Long-term results and complications using augmentation cystoplasty in reconstructive urology

One hundred and twenty-two augmentation cystoplasties performed over an 8-year period were reviewed. Mean age at surgery was 37 years (range 2–82 years). There were 82 female patients. The primary urodynamic diagnosis was reduced compliance in 92 (77%) pattenls and detrusor hyperreflexia/instability in the remainder. The clinical diagnostic groups were: spinal cord injury/disease in 32 (27%), myelodysplasia in 27 (22%), interstitial cystitis in 21 (17%), idiopathic detrusor instability in 13 (11%), radiation cystitis in 8 (7%). Hinman-Allen syndrome in 5 (4%), and miscellaneous in 11 (9%). A detubularized, ileal augmentation was used in 82 (67%) patients. In 36 (30%) a detubularized ileocecocystoplasty was fashioned and in the remainder detubularized sigmoid was used. In 19 patients augmentation accompanied undiversion. Sixteen patients had a simultaneous fascial sling for urethral incompetence. Mean follow-up was 37 months (range 6–96 months). There was no postoperative mortality. During follow-up 4 patients died from unrelated causes, 11 have been lost to follow-up, and 5 patients await planned transplantation. Bladder capacity was increased from a preoperative mean of 108 ml (range 15–500 ml) to 438 ml (200–1,200 ml) postoperatively. Of the 106 assessable patients, 80 (75%) had an excellent result, 21 (20%) were improved, and 5 (5%) had major ongoing problems. During the period of follow-up, 17 (16%) patients underwent revision of their augmentation. Twenty-four (21%) patients developed bladder stones and 30% of these did so more than once. Urinary incontinence became manifest in 15 (13%) patients but required surgical treatment in only half of these. Pyelonephritis occurred in 13 (11%) patients. Five patients developed small bowel obstruction following discharge from hospital. There were 7 instances of reservoir rupture in 5 (4%) patients. Augmentation cystoplasty has a pivotal role in the treatment of a broad range of lower and upper urinary tract problems. Careful patient selection and close follow-up are essential. © 1995 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/38474/1/1930140402_ftp.pd

Ecology and Transmission of Buruli Ulcer Disease: A Systematic Review

Buruli ulcer is a neglected emerging disease that has recently been reported in some countries as the second most frequent mycobacterial disease in humans after tuberculosis. Cases have been reported from at least 32 countries in Africa (mainly west), Australia, Southeast Asia, China, Central and South America, and the Western Pacific. Large lesions often result in scarring, contractual deformities, amputations, and disabilities, and in Africa, most cases of the disease occur in children between the ages of 4–15 years. This environmental mycobacterium, Mycobacterium ulcerans, is found in communities associated with rivers, swamps, wetlands, and human-linked changes in the aquatic environment, particularly those created as a result of environmental disturbance such as deforestation, dam construction, and agriculture. Buruli ulcer disease is often referred to as the “mysterious disease” because the mode of transmission remains unclear, although several hypotheses have been proposed. The above review reveals that various routes of transmission may occur, varying amongst epidemiological setting and geographic region, and that there may be some role for living agents as reservoirs and as vectors of M. ulcerans, in particular aquatic insects, adult mosquitoes or other biting arthropods. We discuss traditional and non-traditional methods for indicting the roles of living agents as biologically significant reservoirs and/or vectors of pathogens, and suggest an intellectual framework for establishing criteria for transmission. The application of these criteria to the transmission of M. ulcerans presents a significant challenge

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Acquired crossed renal ectopia secondary to a giant renal cyst

We report a case of contralateral renal displacement due to a giant ipsilateral renal cyst. Drainage and partial excision of the cyst was followed by return of the kidney and liver to their normal positions. Incidentally, a small focus of renal cell carcinoma was found after pathologic examination of the cyst wall. The relevant literature is reviewed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31753/1/0000693.pd

Delayed presentation of a detached resectoscope beak and treatment with thulium laser

Intraoperative detachment of a resectoscope beak is an extremely rare and unusual event. Retrieval of the ceramic beak can be difficult due to the sheath’s large size relative to the urethral lumen. Our report describes the retrieval of a calcified ceramic resectoscope beak from the urinary bladder 4 years after transurethral resection of the prostate (TURP). The calcified beak was successfully fragmented into 3 separate pieces with a thulium laser. This method allowed for safe removal of each fragment through the urethra

Augmentation cystoplasty and extracellular matrix scaffolds: an ex vivo comparative study with autogenous detubularised Ileum

Background: Augmentation cystoplasty (AC) with autogenous ileum remains the current gold standard surgical treatment for many patients with end-stage bladder disease. However, the presence of mucus-secreting epithelium within the bladder is associated with debilitating long-term complications. Currently, decellularised biological materials derived from porcine extracellular matrix (ECM) are under investigation as potential augmentation scaffolds. Important biomechanical limitations of ECMs are decreased bladder capacity and poor compliance after implantation. Methodology/Principal Findings: In the present ex vivo study a novel concept was investigated where a two-fold increase in ECM scaffold surface-area relative to the resected ileal segment was compared in ovine bladder models after AC. Results showed that bladder capacity increased by 4064% and 37611% at 10 mmHg and compliance by 40.464% and 39.766% (DP = 0–10 mmHg) after AC with ileum and porcine urinary bladder matrix (UBM) respectively (p,0.05). Comparative assessment between ileum and UBM demonstrated no significant differences in bladder capacity or compliance increases after AC (p.0.05). Conclusions: These findings may have important clinical implications as metabolic, infective and malignant complications precipitated by mucus-secreting epithelium are potentially avoided after augmentation with ECM scaffolds

Augmentation Cystoplasty and Extracellular Matrix Scaffolds: An Ex Vivo Comparative Study with

Background: Augmentation cystoplasty (AC) with autogenous ileum remains the current gold standard surgical treatment for many patients with end-stage bladder disease. However, the presence of mucus-secreting epithelium within the bladder is associated with debilitating long-term complications. Currently, decellularised biological materials derived from porcine extracellular matrix (ECM) are under investigation as potential augmentation scaffolds. Important biomechanical limitations of ECMs are decreased bladder capacity and poor compliance after implantation. Methodology/Principal Findings: In the present ex vivo study a novel concept was investigated where a two-fold increase in ECM scaffold surface-area relative to the resected ileal segment was compared in ovine bladder models after AC. Results showed that bladder capacity increased by 4064 % and 37611 % at 10 mmHg and compliance by 40.464 % and 39.766% (DP = 0–10 mmHg) after AC with ileum and porcine urinary bladder matrix (UBM) respectively (p,0.05). Comparative assessment between ileum and UBM demonstrated no significant differences in bladder capacity or compliance increases after AC (p.0.05). Conclusions: These findings may have important clinical implications as metabolic, infective and malignant complications precipitated by mucus-secreting epithelium are potentially avoided after augmentation with ECM scaffolds