PETCT upstages anal SCC and influences subsequent management. PETCT should be considered in the staging of anal SCC, although the definitive benefit of such a strategy requires further evaluation.
Epidermal cysts are very common lesions. Here we present the unusual case of an epidermal cyst occurring between the anal sphincters, presenting as a lump in the perineum. This was successfully excised with careful dissection of the intersphincteric plane. To our knowledge this is the only case of its kind reported in the literature.
Levy and Charkin described the longitudinal cut at the tip of the catheter to allow the guide-wire to pass through for rail-roading into the bladder. This method maintains the manufactured conical shape of the catheter tip, hence the ease of advancement. However, the longitudinal cut to the tip of the catheter can potentially cause the catheter to bivalve and split, which can lead to urethral trauma.An alternative technique, using a 14-gauge (Brown) intravenous cannula needle threads through the side drainage hole of the urethral catheter and then punctures the centre of the tip of the catheter to form a track; the guide-wire is subsequently passed retrograde through the intravenous cannula needle. The needle is removed which allows the guide-wire to pass into the central catheter drainage lumen. After lubricating the guidewire and the urethral catheter with lignocaine gel, the catheter is passed into the bladder over the guide-wire. From our experience, this method is easy to use, and also maintains the integrity of the shape of the catheter with no risk of the above complication. We have never experienced the theoretical problem of the catheter splitting. We believe this is because the slit made in the catheter is small as it only needs to allow a guide-wire to pass through. We do agree though that a long slit could potentially cause the catheter to bivalve and, hence, cause further trauma. Therefore, the slit should be kept as short as possible to allow the guide-wire to pass through. AUTHORS' RESPONSEThe technique described involving the guide-wire being passed through the side drainage hole and then through the tip of the catheter using a 14-G intravenous cannula is an alternative technique. The problem we have had with this approach is the difficulty in advancing the catheter over the guide-wire. As the authors state, the guide-wire and catheter must be well lubricated: if not, the catheter catches on the guide-wire due to the oblique angle that it runs through the distal catheter. Advancement is then very difficult and one is uncertain whether the resistance is due to the guide-wire or due to urethral narrowing.
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