Penile Cancer

In Western countries, carcinoma of the penis is a rare neoplasm accounting for less than 1 of all cancers in males. More than 50 of patients with squamous cell carcinoma of the penis have lymph node involvement or distant metastasis at initial presentation. Hypercalce-mia is the most common life-threatening metabolic disorder associated with malignancies it has been rarely been reported in association with primary squamous cell carcinoma of the penis. Ideally, treatment of the primary cancer...

General Anesthetic Agents and Neuromuscular Blocking Agents

The main agents used for induction of anesthesia are hypnotics (thiopentone, propofol, and etomidate), opioids (fentanyl), neuroleptics, and benzodiazepines (Thong and Yeow-Chan 2004). The majority of intraoperative anaphylactic reactions are caused by the neu-romuscular blocking agents commonly used to induce paralysis to facilitate endotracheal intubation or to optimize surgical exposure (Birnbaum et al. 1994). The use of intradermal skin tests for the diagnosis of IgE-mediated anaphylaxis to...

Renal Transplantation

The orthotopic kidney is protected against external force by muscles, Gerota's fascia, and perinephric fat. A renal graft is located in the lower pelvis in the iliac fossa through a retroperitoneal incision anastomosed to the iliac artery and vein and therefore is more susceptible to injury, especially from direct blows to the abdomen. The transplanted kidney, unlike the native kidney, is fixed in position by a thick fibrosis capsule that develops after transplantation and is not really...

Diagnostic Tests and Risk Factors

There are many different diagnostic tests, including serum tryptase, plasma histamine, specific IgE-level measurements, and skin tests. However, all of these tests have their pitfalls. An elevated tryptase level 1 - 6 h after a suspected anaphylactic reaction indicates mast cell degranulation. Together with a suggestive history and clinical findings, this supports the diagnosis of anaphylaxis (Fisher and Baldo 1998). However, serum tryptase concentration may be normal even in fatal anaphylaxis....

Deep Vein Thrombosis and Pulmonary Embolism 321

Perioperative thromboembolic disease and pulmonary embolism contribute to morbidity and mortality in urological patients. Venous thromboembolism is a multifactorial disease involving clinical risk factors as well as genetic and environmental interactions. It is uncommon in the young, but after 40 years of age the incidence doubles with each decade of life. Hereditary risk factors include factor V Leiden mutation, G20210A prothrombin gene mutation, and deficiencies in protein C, protein S, and...

Clinical Presentation and Differential Diagnosis

The severity of the hypersensitivity reaction is classified into four grades (see Table 4.3) IgE- or non-IgE-mediated reactions and anaphylactoid or anaphylactic reactions, respectively, cannot be differentiated clinically. The most important clinical signs are (Chiu and Kelly 2005) Cutaneous reactions (erythema, urticaria ) and soft tissue swelling (e.g., eyelids, lips) Hypotension and tachycardia Table 4.3. Severity of immediate hypersensitivity reactions Grade 1 Only cutaneous signs diffuse...

Percutaneous Renal Procedures

Percutaneous nephrostomy is achieved in nearly all patients without major complications. Hematuria is common for a few days, but massive retroperitoneal hemorrhage is rare. Small subcapsular renal hematomas resolve spontaneously, while arteriovenous-caliceal fistulas are best managed by angiographic embolization. If a nephrostomy catheter is seen to transverse the renal pelvis the possibility of injury to a large renal artery must be considered. The misplaced nephrostomy catheter should be...

Complications

Early complications occur within the 1st month after injury and can be bleeding, arteriovenous fistulae involving the renal artery, infection, perinephric abscess, sepsis, urinary fistula, hypertension, urinary extravasation, and urinoma. Delayed complications include bleeding, hydronephrosis, calculus formation, chronic pyelonephritis, hypertension, arteriovenous fistula, hydronephrosis, and pseudoaneurysms. Delayed retroperitoneal bleeding usually occurs within several weeks of an injury or...

Trauma

The kidney is the most commonly injured organ following abdominal trauma. Children in particular are at an increased risk of renal injury due to several unique anatomical features of the pediatric axial skeleton and surrounding soft tissue. These include the less well-developed and ossified ribcage as well as decreased peri-renal fat and smaller paraspinal and abdominal muscles. These features all contribute to the increased susceptibility to renal trauma in the pediatric patient (McAleer et...

Noncontrast Helical Abdominal Pelvic CT

In the emergency room setting, noncontrast helical abdominal pelvic CT has become the examination of choice in the evaluation of flank pain and obstructive anuria (Niall et al. 2002 Shokeir et al. 2002, 2004 Coli-stro et al. 2002). Introduced by Smith and colleagues in 1995, noncontrast CT is quick, relatively easy to interpret, and obviates risks associated with the use of contrast media (Smith et al. 1999). Noncontrast CT is the gold standard in the detection of urinary calculi with an...

Etiology

An etiological factor or factors can be identified in more than 90 of cases and should be actively sought, because it may determine the treatment and prognosis (Smith et al. 1998 Santora and Rukstalis 2001). In apparently idiopathic cases, the cause may have been overlooked or obscured by the necrotizing disease process. Any process where a virulent, synergistic infection gains access to the subcutaneous tissue of the perineum may serve as the point of origin. The cause of infection may be from...

Urinary Tract Infections

Urinary Tract Patient Value

Because of anatomic, functional, and hormonal modifications, urinary tract infection is frequent during pregnancy. It can present as three different entities asymptomatic bacteriuria, acute cystitis, or acute pyelonephritis (Ovalle and Levancini 2001). Different risk factors have been discussed maternal age, socioeconomic status, antecedents of UTI, sexual intercourse, hemoglobinopathies, diabetes, immunodepression of HIV infection, multiparity, and race (Connolly and Thorpe 1999 Ovalle and...

References

Akashi T, Fuse H, Muraishi Y et al (2002) Parathyroid hormone related protein producing penile cancer. J Urol 167 249 Albright F (1941) Case records of the Massachusetts general Hospital-Case 390N. Eng J Med 225 789 Antonipillai I (1993) Epidermal growth factor is a potent inhibitor of renin secretion. Hypertension 21 654 Antonipillai I, Le TH, Soceneantu L, Horton R (1993) Transforming growth factor-beta is a renin secretagogue at pico-molar concentrations. Am J Physiol 265 F537 Apaydin R, Gul...

Autonomic Dysreflexia

Autonomic dysreflexia is an acute syndrome characterized by abrupt onset of excessively high blood pressure caused by uncontrolled sympathetic nervous system discharge in patients with spinal cord injury (SCI). Au-tonomic dysreflexia is potentially life-threatening. The syndrome was first described by Head and Rid-doch in 1917 (Head and Riddoch 1917). In 1947, Gutt-mann and Whitteridge showed the effects of bladder distensions on the cardiovascular system (Guttmann and Whitteridge 1947)....

Neurogenic Bladder and Spinal Shock

Directly after the spinal cord injury, all reflexes below the neurologic lesion have disappeared. This is called spinal shock. In this phase, the bladder is hypotonic. This phase takes normally 4-6 weeks, sometimes up to 6-8 months. To prevent the bladder from overdistension (due to polyuria), it is important to drain the urine continu ously. Usually indwelling catheters are used. A better approach is a suprapubic catheter, especially in men, to prevent the patient from urethral trauma and...

Hematologic Syndromes

The association of bleeding diathesis and intravascular coagulopathy abnormalities in patients with prostate cancer has been reported. Bleeding problems in the prostate cancer patient may result from the effects of the tumor on hemostatic mechanisms or from the treatment of the tumor by cytotoxic and other agents. Among the tumor-related bleeding problems are disseminated intravascular coagulation, primary fibrinolysis, thrombocytopenia, acquired platelet dysfunction, and circulating inhibitors...

Epidemiology and Diagnosis

It is important to remember that BPH is a pathological diagnosis, and most of the patients seen in practice have clinically enlarged prostate glands but no histological confirmation of BPH. Hence the term benign prostatic enlargement (BPE) is more appropriate in those in whom tissue diagnosis is not confirmed. BPH is one of the most prevalent conditions affecting men aged 40 and above. Histological studies have shown features of BPH to be present in the prostate of approximately 60 of men aged...

Reconstructive Surgery

Depending on the extent of skin defects, the options in reconstruction are suturing, split thickness skin grafting, or myocutaneous vascularized pedicle flaps. Small defects can be closed by primary suturing, especially where only the pliable scrotal skin is involved. Split thickness skin grafting is most often used and yields acceptable results, even in large defects (Hessel-feldt-Nielsen et al. 1986). Healthy skin from the legs, buttocks, and arms can be used, in a single or multiple...

Idiopathic Scrotal Edema

Acute idiopathic scrotal edema (AISE) is a fairly common, yet underreported cause of the acute scrotum in children, accounting for as many as 30 of patients who undergo assessment (Najmaldin and Burge 1987). It is characterized by the rapid onset of nontender, frequently unilateral scrotal and penile erythema and edema. The patient is usually afebrile and is otherwise asymptomatic, apart from the distressing appearance of the genitalia. It is usually found in prepubertal children from 5 to 11...

Immunological Mechanism

Coombs and Gell (1975) first classified four types of hypersensitivity (immunopathologic) reactions (Table 4.2). Type I Immediate (IgE-dependent) Type II Cytotoxic (IgG, IgM-dependent) Type III Immune complexes (IgG, IgM-dependent complex) Type IV Delayed (T lymphocyte-dependent) 4.3 Clinical Presentation and Differential Diagnosis Table 4.2. Classification of hypersensitivity (Coombs and Gell 1975) Table 4.2. Classification of hypersensitivity (Coombs and Gell 1975) IgE antibodies Mast cells...

Placenta Percreta Involving Urinary Bladder

The incidence of placenta accreta is estimated from one in 540 to one in 93,000 deliveries (Smith and Ferrara 1992). Placenta percreta is a variant of placenta accreta in which chorionic villi penetrate the entire thickness of the myometrium and may involve adjacent structures. Placenta percreta involving the bladder is extremely rare (less than 60 published cases) (Washecka and Behling 2002) and is encouraged by uterine scars and cesarean section. This potentially catastrophic condition may...

Immediate and Nonimmediate Reactions to Contrast Media

Since their development in the 1950s tri-iodinated benzene derivates have been used for opacification of the urinary tract. The radiopacity of such compounds is produced by molecular iodine, which is attached to the benzene ring. The agents are further characterized by their ionic and nonionic side chains as well as their monomeric or dimeric ring structure. Contrast media are used in many diagnostic and in-terventional procedures, including intravenous ur-ography, CT scan, angiography,...

Intensive Care Procedures 351

Behavioral Pain Scale Payen

The use of analgetics and sedatives for the treatment of pain, anxiety, and agitation is a daily challenge in the intensive care environment. It is usually needed for the mechanically ventilated patient. To achieve a sufficient level of patient shielding while minimizing side effects and a short and cost-effective weaning period, the algorithm for analgosedation (AS) is an important task for the clinician. Emphasis should be placed on the consequent and correct implementation of a concept while...

Hemorrhagic Cystitis

Hemorrhagic cystitis is defined as gross hematuria secondary to diffuse inflammation of the bladder. Viral infection, radiation-induced inflammation, and chemotherapy-induced inflammation account for the majority of cases among cancer patients. While relatively un- common in patients with genitourinary malignancies, viral-mediated hemorrhagic cystitis occurs in as many as 50 of patients undergoing bone marrow transplantation (Bedi et al. 1995). The principle etiologic factor involved is the BK...

Pyelonephritis and Pyonephrosis

Urinary tract infection (UTI) occurs in approximately 8 of girls and 6 of boys during their first 6 years of life (Marild and Jodal 1998). Although older patients Fig. 8.16a-c. DMSA scan showing multiple photopenic areas consistent with renal scars (Courtesy H.G. Rushton) may complain of irritative voiding symptoms and thus direct clinical suspicion to the urinary tract, infants and neonates may present with only nonspecific symptoms such as poor feeding, irritability, and failure to thrive....

Urological Aspects of Terrorist Related Injuries

A review of the literature reveals that there is a paucity of data on terrorist-related urological injuries. Important data is available from the Israeli Trauma Registry (ITR), which records all hospitalizations for physical trauma at most of the Israeli trauma centers. Unfortunately, the accumulated experience of the Israeli medical system with terrorist-related injuries during the last two decades is exceptional in duration and intensity, out-ranging any comparable practice gained elsewhere,...

Circumcision Injuries

Glans Amputation Circumcision

Newborn circumcision is the most common surgical procedure performed in the United States. Over 61 of newborn boys underwent circumcision in 2000 and the incidence continues to increase (Nelson et al. 2005). Although some lay people and professionals alike still question the need for circumcision, it has become apparent that it does afford a number of recognized medical benefits. Firstly, the risk of UTI in male infants is reduced in those who undergo circumcision, from 1 to 0.1 (Singh-Grewal...

Radiation Cystitis

Radiation cystitis is a late complication of radiotherapy which, by definition, occurs at least 90 days after the initiation of radiation treatment but maybe delayed up to 10 years or more (Cox et al. 1995). Most patients develop severe irritative voiding symptoms however, gross hematuria dominates the clinical picture (Pas-quier et al. 2004). While any patient receiving pelvic radiotherapy is at risk, radiation cystitis is most common among those treated for prostate or cervical cancer. Three...

Treatment of Intractable Bladder Hemorrhage

The approach to the patient with intractable bladder hemorrhage is fairly standard and begins with a thorough evaluation to determine its cause. Information obtained on history e.g., prior malignancy, prior radiotherapy, prior cyclophosphamide, etc. may suggest the etiology however, multiple factors maybe involved and assumptions should not be made. Outside of the acute setting, all cases in which the etiology has not been identified require a formal hematuria workup, including cystoscopy,...

Unilateral Upper Urinary Tract Obstruction

One of the most common forms of failed drainage in the upper urinary tract is acute unilateral ureteral ob- Table 10.1. Etiology of upper urinary tract obstruction Intrinsic Urothelial carcinoma Fibroepithelial polyp UPJ obstruction Renal cell carcinoma Wilms tumor Cystic renal diseases Parapelvic cysts Renal artery aneurysm Retroperitoneal malignancy primary or metastatic Inflammatory bowel disease Trauma ureteral ligation Radiation therapy Lymphocele Urinoma Retroperitoneal fibrosis Pelvic...

Introduction

Gynecologic Preteen

Pediatric urologic emergencies fortunately remain rare occurrences within the emergency department of a hospital or ambulatory care center. More commonly, congenital anomalies noted at birth, or benign lesions that prompt significant parental anxiety such as benign scrotal conditions , often result in a visit to the emergency department for evaluation. These urgencies nonetheless require both the appropriate investigations and management in order to allay patient and parental concern. The...