Continent ileocecal diversion with an unaltered in situ appendix conduit

PURPOSE

We performed continent urinary diversion using an unaltered, in situ appendix to decrease the risk of appendicocolic manipulation.

MATERIALS AND METHODS

Since September 1994, 19 patients a mean of 46.5 years old underwent continent urinary diversion with an ileocecal segment and an unaltered, in situ appendiceal conduit. In 1 case of a permanent colostomy we performed simple transposition of the appendix on the ileal pouch as a conduit, which to our knowledge is the first reported case.

RESULTS

During the 4 to 24-month followup (mean 12) 17 patients were continent day and night, defined as being completely dry for 3 to 5 hours. Two patients were occasionally incontinent at night. One patient with a history of multiple operations who was completely incontinent achieved complete continence with endoscopic polytetrafluoroethylene (Teflon) injection at the appendicocecal junction.

CONCLUSIONS

This unaltered in situ appendix technique is timesaving, safe, effective and comparable with other methods that provide urinary continence.

Accuracy of residual urine measurement in men: comparison between real-time ultrasonography and catheterization

PURPOSE

The practical value of ultrasonography as a rapid means to determine accurately residual urine volume was assessed.

MATERIALS AND METHODS

Transverse and sagittal bladder diameters, as well as areas from longitudinal and transverse images, were measured with real-time ultrasonography in 324 men immediately after voiding. Calculated bladder volumes using measured diameters and areas for each of 11 formulas in the literature were compared to the corresponding measured total residual urine volumes.

RESULTS

The lower limit of ultrasonographic visualization of urine in the bladder was approximately 48 ml. No correlation existed between ultrasound calculated bladder volumes and measured residual urine for any of the 11 formulas.

CONCLUSIONS

Ultrasonography cannot rapidly measure bladder volumes accurately to date. Catheterization remains the most accurate method of assessing post-void residuals but in many cases it may not be the best approach to patient care.

Prevesical xanthogranulomatous pseudotumor

We describe a patient who was referred to our hospital because of dysuria, frequency and a palpable mass in the suprapubic area. A specimen obtained at suprapubic exploration consisted of fatty tissue and tentative diagnosis was pelvic lipomatosis. The symptoms persisted and the entire mass was removed from its prevesical pelvic position. The pathological report was xanthogranuloma. Postoperatively, the symptoms disappeared.