- Spontaneous Perforation of the UPJ: A Case Report and Review of the Literature. [Journal Article]
- UCUrol Case Rep 2017; 10:30-32
- Spontaneous rupture of the ureter is an uncommon condition defined by non-traumatic extravasation of urine. Causative factors leading to rupture include urinary calculi, malignancies, instrumentation...
Spontaneous rupture of the ureter is an uncommon condition defined by non-traumatic extravasation of urine. Causative factors leading to rupture include urinary calculi, malignancies, instrumentation or trauma. Ureteral rupture can lead to numerous complications, including abscess formation, urinomas, and urosepsis. Minimal literature is available regarding spontaneous ureteral perforation, especially at the ureteropelvic junction. We present a rare case of spontaneous perforation of the ureter at the ureteropelvic junction caused by an undiagnosed non-compliant bladder. This case illustrates a previously undescribed cause of spontaneous ureteral perforation and the importance of prompt identification and treatment.
- Long-term follow-up of Fournier's Gangrene in a tertiary care center. [Journal Article]
- JSJ Surg Res 2016; 206(1):175-181
- CONCLUSIONS: Surgical colostomy may not be mandatory (and might be associated with a high additional morbidity) in FG. With appropriate patient selection, it may be possible to avoid colostomy formation using a less-invasive diversion technology without compromising patient outcomes.
- Evaluation of the Axonics Modulation Technologies Sacral Neuromodulation System for the Treatment of Urinary and Fecal Dysfunction. [Journal Article]
- ERExpert Rev Med Devices 2016 Dec 04
- Sacral neuromodulation (SNM) remains one of the few effective treatments for refractory bladder and bowel dysfunction. However, SNM is associated with frequent need for surgical intervention, in many...
Sacral neuromodulation (SNM) remains one of the few effective treatments for refractory bladder and bowel dysfunction. However, SNM is associated with frequent need for surgical intervention, in many cases because of a failed battery. A rechargeable SNM system, with a manufacturer-reported battery life of 15 years or more, has entered post-market clinical testing in Europe but has not yet been approved for clinical testing in the United States. Areas covered: We review existing neuromodulation technologies for the treatment of lower urinary tract and bowel dysfunction and explore the limitations of available technology. In addition, we discuss implantation technique and device specifications and programming of the rechargeable SNM system in detail. Lastly, we present existing evidence for the use of SNM in bladder and bowel dysfunction and evaluate the anticipated trajectory of neuromodulation technologies over the next five years. Expert commentary: A rechargeable system for SNM is a welcome technological advance. However surgical revision not related to battery changes is not uncommon. Therefore, while a rechargeable system would be expected to reduce costs, it will not eliminate the ongoing maintenance associated with neuromodulation. No matter the apparent benefits, all new technologies require extensive post-market monitoring to ensure safety and efficacy.
- Urothelium-adherent, ion-triggered liposome-in-gel system as a platform for intravesical drug delivery. [Journal Article]
- JCJ Control Release 2016 Nov 29
- Instillations of therapeutic agents into the urinary bladder have limited efficacy due to drug washout and inadequate attachment to and penetration into the bladder wall. Instilled nanoparticles alon...
Instillations of therapeutic agents into the urinary bladder have limited efficacy due to drug washout and inadequate attachment to and penetration into the bladder wall. Instilled nanoparticles alone have low stability and high susceptibility to washout, while gel-based systems are difficult to administer and retain. To overcome disadvantages of current technologies, a biodegradable, in situ-gelling liposome-in-gel (LP-Gel) system was developed for instillation into the bladder, composed of nano-sized, fluidizing liposomes incorporated into a "smart" biopolymeric, urine-triggered hydrogel. The liposomes are optimized for their fluidizing composition in order to enhance cellular penetration through the urothelial barrier, while the hydrogel co-delivers the suspended nanocarriers and enhances adhesion on the mucin layer of the urothelium. The composite system thus mimics both the lipid membranes and mucosal layer that comprise the urothelial barrier. LP-Gel showed appreciable cytotoxicity in rat and human bladder cancer cells, and instillation into rat bladder showed enhanced adhesion on the urothelium and increased penetration into the bladder wall. Instillation of paclitaxel-loaded LP-Gel showed drug retention for at least 7days, substantially higher than free drug (few hours), and with negligible systemic levels. The LP-Gel platform system thus facilitates prolonged drug localization in the bladder, showing potential use in intravesical applications.
- Management of Urethral Strictures After Hypospadias Repair. [Review]
- UCUrol Clin North Am 2017; 44(1):105-111
- Strictures of the neourethra after hypospadias surgery are more common after skin flap repairs than urethral plate or neo-plate tubularizations. The diagnosis of stricture after hypospadias repair is...
Strictures of the neourethra after hypospadias surgery are more common after skin flap repairs than urethral plate or neo-plate tubularizations. The diagnosis of stricture after hypospadias repair is suspected based on symptoms of stranguria, urinary retention, and/or urinary tract infection. It is confirmed by urethroscopy during anticipated repair, without preoperative urethrography. The most common repairs for neourethra stricture after hypospadias surgery are single-stage dorsal inlay graft and 2-stage labial mucosa replacement urethroplasty.
- Are complications of stress urinary incontinence surgery procedures associated with the position of the sling? [Journal Article]
- IJInt J Urol 2016 Dec 01
- CONCLUSIONS: Sling location plays a pivotal role in the occurrence of certain complications. The sling position in the proximal part of the urethra or between the middle and proximal urethra appears to be connected with a high rate of unsuccessful stress urinary incontinence treatment. A sling-longitudinal smooth muscle distance below 2 mm is often connected with sling complications, such as overactive bladder, urinary retention and recurrent urinary tract infections.
- Acute Urinary Retention and Catatonia in a Schizophrenic Male Patient. [Letter]
- PCPrim Care Companion CNS Disord 2016 Nov 10; 18(6)
- The role of prostatic inflammation in the development and progression of benign and malignant diseases. [Journal Article]
- COCurr Opin Urol 2016 Nov 30
- CONCLUSIONS: Men with BPH-related lower urinary tract symptoms and chronic prostatic inflammation should be considered at increased risk of symptom progression and acute urinary retention during follow-up. Although preclinical studies provide a biological rationale for the relationship between inflammation and the risk of PCa, clinical investigations report conflicting results and the direct relationship between inflammation and malignant transformation in the human prostate is still debated.
- Urachal Cyst Causing Small Bowel Obstruction in an Adult with a Virgin Abdomen. [Journal Article]
- CRCase Rep Surg 2016; 2016:3247087
- Introduction. A patent urachus is a rare congenital or acquired pathology, which can lead to complications later in life. We describe a case of urachal cystitis as the etiology of small bowel obstruc...
Introduction. A patent urachus is a rare congenital or acquired pathology, which can lead to complications later in life. We describe a case of urachal cystitis as the etiology of small bowel obstruction in an adult without prior intra-abdominal surgery. Case Report. A 64-year-old male presented to the acute care surgery team with a 5-day history of right lower quadrant abdominal pain, distention, nausea, and vomiting. He had a two-month history of urinary retention and his past medical history was significant for benign prostate hyperplasia. On exam, he had evidence of small bowel obstruction. Computed tomography revealed high-grade small bowel obstruction secondary to presumed ruptured appendicitis. In the operating room, an infected urachal cyst was identified with adhesions to the proximal ileum. After lysis of adhesions and resection of the cyst, the patient was subsequently discharged without further issues. Conclusion. Although rare, urachal pathology should be considered in the differential diagnosis when evaluating a patient with small bowel obstruction without prior intraabdominal surgery, hernia, or malignancy.
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- Surgical outcomes and complications of Tube® (Promedon) malleable penile prostheses in diabetic versus non-diabetic patients with erectile dysfunction. [Journal Article]
- AJArab J Urol 2016; 14(4):305-311
- CONCLUSIONS: Tube malleable penile prostheses are associated with low complication and high satisfaction rates. There was no significant difference in the complication rate or prostheses infection between diabetic and non-diabetic patients. A prospective comparative study with a large number of patients is recommended.