Urological Survey 794Others have pushed for early catheter removal but have admitted a higher chance of urinary extravasation.I think what is clear from this article is that surgeons have a choice -they can leave the catheter in for a long period of time and not perform imaging or they can try to remove the catheter early but should perform imaging if they do so. With prolonged catheterization comes increased risk of urinary tract infection and patient discomfort. With early catheter removal comes the risk that about 1 in 5 will need the catheter replaced for another week or two due to extravasation on imaging. It would seem that for patients who live close to a reconstructive center, early catheter removal with imaging and a chance of catheter replacement may be preferable. For those who live far from their reconstructive surgeon or who want to minimize extra visits, a longer period of catheterization without subsequent imaging would be appropriate. Study Type -Therapy (case series) Level of Evidence4 What's known on the subject? and What does the study add? Milroy reported 84% success at a mean of 4.5 years follow-up by usage of a permanently implantable "urolume" spent in 1993. Study Type -Therapy (case series) Level of Evidence Memotherm was developed later, especially for urologic use. Our study is one of the largest in this urea, with a high number of patients and a long follow-up period. Objective: To evaluate the effectiveness and long-term results of permanent urethral stent (Memotherm) implantation in the treatment of recurrent bulbar urethral stricture. Patients and Methods: In all, 47 patients with a history of previous unsuccessful treatment for bulbar urethral stricture were treated using Memotherm bulbar urethral stents between 1998 and 2002. Long-term follow-up data was analysed and discussed.Results: At the end of the 7-year period 37 of 47 patients (78.7%) had been treated successfully. Post-micturition dribbling incontinence lasting up to 3 months after stent placement occurred in 32 (68.1%) patients, but this was reduced to only seven patients (14.9%) by the 7-year follow-up. There was stress incontinence of various severities in nine (19.2%) patients at the 1-year follow-up. These patients were those who had stenosed urethral segments adjacent to the external sphincter. At the long-term follow-up < 10% of the patients had stress incontinence complaints. Conclusion: Memotherm is a good treatment option in patients with recurrent bulbar urethral stricture of any cause.
Shingles (herpes zoster) is a well-known disease presented with a cutaneous rash of fluid-filled blisters, similar to chickenpox. Rarely, inflammatory reaction could involve the spinal cord and anterior horn cells causing varied neurological disorders including urological alterations. We report a 57-year-old woman presenting with acute urinary retention and faecal incontinence attributable to unilateral sacral herpes zoster reactivation (S2-4). The patient was treated with valacyclovir. She recovered her urinary and bowel functions without complications 6 weeks later. (Hong Kong j.emerg.med. 2014;21:326-328)
Objective: To classify intraoperative and postoperative complications using the modified Clavien classification system (MCCS) and modified Satava classification system (SCS) and to evaluate the parameters associated with complications in patients undergoing retrograde intrarenal surgery (RIRS) for renal and proximal ureteral stones. Materials and Methods: We performed a retrospective analysis of 949 patients who underwent RIRS for renal stones and upper ureteral stones at two institutions between March2015 and June2020. Intraoperative complications were assessed using SCC and postoperative complications were graded according to MCCS. Univariate and multivariate analyses were undertaken to determine predictive factors affecting complication rates. Results: The female/male ratio of 949 patients was found to be 346 (36.5)/603(63.5). The median stone size was determined as 13 mm. The stone-free rate was 83.6%after the first intervention, and the final stone-free rate was 94.4% after re-procedure. According to SCS, the intraoperative event and complication incidence was 153(16.1%). MCCS revealed postoperative complications in 121(12.8%) patients. Major complications were observed in 18(1.9%) patients. The rate of complications was higher in patients with renal anomalies (9.9% vs 3.9%, p=0.006). Besides, stone localization, size, number and density were associated with the development of complications (p<0.001, p<0.001, p<0.001 and p=0.002, respectively). In addition, the multivariate analysis revealed that for the patients with grade≥3 complications according to MCCS, only stone-free status was a significant predictor of complication development (p=0.044) whereas for those with grade ≥2b complications according to SCS, significant predictors were stone size (p<0.001), stone density (p=0.022), and fluoroscopy time (p<0.001). Conclusion: This study showed that abnormal kidney anatomy, multiple stones, operative time, and stone-free status were reliable predictors of complication development during and after RIRS. Appropriate preoperative management should be planned according to these predictors to prevent intraoperative and postoperative complications.
Background: Preoperative bladder urine culture (PBUC) analysis has become a standard application before any stone surgery. When growth is detected in PBUC, it is contraindicated to perform flexible ureterorenoscopy (f-URS). The results of the PBUC susceptibility test do not correlate well with those of the renal pelvic urine culture (RPUC) analysis. Previous studies have demonstrated the positivity of RPUC as an important marker for the development of infections after endoscopic operations. In the current study, we aimed to evaluate the consistency between PBUC and RPUC and to identify preoperative markers associated with a positive RPUC. Methods: Data from 129 patients who underwent f-URS on renal and proximal ureteral stones in two centers between 2015 and 2020 were prospectively recorded in a database and retrospectively analyzed. PBUC was obtained from all the patients preoperatively, and RPUC was taken at the beginning of the f-URS operation. The results of the two cultures were compared. Results: There was growth in PBUC in 25 (19.4%) patients and RPUC in 35 (27.1%) patients. Possible predictive markers in predicting a positive RPUC were evaluated using multivariate logistic regression analysis. Preoperative urine density at the renal pelvis [odds ratio (OR): 0.848, p<0.001],grade≥2 hydronephrosis (OR:18.970,p=0.001), and lower calyceal stone localization (OR:0.033,p=0.017) were determined as independent predictive factors for a positive RPUC. The ability of pelvis urine density to predict positive RPUC positivity was evaluated using the receiver operating characteristic analysis, in which the area under the curve value was determined to be 0.858 (0.780-0.936). The cut-off value of pelvis urine density in the prediction of RPUC positivity was 4.5, at which it had 80% sensitivity and 77.7% specificity. Conclusions: PBUC may not represent true colonization. Although bladder urine culture is negative before the operation, patients with preoperative hydronephrosis and low pelvis urine density may have RPUC growth.
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