Aim

Open nephrectomy is associated with significant post-operative pain. Epidurals have been a core method for provision of analgesia, however, there is increased use of novel analgesic strategies with comparative analgesia but potentially fewer side effects. This pilot study aims to assess the feasibility of a randomised control trial comparing continuous wound infusion (CWI) to epidural analgesia for open renal surgery. Objectives included estimation of recruitment rates, failure rates and complications and refining design of a randomised control trial.

Methods

Participants were randomised using randomisation software. Patients received standardised anaesthesia as per the study protocol. Patients randomised to the CWI group had a wound infiltration catheter inserted at the end of surgery. In the epidural group, patients had an epidural sited prior to surgery. Primary outcomes evaluated were visual analogue pain scores. Secondary outcomes included intravenous fluid use, hypotensive episodes, patient mobilisation, evidence of post-operative ileus, respiratory morbidity, demands on medical and nursing care, length of hospital stay and patient acceptability as assessed by the Quality of Recovery (QoR-15) questionnaire.

Results

Pain scores were similar for both groups with marginally higher mean scores in the wound infiltration group on post-operative day 1 and 3. Supplementary analgesia rates were comparable for both groups with tramadol use being higher in the wound infiltration group.

Conclusion

Collecting outcome data for an appropriately powered randomised controlled trial is feasible. Recruitment was challenging due to the increased minimally invasive laparoscopic or robotic nephrectomies and consideration of a multicentre study is warranted. The two analgesic techniques appear broadly comparable in efficacy and time to discharge. CWI potentially presents safety advantages compared to epidural analgesia.

Aim

Current methods used to assess patient suitability for bladder neck suspension prior to surgery are limited due to their inability to examine patients in physiologic positions. The purpose of this study was to examine the usefulness of upright magnetic resonance imaging (MRI) in the evaluation of patients with genuine stress urinary incontinence (GSUI) prior to undergoing MonarcR bladder neck suspension.

Materials and Methods

Twenty-seven female patients with known GSUI were selected to participate in the study. Each patient was asked to complete an incontinence symptom score and then have 300 ml of sterile water instilled into their bladder. While standing in an upright MRI scanner a T2-weighted image at 0.6 tesla was then obtained while at rest and then undergoing standardized Valsalva maneuver. Special attention was then given to the downward movement of the H-line against the M-line. Measurements were taken to determine excursion of the H-line against the M-line. The procedure was then repeated for each patient three-months after surgery. The change in H-line excursion following surgery was compared to the change in symptom score using Spearman’s rank correlation test.

Results

A positive correlation was found between the pre- and post-operative improvements in international consultation on incontinence questionnaire female lower urinary tract symptoms modules (ICIQ-FLUTS) and the post-operative reduction of excursion of the pelvic floor. These correlations were found to be statistically significant (p<0.001)  using Spearman’s rank correlation test.

Conclusion

A greater degree of pelvic floor prolapse visible on magnetic resonance imaging (MRI) with a standardized Valsalva maneuver prior to MonarcR bladder neck suspension surgery predicts for better patient symptom score outcomes as determined by ICIQ-FLUTS.

Keywords

Magnetic resonance imaging (MRI); Bladder neck suspension; Stress urinary incontinence.

Renal cell carcinoma of the collecting ducts is one of the least frequent variants of renal carcinomas, with highly aggressive behavior, having the worst prognosis and the lowest specific cancer survival rate of all renal carcinomas, as 70% of patient deaths are secondary to the disease. We present a clinical case of a male patient with a diagnosis of paraneoplastic syndrome secondary to renal neoplasia. After a renal biopsy returned a diagnosis of sarcomatoid carcinoma, the patient elected surgical excision, and final pathology was consistent with renal carcinoma of the collecting ducts. As was common in the largest published series, this patient developed local and distant relapse in the early post-operative period, despite adjuvant systemic treatment. This variant of renal carcinoma has an ominous short-term prognosis, with high rates of distant disease present at the time of diagnosis. The unfavorable biological behavior manifests despite the use of multi-modality, adjuvant treatment.

Keywords

Bellini disease; Collecting ducts carcinoma; Renal carcinoma.

Pubo-penile ectopic testis is a rare congenital anomaly whose etiopathogenesis is still poorly understood. We report one case of bilateral pubo-penile ectopic testis in a two-year-old child. The diagnosis was made on physical examination alone. Orchidopexy in the dartos muscle was easy to perform.

Keywords

Pubo-Penile ectopic testis; Orchidopexy

Pseudotumoral calcinosis is a rare condition characterized by periarticular calcium deposition. It preferentially affects large joints such as the hip, shoulder and elbow. It is a severe complication of chronic renal failure. We report a case of secondary pseudotumoral calcinosis in a chronic hemodialysis patient.

Keywords

Tumoral calcinosis; Chronicrenal failure; Hemodialysis.

Incomplete duplex system is a congenital abnormality, which is often found in children. It corresponds to a doubling of the upper urinary tract with two ureters which join into a common distal portion with a single ureteral orifice. In adults, this infection is fortuitous and often asymptomatic. Therefore, it does not require surgery in the absence of complications. Therefore, we would like to present this new case.
Keywords
Upper urinary tract; Duplex system; Bifid ureter; Incomplete duplication.

An incidentally discovered Meckel’s diverticulum while performing radical cystoprostatectomy with neobladder for muscle invasive carcinoma bladder was utilized as the most dependent part of the pouch for anastomosis with the urethral stump leading to a simple tension free anastomosis with very good post-operative results.

Keywords

Meckel’s diverticulum; Ileal neobladder; Radical cystectomy; Carcinoma bladder.