The in vitro responses of isolated detrusor strips obtained from neuropathic patients with neuropathic bladder dysfunction were found to be supersensitive to both carbachol [ED50 1.2 x 10(-6) M. versus 2.5 x 10(-6) M. in control strips; p < 0.005] and potassium chloride [ED50 41.8 mM. versus 49.3 mM. in control strips, p < 0.05]. There were no significant differences in the frequency-response curves obtained with intramural nerve stimulation. However, expressed as a percentage of the maximal response with carbachol, the maximal responses to intramural nerve stimulation in neuropathic strips were reduced [58.3 +/- 21% versus 74.4 +/- 18% for control strips; p < 0.005, Student t test]. Morphometric studies revealed a lower density of 'presumptive' cholinergic nerves in neuropathic detrusor (1.0 +/- 1.4 x 10(-4) microns -2 compared with 3.2 +/- 1.3 x 10(-4) microns -2 in controls, p < 0.05, Mann Whitney U test). The combined physiological and morphometric results were in keeping with a state of postjunctional supersensitivity of neuropathic detrusor secondary to a partial parasympathetic denervation of the smooth muscle. This may be an important factor in the etiology of detrusor hyperreflexia. The contractility of neuropathic tissue in response to field stimulation was found to be much lower than normal (2.4 +/- 1.5 g./10 mg. versus 5.9 +/- 3.0 g./10 mg., p < 0.001; Mann Whitney U test). This reduced contractility to neuronal stimulation might be responsible for some of the characteristics of bladder dysfunction that are seen in patients with similar neurological conditions.

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We present the case of a 37-year-old lady who presented with severe colicky left sided flank pain associated with vomiting, chills and rigors. A non-contrast Computed Tomography of the Kidney Ureter and Bladder was performed which showed a 2–3 mm stone in the pelvic part of the left ureter. Following 2 days of conservative treatment she was still complaining of increasingly severe pain. A contrast computed tomography of the abdomen was performed which was suggestive of a perforation of the left collecting system. A diagnosis of spontaneous left proximal ureteric perforation secondary to urolithiasis was made. We opted to treat her with retrograde endoscopic ureteric stent insertion. Spontaneous rupture of the ureter is a relatively rare urological occurrence with only a small number of cases reported in the literature. Although there are no recommendations, ureteric double-J stenting is the most commonly used management option with good results reported.

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Results of the ureteral Mitrofanoff channel seem somewhat less satisfactory than those of appendicovesicostomy but they remain acceptable and even comparable, strongly supporting its use in certain circumstances.

Summary:In a randomized prospective trial of prophylactic antibiotics in at-risk abdominal surgery, one dose ofintravenous Augmentin (amoxycillin 250 mg and clavulanic acid 125 mg) on induction has been compared with three 8 hourly doses in 900 patients. Wound infection rates which included minor and delayed infections were very similar in those given one dose: 48/449 (10.7%) compared with those given three doses: 49/451 (10.9%) 95% confidence limits -4.25% + 3.9%.There were more septic and sepsis-related deaths in those patients given one dose (14 deaths) than in those given three doses (7 deaths) P > 0.1 95% CL -0.4% + 3.0%. However, there were more very elderly patients in the one dose group: 64% of the deaths were aged over 80 and all but one had an emergency operation. There was no difference in the other outcome measures studied which included non-fatal deep sepsis, length of postoperative hospital stay, duration of postoperative fever or the use of antibiotics for postoperative infection.One dose of a suitable intravenous antibiotic gives prophylaxis against wound infection in at-risk abdominal surgery which is at least as effective as multiple doses. However, there may be a risk of overwhelming systemic sepsis in very elderly patients having emergency surgery.

No abstract

Results of the ureteral Mitrofanoff channel seem somewhat less satisfactory than those of appendicovesicostomy but they remain acceptable and even comparable, strongly supporting its use in certain circumstances.