The incidence of urethral stricture has been surprisingly high following cardiovascular surgery in the last few years. We conducted a prospective study on 68 male patients undergoing cardiovascular surgery to determine the main factor(s) responsible for the development of urethral stricture. The penile-brachial pressure index was checked by strain gauge plethysmography. We found that urethral strictures developed in 15 patients (22 per cent) within an average of 3 months after cardiovascular surgery. Of these patients 13 had a penile-brachial index of 0.6 or less and complained of erectile impotence. A latex type of catheter was used in 11 and a silicone catheter in 4 of these 15 patients for urinary drainage. We conclude that urethral ischemia has an important role in the development of stricture, particularly when a latex urethral catheter is used for drainage. We recommend that a vascular penile study should be done in patients with erectile impotence undergoing an open heart operation, and that serious consideration should be given to the use of a cystocatheter diversion the night before the operation in those with a penile-brachial index less than 0.6. We strongly recommend the use of a silicone catheter in all other patients undergoing open heart surgery with hypothermia.
A high incidence of urethral stricture was noted following cardiovascular surgery. In an attempt to elucidate factors predisposing to the occurrence of urethral stricture, we studied the penile blood flow in 7 patients presenting with strictures after cardiovascular surgery. Of these patients 5 had penile-brachial pressure indexes less than 0.5 and 6 had weak or absent erections. Of 14 patients studied prospectively by penile blood flow 2 had a low penile-brachial pressure index and suffered urethral strictures 6 weeks after cardiovascular surgery. This finding suggests that urethral ischemia could be a predisposing factor for the development of urethral strictures after cardiovascular surgery.
647CAN J ANESTH 2000 / 47: 7 / pp [647][648][649][650][651][652] Purpose: To report a case of severe coronary artery disease complicating pheochromocytoma, managed with combined coronary artery bypass grafting (CABG) and adrenalectomy.Clinical features: A 55-yr-old woman presented with poorly controlled hypertension and investigation revealed an active pheochromocytoma of her left adrenal gland. During medical preparation for adrenalectomy, she developed an acute myocardial infarct complicated with unstable angina. This required urgent CABG, and combined surgery for the triple vessels coronary artery disease and the pheochromocytoma was planned. We explain the details of medical preparation before surgery and the anesthetic considerations during the surgical procedure. Postoperative recovery was normal and no complication occurred. Even if the pheochromocytoma was malignant, her urinary catecholamines two months after the surgery were normal and remain normal after more than two years of follow-up.
Conclusion:We report a patient who underwent combined CABG and adrenalectomy for pheochromocytoma. The CABG was done first, followed by the adrenalectomy with invasive monitoring. The procedure was well tolerated with cure of the two underlying conditions. So we propose that combined procedure should be considered in this clinical setting.Objectif : Citer un cas de phéochromocytome compliqué d'une cardiopathie ischémique, traité par un pontage aortocoronarien combiné à une surrénalectomie.Éléments cliniques : L'examen d'une femme de 55 ans souffrant d'hypertension difficilement contrôlée a révélé un phéochromocytome actif de la glande surrénale gauche. Pendant la préparation médicale à la surrénalectomie, elle a subi un infarctus myocardique aigu accompagné d'angine instable qui exigeait donc un pontage aortocoronarien d'urgence. On a alors planifié une intervention combinée pour les trois vaisseaux touchés par la cardiopathie ischémique et pour le phéochromocytome. Nous avons expliqué les détails de la préparation médicale avant l'opération et les aspects anesthésiques de l'intervention. La récupération postopératoire a été normale et sans complication. Malgré un phéochromocytome malin, les catécholamines urinaires étaient normales deux mois après l'opération et sont demeurées telles après plus de deux ans de suivi.Conclusion : Nous avons cité le cas d'une patiente qui a subi un pontage aortocoronarien combiné à une surrénalectomie pour l'ablation d'un phéochromocytome. Le pontage a été fait d'abord suivi par la surrénalectomie soutenue par un monitorage effractif. L'intervention, bien tolérée, a été suivie d'une guérison des deux conditions qui l'ont commandée. Nous suggérons que soit envisagée une intervention combinée dans ces circonstances.
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