scholarly journals Direct Visual Internal Urethrotomy in Supine Position in a Patient with Complex Deformities of Both Lower Limbs and Neurogenic Bladder: A Case Report

2021 ◽  
Vol 3 (1) ◽  
pp. 34-37
Author(s):  
Balantine U. Eze ◽  
Frank K. Chacha ◽  
Timothy U. Mbaeri
Keyword(s):  
Neurogenic Bladder ◽  
Supine Position ◽  
Lower Limbs ◽  
Clean Intermittent Catheterization ◽  
Internal Urethrotomy ◽  
Short Segment ◽  
Urethral Strictures ◽  
Moderate Growth ◽  
Post Procedure ◽  
History Of

Direct visual internal urethrotomy (DVIU) is a minimally invasive treatment for urethral stricture and is usually done in lithotomy position. We presented a case of a 35-year-old man with complex deformities of both lower limbs from birth. The lower limbs were severely wasted with ankylosis of the hips, flexion of the knee joints and dorsiflexion at the ankle joints. He had a history of progressively worsening difficult in urination characterized by frequency, urgency, urgency incontinence, nocturia, poor urinary stream (improved by straining), intermittency and feeling of incomplete bladder emptying. He had occasional dysuria and total hematuria. He was not a known hypertensive or diabetic patient. No history of trauma, previous urethral instrumentation, and no history of purulent urethral discharge before the onset of problems. On presentation, his abdomen was full with slight suprapubic distention. The anal sphincter was spastic and the prostate was not enlarged. He had normal non-circumcised male external genitalia. There was no spinal deformity and the upper limbs were normal. White cell count was 14,000 cells/ mm3 with a differential neutrophil of 85.5% and urine culture showed moderate growth of coliforms. Abdominopelvic ultrasound showed a thickened bladder wall with mild hydronephrosis bilaterally and a retrograde urethrography and micturating cystourethrography showed 3 short segment bulbar urethral strictures. There was also a Christmas tree appearance of the bladder. A diagnosis of bladder outlet obstruction secondary to multiple short segment idiopathic bulbar urethral strictures on background neurogenic bladder was made. He had intravenous antibiotics for 48 hours and subsequently a DVIU under spinal anesthesia and in the supine position. Catheter was removed on the 7th day post procedure and he started clean intermittent catheterization (CIC) with 12 French catheters. Seven months post procedure, patient is still satisfied with the outcome of his treatment. We concluded that DVIU can be done safely in the supine position and CIC can help improve post procedure outcome and in managing comorbid neurogenic bladder.

scholarly journals Holmium laser vs. conventional (cold knife) direct visual internal urethrotomy for short-segment bulbar urethral stricture: Outcome analysis

2016 ◽  
Vol 10 (5-6) ◽  
pp. 161 ◽  
Author(s):  
Ankur Jhanwar ◽  
Manoj Kumar ◽  
Satya Narayan Sankhwar ◽  
Gaurav Prakash
Keyword(s):  
Urethral Stricture ◽  
Operating Time ◽  
Holmium Laser ◽  
Outcome Analysis ◽  
Internal Urethrotomy ◽  
Short Segment ◽  
Urethral Strictures ◽  
Group A ◽  
Cold Knife ◽  
Group B

Introduction: Our goal was to analyze the outcome between holmium laser and cold knife direct visual internal urethrotomy (DVIU) for short-segment bulbar urethral stricture.Methods: We conducted a prospective study comprised of 112 male patients seen from June 2013 to December 2014. Inclusion criterion was short-segment bulbar urethral stricture (≤1.5cm). Exclusion criteria were prior intervention/urethroplasty, pan-anterior urethral strictures, posterior stenosis, urinary tract infection, and those who lost to followup. Patients were divided into two groups; Group A (n=58) included cold knife DVIU and group B (n=54) included holmium laser endourethrotomy patients. Patient followup included uroflowmetry at postoperative Day 3, as well as at three months and six months.Results: Baseline demographics were comparable in both groups. A total of 107 patients met the inclusion criteria and five patients were excluded due to inadequate followup. Mean stricture length was 1.31 ± 0.252 cm (p=0.53) and 1.34 ± 0.251 cm in Groups A and B, respectively. Mean operating time in Group A was 16.3 ± 1.78 min and in Group B was 20.96 ± 2.23 min (p=0.0001). Five patients in Group A had bleeding after the procedure that was managed conservatively by applying perineal compression. Three patients in Group B had fluid extravasation postoperatively. Qmax (ml/s) was found to be statistically insignificant between the two groups at all followups.Conclusions: Both holmium laser and cold knife urethrotomy are safe and equally effective in treating short-segment bulbar urethral strictures in terms of outcome and complication rate. However, holmium laser requires more expertise and is a costly alternative.

Comparative Study Of Optical Internal Urethrotomy Versus Anastomotic Urethroplasty For Short Segment Bulbar Urethral Stricture

2020 ◽  
Vol 16 (1) ◽  
pp. 21-25
Author(s):  
Asm Shafiul Azam ◽  
Akm Kawsar Habib ◽  
Sm Mahbub Alam ◽  
Md Habibur Rahman ◽  
Md Abdus Salam ◽  
...  
Keyword(s):  
Urethral Stricture ◽  
Internal Urethrotomy ◽  
Short Segment ◽  
College Hospital ◽  
Exact Probability ◽  
Urethral Strictures ◽  
Significant Difference ◽  
Urinary Stream ◽  
Optical Internal Urethrotomy ◽  
Anastomotic Urethroplasty

Objective: This study was conducted to compare the outcome of anastomotic urethroplasty with that of traditional optical internal urethrotomy in the treatment of short-segment bulbar urethral stricture. Methods: This comparative clinical study was conducted in the Department of Urology, Dhaka Medical College Hospital over a period 1 year from January 2007 to December 2008. A total of 50 patients with short-segment (< 2 cm) bulbar urethral strictures were consecutively included in the study. The test statistics used to analyses the data were Fisher’s Exact Probability Test, Student’s t-Test. For all analytical tests, the level of significance was set at 0.05 and p < 0.05 was considered significant. Results: About one-quarter (24%) of patients in OI Urethrotomy group experienced bleeding, 4% epididymitis and another 4% incontinence. In contrast, 8% of patients in Anastomotic Urethroplasty group complained of periurethral leakage, 8% fever and another 8% wound infection. Apart from bleeding, all the complications were almost homogeneously distributed between groups.Six (24%) of patients in OI Urethrotomy Group exhibited narrow urinary stream at month 3, as opposed to none in Anastomotic Urethroplasty Group (p = 0.001). Nearly 30% of patients in OI Urethrotomy Group had narrow urinary stream at month 6 compared 4% in Anastomotic Urethroplasty Group (p = 0.024). Of the 25 patients in OI Urethrotomy Group, 1(4%) developed UTI at month 3 and 5(20%) at month 6. None of the patients in Anastomotic Urethropasty Group developed UTI. There was significant difference between groups in terms of UTI at month 6 (p = 0.025).The recurrence rate of stricture in OI Urethrotomy was 24% (6 out of 25 patients) at month 3. However, none in Anastomotic Urethroplasty Group had history of recurrence of stricture (p = 0.011). At baseline the mean uroflowmetry was 5.5 ml/sec in both groups which immediately increased to 25.3 ± 2.6 ml/sec and 23.9 ± 2.2 ml/sec in OI urethrotomy and Anastomotic Urethroplasty groups respectively and then dropped to 18.4 ± 6.3 ml/sec and 20.2 ± 2.6 ml/sec in OI Urethrotomy and Anastomotic Urethroplasty groups respectively at month 3 and to 17.8 ± 6.4 ml/sec and 19.6 ± 2.6 ml/sec respectively at month 6. Conclusion: This study concludes that Anastomotic Urethroplasty is an effective and satisfactory technique for the treatment of short-segment bulbar urethral stricture. Bangladesh Journal of Urology, Vol. 16, No. 1, Jan 2013 p.21-25

Aspergillus Spondylodiscitis After Spinal Stenosis Surgery: A Case Report

2020 ◽  
Vol 5 (3 And 4) ◽  
pp. 155-160
Author(s):  
Mohsen Aghapoor ◽  
◽  
Babak Alijani Alijani ◽  
Mahsa Pakseresht-Mogharab ◽  
◽  
...  
Keyword(s):  
Antifungal Drugs ◽  
The Body ◽  
Lower Limbs ◽  
Lumbar Pain ◽  
Case Presentation ◽  
Delay In Diagnosis ◽  
Death Case ◽  
Therapeutic Results ◽  
History Of ◽  
Probable Diagnosis

Background and Importance: Spondylodiscitis is an inflammatory disease of the body of one or more vertebrae and intervertebral disc. The fungal etiology of this disease is rare, particularly in patients without immunodeficiency. Delay in diagnosis and treatment of this disease can lead to complications and even death. Case Presentation: A 63-year-old diabetic female patient, who had a history of spinal surgery and complaining radicular lumbar pain in both lower limbs with a probable diagnosis of spondylodiscitis, underwent partial L2 and complete L3 and L4 corpectomy and fusion. As a result of pathology from tissue biopsy specimen, Aspergillus fungi were observed. There was no evidence of immunodeficiency in the patient. The patient was treated with Itraconazole 100 mg twice a day for two months. Pain, neurological symptom, and laboratory tests improved. Conclusion: The debridement surgery coupled with antifungal drugs can lead to the best therapeutic results.

scholarly journals Sirenomelia: two case reports

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Asiyeh Shojaee ◽  
Firooze Ronnasian ◽  
Mahdiyeh Behnam ◽  
Mansoor Salehi
Keyword(s):  
Case Reports ◽  
Three Dimensional ◽  
First Trimester ◽  
Mendelian Inheritance ◽  
Lower Limbs ◽  
Congenital Deformity ◽  
White Family ◽  
Her Family ◽  
Caudal Regression ◽  
History Of

AbstractBackgroundSirenomelia, also called mermaid syndrome, is a rare lethal multi-system congenital deformity with an incidence of one in 60,000–70,000 pregnancies. Sirenomelia is mainly characterized by the fusion of lower limbs and is widely associated with severe urogenital and gastrointestinal malformations. The presence of a single umbilical artery derived from the vitelline artery is the main anatomical feature distinguishing sirenomelia from caudal regression syndrome. First-trimester diagnosis of this disorder and induced abortion may be the safest medical option. In this report, two cases of sirenomelia that occurred in an white family will be discussed.Case presentationWe report two white cases of sirenomelia occurring in a 31-year-old multigravid pregnant woman. In the first pregnancy (18 weeks of gestation) abortion was performed, but in the third pregnancy (32 weeks) the stillborn baby was delivered by spontaneous vaginal birth. In the second and fourth pregnancies, however, she gave birth to normal babies. Three-dimensional ultrasound imaging showed fusion of the lower limbs. Neither she nor any member of her family had a history of diabetes. In terms of other risk factors, she had no history of exposure to teratogenic agents during her pregnancy. Also, her marriage was non-consanguineous.ConclusionThis report suggests the existence of a genetic background in this mother with a Mendelian inheritance pattern of 50% second-generation incidence in her offspring.

scholarly journals Acute-onset paraplegia as an unexpected complication under general anesthesia in supine position during abdominal endovascular aneurysm repair: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Atsushi Morio ◽  
Hirotsugu Miyoshi ◽  
Noboru Saeki ◽  
Yukari Toyota ◽  
Yasuo M. Tsutsumi
Keyword(s):  
Spinal Cord ◽  
General Anesthesia ◽  
Supine Position ◽  
Spinal Cord Ischemia ◽  
Endovascular Aneurysm Repair ◽  
Acute Onset ◽  
Lower Limbs ◽  
Canal Stenosis ◽  
Cord Injury ◽  
Aneurysm Repair

Abstract Background Acute onset paraplegia after endovascular aneurysm repair (EVAR) is a rare but well-known complication. We here show a 79-year-old woman with paraplegia caused by static and dynamic spinal cord insult not by ischemia after EVAR. Case presentation The patient underwent EVAR for abdominal aortic aneurism under general anesthesia in the supine position. She had a medical history of lumbar canal stenosis. After the surgery, we recognized severe paraplegia and sensory disorder of lower limbs. Although the possibility of spinal cord ischemia was considered at that time, postoperative magnetic resonance imaging (MRI) revealed burst fracture of vertebra and compressed spinal cord. Conclusions Patients with spinal canal stenosis can cause extrinsic spinal cord injury even with weak external forces. Thus, even after EVAR, it is important to consider extrinsic factors as the cause of paraplegia.

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