Cutaneous continent diversion pouchitis

early postoperative period when mucous accumulation can be high can cause
pouchitis.

A simple program of mechanical irrigation can decrease the incidence of

infections, though asymptomatic colonization may not decrease.

Large catheter doesn’t drain mucus so not useful

. Prophylactic antibiotics or

urine acidification are useful in patients who do not respond to simple measures
and remain persistently infected.

A pouchogram is done late

subcapsular hematoma.

While subcapsular hematoma can occur in the absence of renal malignancy, the
clinician should always be suspicious of an underlying tumor as a cause for the
bleeding.

In those cases in which an underlying tumor is not evident, delayed imaging is

advised as it can allow evaluation for tumor after the hematoma is reabsorbed.

So in cases of subcapsular hematoma needs a reimaging after 3 months to r/o

malignancy
Ileal conduit pyocystitis

Pyocystis occurs in approximately 20% of patients who undergo supravesical

diversion.

Patients typically have a malodorous discharge and may develop sepsis.

If conservative measures, such as routine bladder irrigations fail,

vaginal vesicostomy (creation of a large vesico-vaginal fistula), is an effective

method of preventing pyocystis in women.

This is an especially good alternative for an elderly or high risk patient.

A stapling device can be used to quickly perform this operation.

Absorbable staples should be used if the patient is sexually active.

Bladder irrigations

Acidification

Vaginal vesicostomy

CYSTECTOMY is last option.

A SPC will not facilitate bladder drainage, as well as a vaginal vesicostomy.

Radiation cystitis

A 75-year-old-man has severe bleeding from radiation cystitis requiring transfusion.

Cystogram reveals no reflux. Previous therapeutic measures have failed including
fulguration, clot evacuation, and irrigations with silver nitrate and 1 % alum. The next
step is:

A. ileal loop urinary diversion.

B. instillation of 10% formalin.
C. instillation of 5% formaldehyde.
D. instillation of 2% formalin.
E. internal iliac artery embolization.

Formaldehyde is a 37% solution do not use

Formalin 10% should not be used.

1 A cystogram should be performed before instillation to r/o vur.

2 Many begin with a 1-2% solution if other measures (i.e., silver nitrate and 1%
alum) have failed.

3 Formalin instillation should begin with a 1%

4 Selective internal iliac arterial embolization is more invasive and should be

reserved for patients that fail formalin instillation.

5 Ileal loop urinary diversion is the final option for patients with intractable
hemorrhage and a nonfunctional bladder.
A newborn girl has an abdominal mass.
An interlabial bulging mass is also noted.
Ultrasound shows a cystic mass anterior to the rectum that
does -not change with bladder catheterization.
The most likely diagnosis is:

A. imperforate hymen.
B. rhabdomyosarcoma.
C. sacrococcygeal teratoma.
D. Gartner's duct cyst.
E. prolapsed ureterocele.

IH and prolapsed ureterocele are interlabial masses.

In IN cervical glands produce mucus in response to maternal hormones and so It

bulges.
A 26-year-old man has had four ureteroscopic stone extractions over the past three
years. All stones were pure calcium phosphate (brushite). He denies prior UTIs. The
most likely etiology for his stone disease is:
A. hyperuricosuria.
B. resorptive hypercalciuria.
C. phosphate renal leak.
D. renal hypercalciuria.
E. excess meat consumption.

Correct answer : B

A. hyperuricosuria.m/c d/t high purine diet

B. resorptive hypercalciuria. Htper PTH- ca3po4 stones
C. phosphate renal leak.- a/w ca oxalate stones
D. renal hypercalciuria.- ca oxalate
E. excess meat consumption.

Recurrent calcium phosphate (100%) brushite stones are unusual and should
arouse suspicion for primary hyperparathyroidism (resorptive hypercalciuria).
Serum parathyroid and calcium levels should be evaluated.

Hyperuricosuric calcium nephrolithiasis is most commonly due to excessive

purine intake and can be successfully treated with dietary manipulation.

Phosphate renal leak hypercalciuria is associated with elevated Vitamin

D levels and calcium oxalate or mixed calcium oxalate and calcium phosphate
calculi.

Renal hypercalciuria is associated with calcium oxalate stones and is

successfully treated with hydrochlorothiazides over the long-term
A 24-year-old woman had an ileocystoplasty for neurogenic bladder four years ago.
During an emergency cesarean section, the vascular pedicle to the cystoplasty
segment is divided. The next step is: . .

A. revascularization of the pedicle.

B. excise ileal patch; immediate ileal augmentation.
C. excise ileal patch; delayed sigmoid augmentation.
D. place suprapubic tube and drain.
E. observation with follow-up urodynamics

CYSTOPLASTY SEGMENT WILL RECEIVE MANY COLLATERALS FROM THE

BLADDER AND CAN STILL SURVIVE