1/3. When the sling is too proximal: a specific mechanism of persistent stress incontinence after pubovaginal sling placement.OBJECTIVES: To review a series of patients with persistent stress urinary incontinence (SUI) after pubovaginal sling (PVS) placement because of an excessively proximal position of the graft on the bladder neck. methods: Four women, who had previously undergone PVS placement for SUI, presented for evaluation of persistent SUI. All underwent investigations, including history, symptom questionnaire, quality-of-life assessment, physical examination, voiding cystourethrography, and multichannel urodynamic studies. Subsequently, takedown of the primary PVS and placement of an autologous fascial PVS were performed on all patients. A detailed case review of one of the patients is presented. RESULTS: All patients had persistent severe SUI confirmed by a positive supine stress test and Valsalva leak point pressure determination. Malposition of the graft was diagnosed preoperatively on the basis of severe distortion of the bladder base and a wide-open bladder neck at rest on the lateral standing voiding cystourethrography images. The diagnosis was confirmed on operative exploration. All patients were continent after takedown of the prior PVS and placement of an autologous fascial sling. CONCLUSIONS: Persistent SUI after PVS placement may occur secondary to positioning of the graft excessively proximally on the bladder neck. True lateral voiding cystourethrography views are essential for the precise diagnosis. In our experience, optimal management involves takedown of the primary PVS and placement of an autologous fascial PVS.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/3. stuttering priapism after ingestion of alfuzosin.A patient who presented with priapism after ingestion of alfuzosin is described. He presented with recurrent priapism, which was relieved temporarily after physical exercise. It did not subside with pharmacologic management and was managed surgically using Winter's procedure. It remained quiescent for a short period, only to reappear later. After additional conservative management, he was well enough to be discharged. At 12 months of follow-up, he was well, had no penile fibrosis, was able to have unaided intercourse, and had moderately bothersome lower urinary tract symptoms. This case illustrates that no therapeutic drug is without side effects and emphasizes the need to warn patients appropriately.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/3. Bladder outlet obstruction in the neonate.Seven neonates with severe bladder outlet obstruction causing urine retention and presenting with a large, palpable lower abdominal mass are reported. The obstruction was due in two cases to posterior urethral valves, in one case each to prune belly syndrome, prolapsing ureterocele, urethral diverticle, and in two cases to pelvic neuroblastoma. diagnosis was based on physical examination and roentgenographic studies. Therapy and prognosis of bladder outlet obstruction in neonates are discussed. Of the seven patients, 3 neonates died, the rest are developing well.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |