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Meeting personal needs: elimination
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
You may have identified the following reasons: to relieve retention of urine (e.g. because of enlarged prostate or neurogenic bladder); before pelvic surgery and certain investigations, to minimise the risk of damage to the bladder;to measure urine output accurately postoperatively and in very ill people (e.g. major trauma, shock) – Jean’s urethral catheter was originally inserted for this reason;to empty the bladder during labour;to introduce fluids into the bladder for irrigation purposes;to introduce drugs as direct therapy (e.g. cytotoxic drugs); to facilitate bladder healing;following certain pelvic, urethral or bladder neck surgery.
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 presence of a PUV should be confirmed by VCUG, but this should be delayed until urinary infection has been brought completely under control and metabolic disturbances have been corrected. A voiding film taken in the steep oblique projection during full micturition is necessary to demonstrate the valve. Dilatation of the urethra proximal to the valve is essential to the diagnosis (Figure 73.5a). Signs of bladder neck hypertrophy (Figure 73.5b) and bladder wall irregularity are also usually present. A very lax valve may occasionally prolapse down as far as the bulbar urethra. Here, the posterior run-off may not be readily apparent, but the filling defect caused by the valve leaflets can usually be made out running down from the verumontanum. It is also important to document the presence and grade of VUR, as well as the estimated cystographic bladder capacity.
Peripheral Autonomic Neuropathies
Published in David Robertson, Italo Biaggioni, Disorders of the Autonomic Nervous System, 2019
The treatment of diabetic cystopathy includes use of an indwelling catheter for 10 days together with appropriate antibiotics. Thereafter, the patient should void every 3 h, aided by manual compression of the suprapubic area (Crede manoeuvre) and receive parasympathomimetic drugs. About 40% of patients respond to this therapy, at least temporarily, until urinary tract infection recurs. Transurethral surgery and bladder neck resection in those without obvious mechanical obstruction may also be useful. Initially, the parasympathomimetic drug can be given parenterally, for example, bethanechol twice weekly and may be continued orally in a dose of 40-50 mg every 6 or 8 h. Cholinergic treatment is withdrawn when residual volumes are less than 100 ml for at least a week (Ellenberg, 1980a).
Lower urinary tract injuries in patients with pelvic fractures at a level 1 trauma center – an 11-year experience
Published in Scandinavian Journal of Urology, 2023
Lasse Rehné Jensen, Andreas Røder, Emma Possfelt-Møller, Upender Martin Singh, Mikael Aagaard, Allan Evald Nielsen, Lars Bo Svendsen, Luit Penninga
Stricture formation following urethral trauma is a known complication and occurred in 40% of our patients with urethral injury. Management of stricture formation is complicated as strictures can occur both as an early and late complication [24]. Delayed urethroplasty is the preferred treatment to prevent stricture formation with a reported 86% stricture free success rate [16,19,24]. Nevertheless, due to heterogeneity of the population and the complexity of (concomitant) injuries, choosing and implementing the correct treatment option for the individual patient remains a challenge. Lastly, 15% of the patients with urethral injury suffered from long-term incontinence of which all had complete rupture. Incontinence can occur secondary to sacral nerve or concomitant bladder neck damages [24]. In our study these patients suffered from multiple complications and received no specific treatment, such as bladder neck reconstruction, for the urinary incontinence.
Urinary undiversion by conversion of the incontinent ileovesicostomy to augmentation ileocystoplasty in spinal cord injured patients
Published in The Journal of Spinal Cord Medicine, 2022
Patrick J. Shenot, Seth Teplitsky, Andrew Margules, Aaron Miller, Akhil K. Das
Numerous studies have shown ileovesicostomy to be a safe and highly effective form of bladder management in individuals who are unable or unwilling to perform intermittent catheterization.12–15,18,22–24 Tan et al. highlighted the improved safety of this procedure, showing a decrease of urosepsis from 55% to 3% after ileovesicostomy, which is similar to other findings.14 As the bladder is left in place as a storage reservoir during this procedure, it is critical to evaluate the bladder outlet before this procedure to avoid or minimize any stress incontinence. In females, particularly those with intrinsic sphincteric deficiency related to subsacral SCI or urethral erosion from chronic urethral catheterization, concomitant obstructing urethral sling placement is often required to eliminate urethral leakage. Surgical bladder neck closure may also reduce the risk of later urethral incontinence.
Correlation of the Grade Group of Prostate Cancer according to the International Society of Urological Pathology (Isup) 2014 Classification between Prostate Biopsy and Radical Prostatectomy Specimens
Published in Cancer Investigation, 2021
Serkan Akan, Caner Ediz, M. Cihan Temel, Ferhat Ates, Omer Yilmaz
Open radical retropubic prostatectomy was performed in all patients with the patient in dorsal decubitus and Trendelenburg position. After routine lower midline incision, endopelvic fascia was opened and the puboprostatic ligaments were divided. The dorsal venous complex was controlled and the urethra was exposed meticulously. We used the electrocautery minimally in these steps in order to protect the nerves and the erectile function. The prostate was dissected from the rectum posteriorly with blunt and sharp dissection. The seminal vesicles and the ejaculatory ducts were identified. The lateral prostate pedicles were ligated separately with 2/0 Vicryl sutures. The bladder neck was opened near the prostate tissue and the prostate was resected. Bladder neck was reconstructed if needed. The urethrovesical anastomosis was constructed with a Foley catheter placed and the catheter was removed on the postoperative day 14.