Episode Of Urinary Retention Research Articles

Endoscopically guided percutaneous repair of inguinal hernia through a 2-cm incision. Minihernia repair.

The laparoscopic repair of inguinal hernia is still controversial. Transabdominal preperitoneal repair violates the peritoneal cavity and may result in visceral injuries or intestinal obstruction. The laparoscopic extraperitoneal approach has the disadvantage of being technically demanding and requires extensive extraperitoneal mobilization. The Lichtenstein repair gives good long-term results, is easy to learn, can be performed under local anesthesia, but requires a larger incision. We describe a novel percutaneous tension-free prosthetic mesh repair performed through a 2-cm groin incision. The inguinal canal is traversed with the aid of a 5-mm video-endoscope and the canal is widened using specially designed balloons. Spermatic cord mobilization, identification and excision of the indirect sac, and posterior wall repair are carried out under endoscopic guidance. Between October 1993 and July 1995, 85 primary inguinal hernia repairs (48 indirect and 33 direct) were performed on 81 patients (80 men, one woman) by the author (A.D.). The mean age was 41 years (range 17-83 years). Six repairs were performed under local anesthetic. Mean operative time was 42 min (range 25-74). Mean hospital stay was 1.2 days (0-3 days). The mean return to normal activity was 8 days (2-10 days). Eight complications have occurred: a serous wound discharge, two scrotal hematomas, a scrotal swelling that resolved spontaneously, wound pain lasting 2 weeks, an episode of urinary retention, and two recurrences early in the series (follow-up 1-22 months). The endoscopically guided percutaneous hernia repair avoids the disadvantages of laparoscopy (i.e., lack of stereoscopic vision, reduced tactile feedback, unfamiliar anatomical approach, risk of visceral injury), yet the use of endoscopic instrumentation allows operation through a 2-cm incision. The minihernia repair thus combines the virtues of an open tension-free repair with minimal access trauma.

Long-term outcome of laparoscopic adhesiolysis in women with chronic pelvic pain after hysterectomy

The management of severe small and large bowel adhesions in patients suffering from chronic pelvic pain after undergoing hysterectomy remains highly challenging. A cohort of 48 women (median age 41 yrs, range 26-59 yrs) with chronic pelvic pain had severe bowel adhesions. Forty-two had undergone a total abdominal hysterectomy (27 with bilateral, 7 with unilateral salpingo-oophorectomy), five a vaginal hysterectomy (4 with bilateral salpingo-oophorectomy), and one a laparoscopic hysterectomy. After laparoscopic adhesiolysis, 23 patients were followed for up to 24 months, 23 for 48 to 60 months, and 2 were lost to follow-up. Three intraoperative complications (6.2%) were one ileus, which required a 2-day hospital admission, one pelvic abscess requiring readmission and second-look laparoscopy, and one episode of urinary retention requiring a 1-day readmission. Of the 23 women followed for more than 24 months, 11 (47.8%) required from one to three subsequent surgeries. Complete pain relief was reported by 10 (43.5%) women, 8 of whom did not require further surgery. Twelve (57.1%) of the 21 patients followed for 6 to 12 months reported complete pain relief. Laparoscopic adhesiolysis achieved complete pain relief in approximately half of the women.

Subdural hematoma following spinal anesthesia.

Of the recognized neurological sequelae of spinal anesthesia, those due to lumbar puncture are generally benign but relatively common, while those due to the constituents of the injection are, as a rule, serious but infrequent. To the list of hazards must be added a complication which, though due to lumbar puncture, is grave but very rare. The following case reports illustrate the occurrence of subdural hematoma as a consequence of spinal anesthesia. Report of Cases Case 1. —The patient was a 69-year-old retired chiropractor who had suffered from chronic sinusitis and bronchiectasis for many years. After an episode of urinary retention, he underwent, on May 23, 1954, a retropubic prostatectomy and vasectomy under spinal anesthesia. The lumbar puncture was made between L-2 and L-3 with a No. 22 needle. Tetracaine hydrochloride, 14 mg., and epinephrine, 0.4 mg., were administered. During the operation he coughed and expectorated several times. Although his

Care of the bladder in neurological disorders.

• Urinary incontinence, frequency, retention, or other kinds of vesical dysfunction are symptoms that must be accurately interpreted and may demand prompt treatment. Urinalysis and culture, determination of residual urinary volume, observation of frequency and amounts, observation of the urinary stream, and rectal and pelvic examinations supply essential information; the neurological examination should consider both the sensory and the motor components of the vesical mechanism. The bladder should receive attention in cases of cerebrovascular accident and in diseases of the spinal cord. This includes poliomyelitis, for episodes of urinary retention are not uncommon during the paralytic stage. The management of these disorders includes such techniques as catheterization with periodic drainage, the use of parasympatholytic drugs such as atropine, and habit training. Proper management is well within the range of the physician who is charged with the general care of the patient.