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urinary retention [keywords]
- Laparoscopic nephrectomy in children for benign conditions: indications and outcome. [Journal Article]
- J Indian Assoc Pediatr Surg 2014 Jan; 19(1):22-7.
To analyze the indications and outcome of laparoscopic nephrectomy for benign non-functioning kidneys in children.The data of all patients operated over a 10 year period was retrospectively analyzed.There were 56 children, aged 4 months to 12 years with a male: female ratio of 2.3:1. The most common presentation in boys and girls was urinary tract infection (UTI) (61.5% and 47.05% respectively). Incontinence due to ectopic ureter was a close second in girls (41.17%). The most common underlying conditions were vesico-ureteric reflux (42.85%) and multicystic dysplastic kidney (23.2%). There were 6 nephrectomies, 4 heminephroureterectomies and the remaining nephroureterectomies. All children tolerated the surgery well. One patient underwent a concomitant cholecystectomy. The post-operative problems encountered were UTI (1), urine retention (1), pyonephrosis in the opposite kidney and development of contra-lateral reflux (1). All others had resolution of pre-operative symptoms with good cosmesis.As per available literature, this appears to be the largest Indian series of pediatric laparoscopic nephrectomies for benign non-functioning kidneys. Laparoscopic approach gives excellent results provided pre-operative investigations rule out other causes for the symptoms with which the patient presents. Often it is not the kidney but the dilated dysplastic ureter which is the seat of stasis and infection or pain and therefore should be completely removed.
- Stapled hemorrhoidopexy - Initial experience from a general surgery center. [Journal Article]
- Med J Armed Forces India 2013 Apr; 69(2):119-23.
Stapled hemorrhoidopexy is gaining popularity as a relatively painless alternative to conventional excisional hemorrhoidectomy. The initial experience from a service hospital is presented along with review of literature.40 cases were managed by stapled hemorrhoidopexy (SH) over a period of two and half years. The primary outcome measures assessed were the analgesic requirement in the post-operative period and the time taken to resume Activities of Daily Living (ADL). Additional outcome measures studied were; presence of bleeding per rectum, prolapse of mass per rectum, incontinence to flatus/stool, post-operative urinary retention, requirement of a repeat procedure, presence of post-operative anal stenosis, and residual external haemorrhoids at 1 week, 1, 3 and 6 months and 1 year after surgery.40 patients with grade II, III and IV hemorrhoids underwent SH under spinal anesthesia. In the first 24 h 17 patients required a single dose of Injection Diclofenac Sodium while 19 patients required two doses and 4 patients had to be given three doses. 14 patients (35%) achieved Katz Index of Independence in Activities of Daily Living score of 6 on the first post-operative day and another 17 (42.5%) on the second post-operative day. By the fourth post-operative day all patients had achieved a score of 6. One patient had a rectal perforation as a complication of the procedure and another required a second procedure for excision of thrombosed external hemorrhoids.Stapled hemorrhoidopexy is associated with less post-operative pain and early resumption of ADL. Although the procedure appears simple to perform, it can be associated with serious complications and still cannot be considered the standard of care for the operative treatment of internal hemorrhoids.
- α1-Blockers in the management of acute urinary retention secondary to benign prostatic hyperplasia: a systematic review and meta-analysis. [JOURNAL ARTICLE]
- Ir J Med Sci 2014 Mar 6.
α1-Blockers have been widely used in the conservative management of acute urinary retention (AUR).To compare the efficacy and safety of α1-blockers in male patients with AUR secondary to benign prostatic hyperplasia (BPH).Electronic searches on PubMed/MEDLINE, EMBASE and the Cochrane Library were performed to identify all published randomized controlled trials (RCTs) and controlled clinical trials (CCTs) of α1-blockers for the treatment of AUR. Relevant reviews and reference lists of included studies were explored.Nine studies involving a total of 1051 men were enrolled in this review. Compared to 38.9 % (161/414) in control groups, 56.8 % (362/637) of patients receiving α1-blockers had a successful trial without catheter (TWOC). Meta-analysis demonstrated that α1-blockers have a substantial effect on the successful resumption of micturition after TWOC (RR = 1.45, 95 % CI 1.20-1.75, P = 0.0001). In the subsequent phase, the outcomes across studies indicated that α1-blockers may provide little benefit to maintain the satisfactory voiding without AUR recurrence or BPH surgery in a long-term follow-up. α1-Blockers were generally low and well tolerated in both phases.In conclusion, α1-blockers provide substantial benefit in increasing a satisfactory micturition within 24 h after TWOC for men with AUR due to BPH, even though the long-term effectiveness remains uncertain.
- Comparison of the classic TVT and TVT-Secur. [Journal Article]
- Clin Exp Obstet Gynecol 2013; 40(4):499-501.
Tension-free vaginal tape (TVT) is a well-established surgical procedure for the treatment of female stress urinary incontinence (SUI) and TVT-Secur was designed to reduce the undesired complications and to minimize the operative procedure as much as possible.To present the authors' experience in using the classic TVT and TVT-Secur and to evaluate and compare complications and short- and long-term results.A retrospective study and analysis of 230 patients presented with SUI at King Abdulaziz University Hospital (KAUH) and United Doctor Hospital (UDH) from March 1, 2007 until July 3, 2010. Classical TVT and TVT-Secur with or without associated operation were performed. All patients were controlled at six months and complications, as well as objective results, have been reported. The study was approved by ethical committee of KAUH.All patients with SUI admitted to KAUH and UDH for sub-urethral tape were analyzed (230 patients); 149 had classical TVT and 81 had TVT-Secur. Their age ranged from 30 years to 73 years with a mean of 49.8 years and std of 9.4. Their parity ranged from two to 15 with a mean of 6.2 and std of 2.4. One hundred eighty patients had SUI and 50 patients had mixed incontinence. The type of anesthesia used was general anesthesia in 69.6% (160) of cases and regional anesthesia in form of epidural or spine in 30.4% (70) of cases. Operative complications revealed a bladder perforation in 3.5% (eight) of cases and 2.2% had bleeding of more than 200 ml, and 53 patients which contribute to 23% had retention and required a catheter for 48 hours or more. After three months, it was observed that erosion of the mesh occurred in three cases. Fourteen cases (7%) continue to have SUI failure rate.The classical TVT and TVT-Secur were found to be very effective, easy, and safe procedures and with excellent results.
- Percutaneous Nerve Evaluation (PNE) for Treatment of Non-Obstructive Urinary Retention: Urodynamic Changes, Placebo Effects, and Response Rates. [Journal Article]
- Urol J 2014; 11(1):1301-7.
To evaluate the results of percutaneous nerve evaluation (PNE) implantation in the treatment of non-obstructive urinary retention and report the changes in the urodynamic parameters. Materials and Methods: Patients with non-obstructive urinary retention or incomplete bladder emptying were included. All patients filled a 7 days voiding diary chart and underwent PNE for one week, and the patient was asked to record the second voiding diary chart and repeat urodynamic study in this period. Then the PNE lead was removed from the S3 foramen, but the connections remained fixed in place for another 3 days to exclude the placebo effects and the third voiding diary chart was completed by the patient. The patient wasn't aware of lead removal. Success was defined as, more than 50% improvement in at least one of the urinary tract symptoms. Results: Forty five patients with a mean age of 37.1 years (ranged 9-83 years) were treated with PNE for refractory, non-obstructive urinary retention. Of study subjects 28 complained from complete urinary retention, and 17 had incomplete emptying. Of participants, 28 (62.2%) demonstrated greater than 50% improvement in the urinary symptoms. Urodynamic data, showed a statistically significant increase in maximum flow rate (8 ± 2.2 mL/sec to 16 ± 3.6 mL/sec, P = .06) and voided volume (35 mL to 187 mL, P = .032) in the responders. Any placebo effects in PNE have not been seen. Conclusion: Patients with complete non obstructive urinary retention were good responders to PNE. The placebo effect in sacral nerve stimulation was negligible.
- Endoscopic gold fiducial marker placement into the bladder wall to optimize radiotherapy targeting for bladder-preserving management of muscle-invasive bladder cancer: feasibility and initial outcomes. [Journal Article]
- PLoS One 2014; 9(3):e89754.
Bladder radiotherapy is a management option for carefully selected patients with muscle-invasive bladder cancer. However, the inability to visualize the tumor site during treatment and normal bladder movement limits targeting accuracy and increases collateral radiation. A means to accurately and reliably target the bladder during radiotherapy is needed.Eighteen consecutive patients with muscle-invasive bladder cancer (T1-T4) elected bladder-preserving treatment with maximal transurethral resection (TUR), radiation and concurrent chemotherapy. All underwent endoscopic placement of 24-K gold fiducial markers modified with micro-tines (70 [2.9×0.9 mm.]; 19 [2.1×0.7 mm.) into healthy submucosa 5-10 mm. from the resection margin, using custom-made coaxial needles. Marker migration was assessed for with intra-op bladder-filling cystogram and measurement of distance between markers. Set-up error and marker retention through completion of radiotherapy was confirmed by on-table portal imaging.Between 1/2007 and 7/2012, a total of 89 markers (3-5 per tumor site) were placed into 18 patients of mean age 73.6 years. Two patients elected cystectomy before starting treatment; 16/18 completed chemo-radiotherapy. All (100%) markers were visible with all on-table (portal, cone-beam CT), fluoroscopy, plain-film, and CT-scan imaging. In two patients, 1 of 4 markers placed at the tumor site fell-out (voided) during the second half of radiotherapy. All other markers (80/82, 98%) were present through the end of radio-therapy. No intraoperative (e.g. uncontrolled bleeding, collateral injury) or post-operative complications (e.g. stone formation, urinary tract infection, post-TUR hematuria >48 hours) occurred. Use of micro-tined fiducial tumor-site markers afforded a 2 to 6-fold reduction in bladder-area targeted with high-dose radiation.Placement of the micro-tined fiducial markers into the bladder was feasible and associated with excellent retention-rate and no complications. All markers were well-visualized during radiotherapy with all imaging modalities. Bladder fiducial markers improve targeting accuracy, and may increase treatment efficacy and reduce morbidity from collateral radiation.
- [Carboplatin plus irinotecan induced partial response in a patient with small cell carcinoma of the prostate ; a case report]. [English Abstract, Journal Article]
- Hinyokika Kiyo 2014 Jan; 60(1):39-43.
An 80-year-old man with prostate cancer receiving hormone therapy presented with urinary retention. The computed tomographic scan showed metastases to the lung, liver, and lymph nodes, as well as increased prostate volume. Transurethral resection of the prostate (TURP) was performed, and the resected specimen was pathologically found to be a small cell carcinoma of the prostate. The patient was treated with a combination of carboplatin and irinotecan, and achieved a partial response : size reduction of the prostate and the metastatic lesions, and decreased neuron specific enolase (NSE) level. The chemotherapy with carboplatin and irinotecan is reported to have fewer serious adverse effects, and equivalent efficacy to the cisplatin/etoposide chemotherapy. Therefore, this regimen could also be a treatment option for the patients with small cell carcinoma of the prostate.
- Unplanned medication discontinuation as a potential pharmacovigilance signal: a nested young person cohort study. [Journal Article]
- BMC Pharmacol Toxicol 2014; 15(1):11.
Because of relatively small treatment numbers together with low adverse drug reaction (ADR) reporting rates the timely identification of ADRs affecting children and young people is problematic. The primary objective of this study was to assess the utility of unplanned medication discontinuation as a signal for possible ADRs in children and young people.Using orlistat as an exemplar, all orlistat prescriptions issued to patients up to 18 years of age together with patient characteristics, prescription duration, co-prescribed medicines and recorded clinical (Read) codes were identified from the Primary Care Informatics Unit database between 1st Jan 2006-30th Nov 2009. Binary logistic regression was used to assess association between characteristics and discontinuation.During the study period, 79 patients were prescribed orlistat (81% female, median age 17 years). Unplanned medication discontinuation rates for orlistat were 52% and 77% at 1 and 3-months. Almost 20% of patients were co-prescribed an anti-depressant. One month unplanned medication discontinuation was significantly lower in the least deprived group (SIMD 1-2 compared to SIMD 9-10 OR 0.09 (95% CI0.01 - 0.83)) and those co-prescribed at least one other medication. At 3 months, discontinuation was higher in young people (≥17 yr versus, OR 3.07 (95% CI1.03 - 9.14)). Read codes were recorded for digestive, respiratory and urinary symptoms around the time of discontinuation for 24% of patients. Urinary retention was reported for 7.6% of patients.Identification of unplanned medication discontinuation using large primary care datasets may be a useful tool for pharmacovigilance signal generation and detection of potential ADRs in children and young people.
- Evaluation and management of voiding dysfunction after midurethral sling procedures. [REVIEW]
- J Turk Ger Gynecol Assoc 2012; 13(2):123-127.
Midurethral slings have become the most popular surgical procedure for the correction of stress urinary incontinence in women. Urinary retention or obstructive voiding symptoms may arise from partial urethral obstruction as a result of oversuspension of the urethra or exaggerated tension. Fortunately, most cases of voiding dysfunction are transient and resolve spontaneously within days. Clean intermittent self-catheterization is the mainstay of conservative treatment. If symptoms persist, tape mobilization, incision or urethrolysis may be performed. Recurrent stress urinary incontinence may occur in a small group of patients, who may benefit from another incontinence treatment.
- Rectus fascia colpopexy for post-hysterectomy vault prolapse: a valid option. [Journal Article]
- J Turk Ger Gynecol Assoc 2010; 11(2):69-72.
Considering the great variety of techniques and disagreement about the ideal route, there is a need for a safe, simple and effective method for the management of apical prolapse.Twenty seven cases of post- hysterectomy vault prolapse (twenty four following vaginal and three after total abdominal hysterectomy) were treated surgically by anterior abdominal wall colpopexy with autogenous rectus fascia strips.Except for minor complaints like- vomiting, fever and urinary retention in 3.7% cases each (n=1), no major complications were encountered. Moreover, no recurrence, on follow-up thus far.Using autogenous rectus fascia strips in anterior abdominal wall colpopexy is not only a simple, cheap and effective method of treating vault prolapse but is also devoid of any serious complications such as described with other techniques.