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Rentiya ZS, Francis D, Francis SM, Inban P, Raj R, Akuma O, Akuma CM, Montecino RMB, Singh M, Makheja K, Parkash O, Kottoor SJ. The Management of a Urinary Bladder Leak in a Patient with Radiation Cystitis. Radiol Case Rep 2024; 19:2429-2433. [PMID: 38585403 PMCID: PMC10997864 DOI: 10.1016/j.radcr.2024.02.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 04/09/2024] Open
Abstract
Urinary dysfunction following treatment for rectal adenocarcinoma is a common and complex complication. We present a case of a 69-year-old male who underwent laparoscopic-assisted left hemicolectomy and loop ileostomy after receiving chemotherapy and radiation therapy for rectal adenocarcinoma. Postoperatively, it was incidentally discovered the patient had urinary frequency and urgency. Cystoscopy revealed radiation changes to the bladder walls and a bladder leak was confirmed by cystogram. The patient underwent successful repair of the urinary bladder leak, with challenges posed by prior radiation therapy. Effective prevention and management strategies for urinary dysfunction require a comprehensive preoperative risk assessment, consideration of nerve-preserving surgical techniques, and prompt identification and repair of postoperative complications.
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Affiliation(s)
- Zubir S. Rentiya
- University of Virginia, Department of Radiation Oncology & Radiology, Charlottesville, VA, USA
- MedStar Georgetown University Hospital, Department of Surgery, Washington, DC, USA
| | - Deepa Francis
- Windsor University School of Medicine, Department of Internal Medicine, Cayon, St. Kitts and Nevis
| | - Sandra Mary Francis
- Windsor University School of Medicine, Department of Internal Medicine, Cayon, St. Kitts and Nevis
| | | | - Rohan Raj
- Nalanda Medical College and Hospital, Department of Internal Medicine, Patna, India
| | - Ogbonnaya Akuma
- Ebonyi State University, Department of Internal Medicine, Abakaliki, Nigeria
| | - Chinaza Mercy Akuma
- Nnamdi Azikiwe University, Department of Internal Medicine, Awka, Anambra state, Nigeria
| | | | - Manjeet Singh
- Liaquat National Medical College, Department of Internal Medicine, Karachi, Pakistan
| | - Kainat Makheja
- Jinnah Sindh Medical University, Department of Internal Medicine, Karachi, Pakistan
| | - Om Parkash
- Chandka Medical College, Department of Internal Medicine, Larkana, Pakistan
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Mohamed G, Ghani Z, Lynn N, Masilamani M, Rowlands J. Vesicourachal diverticulum. Ann R Coll Surg Engl 2022; 104:e255-e257. [PMID: 35446699 PMCID: PMC9685905 DOI: 10.1308/rcsann.2021.0344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 10/03/2023] Open
Abstract
We report a rare complication involving a healthy 45-year-old male patient who underwent an emergency laparoscopic appendicectomy for acute perforated gangrenous appendicitis. The patient was catheterised pre- procedure and the ports were inserted under vision. Upon completion of the procedure, a 15 Fr Robinson drain was left in the pelvis and was fed through the suprapubic port hole. Postoperatively the patient developed worsening, generalised abdominal pain and high output from the drain. The patient was re-catheterised but the computed tomography (CT) cystogram did not show any injury to the bladder. The drain fluid creatinine was noted to be raised (>4,000), indicating that urine was leaking into the drain. Conventional cystogram confirmed a contrast leak from the dome around the drain. Flexible cystoscopy confirmed that the drain had transversed the vesicourachal diverticula. The drain was pulled back and converted to a suprapubic catheter with the patient subsequently being discharged. Vesicourachal diverticula is a rare and often asymptomatic anomaly. When undertaking laparoscopic surgery, precautions should be taken to prevent port site injury such as catheterising the patient to ensure the bladder is empty and inserting the ports under direct vision. It is safer to visualise muscle rather than peritoneum during port insertion. In this case, the bladder diverticula was noticed extraperitoneally. Though the indirect CT cystogram reported no injury, this was unreliable as the bladder was not distended which led to the subtle injury being missed. Traditional cystogram should be considered in cases with a negative CT cystogram and a strong suspicion of bladder injury.
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Affiliation(s)
- G Mohamed
- Shrewsbury and Telford Hospital NHS Trust, UK
| | - Z Ghani
- Shrewsbury and Telford Hospital NHS Trust, UK
| | - N Lynn
- Shrewsbury and Telford Hospital NHS Trust, UK
| | | | - J Rowlands
- Shrewsbury and Telford Hospital NHS Trust, UK
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Rosiello G, Gandaglia G, Scuderi S, Barletta F, Fossati N, Stabile A, Gallina A, Mazzone E, Vitale LM, Pellegrino A, Bravi C, Martini A, Cucchiara V, Karakiewicz PI, Mottrie A, Briganti A, Montorsi F. Reducing the Risk of Postoperative Complications After Robot-assisted Radical Prostatectomy in Prostate Cancer Patients: Results of an Audit and Feedback Intervention Following the Implementation of Prospective Data Collection. Eur Urol Focus 2021; 8:431-437. [PMID: 33879394 DOI: 10.1016/j.euf.2021.03.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/11/2021] [Accepted: 03/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prospective data collection for perioperative outcomes might increase awareness of surgical results obtained for patients with prostate cancer (PCa) undergoing robot-assisted radical prostatectomy (RARP). This would prompt the implementation of measures aimed at reducing the risk of adverse outcomes. OBJECTIVE To assess the efficacy of an audit and feedback process aimed at identifying the most common complications after RARP and at implementing measures to improve outcomes. DESIGN, SETTING, AND PARTICIPANTS Overall, 415 patients treated with RARP by a high-volume surgeon were included. Perioperative outcomes for 187 patients treated between September 2016 and December 2017 were prospectively collected at 30 d according to the European Association of Urology guideline recommendations (group 1). An audit and feedback process was implemented in January 2018 whereby the most common complication (anastomotic leak) was identified and measures aimed at improving outcomes (changes in the anastomotic technique) were implemented. The outcomes for group 1 were then compared to 228 patients treated after implementation of the modified surgical technique (group 2). SURGICAL PROCEDURE A novel technique for posterior reconstruction and urethrovesical anastomosis was introduced. MEASUREMENTS Perioperative outcomes included blood loss, operative time, length of stay, and 30-d postoperative complications. Logistic regression models tested the effect of the novel surgical technique on anastomotic leaks. RESULTS AND LIMITATIONS Overall, 97 patients (23%) experienced postoperative complications at 30 d. The rate of anastomotic leaks was significantly lower in group 2 compared to group 1 (3.1% vs 9.6%; p < 0.01). Similarly, overall and Clavien-Dindo grade ≥2 complication rates were lower in group 2 versus group 1 (17% vs 31%, and 6% vs 20%; both p ≤ 0.001). In multivariable analyses, treatment after implementation of changes in the anastomotic technique independently predicted a lower risk of complications (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.38-0.89) and of anastomotic leaks (OR 0.43, 95% CI 0.17-0.97). The lack of randomization represents the main limitation. CONCLUSIONS Implementation of changes in the urethrovesical anastomosis technique arising from increased awareness of surgical outcomes reduced the risk of anastomotic leaks. These findings highlight the importance of audit and feedback processes using a standardized method for reporting surgical morbidity. PATIENT SUMMARY Increased awareness of surgical outcomes prompted us to change our technique for connecting the bladder to the urethra during robot-assisted surgery to remove the prostate in patients with prostate cancer. These changes resulted in significant improvements in surgical outcomes.
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Affiliation(s)
- Giuseppe Rosiello
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Giorgio Gandaglia
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simone Scuderi
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Barletta
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Fossati
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Armando Stabile
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Gallina
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elio Mazzone
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Maria Vitale
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antony Pellegrino
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carlo Bravi
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Martini
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vito Cucchiara
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Dolejs SC, Penning AJ, Guzman MJ, Fajardo AD, Holcomb BK, Robb BW, Waters JA. Perioperative Management of Patients with Colovesical Fistula. J Gastrointest Surg 2019; 23:1867-1873. [PMID: 30411309 DOI: 10.1007/s11605-018-4034-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 10/23/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Colovesical fistula (CVF) is an uncommon complication of diverticulitis. Substantial heterogeneity exists in the perioperative management of this condition. We seek to evaluate the role of bladder leak testing, closed suction drainage, prolonged bladder catheter usage, and routine postoperative cystogram in the management of CVF. STUDY DESIGN This is a retrospective study from a single academic health center investigation patients undergoing operation for diverticular CVF from 2005 to 2015 (n = 89). RESULTS Patients undergoing operative repair for diverticular CVF resection had a mortality of 4% and overall morbidity of 46%. Intraoperative bladder leak test was performed in 36 patients (40%) and demonstrated a leak in 4 patients (11%). No patients with a negative intraoperative bladder leak test developed a urinary leak. Overall, five (6%) patients developed postoperative bladder leak. Three were identified by elevated drain creatinine and two by cystogram. The diagnostic yield of routine cystogram was 3%. All bladder leaks were diagnosed between postoperative day 3 and 7. Of patients with a postoperative bladder leak, none required reoperation and all resolved within 2 months. CONCLUSIONS There is significant variability in the management of patients undergoing operation for CVF. Routine intraoperative bladder leak test should be performed. Cystogram may add cost and is low yield for routine evaluation for bladder leak after operation for CVF. Urinary catheter removal before postoperative day 7 should be considered.
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Affiliation(s)
- Scott C Dolejs
- Department of Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Alyssa J Penning
- Department of Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Michael J Guzman
- Department of Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Alyssa D Fajardo
- Department of Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Bryan K Holcomb
- Department of Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Bruce W Robb
- Department of Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Joshua A Waters
- Department of Surgery, Indiana University School of Medicine, Indianapolis, USA. .,, 1801 N. Senate Blvd., Suite 635, Indianapolis, IN, 46202, USA.
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Rajaian S, Murugavaithianathan P, Krishnamurthy K, Murugesan L. Retrograde Pyelogram during intended Cystogram: A Rare complication of a common procedure. J Clin Imaging Sci 2019; 8:55. [PMID: 30652058 PMCID: PMC6302557 DOI: 10.4103/jcis.jcis_59_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/14/2018] [Indexed: 11/15/2022] Open
Abstract
Inadvertent placement of the urinary catheter into the ureter can cause several complications. We describe a rare complication during cystogram due to unrecognized inadvertently placed urinary catheter in ureter, resulting in a life-threatening situation. A 47-year-old multiparous female underwent total laparoscopic hysterectomy for adenomyosis. During early postoperative period, she developed vesicovaginal fistula and transvaginal repair of fistula was done. During filling cystography done at 2 weeks, she developed right loin pain and urosepsis. Contrast extravasation was seen in the right renal subcapsular space with Foley's catheter inside the right ureter. Subsequently, she recovered well.
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Abstract
PURPOSE To determine normal bladder wall thickness on CT in patients without bladder disease. MATERIALS AND METHODS Four hundred and nineteen patients presenting for trauma with normal CTs of the abdomen and pelvis were included in our retrospective study. Bladder wall thickness was assessed, and bladder volume was measured using both the ellipsoid formula and an automated technique. Patient age, gender, and body mass index were recorded. Linear regression models were created to account for bladder volume, age, gender, and body mass index, and the multiple correlation coefficient with bladder wall thickness was computed. Bladder volume and bladder wall thickness were log-transformed to achieve approximate normality and homogeneity of variance. Variables that did not contribute substantively to the model were excluded, and a parsimonious model was created and the multiple correlation coefficient was calculated. Expected bladder wall thickness was estimated for different bladder volumes, and 1.96 standard deviation above expected provided the upper limit of normal on the log scale. RESULTS Age, gender, and bladder volume were associated with bladder wall thickness (p = 0.049, 0.024, and < 0.001, respectively). The linear regression model had an R2 of 0.52. Age and gender were negligible in contribution to the model, and a parsimonious model using only volume was created for both the ellipsoid and automated volumes (R2 = 0.52 and 0.51, respectively). CONCLUSION Bladder wall thickness correlates with bladder wall volume. The study provides reference bladder wall thicknesses on CT utilizing both the ellipsoid formula and automated bladder volumes.
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Affiliation(s)
- Ghaneh Fananapazir
- University of California Davis Medical Center, 4860 Y Street Suite 3100, Sacramento, CA, 95817, USA.
| | - Aleksandar Kitich
- University of California Davis Medical Center, 4860 Y Street Suite 3100, Sacramento, CA, 95817, USA
| | - Ramit Lamba
- University of California Davis Medical Center, 4860 Y Street Suite 3100, Sacramento, CA, 95817, USA
| | - Susan L Stewart
- University of California Davis Medical Center, 4860 Y Street Suite 3100, Sacramento, CA, 95817, USA
| | - Michael T Corwin
- University of California Davis Medical Center, 4860 Y Street Suite 3100, Sacramento, CA, 95817, USA
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Chang LW, Hung SC, Hu JC, Chiu KY. Retzius-sparing Robotic-assisted Radical Prostatectomy Associated with Less Bladder Neck Descent and Better Early Continence Outcome. Anticancer Res 2018; 38:345-351. [PMID: 29277793 DOI: 10.21873/anticanres.12228] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 10/25/2017] [Accepted: 10/26/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM We attempted to evaluate the association of early continence outcome of Retzius-sparing robotic assisted radical prostatectomy (RARP) and bladder neck descent with postoperative cystography. PATIENTS AND METHODS From November 2014 to December 2015, 30 patients with prostate cancer who received Retzius-sparing LRP/ RARP were compared to 30 patients that received retropubic approach RARP with propensity score matching analysis. Cystogram was used to evaluate the bladder neck descent using the bladder neck to pubic symphysis (BNPS) ratio and the continence state was evaluated. RESULTS A total 60 patients were included 30 of which had received Retzius-sparing and 30 the retropubic approach, using propensity score matching analysis. There was no difference in age, prostate size, pathology T stage and PSA among groups. BNPS ratio is significantly low in the Retzius-sparing group (0.25±0.10 vs. 0.46±0.14, p=0.000). Early continence was improved in the Retzius-sparing group and early continence within the first week was 73.3% compared to 26.7% (p=0.000), but no difference was seen at one year (100.0% vs. 93.30%, p=0.150). The independent risk factors affecting post-operative continence were age and approach. The association between less bladder neck descent as BNP ratio and continence was also confirmed (HR=0.048, 95%CI=0.005-0.420, p=0.006). CONCLUSION With the advantage of more normal pelvic anatomy preserved in Retzius-sparing RARP, it was associated with less bladder neck descent and better early continence outcome. Age was also an independent risk factor for postoperative continence.
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Affiliation(s)
- Li-Wen Chang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
| | - Sheng-Chun Hung
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, R.O.C
| | - Ju-Chuan Hu
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
| | - Kun-Yuan Chiu
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.
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Bertelson NL, Abcarian H, Kalkbrenner KA, Blumetti J, Harrison JL, Chaudhry V, Young-Fadok TM. Diverticular colovesical fistula: What should we really be doing? Tech Coloproctol 2017; 22:31-36. [PMID: 29214364 DOI: 10.1007/s10151-017-1733-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 07/14/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Colovesical fistula secondary to diverticular disease is increasing in incidence. Presentation and severity may differ, but a common management strategy may be applied. The aim of this study is to evaluate the characteristics and perioperative management of patients with colovesical fistulae and determine optimal management. METHODS From 2003 to 2012, all charts of surgical patients with diverticular colovesical fistulae at two different institutions were reviewed. Patient and presentation characteristics and perioperative management and outcomes were recorded. Patient groups with early and late catheter removal (< 8 and ≥ 8 days) were compared with significance level set at p < 0.05. RESULTS Seventy-eight patient charts were reviewed. The mean duration of symptoms was 7.5 months. Laparoscopic assisted surgery was carried out in 35% of patients. Complex bladder repair was performed in 27%. Mean length of stay was 8 days. Mean urinary catheter duration was 13 days. Seventy percent of patients underwent postoperative cystogram, with 4% positive for extravasation. Patients with early catheter removal were significantly older, more likely to have received intraoperative methylene blue instillation, and less likely to have had a complex bladder repair (p < 0.05). Complication rate, length of stay, postoperative cystography, and stent use were similar for both catheter removal groups. CONCLUSIONS Intraoperative methylene blue bladder instillation should be utilized to limit unnecessary bladder repairs. In the setting of negative methylene blue extravasation, surgeons may confidently remove urinary catheters in 7 days or less, in some cases as early as 48 h. In complex bladder repairs, cystogram is still an important adjunct, with those patients with negative studies benefiting from catheter removal at 7 days or less.
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Affiliation(s)
- N L Bertelson
- Division of Colon and Rectal Surgery, John H, Stroger Hospital of Cook County, Chicago, IL, USA.
- , 1601 E 19th Ave #6300, Denver, CO, 80238, USA.
| | - H Abcarian
- Division of Colon and Rectal Surgery, John H, Stroger Hospital of Cook County, Chicago, IL, USA
| | - K A Kalkbrenner
- Department of Colon and Rectal Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - J Blumetti
- Division of Colon and Rectal Surgery, John H, Stroger Hospital of Cook County, Chicago, IL, USA
| | - J L Harrison
- Division of Colon and Rectal Surgery, John H, Stroger Hospital of Cook County, Chicago, IL, USA
| | - V Chaudhry
- Division of Colon and Rectal Surgery, John H, Stroger Hospital of Cook County, Chicago, IL, USA
| | - T M Young-Fadok
- Department of Colon and Rectal Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA
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Raghavendran M, Kumar KG, Venugopal A, Prasad S, Venkatesh HA. Spontaneous Bladder Rupture Masquerading as Pseudo-diverticulum. Urol Case Rep 2017; 12:73-5. [PMID: 28377891 DOI: 10.1016/j.eucr.2017.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/08/2017] [Indexed: 11/21/2022] Open
Abstract
Spontaneous bladder rupture is rare. Presentation is non-specific and in absence of history of trauma, radiation, inflammatory conditions and other leading causes, there is considerable diagnostic delay. Absence of clear cut diagnostic signs leads to increased morbidity and mortality. In many patients, omentum seals perforation, giving diverticular appearance in Cystogram. The objective of this case report is to highlight important specific diagnostic points in history and radiology which will help in clear, early diagnosis and treatment causing immense benefit to the patient. We would also like to highlight a specific radiological point to distinguish true from pseudo-diverticulum.
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Tillier C, van Muilekom HAM, Bloos-van der Hulst J, Grivas N, van der Poel HG. Vesico-urethral anastomosis (VUA) evaluation of short- and long-term outcome after robot-assisted laparoscopic radical prostatectomy (RARP): selective cystogram to improve outcome. J Robot Surg 2017; 11:441-446. [PMID: 28078524 DOI: 10.1007/s11701-017-0677-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 01/02/2017] [Indexed: 01/27/2023]
Abstract
The role of a cystogram to assess the vesico-urethral anastomosis (VUA) after robot-assisted laparoscopic radical prostatectomy (RARP) has been debated. Early catheter removal without cystogram was reported to be associated with a trend towards an increased risk of acute urinary retention (AUR). In two cohorts we studied the effects of VUA leakage on cystogram and functional outcome after RARP. Cohort A contained 1390 consecutive men that routinely underwent a cystogram after RARP. Transurethral catheter (TUC) was removed in the absence of VUA leakage or minimal leakage on subsequent repeat cystogram. Outcome was compared to a group of 120 men that underwent cystography 7-10 days after RARP but had the TUC removed independent of cystography findings (cohort B). Outcome was assessed by early clinical follow-up and quality of life (QOL) questionnaires at 6 months. Men in cohort B had an increased risk of AUR and 6 months voiding complaints when compared to cohort A. The incidence of AUR and voiding complaints was associated with grade 2-3 leakage on cystography in cohort B but not in cohort A. Grade 2-3 leakage on cystogram was more likely in men with larger prostates larger and preoperative voiding complaints. Selective cystogram in men with larger prostates and preoperative lower urinary tract symptoms (LUTS) may prevent early AUR and voiding complaints after RARP when prolonged TUC use is applied.
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Affiliation(s)
- C Tillier
- Department of Urology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - H A M van Muilekom
- Department of Urology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - J Bloos-van der Hulst
- Department of Urology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - N Grivas
- Department of Urology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - H G van der Poel
- Department of Urology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
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Abstract
BACKGROUND Injuries of the urinary bladder can be associated with blunt and penetrating abdominal or pelvic trauma. In addition, they can be an iatrogenic complication in open, laparoscopic, and endoscopic urogenital or abdominal surgery. OBJECTIVES The present article reviews relevant causes of bladder injuries and the subsequent diagnostic and treatment modalities.
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Abstract
Urinary bladder is a known content of sliding inguinal hernias but rarely presents as irreducible direct inguinal hernia. As inguinal hernia repair is commonly undertaken even at peripheral surgical centers. Cystogram a simple radiological investigation (picturesque view) is useful for pre-surgical evaluation as it can prevent iatrogenic bladder injury during inguinal hernia repair. This investigation can be performed where other radiological expertises like computerized tomography scan/magnetic resonance imaging or even ultrasound facilities are not readily available.
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Affiliation(s)
- Mohinder Kumar Malhotra
- Department of Surgery, SGT Medical College, Hospital and Research Institute, Village-Budhera, Gurgaon, Haryana, India
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13
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Mahadevappa B, Suresh SC, Natarajan K, Thomas J. Cystogram with dumbbell shaped urinary bladder in a sliding inguinal hernia. J Radiol Case Rep 2009; 3:7-9. [PMID: 22470640 DOI: 10.3941/jrcr.v3i2.91] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Sliding inguinal hernias present with various symptoms and these are usually direct inguinal hernias containing various abdominal viscera. Case reports and series have been published with various organs and rare organs being part of the hernia. Urinary bladder is a known content of sliding hernias. This case report emphasizes this aspect in a picturesque manner and the importance of radiological investigations for pre-surgical evaluation.
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Affiliation(s)
- Basant Mahadevappa
- Transplantation Surgery, Westchester Medical Center, Valhalla, New York, USA
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