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1/362. Crede expression of the bladder: a sometimes useful maneuver.

    Two children with neurovesical dysfunction are described. The upper tract changes were resolved following the initiation of the Crede expressions of the bladder. It is suggested that the Crede maneuver has a place in the management of selected children with neurovesical dysfunction, particularly when temporization is needed. ( info)

2/362. 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.. ( info)

3/362. An unexpected complicationof the remote-controlled intraurethral valve pump for urinary incontinence.

    We report an unexpected complication of the remote-controlled intraurethral valve pump in a patient with neurogenic bladder. A meningomyelocele patient with an atonic bladder received an intraurethral valve pump. Acute urinary retention was caused by a mucus clot obstructing the pump. Prior to extended clinical use, the remote-controlled intraurethral valve pump should be evaluated in prospective multicenter studies. ( info)

4/362. Regression of vasomotor disorders under intrathecal baclofen in a case of spastic paraplegia.

    Continuous intrathecal baclofen infusion via a subcutaneously implanted programmable pump has been used in the treatment of severe spasticity. Improvement classically concerns the neurological (hypertonia, spasms, hyperreflexia), urological (bladder function) and other clinically relevant outcomes, such as functional status of daily living. This short note reports on another effect of intrathecal baclofen on vasomotor disorders and cyanosis in the lower limbs, described in a patient with spastic paraplegia. ( info)

5/362. Ureterocystoplasty in a patient with a single kidney.

    Ureterocystoplasty (UCP) has now been widely used for bladder augmentation, with and without unilateral nephrectomy. Many techniques have been described to incorporate portions of the upper renal tract, but none have yet described UCP in a child with unilateral renal agenesis. ( info)

6/362. Clean technique for intermittent self-catheterization.

    Seven patients with neurogenic bladder dysfunction who ranged in age from 16 to 54 years, and who had been on sterile intermittent self-catheterization, were changed to clean intermittent self-catheterization. urine was monitored for one year after changing to clean technique. urine specimens obtained while on clean technique were bacteriologically equivalent to urine specimens examined while patients were on sterile technique; the only exception to equivalent urine results were in patients who did not catheterize themselves at frequent intervals. Renal function tests on all patients were also normal. The clean, intermittent self-catheterization technique was effective, since infection did not seem to be caused by introducing bacteria into the bladder via the urethra. ( info)

7/362. An unusual cause of bladder rupture in a paraplegic.

    Over distention of the bladder or a bladder substitute may lead to rupture. The chances of rapture are more in a previously scarred bladder, particularly in a patient with poor sense of bladder fullness such as paraplegic. ( info)

8/362. Vesicocolonic fistula four years after augmentation colocystoplasty.

    An 8-year-old girl was born with crossed fused renal ectopia and neurogenic bladder due to sacral agenesis. Due to progressive upper tract deterioration and incontinence despite clean intermittent catheterization and pharmacotherapy with anticholinergic agents, the patient underwent augmentation colocystoplasty at the age of 4 years. Four years after surgery the girl was readmitted because of persistent febrile urinary tract infection, persistent metabolic acidosis, and intermittent watery diarrhea. A cystogram revealed a fistula between the dome of the augmented bladder and the transverse colon. The fistula was successfully resected. The presence of enterovesical fistula should always be suspected in a patient with augmented bladder who have late onset of urinary tract infection, metabolic acidosis, and diarrhea. ( info)

9/362. Neurogenic bladder dysfunction due to Behcet's disease.

    BACKGROUND: Behcet's disease is a chronic multisystem condition of unknown origin. Genitourinary tract involvement with genital apthous ulcers, epididymitis, urethritis and recurrent cystitis is encountered commonly. Neurogenic bladder dysfunction due to neural involvement of the syndrome, has been reported extremely rarely. methods: A case of neurogenic bladder dysfunction due to Behcet's disease is presented. The patient was 17-year-old young male with a long history of the disease and neurological affection, but with neglected lower urinary tract symptoms and urinary incontinence. The patient was diagnosed urodynamically to have hyperreflexic detrusor. RESULTS/DISCUSSION: After failure of medical treatment (oxybutynin chloride) the patient submitted to augmentation clam-type sigmoidocystoplasty. Four years postoperatively, the patient is dry, on clean intermittent self catheterization twice daily and he is practically asymptomatic from lower urinary tract symptoms. ( info)

10/362. Primary sjogren's syndrome with severe central nervous system disease.

    OBJECTIVE: central nervous system (CNS) involvement in primary sjogren's syndrome (pSS) is controversial with regard to frequency, significance, and etiology. methods: We describe a young woman with pSS and severe CNS disease and review the literature on the pathophysiology, clinical significance, symptoms, diagnostic examinations, and treatment of CNS disease with concomitant pSS (CNS-SS). RESULTS: Our patient with pSS had a 5-month history of benign lymphadenopathy and myositis, after which she developed severe CNS disease, vasculitic lesions on her hands, and a neurogenic bladder attributable to spinal cord involvement. The diagnosis was based on the clinical picture and the results of a brain magnetic resonance imaging (MRI) scan, electroencephalography (EEG), and cerebrospinal fluid (CSF) analysis. The disease did not respond to corticosteroids, but the administration of cyclophosphamide resulted in recovery. In the literature, the incidence of CNS-SS varies widely, from rare to incidence rates of 20% to 25%. The clinical picture is diverse, ranging from mild cognitive symptoms to fatal cerebrovascular accidents. The pathophysiology of CNS-SS is unclear, specific diagnostic methods are not available, and diagnosis is based on the clinical picture and a combination of examinations. MRI is the most sensitive test and cerebral angiography the most specific. CSF reflects involvement of the leptomeninges, and EEG is nonspecific. There are no controlled studies of the treatment of CNS-SS. Regimens for vasculitis are commonly used. CONCLUSIONS: CNS-SS is uncommonly recognized and difficult to diagnose. Increasingly accurate and available diagnostic examinations will yield more information about the association of CNS disease with pSS. ( info)
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