Overactive bladder is common, underdiagnosed and undertreated. It is challenging to manage but evidence‐based guidelines provide a pathway to effective treatments that will help people with the disease.
cavity. 3 Therefore, biochemical markers such as white cell count and C-reactive protein may not correlate with the degree of inflammation. 6 Often, preoperative computed tomography can be used to diagnose Amyand's hernia. The operative approach to Amyand's hernia is not standardized to date. In a normal appendix, Milanchi and Allins recommended mesh hernia repair without appendicectomy. Meanwhile, laparoscopic appendicectomy followed by hernia repair without mesh are preferred for appendicitis. 7 As highlighted in our case, laparoscopic appendicectomy in a densely adherent inflamed appendix could be challenging, although successful laparoscopic reduction and removal of an inflamed appendix has been previously reported. 8 A more systematic approach was proposed by Losanoff and Basson. The hernia was classified based on the state of the appendix. 9 Type I refers to a normal appendix, and reduction with a tension-free mesh hernioplasty should be performed. Appendicectomy is not routinely performed due to the risk of contamination. This decision is dictated by the surgeon's preference. 2 Type II signifies acute appendicitis confined in the sac. Appendicectomy should be approached via herniotomy without insertion of prosthetic mesh due to risk of infection. Type III is acute appendicitis with peritonitis, in which case, appendicectomy should be performed via laparotomy to allow for source control. Hernioplasty should be deferred if the patient is unstable. Lastly, type IV includes cases where a pathology exists outside of the hernia sac such as colon cancer. Management in this case should be determined by the underlying condition. This case highlights the occurrence and management of Amyand's hernia. The operative approach should take into account the pathological condition of the appendix.
Erectile dysfunction is more common than realised and can be the first indication of systemic disease. Penile prosthesis is a low‐risk intervention with high patient satisfaction, previously deemed an endstage form of management. However, improvements in the devices and a recent American Association of Urology recommendation could change that.
Introduction The purpose of this study was to report our centre’s experience using selective angioembolisation in the treatment of iatrogenic renal artery pseudoaneurysms (RAP) following minimally invasive urological procedures. Methods Our retrospective analysis included four consecutive patients treated with angioembolisation for iatrogenic RAP between October 2016 and October 2021. Data on demographics, minimally invasive urological intervention, clinical features, imaging findings, embolization procedure and perioperative details were collected. Rates of technical and clinical success, defined as 1. total occlusion of the extravasation site on completion digital subtraction angiography (DSA), and 2. resolution of symptoms, signs, and serum hemoglobin (Hb) derangements secondary to RAP, were analysed. Renal function, measured by serum creatinine (Cr) and estimated glomerular filtration rate (eGFR), was recorded prior to and post - angioembolisation procedure and compared. Results Mean time between urological intervention and angioembolisation was 9 days (range, 2–17 days). Rates of technical and clinical success were 100% and 100% respectively. No additional angioembolisation procedures were required, and there were no peri or post-operative complications identified during mean follow-up of 662 days (range, 30–1845 days). Mean serum Cr prior to and post angioembolisation was 83 mmol/L and 79.5 mmol/L. Mean eGFR prior to and post angioembolisation was 73.8 and 77.8 mL/min/1.73 m2. In all patients, no significant difference was observed in serum Cr and eGFR prior to and post angioembolisation. Conclusion Iatrogenic renal artery pseudoaneurysms can occur following a range of minimally invasive urological procedures. This retrospective review highlights the utility of angioembolisation as a safe and effective treatment with high clinical and technical success rates. Further studies involving larger populations are required to validate its broader application.
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