A case of massive right pleural effusion in a postoperative patient of percutaneous nephrolithotomy leading to severe respiratory distress is reported. A high degree of clinical suspicion and prompt intervention by insertion of an intercostal drainage tube prevented the patient from going in to respiratory failure. The development of arrhythmias confused the picture increasing the morbidity of the patient. However, the patient was managed in an intensive care unit with intercostal chest tube insertion and antiarrhythmic agents. After correction of the specific cause of the effusion the intercostal tube was removed on the 4th day without further recurrence of the effusion.
Background: Extracorporeal shock wave lithotripsy (ESWL) is the treatment of choice for upper tract calculi of moderate size. After ESWL, various factors affect the passage of small fragments through ureter like fragment's size and location. To facilitate fragment passage, a lot of medications have been tried and few have stood the test of the time. In this prospective study, we evaluated the role of Tamsulosin with or without Deflazacort versus no treatment after ESWL for ureteric and renal stones in terms of requirement of the number of ESWL sessions, stone clearance rate, stone expulsion time and analgesia requirements. Results:Patients presenting between age-groups of 18-70 years with solitary renal/ureteric calculus of size between 6 and 15 mm in major axis with Hounsfield unit less than 1000 were recruited in one of the three groups (A, B and C) randomly. Patients in Group A were prescribed Tamsulosin (0.4 mg once daily) with Deflazacort (30 mg once daily), Group B were given Tamsulosin (0.4 mg once daily), and Group C received no treatment (analgesics SOS and hydration therapy) after undergoing ESWL. Two hundred and twenty-five patients were recruited in Group A, and 240 patients were recruited in Group B and Group C each. There was an insignificant difference for required mean ESWL sessions and stone clearance rate between three groups. There was an early clearance of stone fragments in Group A than in Groups B and C, and it was statistically significant between Group A and Group C, specifically in the subgroup of stone size 10.1-15 mm. The requirement of mean analgesic tablets difference was significant between Groups A and C. Conclusions:Tamsulosin with Deflazacort decreases the number of required ESWL sessions and improves complete stone clearance, but the difference is not significant. There were significant improvement in facilitating early stone clearance and decrease in requirement of mean analgesic tablets after ESWL with Tamsulosin and Deflazacort. Thus, Tamsulosin with Deflazacort can be used safely to facilitate stone clearance without increased complication rate.
Introduction: Prostatic abscess is a serious urological problem that needs immediate attention due to its high morbidity and mortality in absence of appropriate treatment. The objective of our study is to evaluate the efficacy and safety of various modalities of management of prostatic abscess: medical management (MM), transrectal ultrasound-guided aspiration (TRUS-GA), and transurethral deroofing (TU-DR Methods: This retrospective study was done in a tertiary care center after taking approval from the institutional review board. Conservative management was done by oral or parenteral medications. Transrectal ultrasound GAs were performed under local anesthesia with an 18-gauge two-part needle. Collapse of cavity was seen in “real time” on TRUS. TU-DR of the prostate was done by 26 French continuous irrigation monopolar resectoscopes. The aspirated pus was sent for microbiological investigation. Results: TRUS-guided aspiration was performed in 20 patients, TU-DR in five patients, and conservative management in 15 patients. The mean volume of abscess aspirated by TRUS guidance was 13 cc (range 8–50 cc) with single-time aspiration in 85% of cases. Re-aspiration was done in 3 patients. The mean volume of abscess was 33.2 cc (range: 25–40 cc) in TU-DR group and 1.2 cc (range 0.5–2.0 cc) in the MM group. The predominant organism isolated was Escherichia coli (48%). Clinical improvement was seen in 97.5% of cases. Conclusion: We suggest TRUS-GA for symptomatic patients with abscess size more than 2 cc and TU-DR if TRUS-GA fails or is contraindicated.
The blast during transurethral surgery is a rare but known complication of transurethral resection of prostate (TURP) or transurethral resection of bladder tumors. It may lead to bladder rupture, which can be either extra- or intra-peritoneal requiring urgent laparotomy. It occurs due to the generation and trapping of explosive gases under the dome of the bladder. Even though this complication is rare, but the morbidity associated with this complication is high. Here, we present an interesting case report of an intravesical explosion during TURP leading to bladder rupture to remind urologists of this rare complication with suggestions on how to manage and prevent this complication.
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