Cases reported "Urinary Incontinence"

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11/38. Successful closure of a bladder neck fistula complicated by urethral and vaginal stenosis, using oxidized cellulose (Surgicel) for reinforcement.

    We describe a case of a bladder neck fistula in a 25-year-old lady presenting with true urinary incontinence, vaginal constriction and induration, with vaginal length reduced to only 1.5 cm. There was an 8-mm fistula involving upper urethra and bladder neck, with fibrosis all around. Using Schuchardt incision, the fistula was reached and mobilization tried. As there was less available tissue, a 3 x 2-cm layer of oxidized cellulose was stitched between the bladder and the vaginal mucosa for reinforcement and to achieve a watertight closure of fistula.
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12/38. Long-term survival following aggressive surgery and radiotherapy for pelvic fibromatosis.

    Desmoid tumors of the female pelvis are rare. The efficacy of the available treatment modalities in improving survival and decreasing recurrence remains controversial. A 32-year-old woman presented with an asymptomatic large ischeorectal mass. Computed tomography scan revealed a large tumor adherent to the pubic bone and impinging on the bladder neck and the rectum. Aggressive surgical removal of the mass including partial osteotomy of the pubic bone was followed by radiotherapy. The patient is still alive 6 years later with no evidence of disease. Aggressive surgical management followed by radiotherapy is an acceptable means of treatment of locally invasive desmoid tumor of the female pelvis.
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13/38. Ileal nipple for continence in cloacal exstrophy.

    Since 1985, 7 children 2 to 17 years old with urinary incontinence from cloacal exstrophy underwent bladder augmentation and creation of a small bowel nipple at the bladder outlet. There were 3 genetic female and 4 genetic male patients being reared in the female role. In 3 early cases augmentation was done with small bowel, while gastric augmentation was used in 3 later cases and 1 had both types. Six patients became completely dry and they empty by intermittent self-catheterization. In the youngest patient the operation failed because the nipple became infarcted and disappeared. reoperation will be performed after at least 1 year has passed. In cloacal exstrophy if there is insufficient local tissue to create a bladder neck and urethra, a reversed, catheterizable bowel nipple may be an option to consider.
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14/38. paraplegia as initial presentation of follicular thyroid carcinoma.

    Follicular thyroid carcinoma with metastasis rarely presents with clinical picture of spinal cord compression. This report describes a 53 years old patient with follicular thyroid carcinoma who presented with paraplegia and urinary incontinence. magnetic resonance imaging (MRI) of neck revealed a mass with destruction of C5 and extension to C6. Histopathology study demonstrated metastatic carcinoma of thyroid.
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15/38. Treatment of adult female epispadias without exstrophy in the presence of rhabdosphincter function.

    female epispadias without exstrophy is a very rare entity. Symptoms of female epispadias are primary urinary incontinence and anatomical abnormal features. A 24-year-old married women with two children presented with primary urinary incontinence. Due to previous failure of correct diagnosis and ineffective medical treatment, the patient developed psychological problems (anxiety and depression). In the presence of minimal rhabdosphincter function we could achieve socially acceptable urinary continence by bladder neck plication and a Burch colposuspension. The patient did not consent to a major reconstruction.
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16/38. Splitting the pubis for exposure in difficult reconstructions for incontinence.

    We have presented our technique for and experience with splitting the symphysis to provide wide exposure in reconstructive surgery for incontinence. Our experience has demonstrated that the technique is widely applicable to many reconstructive situations in patients of all ages. We believe that spreading the pubic symphysis provides access to the urethra and bladder neck not otherwise possible and regard it as an important factor in the success of many difficult operations to correct incontinence. Although seemingly a radical maneuver, it did not cause complications in any of 51 cases.
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17/38. pregnancy after augmentation cystoplasty.

    During the past ten years, many children with urinary diversions have undergone reconstruction of the urinary tract by means of augmentation cystoplasty, with or without an artificial genitourinary sphincter. We recently treated two patients with augmented bladders whose pregnancies were complicated by multiple infections of the urinary tract, urinary calculi and incontinence. One patient with an artificial genitourinary sphincter had malfunction of the device during the later stages of pregnancy; it resolved after birth. In the second patient, pyelonephritis may have led to premature delivery. patients with these conditions must be observed for deterioration of renal function, obstruction of the urinary tract and infection throughout the pregnancy. In patients with augmentation and reconstruction of the vesical neck, we recommend delivery by cesarean section because of the potential for disruption of the continence mechanism.
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18/38. Cloacal exstrophy reconstruction for urinary continence.

    From 1978 to 1989 we treated 16 patients with cloacal exstrophy, including 8 who have been treated since birth. To achieve urinary continence bladder reconstruction was required in 12 patients, including 3 ileocystoplasties, 4 gastrocystoplasties and 5 gastric continent urinary reservoirs. All 12 patients underwent simultaneous bladder neck/urethral continence procedures. Of the 12 patients with completed reconstruction 10 were evaluable for continence. All 10 patients are dry for periods of 3 or more hours, and 5 are totally dry day and night. All but 1 patient are totally dependent on clean intermittent catheterization. Followup ranges from 2 to 66 months, and all except 1 patient have stable upper tract function. patients with cloacal exstrophy can undergo reconstruction in a fashion to maintain urinary continence, and stomach is the ideal tissue for such reconstruction.
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19/38. Voiding dysfunction due to neurosyphilis.

    Three patients with neurosyphilis presenting with urinary frequency, incontinence and voiding dysfunction were investigated. Unlike the previously reported finding of areflexia in tabes dorsalis, all 3 had hypocompliant detrusor hyper-reflexia with detrusor-sphincter dyssynergia and post-micturition residual urine. One patient also had bladder neck dyssynergia treated by bladder neck incision. The other 2 patients were initially managed by intermittent catheterisation but 1 ultimately underwent urinary diversion. The clinical relevance of these findings and the treatment of this condition are discussed.
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20/38. Splitting the pubis for exposure in difficult reconstructions for incontinence.

    In the last 13 years splitting the pubic symphysis has been used in 46 patients 1 to 32 years old for wide access to the bladder neck and entire urethra in female, or the bladder neck and urethra down into the bulb in male patients. Each patient had a complex problem to reconstruct and most had undergone a prior operation. Underlying pathological conditions included exstrophy in 16 patients, epispadias in 11, cloacal exstrophy in 6, posterior urethral valves in 3, severe trauma in 2, bilateral single ectopic ureters in 2, radical surgery for sarcoma in 2, myelodysplasia in 2, cloacal anomaly in 1 and iatrogenic injury of the urethra in 1. The pubis, or interpubic ligament in exstrophy cases, was divided in the midline. The pubic rami were spread with a laminectomy spreader to create a gap sufficient to operate on that segment of the urethra, which is usually not accessible with an intact pubis. No patient had a problem of nonunion or pubic osteitis after using this approach. This series includes 2 patients undergoing simultaneous iliac osteotomies for a widened symphysis pubis. In no patient was a segment of pubis resected, as has been used in transpubic repair of certain traumatic urethral strictures.
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