Ann Gen Psychiatry. 2007; 6: 25.
MethodsWe report the case of a 55-year-old female with a history of type-1 DM since the age of 11, and severe ocular and renal vascular complications thereof. While on the waiting list for pancreatic islet cell transplantation, she developed a manic episode that proved recalcitrant to a treatment with gabapentin, lorazepam and quetiapine. Moreover, her mental state affected adversely her already compromised glycemic control, requiring her psychiatric hospitalization. Her psychotropic medication was almost discontinued and replaced by oxcarbazepine (OXC) up to 1800 mg/day for 10 days.
Adv Urol. 2009; 2009: 341268.
Methods. Between December 2006 and July 2007, 20 patients with anterior genital prolapse and voiding dysfunction were treated with the transobturator tension-free vaginal mesh (Prolift) and concomitant tension-free vaginal tape-obturator (TVT-O). Sixteen patients had stress urinary incontinence and 4 patients were considered at risk for development of de novo stress incontinence after the prolapse is repaired. All patients underwent a complete urodynamic assessment. All the patients underwent pelvic examination 4–6 weeks after the operation, and anatomical and functional outcomes were recorded.
Adv Urol. 2009; 2009: 341268.
Results. Twenty cystocoeles were repaired: 6 grade II, 12 grade III, and 2 grade IV. There were no vessel or bladder injuries. Eighteen patients had optimal anatomic results and 2 patients had persistent asymptomatic stage I prolapse.
Adv Urol. 2009; 2009: 341268.
Conclusion. These preliminary results suggest that Prolift system offers a safe and effective treatment for female anterior vaginal wall prolapse. However, a long-term followup is necessary in order to support the good result maintenance.
Adv Urol. 2009; 2009: 341268.
Between December 2006 and July 2007, twenty patients affected with anterior prolapse were included in this prospective survey. All the patients were referred to our Urology Unit because of their voiding problems. Mean age was 52 years (36–76). Mean parity, 3 vaginal childbirths. Sixteen patients with anterior vaginal wall prolapse reported socially annoying type II or III urinary stress incontinence, 4 patients reported voiding difficulty and related a history of urinary incontinence that has resolved with worsening of their prolapse. These patients were considered at risk for development of de novo stress incontinence after the prolapse is repaired. Twelve patients reported symptoms related to prolapse including the sensation of a vaginal mass or bulge, pelvic pressure, low back pain, and sexual difficulty. Twelve patients were sexually active, 8 had sexual difficulty (Table 1). The examination was first performed with the patient supine in lithotomy position. A retractor or Sims speculum was used to depress the posterior vagina to aid in visualizing the anterior vagina. After the resting examination, the patient was instructed to strain down forcefully or to cough vigorously. During this maneuver, the order of descent of the pelvic organs and their relationship at the peak of straining were noted. If physical findings did not correspond to symptoms or if the maximum extent of the prolapse could not be confirmed, the woman was reexamined in the standing position.
Adv Urol. 2009; 2009: 341268.
Table 1 Demographic and clinical characteristics of the patients. Characteristics Patients Median age (y) (range) 52 (36–76) Median parity (range) 3 (0–9) Median BMI (range) 31.2 (21.4–41.5) Prior surgery for prolapse including hysterectomy (n, %) 3 (15) Prior hysterectomy for benign tumor (n, %) 4 (20) Stage of prolapse Stage II (n, %) 6 (30) Stage III (n, %) 12 (60) Stage IV (n, %) 2 (10) Urinary incontinence (n, %) 16 (80) Adv Urol. 2009; 2009: 341268.
Adv Urol. 2009; 2009: 341268.
Surgical Technique All patients received spinal anesthesia and cephalosporin and metronidazol as antibiotic prophylaxis. The patient is placed in the lithotomy position and her thighs flexed approximately 90 degrees. A 16 Fr Foley catheter is placed to empty the bladder.
Adv Urol. 2009; 2009: 341268.
Figure 1 Bladder dissected from the anterior vaginal wall and 3 of the 4 cannulas and retrieval device in Prolift anterior mesh. Adv Urol. 2009; 2009: 341268.
Adv Urol. 2008; 2008: 173694.
63-year old man was referred to us after three rapid recurrences of low-grade urethral papillary transitional cell carcinoma of the bulbar urethra, after repeated primary excision. Cystoscopy confirmed 3-4 low-grade urethral transitional cell carcinomas, which were subsequently fulgurated. After urethral healing, a solution of Mitomycin C (40 mg/80 cc) was instilled into the urethra for fifteen minutes and held in place with a penile clamp. Urethral instillations were repeated weekly for six weeks. The patient is currently disease-free more than one year and three months posttreatment. This case highlights the successful treatment of urethral carcinoma with topical chemotherapy, which is usually reserved for the bladder, using a slight modification of standard technique.
Adv Urol. 2008; 2008: 173694.
63-year old man was referred to us after three rapid recurrences of low-grade urethral papillary transitional cell carcinoma of the bulbar urethra, after repeated primary excision. Cystoscopy confirmed 3-4 low-grade urethral transitional cell carcinomas, which were subsequently fulgurated. After urethral healing, a solution of Mitomycin C (40 mg/80 cc) was instilled into the urethra for fifteen minutes and held in place with a penile clamp. Urethral instillations were repeated weekly for six weeks. The patient is currently disease-free more than one year and three months posttreatment. This case highlights the successful treatment of urethral carcinoma with topical chemotherapy, which is usually reserved for the bladder, using a slight modification of standard technique.
Adv Urol. 2008; 2008: 173694.
Cancer in the male urethra is rare, representing less than 0.5% of all malignancies in males [1, 2]. It is seen primarily in the sixth decade of life, with approximately 55–65% of tumors located in the bulbar part of the urethra and 30–35% occur in the anterior urethra [3].
Adv Urol. 2008; 2008: 173694.
A 63-year old male was referred to our practice with recurrent, low-grade, bulbar urethra transition cell carcinoma which had recurred after two previous excisions. The patient was taken to the operating room for a third excision, where several urethral tumors were removed. Pathology showed T1, Grade 1 urothelial carcinoma. A large caliber urethral stricture in the area was also treated with urethrotomy at the same time. After surgical excision, he underwent 6 weekly installations of 40 mg Mitomycin C reconstituted in 80 cc of saline. While the usual method of intravesical chemotherapy involves installation through a bladder catheter, in this case we used a catheter-tip “Toomey” syringe (Bard; Covington, Ga, USA) to gently instill the medication into the urethral meatus, then used a penile clamp (Storz; Culver City, Calif, USA) to keep the column of medication in the urethra for 15 minutes. The patient suffered usual side effects of Mitomycin, including self-limited fatigue, dysuria, daytime urinary frequency up to every hour, and nocturia 2-3 X nightly [5]. All symptoms but nocturia resolved by the 6th treatment. He had cystoscopy and voided cytology examinations at 2, 6, and 12 and 18 months without recurrence of stricture or development of urethral cancer recurrences. (Previous recurrences X3 had been evident within 3 months of resection). The urethra appeared largely pink and healthy, with only small areas of white scar tissue marking the areas of previous urethral tumor resection.
Adv Urol. 2008; 2008: 173694.
To our knowledge, this is the first case of bulbar, low-grade papillary transitional cell carcinoma treated successfully by application of liquid Mitomycin C. This technique provides a method for application of Mitomycin directly to the urethral mucosa.
Adv Urol. 2008; 2008: 213516.
Patient characteristics. Mean age (range) 42.6 (18–66) No. symptoms (%) Dyspareunia 13 (46) Urgency 11 (39) Frequency 9 (32) Dysuria 8 (29) Recurrent urinary tract infection 13 (46) Stress incontinence 9 (32) Post void dribbling 5 (18) Adv Urol. 2008; 2008: 213516.
Adv Urol. 2008; 2008: 213516.
Figure 1 Urethral diverticulum on MRI (T2 weighted, fast spin echo). Patient presented with dyspareunia, urinary urgency and a normal physical exam. VCUG showed no evidence of urethral diverticulum. MRI revealed the correct diagnosis.
