Contracture Scar

Question: Post Prostate Cancer Surgery Problem – Bladder Neck Contracture. Please Help Me.? I am looking for some information that can help my father in law's urological problem. 14 months ago he was diagnosed with prostate cancer and underwent High Intensity Focused Ultrasound (HIFU). His PSA levels have remained very low but he had developed a nasty side effect from the procedure, a bladder neck contracture. It is scar tissue. It makes him leak, and a very proud man very unhappy. It shuts off his urine passage and puts his kidneys as risk. He has undergone 3, maybe 4 surgeries called a bladder neck incision, to reopen the obstructing scar tissue. He did fine for about a month or so, but the contracture returned. My wife and I are at our wits end because he has to wear an indwelling foley catheter all the time now. His new urologist is recommending a permanent Urolume prostate stent be placed to keep his bladder neck open. The urologist warned us that it could make him leak urine but that can be fixed later with an artificial sphincter implant. I have read some really nasty things about these online. I just don't know where we can get help or the information we need to find a better alternative. There just must be something?? My father has gone from an robust, active father and grandfather to a shell of a man. Depression has set in and drugs barely make a difference. He can’t go on this way. We’ve gone from an easy treatment for his prostate cancer to a living nightmare. Does anybody have personal experience with this terrible situation and will you share how you handled it? We really need some good advice.

Answer: This is a difficult situation. HIFU is a destructive energy source which can leave the affected area with decreased blood supply and prone to scarring. One question that would help clarify the situation a bit is whether he only had transurethral INCISIONS of this bladder neck contracture or if he had a real transurethral RESECTION (removal) of the scar tissue. If he only had bladder neck incisions, then an aggressive transurethral resection would be a reasonable option, recognizing that it places him at high risk of incontinence. I would try to use the Urolume only as a last resort. As you have read, it has a high incidence of complications and is often uncomfortable or downright painful for the person in whom it is placed. Think about where that metal mesh scaffold is placed...right in front of the anus, right where you sit. If he has already had a good transurethral resection of the scar tissue and it contracted down again, another option is to repeat the resection and have him keep it open by performing self-cath at regular intervals.

Question: Can I have some of your inputs on this case...? leaking gas tank which suddenly exploded at 6pm. The patient was brought to the ER at 11pm unconscious with 1st degree burns on the lower extremities, 2nd degree burns at the head and neck area and 3rd degree burns at the chest, abdomen and both upper extremities. BP – 110/80, HR 98, RR – 27, T-36C. 1. what is your impression? 2. what is the TBSA injured? 3. what are your admitting orders? 4. what is the total fluid requirement of this patient? How will you give it and why? 5. what is Parkland’s formula? 6. what other measures can you do? 7. will you give analgesics? why? How will you give it? 8. how will you monitor this patient? 9. when will you refer this patient to your Resident? 10. did you rule out smoke inhalation syndrome?what is this? 11. how frequent should you do debribement? 12. what are the complications of her injuries? 13. what is the most common cause of death following this type of injury? 14. what bacteria will grow on this type of injury? 15. what are the4 criteria for admission to a burn center? 16. what is marjolin’s ulcer? 17. what is the difference between keloid and hypertrophic scar? 18. what is contracture? How do you treat this? How do you prevent this? 19. will you refer the patient to rehab med? 20. what topical antibiotics will you give? Side-effects? 21. anything else that can be done to save this patient? 22. what is the danger of electrical burns? Chemical burns? 23. what is burn wound sepsis? How will you recognize it? 24. what is skin grafting? 25. what is full thickness skin grafts? Partial thickness skin grafts? 26. what is a dermartome? What are the types? 27. what is “take”? 28. what is Curling’s ulcer? How will you prevent this? 29. will you refer this patient for psychiatric evaluation? 30. what are your comments regarding the case?

Answer: hey Guy Do your own homework! Gee sh One question is acceptable but the whole freaking page is just cheating!

Question: Guys, can you help me with this case please...? leaking gas tank which suddenly exploded at 6pm. The patient was brought to the ER at 11pm unconscious with 1st degree burns on the lower extremities, 2nd degree burns at the head and neck area and 3rd degree burns at the chest, abdomen and both upper extremities. BP – 110/80, HR 98, RR – 27, T-36C 1. what is your impression? 2. what is the TBSA injured? 3. what are your admitting orders? 4. what is the total fluid requirement of this patient? How will you give it and why? 5. what is Parkland’s formula? 6. what other measures can you do? 7. will you give analgesics? why? How will you give it? 8. how will you monitor this patient? 9. when will you refer this patient to your Resident? 10. did you rule out smoke inhalation syndrome?what is this? 11. how frequent should you do debribement? 12. what are the complications of her injuries? 13. what is the most common cause of death following this type of injury? 14. what bacteria will grow on this type of injury? 15. what are the4 criteria for admission to a burn center? 16. what is marjolin’s ulcer? 17. what is the difference between keloid and hypertrophic scar? 18. what is contracture? How do you treat this? How do you prevent this? 19. will you refer the patient to rehab med? 20. what topical antibiotics will you give? Side-effects? 21. anything else that can be done to save this patient? 22. what is the danger of electrical burns? Chemical burns? 23. what is burn wound sepsis? How will you recognize it? 24. what is skin grafting? 25. what is full thickness skin grafts? Partial thickness skin grafts? 26. what is a dermartome? What are the types? 27. what is “take”? 28. what is Curling’s ulcer? How will you prevent this? 29. will you refer this patient for psychiatric evaluation? 30. what are your comments regarding the case? 31. present a journal or article regarding this case in 10 minutes?

Answer: 2---(81 as per Wallace`s rule of nine) 3- more than10 pints in 24 hrs iv 5-- Haif`s formula 7--no analgesics to the unconscious 9-- stat , 10 RR rules it out. 11-- just once, 12 -- sepsis shock 13)septicemic shock., 14-- Pseudomonas , Salmonella, 16 -- ulcer on scar 17 -- keloid is partly genetically determined , hypertrophic scar caused by delay in healing , 18 -- shortened mucle ,tendon , treated by tendon lengthening surgery , 19-- certainly , 20 -- soframycin, cotrimoxazole, metronidazole powder ointment , 22 - shock death ,organ poisoning , 26 -- skin muscle nerve supply from same spinal segment , 28-- acute gastric ulcer in burns 29 - later 30-- bad prognosis

Question: UK Only - NHS - Problems with my breast implant? I had breast implants 11 years ago. One of them has now gone extremely hard and is very painful, it has got gradually worse over the last 12 months. My doctor has referred me to the NHS breat clinic for some scans. From the research I have done I think that it could be Capsular contracture where the scar tissue and breast tissue create a capsule and go hard around the implant. One of the cures for this is for the implant to be taken out the breast and scar tissue to be cut and made soft again and the implant put back in. Would i get this done on the NHS if that's the treatment that the breast clinic say that I need, or if I had to have it taken out completely would they replace it? This may sound very vain but I cannot be left with one breast significantly bigger than the other and looking completely different.

Answer: Since you now have clearly got a medical problem, rather than a cosmetic one, the NHS should and I am sure will, deal with it, don't worry.