الفهرس | Only 14 pages are availabe for public view |
Abstract SUJ.\-IMARY During embryonic development, there is a close association between the urinary and genital system, especially in the early stages. This close relationship accounts for the high incidence of associated pathology and anomalies in the two systems and makes one organ system responsive to both benign and malignant alterations in the other. This concept provides the clinician with the rationale for investigating the urinary system when defects are present in the genital system. The disease processes that cause urinary symptoms can arise at any site in the genital tract; ovary, parovarium, fallopian tube, uterine corpus, cervix or vagina. The physician in gynecologic practice often encounters conditions that cause functional and anatomic changes in the urinary tract. Many urinary tract injuries occur in the performance of gynecologic surgery than during any other type of surgery. The major problems are usually encountered in radical pelvic surgeries, as well as the anatomic physiologic alterations of the urinary tract resulting from common malignant and inflammatory gynecologic conditions.Many problems involving the urinary tract that previously could be diagnosed only at the time of surgery are now routinely evaluated through the use of endoscopy. Direct visualization of the urethra, bladder neck and the bladder is accomplished by urethrocystoscopy which is primarily indicated for diagnosis of lower urinary tract disease. Access to the upper urinary tract is also now feasible by ureteroscopy and through the cystoscopic guidance: ureteral catheterization, bougynage and retrograde contrast urography is of utmost importance. Major examples of the value of urethrocystoscopy in gynecology is the evaluation of cervical cancer and for investigation of urinary symptoms including hematuria, and incontinence or fistulae, evaluation of voiding symptoms (obstructive and irritative), and finally other traumatic lesions. Provisionally, the aim of the work was to document fifty cases presenting to Ain Shams University Maternity Hospital with a variety of gynecologic condition with expectation of endoscopic findings. Reversely the underlying gynecologic lesions were evaluated and categorized as far as the degree and the extent, on basis of the endoscopic features. A main part of the work was to acquaint the gynecologits with both the uroendoscopic armementarium and principles of uroscopic handicraft. ·---------------Summary (129) --- Patients were clinically evaluated with scoring of history and feature points as far as gyne is concerned. Certain investigations like radiography, pelvic ultrasonography and laboratory tests were done whenever needed. All cases were submitted to careful examination under anesthesia with snap documentation of clinical manifestations whenever possible. Meanwhile, urethrocystoscopy and occasional ureteroscopy with ureteral gouging and catheterization were done in all cases. Evaulation of the data by endoscopy against the scored clinical features has cleared up a new concept of dimensional assessment of the cases: Primarily, the results urge to proceed with further research and investigations in some cases. - Secondly, the major points revealed are the following: . First: an additional modality to categorize staging of cancer cervix; sometimes showing evidence of lymphatic involvement of the periurethral, bladder neck and trigonal area. Second: both structural and dynamic evaluation of cases of stress incontinence: holding, voiding and retaining mechanism of the bladder and its outlet.Third: defining whether vesical, bladder neck or urethral prolapse as the underlying cause for incontinence and clear definition for preserved or lost ureterovesical angle, which in turn is an important prerequisite for the choice of the type of surgery and the way of access. Fourth: clear evaluation of iatrogenic lesions particularly urinary fistulae communications (vesicovaginal, urethro-vaginal, uretero-vaginal or combined lesions) . . Fifth: two interesting subclinical fistulae formation were revealed and prevented by endoscopic manoeuvering with temporary ureteric stenting after dilatation of entangled ureters following pelvic surgeries to be fully reconnected at a later stage. Finally, a variety of interesting cases were diagnosed and documented endoscopically. A review of the principle of art of uroendoscopy and a description of the basic armementarium were included. |