PURPOSE OF THE STUDY: Authors present their experience in the treatment of posttraumatic distraction urethral defect resulting from traumatic rupture of posterior urethra. MATERIAL: The group comprised 19 patients with posttraumatic urethral distraction defect (average age 41 year, range 27-65 years). In 16 of them (84%) resection urehtroplasty was performed and in three (16%) endoscopic internal urethrotomy was applied. The patients were evaluated of 19 to 48 months after surgery. METHOD: Urethroplasty was performed at least three months after the trauma, always under general anesthaesia in lithotomic position, using perinal approach. Dissection of bulbar urethra was followed by dissection and resection of fibrous posttraumatic distraction defect (the original membranous urethra). Prostatic apex and proximal end of lumbar urethra were spatulated and bulboprostatic anastomosis was performed restoring urethral continuity. A catheter was left in urethra for three weeks. In 12 patients it was necessary to separe corpora cavernosa addition and 5 patients required a wedge resection of the lower arch of public bones to allow urethral bridge the defect. Endoscopic internal urehtrotomy was also performed minimally three months after trauma, always on position 12 of the clock face opposite to symphysis with a discision of the whole stenotic part. Subsequently, catheter was inserted in urethra and left in place for four days. RESULTS: Resection urethroplasty as primary surgery was successful in 15 (94%) patients and only 1 patients (6%) required another reconstruction surgery. Endoscopic management was not successful in any patients (100%). Two of them (66%) had to undergo repeatedly a reconstruction surgery, the third one (33%) is regularly dilated. All patients after urethroplasty are under regular circumstances continent, only in two of them (13%) there occurs of urine in case of an extreme increase of abdominal pressure. Erectile function already impaired by the trauma did not worsen by the surgery in 4 patients (25%), in 2 patients (13%) with preoperatively normal erections there developed erectile dysfunction after urethroplasty of which in 1 patient a permanent disorder. The quality of life was in general evaluated by patients as excellent. DISCUSSION: Epicystotomy is a simple procedure ensuring urinary diversion in patients with posterior urethral rupture. However, such management of urethral rupture almost always results in the development posttraumatic distraction defect. Incontinence occurs in our group only in 2 (12%) patients, mainly in non-standard situations (gym, urgency). Night incontinence does not occur in our patients at all. Continence is in our patients ensured by lissosfincter which is fully sufficient. Erectile dysfunction may result from a trauma or a treatment. In our group all patients have a preserved erection prior to trauma and trauma was evident cause of the loss of erection only in 2 (12%) patients who were primarily treated by epicystotomy. In another 2 patients (12%) who were primarily treated after trauma for coincidental urinary bladder rupture it is impossible to state what caused the erectile dysfunction whether a fracture or surgery. In the acute phase during the revision of the rupture of posterior urethra the peroperative risk of the impairment of neurovascular bundles responsible for erection is much higher than in planned surgery. Satisfaction of patients with the treatment is reflected in the evaluation of the postoperative results and the quality of life in general. None of our patients managed by delayed internal urethrotomy was cured. One is regularly dilated, another two underwent urethroplasty. CONCLUSION: The technique of resection of urethral distraction defects with bulboprostatic anastomosis is a suitable way of the treatment of the preceding rupture of posterior urethra without impairement of continence or erection. A prerequisite of good results is a simple urine diversion by epicystostomy during the primary management of the posterior urethral rupture. Delayed endoscopic therapy of the distraction defect will not probably cure the patients but will result in regular dilatations. It may be an alternative treatment in polymorbid or biologically older patients.
- MeSH
- lidé MeSH
- prostatektomie * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- dějiny 20. století MeSH
- lidé MeSH
- urologie * dějiny MeSH
- Check Tag
- dějiny 20. století MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- historické články MeSH
- Geografické názvy
- Česká republika MeSH
For the establishment of the therapeutic procedure in advanced hydronephroses the basic criterion is the functional state of their damaged kidney which can be assessed best by scintigraphy. The results of plastic repair of the damaged pelviureteral portion depends on the stage of hydronephrosis and the child's age. The best results were achieved in less damaged kidneys (hydronephroses I and II) in all age groups and in advanced hydronephroses (IV and V) in children under the age of one year. Early assessment of the diagnosis is important for achievement of good results. This is made possible by ultrasound screening. Early surgery can reduce the percentage of nephrectomies.
- MeSH
- dítě MeSH
- hydronefróza komplikace diagnóza chirurgie MeSH
- kojenec MeSH
- ledviny chirurgie MeSH
- lidé MeSH
- mladiství MeSH
- předškolní dítě MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
The objective of the study was to find the most suitable method of surgery of primary hydronephrosis and congestive horseshoe kidney, based on the authors own experience. The result was the finding that plastic resection operations according to Anderson-Hynes and flap operations in long stenoses and horseshoe kidneys meet the demands which are the prerequisite of favourable therapeutic results.
The authors evaluated in 13 patients the peroperative and postoperative effect of thermotherapy by transrectal ultrasonography. In all patients for a period of 60 minutes by means of a transurethral cooled catheter a temperature of 50 degrees C was applied. In the two-dimensional B picture in all patients a hypoechogenic border round the urethra was observed which gradually became defined as a canal of varying width. Changes in the blood supply of the prostate were not detected by the authors. The functional equivalent of these changes was an improved uroflowmertric finding and IPPS score.
Between December 1993 and October 1996 the authors performed laparoscopic operations of varicocele in 75 patients incl. 53 for concurrent subfertility. In all patients before operation by Doppler sonography and coloured Doppler mapping venous reflux was detected. The volume of the testis was also assessed by sonography. In subfertile patients changes of the spermiogram were assessed. After operation the blood supply was evaluated (the resistive index), the volume of the testes, the duration of the operation and changes in the spermiogram. The authors did not detect a significant difference between the group of 27 patients where with the vein also the artery was ligatured and the group of 48 patients where only the vein was ligatured. The patients were not damaged by ligature of the artery.
- MeSH
- dítě MeSH
- dospělí MeSH
- laparoskopie * MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- počet spermií MeSH
- regionální krevní průtok MeSH
- spermatogeneze * MeSH
- testis krevní zásobení diagnostické zobrazování MeSH
- ultrasonografie dopplerovská barevná MeSH
- varikokéla diagnostické zobrazování patofyziologie chirurgie MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Although the authors did not detect in 27 patients operated since October 1996 laparoscopically for varicocele, although the spermatic artery was ligatured a deteriorated blood supply of the testis, they evaluated the blood flow through the spermatic artery in the rete testis by coloured Doppler mapping during temporary peroperative ligature of the spermatic artery. In 14 patients the occlusion did not cause any changes of the blood supply of the testis, in one patient during occlusion of the artery the Doppler signal in the rete testis disappeared, after release of the ligature the blood flow reappeared in the coloured Doppler mapping. The authors conclude that in the great majority of men the blood supply of the testis is ensured by collateral circulation. If the ligature of the spermatic artery is inevitable they recommend to check during operation the blood supply of the testis in the rete testis by dopplerometry.
Renal lesions in patients with tuberous sclerosis are angiomyolipomas which are found in 47-73% of patients and cysts which are less frequent and are encountered in 18-53%. Usually they are multiple and bilateral. In the majority they are asymptomatic, sometimes they cause however by their invasive growth renal damage and serious clinical manifestations. The greatest diagnostic asset is ultrasonography, CT and magnetic resonance. In patients with tuberous sclerosis and suspected angiomyolipoma it is always necessary to rule out a malignant renal tumour, which may be sometimes quite difficult. Asymptomatic lesions do not call for treatment. Surgery is indicated in case of complications--haemorrhage threatening life, dangerous compression of neighbouring organs and suspect malignant disease. The authors describe experience with two patients where surgery was necessary, in one instance unilateral nephrectomy and in the other patient consecutive bilateral nephrectomy.
- MeSH
- dospělí MeSH
- hemangiom komplikace MeSH
- lidé MeSH
- lipom komplikace MeSH
- nádory ledvin komplikace MeSH
- tuberózní skleróza komplikace MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
