This case report documents the rapid onset of balanoposthitis in a 58-year-old male patient diagnosed with type 2 diabetes mellitus just 2 weeks prior. The patient presented with acute penile pain, swelling, and purulent discharge, necessitating circumcision due to balanoposthitis and phimosis. The diagnosis of type 2 diabetes mellitus 14 days prior highlights the potential for rapid development of balanoposthitis despite practicing proper hygiene. This underscores the importance of healthcare practitioners proactively examining the penile area in newly diagnosed diabetic patients to prevent balanoposthitis and, conversely, screening patients with balanoposthitis for type 2 diabetes mellitus.
As a quality improvement initiative, our institution's pre-operative education program for patients undergoing robotic radical prostatectomy (Robocare) was changed into a telehealth-based program (Tele-Robocare). During the pre-surgery evaluation process, tele-Robocare was deemed useful (92%) and adequate (100%) in addressing pre-operative needs of patients. Follow-up was deemed necessary to compare patient feedback post-surgery.
2 years since the complete adoption of the Tele-Robocare program in our institution, a follow-up study was conducted on the participants who attended the original quality improvement initiative (n = 147). An 8-question survey was created via Redcap. A survey link was sent to all participants: 144 via email link and 3 via QR code sent via postal mail. All responses were logged onto the Redcap database.
A total of 87 patients (59.2%) completed the survey. 86 patients completed the survey via email link and 1 patient accessed the survey via the mailed QR code.
The percentage of patients who found Tele-Robocare useful in the following sections are: pre-surgery preparation (90%), discharge care (89%), catheter care (82%), follow-up (93%), troubleshooting (80%).
When asked about what should remain as a part of the program handout and presentation, the findings were similar: pre-surgery preparation (94%), hospital stay information (92%), discharge information (93%), follow-up (90%), access to allied health (90%). The most requested topics that needed additional emphasis were sexual health (n = 5) and impact on mental health (n = 3).
78% agree or strongly agree that telehealth was sufficient in receiving patient education programs such as Tele-Robocare. The most common advice from patients (n = 25) to improve the patient experience and sense of preparedness was to actively seek additional information from the healthcare team, patients and/or patient advocates.
Tele-Robocare is now the standard method in delivering pre-prostatectomy patient education in our institution. However, these follow-up findings highlight the importance of sufficient follow-up and support of patients after surgery as their needs change along with their recovery and outcomes.
We present a case of a 17-year-old male with a testicular tumour diagnosed after trauma. A 17-year-old male patient came to our clinic with swelling in the right hemiscrotum. The patient had a history of right scrotal blunt trauma 3 weeks before the admission and had no history of urological surgery or chronic disease. The patient doesn't use tobacco, alcohol, or illicit drugs. Genitourinary system examination revealed swelling and tenderness on palpation in the right hemiscrotum. The right testicle was not palpable. The left hemiscrotum was normal. The left testicle had a normal size and shape. Testicular tumour markers were high (AFP:196 μg/L (N: 0–8 μg/L), b-HCG: 916 mIU/mL (N: <10 mIU/mL), LDH: 364 U/L (N: 0–265 U/L). Scrotal ultrasonography and magnetic resonance imaging revealed that there were areas of 9 × 9 × 11 cm in size of the right scrotal region without viable testis tissue, hematoma area, and areas compatible with necrosis. These findings were related to intratesticular rupture due to trauma. Abdominal tomography revealed lymphadenopathies of approximately 6 × 3 cm in the anterior paracaval area and approximately 4 × 3 cm in the anterior aspect of the psoas muscle. We performed right radical inguinal orchiectomy on the patient. Testicular tumour markers were still high on the 8th postoperative day (AFP:120 μg/L (N: 0–8 μg/L), bHCG: 680 mIU/mL (N: <10 mIU/mL), LDH: 200 U/L (N: 0–265 U/L)). The testicular tumour was diagnosed as mixed germ cell tumour (50% Yolk Sac, 30% Embryonal Carcinoma, 20% Teratoma). The tumour diameter was 9 cm, surgical margins were intact, there was rete testis invasion, and no tumour was detected in the tunica vaginalis. No tumour invasion was seen in the soft tissue around the spermatic cord (pT2). The patient received 3 cycles of chemotherapy with bleomycin, etoposide, and cisplatin. We suggest that patients presenting with scrotal trauma should be carefully evaluated for testicular malignancy, and if malignancy is suspected, radical inguinal orchiectomy should be preferred for the operation.
Research has demonstrated that systematic preoperative oral hygiene reduces nosocomial infections after elective thoracic surgery. However, the impact of preoperative oral hygiene on patients undergoing urologic procedures is unknown. Therefore, the aim of this study was to investigate the effects of systematic preoperative oral hygiene on prescriptions with antibiotics following cystectomy or urethroplasty. A quasi-experimental study design included all patients undergoing elective radical cystectomy or urethroplasty from 1 January 2018 to 31 May 2021. Patients undergoing cystectomy or urethroplasty were grouped into a prospective intervention group and a retrospective control group. Patients in the intervention group were admitted from 1 January 2020 to 31 May 2021, and were recommended to brush their teeth and rinse their mouths with chlorhexidine gluconate 0.12% four times a day starting 2 days before surgery and continuing until the morning of the operation. Patients admitted from 1 January 2018 to 31 December 2019 received no oral hygiene recommendations and were used as a retrospective control group. Data on oral hygiene performance were self-reported and collected at admission and data on prescription of antibiotics were collected through the patients' records. The relative risk was calculated to report the effect of the intervention. In total, 39 patients with cystectomy were in the intervention group, whereas 31 were in the control group. For patients having urethroplasty, 27 were in the intervention group and 98 were in the control group. The effect of oral hygiene on the prescription of antibiotics for patients who completely adhered to the oral hygiene recommendations showed a relative risk of 0.554 (95% CI 0.333–0.921) p = 0.02 for cystectomy and 0.825 (95% 0.308–2.209) p = 0.70 for urethroplasty. This study showed a statistically significant reduction in the prescription of antibiotics following oral hygiene recommendations for patients undergoing cystectomy. However, no statistically significant effect was demonstrated for patients undergoing urethroplasty. Despite this result, it seems important to be aware of oral hygiene in patients undergoing surgery to potentially reduce the number of infections and the use of antibiotics because of the antimicrobial resistance that the healthcare system faces.
Patients with neurological diseases often suffer from overactive bladder. Posterior tibial nerve stimulation is mentioned in guidelines as a treatment when antimuscarinics fail or cannot be tolerated by patients, but the evidence is scant. This article summarizes the evidence on the practical aspects of tibial nerve stimulation for neurogenic overactive bladder (NOAB), such as electrical parameters and treatment duration, and identifies areas requiring further investigation. Scoping review. Literature search on PubMed, CINAHL, and Cochrane Library, including studies from 2010 to 2024 regarding tibial nerve stimulation for NOAB. Sixteen papers were considered: seven on transcutaneous tibial nerve stimulation (TTNS), seven on percutaneous tibial nerve stimulation (PTNS) and two protocols. Most studies enrolled neurological and non-neurological patients or studied non-randomized samples of a few patients. Clinical outcomes, treatment duration, number of sessions, and follow-up times showed considerable heterogeneity, but some practical recommendations could be drawn. For PTNS, most authors suggest using 20 Hz and 200 μs, but the amplitude is highly variable among studies. For TTNS, 10 Hz and 200 μs are suggested, with considerable variability in the number of sessions and overall treatment duration. Most papers propose similar criteria regarding the frequency and duration of the stimulation, and all of them support the efficacy of tibial nerve stimulation, except for one. The areas requiring research include long-term results, allowing for shaping adequate maintenance programmes to avoid losing the results achieved.
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