男女性泌尿生殖系统支原体感染者支原体类型差异及药敏动态分析

目的分析本地区男性与女性泌尿生殖系统支原体感染者支原体类型的差异以及对药物的敏感性。 方法选取204年1月至2016年12月深圳市龙华区三家医院就诊的疑似泌尿生殖系统支原体感染的4 957例患者作为研究对象,其中男性2 435例,女性2 522例,回顾性分析入组患者的支原体检查结果及对药物的敏感性。 结果4 957例研究对象中支原体阳性者2 280例,阳性率为46.0%,其中病原携带者673例（占29.5%）,感染者1 607例（占70.5%）。不同年份间支原体阳性率差异均有统计学意义（P均< 0.05）,支原体阳性率逐年升高。不同年龄组患者的支原体阳性率差异均有统计学意义（P均< 0.05）。男性患者解脲脲原体（Uu）构成比显著高于女性患者,人型支原体与Uu混合感染（Mh + Uu）构成比显著低于女性患者,差异均具有统计学意义（P均< 0.01）;但两种性别Mh构成比差异无统计学意义（P > 0.05）。支原体对原始霉素、交沙霉素和强力霉素的敏感性分别为90.6%、76.9%和69.9%。 结论21~40岁女性人群泌尿生殖系统支原体感染的健康宣教应加强,且诊治时应取材进行支原体培养和药敏试验,依据诊断有目的地选择药物治疗。     

Clinical and urodynamic outcomes of tension-free vaginal tape procedure

The tension--free vaginal tape procedure (TVT) has been regarded as a safe, minimally invasive method for the treatment of female stress urinary incontinence. In a prospective multicenter study we evaluated safety and efficacy of TVT procedure for the treatment of female stress incontinence. From 1998. to 2003, a total of 42 patients, mean age 60 years (range 34-76) with urodynamically verified stress urinary incontinence underwent the TVT procedure. The mean follow-up period was 28 months (range 14 to 32). Intra- and postoperative complications were few, including bladder perforations (4.7%), vaginal hematoma (2.4%), complete urinary retention (2.4%), transient urinary retention (19%) and urinary tract infection (7.1%). Postoperatively, voiding time and functional urethral length significant increased. The subjective and objective cure rates were 85.7% and 90.5%, respectively. We conclude that the TVT procedure is associated with high cure rate and low morbidity.     

Correlation between urogenital prolapse and detrusor overactivity

PurposeTo evaluate the urodynamic characteristics of a series of women with stress urinary incontinence presenting various rates of vaginal prolapse.Methods92 female patients were included in this study, mean age was 48 years (range 29-75). All patients underwent urogynecologic physical examination (vaginal prolapse was graded) and complete urodynamic study in order to detect the presence of detrusor overactivity. Urodynamic terminology and measurements comply with the ICS (International Continence Society) standards. Statistical significance was established below 0.05.Results65 women (70.6%) presented anterior vaginal prolapse and 31 (33.6%) posterior vaginal prolapse. Involuntary contractions of the detrusor muscle appeared in 13 patients (20%) who had an anterior vaginal prolapse and 6 women (19.3%) who had a posterior vaginal prolapse. The existence of involuntary contractions was not associated with the diagnosis of vaginal prolapse.ConclusionOur study did not show any correlation between existence of vaginal prolapse and detrusor overactivity.     

Results and complications of TVT procedure in the surgical treatment of female stress incontinence

ObjetivesTo evaluate the efficacy and safety of Tension-free vaginal tape (TVT) for treatment of female stress urinary incontinence (SUI).To determine the mid-term outcome of TVT performed during other pelvic floor reconstructive procedures.Patients and methods100 women with SUI undergoing TVT procedure under spinal anesthesia from January 2000 to 1November 2002 were studied.76 women were treated with TVT alone. 24 patients were treated with TVT and pelvic floor reconstruction: we repaired 24 cystoceles grade II-III, 3 rectoceles and 4 concomitant vaginal histerectomies.ResultsMean age was 49,3 years (range 35-78). Mean parity: 2 (range 0-6) and mean operative time was 38 minutes (range 20 to 50). The postoperative hospital stay was 24 hours for women treated with TVT alone. Only 1 patient (1%) need bladder catheterization during 7 days due to urinary retention.Mean followup was 18 months (range 12-48). Objetive cure rate was 95%. In our study the rate of de novo post-operative urge symptoms (16%) was the most frequent complication. Bladder injury was the most grave problem and it happened in 1 patient (1%).ConclusionThe results confirm the feasibility and safety of TVT for treatment of SUI. Moreover, TVT procedure is economical and efectiveness.Pelvic floor defects, benign uterine disorders and SUI can be safely treated with TVT and vaginal procedures during the same surgical time.     

肾移植术后泌尿系感染的特点分析

目的探讨肾移植术后泌尿系感染的特点。方法回顾性分析2009年1月至12月在暨南大学附属第一医院进行肾移植的38例患者(男性24例,女性14例)的临床资料,对其术后1年内尿常规、尿培养结果及其他临床资料进行总结分析。结果 38例患者肾移植术后1年内共查尿常规次数787例次,其中尿常规阴性结果为633例次,标本污染53例次,细菌尿次数101例次,其中71例次发生肾移植术后半年内。101例次泌尿系感染中,无症状性菌尿为68例次,上尿路感染19例次,下尿路感染14例次,并发脓毒血症者3例次。38例患者中,共有25例(男14例、女11例)患者出现细菌尿,有19例患者出现不少于2次泌尿系感染。最常见的致病菌为大肠埃希菌(36例次),其次是粪肠球菌(26例次)。肾移植术前血液透析患者术后感染率为70%。36例术后7d内拔出尿管和双J管的患者肾移植术后感染率64%,而2例肾移植术后7d后拔出尿管和双J管患者均发生感染。术后出现膀胱输尿管反流的3例患者均出现泌尿系感染。结论肾移植术后泌尿系感染具有高发性、反复发作的特点,最常见的致病菌为大肠埃希菌。女性、尿管和双J管的长时间留置、术后膀胱输尿管反流、术前长时间血液透析等都会诱发肾移植术后的泌尿系感染。     

Short‐term assessment of a tension‐free vaginal tape for treating female stress urinary incontinence

OBJECTIVE

To evaluate the short‐term surgical complications and results of a tension‐free vaginal tape (TVT) system (TVT‐Secur^TM, Gynecare, Ethicon, Somerville, NJ, USA) in the treatment of female stress urinary incontinence (SUI).

PATIENTS AND METHODS

TVT‐Secur was applied to 107 women with SUI through a vaginal incision and left abutting the urethra. Postoperative pain, complications, de novo lower urinary tract symptoms, incontinence cure rate and the King’s Health Questionnaire (KHQ) score were evaluated.

RESULTS

The operative duration was 12 min; the mean pain score was 2.3 and only one patient had transient voiding difficulties. After a mean follow‐up of 15 months, 71% of the patients were dry and 14% improved. The KHQ scores decreased significantly for most subscores. Urgency appeared de novo in six patients (5.6%), and vaginal erosion required one TVT‐Secur explantation.

CONCLUSION

This study shows that TVT‐Secur is a simple and safe treatment for female SUI, but before recommending this sling as a first choice for treating SUI, TVT‐Secur must pass the test of time and comparative studies with conventional slings.     

Treatment of female stress urinary incontinence with TVT system (tension-free vaginal tape): complications in our first 100 cases

Introduction: The TVT system is the most common surgical technique of female stress urinary incontinence, because of the simplicity, good clinical results and rare complicationsMaterial and methodsFrom april, 1999 to march, 2004, it has been done in our department 100 TVT systems with the revision of the result over the six following months. The average follow-up rate was 10, 36 months (R: 1-54 months) and looses mean the 11% of the cases. All the patients presented stress incontinence and their average age was 56,6 years old (30-80). The 12% of the cases have been previously operated of urinary incontinence. 21 patients presented previous surgery of pelvic floor. In the 17% of the cases, TVT systems was associated to another surgical technique: 15% of them was operated of cystocele, 1% of them had surgical correction of rectocele, 1% of them had a strong surgery of pelvic floor, that included TVT system, correction of pelvic floor and hysterectomyResultsWe obtained 65% of successful cases, defined as objective confirmation of absence of looses from the observer and the subjective reference of the patient; 17% of clear improvement (clear decrease of looses from the patient and subjective improvement) and 7% of failure of the technique. The total percentage of appearance of novo post-surgery urgency is 9%. There were complications in the 12% of the cases: there were three cases of bladder perforation, two of them intra-operative and one of them deferred and associated to an infection of surgical wound; another three cases of residue in the immediate post-operative that were resolved with bladder catheterization; one case of acute urinary retention that was treated with bladder catheterization with suprapubic cistostomy; one case of chemical peritonitis corrected with a conservative treatment; two cases of vaginal extrusion of sling, which were resolved with the section of the outer sling; one patient presented a hipogastric hematoma resolved with conservative measures; and one patient presented pelvic discomfort with spontaneous resolutionConclusionsWe consider the TVT system as an effective surgical technique in the treatment of the female stress urinary incontinence. It is a simple technique with a short stay in the hospital and rare complications.     

Impacto de la suspensión de la cúpula vaginal al ligamento sacroespinoso sobre el compartimiento anterior

ObjectivesA prospective study was conducted to assess the efficacy of sacrospinous vaginal vault fixation and its impact on the anterior compartment. The Pelvic Organ Prolapse Quantification (POP-Q) system was used to quantify pelvic organ prolapse in the apical and anterior vaginal compartments.MethodsFifty-eight patients underwent a procedure to correct apical prolapse from March 2003 to February 2006. Mean preoperative and postoperative POP-Q scores were respectively: Aa (+0.74; -1.45); Ba (+3.17; -1.36); C (+3.41; -7.71) (p<0.001).ResultsCure rate was 93.1%. Preoperative and postoperative evaluation of the anterior vaginal compartment was respectively: stage 1 (5.2%; 48.3%), stage 2 (6.9%; 34.5%), stage 3 (74.1%; 5.2%), and stage 4 (13.8%; 0%). De novo cystocele occurred in 87.9% of cases. An improvement was seen in lower urinary tract symptoms of urgency, nocturia, and urge incontinence.ConclusionsSacrospinous vaginal vault suspension is effective for the treatment of apical prolapse and leads to formation of cystocele in most cases     

What is evaluation of hematuria by primary care physicians? Use of electronic medical records to assess practice patterns with intermediate follow-up

BackgroundTo determine whether patients found to have hematuria by their primary care physicians are evaluated according to best practice policy.Materials and methodsThe University of Texas Southwestern Medical Center maintains institutional outpatient electronic medical records (EMR) that are used by all providers in all specialties. We conducted an Institutional Review Board approved observational study of patients found to have more than 5 red blood cells/high power field between March 2009 and February 2010.ResultsThere were 449 patients of whom the majority were female (82%), Caucasian (39%), with microscopic hematuria (MH) (85%). Almost 58% of patients were initially symptomatic with urinary symptoms or pain. Evaluation for the source of hematuria was limited and included imaging (35.6%), cystoscopy (9%, and cytology (7.3%). Only 36% of men and 8% of women were referred to a urologist. No abnormality was found in 32% and 51% of patients with gross hematuria and MH, respectively (P = 0.004). There were 4 bladder tumors and 1 renal mass detected. Male gender, ethnicity and gross (vs. microscopic) hematuria were associated with higher rate of urological referral. Advanced age, smoking, provider practice type, and the presence of urinary symptoms were not associated with an increase rate of urological referral. No additional cancers were diagnosed with 29-month follow-up.ConclusionsWhile urinalysis remains a common diagnostic tool, most cases of both microscopic and gross hematuria are not fully evaluated according to guidelines. Use of cystoscopy, cytology, and upper tract imaging is limited. Further studies will be needed to determine the extent of the problem and impact on morbidity and survival.     

Erosion of woven polyester pubovaginal sling

PURPOSE: Various materials have been used for pubovaginal slings to correct female stress urinary incontinence. Use of synthetic materials provides a theoretical advantage in that no graft harvesting is necessary. Major risks of synthetic material use are erosion and infection of the sling. We report on erosion of woven polyester slings treated with pressure injected bovine collagen (ProteGen) which required removal. MATERIALS AND METHODS: Office records of patients who had ProteGen slings removed at 5 centers during the last 24 months were retrospectively reviewed. Presenting symptoms, interval between sling placement and removal, subsequent procedures and continence status following sling removal were evaluated. RESULTS: A total of 34 women required removal of the polyester sling secondary to erosion, infection or pain. The most common presenting complaints were delayed vaginal discharge in 21 patients (62%), vaginal pain or pressure in 21 (62%), suprapubic pain in 11 (32%) and recurrent urinary tract infection in 5 (15%) at a mean of 7.95 months (range 1 to 22) after sling placement. Of the patients 17 (50%) had vaginal erosion only, 7 (20%) isolated urethral erosion and 6 (17%) urethrovaginal fistulas. In 4 patients no erosion was obvious but slings were removed secondary to vaginal pain. Before sling removal 16 patients (47%) were totally dry, 13 (38%) had some degree of urinary incontinence and 3 (8%) had retention. Following sling removal 7 patients (20%) remained dry, 25 (74%) had mild to severe stress urinary incontinence with or without urgency and urge incontinence, and 2 (6%) are pending followup. CONCLUSIONS: Woven polyester slings treated with pressure injected bovine collagen are prone to erosion. Although the ProteGen sling was recalled in January 1999, patients who have had the sling placed must be followed closely.     

Hallazgos urodinámicos en pacientes con enfermedad de Charcot-Marie-Tooth con síntomas del tracto urinario inferior

IntroductionOur aim was to describe the lower urinary tract symptoms (LUTS) and urodynamic findings in Charcot-Marie-Tooth (CMT) disease patients referred to our Urology Department.MethodsRetrospective study of those patients with CMT disease diagnosed at the Neurology Department of our Tertiary Hospital and referred to our Urology Department since 2008 due to LUTS. We reviewed their clinical charts regarding the age at CMT disease diagnosis, type of CMT disease and the presence of other comorbidities which could cause LUTS. We collected data on the characterization of LUTS, findings of neurological examination and urodynamic findings.ResultsSeven patients were referred to our department due to the presence of LUTS. They were 3 male and 4 female, with median age at the moment of LUTS onset of 55 (29-67) years and median time from the diagnosis of the neuropathy to the onset of LUTS was 14 (1-37) years. Voiding symptoms were referred by 5 patients and urinary incontinence by 3 patients. Two patients presented recurrent urinary tract infection. Six urodynamic tests were performed which showed a neurogenic acontractile detrusor in 2 patients, detrusor underactivity in one patient, a delayed opening time in one patient, a neurogenic detrusor overactivity in one patient and a urodynamic stress incontinence in one patient. In one patient the urodynamic test was normal.ConclusionsMost of CMT patients with LUTS complained from voiding symptoms. Several urodynamic findings could be observed mostly during the voiding phase. We recommend performing urodynamic tests in CMT patients presenting with LUTS seeking for treatment or in those with related complications.     

The Modified Prone Jack-knife Position for the Excision of Female Urethral Diverticula

BackgroundFemale urethral diverticula (UD) are an uncommon and often overlooked aetiology in women presenting with lower urinary tract symptoms, urethral pain, and recurrent urinary tract infection. With increasing awareness, appropriate imaging is more commonly undertaken with consideration given to surgical management.ObjectiveThe video presented demonstrates the technique for excising large and/or complex UD using a modified prone jack-knife position—a position that offers excellent surgical access and allows the surgeon to operate in a more ergonomic position.Design, setting, and participantsA retrospective review of the data on patients undergoing excision of UD at a tertiary referral unit was performed.Surgical procedureUrethral and suprapubic catheters (±insertion of ureteric stents) were placed in supine position. UD excised in the modified prone jack-knife position (±placement of a Martius flap).MeasurementsSubjective cure rate, recurrence rate, rates of postoperative urinary incontinence, need for secondary incontinence procedure, and postoperative complications were measured.Results and limitationsA total of 121 patients were operated on in the study period. The mean follow-up time was 10 mo (range 3–40). The most frequent presenting symptoms included a vaginal mass (n = 76, 63%), followed by dysuria (n = 72, 60%) and pelvic pain (n = 71, 59%). An identifiable aetiological factor was present in 45 patients, including traumatic vaginal delivery (18, 15%), prior periurethral surgery (17, 14%), and urethral dilatation (10, 8%). All patients underwent postvoiding magnetic resonance imaging (MRI) to confirm the diagnosis and plan surgery. UD ranged in maximum diameter from 8 to 48 mm, with a mean of 43 mm (standard deviation 9.24). The most common anatomical location was midurethral (55, 46%), followed by distal (36, 30%), proximal (25, 21%), and full length (5, 4%). Most UDs were single in configuration (74%), followed by multiloculated (15%), saddle shaped (7%), and circumferential (5%). On preoperative videourodynamics, 17 (14%) had stress urinary incontinence. UD excision was undertaken in the modified prone jack-knife position in all cases. A Martius flap was utilised in 36 (30%). The median postoperative postvoiding residual was 26 ml (interquartile range 0–40). In total, 88 (73%) patients were continent postoperatively and 16 (13%) experienced de novo stress urinary incontinence. Of the 37 with pre-existing stress incontinence symptoms, 20 (54%) were continent after operation. A total of 14 patients had subsequent autologous fascial sling at 6 mo. In total, five symptomatic recurrences occurred (4%); of these patients, three elected to undergo surgical excision, all of whom had symptom resolution and were continent after operation. A total of 11 patients (9%) experienced a Clavien-Dindo grade I–II complication within 90 d after operation. Five patients complained of dyspareunia, which resolved by 6 mo.ConclusionsThe modified prone jack-knife position facilitates excellent access for excision of both simple and complex UDs. This positioning of the patient is not widely recognised amongst urologists. Using this approach, there were low rates of symptomatic recurrence and de novo stress incontinence at medium-term follow-up. Associated urinary incontinence resolves in over half of patients following UD excision; hence, we advocate deferring any incontinence procedure until after the results of surgery are established.Patient summarySurgical removal of urethral outpouching (diverticula) in women is challenging due to its potential to damage the nearby sphincter muscle, which controls continence, or the urethra tube. Placement of patients on their front, rather than on their back, provides excellent access for the surgical removal of urethral diverticula. With this approach, we achieved excellent rates of cure and low rates of urinary incontinence at an average follow-up of 10 mo.     

泌尿生殖道支原体感染的诊断和治疗

应用间接血球凝集法对６０例泌尿外科患者做了溶脲脲原体和人型支原体的抗体检测，其中慢性前列腺炎３５例，各种原因引起的尿路感染２５例。检测结果表明：溶脲脲原体抗体阳性１４例（２３％），其中慢性前列腺炎及尿路感染的发病率分别为２５．７％和２０％；人型支原体抗体阳性１例（１．６％）为慢性前列腺炎者。本文认为间接血球凝集试验主要反映血清中ＩｇＭ抗体的水平，较病原分离更为实用。     

Effect of dietary protein restriction and influence of proteinuria on progression of type 2 diabetic renal failure

PURPOSE: This study investigated the effect of dietary protein restriction on disease progression and how it is influenced by proteinuria in patients with type 2 diabetic nephropathy(DN) and renal failure. METHODS: One hundred and six type 2 DN patients whose baseline creatinine clearance(Ccr) values were 29 +/- 12 ml/min/1.73 m2 were maintained on a diet containing 0.66 +/- 0.05 g/kg/day of protein. They were classified into 3 groups according to mean dietary protein intake(DPI) estimated from urinary urea nitrogen excretion during the follow-up period of 23 +/- 14 months(I, < 0.7 g/kg/day; II, 0.7-0.89 g/kg/day; III, > or = 0.9 g/kg/day). Furthermore, they were divided into 3 subgroups according to mean urinary protein excretion(UP) during the follow-up period (a, > or = 5.0 g/day; b, 2.0-4.99 g/day; c, < 2.0 g/day). Their rates of decline of Ccr(D-Ccr) and the changes in UP were examined. RESULTS: There were no significant differences in D-Ccr among Group Ia, IIa, and IIIa(1.1 +/- 0.6, 1.5 +/- 0.7, 1.2 +/- 0.6 ml/min/1.73 m2/month), among Group Ib, IIb, and IIIb(0.6 +/- 0.3, 0.7 +/- 0.4, 0.8 +/- 0.4 ml/min/1.73 m2/month), and also among Group Ic, IIc, and IIIc(0.1 +/- 0.3, 0.2 +/- 0.2, 0.2 +/- 0.6 ml/min/1.73 m2/month). On the other hand, significant differences were revealed in D-Ccr among Group Ia, Ib, and Ic, among Group IIa, IIb, and IIc, and among Group IIIa, IIIb, and IIIc. There were no significant differences in final UP and minimum UP during follow-up among 3 groups of different DPI levels in patients with 5.0 g/day < or = baseline UP(n = 49) and in patients with 2.0 < or = baseline UP < 5.0 g/day(n = 37). However, significant correlations were demonstrated between D-Ccr and the relative changes in UP between baseline and minimum during the follow-up period in both patients(r = 0.49, 0.48, p < 0.001, p < 0.01). CONCLUSIONS: Irrespective of the level of dietary protein restriction, proteinuria has a great influence on disease progression, and the reduction in UP correlates with retardation of renal function loss in patients with type 2 DN and renal failure.     

An update on urethral diverticula: Results from a large case series

IntroductionWe aimed to describe the presentation, investigations, and management of patients with urethral diverticula and to review the importance of magnetic resonance imaging (MRI) in the diagnosis and surgical management of urethral diverticula.MethodsThis was a retrospective review of female patients who underwent urethral diverticulectomies. This study was approved by the research ethics review board. Data was collected on patient demographics, presenting symptoms, investigations performed, operative technique, and minimum of two-year followup.ResultsA total of 17 patients were included in this study, with a median age of 43 years. Most patients (70%) presented with a palpable vaginal lump; 64% presented with either lower urinary tract symptoms (LUTS) or recurrent urinary tract infections (UTIs). Patients underwent a preoperative MRI, which demonstrated that 59% of diverticula were distal and 53% were locally round. These imaging findings were consistent with the operative findings. MRI also demonstrated communication between the urethral diverticulum and the urethral lumen in 80% of cases, compared to only 47% endoscopically.ConclusionsThe most common presentation of a woman with a urethral diverticulum is with either a palpable vaginal lump, LUTS, or recurrent UTIs. A high index of suspicion is required. Pelvic MRI appears to be an ideal imaging modality for the diagnosis of urethral diverticulum. A preoperative MRI is important to exclude alternative pathologies, appropriately counsel the patient, and assist with the surgical planning.     

泌尿生殖道炎症病人支原体感染现况及耐药性分析

目的 :了解泌尿生殖道炎症病人支原体感染现况及耐药性情况。　方法 :统计 1999～ 2 0 0 3年门诊诊断为非淋菌性尿道炎 (NGU)、慢性前列腺炎及盆腔炎等泌尿生殖道疾病病人 30 5 5例 ,分析其支原体培养及药物敏感试验结果。　结果 :30 5 5例病人共检出支原体感染 992例 ( 32 .5 % ) ,5年间差异无显著性 (P <0 .0 5 )。其中单纯溶脲脲原体 (Uu)感染 70 1例 ( 70 .7% ) ,单纯人型支原体 (Mh)感染 4 4例 ( 4 .4 % ) ,Uu和Mh混合感染 2 4 7例 ( 2 4 .9% ) ,单纯Uu感染远高于混合感染和单纯Mh感染 (P <0 .0 1)。单纯Uu感染计数≥ 10 4cfu/ml占 76 .7% ,而单纯Mh感染者≥10 4cfu仅占 18.2 %。对强力霉素、原始霉素、交沙霉素和四环素敏感性较高 ,分别为 94 .3%、96 .6 %、86 .5 %和97.4 % ,对红霉素和氧氟沙星敏感性仅 5 4 .8%和 2 9.4 %。　结论 :在对病人进行支原体检测时 ,应同时进行Uu和Mh的检测 ,并做支原体药物敏感试验 ,以合理选择抗生素。     

Disorders of bladder emptying following Burch colposuspension

Forty patients with recurrence urinary stress incontinence (RUSI) were evaluated before and after Burch-colposuspension for voiding difficulties. Thirty-two (80%) patients were cured. Seven females developed an urge incontinence in the postoperative course, one female an urge plus stress incontinence. Residual urine was found in 6 of 7 patients with urge incontinence, in 5 patients a urinary tract infection. Four patients with urge incontinence after colposuspension were insulin dependent diabetics. In 18 patients residual urine was found in the postoperative course, only 6 patients were symptomatic with urge and urinary tract infection. We see a limited indication for Burch colposuspension in RUSI with reduction in vaginal mobility, detrusor hypocontractility, detrusor instability and in diseases predisposing to neurogenic bladder disorders.     

Laparoscopic radical cystectomy with extracorporeal creation of a "Y" shaped orthotopic ileal neobladder using non-reabsorbable mechanical suture (Fontana)

IntroductionWe describe the technique and present the preliminary results of the laparoscopic radical cystectomy technique with the extracorporeal creation of a “y” shaped ileal orthotopic neobladder using non-absorbable mechanical suture (Fontana).Materials and methodWe describe the technique step by step and we present a series of 15 patients that underwent this surgery between November 2005 and August 2009, with special emphasis on the duration of the surgery, urinary diversion time, intraoperative and postoperative complications, daytime and night time continence and the frequency of postoperative micturition.ResultsThe mean follow-up of the series was 24 months (6-32). The mean duration of surgery was 280 (range 210-345) minutes and the mean urinary diversion time was 54.5 (range 40-75) minutes. There were no intraoperative complications and the average hospitalization time was 7 (range 5-15) days. During the follow-up, there were 5 late postoperative complications, 2 cases of urinary infection with good response to antibiotic treatment and 3 uretero-neovesical anastomosis strictures, which were treated with percutaneous balloon dilation, with a good functional result. No lithiasis was found in the neobladder. Complete daytime continence was obtained in 13/14 patients (92.9%) and complete night time continence in 6/14 (42.9%). One patient (6.7%) required clean intermittent self-catheterization as the patient did not micturate spontaneously.ConclusionsThe creation of a “Y” shaped ileal orthotopic neobladder using non-absorbable mechanical suture is a feasible, fast and safe technique and it provides promising functional results. Further follow-up is required to determine its long-term results.     

Trans-obturator tape for incontinence: a 3-year follow-up

AIM: To assess operative and functional outcomes, including morbidity, after using the trans-obturator tape for stress incontinence. PATIENTS AND METHODS: The first 24 consecutive patients undergoing trans-obturator tape insertion in a single centre were included in this retrospective study. All patients were female with a mean age of 63 (range 40-83) years. Fifteen patients (62.5%) suffered from pure stress incontinence, and 9 patients (37.5%) had mixed incontinence. Of the latter, 2 patients also had nocturnal enuresis. Each patient was followed up for between 3 and 12 months postoperatively and again at 36 months. The patients were assessed by clinical examination, ultrasound for residual urinary volume, and subjective satisfaction which was assessed at 3 and 12 months. At 36 months, all patients completed a validated incontinence questionnaire (International Consultation on Incontinence Questionnaire: ICIQ) which assessed female lower urinary tract symptoms and their impact on the quality of life. RESULTS: All operations were performed under epidural anaesthesia in day surgery, and the mean operative time was 20 (range 15-38) min. Nineteen patients (79.2%) showed significant improvement postoperatively, with 16 of those (66.6%) being completely cured of their incontinence. The remaining 5 patients (20.8%) were considered to have had failed procedures. There were no vascular, bladder, or urethral injuries. One patient had perforation of the vaginal fornix, and 3 patients developed vaginal erosion. CONCLUSIONS: The trans-obturator tape is a safe and effective treatment for stress incontinence and has a low morbidity after a 3-year follow-up period; however, it should only be performed by clinicians with the relevant surgical expertise and experience in treating female incontinence.