Interpleural block: a new technique for regional anaesthesia during percutaneous nephrostomy and nephrolithotomy

Canadian Journal of Anesthesia/Journal canadien d'anesthésie - Interpleural block was used in four patients undergoing percutaneous nephrostomy, one of whom also underwent percutaneous...     

Bladder management methods and urological complications in spinal cord injury patients

Background:

The optimal bladder management method should preserve renal function and minimize the risk of urinary tract complications. The present study is conducted to assess the overall incidence of urinary tract infections (UTI) and other urological complications in spinal cord injury patients (SCI), and to compare the incidence of these complications with different bladder management subgroups.

Materials and Methods:

545 patients (386 males and 159 females) of traumatic spinal cord injury with the mean age of 35.4±16.2 years (range, 18 – 73 years) were included in the study. The data regarding demography, bladder type, method of bladder management, and urological complications, were recorded. Bladder management methods included indwelling catheterization in 224 cases, clean intermittent catheterization (CIC) in 180 cases, condom drainage in 45 cases, suprapubic cystostomy in 24 cases, reflex voiding in 32 cases, and normal voiding in 40 cases. We assessed the incidence of UTI and bacteriuria as the number of episodes per hundred person-days, and other urological complications as percentages.

Results:

The overall incidence of bacteriuria was 1.70 / hundred person-days. The overall incidenceof urinary tract infection was 0.64 / hundered person-days. The incidence of UTI per 100 person-days was 2.68 for indwelling catheterization, 0.34 for CIC, 0.34 for condom drainage, 0.56 for suprapubic cystostomy, 0.34 for reflex voiding, and 0.32 for normal voiding. Other urological complications recorded were urethral stricture (n=66, 12.1%), urethritis (n=78, 14.3%), periurethral abscess (n=45, 8.2%), epididymorchitis (n=44, 8.07%), urethral false passage (n=22, 4.03%), urethral fistula (n=11, 2%), lithiasis (n=23, 4.2%), hematuria (n=44, 8.07%), stress incontinence (n=60, 11%), and pyelonephritis (n=6, 1.1%). Clean intermittent catheterization was associated with lower incidence of urological complications, in comparison to indwelling catheterization.

Conclusions:

Urinary tract complications largely appeared to be confined to the lower urinary tract. The incidence of UTI and other urological complications is lower in patients on CIC in comparison to the patients on indwelling catheterizations. Encouraging CIC; early recognition and treatment of the UTI and urological complications; and a regular follow up is necessary to reduce the medical morbidity.     

Sublingual oxybutynin reduces postoperative pain related to indwelling bladder catheter after radical retropubic prostatectomy

Background: Bladder discomfort related to an indwelling catheter can exacerbatepostoperative pain. It mimics overactive bladder syndrome thatis resistant to conventional opioid therapy. Muscarinic receptorantagonists are effective for treatment of the overactive bladder.The aim of this study was to assess the efficacy of oxybutyninin the management of postoperative pain after radical prostatectomy. Method: Forty-six ASA I or II men undergoing radical retropubic prostatectomyunder general anaesthesia were randomly assigned to two groups,in a double-blind fashion: Group O and Group P (n = 23 each).Group O and Group P received, respectively, sublingual oxybutynin5 mg or placebo every 8 h during the 24 h after surgery. A 16FFoley catheter was placed during the vesico-urethral anastomosisand the balloon inflated with 10 ml of saline. Pain was assessedin the recovery room starting 10 min after extubation usinga 100-point visual analogue scale (VAS). The patients were askedto specify whether pain was related to the surgical incisionor bladder pain. Standardized postoperative analgesia includedacetaminophen and tramadol administered via a patient-controlledanalgesia system. Results: The incidence of bladder catheter pain was 65% (15 of 23 patients)in Group P compared with 17% (4 of 23 patients) in Group O (P< 0.01). Overall VAS scores at rest were significantly lowerin Group O. Cumulative tramadol consumption was 322.9(124.3)mg [mean(SD)] in Group P and 146(48) mg in Group O (P < 0.01).No oxybutynin-related side-effects were reported. Conclusions: Sublingual oxybutynin is an effective treatment for postoperativepain after radical retropubic prostatectomy and produces a significantreduction in tramadol requirements.     

Robotic urological surgery: Prospects for Hong Kong

Robotic surgery was first begun in the early 1980s and the da Vinci robotic surgical system is currently the most commonly used system in the world. The Prince of Wales Hospital, the Chinese University of Hong Kong, was the first centre in Hong Kong to have this system installed. Since November 2005, more than 50 cases of various urological procedures have been performed, and robotic radical prostatectomy is the most commonly performed procedure in our centre. With the benefits of three‐dimensional vision, EndoWrist technology and ergonomic advantage, a result comparable to the world standard can be achieved within a short learning time. In the present article, a summary of the development of robotic surgery, as well as the early experiences of the da Vinci surgical system will be discussed.     

Endoscopic transanal resection of rectal tumours using a urological resectoscope--still has a role in selected patients.

INTRODUCTION: Transanal resection of rectal villous adenomas or adenocarcinomas can be carried out using various modalities such as operative excision, fulguration, laser coagulation or cryotherapy. Transanal endoscopic microsurgery is currently not widely available. Transanal resection can provide effective palliation for locally advanced rectal tumours in patients unfit for abdomino-perineal excision of rectum. A urological resectoscope can be safely and repeatedly used to resect advanced primary or locally recurrent rectal tumours by colorectal surgeons with urological expertise. This study reports our experience of treating rectal lesions with endoscopic transanal resection (ETAR) using the urological resectoscope. METHODS: Patients were identified from one surgeons' prospectively collected operating data. Charts were retrieved and reviewed. RESULTS: Over a 13-year period a total of 43 ETAR procedures were carried out in 20 patients (11 males; mean age 74 years; range 54-92 years) using the urological resectoscope. Twelve (60%) patients had a single resection; 8 (40%) patients required more than one resection; the mean number of procedures per patient was 2.2 (range 1-8). The median interval between resections for recurrent disease (excluding planned repeat resections) was 340 days (range 168-2337 days). Histopathology revealed rectal adenoma (with varying degrees of dysplasia) in 11 (55%) patients and adenocarcinoma in 9 (45%). The majority (30; 70%) of resections were carried out in patients with benign disease, with 13 (30%) in patients with rectal adenocarcinoma. Mean operating time per resection was 25 min. Thirteen (30%) resections were carried out under spinal anaesthetic. There was no procedure related mortality. There were no cases of haemorrhage, rectal perforation, 'TUR syndrome' or pelvic sepsis. No patients with benign disease subsequently developed an invasive carcinoma. CONCLUSIONS: Accepting that this technique provides limited histopathological information regarding extent of resection and tumour clearance, our experience demonstrates that ETAR of rectal tumours using the urological resectoscope can provide a minimally invasive, effective and safe means of treating and palliating patients with benign and malignant rectal disease. There remains a place for this technique in selected patients.