Limitations in virtual clinical skills education for medical students during COVID-19 Les limites de l'enseignement virtuel de compétences cliniques aux étudiants en médecine dans le contexte de la COVID-19
PurposeTo compare patients with sepsis due to obstructive urolithiasis (Sep-OU) and underwent drainage by percutaneous nephrostomy (PCN) or a double-J (DJ)-ureteral stent and to identify predictive risk factors of DJ stent failure in these patients.Materials and MethodsWe reviewed our records from January 2013 to July 2018 and identified 286 adult patients with Sep-OU out of which 36 had bilateral involvement, thus total 322 renal units were studied. Urologic residents in training carried out both ureteral stenting and PCN tube placement. Demographic data and stone characteristics were recorded along with Charlson comorbidity index. For predicting risk factors of DJ stent failure, those variables that had a p-value <0.1 in univariate analysis were combined in a multinomial regression analysis model.ResultsThe patients with PCN placement were significantly older than those with DJ stent placement (p=0.001) and also had significant number of units with multiple calculi (p=0.018). PCN was also placed more frequently in those patients with a upper ureteric calculi (p<0.05). On multinomial regression analysis multiple calculi (p=0.014; odds ratio [OR], 4.878; 95% confidence interval [CI], 1.377–17.276) and larger calculi size (p=0.040; OR, 0.974; 95% CI, 0.950–0.999) were the significant predictors of DJ stent failure.ConclusionsIn patients with sepsis from obstructive urolithiasis due to larger and multiple calculi a PCN placement might be better suited although this data requires further prospective randomized studies to be extrapolated.
Haematuria in paediatric population is common yet alarming. It warrants a thorough physical examination and other investigations. Of late, a number of extremely rare aetiology of childhood haematuria have come to forefront. One such uncommon cause is benign fibroepithelial urinary bladder polyp. The presentation is of a child with intermittent haematuria exacerbated by physical/sports activity associated with or without suprapubic pain. Diagnosis is usually made by ultrasonography and cystoscopy and confirmed by histopathological examination. Treatment is surgical and involves cystoscopic transurethral resection of the mass. The exact aetiology of benign fibroepithelial polyp is uncertain with no clear guidelines on long-term surveillance. However, these cases should be subjected to cystourethroscopy if haematuria recurs. Treatment is surgical with good long-term prognosis. Not much is written in literature about benign fibroepithelial bladder polyp.
I n d e x e d i n P u b M e d , W e b o f S c i e n c e a n d S c o p u s İsa Burak Güney, et al., The role and effect of FDG-PET/CT on patient management and restaging of bladder carcinoma.
Objective:To analyze the patterns of presentation and management for urologic complications of obstetrics and gynecology in the form of genitourinary fistulas at a tertiary referral center and highlight the social issues associated with them.
Material and methods:We conducted this retrospective study analyzing 311 patients with genitourinary fistulas after obstetric and gynecologic surgeries between January 2005 and January 2018. We recorded the patients' characteristics and area of residence and then analyzed the etiology, surgical management and success rates by grouping the patients into four types of genitourinary fistulas. The primary end point of success was patient being leak free.Results: Majority of patients (90.4%) were from rural areas. The distribution of genitourinary fistulas in descending order was vesicovaginal (79.7%), ureterovaginal (11.8%), urethrovaginal (10.2%) and vesicouterine fistulas (2.6%). The mean time to presentation was 25.80±48.69 days with a wide range of 10 days to 360 months. The most common etiology was obstructed labour (58.5%) followed by abdominal hysterectomy (32.7%). For vesicovaginal fistulas the route to be used for repair depended on surgeon's preference and both transabdominal and transvaginal routes had almost equal success rates. The success rate of laparoscopic vesicovaginal fistula repair was 89.4% and all (100%) laparoscopic ureteroneocystostomies were successful.
Conclusion:Genitourinary fistulas especially due to obstructed labour are still common in developing world showcasing the problem of inequitable distribution of healthcare. The surgical treatment approach depends on the surgeon's familiarity with the said procedure although versatility is required.
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