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Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
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Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations01:26

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Renal calculi, commonly termed kidney stones, are crystalline solid masses that form in the kidneys but can occur at any point within the urinary system, encompassing the kidneys, ureters, bladder, and urethra.The pathophysiology of renal stones involves several key factors: supersaturation of the urine with stone-forming constituents, changes in urine pH, a decrease in urine volume, and the presence of substances that promote or inhibit stone formation.Supersaturation of Urine: This is the...
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The lower urinary system consists of the urinary bladder and urethra, which are essential in storing and expelling urine from the body. Together with the internal and external sphincters, these structures work together to regulate urination effectively.Anatomy of the BladderThe urinary bladder is a muscular, stretchable organ behind the pubic bone and in front of the rectum. In females, the bladder is positioned anterior to the vagina and inferior to the uterus, while in males, it is located...
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The urethra is a hollowed tubular organ through which urine is expelled from the body. This structure extends from the bladder to the external opening, allowing urine to be released.
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The ureters are retroperitoneal tubes located on either side of the vertebral column. They are responsible for transporting urine from each kidney to the urinary bladder. These tubes have thick walls and are approximately 25-30 cm long. Their diameter is around 10 mm at the renal pelvis, gradually narrowing to 1 mm as the ureter obliquely enters the posterior bladder wall through the ureteric orifices. The shape of these orifices is slit-like, which helps to prevent urine backflow toward the...
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Urinary Tract Calculi III: Medical Management01:30

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The diagnosis of renal calculi involves several imaging techniques, including non-contrast CT scans and ultrasound. These methods help visualize kidney stones, assess their size and location, and detect possible obstructions. Additionally, Measuring urine pH is useful for diagnosing specific stone types, such as struvite (alkaline pH) and uric acid stones (acidic pH). Cystine stones are primarily linked to cystinuria, a genetic condition. A urinalysis helps detect blood in the urine (hematuria)...
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Urethroplasty with Pedicled Tunica Vaginalis for the Treatment of Long-segment Anterior Urethral Stricture Caused by Lichen Sclerosus of Glans Penis
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Complex posterior urethral injury.

Sanjay B Kulkarni1, Pankaj M Joshi1, Craig Hunter1

  • 1Center for Reconstructive Urology, Pune, India.

Arab Journal of Urology
|May 29, 2015
PubMed
Summary
This summary is machine-generated.

This study evaluates treatment strategies for complex pelvic fracture urethral injuries (PFUI), finding high success rates for various complex scenarios including repeat surgeries and pediatric cases. Appropriate management ensures successful outcomes for PFUI patients.

Keywords:
BMG, buccal mucosal graftBMU, bulbomembranous urethraBNP, bladder neck prostateBUN, bulbar urethral necrosisBladder neck injuryBulbar urethral necrosisFemaleOMF, oral mucosal flapPFUI, pelvic fracture urethral injuryRUG, retrograde urethrographyRecto-urethral fistulaUVF, urethrovaginal fistulaVCUG, voiding cysto-urethrography

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Area of Science:

  • Urology
  • Trauma Surgery
  • Reconstructive Surgery

Background:

  • Complex pelvic fracture urethral injury (PFUI) presents unique surgical challenges.
  • Management strategies vary significantly based on injury complexity and patient demographics.
  • Optimal treatment requires a nuanced understanding of specific injury patterns.

Purpose of the Study:

  • To assess treatment strategies and success rates for seven distinct complex pelvic fracture urethral injury (PFUI) scenarios.
  • To evaluate outcomes for repeat surgeries, ischemic bulbar urethral necrosis (BUN), pediatric PFUI, recto-urethral fistulas, bladder neck incontinence, and double urethral obstructions.
  • To identify factors contributing to successful surgical repair in complex PFUI cases.

Main Methods:

  • Retrospective review of over 550 PFUI procedures performed between 2000 and 2013.
  • Analysis of surgical techniques and success rates in 308 patients with complex PFUI, with follow-up data available for 225.
  • Categorization of complex PFUI into seven distinct clinical scenarios for outcome assessment.

Main Results:

  • Overall success rates for primary and repeat PFUI procedures were 81% and 77%, respectively.
  • Successful repair of ischemic bulbar urethral necrosis (BUN) was achieved in 76% of cases using novel techniques.
  • Pediatric patients (boys and girls ≤12 years) and those with recto-urethral fistulas demonstrated varying success rates (66%-90%) depending on surgical approach and principles.

Conclusions:

  • Effective management of complex pelvic fracture urethral injuries (PFUI) is achievable with appropriate surgical strategies.
  • Understanding specific injury patterns, such as pediatric involvement or fistulas, is crucial for optimizing outcomes.
  • Successful outcomes in complex PFUI cases underscore the importance of tailored surgical approaches and adherence to established principles.