L. Kretzmer, A. Damola, Chloe Libotte, S. Ehsanullah, A. Jones, I. Apakama
Introduction: Group and save (G&S) sampling is commonplace for patients undergoing transurethral resection of the prostate (TURP) due to the historically high risk of bleeding. However, modern adjustments to the procedure, including the advent of bipolar TURP in saline, have significantly reduced this risk. This study assessed whether routinely performing G&Ss before the modern TURP is still appropriate. Materials and Methods: This study was a retrospective review of all patients who underwent a TURP from January 2009 until December 2019 in one centre. A total of 687 patients were identified during this period. In addition, data was collected on G&S samples, blood products, and postoperative complications such as clot retention or if patients required a blood transfusion. Results: All patients had G&S samples taken before their operation. Only six (0.87%) patients required a blood transfusion. Half were transfused intra-operatively and half post-operatively. Remarkably, none of the transfused patients were below the National Institute for Health and Care Excellence (NICE) threshold to transfuse of <70g/L(8). Six patients were also noted to develop clot retention following the catheter removal. Discussion and Conclusion: This study has determined that patients undergoing a TURP rarely require blood transfusions. We propose that the practice of routinely taking G&S samples before this procedure should be reviewed. This would give a financial benefit and relieve patients of the unnecessary test. We would recommend thorough optimisation of patients before surgery, including review of anticoagulation and correction of any preoperative anaemia.
{"title":"Is Group and Saving Before the Modern Bipolar Transurethral Resection of the Prostate Still Necessary?","authors":"L. Kretzmer, A. Damola, Chloe Libotte, S. Ehsanullah, A. Jones, I. Apakama","doi":"10.22374/jeleu.v5i2.150","DOIUrl":"https://doi.org/10.22374/jeleu.v5i2.150","url":null,"abstract":"Introduction: Group and save (G&S) sampling is commonplace for patients undergoing transurethral resection of the prostate (TURP) due to the historically high risk of bleeding. However, modern adjustments to the procedure, including the advent of bipolar TURP in saline, have significantly reduced this risk. This study assessed whether routinely performing G&Ss before the modern TURP is still appropriate. Materials and \u0000Methods: This study was a retrospective review of all patients who underwent a TURP from January 2009 until December 2019 in one centre. A total of 687 patients were identified during this period. In addition, data was collected on G&S samples, blood products, and postoperative complications such as clot retention or if patients required a blood transfusion. \u0000Results: All patients had G&S samples taken before their operation. Only six (0.87%) patients required a blood transfusion. Half were transfused intra-operatively and half post-operatively. Remarkably, none of the transfused patients were below the National Institute for Health and Care Excellence (NICE) threshold to transfuse of <70g/L(8). Six patients were also noted to develop clot retention following the catheter removal. \u0000Discussion and Conclusion: This study has determined that patients undergoing a TURP rarely require blood transfusions. We propose that the practice of routinely taking G&S samples before this procedure should be reviewed. This would give a financial benefit and relieve patients of the unnecessary test. We would recommend thorough optimisation of patients before surgery, including review of anticoagulation and correction of any preoperative anaemia.","PeriodicalId":136362,"journal":{"name":"Journal of Endoluminal Endourology","volume":"209 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133827147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 50-year-old tetraplegic gentleman was referred with visible haematuria and recurrent urinary tract infections (UTI) presenting as behavioural difficulty. His past medical history includes diffuse brain injury following a motorbike accident, hypertension, BMI 41, performance status 4, and needing a hoist for transfer. CT showed bilateral staghorn complete calculi measuring the maximum length of 3 cm (left) and 4.2 cm (right) with 600 HU. Following best interest meetings, the patient communicated his unwillingness to proceed with PCNL or open surgery due to risks and opted for FURS. His bilateral staghorn stone was completely cleared simultaneously at his primary procedure after a total operative time of 190 min. He had no postoperative complications and was discharged with bilateral stents in situ. He had a second-look FURS 4 weeks later but only required washout of minimal dust and removal of bilateral ureteric stents. His stone analysis confirmed struvite stone. His haematuria, recurrent UTIs, and behavioural issues were resolved. His 6 months postoperative CTKUB showed a dust-free status. This report discusses the challenges of simultaneous bilateral staghorn clearance using FURS.
{"title":"Successful Simultaneous Clearance of Bilateral Staghorn Stones with Flexible Uretero-Renoscopic Lasertripsy","authors":"A. Kodera, Tara Burnhope, V. Koo","doi":"10.22374/jeleu.v5i2.140","DOIUrl":"https://doi.org/10.22374/jeleu.v5i2.140","url":null,"abstract":"A 50-year-old tetraplegic gentleman was referred with visible haematuria and recurrent urinary tract infections (UTI) presenting as behavioural difficulty. His past medical history includes diffuse brain injury following a motorbike accident, hypertension, BMI 41, performance status 4, and needing a hoist for transfer. CT showed bilateral staghorn complete calculi measuring the maximum length of 3 cm (left) and 4.2 cm (right) with 600 HU. Following best interest meetings, the patient communicated his unwillingness to proceed with PCNL or open surgery due to risks and opted for FURS. His bilateral staghorn stone was completely cleared simultaneously at his primary procedure after a total operative time of 190 min. He had no postoperative complications and was discharged with bilateral stents in situ. He had a second-look FURS 4 weeks later but only required washout of minimal dust and removal of bilateral ureteric stents. His stone analysis confirmed struvite stone. His haematuria, recurrent UTIs, and behavioural issues were resolved. His 6 months postoperative CTKUB showed a dust-free status. This report discusses the challenges of simultaneous bilateral staghorn clearance using FURS.","PeriodicalId":136362,"journal":{"name":"Journal of Endoluminal Endourology","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122524470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Ameen, Jong Seok Ahn, J. Carton, W. Hwang, Hama Attar
A 35-year-old male presented with multiple interrupted episodes of frank hematuria and persistent microscopic hematuria. CT urogram demonstrated a nonspecific lesion in the bladder. Cystoscopy showed a lesion in the bladder wall that was biopsied, and histopathology confirmed a xanthoma, a rare diagnosis in the bladder. This case report performs a review of current literature and examines necessary investigations,differential diagnoses, and management required for bladder xanthoma.
{"title":"Bladder Xanthoma","authors":"T. Ameen, Jong Seok Ahn, J. Carton, W. Hwang, Hama Attar","doi":"10.22374/jeleu.v5i2.151","DOIUrl":"https://doi.org/10.22374/jeleu.v5i2.151","url":null,"abstract":"A 35-year-old male presented with multiple interrupted episodes of frank hematuria and persistent microscopic hematuria. CT urogram demonstrated a nonspecific lesion in the bladder. Cystoscopy showed a lesion in the bladder wall that was biopsied, and histopathology confirmed a xanthoma, a rare diagnosis in the bladder. This case report performs a review of current literature and examines necessary investigations,differential diagnoses, and management required for bladder xanthoma.","PeriodicalId":136362,"journal":{"name":"Journal of Endoluminal Endourology","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128402596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Renal cysts have a prevalence of 10% in the general population. Although they are usually asymptomatic, around 8% will develop complications such as cystic infection. A 75-year-old female presented with flank pain and hematuria. Computed tomography showed a dominant cyst with connection with the excretory system, as well as ipsilateral hydronephrosis secondary to pyelo-ureteral obstruction. A double J catheter was installed, and antibiotic treatment was started. One month later, she was admitted for ureterorenoscopy which revealed communication between the main cyst and the urinary tract, and proceeded to performendoscopic drainage of the cyst.
{"title":"Complicated Renal Cyst as a Cause of Renal Colic and its Endoscopic Treatment","authors":"G. Astroza, Francisca Sepúlveda","doi":"10.22374/jeleu.v5i2.146","DOIUrl":"https://doi.org/10.22374/jeleu.v5i2.146","url":null,"abstract":"Renal cysts have a prevalence of 10% in the general population. Although they are usually asymptomatic, around 8% will develop complications such as cystic infection. A 75-year-old female presented with flank pain and hematuria. Computed tomography showed a dominant cyst with connection with the excretory system, as well as ipsilateral hydronephrosis secondary to pyelo-ureteral obstruction. A double J catheter was installed, and antibiotic treatment was started. One month later, she was admitted for ureterorenoscopy which revealed communication between the main cyst and the urinary tract, and proceeded to performendoscopic drainage of the cyst.","PeriodicalId":136362,"journal":{"name":"Journal of Endoluminal Endourology","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133854685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Burnhope, M. Kitchen, A. Chakravarti, D. Mak, I. Wharton, West Midlands Urology Research Collaborative
Radical cystectomy (RC) is commonly performed with curative intent for primary or recurrent high-risk non-muscle-invasive and muscle-invasive bladder cancers. Urethral recurrence (UR) within the residual urethra, often proximally where the epithelial lining comprises urothelial cells, is a rare but well-described occurrence associated with adverse clinical outcomes. Current national guidelines therefore suggest that male patients with a defunctioned urethra should undergo annual endoscopic or urethral washing surveillance for 5 years following RC, to identify UR early, where local disease management (e.g., urethrectomy) may still be possible. Anecdotally, however, urethroscopy and urethral washing cytology appear to be infrequently performed. Our regional trainee-led research collaborative evaluated the frequency and tim-ing of urethral surveillance in the West Midlands in comparison to National Institute for Health and Care Excellence (NICE) guidelines. Patients and methodsOur 10-year cross-sectional retrospective regional analysis included 495 patients from 2008–2018. Clinical and demographic data were collected alongside cross-sectional staging and imaging, and timings and frequency of urethral endoscopic surveillance or urethral washing cytology. ResultsOverall, 159 (35.2%) patients received one (or more) surveillance urethroscopy. A minority of surveillance urethroscopies were annual, with hugely variable frequency or intervals ranging from every 4–50 months. Only 81 (19.6%) patients had urethral surveillance in keeping with the frequency suggested by NICE guidelines. At 10 years, disease-specific mortality was 42.0%, and overall or all-cause mortality was 44.7%. The overall UR rate (as detected by staging CT and/or urethroscopy) was 1.0% (n = 4); all four cases of UR were found in patients with positive urethral margins after RC who did not undergo immediate urethrectomy. ConclusionsOur regional urethral surveillance practice following RC is heterogeneous and suboptimal in comparison to NICE guidelines. Our UR rate was so low that we are unable to assert whether early detection has any clinical benefit, and therefore we cannot advocate routine urethral surveillance, but suggest that patients with positive urethral margins should be offered immediate urethrectomy post RC. In addition, we encourage collaborative urological research and data collection to generate higher volume series, more representative and generalisable data, and more meaningful conclusions.
{"title":"Urethral Surveillance after Radical Cystectomy","authors":"T. Burnhope, M. Kitchen, A. Chakravarti, D. Mak, I. Wharton, West Midlands Urology Research Collaborative","doi":"10.22374/jeleu.v5i1.142","DOIUrl":"https://doi.org/10.22374/jeleu.v5i1.142","url":null,"abstract":"Radical cystectomy (RC) is commonly performed with curative intent for primary or recurrent high-risk non-muscle-invasive and muscle-invasive bladder cancers. Urethral recurrence (UR) within the residual urethra, often proximally where the epithelial lining comprises urothelial cells, is a rare but well-described occurrence associated with adverse clinical outcomes. Current national guidelines therefore suggest that male patients with a defunctioned urethra should undergo annual endoscopic or urethral washing surveillance for 5 years following RC, to identify UR early, where local disease management (e.g., urethrectomy) may still be possible. Anecdotally, however, urethroscopy and urethral washing cytology appear to be infrequently performed. Our regional trainee-led research collaborative evaluated the frequency and tim-ing of urethral surveillance in the West Midlands in comparison to National Institute for Health and Care Excellence (NICE) guidelines. \u0000Patients and methodsOur 10-year cross-sectional retrospective regional analysis included 495 patients from 2008–2018. Clinical and demographic data were collected alongside cross-sectional staging and imaging, and timings and frequency of urethral endoscopic surveillance or urethral washing cytology. \u0000ResultsOverall, 159 (35.2%) patients received one (or more) surveillance urethroscopy. A minority of surveillance urethroscopies were annual, with hugely variable frequency or intervals ranging from every 4–50 months. Only 81 (19.6%) patients had urethral surveillance in keeping with the frequency suggested by NICE guidelines. At 10 years, disease-specific mortality was 42.0%, and overall or all-cause mortality was 44.7%. The overall UR rate (as detected by staging CT and/or urethroscopy) was 1.0% (n = 4); all four cases of UR were found in patients with positive urethral margins after RC who did not undergo immediate urethrectomy. \u0000ConclusionsOur regional urethral surveillance practice following RC is heterogeneous and suboptimal in comparison to NICE guidelines. Our UR rate was so low that we are unable to assert whether early detection has any clinical benefit, and therefore we cannot advocate routine urethral surveillance, but suggest that patients with positive urethral margins should be offered immediate urethrectomy post RC. In addition, we encourage collaborative urological research and data collection to generate higher volume series, more representative and generalisable data, and more meaningful conclusions.","PeriodicalId":136362,"journal":{"name":"Journal of Endoluminal Endourology","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126242608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BackgroundThe use of spinal anaesthesia (SA) for retrograde uretero-renoscopic surgery is considered to be not as effective as a general anaesthetic (GA) by urologists. However, there were significant concerns associated with GA both for the patient and the anaesthetic team at the height of the COVID-19 pandemic. Our unit was able to successfully transfer surgery to a purpose-built day facility that had extensive experience in delivering SA. This created the opportunity to assess the SA technique in uretero-renoscopy in a cohort of unselected patients. ObjectiveTo assess the feasibility of SA as a primary form of anaesthetic for retrograde endoluminal renal and ure-teric surgery. ResultsOver 4 months, 41 ureteroscopic procedures were performed. The conversion rate to GA (for inadequate analgesia) was 9.8%. Surgical outcome data were compared with an equivalent cohort of patients’ who underwent GA before the pandemic. Both groups had similar outcomes: day-case discharge rate (SA 84%, GA 86%) and surgical completion rate (SA 94%, GA 90%). However, there was a difference in post-operative readmission rate (SA 8%, GA 22%) favouring SA. ConclusionsThis observational study demonstrated that SA is a safe and effective form of anaesthesia for uretero-renoscopic surgery, delivering non-inferior outcomes to GA. This has implications for the immediate provision of care as COVID-19 continues and as an alternative anaesthetic option to suit patients post pandemic. A larger pro-spective observational study would be appropriate to clearly define the benefits of SA for ureteroscopy.
背景:泌尿科医生认为在逆行输尿管镜手术中使用脊髓麻醉(SA)不如全身麻醉(GA)有效。然而，在COVID-19大流行高峰期，患者和麻醉团队都对GA存在重大担忧。我们的单位能够成功地将手术转移到一个专门建造的日间设施，该设施在提供SA方面具有丰富的经验。这为在一组未选择的患者中评估输尿管-肾镜检查中的SA技术创造了机会。目的探讨SA作为逆行腔内肾及腹腔手术主要麻醉形式的可行性。结果4个月内共行输尿管镜41例。转换率为GA(止痛不充分)为9.8%。将手术结果数据与大流行前接受GA的等效队列患者进行比较。两组的结果相似:日出院率(SA 84%， GA 86%)和手术完成率(SA 94%， GA 90%)。然而，SA组在术后再入院率(SA 8%， GA 22%)方面存在差异。结论:本观察性研究表明，在输尿管镜手术中，SA是一种安全有效的麻醉形式，其麻醉效果优于GA。这对在COVID-19持续期间立即提供护理以及作为大流行后适合患者的另一种麻醉选择具有影响。一项更大的前瞻性观察性研究将适合明确定义输尿管镜下SA的益处。
{"title":"The Use of Spinal Anaesthesia for Retrograde Uretero-Renoscopy during the COVID-19 Pandemic","authors":"W. Gallagher, Anna Longshaw, A. Dickinson","doi":"10.22374/jeleu.v5.1.138","DOIUrl":"https://doi.org/10.22374/jeleu.v5.1.138","url":null,"abstract":"BackgroundThe use of spinal anaesthesia (SA) for retrograde uretero-renoscopic surgery is considered to be not as effective as a general anaesthetic (GA) by urologists. However, there were significant concerns associated with GA both for the patient and the anaesthetic team at the height of the COVID-19 pandemic. Our unit was able to successfully transfer surgery to a purpose-built day facility that had extensive experience in delivering SA. This created the opportunity to assess the SA technique in uretero-renoscopy in a cohort of unselected patients. \u0000ObjectiveTo assess the feasibility of SA as a primary form of anaesthetic for retrograde endoluminal renal and ure-teric surgery. \u0000ResultsOver 4 months, 41 ureteroscopic procedures were performed. The conversion rate to GA (for inadequate analgesia) was 9.8%. Surgical outcome data were compared with an equivalent cohort of patients’ who underwent GA before the pandemic. Both groups had similar outcomes: day-case discharge rate (SA 84%, GA 86%) and surgical completion rate (SA 94%, GA 90%). However, there was a difference in post-operative readmission rate (SA 8%, GA 22%) favouring SA. \u0000ConclusionsThis observational study demonstrated that SA is a safe and effective form of anaesthesia for uretero-renoscopic surgery, delivering non-inferior outcomes to GA. This has implications for the immediate provision of care as COVID-19 continues and as an alternative anaesthetic option to suit patients post pandemic. A larger pro-spective observational study would be appropriate to clearly define the benefits of SA for ureteroscopy.","PeriodicalId":136362,"journal":{"name":"Journal of Endoluminal Endourology","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122477291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Proceedings of the Welsh Urological Society 28th & 29th April 2022Hensol, Pontyclun
威尔士泌尿学会学报，2022年4月28日和29日，hensol, Pontyclun
{"title":"Proceedings of the Welsh Urological Society","authors":"G. Kandaswamy","doi":"10.22374/jeleu.v5i2.148","DOIUrl":"https://doi.org/10.22374/jeleu.v5i2.148","url":null,"abstract":"Proceedings of the Welsh Urological Society \u000028th & 29th April 2022Hensol, Pontyclun","PeriodicalId":136362,"journal":{"name":"Journal of Endoluminal Endourology","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116077944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ibrahim Alkhafaji, Harmony Uwadiae, Hajir Al-Hashimi, E. Abusada, S. Srirangam, Omar Al-Mula Abed
We report a 79-year-old gentleman with an asymptomatic intra-ureteric encrusted suture thread. He was found to have calcification in the left renal pelvis and thickening of the upper ureteric wall on a follow-up computerised tomography (CT) scan ten years after a radical cystoprostatectomy and ileal conduit formation for bladder and prostate cancer. These incidental CT scan findings raised the possibility of either ureteric stone or tumour. Subsequently, the patient underwent a ureterorenoscopy, which revealed a calcified 6cm length thread thought to be a suture that slipped intraoperative during his initial radical surgery ten years earlier.
{"title":"An Unexpected Finding in a Patient with Suspected Urothelial Recurrence during Surveillance Post Radical Cystoprostatectomy for Urothelial Bladder Carcinoma","authors":"Ibrahim Alkhafaji, Harmony Uwadiae, Hajir Al-Hashimi, E. Abusada, S. Srirangam, Omar Al-Mula Abed","doi":"10.22374/jeleu.v5i1.129","DOIUrl":"https://doi.org/10.22374/jeleu.v5i1.129","url":null,"abstract":"We report a 79-year-old gentleman with an asymptomatic intra-ureteric encrusted suture thread. He was found to have calcification in the left renal pelvis and thickening of the upper ureteric wall on a follow-up computerised tomography (CT) scan ten years after a radical cystoprostatectomy and ileal conduit formation for bladder and prostate cancer. These incidental CT scan findings raised the possibility of either ureteric stone or tumour. Subsequently, the patient underwent a ureterorenoscopy, which revealed a calcified 6cm length thread thought to be a suture that slipped intraoperative during his initial radical surgery ten years earlier.","PeriodicalId":136362,"journal":{"name":"Journal of Endoluminal Endourology","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125028398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This case report describes a rare cystoscopic finding in an octogenarian, presenting initially with nonspecific lower urinary tract symptoms. Physical examination did not reveal any abnormal skin or mucoepi-dermoid pigmentation. Routine ultrasound identified cystic changes in the bladder prompting cystoscopic investigation. Flexible cystoscopy identified melanin deposits within the bladder mucosa, and biopsy subsequently confirmed a diagnosis of bladder melanosis. The authors of this report wish to add to the available literature on this extremely rare finding in the hope a more robust evidence base would allow a protocol to be established for follow-up. The ultrasound findings reported in this study have not been previouslyreported and may benefit future guidelines on diagnosis.
{"title":"Bladder Melanosis","authors":"D. Hogan, Nick Meyer, D. Hennessey","doi":"10.22374/jeleu.v5i1.136","DOIUrl":"https://doi.org/10.22374/jeleu.v5i1.136","url":null,"abstract":"This case report describes a rare cystoscopic finding in an octogenarian, presenting initially with nonspecific lower urinary tract symptoms. Physical examination did not reveal any abnormal skin or mucoepi-dermoid pigmentation. Routine ultrasound identified cystic changes in the bladder prompting cystoscopic investigation. Flexible cystoscopy identified melanin deposits within the bladder mucosa, and biopsy subsequently confirmed a diagnosis of bladder melanosis. The authors of this report wish to add to the available literature on this extremely rare finding in the hope a more robust evidence base would allow a protocol to be established for follow-up. The ultrasound findings reported in this study have not been previouslyreported and may benefit future guidelines on diagnosis.","PeriodicalId":136362,"journal":{"name":"Journal of Endoluminal Endourology","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132500250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Gabriel, M. Quraishi, B. Osman, L. Shafik, Abraham Gabriel, G. Watson, S. Mackie
Background and ObjectiveTo characterise the evidence surrounding local anaesthetic ureteric stent insertion (LAUSI) in contexts outside of pregnancy, a procedure typically performed under general anaesthetic (GAUSI), as it has never been the subject of a systematic review.Materials and MethodsA systematic review of the Medline, EMBASE, PubMed, AMED, BNI, EMCARE, HMIC and PsycINFO databases was conducted to examine the published evidence in line with the Preferred Reporting Items of Systematic Review and Meta-analyses (PRISMA) guidelines surrounding the technique, patient demographics, setting, type of LA± sedoanalgesia used, cystoscopy and fluoroscopy usage, patient tolerability and pain, efficacy, complications and cost-effectiveness. Around 1,460 papers were systematically screened for inclusion.ResultsSeventeen studies were identified; one randomised controlled trials (RCT), four non-randomised com-parative studies, and 12 case-series describing LAUSI. The 17 studies encompassed a total of some 1545 LAUSI. The clinical indications were similar to those for GAUSI. Successful LAUSI rate ranged from 71-98.9% in studies overall, with a pooled mean success rate of 89.3% overall (86.8% in LA only, 91.75% in LA ± sedoanalgesia). The tolerability of a LAUSI patient across 14 studies had a pooled mean rate of 91.8% (88.6% in LA only, 95% in LA ± sedoanalgesia). The procedure time was reported in seven studies, and it ranged from 5.35±0.87 to 65.0±27.5 minutes. The four comparative studies showed no difference in complication rates between LAUSI and GAUSI. All five studies reporting on cost-effectiveness showed LAUSI to be superior to GAUSI.ConclusionsLAUSI is a safe, effective, and cost-effective alternative to GAUSI, which is underutilised. Further research in the form of RCTs is required to formally establish its place and acceptability amongst urologists.
{"title":"Primary Ureteric Stent Insertion Under Local Anaesthetic or Sedoanalgesia in Non-pregnancy","authors":"J. Gabriel, M. Quraishi, B. Osman, L. Shafik, Abraham Gabriel, G. Watson, S. Mackie","doi":"10.22374/jeleu.v5i1.137","DOIUrl":"https://doi.org/10.22374/jeleu.v5i1.137","url":null,"abstract":"Background and ObjectiveTo characterise the evidence surrounding local anaesthetic ureteric stent insertion (LAUSI) in contexts outside of pregnancy, a procedure typically performed under general anaesthetic (GAUSI), as it has never been the subject of a systematic review.Materials and MethodsA systematic review of the Medline, EMBASE, PubMed, AMED, BNI, EMCARE, HMIC and PsycINFO databases was conducted to examine the published evidence in line with the Preferred Reporting Items of Systematic Review and Meta-analyses (PRISMA) guidelines surrounding the technique, patient demographics, setting, type of LA± sedoanalgesia used, cystoscopy and fluoroscopy usage, patient tolerability and pain, efficacy, complications and cost-effectiveness. Around 1,460 papers were systematically screened for inclusion.ResultsSeventeen studies were identified; one randomised controlled trials (RCT), four non-randomised com-parative studies, and 12 case-series describing LAUSI. The 17 studies encompassed a total of some 1545 LAUSI. The clinical indications were similar to those for GAUSI. Successful LAUSI rate ranged from 71-98.9% in studies overall, with a pooled mean success rate of 89.3% overall (86.8% in LA only, 91.75% in LA ± sedoanalgesia). The tolerability of a LAUSI patient across 14 studies had a pooled mean rate of 91.8% (88.6% in LA only, 95% in LA ± sedoanalgesia). The procedure time was reported in seven studies, and it ranged from 5.35±0.87 to 65.0±27.5 minutes. The four comparative studies showed no difference in complication rates between LAUSI and GAUSI. All five studies reporting on cost-effectiveness showed LAUSI to be superior to GAUSI.ConclusionsLAUSI is a safe, effective, and cost-effective alternative to GAUSI, which is underutilised. Further research in the form of RCTs is required to formally establish its place and acceptability amongst urologists.","PeriodicalId":136362,"journal":{"name":"Journal of Endoluminal Endourology","volume":"171 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126286051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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