Suprapubic Cystostomy: Urinary Tract Infection and Other Short Term Complications A.T
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Melanoma of Urinary Bladder Presented As Acute Urine Retention. Nirmal Lamichhane1, Hari P Dhakal2 1Department of Surgical Oncology and 2Pathology, B
dd] fl] /on Sof fnf G;/ O] / c f : =s k L t k f = n L a B L . P A . T K I O P S IR O Nepalese Journal of Cancer (NJC) Volume 1 Issue 1 Page 67 - 70 A 2049BS/1992AD H BPKMCH LA BPKMCH,NEPAL R M CE EMORIAL CAN Case report Melanoma of Urinary Bladder presented as acute urine retention. Nirmal Lamichhane1, Hari P Dhakal2 1Department of Surgical Oncology and 2Pathology, B. P. Koirala Memorial Cancer Hospital, Bharatpur, Chitwan, Nepal. ABSTRACT This report is of a 50-year-old man with a rare urinary bladder melanoma. He presented with hematuria followed by bladder outlet obstruction at the time of presentation. Ultrasonogram of the pelvis revealed a mass in the bladder outlet, suggestive of enlarged prostate. Suprapubic cystostomy was then performed. Subsequent transvesical exploration revealed a dark coloured mass at the outlet of bladder, which on histopathology confirmed to be melanoma. After ruling out other possible primary sites, he underwent radical cysto-urethrectomy with urinary diversion. Disease was confirmed with immunohistochemistry. Patient died after 3 months with bilateral lung metastasis. Keywords: Melanoma, Urinary bladder, Cystectomy, Prognosis. INTRODUCTION but was not successful. Sonography was performed Malignant melanoma of urinary bladder is a very rare which showed enlarged prostate and distended bladder. entity and scantly reported in medical literature. Wheelock Suprapubic cystostomy was performed that comforted was the first to report a primary melanoma of the urinary the patient. bladder in 1942, and Su et al. reported the next case in 1962.1, 2 Approximately 50 patients with this tumour On asking, he had voiding type lower urinary tract have been reported in the literature shown by Medline symptoms for 2 and half months, but had no haematuria search. -
Continent Urostomy Guide
$POUJOFOU6SPTUPNZ(VJEF "QVCMJDBUJPOPGUIF6OJUFE0TUPNZ"TTPDJBUJPOTPG"NFSJDB *OD i4FJ[FUIF 0QQPSUVOJUZw CONTINENT UROSTOMY GUIDE Ilene Fleischer, MSN, RN, CWOCN, Author Patti Wise, BSN, RN, CWOCN, Author Reviewed by: Authors and Victoria A.Weaver, RN, MSN, CETN Revised 2009 by Barbara J. Hocevar, BSN,RN,CWOCN, Manager, ET/WOC Nursing, Cleveland Clinic © 1985 Ilene Fleischer and Patti Wise This guidebook is available for free, in electronic form, from United Ostomy Associations of America (UOAA). UOAA may be contacted at: www.ostomy.org • [email protected] • 800-826-0826 CONTENTS INTRODUCTION . 3 WHAT IS A CONTINENT UROSTOMY? . 4 THE URINARY TRACT . 4 BEFORE THE SURGERY . .5 THE SURGERY . .5 THE STOMA . 7 AFTER THE SURGERY . 7 Irrigation of the catheter(s) 8 Care of the drainage receptacles 9 Care of the stoma 9 Other important information 10 ROUTINE CARE AT HOME . 10 Catheterization schedule 11 How to catheterize your pouch 11 Special considerations when catheterizing 11 Care of the catheter 12 Other routine care 12 HELPFUL HINTS . .13 SUPPLIES FOR YOUR CONTINENT UROSTOMY . 14 LIFE WITH YOUR CONTINENT UROSTOMY . 15 Clothing 15 Diet 15 Activity and exercise 15 Work 16 Travel 16 Telling others 17 Social relationships 17 Sexual relations and intimacy 17 RESOURCES . .19 GLOSSARY OF TERMS . 20 BIBLIOGRAPHY . .21 1 INTRODUCTION Many people have ostomies and lead full and active lives. Ostomy surgery is the main treatment for bypassing or replacing intestinal or urinary organs that have become diseased or dysfunctional. “Ostomy” means opening. It refers to a number of ways that bodily wastes are re-routed from your body. A urostomy specifi cally redirects urine. -
Long-Term Indwelling Double-J Stent and Multiple Encrusted Stones in the Ureter and Bladder: a Case Report on Holmium Laser Treatment
Pediatr Urol Case Rep 2018; 5(6):161-164 DOI: 10.14534/j-pucr.2018645052 PEDIATRIC UROLOGY CASE REPORTS ISSN 2148-2969 http://www.pediatricurologycasereports.com Long-term indwelling double-J stent and multiple encrusted stones in the ureter and bladder: A case report on Holmium laser treatment Mehmet Hanifi Okur, Selcuk Otcu Department of Pediatric Surgery, Dicle University, School of Medicine, Diyarbakir, Turkey ABSTRACT Double-J (D-J) stents are widely used in a variety of urological interventions. Forgotten D-J stents may lead to complications, such as migration, fragmentation and encrustation. We report the case of a forgotten stent, concomitant with ureteral and bladder stones. The forgotten D-J stent was placed four years prior to our intervention, during treatment for multiple right renal stones. Holmium laser lithotripsy was used to disrupt encrustations on a ureteral orifice and the ureteral stent. The percutaneous suprapubic cystostomy was removed without breaking the stent. The patient was discharged without further complications. Key Words: Double-J (D-J) stents; forgotten stent; encrustation; stone; Holmium laser lithotripsy. Copyright © 2018 pediatricurologycasereports.com Corresponding Author: Dr. Mehmet Hanifi Okur. endourological and open surgical methods Department of Pediatric Surgery, Dicle University, have been reported for the management of School of Medicine, Diyarbakir, Turkey. forgotten D-J stents, there is no standardized E mail: [email protected] ORCID ID: https://orcid.org/0000-0002-6720-1515 approach for their removal in adults and Received 2018-10-09, Accepted 2018-10-21 children [4]. Publication Date 2018-11-01 We report on a case of a forgotten D-J ureteral stent that had been placed during a Introduction percutaneous nephrolithotomy, four years Although Double-J (D-J) stents are widely prior to our intervention. -
An Unusual Consequence of Urinary Catheter Neglect: a Giant Bladder Stone
Int J Case Rep Images 2014;5(6):427–430. Agarwal et al. 427 www.ijcasereportsandimages.com CASE REPORT OPEN ACCESS An unusual consequence of urinary catheter neglect: A giant bladder stone Archana Agarwal, Justin Gould ABSTRACT How to cite this article Introduction: Indwelling urinary catheters cause Agarwal A, Gould J. An unusual consequence of a variety of complications including infections, urinary catheter neglect: A giant bladder stone. Int J pain and bleeding. Sometimes, the catheter Case Rep Images 2014;5(6):427–430. becomes encrusted and blocked. Case Report: A 66-year-old male was presented with increasing suprapubic pain for about two months because doi:10.5348/ijcri-201481-CR-10392 of a poorly draining Foley catheter. Two years earlier, the patient had undergone a transurethral resection of the prostate (TURP) gland. He was given a Foley catheter and asked to follow-up in a week. He did not follow-up or change the catheter INTRODUCTION for two years. The catheter could not be removed. A computed tomography scan of the abdomen Indwelling urinary catheters cause a variety of showed a large encrustation of 5.0x5.2x5.5 cm complications including infections, pain and bleeding [1]. surrounding the Foley. The patient underwent Sometimes, the catheter becomes encrusted and blocked open suprapubic cystostomy with intact retrieval [1]. We present a case of a giant bladder stone formation of stone along with the catheter. Conclusion: in a patient who did not change the catheter for more Indwelling Foley catheters frequently become than two years. encrusted and may become difficulty to remove. -
Complications of Urinary Diversion
Complications of Urinary Diversion Jennifer L. Dodson, M.D. Department of Urology Johns Hopkins University Types of Diversion Conduit Diversions Ileal conduit Colon conduit Continent Diversions Continent catheterizable reservoir Continent rectal pouch 1 Overview of Complications Mechanical Stoma problems Bowel obstruction Ureteral obstruction Reservoir perforation Metabolic Altered absorption Altered bone metabolism Growth delay Stones Cancer Conduit Diversions Ileal Conduit: Technically simplest Segment of choice Colon Conduit: Transverse or sigmoid Used when ileum not appropriate (eg: concomitant colon resection, abdominal radiation, short bowel syndrome, IBD) Early complications (< 30 days): 20-56% Late complications : 28-81% Risks: abdominal radiation abdominal surgery poor nutrition chronic steroids Farnham & Cookson, World J Urol, 2004 2 Complications of Ileal Conduit Campbell’s Urology, 8th Edition, 2002 Conduit: Bowel Complications Paralytic ileus 18-20% Conservative management vs NGT Consider TPN Bowel obstruction 5-10% Causes: Adhesions, internal hernia Evaluation: CT scan, Upper GI series Anastomotic leak 1-5 % Risk factors: bowel ischemia, radiation, steroids, IBD, technical error Prevention: Pre-operative bowel prep Attention to technical detail Stapled small-bowel Anastomosis (Campbell’s Blood supply, tension-free anastomosis, Urology, 8th Ed, 2004) realignment of mesentery Farnham & Cookson, World J Urol, 2004 3 Conduit Complications Conduit necrosis: Acute ischemia to bowel -
Urinary Diversion: Ileovesicostomy/Ileal Loop/Colon Loop
Urinary Diversion: Ileovesicostomy/Ileal Loop/Colon Loop Why do I need this surgery? A urinary diversion is a surgical procedure that is performed to allow urine to safely pass from the kidneys into a pouch on a person’s abdomen (belly). It is performed for people who have otherwise untreatable urinary incontinence (leakage) chronic urinary infections, or dangerous bladder conditions that may damage kidney function. The goal of these procedures is to improve a person’s long term health and quality of life. What is a stoma? A stoma is the end of the urinary diversion that protrudes through your abdominal wall. The stoma is red, moist, soft, and has no nerve endings. A pouch is placed around the stoma to collect the urine. You will meet with an enterostomal therapy nurse prior to surgery to find the optimal location for the stoma on your abdomen, provide education regarding stoma and skin management, and show you samples of the ostomy pouches that may be used over your stoma after surgery. What is done during the surgery? A urinary diversion surgery is performed in the operating room under general anesthesia (you are not awake for the procedure). The procedure can take 3 to 5 hours, depending on the complexity. Types of urinary diversions: 1. Ileovesicostomy. Department of Urology 734-936-7030 - 1 - In this procedure, the surgeon isolates a 15cm segment of intestine (ileum) from the GI tract. The bowels are then reconnected so that you will still have regular bowel movements, if you had regular movements before. A small hole is made in the bladder and the isolated segment is then sewn to the bladder. -
EAU Guidelines on Bladder Stones 2019
EAU Guidelines on Bladder Stones C. Türk (Chair), A. Skolarikos (Vice-chair), J.F. Donaldson, A. Neisius, A. Petrik, C. Seitz, K. Thomas Guidelines Associate: Y. Ruhayel © European Association of Urology 2019 TABLE OF CONTENTS PAGE 1. INTRODUCTION 3 1.1 Aims and Scope 3 1.2 Panel Composition 3 1.3 Available Publications 3 1.4 Publication History and Summary of Changes 3 1.4.1 Publication History 3 2. METHODS 3 2.1 Data Identification 3 2.2 Review 4 3. GUIDELINES 4 3.1 Prevalence, aetiology and risk factors 4 3.2 Diagnostic evaluation 4 3.2.1 Diagnostic investigations 5 3.3 Disease Management 5 3.3.1 Conservative treatment and Indications for active stone removal 5 3.3.2 Medical management of bladder stones 5 3.3.3 Bladder stone interventions 5 3.3.3.1 Suprapubic cystolithotomy 5 3.3.3.2 Transurethral cystolithotripsy 5 3.3.3.2.1 Transurethral cystolithotripsy in adults: 5 3.3.3.2.2 Transurethral cystolithotripsy in children: 6 3.3.3.3 Percutaneous cystolithotripsy 6 3.3.3.3.1 Percutaneous cystolithotripsy in adults: 6 3.3.3.3.2 Percutaneous cystolithotripsy in children: 6 3.3.3.4 Extracorporeal shock wave lithotripsy (SWL) 6 3.3.3.4.1 SWL in Adults 6 3.3.3.4.2 SWL in Children 6 3.3.4 Treatment for bladder stones secondary to bladder outlet obstruction (BOO) in adult men 7 3.3.5 Urinary tract reconstructions and special situations 7 3.3.5.1 Neurogenic bladder 7 3.3.5.2 Bladder augmentation 7 3.3.5.3 Urinary diversions 7 4. -
Suprapubic Catheter Insertion Using an Ultrasound-Guided Technique and Literature Review BJUIBJU INTERNATIONAL Preman Jacob , Bhavan Prasad Rai * and Alistair W
Suprapubic catheter insertion using an ultrasound-guided technique and literature review BJUIBJU INTERNATIONAL Preman Jacob , Bhavan Prasad Rai * and Alistair W. Todd Department of Radiology , * Department of Urology, Raigmore Hospital, Inverness, UK Accepted for publication 9 November 2011 Suprapubic catheter (SPC) insertion is a What ’ s known on the subject? and What does the study add? common method of bladder drainage in The conventional ‘ blind ’ technique for suprapubic catheter (SPC) insertion relies on contemporary urological practice. The adequate fi lling of the bladder to displace bowel away from the site of needle procedure involves insertion of a sharp puncture. However, in a small percentage of patients this fails to happen, which trocar into the bladder percutaneously, can occasionally lead to life-threatening bowel injury. Recently published British usually by palpation, percussion or Association of Urological Surgeons (BAUS) guidelines have recommended that cystoscopy for guidance. Although ultrasonography (US) may be helpful to identify bowel loops and recommends its generally considered a safe procedure, the usage whenever possible. risk of bowel injury is estimated at up to 2.4% with a mortality rate of 1.8%. This paper describes the technique of US-guided needle puncture and SPC insertion Recently published British Association of to reduce the likelihood of bowel injury. The paper addresses training, equipment Urological Surgeons (BAUS) guidelines have and logistical issues associated with this advice. We have reviewed the available recommended that ultrasonography (US) publications on the outcomes from this technique and also present our experience. may be helpful to identify bowel loops and recommends its usage whenever possible. -
Continent Urinary Reservoirs and Bladder Substitutes.Pdf
������������������ ��������������� ������������������� �������������������� ���������������� ��������������������� Continent Cutaneous Urinary Reservoirs and Bladder Substitutes Anatomy The bladder is an organ in the pelvis that collects, stores and expels urine. Urine is produced by the kidneys and travels down two tube-like structures called the ureters. The ureters connect the kidneys to the bladder. Urine leaves the bladder through another tube-like structure called the urethra. (Figure 1) Removal of the bladder (cystectomy) may be necessary in some people with bladder cancer, congenital disor- ders of the urinary tract, and in some people who have suffered surgical, traumatic or neurologic damage to the bladder. In these situations, another method of col- lecting and excreting urine must be found. The most common and easiest method for urinary diversion is to use a short piece of intestine as the connection between the ureters and the outside of the body (ileal or colon conduit). This type of diversion is easy for the patient to manage and has a low rate of complication. However, an ostomy bag must be worn at all times to collect urine. Newer surgical techniques are available which do not require the patient to wear an ostomy bag. These newer proce- dures involve creation of a continent urinary reser- voir that collects and stores urine. What is a Continent Urinary Reservoir and How is it Made? A continent urinary reser- voir is an internal “pouch” made from segments of the intestine. Urinary reservoirs can be made from small intestine alone, large intestine alone or from a combination of the above. (Figure 2) The bowel segments selected for use are disconnected from the remainder of the intestinal tract to avoid mixing the gastrointestinal contents (feces) with urine. -
Suprapubic Cystostomy and Nephrostomy Care This Brochure Will Help You Learn How to Care for Your Catheter
Northwestern Memorial Hospital Patient Education CARE AND TREATMENT Suprapubic Cystostomy and Nephrostomy Care This brochure will help you learn how to care for your catheter. The following are general guidelines. If you have any questions or concerns, please ask your physician or nurse. Wash your A suprapubic cystostomy is a surgical Figure 1. Suprapubic hands carefully opening made into the bladder directly cystostomy above the pubic bone. A tube (catheter) before and is inserted into the bladder. The catheter is held in place by a balloon or sutures. after changing Urine flows through the catheter into a Catheter drainage bag (Figure 1). the bandage or A nephrostomy tube works much the same way, except: Tape drainage bag. ■ The surgical opening is made into the kidney. Drainage bag ■ The catheter is held in place by sutures and/or a wax wafer with a catheter holder (Figure 2). Figure 2. Nephrostomy General guidelines It is important to keep the area around the catheter site clean. Change the gauze bandage every day or any time it comes off. Change the catheter tape when it becomes soiled or loose. When taping the catheter to your skin, make sure the catheter is not kinked. If your skin is sensitive to adhesive bandage tape, use a Catheter non-allergenic tape. Wash your hands carefully before and after changing the bandage Tape or drainage bags. Avoid pulling on the catheter or tube. Do not clamp your catheter or tube. You may notice dried crusts around the outside of the catheter. These can be removed by gently wiping with a wet washcloth. -
Urinary Tract Infection
Urinary Tract Infection Urinary tract infection (UTI) is a term that is applied to a variety of clinical conditions ranging from the asymptomatic presence of bacteria in the urine to severe infection of the kidney with resultant sepsis. UTI is one of the more common medical problems. It is estimated that 150 million patients are diagnosed with a UTI yearly, resulting in at least $6 billion in healthcare expenditures. UTIs are at times difficult to diagnose; some cases respond to a short course of a specific antibiotic, while others require a longer course of a broad-spectrum antibiotic. Accurate diagnosis and treatment of a UTI is essential to limit its associated morbidity and mortality and avoid prolonged or unnecessary use of antibiotics. Advances in our understanding of the pathogenesis of UTI, the development of new diagnostic tests, and the introduction of new antimicrobial agents have allowed physicians to appropriately tailor specific treatment for each patient. EPIDEMIOLOGY Approximately 7 million cases of acute cystitis are diagnosed yearly in young women; this likely is an underestimate of the true incidence of UTI because at least 50% of all UTIs do not come to medical attention. The major risk factors for women 16–35 years of age are related to sexual intercourse and diaphragm use. Later in life, the incidence of UTI increases significantly for both males and females. For women between 36 and 65 years of age, gynecologic surgery and bladder prolapse appear to be important risk factors. In men of the same age group, prostatic hypertrophy/obstruction, catheterization, and surgery are relevant risk factors. -
A Patient Guide to Urinary Diversions This Information Will Help You Understand Your Surgical Procedure
Northwestern Memorial Hospital Patient Education CARE AND TREATMENT A Patient Guide to Urinary Diversions This information will help you understand your surgical procedure. It will be a resource for your ostomy care after leaving the hospital. Feel free to write down any questions you may have for To understand your physician and nurse. During your hospital stay, you will be visited by a wound, ostomy how your ostomy and continence (WOC) nurse. This nurse is trained and certified in the care of patients with an ostomy. The WOC nurse will work functions, you with your physician and staff nurses to aid you in your recovery. When you leave the hospital, the WOC nurse will continue to be a need to become resource person for you. familiar with the The urinary system urinary system. To understand how your ostomy functions, you need to become familiar with the urinary system (see Figure 1). The system’s main purpose is to remove urinary waste products from the body. Urine is produced in the kidneys, moves through the ureters and is stored in the bladder until urine is emptied. Urinary diversion – what is it? Sometimes the bladder must be removed or no Figure 1 longer can store urine. In these cases, some type of Kidneys bypass is needed. This is called a urinary diversion. Conditions which may lead to urinary diversion are: ■ Birth defects ■ Trauma ■ Infections ■ Tumors Ureters ■ Other blockages (not managed by conservative measures) There are several types of urinary diversions. The most common, an ileal conduit, involves a section of bowel that Bladder is removed and separated from the gastrointestinal (GI) tract.