https://uroweb.org/wp-content/uploads/20_Neurogenic-LUTD_LR.pdf

EAU Guidelines on Neurogenic Lower Urinary Tract Dysfunction

Broth microdilution MICs were determined for 258 clinical isolates of Mycobacterium fortuitum (3 biovariants) and M. chelonae (2 subspecies) with amikacin, tobramycin, cefoxitin, doxycycline, erythromycin, and sulfamethoxazole-trimethoprim and with several new beta-lactams and aminoglycosides and ciprofloxacin. Variations in susceptibility by and within species subgroups confirm the need for susceptibility testing against clinically important strains.

Antimicrobial susceptibility of five subgroups of Mycobacterium fortuitum and Mycobacterium chelonae.

The Consensus on Genitourinary Trauma continues this month with an evidence-based analysis, by a team of experts under the chairmanship of Dr Jack McAninch, of current reports on the diagnosis and management of ureteric trauma. This is quite a unique document, and of interest to all urologists; not only as a consensus on how this condition should be managed, but also as a model of how to review current publications.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1464-410X.2004.04978.x

Diagnosis and management of ureteric injury: an evidence‐based analysis

Background

The development and anatomy of Denonvilliers' fascia have been controversial for many years and confusion exists about its operative appearance. Better appreciation of this poorly understood anatomy, and its significance for impotence after rectal dissection, may lead to further functional improvements in pelvic surgery.



Method

A literature review of the embryology and anatomy of Denonvilliers' fascia and impotence after pelvic rectal surgery was undertaken.



Results

Denonvilliers' fascia has no macroscopically discernible layers. The so-called posterior layer refers to the fascia propria of the rectum. The incidence of erectile and ejaculatory dysfunction after rectal excision is high in older patients, and when performed for rectal cancer. There is no consensus about the relationship of Denonvilliers' fascia to the plane of anterior dissection for rectal cancer.



Conclusion

Colorectal surgeons should focus on the important anatomy between the rectum and the prostate to improve functional outcomes after rectal excision. A classification of the available anterior dissection planes is proposed. Surgeons should be encouraged to document the plane used as well as outcome in terms of sexual function. © 2000 British Journal of Surgery Society Ltd

Anatomy of Denonvilliers' fascia and pelvic nerves, impotence, and implications for the colorectal surgeon.

Sixteen published series were reviewed in which local excision was used as definitive treatment for patients with invasive rectal carcinoma located within 6 cm of the anal verge. Ninety-four percent of tumors were T1 or T2 adenocarcinomas with no identified regional metastases. Five-year cancer-specific survival was 89%. Local recurrence was 19%, although more than half of these patients were cured with additional surgery. These results were comparable with those for historical controls treated with abdominoperineal resection (APR). Four pathologic features of the surgical specimen were analyzed to assess their correlation with patient outcome. Positive surgical margins, poorly differentiated histology, and increasing depth of bowel wall invasion were associated with increased local recurrence and decreased survival. Tumor size greater than 3 cm was not a significant factor. When criteria for appropriate patient selection are followed, local excision may provide survival and recurrence rates comparable with those achieved with APR with less morbidity and operative mortality.

Local excision of rectal carcinoma

Urologic Complications Following Abdominoperineal Resection

Blastomycosis of the Genitourinary Tract

Cefamandole readily diffuses from the serum into soft tissue interstitial fluid. The rate of diffusion differs little from that of cephalothin. The concentrations of antibiotic were greater in bile and urine during the entire period of study than is necessary to kill susceptible pathogenic bacteria present in these fluids.

Concentration of Cefamandole in Serum Interstitial Fluid, Bile, and Urine

Utilizing multiperforated capsules implanted in tissue, the concentrations of cephalotin, ampicillin, and tetracycline in soft tissue interstitial fluid (STIF) and renal interstitial fluid (RIF) were measured simultaneously and compared with concentrations found in serum and urine in dogs. Antibiotic concentration in RIF was less than urinary levels but exceeded serum concentrations. A direct time-concentration relationship of these three structurally unrelated antibiotics in serum and renal interstitial fluid was found. This model helps illuminate the basic pharmacokinetics of antibiotic in the renal interstitium where pyelonephritis occurs.

Concentration of antibiotics in renal interstitial fluid, soft tissue interstitial fluid, urine and serum

Utilizing multiperforated capsules implanted into subcutaneous tissue and the prostate in dogs, the concentration of cephalothin in soft tissue interstitial fluid (STIF) and prostatic interstitial fluid (PIF) was measured simultaneously and compared with concentration in serum. At all times the antibiotic concentration in PIF was lower than levels found in STIF and serum. This model may aid in the understanding of the basic pharmocokinetics of antibiotics in the prostatic interstitium and provide guidelines for treatment of prostatitis.

H. U. Eickenberg

Papers

Urologic Complications Following Abdominoperineal Resection

Blastomycosis of the Genitourinary Tract

Concentration of Cefamandole in Serum Interstitial Fluid, Bile, and Urine

Concentration of antibiotics in renal interstitial fluid, soft tissue interstitial fluid, urine and serum

A new model for measuring concentration of antibiotics in prostatic interstitial fluid