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An Indwelling suprapubic catheter is an established solution for patients with meningomyelocele neurogenic bladder. We report on a case in which a routinely replaced suprapubic catheter obstructed the left ureter orifice. The catheter drainage holes were inside the distal left ureter which compromised urinary drainage from the other kidney as well. As a result, the patient suffered from acute renal failure. During his hospitalization, the catheter was replaced and re-located, and renal function rapidly improved. This case emphasizes that even procedures that have been routinely performed for decades can manifest with an unusual complications.

BackgroundBladder recurrence after nephroureterectomy (NU) is common. However, there is no acceptable policy of adjuvant intravesical treatment after NU.ObjectiveTo assess the rate of bladder recurrence following NU and to identify the high-risk subgroups that may become candidates for adjuvant intravesical therapy after NU.Patients and methodsNinety-one patients (mean age 66.4 years) underwent NU. High-grade (HG) tumors were found in 63 patients and low-grade (LG) tumors in 28. Median follow-up was 72 months. The risk of bladder recurrence was assessed by uni- and multivariate analyses of patient and tumor characteristics.ResultsBladder recurrence developed in 38 patients (41.8%) after a median period of 11 months. Among these, 25 patients with HG upper tract urothelial carcinoma (39.7%) and 13 patients with LG upper tract urothelial carcinoma (46.4%) developed recurrence. HG bladder recurrence developed in 24 patients (63.2%) and LG recurrence developed in 14 patients (36.8%). Stages pTa, pT1, pT2, or higher bladder recurrence developed in 26 (68.4%), 7 (18.4%), and 4 patients (10.5%), respectively, and pure pTis developed in 1 patient. On uni- and multivariate analyses, the risk of bladder recurrence was independent of any clinicopathologic characteristics.ConclusionHigh rate and short time interval of bladder recurrence after NU were found, with no specific subgroup of patients with increased risk. These findings support prescribing adjuvant intravesical therapy to all patients after NU.

Purpose: To determine whether there is any effect of weather parameters on the incidence of renal colic patients presenting to emergency rooms (ERs) during the hottest season in Israel. Materials and Methods: This retrospective multicenter study involved all ER admissions related to renal colic in nine centres throughout Israel between 2010 and 2017. The collected data included the date of ER visits, the patients’ age and sex, and the weather features of ambient temperature, wind velocity, noon heat index, and barometric pressure. Multivariable logistic regression analyses identified predictors of increased ER visits for renal colic. Results: There were 85,501 renal colic-related ER visits during the study period, involving 62,935 (74%) males and 22,566 (26%) females ( p < 0.005). The mean ± standard deviation (SD) age of the males and females was 50 ± 5.8 and 48 ± 19.6 years, respectively ( p = 0.1). Most of the ER arrivals were in the 31- to 50-year-old age group (37%, 31,508) ( p = 0.02). The maximal ambient temperature (odds ratio (OR) = 2.213, 95% confidence interval (CI) = 2.148–2.279, p < 0.0001), lower heat index (i.e. low humidity; OR = 0.880, 95% CI = 0.872–0.887, p < 0.0001) and increased wind velocity (OR = 1.165, 95% CI = 1.149–1.182, p < 0.0001) had a significant linear effect on ER visits for renal colic events. Conclusion: Conditions that increase sweat evaporation during the hottest months, including a decreased heat index and increased wind velocity, correlated with more ER visits for renal colic events, probably due to dehydration associated with elevated sweat evaporation. Level of evidence: Not applicable

Objectives Patients “no‐show” in outpatient clinics is a worldwide challenge. Healthcare providers and patients suffer from negative impacts that include increased expenditure, clinical management ineffectiveness, and decreased access to care. This study aims to evaluate no‐show rate among extracorporeal shock wave lithotripsy patients visiting endourology clinic and to identify the demographic and clinical predictors of no‐show. Methods A cross‐sectional and historical cohort study using electronic medical records. We included 790 patients aged >18 years old referred for endourology clinic following shock wave lithotripsy during 2010–2017 at Hadassah Medical Center in Israel. We predicted no‐show rate following shock wave lithotripsy by various patient characteristics by a multivariate logistic regression model. Results Overall, 291 (36.8%) patients did not arrive for postoperative clinic. Of these, 91 (11.52%) patients referred to Emergency Department. Patients who were younger in age (odds ratio 1.49, 95% confidence interval 1.08–2.04), patients who underwent hospitalization ≥3 days (odds ratio 1.63, 95% confidence interval 1.11–2.41) and patients who had undergone a stent‐free shock wave lithotripsy (odds ratio 5.71, 95% confidence interval 2.40–13.57) were significantly associated with higher no‐show rate. Larger stone size was associated with reduction in no‐show rate with every millimeter increase of stone diameter was associated with a reduction of 6.1% probability for no‐show (odds ratio 0.94, 95% confidence interval 0.89–0.99). Conclusions Predicting patients' characteristics and no‐show patterns is necessary to improve clinical management efficiency, access to care, and costs. We showed that patients who were younger, patients who underwent stent‐free shock wave lithotripsy, patients who had a smaller stone, and patients who underwent a longer hospitalization were more prone to miss their appointment. Paying attention to the characteristics of individual patients may assist in implementing intervening program of patient scheduling.

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