Retrograde Cystography Research Articles

Значение видео-уродинамического исследования в выборе метода лечения детей с нейрогенными дисфункциями мочевого пузыря

Video urodynamics is the standard for assessment of the lower urinary tract in children with neurogenic urinary disorders aiming to provide more information about the condition of the lower urinary tract v. retrograde urethrocystography. Video urodynamics parameters are used as possible indicators for choosing various surgical treatment options, however, all work is focused on adult patients, and data for the pediatric cohort were not available as yet. The purpose of this research was the evaluation of the role of video urodynamics and retrograde urethrocystography in the selection of effective conservative and surgical treatment of neurogenic urinary disorders in children. Materials and methods used: 112 patients aged 1,8 to 18 y/o with neurogenic urinary disorders were included in the study, of whom 101 were those who had been proven effectively treated with conservative M-cholinoblockers or had successfully undergone minimally invasive surgery as follows: intradetrusor injection of botulinum toxin (n=21), transurethral correction of VUR (n=17), simultaneous execution of two of these interventions (n=22). Based on the results of video urodynamic and cystographic examination of these patients with the CHAID technique, the classification trees were built in order to evaluate the effective treatment (conservative/surgical). Results: the median age of patients was 9,0 years [7,8-12,0]. The first classification tree containing the parameter “presence of VUR according to the results of retrograde cystography.” The sensitivity of the obtained model for the effectiveness of surgical treatment was 83,3% v. 73,2% for conservative treatment. The accuracy was 79,2%. The ROC-AUC value was 0,783. The second classification tree contained the maximum Pves value according to the results of the video urodynamics, presence of hyperactivity, presence of VUR. The sensitivity of the obtained model for the effectiveness of surgical treatment was 93,3% v. 97,6% for conservative treatment. The accuracy was 95,0%. The ROC-AUC value was 0,972. Comparison of ROC-AUC values by the Delong test revealed statistically significant differences between these binary classification metrics (p<0.001). Conclusion: the parameters of video urodynamics have greater diagnostic accuracy in effective prediction of both conservative and surgical treatment methods compared to the retrograde urethrocystography.

Assisted Virtual Cystoscopy in the Condition of Retrograde CT Cystography in Patients with Chronic Kidney Disease

Virtual CT cystoscopy is an imaging method that allows assessing of bladder wall for possible intraluminal formations. It can give a preliminary idea about the number, size and location of the lesions and their relationship to the bladder wall. The most common method of virtual cystoscopy is to apply contrast material intravenously and follow its excretion. However, this method is not applicable in patients with chronic kidney disease (CKD). For this reason we have developed and introduced for the first time in our country an alternative method suitable for this group of patients. It is based on the homogeneous filling of the bladder with a contrast agent during preliminary catheterization, thanks to which quality images are obtained – assisted virtual cystoscopy in conditions of CT cystography.
 A total of 44 patients with hematuria underwent assisted virtual cystoscopy during retrograde CT cystography: as a primary examination in 35 cases (79.5%) and as a control study in 9 patients (20.5%) with a history of proven superficial non-muscle invasive bladder cancer. From the performed conventional urethrocystoscopy in 12 patients (27%) formations ≤ 4 mm were found, which did not have a specific diagnostically significant CT image. In 32 patients (73%) formations greater than ≥ 4 mm in diameter were observed and it was found that there is 100% coincidence in terms of location, shape and the dimensions of the volumetric process.
 Assisted virtual cystoscopy in retrograde CT cystography is a method with good diagnostic results in patients with CKD and hematuria of bladder origin.

Classification urine leakage from urethrovesical anastomosis after prostatectomy

Background. Urine leakage from urethrovesical anastomosis (UVA) is a frequent and significant complication after prostatectomy.Aim. To determine frequency urine leakage from the anastomosis after prostatectomy, evaluate diagnostic methods, develop classification and management guidelines for patients with this complication.Materials and methods. A retrospective analysis of 1426 patients who underwent prostatectomy was performed. Results. In total, 97 (6.8 %) patients developed UVA failure in the early postoperative period. The complication was diagnosed on the 7th day after prostatectomy using retrograde cystography. An original classification urine leakage from the anastomosis after prostatectomy was proposed using numbers (0, I, II, III) and letters (A, B, C). In 50 (3.4 %) patients, grade I (A, B, C) UVA failure was diagnosed; 38 (2.7 %) patients had grade II (A, B, C) UVA failure; 9 (0.6 %) patients had grade III (A, B) UVA failure. The developed classification allows to accurately determine the severity of UVA failure and apply the appropriate methods for its correction.Conclusion. Urine leakage from UVA is a serious problem in surgical treatment of prostate cancer. Currently, it is necessary to systematize the available data and introduce unified classification and algorithm for correcting this complication into clinical practice.

Urinary Bladder Hernia: A Rare Cause of Voiding Disorders in Adults - A Case Report

Urinary bladder hernia is a rare event corresponding to the externalization of a bladder segment through the inguinal orifice, resulting from the association of wall weakness with increased intra-abdominal pressure. We report the case of a 38-year-old patient with no particular pathological history who presented to the urological surgery department complaining of dysuria associated with pollakiuria, intermittent left inguinoscrotal bulge, with the need to compress the scrotum to finish urination. The physical examination revealed a large, painless left inguinoscrotal hernia, the pressure of which caused an urge to urinate. Retrograde cystography noted filling of a left inguinoscrotal bladder portion during voiding with upstream bladder emptying. The examination was completed by a CT scan which revealed an inguinal parietal defect with a passage of the anterosuperior part of the bladder which fills up with contrast product at the delayed acquisition. Urinary bladder hernia is most often asymptomatic and its discovery is intraoperative in most cases. The diagnosis is suspected due to the association of inguinoscrotal hernia and urinary signs, especially two-step urination with the need to compress the scrotum during urination. Retrograde cystography is the best technique to image, showing a dogear-shaped bladder in the scrotum.

Раннее удаление уретрального катетера после робот-ассистированной радикальной простатэктомии

Robot-assisted radical prostatectomy (RARP) is a widely used treatment method for patients with clinically localized prostate cancer. Posterior reconstruction of urethrovesical anastomosis (UVA) is one of the techniques that provides early recovery of urinary continence after surgery. Changes in the technique of performing posterior reconstruction of UVA may contribute to further improvement of functional results.To evaluate the functional results of early removal of the urethral catheter (after 3 days) after RARP using a modified surgical technique of performing posterior reconstruction of UVA compared with the standard catheterization time (7 days after surgery).Patients who underwent RARP were randomly assigned to early catheter removal (3 days after surgery, main group, n=15) and standard catheterization time (7 days after surgery, control group, n=15). RARP was performed using the Da Vinci Si system. The primary end point was the rate of spontaneous voiding after catheter removal. Secondary endpoints were the incidence of urine leakage into the paravesical tissue during retrograde cystography, as well as complications according to the Clavien-Dindo system. The frequency and severity of stress urinary incontinence after catheter removal was assessed using the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF).There were no significant differences between groups in terms of baseline and perioperative parameters. After removal of the catheter, no acute urinary retention was observed in both groups. Also, there were no cases of urine leakage into the paravesical tissue during retrograde cystography. The ICIQ-UI SF questionnaire showed no significant differences between the groups at 1, 3, 6, and 12 months after surgery.The method of modified posterior reconstruction allows to remove the urethral catheter 3 days after RARP. Early removal of the urethral catheter did not adversely affect the early recovery of urinary continence, the quality of UVA, and did not increase the incidence of acute urinary retention. Further studies with longer follow-up periods are needed.

Abordaje laparoscópico exitoso de lesión vesical intraperitoneal ocasionada durante una cirugía ginecológica. Reporte de caso

Introduction: Urinary tract injuries are common in the context of pelvic surgery; however, there is little information in the medical literature on the management of these injuries using a laparoscopic approach. The following is the clinical case of a patient with intraperitoneal bladder injury secondary to gynecological pelvic surgery that was successfully treated using a laparoscopic approach. Moreover, a management algorithm is proposed based on the scientific data available. Case report. A 39-year-old female patient was admitted to the hospital with generalized abdominal pain and anuria three days after undergoing a left laparoscopic salpingectomy and resection of a migrated intrauterine device. Laboratory tests showed microhematuria, serum creatinine of 4.35mg/dL, and urea nitrogen of 35.2mg/dL. Computed tomography cystography showed a solution of continuity on the left posterolateral intraperitoneal bladder. The patient underwent successful laparoscopic treatment for the bladder injury, and two weeks later, retrograde cystography confirmed its adequate resolution. Conclusions. Based on the benefits of the laparoscopic approach and after extrapolating the outcomes of the laparoscopic management of bladder trauma, it can be concluded that the laparoscopic approach to surgical injuries of the bladder is a feasible therapeutic option.

Long-term results of endoscopic treatment in vesicoureteral reflux after kidney transplantation.

To assess the long-term clinical outcomes and identify factors predicting success of endoscopic treatment for symptomatic vesicoureteral reflux (VUR) after kidney transplantation. A retrospective chart review of all patients who had a symptomatic VUR after renal transplantation at our centre between January 2000 and December 2020 was performed. VUR was documented by retrograde cystography and was determined by at least one episode of acute graft pyelonephritis (AGPN). Endoscopic injections of polydimethylsiloxane (MacroPlastique™) or dextranomer/hyaluronic acid copolymer (Deflux™) were performed by expert urologists via rigid cystoscopy with a bevelled needle system. The results of endoscopic treatment were evaluated by cystography at three months. The primary endpoint was clinical efficacy as defined by the absence of AGPN during follow-up. Radiological success was defined by the absence of VUR at the three months follow-up cystography. Out of 2135 kidney transplantations, a total of 117 (5.5%) patients had symptomatic VUR: 100 (85.5%) underwent Deflux™ and 17 (14.5%) MacroPlastique™. Preoperative high-grade VUR was recorded in 71% of patients. One postoperative complication was observed, Clavien > II. After a median follow-up of 11.2years (IQR 6.5-14.4), clinical success was achieved in 73 patients (62.4%). Radiological success was obtained in 42 patients (36%). Multivariable analysis failed to identify predictors of endoscopic treatment success, which was independent of the preoperative grade of VUR and the type of bulking agent used. Endoscopic treatment of VUR is a simple and well-tolerated procedure with long-term clinical efficacy.

Transperineal Urethroplasty for Urethral Distraction Defects Caused by Pelvic Fracture

Purpose: We report the outcomes of transperineal urethroplasty in patients with pelvic fracture urethral distraction defects (PFUDDs) over the past 12 years. Materials and Methods: Patients who received transperineal anastomotic repair of PFUDDs from January 2007 to December 2019 were retrospectively analyzed, specifically focusing on demographic findings, pelvic fracture type, urethral distraction defect length (based on retrograde urethrography and cystography), previous treatments, and ancillary maneuvers during surgery. Simultaneously, differences in clinical factors between successful and failed cases were also analyzed. Results: A total of 36 patients were included, with a final success rate of 83%. The mean age was 40.4 years, whereas the mean urethral distraction defect length was 31.9 mm. Most patients (69%) presented with unstable pelvic fractures. Treatment before referral included endoscopic treatment and urethroplasty in 13 (36%) and 2 cases (6%), respectively. For difficult cases, ancillary procedures, which included corporeal splitting (61.1%) and inferior pubectomy (8.3%), were performed. The postoperative average peak flow rate was 14.9 mL/s in the success group. Age and urethral defect length differed significantly between the success and failure groups. Conclusions: Over the past 12 years, transperineal urethral reconstruction demonstrated a success rate of 83% in 36 patients with PFUDD. Age and urethral defect length were identified as the two main factors affecting surgical prognosis.

Simultaneous antegrade urography of the upper urinary tract and retrograde cystography combined with computed tomography imaging in the management of ureteral complications after renal transplantation.

BackgroundTo investigate the significance of simultaneous urography of the upper and lower urinary tract of transplanted kidneys combined with computed tomography urography (CTU), computed tomography arteriography (CTA), and computed tomography venography imaging in the planning of open surgery performed to treat any ureteral complications of a transplanted kidney.MethodsIn all, 24 patients with ureteral complications after renal transplantation were admitted, 12 of whom had renal graft ostomy during open surgery. Simultaneous antegrade urography of the upper urinary tract and retrograde cystography of the transplanted kidneys were performed on the patients. With the use of computed tomography imaging results, surgical planning was carried out.ResultsAll surgeries were successfully completed according to preoperative planning. Three patients underwent end-to-end anastomosis of the ureter and bladder muscle flap, 8 patients underwent ureterocystostomy, and 1 patient underwent an end-to-end ureteral anastomosis. After the follow-up up to now, all the patients had stable renal function, and no complications such as ureteral stenosis or urine leakage have thus far reoccurred in the transplanted kidneys.ConclusionsWhen open surgery is required to treat any ureteral complications following renal transplantation, preoperative multiangle imaging can be used to better understand the condition of the transplanted urinary tract and thus aid considerably in surgical planning.

Ureteral reimplantation after deflux failure for vesicoureteral reflux in renal transplant.

To evaluate the outcomes of ureteral reimplantation (UR) after failure of endoscopic treatment for symptomatic vesicoureteral reflux (VUR) in renal transplant recipients. We conducted a monocentric retrospective study that included all renal transplant recipients with failure of Deflux™ as first-line treatment of VUR from January 2007 to December 2020. Failure of Deflux™ was defined by: VUR on retrograde cystography and at least one acute pyelonephritis of the renal graft. The preferred surgical treatment was native ureteropyelostomy (NPUS) in the recent years. If the native ureter could not be used, ureteroneocystostomy (UNC) was performed. The primary outcome was the clinical efficacy of UR defined as the absence of acute graft pyelonephritis during follow-up. Out of 1565 kidney transplantations, 119 (7.6%) had symptomatic VUR treated with bulking agent. 35 (29.4%) had Deflux™ failure and were addressed to UR: 21/35 (60%) NPUS and 14/35 (40%) UNC. The median estimated blood loss, operative time, and length of stay were 120mL, 90min, and 7days, respectively. After a median follow-up of 7.1 (IQR 4.1-9.8) years, UR was clinically successful in a total of 32 patients (91.4%): 20 (95.2%) and 12 (85.7%) patients in the NPUS and UNC groups, respectively (p = 0.55). Three (8.5%) high-grade complications have been reported. No nephrectomy of native kidney was required in the NPUS group. After failure of Deflux™ for VUR of renal graft, surgical treatment with native ureteropyelostomy or ureteroneocystostomy is associated to a high success rate and few high-grade complications.

Ureterocele associated with simplex ureter in children: clinical and therapeutic features

L´urétérocèle est une dilatation pseudo-kystique de l´uretère terminal sous muqueux. C´est une uropathie malformative rare surtout si elle survient sur un uretère simplex. Il s´agit d´une étude rétrospective menée sur dix ans, de 12 dossiers de malades colligés au Service de Chirurgie Pédiatrique de l´Hôpital Fattouma Bourguiba de Monastir entre 2006 et 2016. L´âge moyen de nos malades est de 2,7 ans avec des limites allant de 7 jours à 11 ans, le sex-ratio est de 1. Le tableau clinique a été dominé par la fièvre en rapport avec une infection urinaire haute. Le diagnostic a été posé essentiellement par l´échographie rénale et vésicale, l´urographie intraveineuse (UIV) et l´uréthro-cystographie rétrograde (UCR). L´urétérocèle était unilatéral dans 10 cas et bilatérale dans 2 cas soit un total de 14 cas d´urétérocèles. Tous ont été sur uretère simplex et ont été opérées par voie endoscopique. Aucun incident peropératoire n´a été noté. Les suites opératoires étaient simples. Une amélioration clinique et radiologique a été obtenue dans tous les cas. L´urétérocèle sur uretère simplex est une malformation urinaire très rare. Non diagnostiquée à temps, elle peut retentir sur le haut appareil. Le traitement endoscopique est une alternative séduisante avec des résultats satisfaisants.

Successful resolution of urothorax secondary to non-traumatic uroabdomen in a cat managed with peritoneal dialysis as a bridge to surgery

Case summaryA 9-year-old neutered male domestic shorthair cat was presented for evaluation of severe hemodynamic collapse and suspected lower urinary tract disease. On admission, severe metabolic acidosis, hyperkalemia and azotemia, and electrocardiographic findings consistent with cardiotoxicity were identified. The diagnosis of uroabdomen was made based on abdominal fluid to plasma concentration ratios of creatinine and potassium. A central line catheter was placed percutaneously into the abdomen for peritoneal drainage and used for peritoneal dialysis as a bridge to surgery. Retrograde contrast cystography confirmed rupture of the urinary bladder. Point-of-care ultrasound of the chest postoperatively revealed the presence of mild pleural effusion. Echocardiography was then performed showing no evidence of cardiac disease. Pleural fluid analysis revealed a transudate with a creatinine ratio of 2.38 ([Creatinine]pleural fluid/[Creatinine]plasma), consistent with the diagnosis of urothorax. The cat recovered uneventfully from surgery and was monitored for signs of respiratory distress during the rest of its stay in hospital. The cat was discharged 4 days later and the pleural effusion resolved without further medical intervention.Relevance and novel informationThere is limited information on the causes of urothorax and uroabdomen management of feline patients. Pleural effusion is a complication observed in critically ill cats secondary to fluid overload, underlying cardiomyopathy, primary thoracic pathology or a combination of these. To our knowledge, this is the first report of urothorax in a cat secondary to non-traumatic uroabdomen. Careful monitoring of respiratory signs consistent with pleural space disease is recommended in cases of uroabdomen.

Symptomatic lymphatic cysts after oncourological operations on the pelvic organs and influence of their anatomical localization on the clinical appearance

Introduction. Lymphatic cysts (LC) are the accumulation of free lymphatic fluid in a limited space (between tissues and organs), in the place where the lymphadenectomy was performed. They are the most frequent complications in pelvic oncourology. LC are divided into symptomatic and asymptomatic.Purpose of the study. To assess the influence of the anatomical localization of symptomatic lymphatic cysts (sLC) on the clinical appearance.Materials and methods. 203 radical prostatectomies (RPE) and 42 radical cystectomies (RC) were performed with pelvic lymph node dissection (PLND) in the N.I. Pirogov City Clinical Hospital № 1 from January 2017 to March 2020. Of 203 patients, 13 (6.4%) developed SLC, and of 42 patients, 6 (14.3%). All patients who developed complications underwent complex ultrasound studies and multispiral computed tomography (MSCT) of the retroperitoneal space, abdomen, and pelvic area to assess the localization and volume of the sLC.Results. Four anatomical localizations of the sLC can be distinguished after analyzing the clinical picture of 19 patients with sLC and comparing the obtained data with MSCT: paravasal-iliac, paravesical, prevesical, and pelvic-retroperitoneal. The frequency of paravasaliliac sLC was higher, they developed in 13 (68.5%) patients. The clinical picture included: pain in the pelvic area, lymphedema of the lower limb, body temperature ≥ 39.0 °C, due to LC infection and compression of the iliac vessels. Paravesical sLC were found in 2 (10.5%) patients. There was a failure of the urethrovesical anastomosis, according to retrograde cystography, due to displacement of the bladder. Prevesical sLC were found in 2 (10.5%) patients. Patients noted progressive urinary incontinence and pain above the pubic symphysis. Pelvic-retroperitoneal sLC was observed in 2 (10.5%) patients, with the clinical appearance of nagging pain in the lumbar region, body temperature ≥ 38.0 °C, due to ureteral compression and the development of obstructive pyelonephritis, as well as compression of the inferior vena cava by a lymphatic cyst. The repeated intervention was performed in 18 cases: percutaneous drainage of the LC under ultrasound guidance in 12 (63.2%) patients, laparoscopic marsupialization of the LC in 3 (15.7%) patients, an open technique in 3 (15.7%). In 1 patient (5.4%) the treatment was conservative.Conclusion. Symptomatic LC can be classified according to 4 anatomical locations, which define their clinical symptoms. Most sLC require reoperation.

Computed tomography urography findings of complete inguinoscrotal bladder herniation

Inguinoscrotal bladder herniation (IBH) is a rare type of inguinal hernia associated with significant urologic complications such as acute renal failure, hydronephrosis, obstructive uropathy, and sepsis. Diagnosis of this condition can be made with common imaging modalities including excretory urography, retrograde cystography, computed tomography (CT), and magnetic resonance imaging. We present the classic symptomatology and imaging findings of inguinoscrotal bladder herniation on CT urogram in two patients. Although the majority of IBH are diagnosed intraoperatively, radiologists and the surgical team should be aware of this diagnosis when working up a patient, as preoperative diagnosis is crucial to assist with surgical planning and avoid intraoperative complications. Level of evidence: 4.

Laparoscopic Partial Resection of the Urinary Bladder for Colorectal Cancers With Suspected Urinary Bladder Invasion

Introduction Although partial cystectomy has been performed by laparoscopy in patients with benign disease, there have only been a few reports regarding the laparoscopic partial resection of urinary bladder–adherent colorectal cancer. This study was conducted to evaluate the short-term surgical outcomes of laparoscopic partial resection of urinary bladder–adherent colorectal cancer. Case presentation Between April 2014 and February 2017, 6 patients with colorectal cancers that were adherent to the urinary bladder underwent laparoscopic colorectal cancer resection combined with partial cystectomy. Their surgical outcomes were reviewed retrospectively. The primary colorectal cancer was located in the sigmoid colon in 5 patients and the upper rectum in 1 patient. None of the patients required conversion to open surgery. The median duration of surgery was 411 minutes, and the median amount of intraoperative blood loss was 284 mL. In the patients with sigmoid colon cancer, the bladder was primarily closed under direct visualization via the small lower abdominal incision used to remove the tumor. In the patient with upper rectal cancer, the bladder was primarily closed laparoscopically. None of the patients demonstrated urinary leakage on retrograde cystography or anastomotic leakage, and there were no cases of perioperative mortality or morbidity. None of the patients developed recurrence of cancer at the median follow-up of 21 months. Conclusion Laparoscopic partial resection of urinary bladder–adherent colorectal cancer produces good short-term outcomes without increasing morbidity. Performing bladder closure under direct visualization via a small lower abdominal incision might be useful in selected patients.

Spontaneous bladder rupture secondary to warfarin overdose: a case report

BackgroundWarfarin, a vitamin K antagonist, is a widely used medication for the treatment and prophylaxis of thromboembolic events. Patients with various clinical conditions due to warfarin overdose present to emergency departments. Although there may be serious bleeding due to a warfarin overdose, no bleeding may also be seen in some clinical conditions. Some of these bleedings may be life-threatening and result in death. Warfarin overdose and related cases of spontaneous bladder rupture are not frequently observed in the literature. We present a case of spontaneous bladder rupture due to warfarin overdose that was unexpectedly seen in a patient using warfarin for coronary artery disease and arrhythmia.Case presentationA 77-year-old Caucasian male patient was admitted to the emergency department with abdominal pain, haematuria, and a reduced volume of urine lasting for three days. The patient’s amount of urine was reduced, and he came to the hospital for the first time with this complaint. The patient had local bruises on his arms and legs. From the ultrasound, retrograde cystography and computed tomography images, it was thought that there was blood accumulation due to bladder rupture to the intraperitoneal region. Spontaneous bladder rupture secondary to warfarin overdose was considered for this patient who also had an international normalized ratio (INR) level of 13.4. After the INR level was normalized with vitamin K and a prothrombin complex concentrate, the patient underwent surgery. During the operation, a catheter was placed in the bladder, and the bladder mucosa and muscle were closed separately with a primary repair performed by a urologist. The patient was discharged on the 8th postoperative day without any complications.ConclusionIn addition to the known findings of warfarin overdose in these patients presenting to the emergency department, we think that the emergency department staff should suspect bladder rupture, which is a fatal complication in the presence of signs such as oliguria, haematuria, anuria, abdominal pain, and syncope.

Possible predictor of early recovery on urinary continence after laparoscopic radical prostatectomy - Bladder neck level and urodynamic parameters.

To investigate the relationship between post-operative bladder neck levels and urodynamic parameters and their effect on urinary incontinence after laparoscopic radical prostatectomy (LRP). Forty-eight consecutive patients undergoing LRP were retrospectively reviewed. All patients were assessed using retrograde cystography after LRP and were grouped according to their bladder neck position: Level 0: at or above the superior margin of the symphysis pubis (SMSP); Level -1: at <2cm below SMSP; and Level -2: at >2cm below SMSP. Urodynamic studies were conducted at baseline as well as at 1 and 3 months post-operatively. Early recovery of urinary continence was defined as no urine leakage or only one pad/day used within 3 months after surgery. Demographic characteristics, changes in urodynamic parameters, and continence outcomes were analyzed. Overall rate of early recovery of urinary continence was 33.3%. Patients with higher bladder neck levels experienced a significantly earlier recovery of urinary continence in univariate analysis (77.8%, 29.2%, and 13.3% for bladder neck levels 0, -1, and -2, respectively, p=0.004). Patients with early recovery of urinary continence had significantly longer functional profile lengths (FPLs) 1 month post-surgery (21.0mm vs 14.8mm, p=0.019). Higher bladder neck levels were significantly associated with longer FPLs at 1 month (p=0.032). Bladder neck level is associated with FPLs at 1 month post-surgery, which is the possible predictor of early recovery of urinary continence after LRP. Patients with longer FPL at 1 month after LRP have a higher rate of early recovery of urine continence.

A rare case of female bladder spontaneous rupture

Bladder spontaneous rupture in the woman represents an extremely rare urologic emergency; its cause can be iatrogenic, neoplastic or diabetic.Materials and MethodsA 56-year-old woman was referred to our unit because of the presence of acute abdominal pain, oligoanuria and vomiting for two days. At physical examination, the patient presented with confusional state, acute urinary retention and gross hematuria after urethral catheterization. Laboratory data demonstrated important metabolic abnormalities: hyperglycemia (946 mg/dL), acute renal failure (serum creatinine: 3.25 mg/dL), hyponatremia (120 mEq/L) and metabolic acidosis. At the CT of her abdomen and pelvis, a suspected bladder rupture (right lateral wall) was revealed, and confirmed after performing a retrograde cystography. Personal history was negative for trauma; glycemia was never controlled despite an important familiarity for type I diabetes. An episode of painless gross hematuria had occurred one month before, treated by the physician with an...

THE POTENTIAL OF THE MEANS OF RADIATION IMAGING IN THE DIAGNOSIS AND SPECIFICATION OF THE DEGREEOF GENITAL PROLAPSE

Objective :to evaluate the efficiency of the means of radiation imaging in the diagnosis of genital prolapse. Material and methods . The work presents the data of the complex analysis of the results of examination of 83 female patients with different clinical degrees of genital prolapse by means of excretory and retrograde cystography, MRI, and CT. Results . The article presents the results of static and dynamic MRI of the pelvis, as well as CT of the pelvis in patients with genital prolapse, and gives the evaluation of the informative value of these methods in the diagnosis of this disease. Conclusion . MRI and CT of the pelvis play a leading role in the documentation diagnosis of genital prolapse and clarification of its degree.

Ускладнення ендовезикальної корекції міхурово-сечовідного рефлюксу у дітей

Objective. To reduce the percentage of complications in children after intravesical correction of VUR. Material and methods. The clinical material covers 270 patients with uni- and bilateral VUR II-IV grades, aged from 9 months to 14 years. Patients with VUR were collected complaints and anamnesis, a clinical examination, general clinical laboratory examinations with an assessment of the functional status of the glomerular apparatus and the degree of nephrosclerosis, ultrasound of the urinary tract and bladder with Doppler effect, retrograde cystography, excretory urography, dynamic angiography and renography with 99mTc-DTPA, cystoscopy. At the stage of clinical and laboratory remission patients underwent intravesical restored urodynamics – STING (subureteric injection), HIT (hydrodistention implantation technique), Double HIT, and, if necessary, their combination. Results. In the early postoperative period 8 (2.96%) patients had a disorder of urodynamics with exacerbation of pyelonephritis, requiring more intensive and prolonged parenteral antibiotic therapy – more than 3 days. In 4 patients a dilatation of the ureter and pyelocaliceal system (PCS) with signs of urinary tract obstruction was revealed via the ultrasonography. These patients performed an intravesical internal stenting of ureter and PCS with JJ-stent for 1-3 months. In 2 patients in the late postoperative period an obstructive ureterohydronephrosis was diagnosed according to the urological X-ray examination, which required the ureterocystoneostomy. The clinical case of minimally invasive removal of concrement fragments from the left ureter after intravesical treatment of VUR III grade in both segments of the left double kidney in a 3-year-old patient, who was twice operated and the defect was successfully corrected. Obstructive uropathy after the injection of implant under the urethra orifice is the results of neuromuscular dysplasia of the urinary tract, which associated with fibrous tissue changes in the area of the uretero-vesical junction. Conclusions. The endoscopic method is the most optimal way of treating VUR in children and its complications. However, intravesical treatment of VUR, as well as other methods of surgical intervention, also has various complications.