Bladder Protrusion Research Articles

Comparison of urethral parameters in females presenting cystoceles with and without stress urinary incontinence based on dynamic magnetic resonance imaging: are they different?

To compare urethral parameters between cystocele patients with and without stress urinary incontinence (SUI) and explore factors influencing SUI in cystocele patients via dynamic MRI. The two-dimensional parameters evaluated included the paravaginal defects, levator ani muscle defects, urethral length, urethral funnel shape, bladder neck funnel width, bladder neck funnel depth, urethral angle, posterior vesicourethral angle, and anterior bladder protrusion. The three-dimensional parameters included the proximal urethra rotation angle, the distal urethra rotation angle, bladder neck mobility, urethral midpoint mobility, and externalurethralmeatus mobility. The independent samples t test was used for continuous variables, and the chi-square test was used for categorical variables. Binary logistic regression was used to identify factors independently associated with SUI in cystocele patients. The baseline parameters were similar between the 2 groups. Cystocele patients with SUI had a significantly higher point Aa (1.63 ± 1.06cm vs. 0.81 ± 1.51cm, p = 0.008); more anterior bladder protrusion (33.3% vs. 11.4%, p = 0.017); greater bladder neck mobility (36.38 ± 11.46mm vs. 28.81 ± 11.72mm, p = 0.005); mid-urethral mobility (22.94 ± 6.50mm vs. 19.23 ± 6.65mm, p = 0.014); and external urethral meatus mobility (22.42 ± 8.16mm vs. 18.03 ± 8.51mm, p = 0.022) than did cystocele patients without SUI. The other urethral parameters were similar in the groups (p > 0.05). Binary logistic regression showed that bladder neck mobility was independently associated with SUI in females with cystoceles (odds ratio, 1.06; 95% CI 1.015-1.107; p = 0.009). Cystocele patients with SUI have a higher point Aa, more anterior bladder protrusion, and greater urethral mobility than those without SUI. Bladder neck mobility is independently associated with SUI in females with cystoceles. NCT03146195.

Ectopic Vesicae in Adult : A Rare Case Report

Urinary bladder exstrophy is a relatively uncommon genitourinary malformation characterised by incomplete closure of the lower abdominal wall, resulting in bladder protrusion. Incidence is 3 to 5 per 1,00,000 births. It occurs as an isolated sporadic defect, but it has also been linked to other anomalies such as omphalocele, anal defect, neural tube defect, cleft lip/palate, preterm birth, and others. Adult presentation is unusual because it is usually surgically corrected in the neonatal period. The prognosis of such cases is determined by the level of continence achieved. We report a rare case of 23 years old patient with Ectopia Vesicae with the chief complaint of Dribbling of urine and using Diapers. On elaborating the history, the parents of the patient told that the condition was from birth. He had a history of incontinence noted soon after birth and a history of past surgical intervention at the age of 5 years. On physical examination revealed that the patient had a scar mark over the lower part of the abdomen and scar mark present over the penile region with excoriation of skin, extravasation of urine from opening over the penile shaft region, and doctors’ advice for Hospitalization. After admission patient undergone with various diagnostic investigations like CBC, LFT, KFT, ultrasonography, 2D ECHO, and patient undergone with cystoscopy. According to reviews, it suggests that this procedure can also benefit patients and is especially appropriate for adult patients with limited financial resources. This may open up new surgical options for patients suffering from bladder exstrophy.

Accuracy of Transvaginal Ultrasound Compared to Cystoscopy in the Diagnosis of Bladder Endometriosis Nodules.

To evaluate the accuracy of transvaginal ultrasound (TVUS) in predicting detrusor infiltration and ureteral meatus involvement in patients with bladder endometriosis (BE) to select which cystoscopic procedures could be avoided and, secondarily, to assess the relationship between symptoms and the characteristics of nodules and the association of BE with other forms of endometriosis. Patients with BE diagnosed by TVUS were classified according to detrusor infiltration: BE with partial involvement of the muscular layer (group 1) and total muscular layer involvement with bladder protrusion (group 2). We analyzed the accuracy of TVUS compared with subsequently performed cystoscopy, the correlation with symptoms, and the association with other forms of endometriosis. Among the 22 patients included, TVUS showed 9 patients with BE nodules partially affecting the detrusor (group 1) with normal cystoscopic findings (TVUS negative predictive value, 100%). Transvaginal ultrasound detected 13 nodules with total involvement, all visible by cystoscopy (TVUS positive predictive value, 100%). Transvaginal ultrasound also identified ureteral orifices that were free of involvement at greater than 10 mm from the BE nodule in 21 of 22 women (TVUS sensitivity, 95%). Ultrasound criteria for adenomyosis and endometriosis in other locations were present in 20 of 22 patients. Transvaginal ultrasound can identify the infiltration of BE nodules in the bladder wall and predict cystoscopic findings with great accuracy. Nodules that partially affect the muscular layer have normal cystoscopic findings, thereby obviating the need for this procedure. Bladder endometriosis nodules are commonly associated with other forms of endometriosis and do not usually affect the ureteral meatus.

Utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection.

AIMTo study the utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection.METHODSA 2 cm transverse skin incision was made in the umbilicus, extending to the intraperitoneal cavity. Carbon dioxide was insufflated followed by insertion of laparoscope to observe the intraperitoneal cavity. The type of hernia was diagnosed and whether there was the presence of intestinal incarceration was confirmed. When an intestinal incarceration in the hernia sac was found, the forceps were inserted through the incision site and the intestine was returned to the intraperitoneal cavity without increasing the number of trocars. Once the peritoneum was closed, totally extraperitoneal inguinal hernia repair was performed, and finally, intraperitoneal observation was performed to reconfirm the repair.RESULTSOf the 75 hernias treated, 58 were on one side, 17 were on both sides, and 10 were recurrences. The respective median operation times for these 3 groups of patients were 100 min (range, 66 to 168), 136 min (range, 114 to 165), and 125 min (range, 108 to 156), with median bleeding amounts of 5 g (range, 1 to 26), 3 g (range, 1 to 52), and 5 g (range, 1 to 26), respectively. Intraperitoneal observation showed hernia on the opposite side in 2 cases, intestinal incarceration in 3 cases, omental adhesion into the hernia sac in 2 cases, severe postoperative intraperitoneal adhesions in 2 cases, and bladder protrusion in 1 case. There was only 1 case of recurrence.CONCLUSIONSingle-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection makes hernia repairs safer and reducing postoperative complications. The technique also has excellent cosmetic outcomes.

Diagnostic et évolution prénatale de l’ouraque perméable : à propos d’un cas

Prenatal ultrasonographic features of patent urachus consist in anechoic proximal cord cyst communicating with the bladder associated with large umbilicus. Distinction should be made with omphalocele and bladder extrophy. Spontaneous evolution leads to rupture during mid-trimester and bladder protrusion. Karyotyping is not mandatory in isolated typical cases. Early postnatal surgery is usually required.

A rare case of inguinal bladder hernia in a child

Indirect inguinal hernia requiring surgical treatment is common in children and most patients recover uneventfully. However, rare complications, such as bladder damage, have been reported. Here, we report a rare case of pediatric bladder hernia presenting as an incarcerated inguinal hernia. In the laparoscopic inspection of this case, we were unable to identify patent processus vaginalis but found the bladder protrusion during an inguinal incision approach. Similar cases carry a risk of intraoperative bladder injury.

Total pelvic mesh repair: a ten-year experience.

This report describes our technique and experience in restoring the pelvic floor of females with pelvic organ prolapse. Total pelvic mesh repair uses a strip of Marlex Mesh secured between the perineal body and the sacrum. Two additional strips, attached to the first, are tunneled laterally to the pubis and support the vagina and bladder laterally. Candidates for the procedure have failed previous standard repair or manifest combined organ prolapse on physical and cystodefecography exams. From January 1990 to December 1999, 236 females had total pelvic mesh repair, and 205 (87 percent) were available for follow-up. Median age was 64 (range, 32-89) years, median parity 2 (range, 1-9); 63 percent had birth-related complications. Bladder protrusion, vaginal protrusion, or both were the predominant chief complaint (54 percent), followed by anorectal protrusion (48 percent). Findings on physical examination showed degrees of prolapse of rectum (74 percent) and vagina (57 percent), perineal descent (63 percent), enterocele (47 percent), and rectocele (44 percent). Mean procedure time and length of hospital stay were 3.2 (standard deviation 0.75) hours and 6 (standard deviation 2.2) days, respectively. Reoperation rate because of complications of the total pelvic mesh repair procedure was 10 percent. Marlex erosion into rectum or vagina occurred in 5 percent of patients and constituted 46 percent of the complications requiring reoperation. Additional surgical procedures at various intervals subsequent to total pelvic mesh repair have been performed in 36 percent of patients to further improve bladder function and have been performed in 28 percent of patients to improve anorectal function. There has been no recurrence of rectal or vaginal prolapse to date. Reports of overall satisfaction for correction of primary symptoms for patients grouped into early (0.5-3 years), middle (>3-6 years) and late (>6 years) were 68 percent, 73 percent, and 74 percent respectively. Total pelvic mesh repair is a safe and effective operation for females with pelvic organ prolapse.

Repair of urinary bladder herniation

0 NE of the most diffkuIt varieties of hernia to repair is that in which the minor or major part of the at the iirst surgica1 procedure as re-operation usually produces another so-called “recurrence.” content is a protruded bIadder waI1. This may be either of the primary or the secondary form. The chief objective in the surgical correction hereinafter described is, manifestly, a permanent cure. The fundamental cause, in the past, was timidity on the part of the surgeon to open the bladder protrusion and also failure to analyze the anatomic basis for the condition, which, in reality, was present prior to the first attempt at surgical repair. Hernia of the bladder was first referred to by AbuIcasis in the tweIfth century, and by Guy de Chauliac (I 363). The latter surgeon described the technic of the passage of a catheter as an aid in diagnosis. The first recorded case was that of G. D. Snla, of Padua (1620). PIater (13~0) also described a bIadder hernia.

Wound of Perinæum Extending into Vagina; Compound Separation of Symphysis Pubis, with Protrusion of Bladder

Wound of Perinæum Extending into Vagina; Compound Separation of Symphysis Pubis, with Protrusion of Bladder