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1/18. 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.
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2/18. 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.
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3/18. Meckel's diverticulum: an alternative conduit for the Mitrofanoff procedure.

    The Mitrofanoff procedure is a versatile technique that is successfully used in achieving continent urinary diversion for a wide variety of urological conditions. appendix and usable segment of ureter are commonly employed for this purpose and provide desirable results. This communication describes a teenage girl with lumbosacral agenesis and neurogenic bladder in whom Meckel's diverticulum was successfully used for the Mitrofanoff procedure.
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4/18. Bladder rehabilitation with dorsal rhizotomy and ventral neuroprosthesis.

    Two patients with severe neuropathic bladders were successfully treated with selective dorsal rhizotomy in conjunction with a ventral root neuroprosthesis. Both patients achieved stabilization of their renal function, continence, resolution of vesicoureteral reflux, and relief from indwelling urethral catheters. This alternative form of management avoids the complications of other operative approaches.
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5/18. Anastomotic obstruction after stapled enteroanastomosis.

    We have recently treated two cases of anastomotic obstruction after side-to-side stapled enteroanastomosis. Complete obstruction of a stapled small-bowel anastomosis has not been reported to our knowledge. The mechanism of the obstruction appears to be the healing together of the cut edges of viable bowel beyond the inverted stapled lines. An alternative method of constructing the functional end-to-end enteroanastomosis that is offered is intended to prevent the occurrence of postoperative anastomotic obstruction.
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6/18. Vesical instillation of emepronium bromide in defunctionalized postobstructive noncompliant bladder: an alternative to intestinal augmentation surgery?

    A contracted noncompliant bladder is an infrequent but severe complication of cutaneous ureterostomy. Recently, we effected a significant increase in bladder capacity by long-term, gentle hydraulic dilation with saline solution plus an anticholinergic drug (emepronium bromide). Based on this experience, we suggest a conservative approach like this before electing a patient for bladder augmentation or permanent diversion for any child with vesical contracture.
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7/18. Behavioral methods for teaching self-catheterization skills to anxious children with myelomeningocele.

    A behavior-based protocol was developed which outlined all necessary behaviors for successful self-catheterization to an anxious child with myelomeningocele. The subject had been wearing diapers daily since birth, and he expressed fear of pain and lacked confidence because of previous unsuccessful attempts. The present protocol included progressive muscle relaxation, guided visual imagery, and behavioral rehearsal that was implemented by his parents. Data collected showed daily successful intermittent self-catheterization skills two weeks and 6 months posttreatment. Thus, an alternative to traditional educational methods exists that can successfully enhance the acquisition of self-catheterization skills.
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8/18. Surgical treatment of the static perineal modifications in spinal cord or cauda equina lesions.

    Severe dysuria, due to insufficiency of the perineal floor associated during micturition with a posterior tilting of the prostate-bladder block in lower or in associated upper and lower motor neuron lesions, can be treated surgically by a prostato cytso pexy. Since 1971, eight patients with post-traumatic conus and/or cauda equina lesions have been treated by this intervention. On the follow-up the satisfactory results appear to remain stable. An alternative surgical technique using the abdominal pyramidalis muscle is described so as to fix the prostate, associated with a bladder-pexy. The recurrence of dysuria, after the intervention, has always been caused by an additional lower urinary tract pathology. The comfort of the patients has been greatly improved.
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9/18. Fascial sling to correct male neurogenic sphincter incompetence: the McGuire/Raz approach.

    We report the surgical approach used in 4 male myelomeningocele patients suffering from severe urinary incontinence owing to poor bladder compliance and sphincter incompetence. While bladder compliance was corrected by enlargement cystoplasty the sphincteric incompetence was treated by an autologous fascial sling around the bladder neck with excellent results. We consider this operation as an alternative to the artificial urinary sphincter in cases of male neurogenic sphincter incontinence.
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10/18. Combined bladder augmentation and bladder neck suspension for neuropathic incontinence in girls.

    We treated five girls with congenital neuropathic bladder, who had genuine stress incontinence combined with reduced detrusor compliance and/or detrusor hyperreflexia, by simultaneous Marshall-Marchetti-Krantz bladder-neck suspension and bladder augmentation using a sigmoid or ileocecal pouch. All are dry on 3 to 4 hourly intermittent self-catheterization and we suggest that this method represents a useful and much cheaper alternative to the artificial urinary sphincter.
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