OBJECTIVETo evaluate the elective method and the clinical experience of using appendix in situ in continent urinary diversion.

METHODS26 continent urinary diversions have been performed since 1990. Among them, 11 cases underwent the intussuscepted technique and other 15 cases underwent embedded technique.

RESULTSThe continent rate was 100% at the daytime among all the case, while intermittent incontinence occurred in 3 cases at night, which happened in the intussuscepted group. Other complications included catheterization difficulty in 3 cases, appendix perforation in 1 case, which happened in the embedded group, traction of the appendix into abdominal cavity in 1 case, and prolapse of the intussusepted appendix in 3 cases.

CONCLUSIONSThe embedded technique shows better results than the intussuscepted technique in term of continence. The embedded technique, using appendix in situ as an efferent loop, shows the advantages of easily performing, timesaving, better outcome in continence and less complication. We believe the technique of appendix in situ as an efferent loop is an ideal modality in urinary diversion operation.

Adult ; Aged ; Appendix ; surgery ; Cystectomy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Urinary Bladder Neoplasms ; surgery ; Urinary Bladder, Neurogenic ; surgery ; Urinary Diversion ; methods ; Urinary Reservoirs, Continent

The artificial urinary sphincter (AUS) remains the standard of care in men with severe stress urinary incontinence (SUI) following prostate surgery and radiation. While the current AUS provides an effective, safe, and durable treatment option, it is not without its limitations and complications, especially with regard to its utility in some "high-risk" populations. This article provides a critical review of relevant publications pertaining to AUS surgery in specific high-risk groups such as men with spinal cord injury, revision cases, concurrent penile prosthesis implant, and female SUI. The discussion of each category includes a brief review of surgical challenge and a practical action-based set of recommendations. Our increased understandings of the pathophysiology of various SUI cases coupled with effective therapeutic strategies to enhance AUS surgery continue to improve clinical outcomes of many patients with SUI.
Erectile Dysfunction/surgery* ; Female ; Humans ; Male ; Penile Implantation ; Prosthesis Implantation/methods* ; Reoperation ; Spinal Cord Injuries/complications* ; Urinary Bladder, Neurogenic/surgery* ; Urinary Incontinence, Stress/surgery* ; Urinary Sphincter, Artificial

OBJECTIVETo explore the clinical value of urodynamic study in patients with neurogenic bladder by pelvic fracture postoperative.

METHODSPostoperative 12 cases with pelvic fracture resulted in uroschesis, there were 8 males and 4 females,and age from 26 to 70 years with an average of 46.5 years. Urodynamic study was done in patients at 1 d,1,3 weeks after operation and compared with 12 cases normal subjects.

RESULTSThere was a significant relationship between urodynamic parameter (including residual urine volume of bladder, max free flow, urethral closing pressure in filling end and so on) and course of disease. The residual urine volume of bladder and urethral closing pressure in filling end increased of urodynamic tests in all patients with uroschesis as compared with the normal subjects (P < 0.05); but max free flow decreased at 1 d, 1, 3 weeks after operation (P < 0.05). In the patients with uroschesis, residual urine volume of bladder markedly increased (P < 0.05) and urethral closing pressure in filling end markedly depressed (P < 0.05) at 1 week after operation than other time (at 1 d, 3 weeks after operation), but max free flow had not significant difference (P > 0.05).

CONCLUSIONUrodynamic study might evaluate regenerate the degree of neurogenic bladder by pelvic fracture postoperative and predict the prognosis of the neurogenic bladder.

Adult ; Aged ; Female ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Pelvic Bones ; injuries ; surgery ; Postoperative Complications ; etiology ; physiopathology ; Time Factors ; Urinary Bladder, Neurogenic ; etiology ; physiopathology ; Urodynamics

OBJECTIVETo observe the effects on the lower limbs function after lumbar or sacral nerve root transferring to reconstruct urination function.

METHODSNine patients with bladder dysfunction and normal lower limb function after spinal cord injury were treated with anastomosis the S2 or S3 nerve root with the normal lumbar or sacral nerve root to reconstruct a new bladder artificial reflex arc. Then the alterations on the sensation and motor function of the lower limb after the surgery were observed.

RESULTSMyodynamia of the legs decreased slightly, and the decreasing about half grade of the myodynamia in the plantar flexion of the ankles were detected in 4 of 9 patients with S1 transferring. And the myodynamia recovered 3 months postoperatively. No obvious decreasing of the myodynamia appeared in the other cases.

CONCLUSIONNo obvious effects on the motor function can be found after the single lumbar or sacral nerve root transferring to reconstruct urination function.

Adult ; Exercise ; Female ; Follow-Up Studies ; Humans ; Lower Extremity ; innervation ; physiopathology ; Lumbosacral Region ; Male ; Middle Aged ; Reflex ; Rhizotomy ; Spinal Cord Injuries ; complications ; physiopathology ; Spinal Nerve Roots ; surgery ; Treatment Outcome ; Urinary Bladder ; innervation ; physiopathology ; Urinary Bladder, Neurogenic ; etiology ; physiopathology ; surgery

OBJECTIVETo evaluate urodynamically and clinically bladder augmentation using double-deepithelialized segment of the small intestine lined with urothelium to analyse the recent outcome to treatment of hyperreflexia neurogenical bladder.

METHODS25 patients with neurogenical bladder underwent bladder augmentation using deepithelialized segment of the small intestine lined with urothelium (4 - 14 years old, 16 males and 9 females) from October 1998 to October 2000. 21 patients were followed up. Voiding cystoureterography and urodynamic and clinical evaluation were performed, and serum electrolyte, urea nitrogen and creatinine were tested before and 6 months to 2 years after operation.

RESULTSAfter operation, bladder volume, maximum urine flow rate and compliance were increased, but residual urine/bladder volume and detrusor pressure decreased. Uninhibitory contraction decreased in 15 patients. In 12 patients associated vesicoureteral reflux, clinical evaluation revealed poor outcomes before operation, but excellent (4 patients), good (9), effective (4), poor outcomes (4) after operation. Seven patients had urinary sensation recovered. Vesicoureteral reflux decreased in 9 patients. There were no electrolyte unbalance and abnormal renal function in all patients.

CONCLUSIONSBladder augmentation using double-deepithelialized segment of the small intestine lined with urothelium shows a better result currently.

Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Male ; Reflex, Abnormal ; physiology ; Urinary Bladder, Neurogenic ; physiopathology ; surgery ; Urodynamics ; physiology ; Urologic Surgical Procedures ; Urothelium ; physiology

OBJECTIVETo establish an artificial somatic-autonomic reflex arc in rats and observe the following distributive changes of neural fibers in the bladder.

METHODSAdult Sprague-Dawley rats were randomly divided into three groups: control group, spinal cord injury (SCI) group, and reinnervation group. DiI retrograde tracing was used to verify establishment of the model and to investigate the transport function of the regenerated efferent axons in the new reflex arc. Choline acetyltransferase (ChAT) in the DiI-labeled neurons was detected by immunohistochemistry. Distribution of neural fibers in the bladder was observed by acetylcholine esterase staining.

RESULTSDiI-labeled neurons distributed mainly in the left ventral horn from L3 to L5, and some of them were also ChAT-positive. The neural fibers in the bladder detrusor reduced remarkably in the SCI group compared with the control (P < 0.05). After establishment of the somatic-autonomic reflex arc in the reinnervation group, the number of ipsilateral fibers in the bladder increased markedly compared with the SCI group (P < 0.05), though still much less than that in the control (P < 0.05).

CONCLUSIONThe efferent branches of the somatic nerves may grow and replace the parasympathetic preganglionic axons through axonal regeneration. Acetylcholine is still the major neurotransmitter of the new reflex arc. The controllability of detrusor may be promoted when it is reinnervated by the pelvic ganglia efferent somatic motor fibers from the postganglionic axons.

Acetylcholinesterase ; biosynthesis ; Anastomosis, Surgical ; Animals ; Autonomic Fibers, Preganglionic ; physiology ; Cholinergic Fibers ; metabolism ; Immunohistochemistry ; Motor Neurons ; cytology ; metabolism ; Nerve Regeneration ; physiology ; Neural Pathways ; cytology ; metabolism ; Rats ; Rats, Sprague-Dawley ; Reflex ; physiology ; Spinal Cord Injuries ; physiopathology ; Spinal Nerve Roots ; surgery ; Urinary Bladder ; innervation ; physiology ; surgery ; Urinary Bladder, Neurogenic ; surgery

Epiduroscopy is defined as a percutaneous, minimally invasive endoscopic investigation of the epidural space. Periduroscopy is currently used mainly as a diagnostic tool to directly visualize epidural adhesions in patients with failed back surgery syndrome (FBSS), and as a therapeutic action in patients with low back pain by accurately administering drugs, releasing inflammation, washing the epidural space, and mechanically releasing the scars displayed. Considering epiduroscopy a minimally invasive technique should not lead to underestimating its potential complications. The purpose of this review is to summarize and explain the mechanisms of the side effects strictly related to the technique itself, leaving aside complications considered typical for any kind of extradural procedure (e.g. adverse reactions due to the administration of drugs or bleeding) and not fitting the usual concept of epiduroscopy for which the data on its real usefulness are still lacking. The most frequent complications and side effects of epiduroscopy can be summarized as non-persistent post-procedural low back and/or leg discomfort/pain, transient neurological symptoms (headache, hearing impairment, paresthesia), dural puncture with or without post dural puncture headache (PDPH), post-procedural visual impairment with retinal hemorrhage, encephalopathy resulting in rhabdomyolysis due to a dural tear, intradural cyst, as well as neurogenic bladder and seizures. We also report for first time, to our knowledge, a case of symptomatic pneumocephalus after epiduroscopy, and try to explain the reason for this event and the precautions to avoid this complication.
Brain Diseases ; Cicatrix ; Epidural Space ; Failed Back Surgery Syndrome ; Hearing Loss ; Humans ; Inflammation ; Leg ; Low Back Pain ; Paresthesia ; Pharmaceutical Preparations ; Pneumocephalus ; Post-Dural Puncture Headache ; Punctures ; Retinal Hemorrhage ; Rhabdomyolysis ; Seizures ; Tears ; Tissue Adhesions ; Urinary Bladder, Neurogenic ; Vision Disorders

OBJECTIVETo identify and separate the ventral root from dorsal root, which is the key for success of the artificial somatic-autonomic reflex pathway procedure for neurogenic bladder after spinal cord injury (SCI). Here we report the results of intra-operating room monitoring with 10 paralyzed patients.

METHODSTen male volunteers with complete suprasacral SCI underwent the artificial somatic-autonomic procedure under general anesthesia. Vastus medialis, tibialis anticus and gastrocnemius medialis of the left lower limb were monitored for electromyogram (EMG) activities resulted from L4, L5, and S1 stimulation respectively to differentiate the ventral root from dorsal root. A Laborie Urodynamics system was connected with a three channel urodynamic catheter inserted into the bladder. The L2 and L3 roots were stimulated separately while the intravesical pressure was monitored to evaluate the function of each root.

RESULTSThe thresholds of stimulation on ventral root were 0.02 ms duration, 0.2-0.4 mA, (mean 0.3 mA+/-0.07 mA), compared with 0.2-0.4 ms duration, 1.5-3 mA (mean 2.3 mA+/-0.5 mA) for dorsal root (P<0.01) to cause revoked potentials and EMG. Electrical stimulation on L4 roots resulted in the EMG being recorded mainly on vastus medialis, while stimulation on L5 or S1 roots caused electrical activities of tibialis anticus or gastrocnemius medialis respectively. The continuous stimulation for about 3-5 seconds on S2 or S3 ventral root (0.02 ms, 20 Hz, and 0.4 mA) could resulted in bladder detrusor contraction, but the strongest bladder contraction over 50 cm H2O was usually caused by stimulation on S3 ventral root in 7 of the 10 patients.

CONCLUSIONSIntra-operating room electrophysiological monitoring is of great help to identify and separate ventral root from dorsal root, and to select the appropriate sacral ventral root for best bladder reinnervation. Different parameters and thresholds on different roots are the most important factors to keep in mind to avoid damaging the roots and to assure the best results.

Adult ; Autonomic Pathways ; physiopathology ; Electric Stimulation Therapy ; methods ; Electromyography ; Electrophysiology ; methods ; Humans ; Male ; Muscle Contraction ; Muscle, Skeletal ; physiopathology ; Muscle, Smooth ; physiopathology ; Reflex ; Spinal Cord Injuries ; complications ; physiopathology ; Spinal Nerve Roots ; physiopathology ; surgery ; Thigh ; Urinary Bladder ; innervation ; physiopathology ; Urinary Bladder, Neurogenic ; etiology ; physiopathology ; surgery