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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.
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.
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.
Magnetic resonance imaging (MRI); Bladder neck suspension; Stress urinary incontinence.
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.
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.
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.
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.
Prostate cancer is the second most common cancer in men. It can be located, present local extension and finally metastasize. Cutaneous metastasis is an infrequent event that is associated with a poor prognosis. We present a clinical case of advanced undifferentiated prostate cancer with cutaneous metastases diagnosed by a punch biopsy and confirmed by immunohistochemistry.
Prostate cancer; Cutaneous metastases; Immunohistochemistry.
We report an atypical clinical case of an infrequent subtype of upper tract urothelial carcinoma (UTUC), with a nested variant. It is an infrequent histological subtype with poor prognosis. Laparoscopic left nephroureterectomy and adjuvant chemotherapy (AC)
with good outcomes were performed.
UTUC; Adjuvant chemotherapy; Nested variant urothelial carcinoma (NVUC).
Miniaturized percutaneous nephrolithotomy (mini-PCNL) is the primary treatment modality in stone management. However, prone and supine positioning remains a matter of concern because of associated complications and morbidity. The present study aimed to compare success and complication rates of supine and prone position in patients undergoing mini-PCNL.
Material and Methods
A prospective observational study was conducted in patients (age >18-years) with renal calculi 1-3 cm in size who performed mini-PCNL between September 2017 and February 2019. The stone size was determined by computed tomography (CT) scan and kidney, ureter, and bladder X-ray. Post-operative parameters and complications were compared in both the groups. Statistical significance was defined as p<0.05.
A total of 116 patients were enrolled (52 in the supine mini-PCNL group and 64 patients in the prone mini PCNL groups). The mean operative time was significantly lower (44.80 mins) in supine mini-PCNL compared to the prone mini-PCNL (53.93 mins) (p<0.0074). The mean hospital stays in supine and prone mini-PCNL group was 2.06 and 2.51-days, respectively (p=0.01). A complete stone clearance was observed in supine mini-PCNL group. The incidence of tubeless and totally tubeless procedure was significantly higher in supine mini-PCNL group (90% and 61%, respectively) (p<0.0001). No difference in terms of complications is reported between the supine and prone mini-PCNL group.
Supine mini-PCNL and prone mini-PCNL found to be comparable in terms of success rate and complications. However, supine mini-PCNL can be preferred due to its shorter operative time in the patients with renal stones.
Percutaneous nephrolithotomy; Prone position; Supine position; Stone free rate.
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.
Tumoral calcinosis; Chronicrenal failure; Hemodialysis.
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.
Pubo-Penile ectopic testis; Orchidopexy
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.
Bellini disease; Collecting ducts carcinoma; Renal carcinoma.
Department of Urology
Icahn School of Medicine at Mount Sinai
1 Gustave L. Levy Place, Box 1272
New York, NY 10029, USA
Department of Urology
Princess Alexandra Hospital
Ipswich Rd,Woolloongabba 4102