1/70. Ureteric obstruction due to kinking of the reservoir inlet in a continent urinary reservoir.We report a case of symptomatic intermittent upper tract obstruction in a continent urinary reservoir. The ureters were of great intraperitoneal length and were positioned in front of the mesenterium, resulting in a mobile reservoir. Only the retroperitoneal part of the ureters was dilated due to kinking in the peritoneal passage. After the ureters were shortened and reanastomosed retroperitoneally, the repeated episodes of abdominal pain and discomfort disappeared..- - - - - - - - - - ranking = 1keywords = disc (Clic here for more details about this article) |
2/70. Medically resistant neonatal hypertension: revisiting the surgical causes.OBJECTIVE: To present the importance of searching for the surgical causes of pharmacologically resistant hypertension in the neonatal population. STUDY DESIGN: A case report and discussion are provided. RESULTS: Severe hypertension in the neonatal period is uncommon and almost always has a secondary cause. Although a majority of hypertensive neonates can be successfully managed with medical therapy, some cases are resistant to pharmacological treatment. We report three hypertensive neonates who failed to respond to intensive multidrug therapy. This led to further evaluation and identification of obstructive uropathies in two neonates and renovascular disease that necessitated surgical intervention. Subsequently, all patients had prompt resolution of hypertension and normalization of renal function. All are now off antihypertensive medications and have normal renal function at 12 months of follow-up. CONCLUSION: Our report exemplifies the importance of the consideration of surgical etiologies for differential diagnosis in neonates with severe hypertension that is unresponsive to pharmacological therapy. early diagnosis and prudent management of these etiologies reduce morbidity and mortality and preserve of renal function.- - - - - - - - - - ranking = 1keywords = disc (Clic here for more details about this article) |
3/70. Bladder cancer arising in a spina bifida patient.We report the case of a 52-year-old patient with spina bifida, neurologic bladder, and a history of recurrent urinary tract infections (UTIs) in whom a bladder cancer was incidentally discovered. Cytology, cystoscopy, and cystography showed nonspecific, extensive inflammatory lesions. Cystography demonstrated a complex of diverticulae and cellules. Pathologic examination of a diverticulectomy specimen revealed a grade III pT3b transitional and squamous cell carcinoma. Because of the similar disease causation (recurrent UTIs, stones, and indwelling catheterization), we suggest extension of the guidelines proposed for patients with spinal cord injuries (ie, annual serial bladder biopsies) to patients with nontraumatic neurogenic bladder.- - - - - - - - - - ranking = 1keywords = disc (Clic here for more details about this article) |
4/70. Laparoscopic bladder auto-augmentation in an incomplete traumatic spinal cord injury.OBJECTIVES: To assess the urodynamic and clinical outcome of a laparoscopic auto-augmentated bladder. methods: Laparoscopic bladder autoaugmentation in a 27-year-old woman with an incomplete spinal cord injury at T12 level with urge incontinence caused by a hyperreflexic bladder. RESULTS: Six months later the patient voids by Valsalva's manoeuvre every 3 h and remains dry day and night. The radio-urodynamic study, performed 2 months later, revealed an intact bladder with a diverticulum of anterior wall and a capacity of 510 ml with filling rate of 100 ml/min without evidence of leakage of infusion water. CONCLUSION: Laparoscopic retropubic auto-augmentation allows a brief hospital stay and minor postoperative discomfort. Moreover the laparoscopic approach should not complicate or preclude subsequent enterocystoplasty if necessary.- - - - - - - - - - ranking = 1keywords = disc (Clic here for more details about this article) |
5/70. Slow ascending myelopathy, tetraplegia, carcinoma of the bladder and amyloidosis in a patient with ankylosing spondylitis.OBJECTIVE: We report a case of slow ascending myelopathy in a patient with ankylosing spondylitis (AS). DESIGN: Case report of a 60-year-old patient suffering from AS, who developed over a period of 39 years a slow ascending myelopathy leading to tetraplegia, squamous cell carcinoma of the bladder and amyloidosis of the small intestine secondary to neuropathic bladder and bowel. SETTING: Department and Outpatient's Department of Neurological rehabilitation Sheba Medical Center, Tel Hashomer, israel. SUBJECT: Single patient case report. Main outcome measure: Clinical follow-up of the patient between the years 1959 - 1998. RESULTS: physical examination disclosed deteriorating incomplete tetraplegia with hypotonia and hyporreflexia. Neurogenic bladder and bowel complicated to squamous cell carcinoma and amyloidosis. CONCLUSION: To our knowledge, flaccid tetraplegia associated with AS, has never been reported in the literature. The possibility of vascular compression by the ankylosed spine causing the clinical picture of flaccid tetraplegia in this patient is discussed.- - - - - - - - - - ranking = 2keywords = disc (Clic here for more details about this article) |
6/70. Compression of femoral vein by the strap of a urine-collecting device in a spinal cord injury patient.OBJECTIVE: To report an unusual cause of femoral vein compression in a spinal cord injury (SCI) patient. DESIGN: A case report of a SCI patient in whom the strap of a urinal produced compression of femoral vein. Setting Regional spinal injuries Centre, Southport, england. SUBJECT: A 65-year old male, who had sustained paraplegia at T-10 level 33 years ago, attended the spinal unit for a routine follow-up intravenous urography (IVU). He was wearing a urinal, which was held tightly over the penis by means of two straps coursing over the inguinal regions. MAIN OUTCOME MEASURES: IVU was performed by injecting 50 ml of Ultravist-300 via a 23-gauge butterfly needle inserted in a vein over the dorsum of the left foot. After completion of the injection, an X-ray of the pelvis was taken to evaluate the right hip. This showed contrast in the vena profunda femoris, circumflex femoral veins and inter-muscular veins with evidence of compression of proximal femoral vein. RESULTS: It was suspected that the strap holding the urinal was causing compression of the femoral vein. Therefore, a venogram was performed 5 days later, when the patient had discarded the urinal and the straps. This showed free flow of contrast through the left femoral and iliac veins. CONCLUSION: Compression of femoral vein by a strap holding the urinal was discovered serendipitously in this patient during a routine follow-up. physicians and health professionals should bear in mind this rare complication when examining spinal cord injury patients who use this type of urine collecting device, and discuss with them alternative methods for urinary drainage.- - - - - - - - - - ranking = 3keywords = disc (Clic here for more details about this article) |
7/70. kidney transplantation unraveling wolfram syndrome: a case report.BACKGROUND: In wolfram syndrome insulin-dependent diabetes is associated with a multisystem neurodegenerative disorder. There are no prior reports of kidney transplantation in patients with wolfram syndrome. methods: kidney transplantation was undertaken in a child with dysplastic kidneys, sensorineural hearing impairment and bilateral optic atrophy-a combination of features insufficient to define wolfram syndrome. RESULTS: After the procedure diabetes mellitus, diabetes insipidus and urinary bladder dysfunction emerged, thereby revealing wolfram syndrome. CONCLUSIONS: We discuss the etiology of our patient's postoperative events, and conclude that kidney transplantation may expose dormant manifestations-or aggravate existing manifestations-of wolfram syndrome.- - - - - - - - - - ranking = 1keywords = disc (Clic here for more details about this article) |
8/70. Laparoscopic ileovesicostomy.PURPOSE: We present our initial experience with laparoscopic ileovesicostomy for managing neurogenic bladder. MATERIALS AND methods: A 5 port transperitoneal approach was used for laparoscopic ileovesicostomy. After bladder preparation a 17 cm. ileal segment was harvested and used as the urinary conduit. Ileovesical anastomosis was formed using intracorporeal suturing and knot tying techniques. RESULTS: operative time was 4 hours. blood loss was less than 100 ml. Physical activity and oral intake resumed on postoperative day 1 and the patient was discharged home on postoperative day 3. The postoperative narcotic requirement was 4 mg. morphine sulfate equivalent. There were no intraoperative or postoperative complications. CONCLUSIONS: Laparoscopic ileovesicostomy in this initial experience was associated with acceptable operative time and minimal postoperative morbidity. It may serve as an excellent minimally invasive alternative to conventional open ileovesicostomy.- - - - - - - - - - ranking = 1keywords = disc (Clic here for more details about this article) |
9/70. Impairment of erection after external sphincter resection.Two cases of temporary loss of reflex erectile activity after transurethral bladder-neck and external sphincter resection are reported in two tetraplegics. Only recently such occurrences have been reported in the literature associated with external sphincterotomy. The reasons are discussed and most likely direct damage to erectile tissues is the cause of such a complication.- - - - - - - - - - ranking = 1keywords = disc (Clic here for more details about this article) |
10/70. Spontaneous bladder rupture in a non-augmented neuropathic bladder.A spontaneous bladder rupture in an intact bladder without history of trauma has been reported before with different postulation for the pathogenesis. All these cases were reported in the adult age group. patients with a neuropathic bladder associated with such a complication were post augmentation cystoplasty or catheter induced injury. We present our experience in a boy with a neuropathic bladder secondary to spina bifida who had a spontaneous bladder rupture with no surgical intervention carried out before, and discuss the possible pathogenesis.- - - - - - - - - - ranking = 1keywords = disc (Clic here for more details about this article) |
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