scholarly journals Ten years’ experience of augmentation cystoplasty for varied indications and its outcome

2020 ◽  
Vol 7 (4) ◽  
pp. 1031
Author(s):  
Hemangi R. Athawale ◽  
Shivaji B. Mane ◽  
Natasha Vagheriya ◽  
Prathamesh More ◽  
Taha Daginawala
Keyword(s):  
Serum Creatinine ◽  
Neurogenic Bladder ◽  
Surgical Techniques ◽  
Bladder Augmentation ◽  
Renal Outcome ◽  
Urinary Continence ◽  
Ectopic Ureter ◽  
Safe Procedure ◽  
Augmentation Cystoplasty

Background: The aim of the study was to evaluate long term efficacy and complications of augmentation cystoplasty in patients with bladder dysfunction.  Methods: Our series comprises of 30 patients undergoing enterocystoplasty from March 2009 till December 2019. Clinical findings and investigations result along with surgical techniques used were noted for these patients. Postoperative complications along with urinary continence and renal outcome were evaluated.Results: Mean age of patients was 7 years and their mean follow up was for 4 years. Major complications occurred in 5 patients which were successfully managed and minor complication in 8 patients. Of these 16 patients were with neurogenic bladder and 14 with non-neurogenic bladder. The primary etiology of non-neurogenic bladder was extrophy epispadias complex (10 patients), posterior uretheral valves (2 patients), anterior uretheral valve (1 patient), and bilateral ectopic ureter (1 patient). The primary etiology of neurogenic bladder was meningomyocele (4 patients), anorectal malformation with vertebral anomalies (7 patients), partial sacral ageneis (4), nonneurogenic neurogenic bladder (1 patient). Relative continence was achieved in 97%. The preoperative serum creatinine and blood urea nitrogen (BUN) at the time of bladder augmentation (termed  creatinine-1 and BUN-1)and the serum  creatinine and BUN at the last follow up after bladder augmentation (termed  creatinine-2 and BUN-2)were sought and compared using chi square test showed statistically significant improvement (p<0.01).Conclusions: Augmentation cystoplasty is a necessary and safe procedure to increase the functional capacity of small contracted and poorly compliant bladder and allows patients to achieve relative continence and preserves renal function.

scholarly journals A single centre 10-year experience of Mitrofanoffs procedure for varied indications with its outcome

2020 ◽  
Vol 7 (4) ◽  
pp. 764
Author(s):  
Hemangi R. Athawale ◽  
Shivaji B. Mane ◽  
Natasha Vagheriya ◽  
Hussain Kotawala ◽  
Prathamesh More ◽  
...  
Keyword(s):  
Neurogenic Bladder ◽  
Surgical Techniques ◽  
Clinical Findings ◽  
Renal Outcome ◽  
Urinary Continence ◽  
Complication Rates ◽  
Chi Square ◽  
Preoperative Serum ◽  
Chi Square Test

Background: To evaluate long term efficacy and complications of Mitrofanoffs procedure in patients with bladder dysfunction.Methods: Authors retrospectively reviewed the medical records of 51 patients who underwent construction of a continent catherisable channel (mitrofanoffs and monti) from 2009 till 2019 in our institution. Clinical findings and investigations result along with surgical techniques used were noted for these patients. Postoperative complications along with urinary continence and renal outcome were evaluated.Results: Mean age was 7 years and mean follow up was for 3 years. 27 patients were with neurogenic bladder and 24 with non-neurogenic bladder. The most common type of conduit was appendicovesicostomy (38) followed by illeal monti (12) and ureter (1). The most common stomal site was umbilicus (44) followed by right lower abdominal quadrant (6). Catherterizable conduit complications included stomal leakage in 3, mucosal prolapse at the stoma site in1 and an intra peritoneal leak requiring exploratory laprotomy and revision in1. Relative stomal continence was achieved in 98%. The preoperative serum creatinine & blood urea nitrogen (BUN) at the time of mitrofanoffs procedure at the last follow up after the procedure were sought and compared using Chi square test showed statistically significant improvement (p<0.01). No differences in outcome and complication rates were noted between different types of conduit, sites of implantation, or segments used for augmentation.Conclusions: Mitrofanoff is a safe and reliable procedure in children who are dependent on intermittent catherisation in developing countries. Appendicovesicostomy is our first option followed by yang -monti illeovesicostomy.  While stomal continence is excellent patient education, family motivation and cost reduction are important factors for its lasting efficiency.

Long-Term Follow-Up of Early Cochlear Implant Device Activation

2021 ◽  
pp. 1-11
Author(s):  
Stefanie Bruschke ◽  
Uwe Baumann ◽  
Timo Stöver
Keyword(s):  
Speech Recognition ◽  
Side Effects ◽  
Cochlear Implant ◽  
Surgical Techniques ◽  
Control Group ◽  
First Year ◽  
Safe Procedure ◽  
Sound Processor

Background: The cochlear implant (CI) is a standard procedure for the treatment of patients with severe to profound hearing loss. In the past, a standard healing period of 3–6 weeks occurred after CI surgery before the sound processor was initially activated. Advancements of surgical techniques and instruments allow an earlier initial activation of the processor within 14 days after surgery. Objective: Evaluation of the early CI device activation after CI surgery within 14 days, comparison to the first activation after 4–6 weeks, and assessment of the feasibility and safety of the early fitting over a 12 month observation period were the objectives of this study. Method: In a prospective study, 127 patients scheduled for CI surgery were divided into early fitting group (EF, n = 67) and control group (CG, n = 60). Individual questionnaires were used to evaluate medical and technical outcomes of the EF. Medical side effects, speech recognition, and follow-up effort were compared with the CG within the first year after CI surgery. Results: The early fitting was feasible in 97% of the EF patients. In the EF, the processor was activated 25 days earlier than in the CG. No major complications were observed in either group. At the follow-up appointments, side effects such as pain and balance problems occurred with comparable frequency in both groups. At initial fitting, the EF showed a significantly higher incidence of medical minor complications (p < 0.05). When developing speech recognition within the first year of CI use, no difference was observed. Furthermore, the follow-up effort within the first year after CI surgery was comparable in both groups. Conclusions: Early fitting of the sound processor is a feasible and safe procedure with comparable follow-up effort. Although more early minor complications were observed in the EF, there were no long-term wound healing problems caused by the early fitting. Regular inspection of the magnet strength is recommended as part of the CI follow-up since postoperative wound swelling must be expected. The early fitting procedure enabled a clear reduction in the waiting time between CI surgery and initial sound processor activation.

scholarly journals Glomerular function in relation to fine airborne particulate matter in a representative population sample

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ying-Mei Feng ◽  
Lutgarde Thijs ◽  
Zhen-Yu Zhang ◽  
Esmée M. Bijnens ◽  
Wen-Yi Yang ◽  
...  
Keyword(s):  
Serum Creatinine ◽  
Population Sample ◽  
Airborne Particulate Matter ◽  
Blood Stream ◽  
Renal Outcome ◽  
Cross Sectional ◽  
Cholesterol Ratio ◽  
Median Serum ◽  
Renal Responses

AbstractFrom 1990 until 2017, global air-pollution related mortality increased by 40%. Few studies addressed the renal responses to ultrafine particulate [≤ 2.5 µm (PM2.5)], including black carbon (BC), which penetrate into the blood stream. In a Flemish population study, glomerular filtration estimated from serum creatinine (eGFR) and the urinary albumin-to-creatinine ratio were measured in 2005–2009 in 820 participants (women, 50.7%; age, 51.1 years) with follow-up of 523 after 4.7 years (median). Serum creatinine, eGFR, chronic kidney disease (eGFR < 60 mL/min/1.73 m2) and microalbuminuria (> 3.5/> 2.5 mg per mmol creatinine in women/men) were correlated in individual participants via their residential address with PM2.5 [median 13.1 (range 0.3–2.9) μg/m3] and BC [1.1 (0.3–18) μg/m3], using mixed models accounting for address clusters. Cross-sectional and longitudinally, no renal outcome was associated with PM2.5 or BC in models adjusted for sex and baseline or time varying covariables, including age, blood pressure, heart rate, body mass index, plasma glucose, the total-to-HDL serum cholesterol ratio, alcohol intake, smoking, physical activity, socioeconomic class, and antihypertensive treatment. The subject-level geocorrelations of eGFR change with to BC and PM2.5 were 0.13 and 0.02, respectively (P ≥ 0.68). In conclusion, in a population with moderate exposure, renal function was unrelated to ultrafine particulate.

scholarly journals Non-Traditional Management of the Neurogenic Bladder: Tissue Engineering and Neuromodulation

2007 ◽  
Vol 7 ◽  
pp. 1230-1241 ◽  
Author(s):  
Jane M. Lewis ◽  
Earl Y. Cheng
Keyword(s):  
Tissue Engineering ◽  
Spina Bifida ◽  
Neurogenic Bladder ◽  
Cell Biology ◽  
Bladder Wall ◽  
Bladder Augmentation ◽  
Current Status ◽  
Urinary Continence ◽  
Clean Intermittent Catheterization ◽  
Bladder Tissue

Patients with spina bifida and a neurogenic bladder have traditionally been managed with clean intermittent catheterization and pharmacotherapy in order to treat abnormal bladder wall dynamics, protect the upper urinary tract from damage, and achieve urinary continence. However, some patients will fail this therapy and require surgical reconstruction in the form of bladder augmentation surgery using reconfigured intestine or stomach to increase the bladder capacity while reducing the internal storage pressure. Despite functional success of bladder augmentation in achieving a low pressure reservoir, there are several associated complications of this operation and patients do not have the ability to volitionally void. For these reasons, alternative treatments have been sought. Two exciting alternative approaches that are currently being investigated are tissue engineering and neuromodulation. Tissue engineering aims to create new bladder tissue for replacement purposes with both “seeded” and “unseeded” technology. Advances in the fields of nanotechnology and stem cell biology have further enhanced these tissue engineering technologies. Neuromodulation therapies directly address the root of the problem in patients with spina bifida and a neurogenic bladder, namely the abnormal relationship between the nerves and the bladder wall. These therapies include transurethral bladder electrostimulation, sacral neuromodulation, and neurosurgical techniques such as selective sacral rhizotomy and artificial somatic-autonomic reflex pathway construction. This review will discuss both tissue engineering techniques and neuromodulation therapies in more detail including rationale, experimental data, current status of clinical application, and future direction.

Long-term Follow-up of Sigmoid Bladder Augmentation for Low-compliance Neurogenic Bladder

Urology ◽  
2014 ◽  
Vol 84 (3) ◽  
pp. 697-701 ◽  
Author(s):  
Peng Zhang ◽  
Yong Yang ◽  
Zhi-jin Wu ◽  
Ning Zhang ◽  
Chao-hua Zhang ◽  
...  
Keyword(s):  
Neurogenic Bladder ◽  
Bladder Augmentation ◽  
Long Term Follow Up

scholarly journals Minimally invasive techniques for the treatment of benign prostatic hyperplasia

2018 ◽  
Vol 97 (3) ◽  
pp. 314-319
Author(s):  
João Arthur Brunhara Alves Barbosa ◽  
Alberto Azoubel Antunes
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Minimally Invasive ◽  
Safety Profile ◽  
Surgical Techniques ◽  
Prostatic Hyperplasia ◽  
Safe Procedure ◽  
Favorable Safety Profile ◽  
Ejaculatory Dysfunction ◽  
Favorable Safety

Benign Prostatic Hyperplasia (BPH) occurs in up to 80% of men older than 70 years. The prevalence of BPH increases with age, from approximately 25% of men at 50 years of age to 50 to 90% of individuals in their 8th decade of life. Treatment options for lower urinary tract symptoms (LUTS) secondary to BPH have been long restricted to drug therapy and, after failure of the former, surgical treatment. However, prostate surgery is associated with risks such as bleeding, necessity of transfusion and ejaculatory dysfunction. Several novel and minimally invasive methods for treatment of BPH have arisen in the past years. Common to all of these techniques are a more favorable safety profile and varying rates of success and clinical improvement, however frequently inferior to standard surgical techniques. Patients who will benefit the most from these procedures are those who would not wish to undergo surgery, those at prohibitively high risk for surgery, and those wishing to avoid ejaculatory dysfunction secondary to trans-urethral resection of the prostate (TURP) or open resection. Mechanical devices such as Temporary implantable nitinol device and Urolift appear to provide satisfying results with a favorable safety profile. Persistence of improvement is still questionable since follow-up longer than 5 years is not available for these methods. Of note, these methods may be of limited performance for larger prostates, in special, Urolift for those with a large median lobe or a prostate larger than 100 grams. Similarly, novel techniques for tissue ablation, including convective water vapor energy, appear to offer promising and safe results, yet with limited follow-up. Prostate artery embolization (PAE) is another safe procedure and an option for patients who are not suited for surgery, with satisfying short and medium-term follow-up but unknown results at long-term.

scholarly journals Crescents and Global Glomerulosclerosis in Chinese IgA Nephropathy Patients: A Five-Year Follow-Up

2019 ◽  
Vol 44 (1) ◽  
pp. 103-112 ◽  
Author(s):  
Wei Peng ◽  
Yi Tang ◽  
Li Tan ◽  
Wei Qin
Keyword(s):  
Serum Creatinine ◽  
Iga Nephropathy ◽  
Treatment Modalities ◽  
Renal Outcome ◽  
Urine Protein ◽  
Lower Egfr ◽  
Global Glomerulosclerosis ◽  
Stage Renal Disease ◽  
End Stage

Background/Aims: This study aims to evaluate the clinical significance of crescent and global glomerulosclerosis formation on renal outcome in patients with IgA nephropathy (IgAN). Methods: Biopsy-proven primary IgAN patients from West China Hospital of Sichuan University were studied retrospectively between 2008 and 2015. Clinicopathological features and treatment modalities were recorded. The patients were divided into several groups on the basis of cellular and/or fibrocellular crescents scores and global glomerulosclerosis scores. Crescent (C) was scored according to the updated Oxford classification (C0/C1/C2). Global glomerulosclerosis (G) was scored according to the frequency of global glomerulosclerosis: G0 (≤25% of glomeruli), G1 (26–50% of glomeruli), and G2 (> 50% of glomeruli). The primary endpoint was defined as a 50% reduction in renal function or end stage renal disease. Patients were followed up for at least 12 months, or shorter if they reached study endpoints. 1328 patients with IgAN were recruited. Mean follow-up time was 46.1±23.6 months. The percentage of patients with C1 and C2 was 19.3% and 5.9% respectively. Higher crescent scores was associated with lower estimated glomerular filtration rates (eGFR), decreased serum albumin levels, increased amounts of urine protein, higher serum creatinine, as well as greater proportions of M1 and E1. The percentage of patients with G0, G1 and G2 was 70.5%, 20.7% and 8.8%, respectively. Elevated glomerulosclerosis scores were associated with lower eGFR levels, increased amounts of urine protein, higher levels of serum creatinine, higher incidences of arterial hypertension, as well as greater proportions of M1. There was a significantly higher proportion of T1/2 in patients with G2. In a multivariate model, crescent and global glomerulosclerosis were identified as independent predictors of decreased renal survival. Conclusion: Global glomerulosclerosis and crescents, as detected in renal biopsies, are strong predictors of long-term renal outcome of IgAN.

scholarly journals Robotic-Assisted Endoscopic Resection of an Ectopic Ureter Draining into the Urethra in a Female Patient

2020 ◽  
pp. 1-3
Author(s):  
Anssi Petas ◽  
Anssi Petas ◽  
Jouni Huttunen ◽  
Jukka Sairanen ◽  
Niilo Hendolin
Keyword(s):  
Female Patient ◽  
Endoscopic Resection ◽  
Young Female ◽  
Urinary Continence ◽  
Ectopic Ureter ◽  
Robotic Assisted ◽  
Robotic Assisted Surgery ◽  
Ectopic Ureters

Ectopic ureters are rare in the population. We report a case of an ectopic ureter draining into the urethra in a young female. The ectopic ureter was resected in robotic assisted surgery. The urinary continence was normal at 2 years follow-up

scholarly journals Results of Winograd technique (wedge resection of the toenail and nail bed) in ingrown toe nail

2019 ◽  
Vol 6 (7) ◽  
pp. 2349 ◽  
Author(s):  
Aftab Ahmad Khan ◽  
Shiv Kumar
Keyword(s):  
Surgical Intervention ◽  
District Hospital ◽  
Wedge Resection ◽  
Surgical Techniques ◽  
Safe Procedure ◽  
Recurrence Rates ◽  
Nail Bed ◽  
A Prospective Study ◽  
Late Stages

Background: Ingrown toe nail is a very common condition affecting toes which causes significant morbidity. Most common reasons are improper nail trimming or a tight show wear. Early stages can be managed conservatively by warm soaks, antibiotics and analgesics, however late stages need surgical intervention. Numerous surgical techniques have been described for this condition.Methods: A prospective study was carried out in District hospital Doda from November 2015 to November 2017. Wedge resection of the toe nail and nail bed (Winograd technique) was used. Recurrence rates, complications and patient satisfaction was noted at the end of follow up at one year.Results: We operated 29 toes in 23 patients. We had 3 (10.34%) recurrences out of 29 toes operated, 2 (6.89%) patients got secondarily infected. The overall satisfaction rate in our series was 69.56%.Conclusions: Winograd technique is an easy and safe procedure, however chances of recurrence and cosmetic disfigurement should be explained to the patient during consent. 

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