Early observations from the initial impact of the current COVID-19 pandemic on surgical services in the United Kingdom: a comprehensive review.

OBJECTIVE: The COVID-19 pandemic has resulted in a serious impact on health services. In this comprehensive review, the authors have explored the published evidence that has looked into the early effects of this impact on various aspects of delivering surgical services during the crises in the United Kingdom. MATERIALS AND METHODS: Electronic literature search of the databases (Medline/PubMed, EMBASE, NICE guidelines and Google Scholar). The key words used were COVID-19, SARS-CoV-2, Coronavirus, pandemic, surgery, surgical services. The retrieved studies were systematically reviewed and critically analyzed to construct this comprehensive review. RESULTS: The surgical interventions have been focused on emergency and cancer surgery during the pandemic. Since the service situation is changing quickly; surgeons should be up to date with the local and national guidelines. It is vital to safeguard the specialized clinical professionals to fulfill their tasks through the pandemic; especially that another wave of the pandemic is still a possibility in the horizon. Attention should be given to surgical training and medical education during the crises by the training providers. CONCLUSIONS: The aftermath period is still going to be a serious challenge to the service. Therefore, a strategy of shared responsibility, planning ahead with consideration of developing a transitional period should be adapted.

Is confirmation of ureteric stent placement in laparoscopic pyeloplasty necessary?

PURPOSE: Placement of an antegrade double-J (JJ) ureteric stent is an important component of pyeloplasty. Correct siting of distal end of the stent in the bladder is essential for ease of removal. To date, no studies have compared methods for confirming stent position. This study aims to address that void in the literature. METHODS: Eligible patients underwent laparoscopic pyeloplasty with antegrade stent placement at our institution from 2007 to 2015 inclusive. Methods to verify distal stent position of rigid cystoscopy, artificial bladder filling or no confirmation were compared. Effectiveness was determined by the proportion of malpositioned stents detected intra-operatively compared to the total found malpositioned, both intra-operatively and during follow-up. RESULTS: A total of 75 patients underwent laparoscopic pyeloplasty. Forty-six (61.3%) patients had distal stent position assessed intra-operatively, comprising 27 by cystoscopy and 19 by artificial bladder filling, while for 29 (38.7%) patients no verification method was used. Cystoscopy, artificial bladder filling and no confirmation detected intra-operatively 2, 1 and 0 malpositioned stents, from malpositioned stent totals of 2, 2 and 1, respectively. CONCLUSION: Malposition of JJ ureteric stent is uncommon, and omitting intra-operative position verification appears reasonable in select cases. Artificial bladder filling can help detect malpositioned JJ stents without repositioning the patient for cystoscopy. However, our results suggest both may be unreliable. If stent malposition is suspected, certainty is desired or extended operative duration is less critical, then the surgeon should proceed with cystoscopy.

Severe Intraperitoneal Haemorrhage following Suprapubic Catheter Insertion in a Patient Treated with Iloprost.

Suprapubic catheter (SPC) insertion is a common urological procedure, performed both in the elective and emergency settings. The authors present an unusual case of severe intraperitoneal bleeding following the insertion of an SPC under direct vision, where the use of prostacyclin analogue may have been a contributing factor.

Primary plasmacytoma of the kidney.

Primary renal plasmacytomas are an extremely rare clinical condition. Their management is particularly challenging due to the paucity of evidence, with only just over a dozen previously reported cases. We report a case of a primary extramedullary plasmacytoma of the kidney and performed a review of the literature. The case is presented as a learning point that it is imperative to keep plasmacytic tumours in mind and to include them in the differential diagnosis of anaplastic tumours, even in unusual locations, such as the kidney.

Bladder contracture: review for intravesical bacillus Calmette-Guerin complication.

INTRODUCTION: We are reporting a case of bladder contracture post intravesical bacillus Calmette-Guerin (BCG) therapy; to our knowledge only two cases were reported. We present the clinical history/presentation investigation and the outcome of the treatment. Approximately 75%-85% of patients with bladder cancer present with disease confined to the mucosa (stage Ta-CIS) or submucosa (stage T1). The management of non-muscle invasive bladder cancer has become more complex with regard to initial investigation, treatment and follow-up. In high-grade tumors, BCG therapy has proven to be superior to intravesical chemotherapy. BCG therapy prevents, or at least delays, tumor progression. METHODS AND RESULTS: A case of high grade superficial bladder caner treated with intravesical BCG which has successfully cleared her bladder cancer nevertheless has lead to bladder contracture for which case she may need bladder reconstruction/augmentation surgery if she remained disease free added to her psychological and social effects on her life. CONCLUSION: Although BCG is considered a very effective treatment; consensus exists that not every patient with superficial bladder cancer should be treated with BCG due to its increased risk of toxicity. Ultimately, the choice of treatment will depend upon the patient's risk of recurrence and progression. Assuming that maintenance therapy is necessary for optimal efficacy, the issue of BCG toxicity becomes more relevant. Due to the more pronounced side effects of BCG compared to intravesical chemotherapy, reluctance still exists about BCG use. However, with increased experience in applying BCG, the side effects now appear to be less prominent and few. Serious side effects are encountered in less than 5% of patients and this case carries one of the rarest, yet drastic, side effects of intravesical BCG.

Fournier's gangrene and its emergency management.

Fournier's gangrene (FG) is a rare but life threatening disease. Although originally thought to be an idiopathic process, FG has been shown to have a predilection for patients with diabetes as well as long term alcohol misuse; however, it can also affect patients with non-obvious immune compromise. The nidus is usually located in the genitourinary tract, lower gastrointestinal tract, or skin. FG is a mixed infection caused by both aerobic and anaerobic bacterial flora. The development and progression of the gangrene is often fulminating and can rapidly cause multiple organ failure and death. Because of potential complications, it is important to diagnose the disease process as early as possible Although antibiotics and aggressive debridement have been broadly accepted as the standard treatment, the death rate remains high.

Medical and surgical management of priapism.

Priapism is a pathological condition of penile erection that persists beyond, or is unrelated to, sexual stimulation. Pathologically and clinically, two subtypes are seen-the high flow (non-ischaemic) variety and the low flow (ischaemic) priapism. The low flow type is more dangerous, as these patients are susceptible to greater complications and the long term recovery of erectile function is dependent on prompt and urgent intervention. Many of the causes of priapism are medical, including pharmacological agents, and as such, priapism should be considered as a medical and surgical emergency.