Urologic Considerations in Inguinal Hernia Repair

Urologic Considerations in Inguinal Hernia Repair

Miscellaneous Subjects 933 934 UROLOGIC CONSIDERATIONS IN INGUINAL HERNIA REPAIR. *John A. Mata, *C. William Tanner, and *William C. Mitchell, Shrev...

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Miscellaneous Subjects 933

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UROLOGIC CONSIDERATIONS IN INGUINAL HERNIA REPAIR. *John A. Mata, *C. William Tanner, and *William C. Mitchell, Shreveport, LA (Presentation to be made by nr. Tanner) The bladder, spermatic cord, testicle, ureter, and vas deferens are structures of urologic interest that may be involved with or injured during an inguinal hernia repair. Four patients with dissimilar uroinguinal pathology are reviewed. Patient #1 had an intraoperative transection of a duplicated ureter during repair of a large indirect paraperitoneal ureteroinguinal hernia. Patient #2, a newborn male, had a bladder laceration repaired shortly after uriniferous drainage was noted from the left inguinal incision following bilateral hernia repair. Patient #3, with a large left sided hernia, had a preoperative !VP because of dysuria and vague right sided abdominal pain which revealed a right medially deviated ureter towards the left inguinal hernia. Postoperatively, an !VP revealed resolution of the ureteral deviation. Patient #4, a missed diagnosis, was found to have a right spermatic cord abscess requiring orchiectomy discovered during an exploration for a hernia. The incidence of significance urologic complications in inguinal hernia repair is less than 1%. Uncomplicated uropathology or missed diagnosis add to the urologic spectrum a urologist may encounter in practice. Me review the incidence and potential urologic manifestations and complications associated with the repair of inguinal hernias.

A BLADDER CUSHION TO REDUCE THE TRANSMISSION OF FAST ABDOMINAL PRESSURE CHANGES TO THE BLADDER. August. E.J.L. Kramer* and M. Ali Affandi*, Leiden, The Netherlands. (Presentation to be made by Dr. Kramer) Genuine stress urinary incontinence is mostly caused by an abdominal pressure increase that is transmitted in full to the intravesical pressure but to a lesser extent to the urethral pressure. The reason is that the bladder always is contained completely within the abdominal cavity and, in these patients, the proximal urethra seems to be located partially outside this cavity. Treatment of these patients therefore is often directed to repositioning of the urethra. The other possible approach to this problem is reduction of the abdominal pressure transmission to the bladder. As most hindrance is experienced from rather short-lasting high-pressure abdominal straining (<1-2 s; >100 cm H20) like coughing or jumping this can be accomplished by a system that filters out fast components of abdominal pressure rise from transmission to the bladder. The "shock absorber" with an adequate time constant (1-2 s) will effectively depress the transmission to the intravesical pressure to about 30-70% of the original intra-abdominal amplitude and yet leave the longer-lasting abdominal straining, as used sometimes to facilitate bladder emptying unaffected. A clinical corroborate to this approach can be seen in the prune belly bladder, but in this case the far longer time constant also diminishes the transmission of voluntary straining. After in an 'in vitro' model test the feasability of the advocated approach had been proven an animal model study has been designed to test the efficacy in a clinical set-up.

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THE SURGICAL MANAGEMENT OF URETHRAL CARCINOMA. Darwich E. Bejany*, Pedro Peytave*; Victor A. Politano, Miami, FL (Presentation to be made by Dr. Bejany) We reviewed 15 patients with urethral carcinoma who were treated with surgery alone or received adjunctive radiation therapy. Anterior exenteration was performed in 12 patients (6 males and 6 females), 7 of whom had squamous cell carcinoma. Three out of the 12 had transitional cell carcinoma, and 2 had adenocarcinoma. Two additional male patients underwent a urethrectomy for squamous cell carcinoma, diagnosed 2 and 5 years respectively following a salvage cystectomy. One additional female patient had a local excision of a carcinoma in-situ of the distal urethra and subsequently underwent a radical vulvectomy for local recurrence which was followed by external beam radiation therapy and is still alive 9 years later. Out of the 12 patients who were treated with anterior exenteration, 6 are still aliveatl,2,3,5, 7, and 8 years. Three of them have had adjunctive radiation therapy. None of the 6 patients who died had received adjunctive therapy.

APPLICATIONS OF THE CO2 LASER IN UROLOGIC SURGERY. *Robert F. Graves, M.D., *David P. Dever, M.D., P. Miller Ashman, M.D:, Michael J. Feinstein, M.D., Rochester, NY

(Presentation to be made by Dr. Graves) The CO2 laser has pr6ven to be a very efficient operative laser and is currently being used and evaluated in many of the surgical specialities. In this presentation,

we will report the use of the Sharplin CO2 laser in selected cases of urologic surgery. Specifically, we will discuss and illustrate 2 patients with Fournier's gangrene

who were successfully surgically managed using the CO2 laser.

In addition, a urethral reconstruction was attempt-

ed with the CO2 laser following ablation of the urethra secondary to Fournier's gangrene. Further, a patient with a previous childhood thermal injury to the groin developed painful scarring and a scrotoplasty was performed utilizing the CO2 laser. Moreover, 2 patients with penile condylomata and 1 case of giant condylomata are also illustrated and discussed. Accompanying the discussion

will be intra-operative and follow up photographs of each case.

A brief discussion of the physics of the CO2 laser will also accompany the aforementioned case reports. We feel that these case reports will illustrate that

the CO2 laser can be a significant addition in the armamentarium of the urologic surgeon. The illustrations and the accompanying discussion will serve to illustrate

the application and employment of the CO2 laser in urologic surgery and how it can be useful in the treatment of specific urologic conditions.

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