Urological Aspects Research Articles

Wolfram's (DIDMOAD) Syndrome and its Urological Manifestation

We report 2 patients with DIDMOAD syndrome (diabetes insipidus, diabetes mellitus, optic atrophy and neural deafness), with emphasis on the urological aspects and their management. Both patients underwent thorough radiological endoscopic and urodynamic evaluation, in addition to detailed evaluation of other systems involved. Each had the characteristic hyper-reflexive neurogenic bladder with sphincteric dyssynergia, which resulted in severe urinary tract dilation. One patient was diagnosed at this institution and managed conservatively with clean intermittent catheterisation and anticholinergic medication; the second patient was referred to us after several attempts at surgical correction. The presentation, details of the urological evaluation with special emphasis on the urodynamic findings, and the outcome of different means of management are discussed.

Urologic aspects of traumatic central cord syndrome.

Central cord syndrome (CCS) is a subset of spinal cord injury, characterized by more motor involvement of the upper extremities than the lower extremities and sacral sensory sparing. Patients with central cord syndrome have been reported to have a good rehabilitation and urologic outcome. Our purpose was to assess the urologic outcome in a group of patients with central cord syndrome. We reviewed 23 patients with central cord syndrome who were admitted to Hines VA Hospital between 1983 and 1991, 20 of whom were older than 50 years of age. Urodynamic studies showed detrusor hyperreflexia with a synergistic EMG in 15 patients and detrusor hyperreflexia with external urethral sphincter dyssynergia (DSD) in five patients. Three patients with no urologic problems were not tested. Bladder sensation was preserved during filling in all patients. At follow-up (median = 2-4 months), 16 patients (70 percent) were voiding, seven of whom required either occasional external or intermittent catheterization; nine were voiding independently. The seven other patients (30 percent) required either continuous external or intermittent catheterization (including the five with DSD). Urologic morbidity in the period after SCI included: urinary tract infections (12), renal (2) and bladder calculi (2), superficial bladder cancer (1), epididymitis (1) and none (6). Fifteen patients (65 percent) were ambulatory at follow-up while four patients needed wheelchairs. Data were not available for the other four patients. Urodynamic studies in three of the wheelchair-bound patients showed that two of them had DSD. Most patients with central cord syndrome have favorable urologic and rehabilitation outcomes and can be managed conservatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Bladder hernia in the inguino-crural region

Three cases of bladder hernia have recently been treated in our department. We present our experience and discuss the management of this pathology that is usually treated by general surgery. We point out the urological aspects in the management of this pathology.

Ischiopagus tetrapus twins: Urological aspects of separation and ten-year follow up : E. Shapiro, W.R. Flair, J.L. Ternberg, et al. J Urol 145:120–125, (January), 1991

Ischiopagus tetrapus twins: Urological aspects of separation and ten-year follow up : E. Shapiro, W.R. Flair, J.L. Ternberg, et al. J Urol 145:120–125, (January), 1991

Urological Aspects of Behcet's Disease

Behçet's disease, affecting mostly young males in the Mediterranean countries and Japan, is a multi-system disease with urological manifestations. In this prospective study of 100 consecutive patients with newly diagnosed Behçet's disease, we found that 89% of the males had experienced scrotal ulceration and 6% had epididymitis. We also observed sterile urethritis in 3%. Other urological abnormalities appeared to be coincidental findings.

Urological Aspects of Renal Transplantation

Urological Aspects of Renal Transplantation

Urologic aspects of tethered cord: R.C. Flanigan, D.P. Russell, and J.W. Walsh. Urology 33:80–82, (January), 1989

Urologic aspects of tethered cord: R.C. Flanigan, D.P. Russell, and J.W. Walsh. Urology 33:80–82, (January), 1989

Summary of the Annual Meeting of the Section on Pediatric Urology, October 30-November 2, 1987: Update on Subjects of Current Interest to Pediatricians

The Section on Urology of the American Academy of Pediatrics met for 3 days in conjunction with the 56th Annual Meeting of the Academy in New Orleans, Louisiana. Throughout the meeting, numerous research papers were presented along with clinical reports. This meeting has become the premier pediatric urology meeting and attracts worldwide attendance and participation. The growth of clinical and research aspects of pediatric urology has long been promoted by the recipient of this year's Pediatric Urology Medal, John K. Lattimer. URETEROPELVIC JUNCTION OBSTRUCTION The problem of neonatal ureteropelvic junction obstruction, its evaluation, and the criteria for intervention are areas of intense interest to both the pediatric urologist and the primary care pediatrician.

Urologic aspects of tethered cord

Tethered cord syndrome, a form of spinal dysrhaphism, may involve vesical neurologic dysfunction. We present herein 60 cases of tethered cord syndrome, including 24 patients who underwent preoperative urodynamics studies. Preoperative cystometrography revealed areflexic bladders in 71 percent of cases and hyperreflexic bladders in 29 percent. Eight patients had serial pre- and postoperative urodynamics testing. Slight improvement was noted in postoperative urodynamics studies performed on 4 of 6 areflexic bladders and in the only hyperreflexic bladder studied. In addition, of the 3 patients in the serial urodynamics groups who had urinary symptoms preoperatively, 2 noted clinical improvement postoperatively. The urologist's role is important in the early detection, evaluation, and treatment of tethered cord syndrome and the neuropathic bladders that may result.

Urological Aspects of Surgical Management for Metastatic Renal Cell Cancer

At the time of diagnosis one-third of patients with renal cell cancer are found to have metastatic spread. The patient's general condition and biological age as well as the resectability of the primary and/or secondary tumor decide whether surgery is indicated. Of our 44 patients, 12 underwent extirpation of metastases; 5-year survival was 47%. This is in agreement with published data. Patients with renal cell cancer and a solitary metastasis are, therefore, good candidates for surgery. In the presence of disseminated metastatic spread there is currently no place for tumor-reducing surgery because of the lack of effective adjuvant treatment modalities.

Urological Aspects of Cloacal Malformations

Cloacal malformations occur in a spectrum of severity. In general the urethra (sometimes short or absent), vagina (often 2) and rectum converge in the urogenital sinus. Immediate colostomy is necessary. However, after colostomy the urinary tract assumes prime importance because of life-threatening obstruction and/or reflux. I treated 72 patients with complex cloacal malformations, 33 as primary and 39 as secondary cases. In 40 patients there was severe reflux with severe upper tract damage in more than half of the cases: 19 had prior urinary diversions (4 ileal loop, 5 loop ureterostomy and 10 vesicostomy). In nearly all secondary cases a definitive rectal operation had been done but the more life-threatening urinary tract had not been repaired. Some patients had other urological and nonurological malformations.Review of these cases emphasizes several points. Each case should be evaluated early endoscopically and radiographically to guide immediate and later treatment. Rectal reconstruction (now done via the posterior sagittal approach) should not be done as the initial procedure, which often was practiced in the past. In some patients the urinary tract should be repaired first when there is obstruction or massive reflux to prevent upper tract deterioration. In most cases it is feasible to repair all aspects of the anomaly in a single operation, that is the urinary tract, genital tract and rectum. With a well planned and coordinated approach to all 3 organ systems a satisfactory outcome is possible in most cases.

Adolescent males who insert genitourinary foreign bodies: Is psychiatric referral required?

Although much is known about the urologic aspects of genitourinary foreign bodies, the psychiatric profile of the adolescent male who inserts a foreign body into his urethra is not available. Six cases from a urologic service are presented, and the pertinent literature is reviewed. Psychiatric consultation for such selfinserters will allow the development of such a profile. An appropriate management plan can then be formulated.

Urologic aspects associated with isolated hypogastric artery aneurysm

The isolated hypogastric artery aneurysm may give rise to urologic symptoms. This occurs as a consequence of extrinsic compression exerted by the aneurysm itself to the urinary tract or the involvement of the urinary tract by the perianeurysmatic fibrosis. We report 2 cases of isolated hypogastric artery aneurysm. One of the patients had unilateral ureteral obstruction while the other revealed a mass on rectal examination. In both cases surgery was performed and the urologic manifestations were relieved completely.

Book reviewsEndourology. Ed. by CarsonCulley C. and DunnickN. Reed, pp. xii + 315 + index, 1985 (Churchill Livingstone, Edinburgh), £55.00. ISBN 0–443–08367–3

The transformation that has taken place over the last 5 years for the treatment of calculous disease in the urinary tract seems to have popularised a new term, “endourology”. The editors define endourology as a subspeciality embracing aspects of general urology, urological surgery, urological radiology and interventional radiology, terms perhaps more familiar and understandable. The fact that the contributors to the book are predominantly radiologists and urologists bears testament to the close co-operation needed to practise endourology with success and this book details the initial radiological steps required before urologists can use endoscopy in the renal tract and manipulate within it. Indeed, it is the endoscopic removal of renal and ureteric calculi that forms the basis of this book.

Urological Aspects of the Tethered Cord Syndrome

We performed urological evaluations in 18 patients with the tethered spinal cord syndrome. Of the patients 4 had low grade vesicoureteral reflux but none had significant upper tract anomalies. Urodynamic studies documented a flaccid bladder in 9 patients (5 with supersensitivity to bethanechol), an uninhibited bladder in 5, mixed bladder dysfunction in 2 and normal function in 2. Repeat urodynamic studies were performed in 15 patients at least 6 months after release of the tethering. Of 8 patients with flaccid bladders studied postoperatively 6 had significant changes: 2 became normal, 2 had limited contractions and 2 had evidence of upper motor neuron abnormalities. Supersensitivity to bethanechol was of no predictive value. All 4 patients with uninhibited bladders who were evaluated preoperatively and postoperatively had improved and 3 currently are entirely normal.Careful urological evaluation of patients with the tethered spinal cord syndrome is helpful not only for diagnosis but also for appropriate management preoperatively and postoperatively. The fact that lower urinary tract function improves in some patients should encourage early and aggressive neurosurgical management of patients with this syndrome.

Bladder Dysfunction Secondary to Tethered Cord Syndrome in Adults: Is it Curable?

The urological aspects of the tethered cord syndrome were investigated in 15 adults. Impaired detrusor contractility was the most common among the urological symptoms and signs (73 per cent of the patients). Bladder dysfunction was confirmed urodynamically in 93 per cent of the patients and detrusor areflexia was predominant in 60 per cent. Pathological grades were proposed to classify the severity of the tethered cord syndrome. While restoration of bladder function was satisfactory in 67 per cent of the patients postoperatively, the over-all result was less (60 per cent). Patients with sensory motor paralysis of the bladder, symptoms more than 3 years in duration, cutaneous stigmas or a high pathological grade of the syndrome will not benefit from an operation. We conclude that neurogenic bladder secondary to the tethered cord syndrome is curable provided that the underlying pathological condition is recognized properly and an operation is performed early.

End Stage Renal Disease in Children

This is a multiauthored text that deals with the child and infant with end stage renal failure. There are four sections: (1) "Dialysis"; (2) "Clinical Manifestations"; (3) "Transplantation"; and (4) "Psychosocial Considerations." The first section on dialysis initially deals with incidence and etiology and then moves onto hemodialysis of the child. Hemoperfusion is authoritatively dealt with as well as peritoneal dialysis, both intermittent and continuous ambulatory. Separate chapters are devoted to the vexing problems of continuous ambulatory peritoneal dialysis and hemodialysis in infants. In the second section nutrition, growth, neurologic complications, principles of drug therapy, endocrine abnormalities, hypertension, anemia, pulmonary function, hepatic complications, and infection are thoroughly reviewed and referenced. The third section details various aspects of transplantation in children, including basic immunology and the role of pretransplant transfusions. Rejection, recurrence of original disease, immunosuppression, and outcome, as well as the surgical and urologic aspects of transplantation, are given separate

Urological Aspects of the Shy-Drager Syndrome: A Urodynamic and Telemetrie Investigation

A patient with proven Shy-Drager syndrome underwent a complete urodynamic investigation with telemetry. Unstable bladder and rectum were observed. Therapy with an anal pacemaker and the beta 1 agonist, prenalterol, cured both bladder and fecal incontinence.

Experience with inflatable penile prosthesis

Prosthesis surgery for management of erectile impotence has become an increasingly important aspect of urology. The inflatable penile prosthesis (IPP) provides the impotent patient with a controllable, natural-appearing and physiologically functional penis. Major modifications in the prosthesis and in the surgical implantation technique have been made since its initial introduction. In this article we present a histologic review of the IPP and our ten-year experience with it.

Konzept über das interdisziplinäre Vorgehen im Rahmen der Traumatologie — Stellung der Urologie

Following criteria decide on the further life of patients with acute severe trauma: how fast injuries and their severity are recognized and following therapies are managed; prior conditions for a sufficient treatment of the acute trauma patient consist in a perfect organization and a good cooperation of all specialists. Important details of the therapeutic concept, divided in 5 or 6 phases are given. Furthermore special urological aspects in cases of multiple injuries are discussed.