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Bladder exstrophy and epispadias
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
After radical soft-tissue reconstruction and epispadias repair, the penis is enclosed in a foam or adhesive dressing for 1 week. The ureteric stents are left on drainage and removed after 1 week, and the bladder remains on free drainage for a further 3 weeks. At this time, the urethral stent is removed and the suprapubic Malecot catheter is clamped intermittently. When this is possible for 3 hours and the child has voided urethrally (checked by US), the suprapubic catheter is removed. Continence and bladder capacity will evolve with time, and regular evaluations at approximately 3-month intervals are required. Cystoscopic evaluation of the bladder outlet is performed with a fine cystoscope (8 Fr) at 3–6 months.
Endoscopic evaluation of neurogenic bladder
Published in Jacques Corcos, David Ginsberg, Gilles Karsenty, Textbook of the Neurogenic Bladder, 2015
Romain Caremel, Saad Aldousari, Jacques Corcos
Some specialized centers no longer perform incisional sphincterotomies, preferring endoluminal stents instead (i.e., Urolume—AMS). The techniques and results with these stents are detailed in Chapter 49. It is usually easy to introduce a flexible cystoscope through these stents, which “disappear” completely after a few months as the device is epithelialized through and in between its pores: 90%–100% of epithelialization of the stent has been demonstrated in 47.1% of cases 3 months after insertion, and in 87.7% of cases 12 months after insertion. Mild epithelial hyperplasia can occur (34%–44.4%) after stent insertion and may look like an obstructed urethra. Much less frequently, these strictures are severe (3.1%), requiring urethrotomy and sometimes insertion of a second stent at the same level as the first.3 Occasionally, however, and even several years later, part of the stent may remain visible, but usually does not cause any problem. Calcifications of the stents are rare. No stone formation has been reported.3 A study was carried out by Denys and colleagues,4 to evaluate another type of urethral stent, the Ultraflex, for detrusor sphincter dyssynergia. In that study, endoscopic evaluation proved to be very valuable. The mean follow-up of 39 patients was 1.73 ± 1.11 years. No stone encrustation or stenosis of stent extremities was observed. Nonobstructive granulation tissue was identified in 6.8%. The mean percentage of epithelialization of the stent was 90.8% ± 19.7%. No migration of the stent into the bladder was seen in that study, however, minimal displacement of the stent compared to the initial position was observed in 21.7% of cases.
Methods for assigning impairment
Published in Ramar Sabapathi Vinayagam, Integrated Evaluation of Disability, 2019
Micturition function refers to storage of urine in the bladder and periodical expulsion of the urine from the bladder mediated by coordinated activation of smooth and striated muscles through neural mechanism residing in the brain, spinal cord, and peripheral ganglia (84). It also includes a sensation of bladder fullness, the sensation of desire to pass urine, and sensation of voiding. Integrated Evaluation of Disability defines Class 1 impairment of 5% for the urgency of micturition without incontinence confirmed by decreased bladder compliance with the urodynamic study, or stress incontinence confirmed by Valsalva leak point pressure, urodynamic studies and sphincter electromyography, hesitancy of micturition. It denotes Class 2 impairment of 15% for the urgency of micturition with incontinence confirmed by reduced bladder compliance with the urodynamic study or voiding by abdominal straining (Valsalva Maneuver)/Credé maneuver with no post-void residual urine. It labels Class 3 impairment of 25% for uninhibited neurogenic bladder or reflex voiding, and absence of sensation of desire, fullness. It allocates an impairment of 37% for reflex bladder, detrusor sphincter dyssynergia, and requiring alpha blockers or botulinum toxin injection or transurethral sphincterotomy or endo-urethral stents to eliminate post-void residual urine. It describes Class 4 impairment of 50% for a person with the inability to initiate micturition resulting in retention or inability to hold urine resulting in incontinence. And post-void residual urine persists after abdominal straining or Credé maneuver or sphincter management. Further, he/she manifests the absence of sensation of desire, fullness, and voiding by catheter/requiring diapers. The Urodynamic study confirms neurogenic status.
Extended TIP vs. Standard TIP for primary distal hypospadias repair: randomized study for comparing functional and cosmetic outcomes
Published in Scandinavian Journal of Urology, 2021
Yasser A. Noureldin, Tarek Mohamed Gharib, Kareem Ali El Attar, Tarek Mohammed El Karamany, Ahmed Mahmoud Al Adl
In brief, first measurements of the UP width and length, and maximal transverse glans diameter (TGDmax) were taken (Figure 1(a,b)). Adopting the previously described e-TIP technique [4,5], starting from within the hypospadiac meatus and extended up to the apical part of the glans tip, the UP vertical midline incision was made and tubularization initiated from the distal end ensuring adequate diameter of the future neomeatus using a 7/0 polyglactin suture (Figure 1(c–e)). The neourethra was then covered with a second layer of dartos flap. A 6 F or 8 F urethral stent was left for 5–7 days, with a non-compressive dressing for 48 h. Unless necessary, all patients were discharged the next morning of surgery. A third-generation cephalosporin was given to all patients until the urethral stent was removed. After this, patients were examined at 1 month, 3 months and six months. All cases were performed by four consultants ‘Y.N, T.Gh, T.E, A.A’ with experience in hypospadias repair.
Evaluation of erectile function after anastomotic vs substitutional urethroplasty for bulbar urethral stricture
Published in Arab Journal of Urology, 2020
Rabea G. Omar, Mostafa M. Khalil, Hesham Alezaby, Ahmed Sebaey, Hammouda Sherif, Ahmed Mohey
Urethral stricture is considered a surgical challenge amongst urologists and various treatment options are available including: direct internal urethrotomy, urethral stents, and urethroplasty either anastomotic (AU) or substitutional (SU) [1].
Drug-delivering devices in the urinary tract: A systematic review
Published in Arab Journal of Urology, 2021
Panagiotis Kallidonis, Constantinos Adamou, Sara Villarrova Castillo, Despoina Liourdi, Evangelos Liatsikos, Dirk Lange
Aside from urethral DES, a few studies have investigated the use of drug elution to address strcture formation in the urethra. Indomethacin-eluting urethral stents were investigated by Kotsar et al. [16,26,27] in three studies. The first study investigated the degradation pattern of an absorbable urethral stent eluting indomethacin, dexamethasone, and ciprofloxacin. The stents were inserted in the posterior urethra of 16 rabbits, which were killed after 1 month at which point the urethras were harvested and histologically examined. The control and dexamethasone-coated stents were totally absorbed, while indomethacine and ciprofloxacine delayed the degradation process of the stent and caused epithelial hyperplasia. Histologically, there was no difference in either acute or chronic inflammation, or fibrosis [16]. In a subsequent study, they investigated the production of cytokines and other inflammatory mediators caused by absorbable urethral DRE in vitro and in vivo. The eluted compounds were indomethacin, dexamethasone, and simvastatin. The stents were inserted in the posterior urethra of 18 rabbits, which were killed at 3 weeks or 3 months. Overall, only dexamethasone-eluting stents produced a significantly greater reaction than the control group, while at 3 months the reaction was resolved in all groups. Based on these results, they concluded that the drug elution on absorbable stents does not intervene significantly with the degradation process of the stent and is considered safe [27]. In the last study, the group investigated the cytokine profiles induced by an absorbable indomethacin-eluting stent in vitro and in vivo in the rabbit urethra. Initial in vitro tests showed that indomethacin-eluting stents reduced the production of monocyte chemoattractant protein 1 (MCP-1) and RANTES (regulated on activation, normal T-cell expressed and secreted), while it had no influence on TGF-β production. Subsequent in vivo studies showed that at 3 months it caused less inflammation and calcification compared to the bare control stents, with no negative effects of drug elution on the degradation process of the stent [26]. These absorbable urethral stents might be useful after a urethrotomy to reduce the chance of re-stenosis, but further testing is mandatory.