Summary— Primary urinary incontinence is a recognised symptom of ectopic ureter but it is unusual for incontinence in this condition to occur for the first time in adult life. Three cases are described of ectopic ureter presenting in adult life with incontinence; 2 were secondary to ectopic ureterovaginal fistula resulting from gynaecological procedures and one followed prolonged labour.
Perioperative tranexamic acid use is a popular choice among many surgeons for reducing surgical blood loss and its sequelae. While there is evidence in the literature that tranexamic acid use is effective in reducing blood loss in surgery for patients with hip fractures, there is less information on whether it leads to thromboembolic complications. We undertook a retrospective study in patients with hip fractures at two local hospitals to investigate if there was an increased risk of venous thromboembolism in patients who received tranexamic acid, and whether it reduced perioperative blood loss and the need for transfusion. We found that tranexamic acid used in patients undergoing hip fracture surgery reduced the drop in postoperative haemoglobin and the need for postoperative blood transfusion but was not associated with an increased risk of venous thromboembolism.
Mucinous and squamous cell metaplasia of the transitional cell epithelium occurs in response to chronic irritation and is predominantly found in the bladder. When the 2 forms of metaplasia occur simultaneously they usually are associated with malignancy. We report 2 cases of mucinous and squamous metaplasia of the epithelium of the renal pelvis that were not associated with malignancy. This is believed to be the fourth report of this divergent metaplasia. The mechanism for these changes is discussed.
Thirty-eight cases of large bladder diverticula treated surgically between 1970 and 1979 were reviewed. Twenty-two underwent diverticulectomy alone and 19 of these had no further trouble during a follow-up period averaging 4.5 years. Three other patients who had undergone resection of a small prostate gland prior to diverticulectomy might also have been cured by diverticulectomy alone. In at least half of the patients presenting with large bladder diverticula no obstructive factor was present and it is concluded that primary diverticula are more common than was previously thought. Clinically, primary diverticula may be distinguished from secondary on the basis of symptoms, cystoscopic findings of trabeculation and urodynamic studies. A more extensive application of the transperitoneal approach in performing diverticulectomy is recommended.
The influence of 12 clinical and social factors on the length of post-operative stay in hospital after transurethral resection of the prostate was investigated in 100 patients. Using a multiple binary regression analysis, the factors significantly associated with a post-operative stay exceeding 6 days were: patient's age greater than 70 years (P less than 0.005), the presence of existing cardiovascular disease (P less than 0.005) and the weight of the prostate gland resected greater than 10 g (P less than 0.005). The first two factors are useful in providing a prediction of prolonged post-operative stay. The results indicate that those factors associated with a prolonged post-operative stay are beyond the control of the clinician.
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