There are a range of complications associated with UBAs, the most common being urinary tract infection. However, it remains a very well tolerated procedure in the majority of patients. UBAs should be considered as an alternative in patients unsuitable for more invasive procedures and those willing to accept the need for repeat injections. The majority of the literature focuses on subjective improvement measures rather than objective improvement measures. Further randomized controlled trials directly comparing UBAs are required to indicate the most effective agent.
A 46-year-old woman with no urological history or comorbidities presented with an acute abdomen with haematuria after a spell of protracted vomiting. The initial cystogram was negative; however, CT imaging highly suggested an intraperitoneal bladder perforation, which was confirmed during laparotomy and subsequently repaired. Cystoscopic evaluation prior to laparotomy revealed no concurrent bladder pathology, and the ureteric orifices were intact. A cystogram 2 weeks after repair demonstrated no leaks, and her catheters were removed. She recovered well, with expectant postoperative pain and lower urinary tract symptoms settling on 3-month review. Spontaneous bladder rupture is a rare entity, with very few reports in the literature.
Objective: This study aimed to provide real-world data on the multidisciplinary management of metastatic penile squamous-cell carcinoma (mpSCC) patients and their survival outcomes, particularly those who receive best supportive care (BSC). Methods: A retrospective analysis of 1720 patients, managed via a supra-regional penile-specialist multidisciplinary team was conducted between January 2006 and May 2020. Results: A total of 101 patients (median age 63 years; interquartile range 56–72 years; 73% ECOG 0/1) were included. Of these, 32% (32/101) had previously received adjuvant chemotherapy prior to metastatic recurrence, 58% (59/101) received chemotherapy and 42% (42/101) received BSC. Further, 17% (17/101) received second-line systemic therapy, and 3% (3/101) received third-line systemic therapy. For first-line systemic-therapy, there was a 46% (27/59) clinical benefit rate (CBR), with 9% (5/59) complete response, 15% (9/59) partial response and 22% (13/59) stable disease. Patients receiving second-line therapy ( n=17) had a 29% (5/17) CBR. Median progression-free survival for first- and second-line treatment was 3.2 and 2.2 months, respectively. Median overall survival (mOS) for all patients was 6.2 months. mOS for first-line chemotherapy, second-line chemotherapy and BSC patients was 7.2, 4.5 and 2.0 months, respectively. Conclusions: First-line platinum-based chemotherapy is associated with notable response rates in mpSCC patients. Agents with better response rates are needed urgently potentially in combination with platinum-based chemotherapy. Level of evidence: Level 2b.
the development of a virtual urology sub-internship rotation our institution for visiting fourth year medical students. The purpose of this study was to implement a virtual urologic surgery sub-internship program and evaluate medical student impressions of the experience.METHODS: A two-week urology curriculum was created with content delivered by two-way, interactive videoconferencing. The curriculum included synchronous and individual learning with live patient clinical experiences in the outpatient clinic and operating room, faculty lectures, and departmental conferences. The students also completed self-reflective writing exercises and a grand rounds presentation. Student impressions of the rotation were assessed with an anonymous exit survey. Descriptive statistics were utilized to evaluate the 5-point Likert Scale responses, with 5 being "strongly positive" and 1 "strongly negative".RESULTS: A total of 40 students applied for the rotation and 18 were selected for 1 of 5 two-week rotation blocks. All students successfully completed the rotation and received a Pass. Of the 18 students who participated in the virtual rotation, 16 (88.9%) completed the exit survey. The overall experience was rated as "strongly positive" by 14 of 16 (87.5%) students. The learning experience was rated as 4.75AE0.45 (averageAESD). The rotation positively impacted our virtual students' plan to apply to this residency program (4.81AE0.54). All students reported they would recommend this rotation to a fellow student. All feedback regarding the self-reflection activities was positive.CONCLUSIONS: We successfully implemented a two-week virtual urologic sub-internship rotation with a wide variety of clinical and educational experiences. This is a unique experience in surgery that can easily be implemented by other urology or surgical subspeciality programs in the future.
Background: C-reactive protein (CRP) is an acute phase reactant released in response to cell injury of any cause. A rise in CRP in the immediate postoperative period may be misattributed to surgical tissue damage and not to infection, posing a diagnostic challenge for the clinician. We have evaluated its performance as a marker of infective complications following major urological surgery.
Materials and Methods:We reviewed all patients undergoing major urological surgery between March-December 2014. Data including operation, route, Charlson index, post-operative infection, and CRP measurements were recorded. We plotted receiver operating characteristic curves to evaluate the utility of CRP as a marker of infection and explored procedure specific and patient specific risks for CRP elevation.Results: 117 patients were included. Differences in post-operative CRP measurement between procedures are statistically significant on days 1 to 3 (p <0.05). Using receiver operator characteristics, CRP performs well as a marker of infection from postoperative days (POD) 2 to 8. Discriminatory power is best for patients with septic shock, peaking at POD 5 (<0.0001). In binary logistic regression, adjusting for operation, route, and Charlson Index, CRP remained a statistically significant independent marker of infection from POD 2 to 6.
Conclusion:CRP has high discriminatory power on PODs 2 to 6, particularly for septic shock. The individual major procedures and the route of access have a large influence on postoperative CRP.A larger cohort is required to accurately define normal ranges for CRP adjusted to both procedure specific and patient specific factors.
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