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Multiple Sclerosis, Transverse Myelitis, Tropical Spastic Paraparesis, Progressive Multifocal Leukoencephalopathy, Lyme Disease
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
Michele Fascelli, Howard B. Goldman
Clean intermittent catheterization (CIC) is a simple, very effective treatment for neurogenic voiding dysfunction in patients with primary emptying difficulties or after pharmacologic therapy for DO.7,43–46 For patients with advanced disease, poor hand dexterity, or pain with catheterization, CIC is problematic.45,46 These patients may require an indwelling catheter or suprapubic cystostomy. The latter is attractive as it has several advantages over a conventional indwelling catheter: urethral erosion and traumatic hypospadias in males and bladder neck and urethral damage in females are avoided, and personal hygiene/catheter care are simplified because of the catheter's accessibility and its position remote from perineal or vaginal soilage.41 The external genitalia can be free of foreign bodies and may render sexual activity possible.42,47
The Pelvis
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
Endourological techniques with two cystoscopes can also allow early (2–7 days) primary realignment, which is accompanied by a significant decrease in stricture formation and need for further extensive surgery. Suprapubic cystostomy and delayed urethral repair may be needed if the patient is unstable but does not require surgery for other reasons. Septic complications with urethral injuries in the presence of pelvic fractures requiring fixation do not seem to be of concern.13
Anorectal Conditions Requiring Urgent or Emergency Intervention
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
It is often necessary to create a diverting stoma because of extensive destruction of the anal sphincter and/or owing to the presence of ongoing wound contamination and the prevention of faecal soiling of the perineum. Patients with an anorectal source for the Fournier’s gangrene are more likely to require a diverting stoma. However, this need not be made at the initial debridement, as the priority is really that of ensuring that all infected and devitalised tissue has been adequately debrided. One can usually wait to see how things progress with respect to wound care and the pragmatic aspects of wound management. Faecal diversion, when necessary, can usually be delayed until there is physiologic improvement in the patient’s condition, as there is seldom a real need to rush into this until the acute infection is brought under control. A suprapubic cystostomy may be required in cases when the urinary tract is involved.16,43–49
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.
A modified Malecot catheter design to prevent complications during difficult percutaneous nephrostomy
Published in Arab Journal of Urology, 2019
Parag Sonawane, Arvind Ganpule, Sudharsan B, Abhishek Singh, Ravindra Sabnis, Mahesh Desai
The Malecot (Stamey) catheter has been routinely used as a self-retaining tube in the drainage of different body fluids, e.g. urine, bile, pus. It was originally described for use in suprapubic cystostomy, which required the use of a needle with the catheter. This made it difficult to insert in small fluid-filled cavities, such as the pelvis of the kidney [1]. A modification employing a flexible introduction system by Rusnak et al. [2] allowed insertion and drainage of even small fluid-filled spaces. Subsequent design modifications, e.g. the flexible stellate and use of dual stiffness material, improved the insertion properties and patient acceptance [1].