Bzdok, Danilo; Heeger, Adrian; Langner, Robert; Laird, Angela R.; Fox, Peter T.; Palomero-Gallagher, Nicola; Vogt, Brent A.; Zilles, Karl; Eickhoff, Simon B.

    2014-01-01

    The posterior medial cortex (PMC) is particularly poorly understood. Its neural activity changes have been related to highly disparate mental processes. We therefore investigated PMC properties with a data-driven exploratory approach. First, we subdivided the PMC by whole-brain coactivation profiles. Second, functional connectivity of the ensuing PMC regions was compared by task-constrained meta-analytic coactivation mapping (MACM) and task-unconstrained resting-state correlations (RSFC). Third, PMC regions were functionally described by forward/reverse functional inference. A precuneal cluster was mostly connected to the intraparietal sulcus, frontal eye fields, and right temporo-parietal junction; associated with attention and motor tasks. A ventral posterior cingulate cortex (PCC) cluster was mostly connected to the ventromedial prefrontal cortex and middle left inferior parietal cortex (IPC); associated with facial appraisal and language tasks. A dorsal PCC cluster was mostly connected to the dorsomedial prefrontal cortex, anterior/posterior IPC, posterior midcingulate cortex, and left dorsolateral prefrontal cortex; associated with delay discounting. A cluster in the retrosplenial cortex was mostly connected to the anterior thalamus and hippocampus. Furthermore, all PMC clusters were congruently coupled with the default mode network according to task-constrained but not task-unconstrained connectivity. We thus identified distinct regions in the PMC and characterized their neural networks and functional implications. PMID:25462801

  5. Fuchs's heterochromic cyclitis and posterior capsulotomy.

    PubMed Central

    Roussel, T J; Coster, D J

    1985-01-01

    We report a case of intractable glaucoma following an uncomplicated secondary posterior capsulotomy in a 48-year-old male with Fuchs's heterochromic cyclitis. The patient had been free of inflammation and glaucoma since cataract extraction 27 years previously. We also report the results of phenotypic analysis of lymphocytes removed from the anterior chamber. Images PMID:3859323

  6. Posterior dislocation of the shoulder in athletes.

    PubMed

    Samilson, R L; Prieto, V

    1983-07-01

    Although posterior dislocation of the shoulder is a rare injury in athletes, failure to recognize and properly manage acute dislocation may have serious consequences. The article discusses the incidence, mechanism of injury, classification, pathologic findings, clinical and radiologic diagnosis, and management.

  7. BAER suppression during posterior fossa dural opening

    PubMed Central

    Shields, Christopher B.; Shields, Lisa B. E.; Jiang, Yi Dan; Yao, Tom; Zhang, Yi Ping; Sun, David A.

    2015-01-01

    Background: Intraoperative monitoring with brainstem auditory evoked responses (BAER) provides an early warning signal of potential neurological injury and may avert tissue damage to the auditory pathway or brainstem. Unexplained loss of the BAER signal in the operating room may present a dilemma to the neurosurgeon. Methods: This paper documents two patients who displayed a unique mechanism of suppression of the BAER apparent within minutes following dural opening for resection of a posterior fossa meningioma. Results: In two patients with anterior cerebellopontine angle and clival meningiomas, there was a significant deterioration of the BAER soon after durotomy but prior to cerebellar retraction and tumor removal. Intracranial structures in the posterior fossa lying between the tumor and dural opening were shifted posteriorly after durotomy. Conclusion: We hypothesized that the cochlear nerve and vessels entering the acoustic meatus were compressed or stretched when subjected to tissue shift. This movement caused cochlear nerve dysfunction that resulted in BAER suppression. BAER was partially restored after the tumor was decompressed, dura repaired, and bone replaced. BAER was not suppressed following durotomy for removal of a meningioma lying posterior to the cochlear complex. Insight into the mechanisms of durotomy-induced BAER inhibition would allay the neurosurgeon's anxiety during the operation. PMID:25883849

  8. Urine-based asymptomatic urethral gonorrhea and chlamydia screening and sexual risk-taking behavior in men who have sex with men in greater Boston.

    PubMed

    Russell, Christopher J; Golub, Sarit A; Cohen, Daniel E; Mayer, Kenneth H

    2007-03-01

    To assess the prevalence of asymptomatic urethral gonorrhea and chlamydia men who have sex with men (MSM) living in greater Boston, 206 men attending routine medical appointments consented to urine-based chlamydia and gonorrhea screening using urine LCR amplification. Of those screened, 201 patients also completed a seven-question survey to assess sexual risk behaviors associated with urethral sexually transmitted infections. Less than 1% of the asymptomatic patients screened tested positive for urethral chlamydia; none tested positive for urethral gonorrhea. Forty-eight percent reported multiple sexual partners in the 30 days prior to screening, with HIV-infected patients reporting fewer partners and less unprotected insertive anal sex than HIV-uninfected patients. Almost 25% of patients screened used the Internet in the 30 days prior to screening to find a sexual partner. Internet use was associated with increased numbers of sexual partners in the 30 days prior to screening. Findings suggest that asymptomatic urethral chlamydia and gonorrhea may be uncommon in MSM living in the greater Boston area and that the recent rise in the prevalence of sexually transmitted infections may not be due to untreated asymptomatic infections. Increased awareness of STD symptoms among patients and medical providers is critical to timely diagnosis and treatment of STDs in MSM.

  9. OnabotulinumtoxinA Urethral Sphincter Injection as Treatment for Non-neurogenic Voiding Dysfunction – A Randomized, Double-Blind, Placebo-Controlled Study

    PubMed Central

    Jiang, Yuan-Hong; Wang, Chung-Cheng; Kuo, Hann-Chorng

    2016-01-01

    Non-neurogenic voiding dysfunction including dysfunctional voiding and detrusor underactivity caused by a spastic or non-relaxing external urethral sphincter can theoretically be treated by injections of botulinum A toxin into the external urethral sphincter. This randomized, double-blind, placebo-controlled trial was designed to determine the clinical efficacy of onabotulinumtoxinA urethral sphincter injections in patients with dysfunctional voiding or detrusor underactivity. Patients with medically refractory dysfunctional voiding (n = 31) or detrusor underactivity (n = 31) were randomly allocated in a 2:1 ratio to receive either onabotulinumtoxinA (100 U) (n = 38) or placebo (normal saline) (n = 24). There were no significant differences in subjective or objective parameters between patients who received onabotulinumtoxinA and those who received saline injection therapy, and the overall success rate was 43.5% (reduction in Patient perception of Bladder Condition by ≥2: onabotulinumtoxinA 36.8% vs placebo 54.2%, p = 0.114). The results were similar between the dysfunctional voiding and detrusor underactivity subgroups; however, a significant reduction in detrusor voiding pressure was only observed in dysfunctional voiding patients who received onabotulinumtoxinA. Repeat urethral sphincter onabotulinumtoxinA injections offered greater therapeutic effects in both dysfunctional voiding and detrusor underactivity patients. For patients with non-neurogenic voiding dysfunction, the success rate of onabotulinumtoxinA urethral sphincter injection was not superior to placebo. PMID:27958325

  10. Statistical methods for clinical verification of dose response parameters related to esophageal stricture and AVM obliteration from radiotherapy

    NASA Astrophysics Data System (ADS)

    Mavroidis, Panayiotis; Lind, Bengt K.; Theodorou, Kyriaki; Laurell, Göran; Fernberg, Jan-Olof; Lefkopoulos, Dimitrios; Kappas, Constantin; Brahme, Anders

    2004-08-01

    The purpose of this work is to provide some statistical methods for evaluating the predictive strength of radiobiological models and the validity of dose-response parameters for tumour control and normal tissue complications. This is accomplished by associating the expected complication rates, which are calculated using different models, with the clinical follow-up records. These methods are applied to 77 patients who received radiation treatment for head and neck cancer and 85 patients who were treated for arteriovenous malformation (AVM). The three-dimensional dose distribution delivered to esophagus and AVM nidus and the clinical follow-up results were available for each patient. Dose-response parameters derived by a maximum likelihood fitting were used as a reference to evaluate their compatibility with the examined treatment methodologies. The impact of the parameter uncertainties on the dose-response curves is demonstrated. The clinical utilization of the radiobiological parameters is illustrated. The radiobiological models (relative seriality and linear Poisson) and the reference parameters are validated to prove their suitability in reproducing the treatment outcome pattern of the patient material studied (through the probability of finding a worse fit, area under the ROC curve and khgr2 test). The analysis was carried out for the upper 5 cm of the esophagus (proximal esophagus) where all the strictures are formed, and the total volume of AVM. The estimated confidence intervals of the dose-response curves appear to have a significant supporting role on their clinical implementation and use.

  11. mRNA expression of CDH3, IGF2BP3, and BIRC5 in biliary brush cytology specimens is a useful adjunctive tool of cytology for the diagnosis of malignant biliary stricture

    PubMed Central

    Kim, Tae Ho; Chang, Jae Hyuck; Lee, Hee Jin; Kim, Jean A; Lim, Yeon Soo; Kim, Chang Whan; Han, Sok Won

    2016-01-01

    Abstract Although advances have been made in diagnostic tools, the distinction between malignant and benign biliary strictures still remains challenging. Intraductal brush cytology is a convenient and safe method that is used for the diagnosis of biliary stricture, but, low sensitivity limits its usefulness. This study aimed to demonstrate the usefulness of mRNA expression levels of target genes in brush cytology specimens combined with cytology for the diagnosis of malignant biliary stricture. Immunohistochemistry for cadherin 3 (CDH3), p53, insulin-like growth factor II mRNA-binding protein 3 (IGF2BP3), homeobox B7 (HOXB7), and baculoviral inhibitor of apoptosis repeat containing 5 (BIRC5) was performed in 4 benign and 4 malignant bile duct tissues. Through endoscopic or interventional radiologic procedures, brush cytology specimens were prospectively obtained in 21 and 35 paitents with biliary strictures. In the brush cytology specimens, the mRNA expressions levels of 5 genes were determined by real-time polymerase chain reaction. Immunohistochemistry for CDH3, p53, IGF2BP3, HOXB7, and BIRC5 all showed positive staining in malignant tissues in contrast to benign tissues, which were negative. In the brush cytology specimens, the mRNA expression levels of CDH3, IGF2BP3, HOXB7, and BIRC5 were significantly higher in cases of malignant biliary stricture compared with cases of benign stricture (P = 0.006, P < 0.001, P < 0.001, and P = 0.001). The receiver-operating characteristic curves of these 4 mRNAs demonstrated that mRNA expression levels are useful for the prediction of malignant biliary stricture (P = 0.006, P < 0.001, P < 0.001, and P = 0.002). The sensitivity and specificity, respectively, for malignant biliary stricture were 57.1% and 100% for cytology, 57.1% and 64.3% for CDH3, 76.2% and 100% for IGF2BP3, 71.4% and 57.1% for HOXB7, and 76.2% and 64.3% for BIRC5. When cytology was combined with the mRNA levels of CDH3, IGF2BP3, or BIRC5, the

  12. Outcomes following vaginal Prolapse repair and mid Urethral Sling (OPUS) trial

    PubMed Central

    Wei, John T.; Nygaard, Ingrid; Richter, Holly E.; Brown, Morton B; Barber, Matthew D.; Xu, Xiao; Kenton, Kim; Nager, Charles W.; Schaffer, Joseph; Visco, Anthony; Weber, Anne

    2010-01-01

    Background Many women without preexisting stress urinary incontinence (SUI) who undergo vaginal surgery to correct pelvic organ prolapse will develop symptoms of SUI. A concomitant prophylactic anti-incontinence procedure may prevent SUI symptom development in women undergoing vaginal prolapse surgery. Purpose To present the rationale, design and methodology of a randomized controlled surgical trial (RCT), the Outcomes Following Vaginal Prolapse Repair and Mid Urethral Sling (OPUS) Trial. The primary aims of this RCT are to determine (1) whether the prevalence of post-operative urinary incontinence (UI) differs between stress continent women receiving vaginal prolapse repair with concomitant tension-free vaginal tape (TVT®; a sling procedure commonly used to treat SUI) and those with only sham incisions at 3 months post surgery (2) whether it is more cost-effective to place a TVT prophylactically than to treat the SUI symptoms postoperatively as they occur over a 12 month period after the index surgery.. The study also incorporates a patient preference trial (PPT). Methods Primary outcome, defined as signs (positive cough stress test), symptoms (per validated questionnaire) and/or need for treatment of SUI and its associated cost, at 3 and 12 months post-operatively. Secondary outcomes consist of group differences in lower urinary tract and prolapse symptoms, health related quality of life, measures of vaginal anatomy, and surgical complications. Limitations Given the invasive nature of surgical intervention trials, some individuals may be reluctant to agree with random assignment, potentially impacting result generalizability. To evaluate the magnitude and direction of non-participation bias, the PPT will enroll a sample of those who decline participation in the RCT but are otherwise eligible. Conclusion This sham-controlled RCT will provide important information for patients and surgeons regarding both the short- and long-term optimal treatment approach for

  13. Long-term recording of external urethral sphincter EMG activity in unanesthetized, unrestrained rats

    PubMed Central

    LaPallo, Brandon K.; Wolpaw, Jonathan R.; Chen, Xiang Yang

    2014-01-01

    The external urethral sphincter muscle (EUS) plays an important role in urinary function and often contributes to urinary dysfunction. EUS study would benefit from methodology for longitudinal recording of electromyographic activity (EMG) in unanesthetized animals, but this muscle is a poor substrate for chronic intramuscular electrodes, and thus the required methodology has not been available. We describe a method for long-term recording of EUS EMG by implantation of fine wires adjacent to the EUS that are secured to the pubic bone. Wires pass subcutaneously to a skull-mounted plug and connect to the recording apparatus by a flexible cable attached to a commutator. A force transducer-mounted cup under a metabolic cage collected urine, allowing recording of EUS EMG and voided urine weight without anesthesia or restraint. Implant durability permitted EUS EMG recording during repeated (up to 3 times weekly) 24-h sessions for more than 8 wk. EMG and voiding properties were stable over weeks 2–8. The degree of EUS phasic activity (bursting) during voiding was highly variable, with an average of 25% of voids not exhibiting bursting. Electrode implantation adjacent to the EUS yielded stable EMG recordings over extended periods and eliminated the confounding effects of anesthesia, physical restraint, and the potential for dislodgment of the chronically implanted intramuscular electrodes. These results show that micturition in unanesthetized, unrestrained rats is usually, but not always, associated with EUS bursting. This methodology is applicable to studying EUS behavior during progression of gradually evolving disease and injury models and in response to therapeutic interventions. PMID:24990895

  14. The fate of synthetic mid-urethral slings in 2013: A turning point

    PubMed Central

    Barboglio, Paholo G.; Ann Gormley, E.

    2013-01-01

    Introduction Since the introduction of the first retropubic tension-free synthetic sling to treat stress urinary incontinence (SUI), newer approaches, different techniques and new devices have been created. Transobturator and single-incision sling (SIS) techniquespara-were developed with the goal of diminishing the rate of complications andspeeding the recovery phase. Methods For this review we searched Medline for relevant papers, with an emphasis on meta-analysis and randomised controlled trials (RCTs). Specially selected reports were identified to address both ’index patients’ (defined as those with genuine SUI and no previous anti-incontinence procedure or other genitourinary sign or symptom that might affect her SUI) and, briefly, non-index patients. Two authors independently reviewed papers for eligibility. Results Level 1 evidence from a Cochrane review and two meta-analyses indicated that subjective outcomes with the mid-urethral sling (MUS) were similar to those from colposuspension. However, the MUS was better than colposuspension when assessing objective outcomes (Level 1). MUS are equally effective as autologous pubovaginal slings (Level1). Two meta-analyses suggest that retropubic MUS (RMUS) might be better than transobturator MUS when assessing objective outcomes. Five more recent RCTs with longer term outcomes showed high success rates and only one reported a significant advantage for the RMUS in women with intrinsic sphincteric deficiency. One meta-analysis addressing the SIS showed inferior outcomes to the MUS (Level 1). New and improved SIS techniques have been used, but long-term outcomes are limited and results are still controversial when compared to the MUS. Conclusion MUS are still the standard to treat the index patient as previously stated by the American and European Associations of Urology. Currently data are lacking to define which sling and what approach works best. Complications are significantly different between sling types and

  15. Long-term recording of external urethral sphincter EMG activity in unanesthetized, unrestrained rats.

    PubMed

    LaPallo, Brandon K; Wolpaw, Jonathan R; Chen, Xiang Yang; Carp, Jonathan S

    2014-08-15

    The external urethral sphincter muscle (EUS) plays an important role in urinary function and often contributes to urinary dysfunction. EUS study would benefit from methodology for longitudinal recording of electromyographic activity (EMG) in unanesthetized animals, but this muscle is a poor substrate for chronic intramuscular electrodes, and thus the required methodology has not been available. We describe a method for long-term recording of EUS EMG by implantation of fine wires adjacent to the EUS that are secured to the pubic bone. Wires pass subcutaneously to a skull-mounted plug and connect to the recording apparatus by a flexible cable attached to a commutator. A force transducer-mounted cup under a metabolic cage collected urine, allowing recording of EUS EMG and voided urine weight without anesthesia or restraint. Implant durability permitted EUS EMG recording during repeated (up to 3 times weekly) 24-h sessions for more than 8 wk. EMG and voiding properties were stable over weeks 2-8. The degree of EUS phasic activity (bursting) during voiding was highly variable, with an average of 25% of voids not exhibiting bursting. Electrode implantation adjacent to the EUS yielded stable EMG recordings over extended periods and eliminated the confounding effects of anesthesia, physical restraint, and the potential for dislodgment of the chronically implanted intramuscular electrodes. These results show that micturition in unanesthetized, unrestrained rats is usually, but not always, associated with EUS bursting. This methodology is applicable to studying EUS behavior during progression of gradually evolving disease and injury models and in response to therapeutic interventions.

  16. Progressive Perineal Urethroplasty for Pelvic Fracture Urethral Distraction Defect in Prepubertal Children: The Outcome

    PubMed Central

    Pal, Bipin Chandra; Modi, Pranjal R.; Qadri, Syed Javid Farooq; Modi, Jayesh; Kumar, Suresh; Nagarajan, Ramya; Safee, Yusuf

    2017-01-01

    Background: Urethroplasty in pediatric patients is a challenging task. In this study, we have tried to assess the complexity and evaluate the outcome of progressive perineal anastomotic urethroplasty in prepubertal children. Materials and Methods: Retrospective data of all the prepubertal children who underwent progressive perineal urethroplasty between March 2009 and April 2014 were analyzed. Patients were evaluated with history, examination, essential laboratory investigations, retrograde urethrogram, and voiding cystourethrogram. Before subjecting the patients for definitive surgery, antegrade and retrograde endoscopic assessment was done. The surgery was performed by the transperineal route with the help of ×2.5 magnification. Patients were followed up with uroflowmetry for every 3 months in the 1st year and for every 6 months in the subsequent years. Results: Mean age of the patients was 7.3 (range 5–11) years. Mean urethral distraction defect was 1.7 (range 1–2.5) cm. All the patients were successfully managed by the perineal approach. Crural separation was performed in all the patients while additional inferior pubectomy was required in six patients. Mean operating time was 298 (range 180–400) min. Mean blood loss was 174 (range 100–500) ml. One patient had the left calf hematoma in the immediate postoperative period. Seven out of nine (77.7%) patients had successful urethroplasty. Two patients had failed urethroplasty who were successfully managed by redo-urethroplasty. Transient incontinence was observed in one patient. Erectile function could not be assessed in these patients. Conclusion: This study shows the feasibility of progressive perineal urethroplasty by the perineal route in prepubertal children. An endoscopic assessment should be performed before the definitive surgery. Use of loupe helps in performing better anastomosis and hence yielding a better result. PMID:28082772

  17. Female Urethral Diverticulum: Presentation, Diagnosis, and Predictors of Outcomes After Surgery

    PubMed Central

    El-Nashar, Sherif A.; Singh, Ruchira; Bacon, Melissa M.; Kim-Fine, Shunaha; Occhino, John A.; Gebhart, John B.; Klingele, Christopher J.

    2017-01-01

    Introduction and Hypothesis To report on clinical presentation, diagnosis, and outcomes after treatment of female urethral diverticulum (UD). Methods Using a record linkage system, women with a new diagnosis of UD at Mayo Clinic from January 1, 1980, through December 31, 2011, were identified. The presenting symptoms, clinical characteristics, diagnosis, and management of women presenting with UD were recorded. Outcomes after surgery were assessed using survival analysis. All statistical analyses were 2-sided and P values less than 0.05 were considered significant. Statistical analysis was done using SAS version 9.2 and JMP version 9.0 (SAS Institute Inc.). Results A total of 164 cases were identified. Median age at diagnosis was 46 years (range, 21–83). The most common presenting symptom was recurrent urinary tract infection (98, 59.8%), followed by urinary incontinence (81, 49.4%), dysuria (62, 37.8%), dyspareunia (37, 22.6%), and hematuria (15, 9.1%). Examination revealed vaginal mass in 55 (33.5%) of the women. A significant trend was noted toward an increase in use of both magnetic resonance imaging and computed tomography (P < 0.001) along with a progressive decrease in use of urethrogram (P < 0.001) for diagnosis of UD over the years. Among 114 women who underwent surgical treatment for UD, 14(12.3%) women presented with recurrent UD and the 5-year recurrence rate after surgery for UD was 23.4% (95% confidence interval, 13.9–37.0) and a reoperation rate of 17.0% (95% confidence interval, 8.8–30.2) at 5 years. Conclusions Female UD is a rare and unique condition. Clinical presentation is usually nonspecific, and magnetic resonance imaging is commonly used for confirming the diagnosis. Recurrence is not uncommon, and repeat surgical intervention might be needed. PMID:27636213

  18. Sperm evaluation and biochemical characterization of cat seminal plasma collected by electroejaculation and urethral catheterization.

    PubMed

    Zambelli, Daniele; Raccagni, Ramona; Cunto, Marco; Andreani, Giulia; Isani, Gloria

    2010-11-01

    This paper aimed to evaluate cat seminal plasma protein profile (with SDS-page) and determine differences in seminal plasma composition from ejaculates obtained using urethral catheterization after pharmacological induction (UrCaPI) and electroejaculation (EE). In addition, this study evaluates whether the recovery method affected seminal plasma protein and zinc concentrations. A single ejaculation was collected from 17 mixed-breed cats by EE (5/21) or UrCaPI (12/21), while 4/21 cats underwent four sperm collections once every four days using EE and UrCaPI techniques alternately. The semen parameters evaluated were: volume, percentage of motility and progressive motility, morphology, and sperm concentration. After centrifugation, the seminal plasma obtained was stored at -80 °C and later used to measure protein and zinc concentrations, and to determine protein profile by SDS-polyacrylamide gel electrophoresis (PAGE). The results obtained indicate that cat seminal plasma protein profile is characterized by many protein bands (>30) with a molecular weight ranging from 3.5 to 200 kDa, and that the recovery method influences the seminal plasma protein profile: EE is related to the absence of two proteins (P55 and P14), and alters three protein bands (P200, P80, P28). The collection technique also affected zinc concentration (mg/dL) and protein concentration (g/dL) which were significantly higher (P < 0.01) in samples collected by UrCaPI; on the contrary the total Zn and protein amount/ejaculate were not significantly different in samples collected by both technique (P < 0.05).

  19. Posterior Wnts Have Distinct Roles in Specification and Patterning of the Planarian Posterior Region

    PubMed Central

    Sureda-Gómez, Miquel; Pascual-Carreras, Eudald; Adell, Teresa

    2015-01-01

    The wnt signaling pathway is an intercellular communication mechanism essential in cell-fate specification, tissue patterning and regional-identity specification. A βcatenin-dependent signal specifies the AP (Anteroposterior) axis of planarians, both during regeneration of new tissues and during normal homeostasis. Accordingly, four wnts (posterior wnts) are expressed in a nested manner in central and posterior regions of planarians. We have analyzed the specific role of each posterior wnt and the possible cooperation between them in specifying and patterning planarian central and posterior regions. We show that each posterior wnt exerts a distinct role during re-specification and maintenance of the central and posterior planarian regions, and that the integration of the different wnt signals (βcatenin dependent and independent) underlies the patterning of the AP axis from the central region to the tip of the tail. Based on these findings and data from the literature, we propose a model for patterning the planarian AP axis. PMID:26556349

  20. Syndrome of Inappropriate Secretion of Antidiuretic Hormone Caused by Carboplatin After Switching from Cisplatin in a Metastatic Urethral Cancer Patient.

    PubMed

    Sugiyama, Yosuke; Naiki, Taku; Kondo, Masahiro; Iida, Keitaro; Kondo, Yuki; Tasaki, Yoshihiko; Kataoka, Tomoya; Hotta, Asami; Yasui, Takahiro; Kimura, Kazunori

    2017-05-01

    There is no established chemotherapy regimen in metastatic primary urethral cancer (mPUC). The efficacy of a cisplatin (CDDP)-based regimen has been reported, however, when the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) occurs, the chemotherapy regimen should be changed to another platinum compound. In this report, we describe a 66-year-old woman who was diagnosed as mPUC with, CDDP-induced SIADH. After switching her to CBDCA and careful managing her sodium balance, three courses of the chemotherapy regimen were completed.

  1. Monte Carlo validation and optimisation of detector packaging for spectroscopic dosimetry for in vivo urethral dosimetry during low dose rate brachytherapy.

    PubMed

    Nourbehesht, L K; Cutajar, D L; Guatelli, S; Rosenfeld, A B

    2015-09-01

    The urethral mini-dosimeter, developed by the Centre for Medical Radiation Physics, University of Wollongong, uses spectroscopic dosimetry to provide real time point dose measurements along the urethra during low dose rate prostate brachytherapy. Spectroscopic dosimetry uses the measured spectrum of the treatment isotope to estimate the dose rate at the point of measurement, however, the silicon mini-detectors employed in the urethral mini-dosimeter require water proof encapsulation which must be capable of providing electromagnetic shielding without greatly increasing the size of the probe. The introduction of non-tissue equivalent materials within the encapsulation can change the spectrum of radiation incident on the detector, which may influence the application of spectroscopic dosimetry within the urethral dosimeter. The Monte Carlo code Geant4 was adopted to study the effect of encapsulation on the operation of the urethral mini-dosimeter, as well as to determine whether an appropriate thickness of aluminium shielding was possible for electromagnetic screening. The depth dose response and angular dependence of the urethral mini-dosimeter with three thicknesses of aluminium shielding (20, 50, 100 µm) was compared with the urethral mini-dosimeter without aluminium shielding. The aluminium shielding had the effect of increasing the depth dose response (up to 3% within 30 mm and up to 5% within 50 mm), slightly reduced the azimuth angular dependence and slightly increased the polar angular dependence. The 100 µm thick shielding provided the least azimuth angular dependence (±2 %) and provided a polar angular dependence of ±1.4 % within the angles of -45° to 45°.

  2. Fasudil inhibits proliferation and collagen synthesis and induces apoptosis of human fibroblasts derived from urethral scar via the Rho/ROCK signaling pathway

    PubMed Central

    Xu, Ning; Chen, Shao-Hao; Qu, Gen-Yi; Li, Xiao-Dong; Lin, Wen; Xue, Xue-Yi; Lin, Yun-Zhi; Zheng, Qing-Shui; Wei, Yong

    2017-01-01

    Fasudil has shown antifibrotic effects in various fibrotic diseases. However, its effects on human urethral fibroblasts are unknown. This study evaluated the effects of fasudil on cellular proliferation, migration, apoptosis, and collagen synthesis in human fibroblasts derived from urethral scar tissues. Human urethral scar fibroblasts were cultured by explant and incubated for 24 h or 48 h with fasudil (12.5, 25, 50 µmol/L) with or without transforming growth factor β1 (TGF-β1, 10 ng/mL), or left untreated (control). Cell proliferation and migration was determined by MTT assay and Transwell chambers, respectively. Apoptosis was measured by flow cytometry. Levels of α-smooth muscle actin (α-SMA), myosin light-chain phosphatase (MLCP), LIM domain kinase 1 (LIMK1), phospho-cofilin (p-cofilin), collagen I, and collagen III were determined by Western blot. Compared with the control group, TGF-β1 was associated with a significant increase in urethral fibroblast proliferation and migration, and α-SMA, MLCP, LIMK1, p-cofilin, collagen I, and collagen III levels. Compared with the control group, fasudil (with or without TGF-β1), significantly and negatively correlated, in a dose-dependent manner, with the proliferation and migration of urethral fibroblasts, as well as α-SMA, MLCP, LIMK1, p-cofilin, collagen I, and collagen III levels. Moreover, fasudil significantly induced apoptosis of fibroblasts induced by TGF-β1. Higher concentrations of fasudil (50 μmol/L) were associated with greater cell apoptosis without TGF-β1 stimulation compared with the normal control group. Fasudil, with or without TGF-β1 stimulation, may inhibit human urethral fibroblasts proliferation, migration, apoptosis, and collagen synthesis via the Rho/ROCK signaling pathway. PMID:28386357

  3. [Manual rotation of occiput posterior presentation].

    PubMed

    Le Ray, C; Goffinet, F

    2011-10-01

    Delivery in occiput posterior position is associated with a higher risk of cesarean section, operative vaginal delivery and severe perineal tears. We report the technic of manual rotation described by Tarnier and Chantreuil and used daily in our maternity center. Only five studies were published on this topic; all of them demonstrate that manual rotation decreases the risk of cesarean section. Moreover, it could decrease the risk of prolonged second stage, chorioamnionitis and third and fourth degree tears in comparison with expectant management. However, manual rotation is associated with a two-fold higher risk of cervical and vaginal lacerations. Manual rotation performed with an adequate technic is an efficient and safe manœuvre to avoid complications associated with occiput posterior vaginal delivery.

  4. Acute traumatic posterior elbow dislocation in children.

    PubMed

    Lieber, Justus; Zundel, Sabine M; Luithle, Tobias; Fuchs, Jörg; Kirschner, Hans-Joachim

    2012-09-01

    Traumatic posterior dislocation of the elbow is often associated with significant morbidity and incomplete recovery. The aim of this study was to retrospectively analyse the outcome of 33 children (median age 10.8 years). Patients underwent reduction and assessment of stability under general anaesthesia. Pure dislocations (n=10) were immobilized, whereas unstable fractures (n=23) were stabilized. Refixation of ligaments was performed if stability was not achieved by fracture stabilization alone. Immobilization was continued for 26 (pure dislocations) or 35 days (associated injuries), respectively. Results were excellent (n=9) or good (n=1) after pure dislocation. Results were excellent (n=15), good (n=7) or poor (n=1) in children with associated injuries. Accurate diagnosis, concentric stable reduction of the elbow as well as stable osteosynthesis of displaced fractures are associated with good results in children with acute posterior elbow dislocations.

  5. Posterior tibial nerve lesions in ankle arthroscopy.

    PubMed

    Cugat, Ramon; Ares, Oscar; Cuscó, Xavier; Garcia, Montserrat; Samitier, Gonzalo; Seijas, Roberto

    2008-05-01

    Ankle arthroscopy provides a minimally invasive approach to the diagnosis and treatment of certain ankle disorders. Neurological complications resulting from ankle arthroscopy have been well documented in orthopaedic and podiatric literature. Owing to the superficial location of the ankle joint and the abundance of overlying periarticular neurovascular structures, complications reported in ankle arthroscopy are greater than those reported for other joints. In particular, all reported neurovascular injuries following ankle arthroscopy have been the direct result of distractor pin or portal placement. The standard posteromedial portal has recognized risks because of the proximity of the posterior neurovascular structures. There can be considerable variability in the course of these portals and their proximity to the neurovascular structures. We found one report of intra-articular damage to the posterior tibial nerve as a result of ankle arthroscopy in the English-language literature and we report this paper as a second case described in the literature.

  6. Progressive visual agnosia with posterior cortical atrophy.

    PubMed

    Mizuno, M; Sartori, G; Liccione, D; Battelli, L; Campo, R

    1996-05-01

    A patient of posterior cortical atrophy characterized by early signs of progressive visual agnosia documented by repeated neuropsychological tests, is reported. SPECT and MRI findings showed left unilateral parieto-occipital involvement in the earlier stage. A PET study executed eight months later showed bilateral parieto-occipital hypometabolism, but predominantly in the left hemisphere. This suggests that the degeneration may have developed asymmetrically, progressing from left unilateral to bilateral.

  7. Endoscopic posterior interhemispheric complete corpus callosotomy.

    PubMed

    Sood, Sandeep; Asano, Eishi; Altinok, Deniz; Luat, Aimee

    2016-12-01

    Traditionally corpus callosotomy is done through a craniotomy centered at the coronal suture, with the aid of a microscope. This involves dissecting through the interhemispheric fissure below the falx to reach the corpus callosum. The authors describe a posterior interhemispheric approach to complete corpus callosotomy with an endoscope, which bypasses the need to perform interhemispheric dissection because the falx is generally close to the corpus callosum in this region.

  8. Material Properties of the Posterior Human Sclera☆

    PubMed Central

    Grytz, Rafael; Fazio, Massimo A.; Girard, Michael J.A.; Libertiaux, Vincent; Bruno, Luigi; Gardiner, Stuart; Girkin, Christopher A.; Downs, J. Crawford

    2013-01-01

    To characterize the material properties of posterior and peripapillary sclera from human donors, and to investigate the macro- and micro-scale strains as potential control mechanisms governing mechanical homeostasis. Posterior scleral shells from 9 human donors aged 57–90 years were subjected to IOP elevations from 5 to 45 mmHg and the resulting full-field displacements were recorded using laser speckle interferometry. Eye-specific finite element models were generated based on experimentally measured scleral shell surface geometry and thickness. Inverse numerical analyses were performed to identify material parameters for each eye by matching experimental deformation measurements to model predictions using a microstructure-based constitutive formulation that incorporates the crimp response and anisotropic architecture of scleral collagen fibrils. The material property fitting produced models that fit both the overall and local deformation responses of posterior scleral shells very well. The nonlinear stiffening of the sclera with increasing IOP was well reproduced by the uncrimping of scleral collagen fibrils, and a circumferentially-aligned ring of collagen fibrils around the scleral canal was predicted in all eyes. Macroscopic in-plane strains were significantly higher in peripapillary region then in the mid-periphery. In contrast, the meso- and micro-scale strains at the collagen network and collagen fibril level were not significantly different between regions. The elastic response of the posterior human sclera can be characterized by the anisotropic architecture and crimp response of scleral collagen fibrils. The similar collagen fibril strains in the peripapillary and mid-peripheral regions support the notion that the scleral collagen architecture including the circumpapillary ring of collagen fibrils evolved to establish optimal load bearing conditions at the collagen fibril level. PMID:23684352

  9. Iris fixation of posterior chamber intraocular lenses.

    PubMed

    Yazdani-Abyaneh, Alireza; Djalilian, Ali R; Fard, Masoud Aghsaei

    2016-12-01

    We introduce a technique for iris fixation of a posterior chamber intraocular lens (IOL) in which most of the procedure is done outside the eye. This minimizes intraocular manipulation, maximizes corneal endothelial preservation, and avoids the risk for IOL drop into the vitreous cavity intraoperatively. The IOL is fixated to the most peripheral part of the iris, resulting in a rounder pupil. Sutures are placed at exact positions on the haptics, resulting in a well-centered IOL.

  10. Cervical disc hernia operations through posterior laminoforaminotomy

    PubMed Central

    Yolas, Coskun; Ozdemir, Nuriye Guzin; Okay, Hilmi Onder; Kanat, Ayhan; Senol, Mehmet; Atci, Ibrahim Burak; Yilmaz, Hakan; Coban, Mustafa Kemal; Yuksel, Mehmet Onur; Kahraman, Umit

    2016-01-01

    Objective: The most common used technique for posterolateral cervical disc herniations is anterior approach. However, posterior cervical laminotoforaminomy can provide excellent results in appropriately selected patients with foraminal stenosis in either soft disc prolapse or cervical spondylosis. The purpose of this study was to present the clinical outcomes following posterior laminoforaminotomy in patients with radiculopathy. Materials and Methods: We retrospectively evaluated 35 patients diagnosed with posterolateral cervical disc herniation and cervical spondylosis with foraminal stenosis causing radiculopathy operated by the posterior cervical keyhole laminoforaminotomy between the years 2010 and 2015. Results: The file records and the radiographic images of the 35 patients were assessed retrospectively. The mean age was 46.4 years (range: 34-66 years). Of the patients, 19 were males and 16 were females. In all of the patients, the neurologic deficit observed was radiculopathy. The posterolaterally localized disc herniations and the osteophytic structures were on the left side in 18 cases and on the right in 17 cases. In 10 of the patients, the disc level was at C5-6, in 18 at C6-7, in 2 at C3-4, in 2 at C4-5, in 1 at C7-T1, in 1 patient at both C5-6 and C6-7, and in 1 at both C4-5 and C5-6. In 14 of these 35 patients, both osteophytic structures and protruded disc herniation were present. Intervertebral foramen stenosis was present in all of the patients with osteophytes. Postoperatively, in 31 patients the complaints were relieved completely and four patients had complaints of neck pain and paresthesia radiating to the arm (the success of operation was 88.5%). On control examinations, there was no finding of instability or cervical kyphosis. Conclusion: Posterior cervical laminoforaminotomy is an alternative appropriate choice in both cervical soft disc herniations and cervical stenosis. PMID:27217655

  11. Posterior fossa syndrome—a narrative review

    PubMed Central

    Wahab, Salima S.; Hettige, Samantha; Mankad, Kshtij

    2016-01-01

    Posterior fossa syndrome (PFS), or cerebellar mutism syndrome (CMS), is a collection of neurological symptoms that occur following surgical resection of a posterior fossa tumour, and is characterised by either a reduction or an absence of speech. Some authors suggest that CM is only one symptom of the CMS complex that also includes ataxia, hypotonia and irritability as well as cranial nerve deficits, neurobehavioral changes and urinary retention or incontinence. It is seen almost exclusively in children. In 1985 Rekate et al. published the first work describing CM as a clinical entity, occurring as a consequence of bilateral cerebellar injury. Other associated symptoms include visual impairment, altered mood, impaired swallowing and significant gross and fine motor deficits. The effects of this can have a devastating impact on both the patient and their carers, posing a significant clinical challenge to neurorehabilitation services. The reported incidence was between 8% and 31% of children undergoing surgery for posterior fossa tumour. The underlying pathologies include vasospasm, oedema, and axonal/neuronal injury. Neuroimaging has contributed to a better understanding of the anatomical location of postoperative injury. There have been a number of suggestions for treatment interventions for PFS. However, apart from some individual reports, there have been no clinical trials indicating possible benefit. Occupational therapy, speech and language therapy, as well as neurocognitive support, contribute to the recovery of these patients. PMID:27942479

  12. Electrocardiographic diagnosis of remote posterior wall myocardial infarction using unipolar posterior lead V9

    SciTech Connect

    Rich, M.W.; Imburgia, M.; King, T.R.; Fischer, K.C.; Kovach, K.L. )

    1989-09-01

    The accuracy of four electrocardiographic criteria for diagnosing remote posterior myocardial infarction was assessed prospectively in 369 patients undergoing exercise treadmill testing with thallium scintigraphy. Criteria included the following: (1) R-wave width greater than or equal to 0.04 s and R-wave greater than or equal to S-wave in V1; (2) R-wave greater than or equal to S-wave in V2; (3) T-wave voltage in V2 minus V6 greater than or equal to 0.38 mV (T-wave index); (4) Q-wave greater than or equal to 0.04 s in left paraspinal lead V9. Twenty-seven patients (7.3 percent) met thallium criteria for posterior myocardial infarction, defined as a persistent perfusion defect in the posterobase of the left ventricle. Sensitivities for the four criteria ranged from 4 to 56 percent, and specificities ranged from 64 to 99 percent. Posterior paraspinal lead V9 provided the best overall predictive accuracy (94 percent), positive predictive value (58 percent), and ability to differentiate patients with and without posterior myocardial infarction of any single criterion (p less than .0001). Combining the T-wave index with lead V9 further enhanced the diagnostic yield: the sensitivity for detecting posterior infarction by at least one of these criteria was 78 percent, and when both criteria were positive, specificity was 98.5 percent. It is concluded that a single, unipolar posterior lead in the V9 position is superior to standard 12-lead electrocardiographic criteria in diagnosing remote posterior myocardial infarction, and that combining V9 with the T-wave index maximizes the diagnostic yield.

  13. N-acetylcysteine for the prevention of stricture after circumferential endoscopic submucosal dissection of the esophagus: a randomized trial in a porcine model

    PubMed Central

    2012-01-01

    Background Circumferential endoscopic submucosal dissection (CESD) of the esophagus would allow for both the eradication of Barrett’s esophagus and its related complications, such as advanced neoplasia. However, such procedures generally induce inflammatory repair resulting in a fibrotic stricture. N-acetylcysteine (NAC) is an antioxidant that has shown some efficacy against pulmonary and hepatic fibrosis. The aim of our study was to evaluate the benefit of NAC in the prevention of esophageal cicatricial stricture after CESD in a swine model. Animals and methods Two groups of six pigs each were subjected to general anesthesia and CESD: after randomization, a first group received an oral NAC treatment regimen of 100 mg/kg/day, initiated one week before the procedure, whereas a second group was followed without any prophylactic treatment. Follow-up endoscopies took place seven, fourteen, twenty-one, and twenty-eight days after CESD. Necropsy, histological assessment of esophageal inflammation, and fibrosis were performed on day 28. Results The median esophageal lumen diameter on day 21 (main judgment criterion) was 4 mm (range 2 to 5) in group 1 and 3 mm (range 1 to 7) in group 2 (P = 0.95). No significant difference was observed between the two groups regarding clinical evaluation (time before onset of clinically significant esophageal obstruction), number of dilations, esophageal inflammation and fibrosis, or oxidative stress damage on immunohistochemistry. Conclusions Despite its antioxidant effect, systemic administration of NAC did not show significant benefit on esophageal fibrosis in our animal model of esophageal wound healing within the experimental conditions of this study. Since the administered doses were relatively high, it seems unlikely that NAC might be a valuable option for the prevention of post-endoscopic esophageal stricture. PMID:22640979

  14. Primary systemic amyloidosis presenting as a colonic stricture: successful treatment with left hemicolectomy followed by autologous hematopoietic stem-cell transplantation: report of a case.

    PubMed

    Rives, S; Pera, M; Rosiñol, L; Vidal, O; Miquel, R; Solé, M; García-Valdecasas, J; Bladé, J

    2002-09-01

    Intestinal tract involvement by primary systemic amyloidosis is frequent but usually asymptomatic. Ischemic colitis caused by amyloid infiltration of wall blood vessels can occasionally be observed. We report a 62-year-old female with primary systemic amyloidosis who presented with intestinal obstruction caused by ischemic stricture of the sigmoid colon, secondary to submucosal amyloid deposition. The patient was successfully treated with surgical resection followed by high-dose chemotherapy and hematopoietic stem-cell transplantation. The clinical manifestations and differential diagnosis of gastrointestinal involvement of primary systemic amyloidosis, as well as its current treatment, are discussed.

  15. Posterior ventricular anchoring neochordal repair of degenerative mitral regurgitation efficiently remodels and repositions posterior leaflet prolapse†

    PubMed Central

    Woo, Y. Joseph; MacArthur, John W.

    2013-01-01

    OBJECTIVES Mitral valve repair techniques for degenerative disease typically entail leaflet resection or neochordal construction, which may require extensive resection, leaflet detachment/reattachment, reliance on diseased native chords or precise neochordal measuring. Occasionally, impaired leaflet mobility, reduced coaptation surface and systolic anterior motion (SAM) may result. We describe a novel technique for addressing posterior leaflet prolapse/flail, which both simplifies repair and addresses these issues. METHODS Fifty-four patients (age 62 ± 11 years) with degenerative MR underwent this new repair, 36 of whom minimally-invasively. A CV5 Gore-Tex suture was placed into the posterior left ventricular myocardium underneath the prolapsing segment as an anchor. This suture was then used to imbricate a portion of the prolapsed segment into the ventricle, creating a smooth, broad, non-prolapsed coapting surface on a leaflet with preserved mobility, additional neochordal support and posteriorly positioned enough to preclude SAM. RESULTS Repair was successful in all patients. The mean MR grade was reduced from +3.8 to +0.1 with 50 of 54 patients having zero MR and 4 of the 54 having trace or mild MR. All patients had proper antero-posterior location of the coaptation line of a mean length of 10.2 mm, and preserved posterior leaflet mobility. No patients had SAM or mitral stenosis. All patients were discharged and are currently doing well. CONCLUSION This new technique facilitated efficient single-suture repair of the prolapsed posterior leaflet mitral regurgitation without the need for resection or sliding annuloplasty. It precluded the need for precise neochordal measurement and preserved the leaflet coaptation surface. PMID:23449863

  16. Talar Osteochondroma Fracture Presenting as Posterior Ankle Impingement.

    PubMed

    Ercin, Ersin; Bilgili, Mustafa Gokhan; Gamsizkan, Mehmet; Avsar, Serdar

    2016-05-01

    Osteochondromas are the most common benign bone tumors. They are usually asymptomatic and found incidentally. When symptomatic, the symptoms are usually due to its location and size. Fracture of an osteochondroma presenting as posterior ankle impingement is a rare condition. We describe a 22-year-old man with solitary exostosis who presented with a posterior ankle mass and posterior ankle impingement with 2 years of follow-up. Surgical intervention was the treatment of choice in this patient, and histologic examination revealed a benign osteochondroma. Osteochondromas found in the posterior aspect of the talus can be complicated by fracture due to persistent motion of the ankle. Talar osteochondroma should be included in the differential diagnosis of posterior ankle impingement causes. Posterior talar osteochondromas, especially when a stalk is present, should be treated surgically before it is more complicated by a fracture and posterior ankle impingement.

  17. Surgical management of posterior fossa metastases.

    PubMed

    Sunderland, Geraint J; Jenkinson, Michael D; Zakaria, Rasheed

    2016-12-01

    The diagnosis of brain metastases is associated with a poor prognosis reflecting uncontrolled primary disease that has spread to the relative sanctuary of the central nervous system. 20 % of brain metastases occur in the posterior fossa and are associated with significant morbidity. The risk of acute hydrocephalus and potential for sudden death means these metastases are often dealt with as emergency cases. This approach means a full pre-operative assessment and staging of underlying disease may be neglected and a proportion of patients undergo comparatively high risk surgery with little or no survival benefit. This study aimed to assess outcomes in patients to identify factors that may assist in case selection. We report a retrospective case series of 92 consecutive patients operated for posterior fossa metastases between 2007 and 2012. Routine demographic data was collected plus data on performance status, primary cancer site, details of surgery, adjuvant treatment and survival. The only independent positive prognostic factors identified on multivariate analysis were good performance status (if Karnofsky performance score >70, hazard ratio (HR) for death 0.36, 95 % confidence interval (CI) 0.18-0.69), adjuvant whole brain radiotherapy (HR 0.37, 95 % CI 0.21-0.65) and adjuvant chemotherapy where there was extracranial disease and non-synchronous presentation (HR 0.51, 95 % CI 0.31-0.82). Patients presenting with posterior fossa metastases may not be investigated as thoroughly as those with supratentorial tumours. Staging and assessment is essential however, and in the meantime emergencies related to tumour mass effect should be managed with steroids and cerebrospinal fluid diversion as required.

  18. [Posterior dislocation of the sternoclavicular joint].

    PubMed

    Mäkinen, Tatu; Madanat, Rami; Heinänen, Mikko; Brinck, Tuomas; Pajarinen, Jarkko

    2013-01-01

    Posterior dislocation of the sternoclavicular joint is a rare injury. It can be associated with life-threatening complications. Computed tomography is the imaging modality of choice with which possible associated injuries can be detected. Acute injuries are managed with closed reduction under general anaesthesia. A fracture-dislocation is inherently more unstable than an isolated dislocation. Surgical treatment is advocated in cases of delayed diagnosis or failed closed reduction. With early diagnosis and treatment, the long-term outcome of this injury is good.

  19. Decompression of Posterior Ankle Impingement With Concomitant Anterior Ankle Pathology by Posterior Ankle Arthroscopy in the Supine Position.

    PubMed

    Lui, Tun Hing

    2016-10-01

    Posterior ankle endoscopy is a safe and effective approach for treatment of posterior ankle impingement. This is usually performed with the patient in prone position. The purpose of this technical note is to describe an arthroscopic approach of decompression of posterior ankle impingement with the patient in supine position. This is indicated if there is posterior ankle impingement together with other ankle pathology requiring anterior ankle arthroscopy. This approach allows treatment of both anterior ankle and posterior ankle pathology with the patient in the supine position. Concomitant anterior ankle arthroscopy can be performed with the usual orientation without the need of change of patient's position.

  20. Traumatic posterior dislocation of hip in children.

    PubMed

    Kutty, S; Thornes, B; Curtin, W A; Gilmore, M F

    2001-02-01

    Traumatic posterior dislocation of the hip joint in children is an uncommon injury. It constitutes a true orthopedic emergency. It makes up over 80% of pediatric hip dislocations. In children, it can occur as a result of minimal trauma, which is attributed to a soft pliable acetabulum and ligamentous laxity. In skeletally mature adolescents, a greater force is required to dislocate the hip joint. Delay in reduction is associated with long-term complications such as avascular necrosis and degenerative arthritis. Avascular necrosis is related to the duration of dislocation. A poorer prognosis is associated with delay in reduction beyond 6 hours, advanced skeletal maturity, or multiple traumas. Prompt reduction minimizes complications. We report two cases of traumatic posterior dislocation of hip in children aged 3 and 14 years. Both were reduced within 6 hours of dislocation, and review at 6 months revealed normal examination and no evidence of any post-traumatic changes. Post-reduction treatment remains without a consensus. This review highlights the clinical presentation, management, and time-sensitive complications of the injury.

  1. Management of an Uncomplicated Posterior Elbow Dislocation

    PubMed Central

    Blackard, Douglas; Sampson, Jo-Ann

    1997-01-01

    Objective: To present a case of an uncomplicated posterior elbow dislocation in a US World Cup athlete and discuss her rehabilitation. Background: Traditional protocol for management of this injury has been splint immobilization for several weeks, but research suggests a shortened duration of immobilization and early active motion. Differential Diagnosis: Elbow dislocation with possible fracture. Treatment: The dislocation was reduced and a compression bandage and sling were applied. The sports medicine staff and athlete determined that rehabilitation would involve limited immobilization with a posterior splint. Also, active range-of- motion exercises were to be incorporated early in the range-of- motion program to decrease pain at the articulation. Uniqueness: The athlete was not immobilized and her aggressive five-phase rehabilitation program progressed according to decrease in inflammation and increase in range of motion and strength. Conclusions: Shortened immobilization and return to World Championship competition 6 weeks postinjury had no longterm adverse effects on the athlete. ImagesFig 1.Fig 2.Fig 3.Fig 4.Fig. 5. PMID:16558436

  2. Posterior malleolar fractures of the ankle.

    PubMed

    Bartoníček, J; Rammelt, S; Tuček, M; Naňka, O

    2015-12-01

    Despite an increasing awareness of injuries to PM in ankle fracture-dislocations, there are still many open questions. The mere presence of a posterior fragment leads to significantly poorer outcomes. Adequate diagnosis, classification and treatment require preoperative CT examination, preferably with 3D reconstructions. The indication for surgical treatment is made individually on the basis of comprehensive assessment of the three-dimensional outline of the PM fracture and all associated injuries to the ankle including syndesmotic instability. Anatomic fixation of the avulsed posterior tibiofibular ligament will contribute to syndesmotic stability and restore the integrity of the incisura tibiae thus facilitating anatomic reduction of the distal fibula. A necessary prerequisite is mastering of posterolateral and posteromedial approaches and the technique of direct reduction and internal fixation. Further clinical studies with higher numbers of patients treated by similar methods and evaluation of pre- and postoperative CT scans will be necessary to determine reliable prognostic factors associated with certain types of PM fractures and associated injuries to the ankle.

  3. Microsurgical anatomy of the posterior fossa cisterns.

    PubMed

    Matsuno, H; Rhoton, A L; Peace, D

    1988-07-01

    The microsurgical anatomy of the posterior fossa cisterns was examined in 15 cadavers using 3X to 40X magnification. Liliequist's membrane was found to split into two arachnoidal sheets as it spreads upward from the dorsum sellae: an upper sheet, called the diencephalic membrane, which attaches to the diencephalon at the posterior edge of the mamillary bodies, and a lower sheet, called the mesencephalic membrane, which attaches along the junction of the midbrain and pons. Several other arachnoidal membranes that separate the cisterns were identified. These include the anterior pontine membrane, which separates the prepontine and cerebellopontine cisterns; the lateral pontomesencephalic membrane, which separates the ambient and cerebellopontine cisterns; the medial pontomedullary membrane, which separates the premedullary and prepontine cisterns; and the lateral pontomedullary membrane, which separates the cerebellopontine and cerebellomedullary cisterns. The three cisterns in which the arachnoid trabeculae and membranes are the most dense and present the greatest obstacle at operation are the interpeduncular and quadrigeminal cisterns and the cisterna magna. Numerous arachnoid membranes were found to intersect the oculomotor nerves. The neural and vascular structures in each cistern are reviewed.

  4. SU-E-T-767: Treatment Planning Study of Prostate Cancer by CyberKnife with Respect to the Urethral Dose

    SciTech Connect

    Mizuno, H; Mizuno, H; Sumida, I; Otani, Y; Yagi, M; Takashina, M; Suzuki, O; Yoshioka, Y; Koizumi, M; Ogawa, K

    2015-06-15

    Purpose: Hypo-fractionated stereotactic body radiation therapy (SBRT) with intensity modulated radiation therapy (IMRT) is nowadays one of the treatment strategies for prostate cancer. There are few reports on planning study of prostate cancer by CyberKnife with respect to the urethral dose because of the invisibility in CT. We have investigated a planning method using fixed collimators with considering dose homogeneity, conformity and urethral dose. Methods: Radiotherapy treatment planning of prostate cancer were under a clinical trial approved by the institutional review board. The prescription dose of 35 Gy were delivered to the PTV in five fractions with the urethral catheter. Urethra position was identified by pretreatment CT and catheter, which was inserted before treatment planning CT and released after the treatment. All plans agreed to the criteria as shown in table 1, and the following constraints were recommended as well: the prescribed iso-dose line should be from 70% to 90%; the total MU should be below 50,000 MU; the minimum MU per beam should be larger than 15 MU; the estimated delivery time (excluding patient setup time) by Multiplan with image time interval of 60 s should be less than 35 min. Collimator size and position were decided as shown in figure 1. Fixed collimator of 15 mm was positioned around urethra and PTV for avoiding high dose of urethra and achieving conformity, and fixed collimator of 30 or 40 were positioned around PTV for achieving dose homogeneity. Results: With this method, all constraints were achieved. (Table 1, Figure 2) Max dose of urethra was ranging from 103.9% to 114.2%, because urethra position was identified by pretreatment CT and urethral catheter. Conclusion: Hypo-fractionated SBRT with IMRT utilizing urethral catheter could be a promising new treatment option for prostate cancer. This work was supported by JSPS Core-to-Core program Number 23003.

  5. Signalment, clinical features, and outcome for male horses with urethral rents following perineal urethrotomy or corpus spongiotomy: 33 cases (1989-2013).

    PubMed

    Glass, Kati G; Arnold, Carolyn E; Varner, Dickson D; Chaffin, M Keith; Schumacher, James

    2016-12-15

    OBJECTIVE To describe the signalment, clinical features, and outcome for male horses with urethral rents following perineal urethrotomy (PU) or corpus spongiotomy (CS). DESIGN Retrospective case series. ANIMALS 33 horses. PROCEDURES Medical records of male horses examined because of hematuria or hemospermia caused by urethral rents that underwent PU or CS at a referral hospital between 1989 and 2013 were reviewed. Data regarding signalment, clinical features, urethroscopic findings, surgical treatment, and outcome were recorded. Long-term follow-up information was obtained by telephone interviews. RESULTS Age of the study population ranged from 3 to 18 years. Nineteen geldings and 1 stallion were examined because of hematuria, of which 13 and 7 underwent PU and CS, respectively, at a mean of 56 days after onset of clinical signs. Thirteen stallions were examined because of hemospermia, of which 7 and 6 underwent PU and CS, respectively, at a mean of 193 days after onset of clinical signs. Hematuria resolved following 1 surgical procedure in all 17 horses for which long-term information was available. Of the 12 stallions for which long-term information was available, 7 had resolution of hemospermia after 1 PU or CS and 5 developed recurrent hemospermia that required additional PUs or CSs (n = 3) or primary closure of the urethral rent (2). CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that PU and CS were reliable treatments for resolution of hematuria in male horses with urethral rents; stallions with urethral rents may require multiple PUs or CSs or primary closure of the rent for resolution of hemospermia.

  6. Urethral closure mechanisms under sneeze-induced stress condition in rats: a new animal model for evaluation of stress urinary incontinence.

    PubMed

    Kamo, Izumi; Torimoto, Kazumasa; Chancellor, Michael B; de Groat, William C; Yoshimura, Naoki

    2003-08-01

    The urethral closure mechanism under a stress condition induced by sneezing was investigated in urethane-anesthetized female rats. During sneezing, while the responses measured by microtip transducer catheters in the proximal and middle parts of the urethra increased, the response in the proximal urethra was almost negligible when the bladder response was subtracted from the urethral response or when the abdomen was opened. In contrast, the response in the middle urethra during sneezing was still observed after subtracting the bladder response or after opening the abdomen. These responses in the middle urethra during sneezing were significantly reduced approximately 80% by bilateral transection of the pudendal nerves and the nerves to the iliococcygeous and pubococcygeous muscles but not by transection of the visceral branches of the pelvic nerves and hypogastric nerves. The sneeze leak point pressure was also measured to investigate the role of active urethral closure mechanisms in maintaining total urethral resistance against sneeze-induced urinary incontinence. In sham-operated rats, no urinary leakage was observed during sneeze, which produced an increase of intravesical pressure up to 37 +/- 2.2 cmH2O. However, in nerve-transected rats urinary leakage was observed when the intravesical pressure during sneezing exceeded 16.3 +/- 2.1 cmH2O. These results indicate that during sneezing, pressure increases elicited by reflex contractions of external urethral sphincter and pelvic floor muscles occur in the middle portion of the urethra. These reflexes in addition to passive transmission of increased abdominal pressure significantly contribute to urinary continence mechanisms under a sneeze-induced stress condition.

  7. Prehension Movements in a Patient (AC) with Posterior Parietal Cortex Damage and Posterior Callosal Section

    ERIC Educational Resources Information Center

    Frak, Victor; Paulignan, Yves; Jeannerod, Marc; Michel, Francois; Cohen, Henri

    2006-01-01

    Prehension movements of the right hand were recorded in a right-handed man (AC), with an injury to the left posterior parietal cortex (PPC) and with a section of the left half of the splenium. The kinematic analysis of AC's grasping movements in direct and perturbed conditions was compared to that of five control subjects. A novel effect in…

  8. GNSS integer ambiguity validation based on posterior probability

    NASA Astrophysics Data System (ADS)

    Wu, Zemin; Bian, Shaofeng

    2015-10-01

    GNSS integer ambiguity validation is considered to be a challenge task for decades. Several kinds of validation tests are developed and widely used in these years, but theoretical basis is their weakness. Ambiguity validation theoretically is an issue of hypothesis test. In the frame of Bayesian hypothesis testing, posterior probability is the canonical standard that statistical decision should be based on. In this contribution, (i) we derive the posterior probability of the fixed ambiguity based on the Bayesian principle and modify it for practice ambiguity validation. (ii) The optimal property of the posterior probability test is proved based on an extended Neyman-Pearson lemma. Since validation failure rate is the issue users most concerned about, (iii) we derive the failure rate upper bound of the posterior probability test, so the user can use the posterior probability test either in the fixed posterior probability or in the fixed failure rate way. Simulated as well as real observed data are used for experimental validations. The results show that (i) the posterior probability test is the most effective within the R-ratio test, difference test, ellipsoidal integer aperture test and posterior probability test, (ii) the posterior probability test is computational efficient and (iii) the failure rate estimation for posterior probability test is useful.

  9. Visual input to the mouse lateral posterior and posterior thalamic nuclei: photoreceptive origins and retinotopic order

    PubMed Central

    Allen, Annette E.; Procyk, Christopher A.; Howarth, Michael; Walmsley, Lauren

    2016-01-01

    Key points The lateral posterior and posterior thalamic nuclei have been implicated in aspects of visually guided behaviour and reflex responses to light, including those dependent on melanopsin photoreception.Here we investigated the extent and basic properties of visually evoked activity across the mouse lateral posterior and posterior thalamus.We show that a subset of retinal projections to these regions derive from melanopsin‐expressing retinal ganglion cells and find many cells that exhibit melanopsin‐dependent changes in firing.We also show that subsets of cells across these regions integrate signals from both eyes in various ways and that, within the lateral posterior thalamus, visual responses are retinotopically ordered. Abstract In addition to the primary thalamocortical visual relay in the lateral geniculate nuclei, a number of other thalamic regions contribute to aspects of visual processing. Thus, the lateral posterior thalamic nuclei (LP/pulvinar) appear important for various functions including determining visual saliency, visually guided behaviours and, alongside dorsal portions of the posterior thalamic nuclei (Po), multisensory processing of information related to aversive stimuli. However, despite the growing importance of mice as a model for understanding visual system organisation, at present we know very little about the basic visual response properties of cells in the mouse LP or Po. Prompted by earlier suggestions that melanopsin photoreception might be important for certain functions of these nuclei, we first employ specific viral tracing to show that a subset of retinal projections to the LP derive from melanopsin‐expressing retinal ganglion cells. We next use multielectrode electrophysiology to demonstrate that LP and dorsal Po cells exhibit a variety of responses to simple visual stimuli including two distinct classes that express melanopsin‐dependent changes in firing (together comprising ∼25% of neurons we recorded). We also

  10. Bile duct stricture

    MedlinePlus

    ... occur after surgery to remove the gallbladder. Other causes of this condition include: Cancer of the bile duct, liver or pancreas Damage and scarring due to a gallstone in the bile duct Damage or scarring after ...

  11. Stress urinary incontinence animal models as a tool to study cell-based regenerative therapies targeting the urethral sphincter.

    PubMed

    Herrera-Imbroda, Bernardo; Lara, María F; Izeta, Ander; Sievert, Karl-Dietrich; Hart, Melanie L

    2015-03-01

    Urinary incontinence (UI) is a major health problem causing a significant social and economic impact affecting more than 200million people (women and men) worldwide. Over the past few years researchers have been investigating cell therapy as a promising approach for the treatment of stress urinary incontinence (SUI) since such an approach may improve the function of a weakened sphincter. Currently, a diverse collection of SUI animal models is available. We describe the features of the different models of SUI/urethral dysfunction and the pros and cons of these animal models in regard to cell therapy applications. We also discuss different cell therapy approaches and cell types tested in preclinical animal models. Finally, we propose new research approaches and perspectives to ensure the use of cellular therapy becomes a real treatment option for SUI.

  12. Double knockout of Bax and Bak from kidney proximal tubules reduces unilateral urethral obstruction associated apoptosis and renal interstitial fibrosis

    PubMed Central

    Mei, Shuqin; Li, Lin; Wei, Qingqing; Hao, Jielu; Su, Yunchao; Mei, Changlin; Dong, Zheng

    2017-01-01

    Interstitial fibrosis, a common pathological feature of chronic kidney diseases, is often associated with apoptosis in renal tissues. To determine the associated apoptotic pathway and its role in renal interstitial fibrosis, we established a mouse model in which Bax and Bak, two critical genes in the intrinsic pathway of apoptosis, were deleted specifically from kidney proximal tubules and used this model to examine renal apoptosis and interstitial fibrosis following unilateral urethral obstruction (UUO). It was shown that double knockout of Bax and Bak from proximal tubules attenuated renal tubular cell apoptosis and suppressed renal interstitial fibrosis in UUO. The results indicate that the intrinsic pathway of apoptosis contributes significantly to the tubular apoptosis and renal interstitial fibrosis in kidney diseases. PMID:28317867

  13. Urethral protrusion of the abdominal catheter of ventriculoperitoneal shunt: Case report of extremely rare complication.

    PubMed

    Yazar, Ugur; Kanat, Ayhan; Akca, Nezih; Gazioglu, Gurkan; Arda, Irfan S; Kazdal, Hizir

    2012-05-01

    Hydrocephalus in its various forms constitutes one of the major problems in pediatric neurosurgical practice. The placement of a ventriculoperitoneal (VP) shunt is the most common form of treatment for hydrocephalus, so that all neurosurgeons struggle with shunt malfunctions and their complications. Well-known complications are connected with the use of the valve systems (malfunction, infectious, overdrainage, secondary craniosynostosis, etc.). We report an unusual case of protruding abdominal catheter from the urethra. This girl had received a VP shunt for hydrocephalus following surgery of posterior fossa medulloblastoma 4 years ago. After admission, the entire system was removed, antibiotic treatment was administered for 2 weeks, and a new VP shunt was placed. The postoperative course was uneventful. This complication is extremely rare.

  14. Retention of clinical trial participants in a study of nongonococcal urethritis (NGU), a sexually transmitted infection in men.

    PubMed

    Lee, Jeannette Y; Lensing, Shelly Y; Schwebke, Jane R

    2012-07-01

    Nongonococcal urethritis (NGU), an inflammation of the urethra not caused by gonorrhea, is the most common urethritis syndrome seen in men in the United States. It is a sexually transmitted infection commonly caused by Chlamydia trachomatis, a pathogen which occurs more frequently in African-American men compared to white men. The purpose of this study was to investigate factors related to retention of study participants in a randomized, double-blinded clinical trial that evaluated four treatment regimens for the treatment of NGU. After the one-week treatment period, follow-up visits were scheduled during days 15-19 and days 35-45. Participants were phoned prior to scheduled appointments to encourage attendance, and contacted after missed appointments to reschedule their clinic visits. Of the 305 male study participants, 298 (98%) were African-American, 164 (54%) were 25 years of age or younger, and 80 (31%) had a post-secondary school education. The overall retention rate was 75%. Factors associated with study completion were educational level attained and clinical center. Participants with higher levels of education were more likely to complete the study. Clinical centers with the highest retention rates also provided the highest monetary incentives for participation. The retention rate for this study suggests that strategies are needed for improving the proportion of study participants that complete a clinical trial among young men with a sexually transmitted disease. These strategies may include increasing contacts with study participants to remind them of scheduled study visits using text messaging or social media and the use of financial incentives.

  15. Local release from affinity-based polymers increases urethral concentration of the stem cell chemokine CCL7 in rats.

    PubMed

    Rivera-Delgado, Edgardo; Sadeghi, Zhina; Wang, Nick X; Kenyon, Jonathan; Satyanarayan, Sapna; Kavran, Michael; Flask, Chris; Hijaz, Adonis Z; von Recum, Horst A

    2016-04-21

    The protein chemokine (C-C motif) ligand 7 (CCL7) is significantly over-expressed in urethral and vaginal tissues immediately following vaginal distention in a rat model of stress urinary incontinence. Further evidence, in this scenario and other clinical scenarios, indicates CCL7 stimulates stem cell homing for regenerative repair. This CCL7 gradient is likely absent or compromised in the natural repair process of women who continue to suffer from SUI into advanced age. We evaluated the feasibility of locally providing this missing CCL7 gradient by means of an affinity-based implantable polymer. To engineer these polymers we screened the affinity of different proteoglycans, to use them as CCL7-binding hosts. We found heparin to be the strongest binding host for CCL7 with a 0.323 nM dissociation constant. Our experimental approach indicates conjugation of heparin to a polymer backbone (using either bovine serum albumin or poly (ethylene glycol) as the base polymer) can be used as a delivery system capable of providing sustained concentrations of CCL7 in a therapeutically useful range up to a month in vitro. With this approach we are able to detect, after polymer implantation, significant increase in CCL7 in the urethral tissue directly surrounding the polymer implants with only trace amounts of human CCL7 present in the blood of the animals. Whole animal serial sectioning shows evidence of retention of locally injected human mesenchymal stem cells (hMSCs) only in animals with sustained CCL7 delivery, 2 weeks after affinity-polymers were implanted.

  16. Iodine-125 radiation of posterior uveal melanoma

    SciTech Connect

    Packer, S.

    1987-12-01

    Twenty-eight cases of posterior choroidal melanoma were treated with iodine-125 in gold eye plaques. Eleven cases were located within 3.0 mm of the optic nerve (group A), nine were within 3.0 mm of the fovea (group B), and eight were within 3.0 mm of the optic nerve and fovea (group C). The mean follow-up of group A was 46.3 months; group B, 25.5 months; and group C, 42.7 months. Complications included macular edema, cataract and tumor growth. Visual acuity remained within two lines of that tested preoperatively for 4 of 11 patients in group A, 4 of 9 in group B, and 5 of 8 in group C. These results with iodine-125 suggest it as an appropriate treatment for patients with choroidal melanoma located near optic nerve and/or macula.

  17. Polycythemia causing posterior segment vascular occlusions

    PubMed Central

    Ganesan, Suganeswari; Raman, Rajiv; Sharma, Tarun

    2017-01-01

    A 44-year-old male patient presented with features suggestive of transient central retinal artery occlusion (CRAO) followed by permanent CRAO and lateral posterior ciliary artery occlusion. He had diagnostic features of polycythemia vera (PV). When presented for the first time, the patient had features of ocular ischemia such as ocular pain, conjunctival congestion, and retinal opacification but with normal arm-to-retina time and normal arteriovenous transit time. During the second presentation, he had ocular pain, congested conjunctiva, retinal opacification, cherry red spot with box-carrying of retinal vessels, and choroidal infarct (Amalric's sign). He had lost light perception in that eye. Patients with polycythemia are prone to multifocal vascular occlusions and this can be the presenting feature in PV. A timely diagnosis and prompt management can prevent these repeated thromboembolic occlusive episodes. PMID:28298862

  18. Hemifacial spasm and posterior auricular muscle.

    PubMed

    Kiziltan, M; Sahin, R; Uzun, N; Kiziltan, G

    2006-09-01

    We aimed to investigate to which extent posterior auricular muscle (PAM) was affected and whether it contributed to the reflex activity in hemifacial spasm (HFS) patients. 19 HFS patients' spasm activities were recorded from facial muscles. Spasm activity of PAM was recorded synchronously on the symptomatic side in all patients. Lateral spread of blink reflex to orbicularis oris and PAMs were recorded in all but two patients. Botulinum toxin was applied to the PAM with the 14 patients presenting tinnitus, "clicking" or a "ticking" sound on the sane side and other positive auricular symptoms. After treatment, there was symptomatic improvement in 9 of 14 patients. The patients presenting with auricular symptoms and showing spasm activity in their PAMs can be thought as a candidate for botulinum toxin treatment scheme.

  19. Diagnostics for insufficiencies of posterior calculations in Bayesian signal inference.

    PubMed

    Dorn, Sebastian; Oppermann, Niels; Ensslin, Torsten A

    2013-11-01

    We present an error-diagnostic validation method for posterior distributions in Bayesian signal inference, an advancement of a previous work. It transfers deviations from the correct posterior into characteristic deviations from a uniform distribution of a quantity constructed for this purpose. We show that this method is able to reveal and discriminate several kinds of numerical and approximation errors, as well as their impact on the posterior distribution. For this we present four typical analytical examples of posteriors with incorrect variance, skewness, position of the maximum, or normalization. We show further how this test can be applied to multidimensional signals.

  20. Posterior tibial subluxation and short-term arthritis resulting from failed posterior cruciate ligament reconstruction.

    PubMed

    Mavrodontidis, Alexandros N; Papadonikolakis, Anastasios; Moebius, Ulf G; Gelalis, Ioannis; Motsis, Efstathios; Soucacos, Panayotis N

    2003-01-01

    Posterior tibial subluxations because of combined or isolated posterior cruciate ligament (PCL) injuries require detailed evaluation. PCL reconstructions are difficult procedures because of the low rate of such injuries and the complex anatomy of the ligament. We report on 2 cases of failed PCL reconstruction because of malpositioned femoral tunnels. These 2 cases support the existing biomechanical evidence that the correct placement of the tunnels, especially in the femur, is a major factor in defining the outcome. It seems that the drilling of the tunnels, especially in the femur, during PCL reconstruction must be performed with accuracy and always be evaluated in cases of graft failure. In addition, failed PCL reconstructions are usually accompanied by a short-term excessive arthritis that results in poor functional outcome.