1/123. Treatment of a retroperitoneal lymphocele after lumbar fusion surgery with intralesional povidone iodine: technical case report.OBJECTIVE AND IMPORTANCE: This case report illustrates an uncommon complication from the retroperitoneal exposure of the lumbar spine. The diagnosis and management of a retroperitoneal lymphocele is presented. The lymphocele was treated with intralesional povidone iodine (Betadine; Purdue-Frederick, Norwalk, CT), which eradicated the lesion and provided symptomatic relief to the patient. CLINICAL PRESENTATION: A young woman developed an iatrogenic, rapidly progressive spondylolisthesis after having undergone three previous lumbar surgeries for radiculopathy at the L5-S1 level. INTERVENTION: A back-front-back approach was used for operative reduction and fusion of the spondylolisthesis. The patient's postoperative course was complicated by a retroperitoneal lymphocele. She presented with symptoms of urinary urgency and incontinence. The lymphocele was successfully treated with repeated drainage and sclerosis with povidone iodine. The patient ultimately developed a solid fusion, and her pain resolved. CONCLUSION: A retroperitoneal lymphocele is an uncommon complication caused by the surgical exposure of the lumbar spine when a ventral approach is used. In this case, it was diagnosed and treated without further surgical intervention.- - - - - - - - - - ranking = 1keywords = incontinence (Clic here for more details about this article) |
2/123. Erosion of a fascial sling into the urethra.When synthetic materials are used for the construction of pubovaginal slings, urethral erosions may occur. This complication has not been reported with fascial slings. We present a case of a 34-year-old woman who underwent a pubovaginal sling procedure using rectus fascia. After 10 weeks of urinary retention, urethroscopy identified an erosion of the sling at the midurethra. Surgical revision restored normal voiding without recurrent stress incontinence. Although urethral erosions have been reported with synthetic suburethral slings, this case suggests that erosions can also occur with fascial slings. Careful positioning and minimal tension on the sling arms may minimize this risk.- - - - - - - - - - ranking = 1keywords = incontinence (Clic here for more details about this article) |
3/123. The relationship of the in-situ advancing vaginal wall sling to vaginal epithelial inclusion cyst.Epithelial inclusion cyst is an under recognized complication of the in-situ advancing vaginal wall sling. A 63-year-old woman with stage I pelvic organ prolapse and mixed incontinence underwent in-situ sling placement in November 1997. In February 1998 she presented with a painful recurrent inflammatory anterior vaginal wall mass. The mass was cystic and drained spontaneously four times over the period of conservative management. The patient underwent resection of a clinical and pathological vaginal epithelial inclusion cyst in September 1998. At 6-month follow-up the patient remains continent and the cyst has not reformed. The vaginal surgeon should be aware of the potential for epithelial inclusion cyst formation after in-situ sling placement, and actively search for them at postoperative examination.- - - - - - - - - - ranking = 1keywords = incontinence (Clic here for more details about this article) |
4/123. Bilateral S3 nerve stimulation, a minimally invasive alternative treatment for postoperative stress incontinence after implantation of an anterior root stimulator with posterior rhizotomy: a preliminary observation.STUDY DESIGN: A preliminary report. OBJECTIVES: Urinary stress incontinence following implantation of an anterior root stimulator and a posterior rhizotomy is a rare complication which is difficult to treat. It is seen in patients with an open bladder neck (T9-L2 lesion). An artificial urinary sphincter is a possible treatment for this condition but has a higher failure rate in patients with neurogenic bladder disease and could complicate micturition. SETTING: Ghent, belgium. methods: A male paraplegic patient (T9, complete lesion) aged 36 was suffering from severe urinary incontinence due to detrusor hyperreflexia. Preoperatively the bladder neck was closed on cystography. Following implantation (6/95) of an intradural anterior root stimulator with posterior rhizotomy, severe urinary stress incontinence presented. Bilateral S3 foramen leads were implanted and connected to a pulse generator. RESULTS: The patient has been continent with continuous stimulation of both S3 roots for 4 years, and no fatigue of the levator muscles has been seen. Preoperative urodynamics are compared to results 3 years postoperatively. CONCLUSION: Bilateral S3 stimulation is a feasible and minimally invasive treatment of urinary stress incontinence following implantation of an anterior root stimulator.- - - - - - - - - - ranking = 8keywords = incontinence (Clic here for more details about this article) |
5/123. Intravesical migration of AMS 800 artificial urinary sphincter and stone formation in a patient who underwent radical prostatectomy.A patient who underwent placement of AMS 800 urinary sphincter for incontinence after salvage prostatectomy after radiation therapy failure, experienced urethral erosion of the cuff after 54 months. He was treated with cuff removal and prosthesis deactivation. Thirteen months later, a large bladder stone was removed transvesically, and it contained the reservoir. The remaining sphincter components were also removed. patients with previous radiotherapy are particularly at risk for sphincter erosion, but intravesical displacement of the reservoir is a very uncommon complication.- - - - - - - - - - ranking = 1keywords = incontinence (Clic here for more details about this article) |
6/123. New onset vesicovaginal fistula after transurethral collagen injection in women who underwent cystectomy and orthotopic neobladder creation: presentation and definitive treatment.PURPOSE: We present our experience with collagen injection for treating urinary incontinence after cystectomy and orthotopic bladder substitution in women. We discuss the efficacy of collagen injection, specific complications and subsequent definitive therapy. MATERIALS AND methods: We performed cystectomy and orthotopic bladder substitution in 2 women for muscle invasive transitional cell carcinoma of the bladder. In each case new onset stress urinary incontinence developed after surgery that was refractory to conservative therapy. Intrinsic sphincter deficiency was diagnosed in each patient by video urodynamic studies. Initial treatment involved transurethral collagen injections but subsequent intervention was required due to resultant complications and primary therapy inefficacy. RESULTS: collagen (3.5 cc per session) was injected in 1 case at 2 treatment sessions and in the other at 3. Incontinence symptoms did not significantly improve in either patient and a new onset vesicovaginal fistula developed 2 days and 1 month after collagen injection, respectively. Subsequently in each case 1-stage transvaginal primary fistula repair was done in multiple layers with a pubovaginal sling procedure. Six months after repair there has been no recurrent fistula and the women remain hypercontinent, requiring intermittent self-catheterization. They are satisfied with their eventual lower tract function and overall outcome. CONCLUSIONS: collagen injection for type 3 stress urinary incontinence after cystectomy and orthotopic bladder replacement in women may not be as effective and innocuous as in patients with a native bladder. Initial treatment with a pubovaginal sling procedure should be considered.- - - - - - - - - - ranking = 3keywords = incontinence (Clic here for more details about this article) |
7/123. Treatment of post-prostatectomy urinary incontinence with heterologous bone implant.A description is given of an improvised method used in the treatment of post-prostatectomy urinary incontinence in a case in which a Kaufman 2 procedure had failed. At the second-operation, Kieler spongiosa bone packaged in a dacron net was used to support the bulbous urethra.- - - - - - - - - - ranking = 5keywords = incontinence (Clic here for more details about this article) |
8/123. Neurologic injury after endovascular stent-graft and bilateral internal iliac artery embolization for infrarenal abdominal aortic aneurysm.The authors report a rare neurologic complication after the implantation of a bifurcated stent-graft for abdominal aortic aneurysm. The stent-graft was extended to both external iliac arteries after embolization of both internal iliac arteries. The patient subsequently had weakness and numbness of both lower limbs with bowel and bladder incontinence. He probably had ischemic injury to the nerve roots or the lumbosacral plexus, which was related to extensive occlusion of their supplying arteries. The mechanism of spinal cord and neurologic ischemia after aortic stent-graft implantation is discussed.- - - - - - - - - - ranking = 1keywords = incontinence (Clic here for more details about this article) |
9/123. pregnancy complicated by a suburethral sling: a case report.Incontinence surgery is rarely performed prior to the completion of a woman's childbearing. The literature is sparse in regard to women with prior incontinence surgery. There are no reports of pregnancy complicated by a sling procedure. A 26-year-old gravida 3, para 2-0-0-2 with prior surgical history of a Pereyra urethropexy followed by a Vesica suburethral sling, was referred at 18 weeks' gestation for assessment of the sling. Her antenatal course was complicated by pyelonephritis and intermittent urethral obstruction requiring Foley catheter placement. She delivered by scheduled cesarean section at 37 weeks' gestation. Three months following delivery she presented with pyelonephritis and recurrence of her incontinence. pregnancy complicated by prior suburethral sling procedure may result in urinary outlet obstruction, pyelonephritis and disruption of the surgical repair.- - - - - - - - - - ranking = 2keywords = incontinence (Clic here for more details about this article) |
10/123. Restoration of fecal continence with chronic electrostimulation of gracilis muscle 17 years after a Pickrell's operation.A 27-year-old woman who had undergone a Pickrell's operation at the age of 10 years, was observed for severe incontinence to solid and liquid stools. Physical examination and physiological tests revealed poor resting anal tone but a very good response of the transposed gracilis to percutaneous electrostimulation, which showed that the gracilis ability to contract was maintained in spite of 17 years of only occasional and unplanned muscular activity. Examination also demonstrated that the muscle had followed body growth during the patient's development. Restoration of continence by continuous electrostimulation of the gracilis muscle was then planned. To allow muscular resistance to this stimulation a fast-to-slow twitch fiber conversion was first obtained by low-frequency electrostimulation. A subcutaneous abdominal implant of a pulse generator connected to the gracilis by intramuscular platinum-iridium electrodes was carried out. After a period of muscular training, fiber conversion was achieved, and continuous electrostimulation led to complete restoration of continence with stable results at the 36 month follow-up evaluation. This case demonstrates that even such a long period of muscular inactivity does not affect the possibility of recovering a failed Pickrell's operation using electrostimulation. This easy and safe procedure can be applied to all previously failed graciloplasties provided that muscle contractility is maintained.- - - - - - - - - - ranking = 1keywords = incontinence (Clic here for more details about this article) |
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