Purpose:To compare the safety and efficiency of conventional monopolar and holmium laser en bloc transurethral resection of bladder tumor (CM-TURBT and HoL-EBRBT) while managing primary nonmuscle-invasive bladder cancer.Materials and Methods:From January 2012 to October 2015, fifty patients with primary nonmuscle-invasive bladder cancer underwent endoscopic surgery. Among them, 27 patients underwent CM-TURBT and 23 patients underwent HoL-EBRBT. Clinical data, included preoperative, operative, and postoperative management and follow-up, were recorded.Results:Patient demographics and tumor characteristics in both groups were compared before surgery. There was no significant difference in operative duration among the groups. Compared with the CM-TURBT group, HoL-EBRBT group had less intraoperative and postoperative complications, including obturator nerve reflex (P < 0.01), bladder perforation (P < 0.01), as well as bleeding and postoperative bladder irritation (P < 0.01). There were no significant differences among the two groups in the transfusion rate and occurrence of urethral strictures. Patients in the HoL-EBRBT group had less catheterization and hospitalization time than those in the CM-TURBT group (P < 0.01), and there were no significant differences in each risk subgroup as well as the overall recurrence rate among the CM-TURBT and HoL-EBRBT groups.Conclusions:HoL-EBRBT might prove to be preferable alternatives to CM-TURBT management of nonmuscle-invasive bladder cancer. HoL-EBRBT however did not demonstrate an obvious advantage over CM-TURBT in tumor recurrence rate.
Introduction: Worldwide, the seventh most commonly diagnosed cancer in the male population is Bladder cancer (BC), while it drops to eleventh when both genders are considered. Radical cystectomy is the surgical treatment of choice for patients with all muscle-invasive and some nonmuscle invasive BCs. An orthotopic continent diversion (neobladder) is preferred whenever possible to achieve a better postoperative quality of life. We attempt to study the functional outcomes of intracorporeal neobladder (ICNB) versus extracorporeal neobladder (ECNB) (ICNB vs. ECNB). Materials and Methods: Forty patients who underwent robot-assisted radical cystectomy with neobladder in our institute during the period of March 2016–March 2018 were included in the study. An orthotopic neobladder (Studer method) was created in all our patients. Our main outcomes of interest were peak flow rates, residual urine, attainment of continence, and Pdet at qmax of the neobladder. Results: The mean age of patients in our study group was 54 ± 6 years. The mean body mass index was 23 ± 2 kg/m 2 . The mean follow-up period was 24 ± 5 months. Twenty patients underwent ICNB and 20 patients underwent ECNB. The urodynamic assessment was done 1-year postprocedure. The same parameters applied to an intact bladder are used, and results analyzed by comparing it with other studies. Common in the initial postoperative period was incontinence which reduced substantially over time. After 1-year, 75% of patients did not require pads in the daytime, and a meager, <10% used more than one pad per day. There was no difference in outcome between both the groups, which was statistically significant. Conclusion: Both ICNB and ECNB groups achieved urodynamically proven values of adequate bladder capacity and compliance. Daytime continence was excellent, and night time continence was good in both groups. Furthermore, there was no significant difference between both the groups as regards to urodynamic parameters. However, continence is attained little earlier in the ICNB group. There is no perceived superiority of ICNB over ECNB.
IntroductionDistal arterial embolisation and subsequent aneurysm formation are rare occurrences and most are secondary to trauma. We have found no case reports that describe posterior tibial aneurysm formation secondary to bacterial endocarditis.Case presentationWe report the case of a 47-year-old Caucasian man who, 2 years after an episode of subacute bacterial endocarditis, presented with signs and symptoms consistent with posterior tibial aneurysm formation.ConclusionPosterior tibial aneurysm formation is a rare occurrence, most commonly occurring after trauma and, although other causes have been described, to our knowledge, endocarditis has not been implicated before, and as such should therefore be borne in mind when dealing with cases where no obvious aetiology is evident.
ObjectiveTo investigate the feasibility and effectiveness of transurethral holmium laser cystolithotripsy (HLC) under local anaesthesia using a flexible cystoscope.Patients and methodsA prospective study was undertaken from January 2013 to June 2015. In all, 37 men with bladder calculi underwent HLC under local anaesthesia, preferably in a lithotomy position using a flexible cystoscope, followed by per urethral Foley catheter placement postoperatively.ResultsThe mean (SD; range) patient age was 46.6 (5.6; 32–76) years. All patients were rendered stone-free, regardless of stone size. The mean (SD; range) stone size was 2.1 (1.2; 1.4–4.1) cm and operative time was 35 (6; 26–52) min. The whole procedure was well tolerated and there were no major intraoperative complications. The mean (SD; range) hospital stay was 2.4 (1.5; 1–5) days. After a mean follow-up of 6 months, no recurrent stones, urinary retention or urethral strictures had developed.ConclusionsTransurethral HLC using a flexible cystoscope under local anaesthesia is a safe and effective technique for the treatment of bladder calculi and can be used as an alternative treatment option.
Introduction:The treatment of renal lithiasis has undergone a sea change with the advent of extracorporeal shock wave lithotripsy (ESWL) and endourological procedures such as percutaneous nephrolithotomy (PCNL), ureterorenoscopy and retrograde intrarenal surgery (RIRS). The presence of anatomical anomalies, such as ectopic pelvic kidney, imposes limitations to such therapeutic procedures. This study is aimed to find a simple and effective way to treat the stones in ectopic kidney.Materials and Methods:From 2010 to 2014, nine patients underwent laparoscopic-assisted mini PCNL with Laser dusting for calculi in ectopic pelvic kidneys at our hospital. Retrograde pyelography was done to locate the kidney. Laparoscopy was performed and after mobilizing the bowel and peritoneum, the puncture was made in the kidney and using rigid mini nephroscope, and stones were dusted with Laser.Results:The median interquartile range (IQR) stone size was 18 (6.5) mm. Median (IQR) duration of the procedure was 90 (40) min. The median (IQR) duration of postoperative hospital stay was 4 (2) days. The stone clearance in our series was 88.9%, with only one patient having a residual stone. No intra- or post-operative complications were encountered.Conclusion:Laparoscopy-assisted mini PCNL with Laser dusting offers advantages in ectopic pelvic kidneys in achieving good stone clearance, especially in patients with a large stone burden or failed ESWL or RIRS.
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