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He S, Zhang S, Sun X, Liu R, Yuan T, Chen X, Zhang X. Global research trends on the links between prostate cancer and erectile dysfunction between 2003 and 2023: A bibliometrics and visualized study. Heliyon 2024; 10:e33834. [PMID: 39027554 PMCID: PMC11255577 DOI: 10.1016/j.heliyon.2024.e33834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/23/2024] [Accepted: 06/27/2024] [Indexed: 07/20/2024] Open
Abstract
Background The incidence of prostate cancer (PC) has increased in recent years. Erectile dysfunction (ED) after prostate cancer treatment has aroused extensive attention. Bibliometric analysis was designed to investigate a systematic understanding of developments between PC and ED during the past 20 years. Methods Literatures on PC and ED were retrieved from the Web of Science Core Collection database (WoSCC). By using the VOS viewer and CiteSpace software to analysis the metrics of bibliometric literature, such as number of articles, journals, countries, institutions, authors, keywords and associated information. The number of publications per year was statistically analysed and plotted thorough Microsoft Office. In addition, Pajek software was used to adjust the visual map. Results A total of 2332 screened articles were included in the analysis. The Journal of Sexual Medicine, ranking first among the analysed journals, published 235 articles. The United States and Canada were leaders in PC and ED research. There is a need to strengthen inter-agency cooperation in this area of research on a global scale. Mulhall JP, as the most prolific author in this area of research, published 80 articles. And Rosen RC was the author with the most co-citated (693 co-citated). The main research focus on the prevention, treatment and management of ED after PC treatment in this field through the keyword analysis. Conclusions Research on PC and ED is expected to expand further worldwide. We found ED, as new sustainable treatment modalities, scientific postoperative management and psychological interventions for patients, may become the research hotspots and should be closely concerned in this study.
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Affiliation(s)
- Songnian He
- Clinical Medical Research Center, Wuxi No.2 People's Hospital, Jiangnan University Medical Center, Affiliated Wuxi Clinical College of Nantong University, Jiangnan University, Wuxi, China
- Nantong Tumor Hospital & Affiliated Tumor Hospital of Nantong University, Nantong, China
- Nantong University, Nantong, China
| | - Siming Zhang
- Nantong Tumor Hospital & Affiliated Tumor Hospital of Nantong University, Nantong, China
| | | | | | | | - Xu Chen
- Nantong University, Nantong, China
| | - Xu Zhang
- Clinical Medical Research Center, Wuxi No.2 People's Hospital, Jiangnan University Medical Center, Affiliated Wuxi Clinical College of Nantong University, Jiangnan University, Wuxi, China
- Nantong University, Nantong, China
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Ribeiro LDS, Silveira RCDCP, Vasques CI, de Menêses AG, Dos Reis PED, Ferreira EB. Hyaluronic acid to manage radiotoxicities in gynecological cancer patients: a scoping review. Support Care Cancer 2024; 32:439. [PMID: 38888632 DOI: 10.1007/s00520-024-08614-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 05/28/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE This study aimed to map the use of hyaluronic acid (HA) in preventing and controlling radiotoxicity in women with gynecological cancer undergoing radiotherapy. METHODS We conducted a scoping review of eight electronic databases: CINAHL, Cochrane CENTRAL, LILACS, PubMed, Scopus, Embase, LIVIVO, and the Web of Science Core Collection. In addition, a grey literature search was performed using Google Scholar and ProQuest Dissertations & Theses Global. A manual search was also identified additional references. The search was conducted on May 18, 2023. We included primary studies, reviews, and guidelines that discussed the use of HA to prevent and manage the toxicities resulting from gynecological radiotherapy. RESULTS Eighteen studies were included in this scoping review, published between 2009 and 2022. There was heterogeneity in the use of HA, particularly in the method of application (moisturizing gel, vaginal ovules, spacer gel, and bladder instillations). Furthermore, the radiotoxicities varied among studies, encompassing, among others, vaginal atrophy, dryness, dyspareunia, telangiectasis, adhesions, vaginal stenosis, bleeding, hematuria, and bladder issues. Most studies addressed the potential benefits of HA in managing the signs and symptoms resulting from radiotherapy. CONCLUSION HA has been utilized in clinical practice, in various formulations, for managing signs and symptoms in patients with gynecological cancer undergoing radiotherapy. However, further studies are necessary to thoroughly investigate the most effective method of HA application and its effectiveness in managing radiotoxicity.
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Affiliation(s)
- Letícia da Silva Ribeiro
- University of Brasilia, School of Health Sciences, Nursing Department, Campus Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Renata Cristina de Campos Pereira Silveira
- University of São Paulo, Ribeirão Preto College of Nursing, General and Specialized Nursing Department, WHO Collaborating Centre for Nursing Research Development, Bandeirantes Avenue, 3900, Campus-Monte Alegre, Ribeirão Preto, SP, 14040-902, Brazil
| | - Christiane Inocêncio Vasques
- University of Brasilia, School of Health Sciences, Nursing Department, Campus Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Amanda Gomes de Menêses
- University of Brasilia, School of Health Sciences, Nursing Department, Campus Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Paula Elaine Diniz Dos Reis
- University of Brasilia, School of Health Sciences, Nursing Department, Campus Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Elaine Barros Ferreira
- University of Brasilia, School of Health Sciences, Nursing Department, Campus Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil.
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Gupta M, Rathored J. Hyperbaric oxygen therapy: future prospects in regenerative therapy and anti-aging. FRONTIERS IN AGING 2024; 5:1368982. [PMID: 38757145 PMCID: PMC11097100 DOI: 10.3389/fragi.2024.1368982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/12/2024] [Indexed: 05/18/2024]
Abstract
Hyperbaric Oxygen Therapy (HBOT) utilizes 100% oxygen at high atmospheric pressure for clinical applications. HBOT has proven to be an effective supplementary treatment for a variety of clinical and pathological disorders. HBOT's therapeutic results are based on the physiological effects of increased tissue oxygenation, or improved oxygen bioavailability. HBOT's current indications in illnesses like as wound healing, thermal or radiation burns, and tissue necrosis point to its function in facilitating the regeneration process. Various research has revealed that HBOT plays a function in vascularization, angiogenesis, and collagen production augmentation. Individual regeneration capacity is influenced by both environmental and genetic factors. Furthermore, the regenerating ability of different types of tissues varies, and this ability declines with age. HBOT affects physiological processes at the genetic level by altering gene expression, delaying cell senescence, and assisting in telomere length enhancement. The positive results in a variety of indications, ranging from tissue regeneration to better cognitive function, indicate that it has enormous potential in regenerative and anti-aging therapy.
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Affiliation(s)
- Manoj Gupta
- Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Jaishriram Rathored
- Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
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Ueda N, Sato M, Matsukawa A, Oki Y, Mizuno R, Akiyama M, Tei N, Miyake O. Maintaining Serum Hemoglobin Levels Within the Physiological Range Prevented Bladder Tamponade Recurrence Due to Radiation-Induced Hemorrhagic Cystitis: A Case Report. Res Rep Urol 2023; 15:395-401. [PMID: 37638329 PMCID: PMC10455857 DOI: 10.2147/rru.s420329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/15/2023] [Indexed: 08/29/2023] Open
Abstract
Radiation-induced hemorrhagic cystitis is a refractory disease that can cause severe hematuria and bladder tamponade. Bladder tamponade due to radiation-induced hemorrhagic cystitis can often recur repeatedly and markedly reduce the quality of life. However, no blood test parameter has been studied yet regarding the prevention of bladder tamponade recurrence. An 84-year-old patient with a history of radiation therapy for cervical cancer was repeatedly hospitalized for bladder tamponade due to radiation-induced hemorrhagic cystitis. At each hospitalization, blood transfusions were performed to treat severe anemia as the first treatment, resulting in hematuria improvement, and the patient was discharged without invasive treatments such as transurethral coagulation. However, anemia developed gradually after each discharge. The anemia progression was obviously unrelated to macrohematuria because macrohematuria did not appear during that period. When the serum hemoglobin level decreased below the physiological range, bladder tamponade recurred. Based on these findings, we posited that the monitoring of the serum hemoglobin level could be useful to predict the occurrence of bladder tamponade. We hypothesized that if the serum hemoglobin level did not fall below the physiological range, bladder tamponade would not occur. We treated chronic anemia after determining its cause and kept serum hemoglobin levels within the physiological range. Since the treatment was initiated, bladder tamponade has not recurred in over 27 months. In this case, the monitoring of the serum hemoglobin level was useful to predict the occurrence of bladder tamponade due to radiation-induced hemorrhagic cystitis. By maintaining serum hemoglobin levels within the physiological range, we successfully prevented the recurrence of bladder tamponade due to radiation-induced hemorrhagic cystitis.
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Affiliation(s)
- Norichika Ueda
- Department of Urology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Mototaka Sato
- Department of Urology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Atsuki Matsukawa
- Department of Urology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Yuta Oki
- Department of Urology, Osaka Rosai Hospital, Sakai, Japan
| | - Ryoya Mizuno
- Department of Urology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Mai Akiyama
- Department of Urology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Norihide Tei
- Department of Urology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Osamu Miyake
- Department of Urology, Toyonaka Municipal Hospital, Toyonaka, Japan
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Huang C, Zhong Y, Yue C, He B, Li Y, Li J. The effect of hyperbaric oxygen therapy on the clinical outcomes of necrotizing soft tissue infections: a systematic review and meta-analysis. World J Emerg Surg 2023; 18:23. [PMID: 36966323 PMCID: PMC10040118 DOI: 10.1186/s13017-023-00490-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/15/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND To determine the efficacy of hyperbaric oxygen therapy (HBO) in the treatment of necrotizing soft tissue infections (NSTI), we conducted a meta-analysis of the available evidence. METHODS Data sources were PubMed, Embase, Web of Science, Cochrane Library, and reference lists. The study included observational trials that compared HBO with non-HBO, or standard care. The primary outcome was the mortality rate. Secondary outcomes were the number of debridement, amputation rate and complication rate. Relative risks or standardized mean differences with 95% confidence intervals were calculated for dichotomous and continuous outcomes, respectively. RESULTS A total of retrospective cohort and case-control studies were included, including 49,152 patients, 1448 who received HBO and 47,704 in control. The mortality rate in the HBO group was significantly lower than that in the non-HBO group [RR = 0.522, 95% CI (0.403, 0.677), p < 0.05]. However, the number of debridements performed in the HBO group was higher than in the non-HBO group [SMD = 0.611, 95% CI (0.012, 1.211), p < 0.05]. There was no significant difference in amputation rates between the two groups [RR = 0.836, 95% CI (0.619, 1.129), p > 0.05]. In terms of complications, the incidence of MODS was lower in the HBO group than in the non-HBO group [RR = 0.205, 95% CI (0.164, 0.256), p < 0.05]. There was no significant difference in the incidence of other complications, such as sepsis, shock, myocardial infarction, pulmonary embolism, and pneumonia, between the two groups (p > 0.05). CONCLUSION The current evidence suggests that the use of HBO in the treatment of NSTI can significantly reduce the mortality rates and the incidence rates of complications. However, due to the retrospective nature of the studies, the evidence is weak, and further research is needed to establish its efficacy. It is also important to note that HBO is not available in all hospitals, and its use should be carefully considered based on the patient's individual circumstances. Additionally, it is still worthwhile to stress the significance of promptly evaluating surgical risks to prevent missing the optimal treatment time.
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Affiliation(s)
- Chengzi Huang
- Department of Anorectum, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yilian Zhong
- Department of Anorectum, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Chaochi Yue
- Department of Anorectum, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Bin He
- Department of Anorectum, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yaling Li
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
| | - Jun Li
- Department of Anorectum, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
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Wang Y, Zhu Y, Xu X. Advances in the management of radiation-induced cystitis in patients with pelvic malignancies. Int J Radiat Biol 2023; 99:1307-1319. [PMID: 36940182 DOI: 10.1080/09553002.2023.2181996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 03/21/2023]
Abstract
OBJECTIVE Radiotherapy plays a vital role as a treatment for malignant pelvic tumors, in which the bladder represents a significant organ at risk involved during tumor radiotherapy. Exposing the bladder wall to high doses of ionizing radiation is unavoidable and will lead to radiation cystitis (RC) because of its central position in the pelvic cavity. Radiation cystitis will result in several complications (e.g. frequent micturition, urgent urination, and nocturia) that can significantly reduce the patient's quality of life and in very severe cases become life-threatening. METHODS Existing studies on the pathophysiology, prevention, and management of radiation-induced cystitis from January 1990 to December 2021 were reviewed. PubMed was used as the main search engine. Besides the reviewed studies, citations to those studies were also included. RESULTS AND DISCUSSIONS In this review, the symptoms of radiation cystitis and the mainstream grading scales employed in clinical situations are presented. Next, preclinical and clinical research on preventing and treating radiation cystitis are summarized, and an overview of currently available prevention and treatment strategies as guidelines for clinicians is provided. Treatment options involve symptomatic treatment, vascular interventional therapy, surgery, hyperbaric oxygen therapy (HBOT), bladder irrigation, and electrocoagulation. Prevention includes filling up the bladder to remove it from the radiation field and delivering radiation based on helical tomotherapy and CT-guided 3D intracavitary brachytherapy techniques.
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Affiliation(s)
- Yimin Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yan Zhu
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaoting Xu
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
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7
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Current strategies to improve erectile function in patients undergoing radical prostatectomy - postoperative scenario. Urol Oncol 2022; 40:87-94. [DOI: 10.1016/j.urolonc.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/01/2021] [Accepted: 12/07/2021] [Indexed: 11/15/2022]
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8
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Tao XC, Hu DC, Yin LX, Wang C, Lu JG. Necrotizing fasciitis of cryptoglandular infection treated with multiple incisions and thread-dragging therapy: A case report. World J Clin Cases 2021; 9:8537-8544. [PMID: 34754865 PMCID: PMC8554422 DOI: 10.12998/wjcc.v9.i28.8537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/19/2021] [Accepted: 08/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Necrotizing fasciitis is a fulminant necrotizing soft tissue disease with a high fatality rate. It always starts with impact on the deep fascia rapidly and might result in secondary necrosis of the subcutaneous tissue, fascia, and muscle. Thus, timely and multiple surgical operations are needed for the treatment. Meanwhile, the damage of skin and soft tissue caused by multiple surgical operations may require dermatoplasty and other treatments as a consequence.
CASE SUMMARY Here, we report a case of 50-year-old male patient who was admitted to our hospital with symptoms of necrotizing fasciitis caused by cryptoglandular infection in the perianal and perineal region. The symptoms of necrotizing fasciitis, also known as the cardinal features, include hyperpyrexia, excruciatingly painful lesions, demonstration gas in the tissue, an obnoxious foul odor and uroschesis. The results of postoperative pathology met the diagnosis. Based on the premise of complete debridement, multiple incisions combined with thread-dragging therapy (a traditional Chinese medicine therapy) and intensive supportive therapies including comprising antibiotics, nutrition and fluids were given. The outcome of the treatment was satisfactory. The patient recovered quickly and achieved ideal anal function and morphology.
CONCLUSION Timely and effective debridement and multiple incisions combined with thread-dragging therapy are an integrated treatment for necrotizing fasciitis.
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Affiliation(s)
- Xiao-Chun Tao
- Department of Anorectal, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - De-Chang Hu
- Department of Anorectal, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Li-Xin Yin
- Department of Anorectal, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Chen Wang
- Department of Anorectal, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Jin-Gen Lu
- Department of Anorectal, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
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Tarasconi A, Perrone G, Davies J, Coimbra R, Moore E, Azzaroli F, Abongwa H, De Simone B, Gallo G, Rossi G, Abu-Zidan F, Agnoletti V, de'Angelis G, de'Angelis N, Ansaloni L, Baiocchi GL, Carcoforo P, Ceresoli M, Chichom-Mefire A, Di Saverio S, Gaiani F, Giuffrida M, Hecker A, Inaba K, Kelly M, Kirkpatrick A, Kluger Y, Leppäniemi A, Litvin A, Ordoñez C, Pattonieri V, Peitzman A, Pikoulis M, Sakakushev B, Sartelli M, Shelat V, Tan E, Testini M, Velmahos G, Wani I, Weber D, Biffl W, Coccolini F, Catena F. Anorectal emergencies: WSES-AAST guidelines. World J Emerg Surg 2021; 16:48. [PMID: 34530908 PMCID: PMC8447593 DOI: 10.1186/s13017-021-00384-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/16/2021] [Indexed: 02/06/2023] Open
Abstract
Anorectal emergencies comprise a wide variety of diseases that share common symptoms, i.e., anorectal pain or bleeding and might require immediate management. While most of the underlying conditions do not need inpatient management, some of them could be life-threatening and need prompt recognition and treatment. It is well known that an incorrect diagnosis is frequent for anorectal diseases and that a delayed diagnosis is related to an impaired outcome. This paper aims to improve the knowledge and the awareness on this specific topic and to provide a useful tool for every physician dealing with anorectal emergencies.The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the boards of the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the WSES-AAST-WJES Consensus Conference on Anorectal Emergencies, and for each statement, a consensus among the WSES-AAST panel of experts was reached. We structured our work into seven main topics to cover the entire management of patients with anorectal emergencies and to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process.
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Affiliation(s)
- Antonio Tarasconi
- Emergency Surgery Department, Parma University Hospital, Parma, Italy.
| | - Gennaro Perrone
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Raul Coimbra
- Riverside University Health System Medical Center, Loma Linda University School of Medicine, Riverside, CA, USA
| | - Ernest Moore
- Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO, USA
| | - Francesco Azzaroli
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Hariscine Abongwa
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Belinda De Simone
- Department of Metabolic, Digestive and Emergency Surgery, Centre Hospitalier Intercommunal de Poissy et Saint Germain en Laye, Poissy, France
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Giorgio Rossi
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, AUSL Romagna, M.Bufalini Hospital, Cesena, Italy
| | - Gianluigi de'Angelis
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Gastroenterology and Endoscopy Unit, Hospital of Parma, Parma, Italy
| | - Nicola de'Angelis
- Minimally Invasive and Robotic Digestive Surgery Unit, Regional General Hospital F. Miulli, Bari, Ital - Université Paris Est, UPEC, Creteil, France
| | - Luca Ansaloni
- Department of Emergency and general Surgery, Pavia University Hospital, Pavia, Italy
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paolo Carcoforo
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Marco Ceresoli
- General Surgery, Monza University Hospital, Monza, Italy
| | - Alain Chichom-Mefire
- Faculty of Health Sciences, Department of Surgery, University of Buea, Buea, Cameroon
| | - Salomone Di Saverio
- General surgery 1st unit, Department of General Surgery, University of Insubria, Varese, Italy
| | - Federica Gaiani
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Gastroenterology and Endoscopy Unit, Hospital of Parma, Parma, Italy
| | - Mario Giuffrida
- Department of Medicine and Surgery, General Surgery Unit, University Hospital of Parma, Parma, Italy
| | - Andreas Hecker
- Department of General & Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Kenji Inaba
- Division of Acute Care Surgery, University of Southern California, Los Angeles, CA, USA
| | - Michael Kelly
- Department of General Surgery, Albury Hospital, Albury, Australia
| | - Andrew Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | | | - Andrey Litvin
- Department of Surgical Disciplines, Regional Clinical Hospital, Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | - Carlos Ordoñez
- Department of Surgery, Fundacion Valle del Lili - Universidad del Valle, Cali, Colombia
| | | | - Andrew Peitzman
- University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, PA, USA
| | - Manos Pikoulis
- 3rd Department of Surgery, National & Kapodistrian University of Athens, Athens, Greece
| | - Boris Sakakushev
- General Surgery Department, University Hospital St George, Plovdiv, Bulgaria
| | | | - Vishal Shelat
- Department of Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Edward Tan
- Department of Surgery, Department of Emergency Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mario Testini
- Academic Unit of General Surgery "V. Bonomo" Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - George Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Imtiaz Wani
- Government Gousia Hospital, Srinagar, Kashmir, India
| | - Dieter Weber
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Walter Biffl
- Department of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, San Diego, CA, USA
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Fausto Catena
- General, Emergency and Trauma Surgery Dept., Bufalini Hospital, Cesena, Italy
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Vorobev V, Beloborodov V, Golub I, Frolov A, Kelchevskaya E, Tsoktoev D, Maksikova T. Urinary System Iatrogenic Injuries: Problem Review. Urol Int 2021; 105:460-469. [PMID: 33535218 DOI: 10.1159/000512882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/04/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION From May to December 2019, a literature review of the urinary system iatrogenic injury problem was performed. The most cited, representative articles in PubMed, Scopus, and WoS databases dedicated to this problem were selected. Urinary system iatrogenic injuries include ureter, bladder, urethra, and kidney traumas. It is widely thought that the main causes of such injuries are urological, obstetric, gynecological, and surgical operations on the retroperitoneal space, pelvis, or perineum. METHODS The purpose of the study is to describe all aspects of the iatrogenic injure problem, under the established scheme and for each of the most damaged organs: the urethra, bladder, kidney, and ureter. The treatment of confirmed iatrogenic injuries largely depends on the period of its detection. Modern medical procedures provide conservative or minimally invasive treatment. An untimely diagnosis worsens the treatment prognosis. "Overlooked" urinary system trauma is a serious threat to society and a particular patient. Thus, incorrect or traumatic catheterization can lead to infection (RR 95%) and urethral stricture (RR ≥11-36%), and percutaneous puncture nephrostomy can cause the risk of functional renal parenchyma loss (median 5%), urinary congestion (7%), or sepsis (0.6-1.5%). RESULTS Lost gain, profits, long-term and expensive, possibly multistage treatment, stress and depression, and the risks of suicide put a heavy financial, moral, and ethical burden on a person and society. Also, iatrogenic injury might have legal consequences. DISCUSSION/CONCLUSION Thus, the significant problem of urinary tract iatrogenic injuries is still difficult to solve. There is a need to implement mandatory examining algorithms for patients at risk, as well as the multidisciplinary principle for all pelvic surgery.
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Affiliation(s)
- Vladimir Vorobev
- Department of General Surgery and Anesthesiology, Irkutsk State Medical University, Irkutsk, Russian Federation,
| | - Vladimir Beloborodov
- Department of General Surgery and Anesthesiology, Irkutsk State Medical University, Irkutsk, Russian Federation
| | - Igor Golub
- Department of General Surgery and Anesthesiology, Irkutsk State Medical University, Irkutsk, Russian Federation
| | - Aleksandr Frolov
- Department of General Surgery and Anesthesiology, Irkutsk State Medical University, Irkutsk, Russian Federation
| | - Elena Kelchevskaya
- Department of General Surgery and Anesthesiology, Irkutsk State Medical University, Irkutsk, Russian Federation
| | - Darizhab Tsoktoev
- Department of General Surgery and Anesthesiology, Irkutsk State Medical University, Irkutsk, Russian Federation
| | - Tatyana Maksikova
- Department of Propedeutics of Internal Diseases, Irkutsk State Medical University, Irkutsk, Russian Federation
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11
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Ju Z, Yu W, Li Y, Han W, Tu X, Zhu S, Zou Q. The clinical research of 5 steps sequential method for whole treatment of hemorrhagic radiation cystitis in china. Int J Med Sci 2021; 18:756-762. [PMID: 33437210 PMCID: PMC7797551 DOI: 10.7150/ijms.47906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 11/19/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Curing hemorrhagic cystitis remains a challenge. We explore a continuous and effective treatment for hemorrhagic radiation cystitis. Methods: The data of patients in 6 provincial cancer hospital urology departments between April 2015 and December 2019 was reviewed retrospectively. Patients were classified as moderate and severe groups. The 5-steps sequential method was adopted. Two groups were initiated with step 1 and step 3 respectively. Step 1 was symptomatic treatment. Thrombin solution or sodium hyaluronate was administrated for bladder irrigation in step 2. Step 3 was transurethral electrocoagulation. Step 4 was interventional embolization. Step 5 was HBO therapy. OABSS was used to assess the improvement of patients' symptoms. The outcome was evaluated after at least 6 months of follow-up. Results: A total of 650 patients (56 men and 594 women), mean age 71.2 years, were enrolled in the 5 steps sequential method. 582 patients were classified as moderate and 68 severe group. In moderate group, the cure rate of step 1 was 61.2% (356/582), 80.4% (468/582) after step 2, 93.1% (542/582) after step 3, 96.2% (560/582) after step 4, and 99.8% (581/582) after step 5. In severe group, the cure rate was 54.4% (37/68) after step 3, 76.5% (52/68) after step 4, and 94.1% (64/68) after the step 5 respectively. The mean OABSS scores of both groups significantly decreased after 5 steps sequential method treatment (P<0.01). Conclusions: Our results show hemorrhagic radiation cystitis can be cured in 5 steps, and the 5 steps sequential method is welcomed and effective. Therapy efficacy depends on the number of steps adopted and the severity of hematuria.
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Affiliation(s)
- Zhenghua Ju
- Department of Urology, Fujian Provincial Cancer Hospital, Fuzhou, China
| | - Wenchang Yu
- Department of Invasive Technology, Fujian Provincial Cancer Hospital, Fuzhou, China
| | - Youyuan Li
- Department of Urology, Hubei Provincial Cancer Hospital, Wuhan, China
| | - Weiqing Han
- Department of Urology, Hunan Provincial Cancer Hospital, Changsha, China
| | - Xinhua Tu
- Department of Urology, Jiangxi Provincial Cancer Hospital, Nanchang, China
| | - Shaoxing Zhu
- Department of Urology, Zhejiang Provincial Cancer Hospital, Hangzhou, China
| | - Qing Zou
- Department of Urology, Jiangsu Provincial Cancer Hospital, Nanjing, China
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12
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Iacovelli V, Cipriani C, Sandri M, Filippone R, Ferracci A, Micali S, Rocco B, Puliatti S, Ferrarese P, Benedetto G, Minervini A, Cocci A, Pastore AL, Al Salhi Y, Antonelli A, Morena T, Volpe A, Poletti F, Celia A, Zeccolini G, Leonardo C, Proietti F, Finazzi Agrò E, Bove P. The role of vacuum-assisted closure (VAC) therapy in the management of FOURNIER'S gangrene: a retrospective multi-institutional cohort study. World J Urol 2021; 39:121-128. [PMID: 32236663 PMCID: PMC7223519 DOI: 10.1007/s00345-020-03170-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/14/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To explore the role of vacuum assisted closure (VAC) therapy versus conventional dressings in the Fournier's gangrene wound therapy. PATIENTS AND METHODS This is a retrospective multi-institutional cohort study. Data of 92 patients from nine centers between 2007 and 2018 were retrospectively analyzed. After surgery, patient having a local or a disseminated FG were managed with VAC therapy or with conventional dressings. The 10-weeks wound closure cumulative rate and OS were analyzed. RESULTS Of the 92 patients, 62 (67.4%) showed local and 30 (32.6%) a disseminated FG. After surgery, 19 patients (20.7%) with local and 14 (15.2%) with disseminated FG underwent to VAC therapy; 43 (46.7%) with local and 16 (17.4%) with disseminated FG were treated using conventional dressings. The multivariable logistic regression analysis demonstrated that the VAC in patients with disseminated FG led to a higher cumulative rate of wound closure than patients treated with no-VAC (OR = 6.5; 95% CI 1.1-37.4, p = 0.036). The Kaplan-Meier survival curves for the OS showed a significant difference between no-VAC patients with local and disseminated FG (OS rate at 90 days 0.90, 95% CI 0.71-0.97 vs 0.55, 95% CI 0.24-0.78, respectively; p = 0.039). Cox regression confirmed that no-VAC patients with disseminated FG showed the lowest OS (hazard ratio adjusted for sex and age HR = 3.4, 95% CI 1.1-10.4; p = 0.033). CONCLUSIONS In this large cohort study, VAC therapy in patients with disseminated FG may offer an advantage in terms of 10-weeks wound closure cumulative rate and OS at 90 days after initial surgery.
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Affiliation(s)
- Valerio Iacovelli
- Urology Unit, San Carlo Di Nancy Hospital, GVM Care and Research, Via Aurelia 275, 00100, Rome, Italy.
- Department of Surgical Sciences, University Tor Vergata, Roma, Italy.
| | - Chiara Cipriani
- Urology Unit, San Carlo Di Nancy Hospital, GVM Care and Research, Via Aurelia 275, 00100, Rome, Italy
| | - Marco Sandri
- Data Methods and System Statistical Laboratory, University of Brescia, Brescia, Italy
| | - Roberta Filippone
- Department of Surgical Sciences, University Tor Vergata, Roma, Italy
| | | | - Salvatore Micali
- Department of Urology, Ospedale Policlinico E Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, Ospedale Policlinico E Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Puliatti
- Department of Urology, Ospedale Policlinico E Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Andrea Minervini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Andrea Cocci
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | | | | | - Alessandro Antonelli
- Urology Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University Hospital of Verona, Verona and Confortini, Borgo General Hospital, Trento, Italy
| | - Tonino Morena
- Urology Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University Hospital of Verona, Verona and Confortini, Borgo General Hospital, Trento, Italy
| | - Alessandro Volpe
- Department of Urology, University of Eastern Piedmont, Maggiore Della Carità Hospital, Novara, Italy
| | - Filippo Poletti
- Department of Urology, University of Eastern Piedmont, Maggiore Della Carità Hospital, Novara, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | | | | | - Flavia Proietti
- Department of Urology, La Sapienza University of Rome, Rome, Italy
| | | | - Pierluigi Bove
- Urology Unit, San Carlo Di Nancy Hospital, GVM Care and Research, Via Aurelia 275, 00100, Rome, Italy
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Helissey C, Cavallero S, Brossard C, Dusaud M, Chargari C, François S. Chronic Inflammation and Radiation-Induced Cystitis: Molecular Background and Therapeutic Perspectives. Cells 2020; 10:E21. [PMID: 33374374 PMCID: PMC7823735 DOI: 10.3390/cells10010021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/10/2020] [Accepted: 12/22/2020] [Indexed: 12/14/2022] Open
Abstract
Radiation cystitis is a potential complication following the therapeutic irradiation of pelvic cancers. Its clinical management remains unclear, and few preclinical data are available on its underlying pathophysiology. The therapeutic strategy is difficult to establish because few prospective and randomized trials are available. In this review, we report on the clinical presentation and pathophysiology of radiation cystitis. Then we discuss potential therapeutic approaches, with a focus on the immunopathological processes underlying the onset of radiation cystitis, including the fibrotic process. Potential therapeutic avenues for therapeutic modulation will be highlighted, with a focus on the interaction between mesenchymal stromal cells and macrophages for the prevention and treatment of radiation cystitis.
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Affiliation(s)
- Carole Helissey
- Department of Radiation Biological Effects, French Armed Forces Biomedical Research Institute, 91220 Brétigny-sur-Orge, France; (C.H.); (S.C.); (C.C.)
- Clinical Unit Research, HIA Bégin, 94160 Saint-Mandé, France
| | - Sophie Cavallero
- Department of Radiation Biological Effects, French Armed Forces Biomedical Research Institute, 91220 Brétigny-sur-Orge, France; (C.H.); (S.C.); (C.C.)
| | - Clément Brossard
- Radiobiology of Medical Exposure Laboratory (LRMed), Institute for Radiological Protection and Nuclear Safety (IRSN), 92260 Fontenay-aux-Roses, France;
| | - Marie Dusaud
- Department of Urology, HIA Bégin, 94160 Saint-Mand, France;
| | - Cyrus Chargari
- Department of Radiation Biological Effects, French Armed Forces Biomedical Research Institute, 91220 Brétigny-sur-Orge, France; (C.H.); (S.C.); (C.C.)
- Gustave Roussy Comprehensive Cancer Center, Department of Radiation Oncology, 94805 Villejuif, France
- French Military Health Academy, Ecole du Val-de-Grâce (EVDG), 75005 Paris, France
| | - Sabine François
- Department of Radiation Biological Effects, French Armed Forces Biomedical Research Institute, 91220 Brétigny-sur-Orge, France; (C.H.); (S.C.); (C.C.)
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14
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Pereira D, Ferreira C, Catarino R, Correia T, Cardoso A, Reis F, Cerqueira M, Prisco R, Camacho O. Hyperbaric oxygen for radiation-induced cystitis: A long-term follow-up. Actas Urol Esp 2020; 44:561-567. [PMID: 32736899 DOI: 10.1016/j.acuro.2020.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION AND OBJECTIVES Bladder complications may be seen in up to 12% of patients treated with pelvic irradiation. Hyperbaric oxygen therapy (HBOT) is an option for the management of radiation-induced hemorrhagic cystitis (RIHC). The aim of this study was to evaluate the efficacy of HBOT in radiation cystitis and to identify the predictive factors for a successful outcome. MATERIAL AND METHODS We retrospectively reviewed 105 patients diagnosed with RIHC which were treated with HBOT between 2007 and 2016 in our institution. Patients received 100% oxygen in a multiplace hyperbaric chamber at 2.4atm for 80minutes. All patients fulfilled a questionnaire documenting symptom severity pre-HBOT and at the end of the follow-up period. RESULTS After a median of 40 HBOT sessions, there was success rate of 92,4% in the control of hematuria. During our follow-up period (median of 63 months) 24,7% patients presented with recurrence of hematuria. The mean score of the questionnaire-assessed variables: dysuria, urinary frequency and hematuria, was significantly lower after the follow-up period (P<.05). Our data shows that the sooner HBOT is delivered after the first episode of hematuria, better response rates are achieved and lower recurrences concerning hematuria were registered (P<.05). No serious complications were observed. CONCLUSIONS Our results support the safety and long-term benefits of HBOT on RIHC and other distressful bladder symptoms, which represents an expected improvement of quality of life in our patients.
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15
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Goucher G, Saad F, Lukka H, Kapoor A. Canadian Urological Association Best Practice Report: Diagnosis and management of radiation-induced hemorrhagic cystitis. Can Urol Assoc J 2019; 13:15-23. [PMID: 30721124 PMCID: PMC6363576 DOI: 10.5489/cuaj.5788] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- George Goucher
- Department of Surgery (Urology) and Oncology, McMaster University, Hamilton, ON, Canada
| | - Fred Saad
- Department of GU Oncology, l’Université de Montréal, Montreal, QC, Canada
| | - Himu Lukka
- Department of Radiation Oncology, McMaster University, Hamilton, ON, Canada
| | - Anil Kapoor
- Department of Surgery (Urology) and Oncology, McMaster University, Hamilton, ON, Canada
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16
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Mohan S, Kumar S, Dubey D, Phadke RV, Baijal SS, Kathuria M. Superselective vesical artery embolization in the management of intractable hematuria secondary to hemorrhagic cystitis. World J Urol 2018; 37:2175-2182. [DOI: 10.1007/s00345-018-2604-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 12/10/2018] [Indexed: 11/30/2022] Open
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17
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Lobo N, Kulkarni M, Hughes S, Nair R, Khan MS, Thurairaja R. Urologic Complications Following Pelvic Radiotherapy. Urology 2018; 122:1-9. [DOI: 10.1016/j.urology.2018.07.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 06/17/2018] [Accepted: 07/07/2018] [Indexed: 11/28/2022]
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18
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Zwaans BMM, Lamb LE, Bartolone S, Nicolai HE, Chancellor MB, Klaudia SW. Cancer survivorship issues with radiation and hemorrhagic cystitis in gynecological malignancies. Int Urol Nephrol 2018; 50:1745-1751. [PMID: 30132277 DOI: 10.1007/s11255-018-1970-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/17/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Given that more cancers are being diagnosed earlier and that treatment of cancer is improving, health issues of cancer survivors are becoming more common and apparent. Pelvic radiation therapy for the treatment of gynecological cancers can lead to long-term collateral damage to the bladder, a condition termed radiation cystitis (RC). Late sequelae may take many years to develop and include incontinence and pain as well as hematuria. RC is a rare but potentially life-threatening condition for which there are few management and treatment options. METHODS There are limited data in the literature regarding the effects of radiation on the bladder after gynecological cancer therapy and we hereby review the literature on cancer survivorship issues of pelvic radiation for gynecology literature. RESULTS Treatment options are available for patients with radiation-induced hemorrhagic cystitis. However, most treatments are risky or only effective for a short timeframe and no therapy is currently available to reverse the disease progress. Furthermore, no standardized guidelines exist describing preferred management options. Common therapies include hyperbaric oxygen therapy, clot evacuation, fulguration, intravesical instillation of astringent agents, and surgery. Novel developing strategies include Botulinum Toxin injections and liposomal-tacrolimus instillations. These treatments and strategies are discussed. CONCLUSIONS In this review, we will present current and advanced therapeutic strategies for RC to help cancer survivors deal with long-term bladder health issues.
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Affiliation(s)
- Bernadette M M Zwaans
- Department of Urology, William Beaumont Hospital, Royal Oak, MI, USA.,Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Laura E Lamb
- Department of Urology, William Beaumont Hospital, Royal Oak, MI, USA.,Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Sarah Bartolone
- Department of Urology, William Beaumont Hospital, Royal Oak, MI, USA
| | - Heinz E Nicolai
- Departamento di Urología, Universidad de Chile, Santiago, Chile.,Hospital Clínico San Borja Arriarán, Santiago, Chile
| | - Michael B Chancellor
- Department of Urology, William Beaumont Hospital, Royal Oak, MI, USA. .,Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
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19
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Biogeau J, Lamandé M, Ripault H, Léger I, Dardaine-Giraud V. [Emphysematous cystitis: Report of one case]. Rev Med Interne 2018; 39:192-194. [PMID: 29395295 DOI: 10.1016/j.revmed.2017.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 12/02/2017] [Accepted: 12/28/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Emphysematous cystitis is a rare urinary tract infection characterized by gas in the bladder wall and lumen. CASE REPORT We report a 92-year-old women admitted with confusion and abdominal pain without fever. Her past medical history included diabetes, urinary incontinence, high blood pressure and mild cognitive impairment. A computed tomography scan (CT scan) revealed emphysematous cystitis. The patient completely recovered within ten days. The main characteristics and the treatment of this uncommon disorder are presented. CONCLUSION Clinicians should be aware of this diagnosis: early management is essential to reduce morbidity and mortality.
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Affiliation(s)
- J Biogeau
- Service de soins de suite et réadaptation gériatrique, CHRU de Tours, CHU de Tours, 2, allée Gaston-Pagès, 37100 Tours, France.
| | - M Lamandé
- Service de soins de suite et réadaptation gériatrique, CHRU de Tours, CHU de Tours, 2, allée Gaston-Pagès, 37100 Tours, France
| | - H Ripault
- Service de soins de suite et réadaptation gériatrique, CHRU de Tours, CHU de Tours, 2, allée Gaston-Pagès, 37100 Tours, France
| | - I Léger
- Service de soins de suite et réadaptation gériatrique, CHRU de Tours, CHU de Tours, 2, allée Gaston-Pagès, 37100 Tours, France
| | - V Dardaine-Giraud
- Service de soins de suite et réadaptation gériatrique, CHRU de Tours, CHU de Tours, 2, allée Gaston-Pagès, 37100 Tours, France
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20
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Actinic cystitis: causes, treatment and experience of a single centre in the last five years. Urologia 2017; 85:25-28. [PMID: 29027183 DOI: 10.5301/uj.5000273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Actinic cystitis (AC) is the manifestation of symptoms and signs following pelvic radiotherapy. Pelvic radiotherapy produces both acute and chronic damage and such damage may have a devastating impact on the quality and on the amount of life of the patient. OBJECTIVES To evaluate the number of radical cystectomies that have become necessary in the last five years in our department for AC after radiation treatment. MATERIALS AND METHODS From February 2012 to February 2017, 11 patients underwent "open" cystectomy for AC. All patients were studied with radiographic examinations and endoscopy prior to surgery. We retrospectively evaluated the type of primitive cancer, the radiation dose administered, the time between radiation treatment and cystectomy. We also studied the related symptoms that required surgery. RESULTS The mean age of patients at the time of cystectomy was 75 years. In six patients (54.4%) radiotherapy was performed for prostate cancer, for rectal cancer in two patients (18.1%), and for endometrial cancer in three patients (27.2%). Total radiant dose was different in different patients depending on the type and localization of cancer. The median time between radiotherapy and cystectomy was 111 months (24-256 months). All patients had symptoms before surgery. Seven patients (63.3%) with gross haematuria were treated with endoscopic clot evacuation and fulguration. DISCUSSION The first approach to patients with AC is often supportive care. Surgery remains the most invasive treatment in the management of those patients who are not responsive to conservative treatments.
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Montgomery BD, Boorjian SA, Ziegelmann MJ, Joyce DD, Linder BJ. Intravesical silver nitrate for refractory hemorrhagic cystitis. Turk J Urol 2016; 42:197-201. [PMID: 27635296 DOI: 10.5152/tud.2016.38445] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Hemorrhagic cystitis is a challenging clinical entity with limited evidence available to guide treatment. The use of intravesical silver nitrate has been reported, though supporting literature is sparse. Here, we sought to assess outcomes of patients treated with intravesical silver nitrate for refractory hemorrhagic cystitis. MATERIAL AND METHODS We identified nine patients with refractory hemorrhagic cystitis treated at our institution with intravesical silver nitrate between 2000-2015. All patients had failed previous continuous bladder irrigation with normal saline and clot evacuation. Treatment success was defined as requiring no additional therapy beyond normal saline irrigation after silver nitrate instillation prior to hospital discharge. RESULTS Median patient age was 80 years (IQR 73, 82). Radiation was the most common etiology for hemorrhagic cystitis 89% (8/9). Two patients underwent high dose (0.1%-0.4%) silver nitrate under anesthesia, while the remaining seven were treated with doses from 0.01% to 0.1% via continuous bladder irrigation for a median of 3 days (range 2-4). All nine patients (100%) had persistent hematuria despite intravesical silver nitrate therapy, requiring additional interventions and red blood cell transfusion during the hospitalization. There were no identified complications related to intravesical silver nitrate instillation. CONCLUSION Although well tolerated, we found that intravesical silver nitrate was ineffective for bleeding control, suggesting a limited role for this agent in the management of patients with hemorrhagic cystitis.
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Affiliation(s)
| | | | | | - Daniel D Joyce
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian J Linder
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
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22
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Pereira K, Halpern JA, McClure TD, Lewis NA, Kably I, Bhatia S, Hu JC. Role of prostate artery embolization in the management of refractory haematuria of prostatic origin. BJU Int 2016; 118:359-65. [DOI: 10.1111/bju.13524] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Keith Pereira
- Department of Interventional Radiology; St. Louis University Hospital; St. Louis MO USA
| | - Joshua A. Halpern
- Department of Urology; Weill Cornell Medical College; New York NY USA
| | | | | | - Isaam Kably
- Department of Interventional Radiology; Jackson Memorial Hospital/University of Miami Hospital; Miami FL USA
| | - Shivank Bhatia
- Department of Interventional Radiology; Jackson Memorial Hospital/University of Miami Hospital; Miami FL USA
| | - Jim C. Hu
- Department of Urology; Weill Cornell Medical College; New York NY USA
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23
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Yassein A, Dason S, Davies T, Kelly S. A novel approach to the repair of urethrocutaneous fistulae arising after abdominoperineal anorectal resection. Can Urol Assoc J 2016; 9:E879-81. [PMID: 26834897 DOI: 10.5489/cuaj.2938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This case report describes a novel approach to the repair of perineal urethrocutaneous fistulae (UCF) after abdominoperineal resection (APR). A 62-year-old patient developed a UCF after an APR for rectal cancer complicated by perineal abscess formation. The patient presented with continuous urinary drainage from the fistula that persisted despite a number of conservative and surgical measures. The patient underwent successful repair of the urethrocutaneous fistula in prone position-an approach that has not previously been described in the literature. Repair was performed by the multi-disciplinary team of a reconstructive urologist, colorectal surgeon, and plastic surgeon. Post-operative retrograde urethrogram demonstrated the absence of a persistent fistula tract and the patient has been continent for 18 months. The prone approach for UCF repair allows for excellent access to the fistula tract for posterior urethroplasty in a patient that has had prior APR.
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Affiliation(s)
- Alaya Yassein
- Division of Urology, McMaster University, Hamilton, ON
| | - Shawn Dason
- Division of Urology, McMaster University, Hamilton, ON
| | | | - Stephen Kelly
- Division of Surgery, McMaster University, Hamilton, ON
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24
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Zwaans BMM, Nicolai HG, Chancellor MB, Lamb LE. Challenges and Opportunities in Radiation-induced Hemorrhagic Cystitis. Rev Urol 2016; 18:57-65. [PMID: 27601964 PMCID: PMC5010626 DOI: 10.3909/riu0700] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
As diagnosis and treatment of cancer is improving, medical and social issues related to cancer survivorship are becoming more prevalent. Hemorrhagic cystitis (HC), a rare but serious disease that may affect patients after pelvic radiation or systemic chemotherapy, has significant unmet medical needs. Although no definitive treatment is currently available, various interventions are employed for HC. Effects of nonsurgical treatments for HC are of modest success and studies aiming to control radiation-induced bladder symptoms are lacking. In this review, we present current and advanced therapeutic strategies for HC to help cancer survivors deal with long-term urologic health issues.
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Ribeiro de Oliveira TM, Carmelo Romão AJ, Gamito Guerreiro FM, Matos Lopes TM. Hyperbaric oxygen therapy for refractory radiation-induced hemorrhagic cystitis. Int J Urol 2015; 22:962-6. [DOI: 10.1111/iju.12857] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/03/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Tiago M Ribeiro de Oliveira
- Underwater and Hyperbaric Medicine Center; Portuguese Navy; Lisbon Portugal
- Department of Urology; Hospital de Santa Maria; Lisbon Portugal
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Abstract
PURPOSE OF REVIEW To better understand the mechanism of radiation-induced hemorrhagic cystitis and the advantages and disadvantages of available treatment options for bladder hemorrhage as well as preventive measures. RECENT FINDINGS There have been several attempts recently to manage hemorrhagic cystitis with hyperbaric oxygen therapy, transurethral coagulation using Greenlight potassium-titanyl-phosphate laser and other different treatment modalities, but we still need more investigation on larger cohort studies. SUMMARY Hemorrhagic cystitis is an uncommon urological problem. It is most often caused by radiation therapy and cyclophosphamide, but can be associated with other contributing factors. Technological advances in radiation therapy have resulted in greater treatment efficacy, with significant reduction in side-effects such as hemorrhagic cystitis. Higher dose radiation treatment, however, is more often associated with problematic hemorrhagic cystitis. Treatment of hemorrhagic cystitis is multifactorial and can range from simple bladder irrigation to cystectomy with urinary diversion.
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27
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Schulz D, Mohor GS, Solovan C. Unusual foreign body in the sigmoid colon, chronic alcohol abuse, and Fournier gangrene: a case report. Clin Interv Aging 2015; 10:673-7. [PMID: 25878494 PMCID: PMC4388072 DOI: 10.2147/cia.s79609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Fournier gangrene (FG) is an infectious condition with fulminant evolution and is sometimes life-threatening. Here, we present the case of an immunocompromised 59-year-old male with surgical history of a pancreatic pseudocyst stented endoscopically. After unrecognized stent migration in the sigmoid without colonic perforation, he developed severe necrosis of the scrotum and perineum, which spontaneously perforated, presenting a smell suggesting moist gangrene. FG that has spread to the male genital organs presents therapeutic challenges. The purpose of our study is to present this case, typical for FG, with an educational aim both for the internal and surgical specialties, and the goal of further multidisciplinary collaboration for the optimal management of the patient with personalized treatment.
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Affiliation(s)
- Dietmar Schulz
- Sana Kliniken Leipziger Land, Klinik fur Urologie, Borna, Leipzig, Germany
| | | | - Caius Solovan
- University Clinic of Dermatology and Venereology, Timişoara, Romania ; Department of Dermatology Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
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Ninan N, Thomas S, Grohens Y. Wound healing in urology. Adv Drug Deliv Rev 2015; 82-83:93-105. [PMID: 25500273 DOI: 10.1016/j.addr.2014.12.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 11/25/2014] [Accepted: 12/02/2014] [Indexed: 12/20/2022]
Abstract
Wound healing is a dynamic and complex phenomenon of replacing devitalized tissues in the body. Urethral healing takes place in four phases namely inflammation, proliferation, maturation and remodelling, similar to dermal healing. However, the duration of each phase of wound healing in urology is extended for a longer period when compared to that of dermatology. An ideal wound dressing material removes exudate, creates a moist environment, offers protection from foreign substances and promotes tissue regeneration. A single wound dressing material shall not be sufficient to treat all kinds of wounds as each wound is distinct. This review includes the recent attempts to explore the hidden potential of growth factors, stem cells, siRNA, miRNA and drugs for promoting wound healing in urology. The review also discusses the different technologies used in hospitals to treat wounds in urology, which make use of innovative biomaterials synthesised in regenerative medicines like hydrogels, hydrocolloids, foams, films etc., incorporated with growth factors, drug molecules or nanoparticles. These include surgical zippers, laser tissue welding, negative pressure wound therapy, and hyperbaric oxygen treatment.
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Dellis A, Deliveliotis C, Kalentzos V, Vavasis P, Skolarikos A. Is there a role for hyberbaric oxygen as primary treatment for grade IV radiation-induced haemorrhagic cystitis? A prospective pilot-feasibility study and review of literature. Int Braz J Urol 2015; 40:296-305. [PMID: 25010295 DOI: 10.1590/s1677-5538.ibju.2014.03.02] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 09/17/2013] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To examine the safety and efficacy of hyperbaric oxygen as the primary treatment for Grade IV radiation-induced haemorrhagic cystitis. MATERIALS AND METHODS Hyperbaric oxygen was prospectively applied as a primary treatment option in 11 patients with Grade IV radiation cystitis. Primary endpoint was the incidence of complete and partial response to treatment. Secondary endpoints included the duration of response, the correlation of treatment success-rate to the interval between the onset of haematuria and initiation of therapy, blood transfusion need and total radiation dose, the number of sessions to success, the avoidance of surgery and the overall survival. RESULTS All patients completed therapy without complications for a mean follow-up of 17.82 months (range 3 to 34). Mean number of sessions needed was 32.8 (range 27 to 44). Complete and partial response rate was 81.8% and 18.2%, respectively. However, in three patients the first treatment session was not either sufficient or durable giving a 72.7% rate of durable effect. Interestingly, all 9 patients with complete response received therapy within 6 months of the haematuria onset compared to the two patients with partial response who received therapy at 8 and 10 months from the haematuria onset, respectively (p = 0.018). The need for blood transfusion (p = 0.491) and the total radiation dose (p = 0.259) were not correlated to success-rate. One patient needed cystectomy, while all patients were alive at the end of follow-up. CONCLUSIONS Early primary use of hyperbaric oxygen to treat radiation-induced grade IV cystitis is an effective and safe treatment option.
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Affiliation(s)
- Athanasios Dellis
- 2nd Surgical Department, University of Athens, Aretaieion Hospital, Athens, Greece
| | | | - Vasileios Kalentzos
- Diving and Hyperbaric Oxygen Department, Naval and Veterans Hospital, Athens, Greece
| | - Pavlos Vavasis
- Diving and Hyperbaric Oxygen Department, Naval and Veterans Hospital, Athens, Greece
| | - Andreas Skolarikos
- 2nd Urologic Department, University of Athens, Sismanoglio General Hospital, Athens, Greece
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Li C, Zhou X, Liu LF, Qi F, Chen JB, Zu XB. Hyperbaric Oxygen Therapy as an Adjuvant Therapy for Comprehensive Treatment of Fournier's Gangrene. Urol Int 2015; 94:453-8. [PMID: 25677386 DOI: 10.1159/000366137] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 07/24/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To compare simple conventional treatment with the addition of hyperbaric oxygen therapy (HBOT) to conventional therapies in the treatment of Fournier's gangrene (FG). METHODS A retrospective study of clinical data was performed by reviewing 28 cases of FG from January 2004 to December 2013 at Xiangya Hospital, Central South University. Among them, 12 patients were treated with the conventional therapy (non-HBOT group) and the other 16 cases were combined with hyperbaric oxygen therapy besides conventional therapy (HBOT group). All patients were followed up for 2 months to assess the therapeutic effect. The analyzed data included age, Fournier gangrene severity index (FGSI) score, number of surgical debridement, indwelling drainage tube time, length of stay (LOS), effective time, and curative time. RESULTS The mortality rate was lower in the HBOT group at 12.5% (2/16) compared to the non-HBOT group, which was 33.3% (4/12). The difference in the number of surgical debridement, indwelling drainage tube time, and curative time between were significantly lower in the HBOT group compared to the non-HBOT group. CONCLUSIONS Our preliminary research suggests that the effect of combining hyperbaric oxygen therapy with conventional therapy offers considerable advantage in the management of Fournier's gangrene. Multicenter studies with a larger sample size are required to confirm these observations.
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Affiliation(s)
- Chao Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Abstract
AbstractIntroductionBladder complications may be seen in up to 12% of patients treated with pelvic irradiation. To report the long-term efficacy of hyperbaric oxygen therapy (HBOT) on radiation-induced cystitis.MethodsWe followed 70 patients diagnosed with radiation cystitis submitted to HBOT in our institution from 2007 to 2013. All patients answered a questionnaire documenting symptom severity pre-HBOT and at the end of the follow-up period using the Late Effects of Normal Tissues – Subjective, Objective, Management, Analytical (LENT-SOMA) scale. Our treatment protocol consisted of multiple sessions (median of 40) of 100% oxygen delivery in a multiplace hyperbaric chamber at 2·4 atm for 80 minutes.ResultsWith a median follow-up of 55·5 (4–85) months, the success rate after the follow-up period in terms of haematuria resolution or improvement was 91·4%. The mean score of each subjective variable of LENT-SOMA scale (dysuria, frequency, haematuria, incontinence) were significantly lower after the follow-up period (p<0·05) with the exception of decreased stream (p=0·14). The sum of all subjective scores of LENT-SOMA scale was also significantly lower after the follow-up period (p<0·05). No serious complications were observed.ConclusionsOur results highlight the safety and long-term benefits of HBOT on haemorrhagic radiation cystitis and other distressful bladder symptoms.
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Loffroy R, Pottecher P, Cherblanc V, Favelier S, Estivalet L, Koutlidis N, Moulin M, Cercueil J, Cormier L, Krausé D. Current role of transcatheter arterial embolization for bladder and prostate hemorrhage. Diagn Interv Imaging 2014; 95:1027-34. [DOI: 10.1016/j.diii.2014.03.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Rajaganapathy BR, Jayabalan N, Tyagi P, Kaufman J, Chancellor MB. Advances in Therapeutic Development for Radiation Cystitis. Low Urin Tract Symptoms 2013; 6:1-10. [PMID: 26663493 DOI: 10.1111/luts.12045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 10/09/2013] [Accepted: 10/17/2013] [Indexed: 12/14/2022]
Abstract
Radiation treatment for pelvic malignancies is typically associated with radiation injury to urinary bladder that can ultimately lead to radiation cystitis (RC). The late sequelae of radiation therapy may take many years to develop and include bothersome storage symptoms such as hematuria, which may be life-threatening in severe cases of hemorrhagic cystitis. Although no definitive treatment is currently available, various interventions are used for radiation and hemorrhagic cystitis including blood transfusion, bladder irrigation, intravesical instillation of substances such as alum, silver nitrate, prostaglandins or formalin, and fulguration of intravesical bleeding sites and surgery options such as supravesical urinary diversions and cystectomy. Effects of non-surgical treatments for radiation and hemorrhagic cystitis are of modest success and studies are lacking to control the effects caused by RC. When such measures have proven ineffective, use of bladder botulinum toxin injection has been reported. New therapy, such as intravesical immunosuppression with local tacrolimus formulation is being developed for the treatment of radiation hemorrhagic cystitis.
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Affiliation(s)
- Bharathi Raja Rajaganapathy
- Department of Urology, Centre for Urology Research Excellence, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Nirmal Jayabalan
- Department of Urology, Centre for Urology Research Excellence, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Pradeep Tyagi
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Michael B Chancellor
- Department of Urology, Centre for Urology Research Excellence, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
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Shyam DC, Rapsang AG. Fournier's gangrene. Surgeon 2013; 11:222-32. [PMID: 23578806 DOI: 10.1016/j.surge.2013.02.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 01/30/2013] [Accepted: 02/01/2013] [Indexed: 12/20/2022]
Abstract
Fournier's gangrene (FG) is a synergistic polymicrobial gangrenous infection of the perineum, scrotum and penis which is characterised by obliterative endarteritis of the subcutaneous arteries, resulting in gangrene of the subcutaneous tissue and the overlying skin. FG affects all ages and both genders, with a male preponderance. It is a rare but life-threatening disease, and despite therapeutic advances in recent years, the mortality rate is 3%-67%, with an incidence of 1:7500-1:750,000. Anorectal, genitourinary and cutaneous sources of infection are the most common causes of FG, with diabetes mellitus being the most common risk factor. The clinical condition presents evolution from 2 to 7 days and is characterised by uneasiness, local swelling and discomfort, fever, crepitus and sometimes frank septic shock. Current imaging techniques for initial evaluation of the disease include radiography, Ultrasonography (USG), Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). However, the diagnosis of FG is usually clinical and imaging can be helpful in uncertain diagnosis and when clinical findings are ambiguous. Treatment of FG is based on a multimodal approach which includes intensive fluid resuscitation to stabilise the patient and correction of electrolyte imbalance, if any. This is followed by extensive debridements and resections in order to remove all necrotic and infected tissue, wide spectrum antibiotics and reconstructive surgery, whenever required. However, despite all the advances in treatment today, FG remains a surgical emergency, hence, early recognition with aggressive haemodynamic stabilisation, parenteral broad spectrum antibiotics and urgent surgical debridement are the mainstay of treatment.
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Affiliation(s)
- Devajit Chowlek Shyam
- Department of General Surgery, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, India.
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Fournier's Gangrene due to Masturbation in an Otherwise Healthy Male. Case Rep Emerg Med 2013; 2012:154025. [PMID: 23326701 PMCID: PMC3542919 DOI: 10.1155/2012/154025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 03/22/2012] [Indexed: 11/18/2022] Open
Abstract
Fournier's gangrene is a rare and often fulminant necrotizing fasciitis of the perineum and genital region frequently due to a synergistic polymicrobial infection. This truly emergent condition is typically seen in elderly, diabetic, or otherwise immune-compromised individuals. Here, we report an unusual case of Fournier's gangrene due to excessive masturbation in an otherwise healthy 29-year-old male who presented to the emergency department complaining of two days of fever, vomiting, and diffuse myalgias. Upon further questioning, he also endorsed severe scrotal pain and swelling and frequent masturbation with soap as a lubricant resulting in recurrent penile erythema and minor skin abrasions. Examination of the patient's perineum was consistent with Fournier's gangrene and included significant erythema, edema, and calor of the penis and scrotum with a large malodorous eschar. He was given intravenous antibiotics and immunoglobulin and promptly underwent three surgical debridements of the scrotum and penis with split-thickness skin grafting. Complications from excessive masturbation are exceedingly rare, but as this case illustrates, they can be life threatening.
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Mallikarjuna MN, Vijayakumar A, Patil VS, Shivswamy BS. Fournier's Gangrene: Current Practices. ISRN SURGERY 2012; 2012:942437. [PMID: 23251819 PMCID: PMC3518952 DOI: 10.5402/2012/942437] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Accepted: 10/24/2012] [Indexed: 12/30/2022]
Abstract
Fournier's gangrene is an acute, rapidly progressive, and potentially fatal, infective necrotizing fasciitis affecting the external genitalia, perineal or perianal regions, which commonly affects men, but can also occur in women and children. There has been an increase in number of cases in recent times. Despite advanced management mortality is still high and averages 20-30%. Early diagnosis using Laboratory Risk Indicator for Necrotizing Fasciitis score and stratification of patients into high risk category using Fournier's Gangrene Severity Index score help in early initiation of treatment. Triple antibiotic combined with radical debridement is the mainstay of treatment. There have been many advances in management of Fournier gangrene including use of vaccum assisted closure and hyperbaric oxygen therapy. With introduction of newer devices like Flexi-Seal, fecal diversion can be done, avoiding colostomy. Reconstruction of perineal defects using skin grafts, flaps, and urethral reconstruction using gracilis flaps can reduce the morbidity associated with FG and provide acceptable functional and aesthetic outcomes.
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Affiliation(s)
- M. N. Mallikarjuna
- Department of General Surgery, Victoria Hospital, Bangalore Medical College and Research Institute, Bangalore 560002, India
| | - Abhishek Vijayakumar
- Department of General Surgery, Victoria Hospital, Bangalore Medical College and Research Institute, Bangalore 560002, India
| | - Vijayraj S. Patil
- Department of General Surgery, Victoria Hospital, Bangalore Medical College and Research Institute, Bangalore 560002, India
| | - B. S. Shivswamy
- Department of General Surgery, Victoria Hospital, Bangalore Medical College and Research Institute, Bangalore 560002, India
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Abstract
The scrotal and perineal area serves a special function. It is the pelvic outlet for the gastrointestinal tract, urinary system, and sexual function. In the male, the scrotum allows testicular mobility to reduce trauma and allow optimal thermal regulation for spermatogenesis. Trauma, infection, and cancer resection create defects that require reconstruction. The reconstructive goal here is to obtain durable coverage, function, and lastly aesthetic outcome. Pedicled local and regional flaps are the mainstay for this area. Due to the special function and appearance of the scrotum, reconstructive options for total scrotal defect always fall far short of the native scrotum. On the other hand, perineal reconstruction is overall satisfactory.
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Affiliation(s)
- Nho V Tran
- Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota
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Shao Y, Lu GL, Shen ZJ. Comparison of intravesical hyaluronic acid instillation and hyperbaric oxygen in the treatment of radiation-induced hemorrhagic cystitis. BJU Int 2011; 109:691-4. [PMID: 21895939 DOI: 10.1111/j.1464-410x.2011.10550.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE • To compare the efficacy of intravesical hyaluronic acid (HA) instillation and hyperbaric oxygen (HBO) in the treatment of radiation-induced haemorrhagic cystitis (HC). PATIENTS AND METHODS • In total 36 patients who underwent radiotherapy for their pelvic malignancies and subsequently suffered from HC were randomly divided into an HA group and an HBO group. • Symptoms of haematuria, frequency of voiding and the visual analogue scale of pelvic pain (range 0-10) were evaluated before and after the treatment with follow-up of 18 months. RESULTS • All patients completed this study and no obvious side effects of intravesical HA were recorded. • The improvement rate showed no statistical difference between the two groups at 6, 12 and 18 months after treatment. • Decrease of frequency was significant in both groups 6 months after treatment, but was only significant in the HA group 12 months after therapy. • The improvement in the visual analogue scale remained significant in both groups for 18 months. CONCLUSIONS • Intravesical instillation of HA was as effective in treating radiation-induced HC as HBO. • It is well tolerated and resulted in a sustained decrease of bladder bleeding, pelvic pain and frequency of voiding for at least 12 months.
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Affiliation(s)
- Yuan Shao
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Tanaka T, Nitta Y, Morimoto K, Nishikawa N, Nishihara C, Tamada S, Kawashima H, Nakatani T. Hyperbaric oxygen therapy for painful bladder syndrome/interstitial cystitis resistant to conventional treatments: long-term results of a case series in Japan. BMC Urol 2011; 11:11. [PMID: 21609485 PMCID: PMC3116481 DOI: 10.1186/1471-2490-11-11] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2010] [Accepted: 05/24/2011] [Indexed: 11/25/2022] Open
Abstract
Background There is no confirmed strategy for treating painful bladder syndrome/interstitial cystitis (PBS/IC) with unclear etiology. Therefore, a pilot study was carried out to evaluate the efficacy and safety of hyperbaric oxygen (HBO) therapy in treatment-resistant PBS/IC patients. Methods HBO treatment (2.0 ATA for 60 minutes/day × 5 days/week for 2 or 4 weeks) was performed on 11 patients with severe symptoms that had not been improved by previous therapy regimens between December 2004 and July 2009. Results Seven of the 11 patients demonstrated persistent improvement in symptoms during the 12 months after HBO treatment. These responders demonstrated a decrease in the pelvic pain scale and urgency scale from 7.7 ± 1.0 and, 6.6 ± 0.9 to 3.4 ± 2.5 and 4.3 ± 2.4 after 12 months, respectively (p < 0.05). The total score of the interstitial cystitis symptom index and 24-hour urinary frequency demonstrated a significant sustained decrease from the baseline. Two responders, who received an additional course of HBO 12 and 13 months after initial treatment, respectively, did not suffer impairment for more than two years. There was one case of transient eustachian tube dysfunction and three cases of reversible exudative otitis media as a consequence of HBO treatment. Conclusions HBO is a potent treatment for PBS/IC patients resistant to conventional therapy. It was well tolerated and provided maintained amelioration of pain, urgency and urinary frequency for at least 12 months.
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Affiliation(s)
- Tomoaki Tanaka
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan.
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Lin Q, Zhu P, Sun GD, Yang BL. Diagnosis and treatment of perianal necrotizing fasciitis. Shijie Huaren Xiaohua Zazhi 2010; 18:3428-3431. [DOI: 10.11569/wcjd.v18.i32.3428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Perianal necrotizing fasciitis (PNF) is a serious infectious disease that results from a synergistic action of multiple bacteria and has a high mortality rate. In the early stage of PNF, symptoms are highly variable. Early diagnosis and adequate treatment are important for the prognosis of PNF. Therapeutic measures for PNF include surgical removal of necrotic tissue, drainage, debridement and full dose of broad-spectrum antibiotics. In this article, we will review the recent advances in the diagnosis and treatment of PNF.
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Outcome of transcatheter arterial embolization for bladder and prostate hemorrhage. J Urol 2010; 183:1947-53. [PMID: 20303518 DOI: 10.1016/j.juro.2010.01.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Indexed: 11/20/2022]
Abstract
PURPOSE We evaluated the efficacy and outcomes of transcatheter arterial embolization for intractable bladder or prostate bleeding after failed conservative treatment. MATERIALS AND METHODS We retrospectively studied the records of 2 women and 18 men with a mean +/- SD age of 73 +/- 17.2 years referred between 1999 and 2008 for selective pelvic angiography after failed conventional therapy. Embolization was feasible in 18 patients, including bilateral and unilateral embolization in 13 and 5, respectively. It consisted of superselective distal particulate or glue embolization of the vesical or prostatic arteries in 11 patients, selective proximal coil or gelatin sponge particle occlusion of the anterior division of the internal iliac artery in 2, the 2 techniques in 3 and coil blockade in 2. Clinical bleeding control and post-embolization angiography findings were used to assess outcomes. RESULTS The technical success rate was 90% (18 of 20 cases). Bleeding was controlled after the first procedure in 15 of 18 patients (83.3%) and after a repeat procedure in the remaining 3. The periprocedural mortality rate was 20% (4 of 20 patients) and all deaths were related to underlying conditions. No major complications related to catheterization occurred. Late bleeding recurrence was reported in 4 of the 14 survivors (28.6%). Mean post-embolization followup was 16 months (range 15 days to 56 months). During followup 6 more patients died, including 2 of repeat bleeding. CONCLUSIONS Selective angiographic embolization is safe and effective to control refractory, life threatening bladder or prostate bleeding. This procedure should be considered the treatment of choice since it usually obviates the need for emergency surgery in these severely ill patients.
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Abstract
Acute radiation cystitis occurs during or soon after radiation treatment. It is usually self-limiting, and is generally managed conservatively. Late radiation cystitis, on the other hand, can develop from 6 months to 20 years after radiation therapy. The main presenting symptom is hematuria, which may vary from mild to severe, life-threatening hemorrhage. Initial management includes intravenous fluid replacement, blood transfusion if indicated and transurethral catheterization with bladder washout and irrigation. Oral or parenteral agents that can be used to control hematuria include conjugated estrogens, pentosan polysulfate or WF10. Cystoscopy with laser fulguration or electrocoagulation of bleeding points is sometimes effective. Injection of botulinum toxin A in the bladder wall may relieve irritative bladder symptoms. Intravesical instillation of aluminum, placental extract, prostaglandins or formalin can also be effective. More-aggressive treatment options include selective embolization or ligation of the internal iliac arteries. Surgical options include urinary diversion by percutaneous nephrostomy or intestinal conduit, with or without cystectomy. Hyperbaric oxygen therapy (HBOT) involves the administration of 100% oxygen at higher than atmospheric pressure. The reported success rate of HBOT for radiation cystitis varies from 60% to 92%. An important multicenter, double-blind, randomized, sham-controlled trial to evaluate the effectiveness of HBOT for refractory radiation cystitis is currently being conducted.
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Affiliation(s)
- Shaun G Smit
- Department of Urology, University of Stellenbosch and Tygerberg Hospital, PO Box 19063, Tygerberg 7505, South Africa.
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Czymek R, Schmidt A, Eckmann C, Bouchard R, Wulff B, Laubert T, Limmer S, Bruch HP, Kujath P. Fournier's gangrene: vacuum-assisted closure versus conventional dressings. Am J Surg 2009; 197:168-76. [PMID: 19185110 DOI: 10.1016/j.amjsurg.2008.07.053] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Revised: 07/02/2008] [Accepted: 07/03/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND Fournier's gangrene is a fulminant and destructive inflammation of the scrotum, penis, and perineum. The objective of this study was to compare 2 different approaches to wound management after aggressive surgical debridement. METHODS Data from 35 patients with Fournier's gangrene were prospectively collected (1996-2007). Once the patients were stabilized following surgery, they were treated with either daily antiseptic (polyhexanide) dressings (group I, n = 16) or vacuum-assisted closure (VAC) therapy (group II, n = 19). RESULTS The mean age of the patients was 58.2 years in group I and 57.2 years in group II. In both groups, the most common predisposing conditions were diabetes mellitus, chronic alcoholism, and obesity. Escherichia coli, streptococcal species, Pseudomonas aeruginosa, and Staphylococcus aureus were the most frequently isolated organisms. Length of hospital stay was 27.8 days +/- 27.6 days (mortality: 37.5%) in group I and 96.8 days +/- 77.2 days (mortality: 5.3%) in group II. Enterostomies were performed in 43.8% of group I patients and in 89.5% of group II patients. CONCLUSIONS VAC was associated with significantly longer hospitalization and lower mortality. A partial explanation is that some patients with severe sepsis died within the first 3 days after admission and thus could not undergo vacuum therapy. Since our clinical experience has shown that vacuum dressings are particularly effective in the management of large wounds, we use VAC primarily for this indication despite the considerable material requirements involved.
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Affiliation(s)
- Ralf Czymek
- Department of Surgery, University of Luebeck Medical School, Luebeck, Germany.
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The clinical features of Fournier's gangrene and the predictivity of the Fournier's Gangrene Severity Index on the outcomes. Int Urol Nephrol 2008; 40:997-1004. [PMID: 18563618 DOI: 10.1007/s11255-008-9401-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Accepted: 05/16/2008] [Indexed: 12/19/2022]
Abstract
Fournier's gangrene (FG) is a rare, rapidly progressive, fulminant form of necrotizing fasciitis of the genital, perianal and perineal regions. Several factors have been reported to contribute to the clinical outcomes. The primary aims of this study were to examine the clinical features of patients with FG and evaluate the predictivity of the Fournier's Gangrene Severity Index (FGSI) score on the outcomes. We carried out a collective retrospective chart review of patients diagnosed and treated for FG in three reference centers between January 1995 and July 2007. Seventy-two patients with FG with were included to the study. Data were collected on medical history, symptoms, physical examination findings, admission and final laboratory tests, timing and extent of surgical debridement and antibiotic therapy. Perianal and perirectal abscess, scrotal abscess and urethral stenosis were the leading etiological factors. Diabetes mellitus was the predominant risk factor. Etiological factors and risk factors did not significantly contribute to survival or mortality, and duration of the symptoms was significantly longer in the non-survivor's group (P < 0.05). The FGSI scores were higher in the non-survivor's group. Regression analysis showed a FGSIS score of 10.5 as the cut-off to the outcome. Based on these results, we conclude that a patient's metabolic status and the extent of disease at presentation are the most important factors determining the prognosis of FG. The FGSI score may be considered as an objective and simple tool to predict the outcome in the patient with FG and should be used in further studies of FG patient series for comparison purposes.
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Abstract
Fournier's gangrene (FG) describes necrotizing infections of the perineum in both sexes. Controversies in treatment of FG include the roles of orchiectomy, urinary and/or fecal diversion, and hyperbaric oxygen (HBO). Because burn centers often treat these patients, we reviewed our experience with FG during a 14-year period. With Institutional Review Board approval, we reviewed our TRACS/ABA database for patients treated for FG during 1992 to 2005. Data was recorded on demographics, preexisting medical conditions, treatment, and outcomes. Thirty patients (20 men) were identified. Mean age was 54.3 +/- 14.1 years. Predisposing conditions included diabetes in 16 patients (53%), and morbid obesity and immunosuppression in 6 each. Twenty-two patients were transferred from outside hospitals, 12 after initial surgery. Sixteen patients presented with shock (blood pressure <90/60 mm Hg). Patients underwent a mean of 4.1 surgical procedures. Ten infections penetrated the deep fascia of the perineum or abdominal wall. Suprapubic cystostomy was performed in three patients, colostomy in seven, orchiectomy in one. HBO was not used. Hospitalization averaged 25.3 +/- 15.6 days. Mean charges ($1000) were $131.5 +/- 108.3. Definitive wound closure was obtained before discharge with suture repair and/or skin grafting in 18 of 25 survivors (72%). Five patients died (17%). In logistic regression analysis, the presence of shock on admission and female gender (mortality 40%) were significantly associated with mortality. FG remains a devastating infection, which occurs primarily in compromised patients. In this series, aggressive burn center care produced outcomes equivalent to those published in other series with or without use of HBO. Colostomy and urinary diversion can be used very selectively in these patients; orchiectomy is rarely required.
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Rastinehad AR, Ost MC, VanderBrink BA, Siegel DN, Kavoussi LR. Persistent prostatic hematuria. ACTA ACUST UNITED AC 2008; 5:159-65. [DOI: 10.1038/ncpuro1044] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2007] [Accepted: 12/10/2007] [Indexed: 11/09/2022]
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Selective Arterial Prostatic Embolization (SAPE) for Refractory Hematuria of Prostatic Origin. Urology 2008; 71:181-4. [DOI: 10.1016/j.urology.2007.09.012] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Revised: 08/07/2007] [Accepted: 09/13/2007] [Indexed: 11/19/2022]
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