Suprapubic Fistula Research Articles

Chronic Pubis Osteomyelitis After Reconstructive Surgery for Bladder Prolapse

Pubis osteomyelitis is a rare bone infection disease. The clinical manifestations of this disease are highly misleading. The symptoms are non-specific and the patients feel pain in their pelvis and have difficulties in walking. The risk factors for this disease are pelvic and urological surgeries. Case Presentation: In this report, a 40-year-old female with suprapubic fistula secretion 6 months after reconstructive surgery for bladder prolapse was introduced. In fistulectomy surgery, pelvic pubis osteomyelitis was identified and treated by curettage and debridement. Inmicroorganism cultureof the samples, Staphylococcus epidermidiswas the result,whichwas resistant tomethicillin. Conclusions: Antibiotic treatment is not enough for pubic osteomyelitis. Curettage and jet lavage surgeries are suggested. Closing the possible route by the urogenital tract is of great importance in controlling the disease.

Vesical Preservation in Patients with Late Bladder Exstrophy Referral: Histological Insights into Functional Outcome

We evaluated bladder growth after combined bladder and epispadias repair in children 5 years or older, and correlated the histological findings with final surgical outcomes. We prospectively evaluated 8 late bladder exstrophy referrals from a series of 26 patients treated during a 5-year period. Evaluated outcome measures were bladder capacity (expressed as percentage of expected bladder capacity for age), upper tracts status, continence and histological findings (collagen-to-smooth muscle ratio and type III-to-total collagen ratio). Data were analyzed using nonparametric Spearman rank correlation coefficient and Mann-Whitney U test. Mean age at combined bladder and epispadias repair was 8.9 years. Volitional voiding with a mean ± SD bladder capacity of 90 ± 7.48 ml was achieved in all patients except 1 with a suprapubic fistula. However, mean ± SD bladder capacity was 33.1% ± 7.47% of expected bladder capacity, and was inversely proportional to age at surgery. Mean ± SD compliance and pressure specific bladder volume less than 20 cm H2O were 13.86 ± 4.97 ml/cm H2O and 69.29±18.07 ml, respectively. Two patients had nonobstructive hydroureteronephrosis with bilateral polar scarring. Mean ± SD collagen-to-smooth muscle and type III-to-total collagen ratios were 2.96 ± 1.062 and 0.4 ± 0.106, respectively. The latter showed a significant negative correlation to bladder compliance (p = 0.025). Successful anatomical closure stimulates bladder growth, even incases of late referral. However, due to histological alterations, these bladders are poorly distensible and noncompliant. Thus, to have an acceptable functional outcome with preserved upper tracts, augmentation cystoplasty is needed in cases of late referral.

Antegrade insertion of guide wire through suprapubic fistula facilitates retrograde dilation for treatment of early stricture following urethroplasty

Objective To discuss the feasibility and safety of a novel urethral dilation procedure using antegrade insertion of guide wire through suprapubic fistula(retrograde insertion failed) to facilitate retrograde dilation for treating early stricture following urethroplasty.Methods Thirteen patients,who failed to receive retrograde insertion,developed early stricture following urethroplasty.The guide wire was inserted through a pre-made suprapubic fistula to pass the stricture with the help of flexible cystoscope.Then the guide wire was used to guide polytef catheter to perform retrograde dilation.Results The procedures were successfully done in all the 13 patients.The mean operation time was(10.7 ± 3.18) min(8-17 min),and there were no serious complications.Conclusion The present dilation procedure is an effective and safe method for management of early stricture recurrence following urethroplasty.

Infected Synthetic Mid-Urethral Sling: Mesh or Mess?

Abstract Background: Synthetic mid-urethral sling (MUS) is a commonly used procedure to relieve stress urinary incontinence. Excellent cure rates make it a surgery of choice, but bothersome mesh-related symptoms can be distressing to the patient. Case: Retropubic synthetic MUS combined with laparoscopic-assisted vaginal hysterectomy in a 46-year-old woman resulted in postoperative chronic purulent discharge from the suprapubic sinus at the exit site of the sling, and profuse vaginal discharge from mesh exposure, of 5 years' duration. Her symptoms persisted in spite of repeated abdominal surgical explorations of the sinus tract and excision of the vaginally exposed mesh. Finally, exploration with complete removal of the infected mesh gave her relief. Conclusions: Relief from chronic suprapubic sinus and vaginal mesh exposure caused by infected synthetic MUS can be achieved only with complete removal of the sling. (J GYNECOL SURG 28:288)

CORRECTION OF BLADDER EXSTROPHY IN ADOLESCENT: 2 CASE REPORT

Introduction: bladder exstrophy is characterized by an incomplete development of anterior portion of bladder, urethra, abdominal wall and a median separation of pubic symphysis. We describe 2 clinical cases in adolescent treated with different surgical approach. Materials and Methods: two patients, one male and one female, respectively, 10 and 14 years old. Both cases had relapse: the bladder plate was performed in female when she was 2 years and in male when he was 6 years old. The male showed bladder exstrophy with epispadias; the female showed bifido clitoris, absence of minora labia with a small vaginal orifice. In both patients ano-rectal manometric and barium enema had normal parameters. The x-Ray basin showed diastasis of pubic bones, respectively, 7.5 cm in male and 10 cm in female. The male had closure of bladder and abdominal wall with transformation of epispadias to peno-scrotal hypospadias. The female had rectal reservoir (about 250cc), with amputation of the rectum with Hartmann’s method and recanalization with Duhamel’s method, anastomosis uretero rectal and vaginoplasty. Results: clinical and laboratory follow-up to date is 6 months. The female holds the urine about 2-3 hours during the day; in the night losses are not reported; the male shows dehiscence of abdominal and vesical wall with suprapubic fistula and loss of urine. The urethral peno-scrotal meatus appears patent. Conclusions: our experience, although limited in the number of cases and in the time of observation, is in agreement with the literature: we can say that the correction of bladder exstrophy in adolescents might be a urinary diversion with creation of rectal reservoir, useful for age of the patients and postoperative management. It is always necessary an adequate follow-up to check any complications.

Sling distress: A subanalysis of the IVS tapes from the SUSPEND trial

To study the incidence of erosions and tape infections following the use of intravaginal slingplasty (IVS) treatment for stress urinary incontinence after the SUSPEND trial period of 30 months. This subanalysis was carried out because of concerns regarding high percentage of delayed sling erosions and infections during follow up of the patients who participated in the trial. The subanalysis patient group consisted of all IVS patients drawn from the SUSPEND randomised control trial that compared the safety and efficacy of three types of suburethral slings, TVT, SPARC and IVS, for the treatment of urodynamic stress incontinence. A total of 62 patients were reviewed during this study conducted from April 2002 to May 2003. Continence was achieved in 88% the patients. A total of eight (13%) sling erosions were found requiring sling removal. Forty-eight (77.4%) patients were followed up at 12 months with one case of erosion (1.7%). Twenty-nine (46.8%) of the 62 patients were followed up between 12 and 34 months, and seven cases of sling erosions were diagnosed. One patient had purulent suprapubic sinus, five patients had foul-smelling discharge, and one had recurrent urinary tract infection associated with pain and discharge. After the slings were removed the patients had no further symptoms. However, three of them had recurrent stress urinary incontinence. The delayed presentation of the sling erosion from this subanalysis is a concern, and pelvic reconstructive surgeons using IVS need to be aware of the delayed presentations we found in our cohort of patients.

Urethral catheter removal 7 or 14 days after radical retropubic prostatectomy: clinical implications and complications in a randomized study

To evaluate the hypothesis that a 7-day period of indwelling catheter after radical retropubic prostatectomy is effective and safe without the need of performing cystography. In the period from January of 2000 to July of 2002, 73 patients underwent radical retropubic prostatectomy, and these patients were prospectively randomized in 2 groups: Group 1-37 patients who had the urethral catheter removed 7 days after the procedure, and Group 2-36 patients who had the catheter removed 14 days after the surgery. The 2 groups were similar, the surgeons and the technique were the same, and no cystography was performed to evaluate the presence of leaks. Two patients in Group 1 had bleeding and clot retention after having the catheter taken out in the seventh postoperative day and were managed by putting the catheter back in for 7 more days. Two patients in Group 2 developed bladder neck stricture and were treated by bladder neck incision with success. The continence rate was the same, with 2 cases of incontinence in each group. About 2 pads a day were used by the patients with incontinence. The average follow-up was 17.5 months (12-36 months). No urinary fistula, urinoma, or pelvic abscesses developed after catheter removal. Two patients were excluded from the analysis of this series: 1 died with a pulmonary embolus in the third postoperative day, and 1 developed a urinary suprapubic fistula before catheter withdrawal, which was maintained for 16 days. Withdrawal of the urethral catheter 7 days after radical retropubic prostatectomy, without performing cystography, has a low rate of short-term complications that are equivalent to withdrawal 14 days after the surgery.

Puncture sets for suprapubic catheter drainage of the bladder

Suprapubic fistula catheter drainage (SFC) has numerous important advantages compared with transurethral bladder drainage. Commercial SFC-sets should provide security and comfort to a high degree for patients and users in general, so that they can make profitable use of these advantages. The equipment of SFC-sets should be adapted to the site and circumstances of use. Therefore, we recommend the introduction of defined standard SFC-sets for application in intensive-care units. We describe 16 usual SFC-sets. Every single set possesses certain disadvantages. Improvements, especially as far as trocar and catheter are concerned, are necessary to lead to a further spread of the SFC-method, so that more patients can benefit from the method. Detailed hints for improvements and alterations are provided.

PROSTATECTOMY VERSUS PROSTATOTOMY IN THE RADICAL TREATMENT OF SENILE HYPERTROPHY OF THE PROSTATE.

In senile hypertrophy of the prostate there is sometimes obstruction to the outflow of urine, due to an enlargement or deformity of the middle or lateral lobes, giving rise to a series of disagreeable symptoms, such as frequency of urination, pain, tenesmus, burning or acute retention, and resulting in complete or incomplete retention, followed in nearly every case by cystitis, pyelitis, and fatal nephritis or pyelonephritis. With the object of overcoming this condition the following various procedures have been resorted to: The use of the catheter to relieve the retention by drawing off the urine as frequently as indicated by the amount of residuum; suprapubic fistula, by means of which an artificial urethra is made in the hypogastric region, through which the patient urinates, or draws his urine by a catheter or tube; dilatation of the prostatic urethra with sounds or dilators every few days; galvano-puncture, by means of a