Total Urinary Retention Research Articles

Determination of Stent Load Conditions in New Zealand White Rabbit Urethra.

Background: Frequency of urethral stenosis makes it necessary to develop new innovative methods of treating this disease. This pathology most often occurs in men and manifests itself in painful urination, reduced urine flow, or total urinary retention. This is a condition that requires immediate medical intervention. Methods: Experimental tests were carried out on a rabbit in order to determine the changes of pressure in the urethra system and to estimate the velocity of urine flow. For this purpose, a measuring system was proposed to measure the pressure of a fluid-filled urethra. A fluoroscope was used to observe the deformability of the bladder and urethra canal. Results: Based on these tests, the range of changes in the urethra tube diameter, the pressures inside the system, and the flow velocity during micturition were determined. Conclusions: The presented studies allowed determining the behavior of the urethra under the conditions of urinary filling. The fluid-filled bladder and urethra increased their dimensions significantly. Such large changes require that the stents used for the treatment of urethral stenosis should not have a fixed diameter but should adapt to changing urethral dimensions.

Skin necrosis of penis after chemotherapy regimen in patients with resistant nonseminomatous testicular tumor

The majority of patients with resistant nonseminomatous testicular tumor can be cured with standard chemotherapy based on cisplatin regimen. However, complete remission cannot be achieved in 10%-30% of patients, or the disease recurs after the first chemotherapy cycle, on what account the salvage chemotherapy is administered. The initial BEP chemotherapy was applied in patients with gonadal nonseminomatous tumors B2 clinical stage after the left side inguinal orchiectomy. Due to manifested resistance, further chemotherapy was given according to VIP and one cycle by VEIP regimen. Upon inserting the urinary catheter because of total urinary retention, the phlegmonous inflammation and subsequently the necrosis of preputial and corpus skin of the penis were observed. The necrectomy with autotransplant was performed after demarcation. The skin necrosis of penis is very rare post chemotherapy complication in the stage of evident peripheral pancytopenia that may be the result of toxic effects of the used cytostatics or development of local infection with resulting necrosis.

P13.01: Introital ultrasound of urethra a bladder in patient with iatrogenic outlet obstruction following anti‐incontinence procedures

A potential complication of all surgical procedures for stress urinary incontinence is iatrogenic outlet obstruction. The diagnostic evaluation of the patient with voiding dysfunction after incontinence surgery consists of a focused historical and physical examination and urodynamics. Ultrasound of the lower urinary tract is an integral part of the diagnostics assessment. to assess to topography of the bladder neck by introital ultrasound in patients with voiding dysfunction after open colposuspension. Hypothesis: Ultrasound examination of the lower urinary tract has a fundamental significance in the diagnosis of hypercorrection. Twenty two women with clinically proven voiding dysfunction were included in this study to investigate the position of the bladder neck at rest and during straining. Introital ultrasound examination was performed in harmony with the recommendations of ICS. Height (H), distance (P), ureterovesical angle (ß), inclination (α) and angle γ (angle between os pubis and ostium urethrae internum) were measured. Continent women without voiding dysfunction after Burch colposuspension were used as the control group (48 women). All twenty-two women shoved voiding difficulties: a) total urinary retention, b) partial urinary retention, c) irritating symptoms, d) urge incontinence, or e) stress incontinence. In comparison with the control group, following morphological measurements they yielded significantly lower values: angle ß, angle α, angle γ and distance P. Height H was changed without statistical significance. Individual clinical examination in some cases is not able to detect morphological changes in conjunction with hypercorrection. Introital ultrasound of the lower urinary tract in patients with voiding dysfunction has a fundamental significance in the diagnosis of hypercorrection. Project is supported by IGA MZ—XJ/7903-3.

OBSTRUCTED SEMINAL VESICLE CAUSING URINARY RETENTION REPAIRED BY VASOVESICLE ANASTOMOSIS

The usual treatment for a congenitally obstructed seminal vesicle with an attached ectopic blind ureter and ipsilateral renal agenesis includes some type of transurethral resection of the ejaculatory duct or en bloc excision of the cyst and ectopic ureter. Carmignani et a1 described en bloc removal using video laparoscopic access.1 Nevertheless, these procedures leave a divided and ligated vas deferens, thereby abolishing the seminal function of a healthy testicle and introducing the risk of inducing antibodies to spermatozoa.2 We describe the restoration of seminal tract continuity by anastomosis of a sufficiently long vas to the contralateral vesicle. CASE REPORT A 21-year-old man presented to the emergency room in total urinary retention and with a long history of symptoms suggestive of lower tract obstruction. He denied any previous episodes of urinary or seminal tract infections, and sperm count was 22 x 106/ml. Rectal examination revealed a large soft mass under the bladder floor. The bladder was catheterized without difficulty and 800 ml. urine were drained. Abdominal ultrasound, excretory urogram and radioisotopic renal scan confirmed a cystic multiloculated mass under the bladder floor and total absence of the right kidney. Retrograde urethrocystography showed an enlarged protruding

Obstruction Following Anti-Incontinence Procedures: Diagnosis and Treatment with Transvaginal Urethrolysis

We reviewed the charts of 41 patients who underwent transvaginal urethrolysis and resuspension of the bladder neck by the Raz technique for urethral obstruction with or without stress urinary incontinence following anti-incontinence surgery. We sought to evaluate the effectiveness of the procedure as well as to determine any factors that had an effect on the outcome of surgery. Patients were evaluated for obstruction and stress urinary incontinence by history, physical examination, video urodynamics (or multichannel urodynamics plus cystogram and voiding cystourethrography) and cystoscopy. All patients reported normal emptying before the procedure that caused obstruction. Several variables were evaluated for individual predictive values for outcome, including type of surgery causing obstruction, number of previous antiincontinence procedures, urodynamic evidence of obstruction (high pressure, low flow), instability, concomitant stress urinary incontinence and total urinary retention, which were evaluated by the Fisher exact test, and the amount of post-void residual, bladder capacity, maximum detrusor pressure, maximum urinary flow and interval since surgery causing obstruction, which were evaluated by logistic regression analysis.Mean patient age was 59 years (range 26 to 86 years) and mean followup was 21 months. A total of 19 patients (46%) suffered from concurrent stress urinary incontinence, 23 (56%) had urodynamic evidence of obstruction (high pressure/low flow) and 6 (15%) had only radiographic or endoscopic evidence with a deviated or kinked urethra. Postoperatively, 29 patients (71%) voided normally without significant residuals. Eight patients (20%) remain on self-catheterization and 1 has persistent stress urinary incontinence. When individual variables were evaluated to determine the predictive values with respect to outcome of urethrolysis, only the preoperative post-void residual was statistically significant (the greater the post-void residual, the more likely was failure, p = 0.021). The presence or strength of the detrusor contraction preoperatively and pressure-flow analysis did not predict outcome. Of the patients with stress urinary incontinence 15 (79%) were cured and 3 (16%) were significantly improved with rare stress urinary incontinence not requiring protection.Overall, 33 patients (80%) had some benefit from surgery. Patients who emptied normally before an anti-incontinence procedure that causes obstruction or impaired emptying should not be excluded from urethrolysis based on low detrusor pressures or pressure-flow analysis alone. Simultaneous radiographic imaging and endoscopy may help to select certain patients with obstruction.

Urological Manifestations of Sacrococcygeal Teratoma

A review was done of 29 patients diagnosed with sacrococcygeal teratoma between 1978 and 1991. Urological disorders included total urinary retention (6 patients), hydronephrosis (6), hydrocele (4) and undescended testis (1). Ultrasonography and voiding cystourethrography were performed on the 6 patients in total urinary retention. These studies revealed cystic retrorectal lesions frequently with intralesional calcifications, and anterior and superior displacement of the bladder. Bladder wall trabeculation occurred in 2 of these 6 patients, and 4 had moderate or severe hydronephrosis. Upper urinary tract dilatation was found in 2 patients not in total retention. Hydronephrosis appeared to be related to poor bladder emptying and presumably high intravesical pressures, since each case resolved spontaneously after tumor resection. No primary upper tract anomalies were identified.

Local Microwave Hyperthermia of Benign Prostatic Hyperplasia

Recently, hyperthermia has been used for treatment of benign prostatic hyperplasia. The preliminary results reported were promising. However, apart from patients with total urinary retention, objective voiding parameters have not been reported in detail for patients with prostatism. In a phase II study we treated 30 patients with benign prostatic hyperplasia by local microwave hyperthermia (915MHz.). The prostate was heated transrectally to 42 to 43C, with the treatment consisting of 8 sessions of 60 minutes each given twice a week. To assess the results of treatment several parameters were determined before and 4 weeks after hyperthermia therapy, including transrectal ultrasound of the prostate with volumetry, urinary flow rate and residual volume. Of the patients 28 could be evaluated and only 2 showed a relevant improvement. Neither the voiding parameters nor the size of the prostate could be changed significantly by hyperthermia. The success rate of 7.1% is even lower than the spontaneous temporary regression rate of benign prostatic hyperplasia. Thus, we believe that hyperthermia cannot be regarded as an effective treatment for benign prostatic hyperplasia comparable to transurethral resection. (J. Urol., 144: 913–917, 1990)

Early Catheter Removal and Reduced Length of Hospital Stay Following Transurethral Prostatectomy: A Retrospective Analysis of 100 Consecutive Patients

We reviewed the charts of 100 consecutive patients who underwent transurethral prostatectomy between January 1986 and April 1987. Average length of hospital stay was 2.9 days, which was considerably shorter than that reported previously in the literature. We usually hospitalize patients on the day of the operation and remove the catheters the following morning. A total of 15 patients required reinsertion of the catheter for hemorrhage or retention. Of these patients 13 had 1 or more of 3 predisposing risk factors (preoperative total urinary retention, preoperative gross hematuria or resected prostatic specimen weight greater than 30gm.). We conclude that early removal of the catheter and reduced lengths of hospitalization will be safe for the majority of patients.

Postoperative urinary retention. I. Incidence and predisposing factors.

198 (3.8% comprising 4.7% of the males and 2.9% of the females) out of 5220 surgical patients developed total urinary retention postoperatively. The frequency of this condition increased with age and was highest after thoracotomies and endoprosthetic surgery of the hip joints. Voiding history was abnormal in 80% of the patients affected. Subclinical obstructive bladder dysfunction, over-distension of the bladder during the operation and in the recovery room after the operation, sympathomimetic and anticholinergic medication during or after anaesthesia, and an inability to stand or sit after surgery were common causes of retention. Premedication, type of anaesthesia, nature of the liquids given and postoperative analgetics seemed not to affect the incidence of retention. Postoperative urinary retention is an underestimated and mostly avoidable complication. Every patient should be asked for a urinary history before an elective operation. Infravesical obstruction should be relieved before any other elective surgical procedures are undertaken. In cases of emergency surgery prophylactic catheterization to prevent postoperative retention is recommended for patients with obstructive symptoms.

Urethral obstruction secondary to carcinoma of prostate: Response to endocrine treatment

Of 749 patients with carcinoma of the prostate 133 (17.8%) presented with total urinary retention; 122 of the 133 patients were given different forms of endocrine therapy. Only 8 patients were treated by initial transurethral resection of the prostate, and 3 patients received no treatment. After endocrine therapy 80 (65.6 %) of 122 patients were free from catheter six months after starting treatment. The response to orchidectomy appeared earlier than that to treatment with estrogens. The mean period of catheterization for the 80 patients who responded was 2.7 months after orchidectomy and 3.4 months during estrogen treatment. The difference was statistically significant (p < 0.05).