Surgery urethra

This chapter discusses drug s used to treat urinary tract infections (UTIs) and certain miscellaneous drag > used to relieve the symptoms associated with an overactive bladder (involuntary contractions of the detrusor or bladder muscle). Structures of the urinary system that may be affected include the bladder (cystitis), prostate gland (prostatitis), the kidney, or the urethra (see Pig. 47-1). These drug s also help control the discomfort associated with irritation of the lower urinary tract mucosa caused by infection, trauma, surgery, and endoscopic procedures. 

In men, SUI is most commonly the result of prior lower urinary tract surgery or injury, with resulting compromise of the sphincter mechanism within and external to the urethra. Radical prostatectomy for treatment of adenocarcinoma of the prostate is probably the most common setting in which surgical manipulation leads to UI. Overall, SUI in the male is uncommon, and in the absence of prior prostate surgery, severe trauma, or neurologic illness, is extraordinarily rare. Transurethral resection of the prostate for benign prostatic hyperplasia (see Chap. 82) may also lead to SUI in men. 

Functional incontinence is not caused by bladder- or urethra-specific factors. Rather, in patients with conditions such as dementia or cognitive or mobility deficits, the UI is linked to the primary disease process more than any extrinsic or intrinsic deficit of the lower urinary tract. An example of functional incontinence occurs in the postoperative orthopedic surgery patient. Following extensive orthopedic reconstructions such as total hip arthroplasty, patients are often immobile secondary to pain or traction. Therefore the patient may be unable to access toileting facilities in a reasonable period of time and may become incontinent as a result. The treatment of this type of UI may involve only placing a urinal or commode at the bedside that allows for simplified access to toileting. 

Fig. 16.13. Complications after urethral surgery. Axial image obtained after retrograde distention of the urethra with saline solution shows a hair-bearing ectatic neourethra curved arrows) in a man with bladder exstrophy and urethral duplication corrected during childhood using a scrotal skin flap...

Skin <1 day Examinatioiv surgery Adhesive skin electrode, urethra catheter, surgical drape Acrylic electroconductive gel silicone, polyvinyl chloride, etc. polyethylene, polyurethane, cellulose, alginic acid gel, etc. 

Ordinarily, small amounts of calcium ions and oxalate ions are excreted in a person s urine, along with tiny crystals of calcium oxalate that may form. In exceptional cases, however, the crystals can lump together to form kidney stones. Kidney stones can block the tubes leading from the kidneys to the urethra. Passing a kidney stone may be extremely painful, and, in some cases, surgery may be required. 

When obstruction of the ureters or urethra can be demonstrated or is strongly suspected, temporary drainage procedures, such as pyelostomies or vesi-costomies, may help to preserve renal function until the child is old enough for reconstructive surgery. 

Fig. 18.12. a Infant with posterior urethral valves. There is dilatation of the posterior urethra (arrow) and marked reflux, b Patient developed echogenic area in the lower pole collecting system after valve surgery (curved arrow), c Stone developed at site of Candida ball 1 month after surgery (open arrowhead)... 

In cases of complete disruption of the posterior urethra, the first step treatment is suprapubic drainage. The Mitrofanoff principle (interposition of the appendix between the urinary bladder and the abdominal wall), has been occasionally applied in severely crushed patients to divert the urine (Freitas Filho et al. 2003). No consensus has been made regarding the surgical strategy (Onen et al. 2005). Either primary realignment over a urethral tube, immediate surgery or delayed repair can be performed. 

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