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The urinary bladder
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Patients should be seen by a stoma care therapist, who will help to advise the patient and will try different ileostomy bags to ensure that the correct site is chosen, avoiding skin creases so that one does not end up with the disaster of a leaking urinary ileostomy. A decision is made about whether the male urethra is to be removed (depending on the estimated risk of recurrence within the urethra); a urethrectomy is usually indicated in patients with primary CIS or those with tumour invading the prostate stroma. Many surgeons are now offering total replacement of the bladder after cystectomy.
Urethral Cancer
Published in Dongyou Liu, Tumors and Cancers, 2017
Localized disease in females is treated by radical urethrectomy or urethral-sparing surgery (local excision of the tumor with partial urethrectomy if it is possible to achieve good clear surgical margins). Local radiotherapy provides an alternative treatment instead of surgical treatment.
Other lower urinary tract disorders
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Ganesh Thiagamoorthy, Sushma Srikrishna
Although BPS is a chronic and debilitating disease, surgical management should only be considered when other conservative and medical therapies have been unsuccessful. Bladder augmentation cystoplasty has been used for refractory BPS for 50 years.25 Urinary diversion with or without total cystectomy and urethrectomy is the ultimate, final and most invasive option. It should be used as a last therapeutic resort in selected patients. Urinary diversion with formation of an ileal conduit is the most common surgical treatment for BPS/IC. Initially, diversion can be performed without cystectomy, and only when bladder pain is persistent, cystectomy may be considered. To avoid further bowel resection, a bowel segment used for cystoplasty can often be converted to a conduit.
Sclerosis as a predictive factor for failure after bulbar urethroplasty: a prospective single-centre study
Published in Scandinavian Journal of Urology, 2018
Teresa Olsen Ekerhult, Klas Lindqvist, Lars Grenabo, Christina Kåbjörn Gustafsson, Ralph Peeker
Visible scar tissue was excised and an excision with anastomosis was performed as previously described [6]. The specimens were fixed in 10% neutral-buffered formalin, dehydrated and embedded in paraffin. Sections measuring 4 µm were stained using three different techniques (hematoxylin–eosin, Van Gieson and Masson’s trichrome), with each block analysed in a standard way. The diagnosis was evaluated by a uropathologist, who was blinded to the study design. The degree of fibrosis was classified as mild, moderate or severe, essentially according to a scheme described previously in the literature [7,8]. These specimens were compared to two resection specimens containing normal urethrae from patients who had been subjected to sex-correction surgery, i.e. penectomy/urethrectomy.
Vulvar pagetoid urothelial intraepithelial neoplasia: a case report
Published in Acta Chirurgica Belgica, 2023
Stephanie Boret, Edward Lambert, Van Praet Charles, Tummers Philippe, Diederik Ponette, Jochen Darras, Pieter Mattelaer, Sofie Verbeke, Nicolaas Lumen, Karel Decaestecker
In 2016, a 66-year-old female underwent an open anterior pelvic exenteration with ileal conduit urinary diversion for urothelial CIS of the bladder (pTis pN0). Urethrectomy was not performed since there was no proven CIS at the bladder neck and the urethral section margin was negative. Because left ureter frozen section margins remained positive, a left nephroureterectomy was performed.
Foreign body granuloma development after calcium hydroxylapatite injection for stress urinary incontinence: A literature review and case report
Published in Arab Journal of Urology, 2023
David A. Csuka, John Ha, Andrew S. Hanna, Jisoo Kim, William Phan, Ahmed S. Ahmed, Gamal M. Ghoniem
Palma et al. describe a case of SUI developing after surgery for a pelvic bone fracture. CaHA was injected and a large 3.0 cm distal urethral mass formed, prolapsing through the urethral meatus during urination. The FBG was removed with an incision around its base, and the patient became continent with a fascia sling [14]. Ko et al. present of case of SUI development after a distal urethrectomy for urethral squamous cell carcinoma. In addition to two distal urethral masses and urethral prolapse, the chief postoperative symptoms were recurrent incontinence and gross hematuria. The two FBGs were found just one month after the procedure and were also circumferentially resected in a transurethral fashion [15]. The patient in Lai et al. remained with SUI after two failed slings, and a distal urethral CaHA-related FBG developed, soon prolapsing through the meatus. Instead of a circumferential resection, the mass was incised, the CaHA particles were removed, and the edges of the urethral mucosa were marsupialized to the vaginal mucosa much like a Spence diverticulum procedure. The SUI persisted after a successful surgery, and the patient became continent after three more urethral CaHA injections [16]. Given that susceptibility to CaHA FBGs likely has a patient-specific immune component, we believe that continuing to administer the same UBA at any time after development of an FBG is an unwise decision despite this positive outcome. In the first case of the Gafni-Kane et al. article, a second suburethral mass appeared one month after the excision of the first. The second mass was incised to remove the CaHA then resected. The patient became continent after receiving two CaHA injections 9 and 10 months postoperatively. In the second case, the CaHA FBG was accidentally discovered during a midurethral incision for a sling. The nodule containing the white CaHA material was excised, the sling surgery was cancelled, and the patient elected to have an alternate UBA injected [17]. Schrop et al. present a case of urinary retention caused by a partially obstructive CaHA FBG from an injection 50 months beforehand. During the excision procedure, the mass began to break apart and was described as whitish, chalky, gritty, and crystalline [18]. Elmhishi et al. describe a patient presenting with nausea, fatigue, and vomiting, with tests that showed hypotension, hypovolemia, urinary tract infection, and acute kidney injury. The bladder neck CaHA mass was obstructive to such a degree that it caused moderate bilateral hydronephrosis, and the Foley catheter inserted drained 800 mL urine immediately. The surgical treatment plan was not specified [19].