1/8. Sacral neuromodulation and pregnancy.PURPOSE: Sacral neuromodulation is effective for lower urinary tract dysfunction. However, despite its increasing use and a preponderance of female patients treated to our knowledge its effect in pregnant women and developing fetuses remains unknown. Therefore, we obtained information on patients on sacral neuromodulation who then achieved pregnancy. MATERIALS AND methods: Data were obtained using a standard questionnaire from 4 physicians with a total of 6 eligible patients. We recorded patient urological history, indication for neuromodulation, pregnancy course, the mode of delivery and neonatal health. We also noted the timing of implant deactivation and reactivation. RESULTS: In 5 patients the stimulator was deactivated between weeks 3 and 9 of gestation, after which 2 with a history of urinary retention had urinary tract infection. In another case, stimulation was discontinued 2 weeks before conception. The only noted complication developed in a pregnancy in which birth was premature at 34 weeks. Three patients underwent normal vaginal delivery, including 1 in whom subsequent implant reactivation did not resolve voiding dysfunction. In 3 cases elective cesarean section was performed. All neonates were healthy. CONCLUSIONS: When a patient on neuromodulation achieves pregnancy, the stimulation should be deactivated. If implant deactivation leads to urinary related complications that threaten the pregnancy, reactivation should be considered. Elective cesarean section should be discussed since it is possible for sacral lead damage or displacement to occur during vaginal delivery.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. Prolonged urinary retention after collagen periurethral injections: a sequela of humoral immunity.BACKGROUND: Approximately 3% of candidates for collagen periurethral injections are ineligible because of an immediate hypersensitivity reaction to skin testing. After a negative skin test, physicians believe patients should be free of any adverse clinical events from hypersensitivity reactions. We present a patient who developed prolonged urinary retention from a delayed hypersensitivity reaction after negative skin testing. CASE: After a negative skin test, a 51-year-old woman underwent collagen periurethral injections for recurrent genuine stress incontinence associated with a fixed bladder neck. After reporting complete resolution of symptoms, she developed complete urinary retention associated with a delayed hypersensitivity reaction at both the skin test and injection sites. Her retention resolved after a year of intermittent catheterization and antibiotics for persistent urinary tract infection. CONCLUSION: Delayed hypersensitivity reactions may be associated with an adverse clinical event in up to 2.5% of patients despite a negative skin test. After skin testing, physicians should counsel their patients accordingly.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
3/8. A case of retention of urine and haematocolpometra.SUMMARY: A 13-year-old local girl presented to the emergency department with a 12-h history of lower abdominal pain and inability to pass urine. Examination showed that she was in urinary retention and an imperforate hymen was found. Further investigation showed haematocolpos and haematometra. This is a rare cause of the retention of urine and the emergency physician should consider this condition in women between the ages of 12 and 18 years presenting with abdominal pain and obscure urinary complaints.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/8. Orthopedic pitfalls: cauda equina syndrome.low back pain is an extremely common complaint encountered by emergency and primary care physicians. Although the majority of patients have uncomplicated benign presentations, there is a small subset who has a much more severe disease process called cauda equina syndrome, which entails acute compression of the nerve roots of the cauda equina. These patients usually present posttraumatically with the triad of saddle anesthesia, bowel or bladder dysfunction, and lower extremity weakness. Significant morbidity can result from delayed diagnosis and treatment; therefore, the emergency physician should remain aware of this potential orthopedic pitfall. This case report discusses the clinical presentation, diagnosis, and relevant treatment of cauda equina syndrome in the ED.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
5/8. hematuria and clot retention after transvaginal oocyte aspiration: a case report.OBJECTIVE: To report a case of bladder injury with hematuria and urinary retention after transvaginal oocyte aspiration. DESIGN: Case report. SETTING: Emergency room in a university medical center. PATIENT(S): A 28-year-old woman presented with urinary retention and suprapubic pain 8 hours after oocyte aspiration. INTERVENTION(S): Foley catheter, intravenous fluid bolus, bladder irrigation, and computed tomography with postvoid films that showed a blood clot in the bladder. Patient was discharged home with antibiotics and catheter in place. MAIN OUTCOME MEASURE(S): Clinical follow-up. RESULT(S): Patient passed voiding trial 4 days later and was artificially inseminated. No further hematuria or voiding problems were reported, and she had a successful pregnancy. CONCLUSION(S): patients who elect to undergo oocyte aspiration should be warned about the possibility of bladder injury because of the close proximity of the ovaries to the bladder, and physicians should have an appropriate treatment plan.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/8. Acute urinary retention in children.Acute urinary retention (AUR) is an uncommon diagnosis in childhood, associated with a variety of causes. The emergency physician is often the first to be called upon to evaluate and treat these children. To assist in making the diagnosis, we present our five-year experience with AUR presenting to the pediatric urology service, often through the pediatric emergency department. We present and discuss examples of not only the common reasons for AUR but also uncommon diagnoses and, in two cases, etiologies for retention we believe have not been previously described in the pediatric literature.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/8. Acute urinary retention: an unusual presentation of appendiceal abscess.Emergency physicians frequently encounter patients with acute urinary retention. Although most common among the elderly, pediatric and young adult patients occasionally may present with this complaint. The differential diagnosis and emergency department work-up must be age specific. We discuss the case of a young man who presented with acute urinary retention, subsequently found to be caused by undiagnosed appendicitis with appendiceal abscess formation. Only nine such cases have been reported in the literature thus far, with only one occurring in the nonpediatric population. This case represents the second such case to be reported. The importance of a thorough history, physical examination, and diagnostic work-up of patients who present with acute urinary retention, particularly those in the younger age group, is emphasized.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/8. Acute urinary retention due to ectopic pregnancy.Two cases of ectopic pregnancy are presented in which acute urinary retention was a salient clinical feature. The emergency physician must consider ectopic pregnancy in the differential diagnosis in any woman of child-bearing age with abdominal, pelvic, or urinary complaints.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |