DOCSLIB.ORG

2 Continence

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
2 Continence C:/Postscript/02_HCNA3_D3.3d – 10/1/7 – 8:41 [This page: 69] 2 Continence Catherine W McGrother and Madeleine Donaldson* 1 Summary Statement of the problem Urinary incontinence is the main symptom of disordered storage of urine as distinct from disordered voiding. It represents several underlying conditions within a classification of diseases of the bladder which needs further development. The two main disorders featuring incontinence are overactive bladder, involving urge incontinence, and sphincter incompetence, involving stress incontinence. However, there are substantial overlaps with conditions such as dementia and stroke, particularly in elderly people, and for those with discrete neurological disorders and long-term disabilities including MS, and learning disability. The two most important recent issues in relation to service provision have been (i) the extent of need related to incontinence, in view of symptom prevalence reports ranging up to two-thirds of the population in women and (ii) the effectiveness of a nurse-led service crossing the primary/secondary care interface. These issues have been comprehensively addressed over the last few years by a research programme funded by the MRC with DoH support. This review includes insights from this research which is still ongoing. The role of the GP in assessment and management of the underlying condition is hampered by a lack of information, training and experience and the lack of an integrated specialist service. Further issues, where more information is needed to develop policy, concern the best management of people with overlapping conditions, e.g. stroke, MSand learning disability, who already receive specialist input of various kinds. One of the longer-term issues concerns the merits of extending an integrated incontinence services to include all disorders of the bladder and its outlet, in view of the extensive overlap between storage and voiding symptoms and the uncertainty about the distinctions between underlying conditions and about the management of prostatic enlargement. * The following people also contributed to this chapter: RP Assassa, Consultant Urogynaecologist, Mid-Yorkshire Hospital NHSTrust and Honorary SeniorLecturer, Department of Epidemiology and Public Health, University of Leicester; TA Hayward, Research Assistant, Department of Epidemiology and Public Health, University of Leicester; G Matharu, Specialist Registrar in Obstetrics and Gynaecology, Leicester General Hospital; DA Turner, Research Associate in Health Economics, Trent Institute for Health Services Research, Department of Epidemiology and Public Health, University of Leicester; A Wagg, Consultant in Geriatrics, Care of the Elderly Department, University College Hospital, London; J Warsame, Specialist Registrar in Public Health Medicine, Department of Epidemiology and Public Health, University of Leicester; JM Watson, Research Associate, Department of Epidemiology and Public Health, University of Leicester; KSWilliams, SeniorNursing Research Fellow, Department of Epidemiology and Public Health, University of Leicester. C:/Postscript/02_HCNA3_D3.3d – 10/1/7 – 8:41 [This page: 70] 70 Continence Sub-categories Storage disorder signifies the totality of clinically recognised abnormal storage symptoms including incontinence, urgency, frequency and nocturia. Incontinence serves as the main epidemiological indicator and has two commonly recognised levels of severity – any and moderate/monthly. At primary care level the syndrome of overactive bladder is commonly represented by the symptoms of urgency, including urge incontinence, often occurring in association with frequency and nocturia. Similarly, sphincter incompe- tence is commonly represented by the symptom of stress incontinence. The ICD-10 codes (see Table 2) encompass all the conditions associated with incontinence but the sub- categories lack coherence. The International Continence Society reflects current thinking in re-organising the main sub-categories as detrusor overactivity (DO) with idiopathic and neurogenic components, and urodynamic stress incontinence (USI). Less common categories involving incontinence in men include chronic retention of urine with overflow, mostly due to prostatic enlargement and post-micturition dribble due to abnormal relaxation of the external sphincter. Health care need is defined in terms of objectively defined abnormal storage symptoms and impact on life. Felt need is defined more subjectively in terms of apparent motivation to obtain help indicated by either using services or wanting help. Health care requirement represents felt need within the context of the defined health care need. Prevalence and incidence The results of a systematic review of UK studies suggest that bladder malfunction is very common, often distressing for the individual and represents a major public health problem in the UK that may be increasing over time. Incontinence and other storage symptoms should be conceptualised as disorder of the bladder on a par with and indeed related to other organ systems of the body and deserve similar consideration for research and service development. Across a range of UK studies, the prevalence of any incontinence averages out at around 40% for women and 10% for men. Incontinence with impact on life is estimated around 30% for women. For those aged 40 or more, storage disorder as a whole affects around 39% of women and 29% of men. This represents considerably more men than are affected by incontinence alone (Table 1). These results are consistent with findings from around the world and the current MRC programme of research. There were no published UK studies available that estimated the full extent of felt need in relation to storage disorder. We estimate this at 25% in women and 18% in men within the previous year, indicating the level of health care requirement. These levels cannot be ascribed to measurement error or uncertainty over thresholds. They appear high in relation to other individual conditions partly because incontinence/storage disorder represents several common conditions affecting the bladder. There is an overall increase in prevalence of symptoms with age in both women and men but the latter start from a lower base after childhood, increasing to similar levels in old age. Women experience a peak of prevalence around menopause, due to stress incontinence. The rise seen in elderly people is related to urge incontinence. These two types of incontinence place very different demands on services, especially with regard to surgery. Overall, the prevalence of need increases with age and the major problem is apparent in old age, equally among men and women. C:/Postscript/02_HCNA3_D3.3d – 10/1/7 – 8:41 [This page: 71] Continence 71 Table 1: Urinary incontinence and storage disorder: prevalence, impact and use of services from UK studies – 1960–2001. Average prevalence % (range in studies)a Women Men Storage disorderd 39 (–) 29 (–) Incontinence (minor)d 40 (16–69) 10 (8–25) Incontinence (monthly) 12 (8–23) 5 (3–9) Nocturia (2þ) 15 (14–26) 15 (14–20) Frequency (hourly) 9 (–) 5 (–) Urgency (difficulty) 9 (6–9) 5 (3–5) Impact – anyd 30 (17–44) 12b (11–12) – more than a little 8 (8–30) 4 (3–6) Consultation 6 (2–11) 3 (1–7) Want help/uptake on offerc 5 (4–9) 4 (3–4) a Estimated from graphs. b Elderly ages only. c Indicator of unmet need. d Indicator of health care need. The prevalence of incontinence is 2–3 times higher in residential care and hospitals and among people with severe disabilities of various kinds than in the general population. Incontinence probably operates as a selection factor but it could deteriorate as a result of institutional care. The incidence of incontinence suggests three distinct peaks in women – early reproductive age, menopause and old age with rates ranging between 6–22% for women and half this for men. The natural history suggests a marked tendency to fluctuation with elements of both remission and progression. There are clear associations with pregnancy/parity, obesity and cognitive impairment, and fairly consistent relationships with stroke and depression. Services available and their costs Division of care between professionals is complex, with varied models of service around the country. Patients may present to GPs or go directly (or indirectly) to continence nurses in the community. They may be treated extensively within primary care with behavioural and medical therapies or be referred at an early stage to specialists, including neurologists, geriatricians, urologists and gynaecologists. In relation to health service pathways for incontinence, most younger women are referred to gynaecologists whereas most older men and women are referred to physicians for the elderly; whilst for voiding problems most men are referred to urologists. Continence nurses of various kinds play a considerable role in managing the problem but the nature and extent of provision is very variable across the country. Community nurses are often the first port of call for patients with incontinence. They may make the initial in-depth assessment and are often involved in providing some degree of behavioural therapy for the common disorders and long-term aids for intractable conditions. C:/Postscript/02_HCNA3_D3.3d – 10/1/7 – 8:41 [This page: 72] 72 Continence Primary care The key issues in the provision of appropriate services to date have been the level of interest in continence on the part of the health care provider, the fragmented approach to provision of specialised services in secondary
Load more

Recommended publications
  • Prof.Dr. S.Mohamed Musthafa
    PROF.DR. S.MOHAMED MUSTHAFA M.B.B.S., M.S(GEN.SURGERY) D.L.O (ENT) FAIS.,FICS.,FACRSI., PROFESSOR OF SURGERY S.R.M. MEDICAL COLLEGE AND RESEARCH CENTRE KATTANKULATHUR – 603 203 INJURIES TO THE MALE URETHRA ANATOMY OF URETHRA TUBULAR PASSAGE EXTEND: NECK OF BLADDER TO EXT. URETHRAL MEATUS O 20 CM O 3.75 CM MALE URETHRA 3 PARTS PROSTATIC PART (3.1 CM) MEMBRANEOUS PART 1.25 CM 1.9 CM SPONGY PART 15 CM BLOOD SUPPLY: ARTERIES TO BULB Br OF INTERNAL PUDENTAL A NERVE SUPPLY PERINEAL Br OF PUDENDAL NERVE INJURIES TO THE MALE URETHRA y RUPTURE OF THE BULBAR URETHRA y RUPTURE OF THE MEMBRANOUS URETHRA RUPTURE OF THE BULBAR URETHRA CAUSE y FALL ASTRIDE PROJECTING OBJECT CYCLING ACCIDENTS y LOOSE MANHOLE COVERS y GYMMNASIUM ACCIDENTS y WORKERS LOSING THEIR FOOTING CLINICAL FEATURES SIGNS y RETENTION OF URINE y PERINEAL HAEMATOMA – SWELLING y BLEEDING FROM EXT.URINARY MEATUS. ASSESSMENT ANALGESIC IF SUSPECTED RUPTURE – DISCOURAGE URETHRA FROM PASSING URINE. FULL BLADDER – PERCUTANEOUS SUPRAPUBIC SPC CATHETER DRAINAGE IF PT. ALREADY PASSED URINE WHEN FIRST SEEN NO EXTRAVASATION PARTIAL URETHRAL RUPTURE SPC NOT NEEDED TREATMENT AVOID INJUDICIOUS CATHETERISATION IT WILL CONVERT PARTIAL TEAR COMPLETE TRANSECTION ASSESS URETHRAL INJURY ASCENDING URETHROGRAM WITH WATER BASED CONTRAST FLEXIBLE CYSTOSCOPY NO FACILITIES FOR SPC VERY OCCASIONALLY TRY TO PASS SOFF, SMALL CALIBRE CATHETER WITHOUT FORCE. COMPLETE URETHRAL TEAR SPC – ARRANGE FOR REPAIR SOME SURGEONS – EARLY INTERVENSION EARLY OPEN REPAIR EARLY REPAIR EXCISION OF TRAUMATISED SECTION AND SPATULATED END TO END REANASTAMOSIS OF URETHRA. OTHER SURGEONS WAIT LONGER FOR REPAIR USING URETHROSCOPE TO FIND WAY ACROSS GAP IN URETHRA WAIT LONGER y ALLOWS URETHRAL CATHETER TO BE PLACED y ENDS OF URETHRA ARE ALIGNED HEALING OCCUR COMPLICATION IF THE PT.
    [Show full text]
  • 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.
    [Show full text]
  • Case Report Jun 2013; Vol 23 (No 3), Pp: 360-362
    Iran J Pediatr Case Report Jun 2013; Vol 23 (No 3), Pp: 360-362 Spontaneous Rupture of Kidney Due to Posterior Urethral Valve– Diagnostic Difficulties Katarzyna Kiliś-Pstrusińska1 ,MD,PhD; Agnieszka Pukajło-Marczyk1,MD; Dariusz Patkowski2 ,MD,PhD; Urszula Zalewska-Dorobisz3 ,MD,PhD; Danuta Zwolińska1 ,MD,PhD 1. Department of Paediatric Nephrology, Wroclaw Medical University, Wrocław, Poland 2. Department of Paediatric Surgery and Urology, Wroclaw Medical University, Wrocław, Poland 3. Department of Radiology, Wroclaw Medical University, Wrocław, Poland Received: Jan 18, 2012; Accepted: Aug 04, 2012; First Online Available: Nov 22, 2012 Abstract Background: Spontaneous kidney rupture could develop in the course of posterior urethral valve (PUV), the most common cause of outflow urinary tract obstruction in male infants. However, urinary extravasation is a rare complication among this group of children. Case Presentation: Our case report presents diagnostic difficulties connected with spontaneous kidney rupture due to PUV in a 6 week-old infant. Due to not equivocal images, thundery course of disease and rapid deterioration in the infant`s condition, the patient required an urgent laparatomy. Conclusion: This case showed that the investigation of renal abnormalities during early neonatal period, is very important specifically in PUV that can lead to kidney rupture. Iranian Journal of Pediatrics, Volume 23 (Number 3), June 2013, Pages: 360-362 Key Words: Urinoma; Kidney Rupture; Urinary Extravasation; Posterior Urethral Valve Introduction rare complication among this group of children. The clinical manifestation is often nonspecific. Kidney rupture in developmental age most often Our report presents diagnostic difficulties takes place in the aftermath of multiorgan trauma, connected with spontaneous kidney rupture due especially when urinary abnormalities or to PUV in a 6-week old male.
    [Show full text]
  • Textbook of Urogynaecology
    Textbook of Urogynaecology Editors: Stephen Jeffery Peter de Jong Developed by the Department of Obstetrics and Gynaecology University of Cape Town Edited by Stephen Jeffery and Peter de Jong Creative Commons Attributive Licence 2010 This publication is part of the CREATIVE COMMONS You are free: to Share – to copy, distribute and transmit the work to Remix – to adapt the work Under the following conditions: Attribution. You must attribute the work in the manner specified by the author or licensor (but not in any way that suggests that they endorse you or your use of the work) Non-commercial. You may not use this work for commercial purposes. Share Alike. If you alter, transform, or build upon this work, you may distribute the resulting work but only under the same or similar license to this one. • For any reuse or distribution, you must make clear to others the license terms of this work. One way to do this is with a link to the license web page: http://creativecommons.org/licenses/by-nc-sa/2.5/za/ • Any of the above conditions can be waived if you get permission from the copyright holder. • Nothing in this license impairs or restricts the authors’ moral rights. • Nothing in this license impairs or restricts the rights of authors whose work is referenced in this document • Cited works used in this document must be cited following usual academic conventions • Citation of this work must follow normal academic conventions http://za.creativecommons.org Contents List of contributors 1 Foreword 2 The Urogynaecological History 3 Lower Urinary Tract Symptoms and Urinary incontinence: Definitions and overview.
    [Show full text]
  • A Highly Uncommon Variation of Spontaneous Urinary Extravasation As an Unusual Presentation of Distal Ureteric Calculus
    Open Access Austin Journal of Radiology Case Presentation A Highly Uncommon Variation of Spontaneous Urinary Extravasation as an Unusual Presentation of Distal Ureteric Calculus Fouad Hajji*, Abdellatif Janane, Mohammed Ghadouane, Ahmed Ameur and Mohammed Abstract Abbar Urolithiasis is a leading cause of acute abdominal pain and one of the most Department of Urology, Mohammed V Military common conditions seen in emergency departments worldwide. Spontaneous University Hospital, Rabat/Morocco Urinary Extravasation (SUE) is a relatively uncommon manifestation of distal *Corresponding author: Fouad Hajji, Department ureteric urolithiasis and has a wide spectrum of clinical presentations depending of Urology, Mohammed V Military University Hospital, on the site of urine leakage. Perforation could occur at any level from the calix Ryad Street-10100, Rabat/Morocco to the bladder but it is usually seen at the fornices or upper ureter. It is important to distinguish true rupture of the ureter from the forniceal tear with backflow Received: May 05, 2015; Accepted: May 26, 2015; extravasation because clinical presentations, outcomes and treatments are Published: June 03, 2015 different. In this case study, a 29-year-old man was admitted to our hospital with sudden-onset of left fossa iliaca pain, fever and lower urinary tract symptoms after a short pain-free period following spontaneous cessation of an acute renal colic. He also had a microscopic haematuria and pyuria on his urinalysis. Contrast Enhanced Computed Tomography of the abdomen (CECT) showed an impacted tiny calculus (< 5mm) in the left intramural ureter and a urine extravasation from both the calyceal fornix and the upper ureter. This unique case is a highly uncommon variant of stone-induced SUE because of a special association between these two phenomena, raising both diagnostic and management challenges.
    [Show full text]
  • Urine Culture, Bacterial
    190.12 - Urine Culture, Bacterial Other Names/Abbreviations Urine culture Description A bacterial urine culture is a laboratory test service performed on a urine specimen to establish the probable etiology of a presumed urinary tract infection. It is common practice to do a urinalysis prior to a urine culture. A urine culture for bacteria might also be used as part of the evaluation and management of another related condition. The procedure includes aerobic agar- based isolation of bacteria or other cultivable organisms present, and quantitation of types present based on morphologic criteria. Isolates deemed significant may be subjected to additional identification and susceptibility procedures as requested by the ordering physician. The physician’s request may be through clearly documented and communicated laboratory protocols. HCPCS Codes (Alphanumeric, CPT AMA) Code Description 87086 Culture, bacterial; quantitative, colony count, urine. 87088 Culture, bacterial; with isolation and presumptive identification of each isolates, urine. ICD-10-CM Codes Covered by Medicare Program The ICD-10-CM codes in the table below can be viewed on CMS’ website as part of Downloads: Lab Code List, at http://www.cms.gov/Medicare/Coverage/CoverageGenInfo/LabNCDsICD10.html Code Description A02.1 Salmonella sepsis A18.14 Tuberculosis of prostate A34 Obstetrical tetanus A40.0 Sepsis due to streptococcus, group A A40.1 Sepsis due to streptococcus, group B A40.3 Sepsis due to Streptococcus pneumoniae A40.8 Other streptococcal sepsis A40.9 Streptococcal sepsis, unspecified A41.01 Sepsis due to Methicillin susceptible Staphylococcus aureus A41.02 Sepsis due to Methicillin resistant Staphylococcus aureus A41.1 Sepsis due to other specified staphylococcus NCD 190.12 Urine Culture, Bacterial 1 Code Description A41.2 Sepsis due to unspecified staphylococcus A41.3 Sepsis due to Hemophilus influenzae A41.4 Sepsis due to anaerobes A41.50 Gram-negative sepsis, unspecified A41.51 Sepsis due to Escherichia coli [E.
    [Show full text]
  • Urinary Incontinence (UI)
    ICD-10-CM Specialty Code Set Training Urology 2014 Module 2 Disclaimer This course was current at the time it was published. This course was prepared as a tool to assist the participant in understanding how to prepare for ICD-10-CM. Although every reasonable effort has been made to assure the accuracy of the information within these pages, the ultimate responsibility of the use of this information lies with the student. AAPC does not accept responsibility or liability with regard to errors, omissions, misuse, and misinterpretation. AAPC employees, agents, and staff make no representation, warranty, or guarantee that this compilation of information is error-free and will bear no responsibility, or liability for the results or consequences of the use of this course. AAPC does not accept responsibility or liability for any adverse outcome from using this study program for any reason including undetected inaccuracy, opinion, and analysis that might prove erroneous or amended, or the coder’s misunderstanding or misapplication of topics. Application of the information in this text does not imply or guarantee claims payment. Inquiries of your local carrier(s)’ bulletins, policy announcements, etc., should be made to resolve local billing requirements. Payers’ interpretations may vary from those in this program. Finally, the law, applicable regulations, payers’ instructions, interpretations, enforcement, etc., may change at any time in any particular area. This manual may not be copied, reproduced, dismantled, quoted, or presented without the expressed written approval of the AAPC and the sources contained within. No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval system or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or taping) without the expressed written permission from AAPC and the sources contained within.
    [Show full text]
  • Spontaneous Fornix Rupture Due to Obstructive Ureteral Stone
    91 Erciyes Med J 2014 36(2): 91-3 • DOI: 10.5152/etd.2013.48 Spontaneous Fornix Rupture Due to Obstructive Ureteral Stone CASE REPORT Cevdet Serkan Gökkaya, Mehmet Murat Baykam, Sedat Yahşi, Süleyman Bulut, Binhan Kağan Aktaş, Ali Memiş ABSTRACT Spontaneous rupture of the renal fornix and urinary extravasation are very rarely encountered in urological practice. In the present paper, a 57-year-old male patient who suddenly developed spontaneous rupture of the fornix and urinary extravasation due to obstructive ureteral stone is presented. The patient developed a sudden onset of renal colic pain without any trauma. His complete blood count and kidney function tests were within the normal limits. Microscopic hematuria was detected on complete urinalysis. There was no urinary opacity on plain X-ray. On urinary ultrasonography, the left renal pelvis and ureter were dilated and there was a hyperechoic appearance consistent with a stone approximately 4 mm in diameter at the distal end of the left ureter. Grade 1 dilatations of the left renal pelvis and ureter and extravasation of contrast material at the peripelvic area were observed on intravenous pyelography. Spiral computed tomography also showed extravasation of contrast material in the left pararenal area. In the present case, double J stent catheterization was performed in order to control symptoms and eliminate ex- travasation. His postoperative pain decreased and alpha-blocker treatment was initiated at the follow-up. Extravasation regressed and hydronephrosis disappeared on follow-up ultrasounds. Two weeks later, the patient stated that he had passed the stone. The catheter was withdrawn and the patient was discharged on the same day.
    [Show full text]
  • GU Model with Coding and Final Definitions V2.Xlsx
    This document created by the Nursing Knowledge Big Data Science Information Modeling Workgroup is licensed under the Creative Commons Attribution Non-Commercial- Share Alike 4.0 International License in January, 2020. To view a summary of the license, go to https://creativecommons.org/licenses/by-nc-sa/4.0/legalcode. Westra BL, Lytle KS, Whittenburg L, Adams M, Ali S, Furukawa M, Hartleben S, Hook M, Johnson S, Collins Rossetti S, Settergren TT. A refined methodology for validation of information models derived from flowsheet data and applied to a genitourinary case. J Am Med Inform Assoc. 2020 Sep 17:ocaa166. doi: 10.1093/jamia/ ocaa166. Epub ahead of print. PMID: 32940673. Concept Synonyms Definitions LOINC LOINC Name SCT ID SCT Term Genitourinary Synonyms No problems with voiding, urine, genitalia 80335‐3 Genitourinary Within Defined associated with voiding, nor any GU Assessment Within Defined LA25085‐4 WDL Limits (WDL) WDL Except Voiding Synonyms Assessment of the patient's ability to Assessment eliminate urine Voiding Changes in voiding Signs (objective data) or symptoms 80332‐0 Voiding Pattern Characteristics patterns (subjective experience) of a genitourinary Alterations in voiding disease or change in condition Voiding signs and symptoms Acute pain Use pain assessment concepts (abdomen, pelvis, back) Anuria Nonpassage of urine, in practice is LA25308‐0 Anuria 2472002 Anuria (finding) defined as passage of less than 100 milliliters of urine in a day Bladder distension Volume > 500–600 ml 54768000 Bladder distention (finding) Bladder fullness Sensation of fullness a Persistent and strong desire to urinate 247335009 Sensation as if bladder without the fear of losing urine still full (finding) Bladder spasm Bladder muscle squeezes suddenly 16844001 Painful urging to urinate without warning, causing an urgent need (finding) to release urine.
    [Show full text]
  • EAU Guidelines on Iatrogenic Trauma
    EUROPEAN UROLOGY 62 (2012) 628–639 available at www.sciencedirect.com journal homepage: www.europeanurology.com Guidelines EAU Guidelines on Iatrogenic Trauma Duncan J. Summerton a,*, Noam D. Kitrey b, Nicolaas Lumen c, Efraim Serafetinidis d, Nenad Djakovic e a Department of Urology, University Hospitals of Leicester, Leicester, UK; b Department of Urology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel; c Department of Urology, Ghent University Hospital, Ghent, Belgium; d Department of Urology, Asklipieion General Hospital, Athens, Greece; e Department of Urology, Mu¨hldorf General Hospital, Mu¨hldorf am Inn, Germany Article info Abstract Article history: Context: The European Association of Urology (EAU) Trauma Guidelines Panel presents Accepted May 28, 2012 an updated iatrogenic trauma section of their guidelines. Iatrogenic injuries are known Published online ahead of complications of surgery to the urinary tract. Timely and adequate intervention is key to their management. print on June 5, 2012 Objective: To assess the optimal evaluation and management of iatrogenic injuries and present an update of the iatrogenic section of the EAU Trauma Guidelines. Keywords: Evidence acquisition: A systematic search of the literature was conducted, consulting Iatrogenic trauma Medline and the Cochrane Register of Systematic reviews. No time limitations were applied, although the focus was on more recent publications. Kidney Evidence synthesis: The expert panel developed statements and recommendations. Ureter Statements were rated according to their level of evidence, and recommendations Urinary bladder received a grade following a rating system modified from the Oxford Centre for Urethra Evidence-based Medicine. Currently, only limited high-powered studies are available addressing iatrogenic injuries. Because the reporting of complications or sequelae of Genitalia interventions is now increasingly becoming a standard requirement, this situation will Injury likely change in the future.
    [Show full text]
  • Urine Extravasation Into the Scrotum
    Urine Extravasation Into the Scrotum Arthur W. Noel and Michael G. Velchik Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania A case report demonstrating urine extravasation into the scrotum following renal transplantation is presented. An anatomic explanation of the pathway of urine drainage into the scrotum is offered with a brief discussion of extravasation following renal transplantation and its detection by scintigraphy. J Nucl Med 27:807-809,1986 R enal scintigraphy is often performed in patients However, over the next several hours, urine output remained following renal transplantation for the evaluation of poor and renal scintigraphy with technetium-99m diethyl- enetriaminepentaacetic acid ([99mTc]DTPA) and iodine-131 perfusion and function. Ureteral fistula with extrava­ l31 sation of urine is a serious complication that can be ( I) hippuran was performed. These scans were felt to be consistent with acute tubular necrosis (ATN), revealing good diagnosed by renal scintigraphy, although its appear­ perfusion and uptake of radiopharmaceutical by the transplant ance varies. We report the unusual scintigraphic ap­ kidney, but no evidence of urine excretion. At our institution, pearance of urine extravasation into the scrotum and the evaluation of renal transplants by renal scintigraphy is offer an explanation on an anatomic basis for the performed in two parts: (a) 15 mCi [WmTc]DTPA are injected passage of urine into the scrotum. This case stresses the intravenously followed by sequential 2-sec images in the an­ importance of clinical correlation and appropriate im­ terior projection over the course of 1-min followed by sequen­ aging views in the detection of urine extravasation into tial 1-min images for ~5 min in order to evaluate perfusion the scrotum.
    [Show full text]
  • Delayed Diagnosis of Bladder Injury Following a Routine Cesarean Section
    Delayed Diagnosis of Bladder Injury Following a Routine Cesarean Section Catherine Dunlop 10/13/2019 RAD 4001 Reviewed by: Dr. Pritish Bawa Clinical History • 39y.o. F POD#3 from an uncomplicated repeat CS w/BTL • PMHx: cHTN w/hx of Pre-E in previous pregnancy, HIV, seizure disorder • On POD#2 pt had a non-eclamptic generalized tonic clonic seizure 2/2 to lowered seizure threshold post-partum, during this seizure her foley catheter was replaced with some hematuria noticed and she received a work-up to r/o stroke because of hemiparesis during postictal phase • Hematuria improved and was assumed to be 2/2 to traumatic foley insertion during her seizure • On POD#3 pt complained of significant abdominal pain, she was not passing flatus and thus was given colace and a CT abd/pelvis w/o contrast was ordered McGovern Medical School CT Abd/Pelvis w/o contrast on POD#3 McGovern Medical School Results of the CT Abd/Pelvis • Impression 1. Expected immediate post –section changes w/small to moderate amount of blood products within the endometrial cavity and endocervical canal and also small hematoma anterior to uterus 2. Small to moderate amount of abdominal and pelvic ascites 3. Few punctate bilateral renal nonobstructing calculi 4. Colonic gaseous distention with mild prominence of cecum 5. No finding to explain abdominal pain McGovern Medical School Hemoperitoneum vs. ascites Hemoperitoneum Ascites McGovern Medical School Differential Diagnosis for Abdominal Pain following CS • Abdominal pain likely 2/2 to post-op ileus or gas pain • Abdominal
    [Show full text]