Introduction: Management of wounds is one of the commonest, often quite challenging as well, in surgical practice. Dressing is an essential component of wound management. Given its importance in achieving wound healing and its complications, methods of dressing have been under constant review since time immemorial. Many innovative techniques of wound dressing have been introduced for quick and problem-free wound healing. Vacuum Assisted Closure (VAC) is one of such methods. Objective: To determine whether VAC can help in reducing the healing time of open wounds.
Abstract
Background and Objective
Renal obstruction is a common urological emergency potentially requiring urgent decompression by percutaneous nephrostomy (PCN) or antegrade ureteric stent (AUrS), procedures performed by interventional radiologists, or retrograde stenting in theatre by a urologist.
The study aimed to assess the burden of PCN / AUrS on the overall workload of a urology department and evaluate impact of procedural delays in terms of bed-occupancy and cost.
The findings serve to explore whether formal PCN / AUrS training would be desirable for UK trainees in urology.
Material and Methods
Prospective study of all patients admitted under urology at Queen Elizabeth Hospital Birmingham (QEHB) between 20thOctober - 18thNovember 2018.
Electronic records to retrieve data pertaining to admission, treatment provided, length of in-patient stay and delay awaiting PCN / AUrS.
Results
n=148 patients identified.
n=22 (14.8% of total) primary admission reason and/or main treatment provided related to PCN / AUrS.
601 urology in-patient days occupied for all causes, 166 (27.6%) related to PCN / AUrS and 66 (10.9%) awaiting PCN / AUrS (delays cost £11,361 / month).
Conclusion
PCN / AUrS constituted a noteworthy proportion of all admissions and in-patient bed days in QEHB urology.
Clinically non-urgent patients experienced notable cumulative delays whilst awaiting PCN / AUrS which adversely impacted bed occupancy.
A suitably trained urologist competent at PCN / AUrS may positively address these issues.
The findings merit consideration of a call for UK urology trainees to be trained in PCN / AUrS as part of CCT requirements.
Background The infection rates for operative management of breast cancer are often unpredictable and higher than average for a clean surgical procedure (0.8% and 28%). We aimed to assess the effectiveness of the American College of Surgeons (ACS) Surgical Risk Calculator (SRC), a preoperative scoring system to calculate the risk of surgical site infection (SSI) and serious complications following breast surgery. Methods Prospective risk scoring using the SRC on 213 patients in the preoperative clinic and the incidence of SSI and serious complications within 30 days postoperatively was prospectively collected. Results The overall SSI rate in our sample was 5% (n=11/210 patients). For a one-unit increase in SRC score, the odds of having SSI increased by a factor of 1.88 (95% CI 1.33 to 2.74). Odds of developing SSI were higher in patients with high Body Mass Index (OR 1.25; 95% 1.13 to 1.40) and American Society of Anesthesiologists score 3 (OR 11.54; 95% CI 2.98 to 43.65). The odds of developing an SSI were ∼19 times higher if a patient had an SRC score >3.0 versus those with an SRC score <3.0. Only 3% (n=4) of patients who had an SRC score of <3.0 experienced SSI, compared with 33% (n=7) for those with a risk score of >3.0. Out of 210 patients, 9 had serious complications (4.2%). Conclusions ACS SRC Score of more than 3 was associated with a higher likelihood of SSI. SRC was able to predict the risk of SSI and serious complications and can be used preoperatively for identification and risk minimisation.
Transurethral resection of the prostate (TURP) is considered the gold-standard operation to treat lower urinary tract symptoms due to benign prostatic enlargement in men. Postoperative bleeding is a recognised complication and managing it is a core skill required by attending urologists. We report a rare case of postoperative bleeding caused by fistulating vessels to the prostate which developed after TURP. These fistulas arose from the right internal iliac vessels and communicated with pre-existing pelvic varices affecting the right paraprostaticand seminal vesicle tissues. The fistulating vessels were successfully embolised with liquid embolic agent. Surgeons should be aware that persisting haemorrhage can occur post-TURP from the rare presence of fistulating vessels communicating with pelvic varices. Early computed tomography angiographic assessment is warranted in cases where bleeding is prolonged and refractory to standard management in view of timely referral for percutaneous embolisation.
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