An Easy Solution for Difficult Urethral Catheter: Three-Way Urethral Catheter Insertion Using a Guidewire Technique.

Urethral catheter insertion is a skill taught to all medical students but often not practised for a multitude of reasons. The difficult catheter can be a clinical nightmare for the junior doctor, especially on call, and can lead to significant mortality and morbidity with suboptimal repeated attempts. The incorporation of a soft-tipped hydrophilic guidewire technique for the insertion of a two-way urethral catheter has been described in the literature and has the potential to reduce the morbidity and mortality of patients by making the insertion of a catheter less traumatic. Here, we propose and describe the insertion of a three-way urethral catheter, performed using the technique employed for the insertion of a two-way urinary catheter via the use of a hydrophilic guidewire, with similar outcomes. A hydrophilic soft-tipped guidewire to insert a three-way urethral catheter can be used in the wards, in the emergency department, and in a theatre setting. The district hospital in which this method was employed demonstrated a 100% success rate in the insertion of a urethral catheter (N = 15), with 26% of cases (four patients out of 15) having a three-way urethral catheter inserted using the soft-tipped hydrophilic guidewire method. Follow-ups of these patients showed that there were no complications or adverse effects experienced by the patients. The use of a soft-tipped guidewire approach to insert a difficult urethral catheter can reduce the financial burden on the healthcare system by eliminating costs due to harm/trauma caused by repeated unsuccessful urethral catheter attempts or those attempts that have been performed suboptimally and have led to potential patient harm. The use of a hydrophilic guidewire-assisted technique to insert a three-way urinary catheter is a safe and easy option for those who have had repeated unsuccessful attempts. The hydrophilic guidewire approach has the potential to reduce morbidity and mortality associated with urethral catheterisation and improve patient safety.

Pitfalls of the duplex system: the mystery of the missing stone.

A duplex ureter constitutes about 1% of the renal tract anomalies.A 39-year-old man presented with a 4-week history of left loin pain and microscopic haematuria. Investigation with a non-contrast CT KUB revealed a 6 mm non-obstructing calculus in the left distal ureter.Left ureteroscopy and lithotripsy was planned. However, ureteroscopy failed to identify the calculus. A double J ureteric stent was left in situ and the procedure abandoned in favour of further assessment with a CT urogram. Imaging surprisingly showed a left duplex ureter with the calculus in the non-stented ureter.Repeat ureteroscopy noted the second ureter opening within the distal intramural part of the stented ureter. The calculus was identified and laser lithotripsy performed. A double J stent was appropriately reinserted and removed 2 weeks later.Our case highlights the importance of contrasted imaging prior to performing ureteroscopy for calculus disease.

Primary Non-Hodgkins Lymphoma of the prostate presenting as haematuria.

We report a rare case of Primary Non-Hodgkins lymphoma of prostate presenting as an emergency with gross haematuria. A review of literature is also discussed. A 71 year old man presented to Emergency department with gross haematuria and was found to have grossly enlarged right lobe of the prostate on digital rectal examination. Histology confirmed a diffuse large B-cell lymphoma of the prostate. CT scan revealed a para-aortic lymphadenopathy which resolved with chemotherapy followed by radiotherapy. The patient remains disease free more than 5 years after initial diagnosis. The treatment and prognosis of primary lymphoma of prostate is same as with other nodal lymphomas. Primary or secondary lymphoma of the prostate should also be considered in patients presenting with haematuria. Cystoscopy and prostate biopsies should be taken to confirm the diagnosis. Treatment with chemo-radiotherapy can provide lasting benefit.