Safe percutaneous suprapubic catheterisation

INTRODUCTION

We describe our technique of percutaneous suprapubic catheter insertion with special reference to steps that help to avoid common complications of haematuria and catheter misplacement.

METHODS

The procedure is performed using a stainless steel reusable trocar under local infiltrative anaesthesia, usually at the bedside. After clinical confirmation of a full bladder, the trocar is advanced into the bladder through a skin incision. Once the bladder is entered, the obturator is removed and the assistant inserts a Foley catheter followed by rapid balloon inflation. Slight traction is applied to the catheter for about five minutes. Patients with previous lower abdominal surgery, an inadequately distended bladder or acute pelvic trauma do not undergo suprapubic catheterisation using this method.

RESULTS

The procedure was performed in 72 men (mean age: 42.4 years, range: 18–78 years) with urinary retention with a palpable bladder. The average duration of the procedure was less than five minutes. No complications were noted in any of the patients.

CONCLUSIONS

Trocar suprapubic catheter insertion is a safe and effective bedside procedure for emergency bladder drainage and can be performed by resident surgeons. The common complications associated with the procedure can be avoided with a few careful steps.     

The use of health related quality of life data to produce information sheets for patients with head and neck cancer

IntroductionHealth related quality of life information gives patients and carers an indication of how they will be affected following treatment. Such knowledge can promote realistic expectations and help patients come to terms with their outcome. The aim of this paper is to describe the background development of patient information sheets produced at our unit.MethodsThe data were compiled using a common head and neck cancer specific quality of life questionnaire (University of Washington Quality of Life [UW-QOL]). There are 12 domains comprising activity, appearance, anxiety, chewing, mood, pain, recreation, saliva, shoulder, speech, swallowing and taste. The data were collected over 19 years at our unit and focus on follow-up records at around 2 years as this gives a good indication of health related quality of life in survivorship. UW-QOL questionnaires were available from 1,511 patients treated following primary diagnosis of head and neck cancer, and there were 24 subgroups based on cancer site, stage and treatment. There were 2 other subgroups: 132 having transoral laser resection and 176 having laryngectomy.ResultsThe patient and carer research forum helped to design the information sheets, which display overall quality of life, percentages with ‘good’ outcome and ‘significant problem’ by domain, and the most important domains. Three examples are included in this paper: early stage oral cancer treated by surgery alone, early laryngeal cancer treated by surgery alone, and late stage oropharyngeal cancer treated by surgery and postoperative radiotherapy. All 26 subgroup information sheets are available in booklet form and on the internet.ConclusionsHow the surgical community best utilises this type of resource needs further research.     

Leiomyoma on the shaft of penis

Primary soft tissue tumours of the penis, such as leiomyomas, are very rare. Most present as small and painless but gradually increasing swellings on the penis. To the best of our knowledge, only 9 cases have been reported in the literature so far. This rare pathologic finding, which usually mimics a malignant lesion, should be included in the differential diagnosis of penile neoplasm. Surgical excision of the lesion provides both the histological diagnosis and an effective therapy. We report a case of a large leiomyoma on the shaft of the penis measuring 8x5 cm, which possibly represents the largest reported leiomyoma of the penis in English literature till date.