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Surgery and traumatology: Surgical management of severely injured patients when resources are limited
Published in Jan de Boer, Marcel Dubouloz, Handbook of Disaster Medicine, 2020
If there is suspected or obvious instability, the patient should not be moved without effective splinting (a vacuum splint or other whole-body splint). If there is severe bleeding from an unstable pelvic fracture, a bandage carefully compressing the pelvic halves together can be used. If the patient is unable to urinate, do not insert a bladder catheter but do a percutaneous cystostomy.
Management of Locally Advanced and Recurrent Rectal Cancer
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Ureteric re-implantation into the bladder with a Psoas hitch is only appropriate where only the distal third of the ureter has been excised. The technique involves complete bladder mobilisation in its fascial planes. A transverse cystostomy is then made, and the surgeon inserts a finger into the dome of the bladder to assess how much laxity there is and the best position where ureter may be implanted without tension. A small cystostomy is then created to allow the ureter to be pulled through and anastomosed to the bladder over a stent. The bladder is also hitched up to the ipsilateral psoas muscle to avoid traction injury on the new uretero-vesical anastomosis. The cystostomy is then closed longitudinally in two layers completing the reconstruction.
Genitourinary trauma
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
Marianne Beaudin, Rebeccah L Brown
Low-grade urethral injuries can be treated with observation alone. If the child is unable to void, a urinary catheter can be inserted. Most partial disruptions of the urethra can be managed with a urinary catheter only. Higher grade injuries can be managed with early surgical repair or delayed surgical repair after insertion of a suprapubic cystostomy. The advantage of delayed repair is avoiding entering a pelvic haematoma with increased risk of bleeding.
Urethral stricture and scrotal abscess: a rare case presentation of penile cancer and review of the literature
Published in The Aging Male, 2020
Aldo Franco De Rose, Francesca Ambrosini, Laura Tomasello, Francesco Boccardo, Carlo Terrone
After the procedure, the patient continued to suffer from swelling, redness of scrotum and undulating pain. In December 2017 symptoms got worse so he went to our Emergency Room complaining of septic fever, purulent urethral discharge, pain, and scrotal swelling. The clinical examination showed a scrotal abscess. Inguinal lymph nodes were not palpable. A contrast-enhanced-computed tomography (CT) scan of abdomen demonstrated an elongated midline abscess with peripheral enhancement at the base of the penis involving also the urethral sponge, measuring approximately 50 mm × 40 mm. In the delayed phase, contrast spread from the urethra to the fluid collection reaching the contiguous thick perineal tissue. He was treated with immediate surgical debridement and drainage of the abscess. A suprapubic cystostomy was placed. The margin of the perineal urethral meatus and a sample of abscessualized and necrotic material were sent to the Pathology Department. Unexpectedly, the histopathological examination showed infiltrating moderately differentiated SCC with positive surgical resection margins.
Stepwise approach in the management of penile strangulation and penile preservation: 15-year experience in a tertiary care hospital
Published in Arab Journal of Urology, 2019
Sandeep Puvvada, Priyatham Kasaraneni, Ramesh Desi Gowda, Prasad Mylarappa, Manasa T, Kanishk Dokania, Abhishek Kulkarni, Vivek Jayakumar
After removal of the foreign body, we visually assess for any urethral injury and pass a 16-F Foley catheter, which is left in situ for 2 days. If catheterisation is not possible, then a suprapubic cystostomy (SPC) is performed and the patient is re-assessed after 3–6 weeks by retrograde urethrography and managed accordingly. Postoperative Doppler ultrasonography of the penis is done within 12 h after removal of the foreign body in all the patients. The skin of the penis is examined and debridement is done if the tissue is not viable with delayed closure (4–6 weeks) if the wound is not healthy (Figure 3). Skin grafting was done when required. The antibiotics were continued for 5 days and anti-oedematous agents, such as trypsin and chymotrypsin, were given for 7 days. The patient was followed-up on postoperative days 7 and 30 with penile Doppler ultrasonography. Patients with unhealthy wounds are re-assessed every week.
Could the bulbar urethral end location on the cystourethrogram predict the outcome after posterior urethroplasty for pelvic fracture urethral injury?
Published in Arab Journal of Urology, 2023
Ahmed M. Harraz, Adel Nabeeh, Ramy Elbaz, Abdalla Abdelhamid, Mohamed Tharwat, Amr A. Elbakry, Ahmed S. El-Hefnawy, Ahmed El-Assmy, Ahmed Mosbah, Mohamed H. Zahran
Electronic records were available for 250 patients of whom 158 (196 urethroplasty procedures) had CUG images available and of adequate quality. The mean patients’ age and body mass index were 32.7 (14.2) years and 27.7 (8.1) Kg/m2, respectively. The procedure was done 2 times in 26 (16.5%) patients and 3 times in 6 (3.8%). Primary realignment was not done in any of our patients with all underwent suprapubic cystostomy at the time of urethral injury. The median (IQR) time to urethroplasty was 4 (3–6) months. Postoperatively, superficial wound infection occurred in 4 patients and required frequent dressing. Blood transfusion was required in 7 patients. The median (IQR) hospital stay was 6 days (5–9).