Objective To determine the risk factors and mechanism of urethral injury associated with pelvic fractures. Patients and methods A total of 203 consecutive male patients with pelvic fracture were studied prospectively, including a clinical examination, radiographic examination of the pelvis, excretory urography and retrograde urethrography. Results Thirty‐nine (19%) patients had urethral injury, five (2.5%) had bladder injury and 12 (6%) had combined urethral and bladder injuries. Urethral injury was by stretching of the intact membranous urethra in 13 patients (25.5%), partial rupture in 13 (25.5%) and complete rupture in 25 (49%). Injury involved the prostatic urethra and bladder neck in three children. Urethral injury was consistently associated with pubic arch fractures. Involvement of the posterior pelvic arch, with fractures of the anterior arch, considerably increased the risk of urethral injury. Also, the risk was greater with an increase in the number of broken rami. Conclusion The highest risk of urethral injury was found in cases with straddle fracture when combined with diastasis of the sacroiliac joint (24 times more than the rest of pelvic fractures); this was followed by straddle fracture alone (3.85 times) and Malgaigne's fracture (3.4 times). Stretching of the membranous urethra usually precedes its rupture, which classically occurs at the bulbomembranous junction.

The prognosis of lung cancer patients who are not candidates for surgery is usually poor. The unfavorable natural history of respiratory failure in this group of patients has been suggested as a causative factor. We analyzed the outcome of 46 consecutive patients with primary lung cancer on whom mechanical ventilators were utilized. Although seven patients were ultimately weaned and survived for at least 24 hours, three of them subsequently died prior to discharge from the hospital. The remaining 39 patients died while using the ventilator. Patient age, tumor cell type, and the etiology of respiratory failure were not significantly different between the weaned and unweaned populations. A difference was noted in the duration of mechanical ventilation: none of the patients who could be weaned required mechanical ventilation for more than six days (range, two to six days). Respiratory failure in the nonsurgical lung cancer patient carries a poor prognosis, and selection of patients for mechanical ventilation should be conservative.

case report E505Cite as: Can Urol Assoc J 2013;7(7-8):e505-7. http://dx.doi.org/10.5489/cuaj.1403 Published online on July 2, 2013. AbstractPercutaneous nephrostomy (PCN) has been widely used to drain an infected, obstructed kidney. Few major complications have been associated with it. Few publications have reported the misplacement of nephrostomy tube into the inferior vena cava (IVC), following percutaneous nephrolithotomy. We report a case of a misplaced silicon catheter, through the left renal vein, extending into the IVC, following nephrostomy tube exchange. Our case was safely managed, and we concluded that although PCN and nephrostomy tube exchange are relatively simple procedures, they should be done cautiously, by a well-trained urologist, and preferably under ultrasound or fluoroscopic guidance.

Partial bladder outlet obstruction is a commonly encountered pathophysiologic state. Recently we have reported on the rapid nature of the contractile and functional changes that occur in the rabbit urinary bladder within one week of chronic partial obstruction. The purpose of this present study is to investigate the ability of the bladder to recover from one week of partial obstruction. Twenty-six mature male white New Zealand rabbits were separated into 3 groups. Each rabbit was anesthetized with ketamine-xylazine and a partial obstruction of the bladder established by gently securing a 2.0 silk suture around the temporarily catheterized bladder neck. The rabbits in group 1 were sacrificed following one week of partial obstruction. For groups 2 and 3, the obstructing suture was surgically removed after one week of obstruction adn the rabbit was allowed to recover for either two or four weeks. At the end of one week of obstruction the bladder displayed a 9-fold increase in tissue mass, 50 per cent reduction in contractile response to bethanechol and a 76 per cent reduction in the ability of the bladder to expel saline. After the two week recovery period, the bladder mass was reduced to approximately twice the control mass, the contractile and pressure responses to bethanechol were returned to control levels, and the ability of the bladder to expel saline recovered to approximately 75 per cent of control levels. No further improvements were observed following the four week recovery period. It appears that although the contractile response recovers completely following the one week obstruction period, the ability of the bladder to empty remains partially impaired.

The shift in age incidence and pathological findings towards those of nonschistosomal cases could conceivably be attributed to the increased incidence of low infestation in recent years. The change in male-to-female ratio is probably due to more exposure of women to schistosomal infestation than has occurred previously.

While daytime continence is determined by maximum urethral closure pressure, during the night it is the net result of 2 forces that have about equal influence but in opposite directions, that is maximum urethral closure pressure vs maximum contraction amplitude plus baseline pressure at mid capacity. Two equations were derived from the logistic regression model to predict the probability of continence after orthotopic bladder substitution, including Z1 (diurnal) = 0.605 + 0.0085 maximum urethral closure pressure and Z2 (nocturnal) = 0.841 + 0.01 [maximum urethral closure pressure - (maximum contraction amplitude + baseline pressure at mid capacity)].

The technique of detubularized isolated ureterosigmoidostomy has important advantages over conventional ureterosigmoidostomy. Patients pass urine and feces separately and at convenient intervals with good anal control. The upper urinary tract is well preserved, and there is potentially less risk of colonic carcinogenesis.

No abstract