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Posterior urethral valves
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Fardod O'Kelly, Martin A. Koyle
The caliber of the penile urethra should first be checked with a well-lubricated 8 Fr sound, which should be introduced only for 1–2 cm. If necessary, a meatotomy can be performed, but no attempt should be made to dilate the urethra. The diagnosis is then confirmed using a well-lubricated 6.5 mm or 9.5 Fr cystoscope introduced under vision. Retrograde passage of the cystoscope is carefully performed as the bladder neck may be hypertrophied and therefore quite high, requiring the surgeon to depress the scope to enter the bladder. Careful cystoscopic examination should be undertaken, noting the presence, degree, and location of trabeculation, diverticulae, and ureteric orifices. Passing the scope back in an antegrade direction will allow the surgeon to appreciate the verumontanum and the presence, quality, and thickness of valve leaflets in the 5 o'clock and 7 o'clock positions on the ventral surface of the urethra at the distal margin of the verumontanum, as the sharp outline of the inferolateral urethral walls are lost.
The Abdomen
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
An uncommon but troublesome hepatic injury is subcapsular haematoma, which arises when the parenchyma of the liver is disrupted by blunt trauma, but Glisson's capsule remains intact. Subcapsular haematomas range in severity from minor blisters on the surface of the liver to ruptured central haematomas accompanied by severe haemorrhage. They may be recognized either at the time of the operation or in the course of CT scanning. If a grade I or II subcapsular haematoma (i.e. a haematoma involving less than 50% of the surface of the liver that is not expanding and is not ruptured) is discovered during an exploratory laparotomy, it should be left alone. If the haematoma is explored, meatotomy with selective ligation may be required to control bleeding vessels. Even if effective, one must still contend with diffuse haemorrhage from the large denuded surface, and packing may also be required. A haematoma that is expanding during operation (grade III) may have to be explored. Such lesions are often the result of uncontrolled arterial haemorrhage and packing alone may not be successful. An alternative strategy is to pack the liver to control venous haemorrhage, close the abdomen, and perform hepatic arteriography and embolization of the bleeding vessels. Ruptured grades III and IV haematomas are treated with exploration and selective ligation, with or without packing (Figure 9.4.3).
Genitourinary and trunk
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
For disease restricted to the prepuce or glans, circumcision (allows glans to dry out) and/or meatoplasty. Urethral dilatation or meatotomy is simple but will restricture. Often used as a temporising measure, but those with meatal/urethral disease will inevitably need definite excision and reconstruction.
Sporadic acoustic neuroma: current treatment options with focus on hearing outcome
Published in Hearing, Balance and Communication, 2018
Daniele Borsetto, Chiara Faccioli, Elisabetta Zanoletti
The second paper [9] reported on the hearing preservation rates in several series published in the previous year [10]. One series concerned 322 consecutive patients who underwent surgery for VS via a retrosigmoid approach and retrolabyrinthine meatotomy from 1976 to 2009. This lengthy period was divided into three phases of hearing preservation surgery, characterised by increasingly restrictive selection criteria [10,11]. The first phase included 207 patients with PTA <50, SDS >50% and tumors >20 mm in size; the second and third phases included 51 and 64 patients, respectively, all with a preoperative PTA <30, SDS >70%, and with tumors <15 and <10 mm in size, respectively. Hearing outcome improved with an increasingly restrictive selection regarding preoperative tumor size, as shown by the overall rates.