JRSM > Volume 96, Number 10 > Pp. 519

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LETTERS

Diagnosis of perforated enterocystoplasty

Peter Lowthian

134 Villiers Road, Oxhey, Watford WD19 4FJ, UK

The data presented by Dr Fontaine and his colleagues (August 2003 JRSM¹) suggest that perforation of an enterocystoplasty is often associated with an overfilled bladder which, in turn, can be produced by poor compliance with a strict intermittent catheterization regimen. It would be interesting to know how many of the total patients involved had diminished pain sensibility in their bladders, and what proportion of these were in the perforation group. Even the most fastidious patients may let their catheterization routine slip and this is a particular temptation when delay in performing catheterization does not result in pain.

It could be that such patients need an efficient ‘pain substitute’. ² Perhaps urological surgeons should reconsider the plastic surgeon's technique (when repairing pressure ulcers) of using normally innervated autografts? Such a graft, using perhaps expanded skin, might one day be incorporated into reconstructed bladders that would otherwise have absent or diminished pain sensibility. I appreciate that this would not be an easy operation, and skin might not be the best tissue to use.

REFERENCES

1. Fontaine E, Leaver R, Woodhouse CRJ. Diagnosis of perforated enterocystoplasty. J R Soc Med 2003; 96:393 -4[Abstract/Free Full Text]

2. Brand PW, Ebner JD. A pain substitute-pressure assessment in the insensitive limb. Am J Occup Ther 1969; 23:379 -486

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This Article Full Text (PDF) Send a Quick Comment Alert me when this article is cited Alert me when Quick Comments are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lowthian, P. Search for Related Content PubMed PubMed Citation Social Bookmarking                      What's this?