Cases reported "Urinary Bladder Diseases"

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1/88. lidocaine toxicity secondary to postoperative bladder instillation in a pediatric patient.

    The intravesical use of local anesthetics has been described for a variety of urologic procedures with no previous reports of toxicity. We recently took care of a 2.5- year-old girl with systemic lidocaine toxicity following treatment for postoperative bladder spasms. The patient developed a generalized seizure requiring endotracheal intubation but recovered fully with supportive care. We report the clinical details of this case as well as a brief review of lidocaine toxicity.
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ranking = 1
keywords = operative
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2/88. Combined antegrade and retrograde endoscopic approach for the management of urinary diversion-associated pathology.

    BACKGROUND: Endourologic management of stones and strictures in patients with a urinary diversion is often cumbersome because of the absence of standard anatomic landmarks. We report on our technique of minimally invasive management of urinary diversion-associated pathology by means of a combined antegrade and retrograde approach. patients AND methods: Five patients with urinary diversion-associated pathology were treated at our institution between May 1997 and October 1998. Their problems were: an obstructing ureteral stone in a man with ureterosigmoidostomy performed for bladder extrophy; two men with a valve stricture in their hemiKock urinary diversions; an anastomotic stricture in a man with an ileal loop diversion; and a long left ureteroenteric stricture in a man with a right colon pouch diversion. After percutaneous placement of an guidewire across the area of interest, the targeted pathology was accessed via a retrograde approach using standard semirigid or flexible fiberoptic endoscopes. Postoperative follow-up with intravenous urography, differential renal scan, or both was performed at 3 to 24 months (mean 12 months). RESULTS: The combined antegrade and retrograde approach allowed successful access to pathologic areas in all patients. holmium laser/Acucise incision of stenotic segments or ballistic fragmentation of stones was achieved in all cases without perioperative complications. None of the strictures with an initially successful outcome has recurred; however, in one patient, the procedure failed as soon as the internal stent was removed. The patient with the ureteral calculus remains stone free, and his ureterosigmoidostomy is patent without evidence of obstruction on his last imaging study, 24 months postoperatively. CONCLUSIONS: Combined antegrade and retrograde endoscopic access to the area of interest is our preferred method of approaching pathologic problems in patients with a urinary diversion. An antegrade nephrostogram provides better delineation of anatomy, while through-and-through access enables rapid and easier identification of stenotic segments that may be hidden by mucosal folds. Furthermore, this approach allows the use of larger semirigid or flexible endoscopes in conjunction with more efficient fragmentation devices, resulting in enhanced vision from better irrigation. Finally, an initial endoscopic approach may be preferred because its failure does not compromise the success of future open surgery.
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ranking = 0.6
keywords = operative
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3/88. Terminal Myelocystocele:an unusual presentation.

    Terminal myelocystocele is an unusual form of occult spinal dysraphism. It consists of a cystic dilatation of a low-lying terminal cord herniated posteriorly through a skin-covered lumbosacral spina bifida. An arachnoid-lined meningocele, continuous with the spinal subarachnoid space, is traversed by the hydromyelic cord. Clinically, this presents with a skin-covered lumbosacral mass, but often no neurological deficit is present. We present a case of terminal myelocystocele in a child born without deficit and without an obvious back mass. diagnosis was delayed until sphincter disturbance and lower limb inequalities developed. We discuss the presentation, imaging and operative findings in this case.
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ranking = 0.2
keywords = operative
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4/88. Modified cesarean hysterectomy for placenta previa percreta with bladder invasion: retrovesical lower uterine segment bypass.

    BACKGROUND: Present conservative and radical surgical management of placenta previa percreta with bladder invasion is associated with significant hemorrhage and the need for blood salvage, transfusion, and component therapy. Conventional cesarean hysterectomy strategies have high surgical morbidity, despite adequate personnel and resources. CASE: A 37-year-old, gravida 3, para 2-0-0-2, with a radiographic diagnosis of placenta previa percreta with bladder invasion, and confirmed fetal lung maturity, had a modified cesarean hysterectomy at 34 weeks' gestation. The bladder was partially mobilized beneath the percreta invasion site via the paravesical spaces. Estimated blood loss was 900 mL. Superficial placental bladder invasion was confirmed by pathology. The postoperative course was uneventful. CONCLUSION: Modified cesarean hysterectomy prevented hemorrhage and need for blood salvage, transfusion, or component therapy in managing a case of placenta previa percreta with bladder invasion.
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ranking = 0.2
keywords = operative
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5/88. Unrecognized bladder perforation during operative laparoscopy.

    During operative laparoscopy in a 42-year-old woman, 12-mm trocar lacerations occurred through anterior and posterior walls of the bladder but were not recognized. This case demonstrates important issues related to predicting, avoiding, detecting, and treating bladder trauma associated with laparoscopic surgery. It also indicates that some classic warning signs of accidental cystotomy may be absent or delayed in appearance.
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ranking = 1
keywords = operative
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6/88. Inflammatory pseudotumor of the bladder in neonates.

    Inflammatory pseudotumors of the bladder are rare in children. We describe a 7-day-old male neonate with inflammatory pseudotumor of the bladder. He presented with a 3-day history of macroscopic hematuria. ultrasonography, computed tomography and cystoscopy showed an intravesical mass arising from the right lateral wall. Pathologic findings obtained by open excision revealed that the tumor had spindle-shaped cells without significant atypia infiltrating into submucosal fibrous tissue. There has been no evidence of recurrent tumor 12 months post-operatively. To our knowledge our case is the first presentation in a neonate among the reported pediatric cases.
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ranking = 0.2
keywords = operative
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7/88. An unusual case of duplex ureteropyelocystoplasty.

    Ileocystoplasty is associated with electrolyte disturbances, mucus production and gastrointestinal tract disruption. An unusual case is presented of duplex ureteropyelocystoplasty with an excellent postoperative result. This technique avoids the complications associated with the use of ileum in the urinary tract.
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ranking = 0.2
keywords = operative
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8/88. Abdominoscrotal hydrocele mimicking a herniation of the bladder.

    We describe an 18-month-old boy with an abdominoscrotal hydrocele that extended into the space of Retzius and mimicked a herniation of the bladder. Preoperative ultrasonography of the scrotum and lower abdomen is recommended in boys with suspected large hydroceles.
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ranking = 0.2
keywords = operative
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9/88. Spontaneous rupture of bladder diverticulum after postoperative radiotherapy for carcinoma of the uterine cervix: a case report.

    We present a case of spontaneous rupture of bladder diverticulum three years after postoperative whole pelvic irradiation (50.4 Gy) for carcinoma of the uterine cervix. The patient had suffered from a neurogenic bladder after hysterectomy, but excretory urography revealed no abnormalities. Bladder diverticulum was found two years later. Spontaneous rupture of the urinary bladder is one of the late complications associated with radiotherapy, although it is very rare. Postoperative neurogenic bladder may also be associated with rupture. We should be aware of this rare complication in patients who receive pelvic irradiation.
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ranking = 1.2
keywords = operative
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10/88. actinomycosis of the urinary bladder.

    The case of a 49 year-old female patient, with frequency of urination for 2 years, having a mass at the anterior bladder wall and at the anterior abdominal wall is reported. cystoscopy found an impression of the anterior bladder wall and hyperremic edematous bladder mucosa. Pre-operative computerized tomography suspected bladder tumor. laparotomy revealed an inflammatory firm mass at the anterior bladder wall and another mass at the anterior abdominal wall. Partial cystectomy and excision of the mass at the anterior abdominal wall were performed. After the pathological examination confirmed actinomycosis, the patient was treated post operatively with penicillin. She recovered well.
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ranking = 0.4
keywords = operative
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