Cases reported "Urologic Diseases"

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1/18. Urologic complications following abdominoperineal resection.

    In a retrospective study we analyzed the high incidence of 75 urological complications after abdominoperineal resection in 52 patients. A prospective study was done also to anticipate as well as to minimize or eliminate these highly significant complications. Direct injury leading to obstruction and fistula formation was avoided. Obstructive uropathy in 10 of 25 male patients was found as a direct result of preoperative evaluation. Same day prostatectomies in 5 patients made no appreciable difference in the urological management, complication rate or end results. Neurogenic bladder dysfunction of various degrees was found in 50 per cent of all patients but represented a long-term problem in only 10 per cent.
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ranking = 1
keywords = operative
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2/18. Intramedullary teratomas: Two case reports and a review of the literature.

    OBJECTIVE: Intramedullary teratomas are extremely rare tumours. A review of the literature found only reports of 59 cases, three of which were treated by us. The most common localisation for these tumours is in the medullary conus. According to our experience as well as more recent reports, MRI images allow a preoperative diagnosis to be made. CLINICAL PRESENTATION: We treated two cases of intramedullary teratoma of the conus: that of a 41-year-old woman and that of a 40-year-old man. Both suffered from motor and sensory disorders, and the woman also suffered from urinary disorders. CT and MRI enabled us to diagnose an intramedullary tumour and to suspect a dysembryogenic origin. INTERVENTION: Both patients were treated surgically; the surgical removal of the tumour was extensive but not total because of the tenacious adhesions of the tumour to the adjacent parenchyma. CONCLUSION: Surgery is the therapy of choice in cases of intramedullary teratomas; the removal, though incomplete, leads to a definite improvement of symptoms. In our two cases the follow-up has been 7 years and 6 years, respectively. No tumour regrowth occurred during this period.
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keywords = operative
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3/18. Gastrocystoplasty: an alternative solution to the problem of urological reconstruction in the severely compromised patient.

    An isolated segment of stomach was used for bladder augmentation in 10 patients or construction of a continent urinary reservoir in 3. Diagnosis in these 13 patients included cloacal exstrophy (5), myelodysplasia (4), posterior urethral valves (2), radiation cystitis (1) and neurogenic bladder secondary to a rectal pull-through procedure (1). Indications for the use of stomach in bladder reconstruction were decreased renal function and acidosis (6 patients), insufficient large and small bowel (6) and decreased mucus production (1). Postoperative followup averaged 13 months (range 6 to 23 months). All patients have stable upper tracts radiographically and stable or improved renal function. Of 13 patients 10 require intermittent clean catheterization to empty and 11 are completely continent. Nine patients have remained free of infection, while 4 had asymptomatic bacteriuria. mucus production is reduced relative to other intestinal segments and 10 patients require no bladder irrigations. Postoperative urodynamic evaluation is similar to that of ileocystoplasty or colocystoplasty. Use of stomach has protected these patients from the development of new or worsened hyperchloremic acidosis. serum chloride values have decreased and serum total carbon dioxide values have increased after bladder reconstruction, particularly in patients with impaired renal function. stomach should be considered when lower urinary tract reconstruction is necessary in such compromised patients.
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ranking = 2
keywords = operative
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4/18. Prevesical xanthogranulomatous pseudotumor.

    We describe a patient who was referred to our hospital because of dysuria, frequency and a palpable mass in the suprapubic area. A specimen obtained at suprapubic exploration consisted of fatty tissue and tentative diagnosis was pelvic lipomatosis. The symptoms persisted and the entire mass was removed from its prevesical pelvic position. The pathological report was xanthogranuloma. Postoperatively, the symptoms disappeared.
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ranking = 1
keywords = operative
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5/18. Pediatric surgical intraoperative consultations.

    Six problems that have surgical implications and that may be encountered unexpectedly during urologic procedures in infants and children are discussed. Evolving practice and increased knowledge about these conditions require that the consultant's opinion regarding their management be updated. Discussed are the indications for concomitant appendectomy in young patients and the pros and cons regarding removal of a Meckel's diverticulum encountered unexpectedly. The necessity for and techniques used to preserve the spleen in the face of operative injury, presence of a splenic cyst, or a wandering spleen are discussed. Finally, the implications of finding a rotational abnormality of the gut are reviewed.
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ranking = 5
keywords = operative
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6/18. Diagnosis of urine extravasation after renal transplantation.

    urine extravasation in the early postoperative period after renal transplantation is a serious complication requiring expedient surgical intervention. Whereas clinical and laboratory findings are inconclusive, radiologic diagnostic studies have definite value. Routine ultrasound and radioisotope studies were performed on 111 renal transplant patients. In the eight who developed urine extravasation, ultrasound and/or radioisotope studies identified the extravasation in seven cases. Four of the eight were studied by intravenous pyelography and another two were studied by cystography. All results were positive. We recommend use of radioisotope and ultrasound studies for routine postoperative screening with invasive techniques reserved for inconclusive cases.
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ranking = 2
keywords = operative
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7/18. Urologic manifestations of the iliacus hematoma syndrome.

    Anticoagulated patients may have a characteristic syndrome of femoral neuropathy from an iliacus muscle hematoma. They may present with urologic signs and symptoms, including groin, flank and thigh pain, groin tenderness, an iliac fossa mass and hematuria. urography may reveal an enlarged psoas shadow and hydronephrosis from ureteral obstruction. Prompt diagnosis is essential so that early operative decompression of the femoral nerve can be done. The urologist has an important role in the diagnosis and treatment of this syndrome.
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ranking = 1
keywords = operative
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8/18. Radiological findings of the urinary tract in hypospadias: a report of 110 cases.

    One hundred and ten patients with hypospadias underwent excretory urography and micturating cysto-urethrography before surgical correction. Urographic studies revealed abnormalities in 50 patients (45%), mainly anomalies of ascent and rotation of the kidneys. None of these patients required corrective surgery. Voiding cysto-urethrography disclosed disease of the urinary tract in 65 of 110 patients (59%). Meatal stenosis was found in 38 patients and a rudimentary vagina or a prostatic utricle was revealed in 11 others. vesico-ureteral reflux was present in 14 patients, seven of whom had meatal stenosis as well. Cystitis was found in eight and a stricture of the membraneous urethra in one patient. The voiding cysto-urethrogram is able to demonstrate functionally significant meatal stenosis, genital abnormalities and vesico-ureteral reflux. It can also serve as a useful baseline for comparison with postoperative studies. We therefore consider that it should be included in the preoperative work-up of every patient with hypospadias. Excretory urography, however, is perhaps indicated only in those with urinary tract infection, or in patients otherwise symptomatic.
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ranking = 2
keywords = operative
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9/18. Postoperative death in paediatric urology.

    In the combined experience of two paediatric urologists over a 25 year period only 4 fatalities relating directly to the surgical procedure could be identified. Two other deaths are presented and retrospectively most of the fatalities could have been avoided by present day management but not at the time they occured. Operative mortality in relation to paediatric urology is discussed fully and it is suggested that death related to the immediate surgery should be fully avoidable in relation to paediatric urology. death from renal failure is a different problem and is unrelated to this paper.
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ranking = 4
keywords = operative
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10/18. Postoperative acute cholecystitis complicating urologic operations.

    Two cases are described of acute gangrenous cholecystitis following urologic operations. The subject is reviewed. The predominance of urologic procedures as the preceding factor for this postoperative complication is pointed out. The possible causes, the presenting features, the diagnosis, management, and serious prognosis are discussed. awareness of the condition, early diagnosis, and operation are recommended. Its importance to the urologist is stressed.
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ranking = 5
keywords = operative
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