Safety and efficacy of sequential balloon dilation prior to ureteral access sheath insertion in nonstented patients undergoing ureteroscopy.

Techniques such as ureteral access sheath placement and balloon dilation are utilized to facilitate ureteroscopy. A retrospective review was performed to evaluate the efficacy and complications from ureteral access sheath (UAS) placement with or without sequential ureteral balloon dilation (SBD) in non-prestented patients who underwent ureteroscopy with UAS with or without SBD for renal or proximal ureteral stones from February 2014 to April 2017. This was a two-surgeon series of 124 patients divided into groups of SBD + UAS or direct UAS placement. Postoperative complications included hematuria, fever, and flank pain. Successful UAS insertion rates and postoperative complication rates were statistically significantly higher in the SBD + UAS group (P = 0.01 and 0.023, respectively). The procedure time, emergency department return, and 6-week stone-free rates were not statistically different between the groups. In conclusion, SBD + UAS has a higher success rate of UAS insertion compared to direct UAS alone, allowing for same-setting ureteroscopy. However, SBD + UAS is associated with significantly higher rates of fever, flank pain, and hematuria. We conclude that SBD + UAS and direct UAS are equivalent.

Comparison of Recurrence and Postoperative Complications Between 3 Different Techniques for Surgical Repair of Idiopathic Hydrocele.

OBJECTIVE: To determine if recurrence rates and complication rates differ between 3 different techniques for treatment of idiopathic hydrocele: Jaboulay's bottleneck, hydrocelectomy, or Lord's technique. METHODS: All surgeries for idiopathic hydrocele in the health system were reviewed from 2000 to 2011. Recurrence rate, complication rate, and other surgical data were collected and analyzed. RESULTS: The 276 surgeries were performed using the following techniques: 70 (26%) Jaboulay's repair, 127 (46%) hydrocelectomy, and 79 (28%) Lord's repair. 18 (6%) hydrocele procedures required repeat surgery for recurrence, and there were no statistical differences between all techniques. Complications occurred in 32 (11.6%) of 276 surgeries and included hematoma, postoperative testalgia, and infection. Lord's repair had a significantly lower overall complication rate and rate of hematoma (P = .0016, P = .023). There was no difference between the groups with regard to infection or pain. The median volume of fluid removed with the Jaboulay's approach was 200 mL, and the volumes were 270 mL for each of the hydrocelectomy and Lord's repair, respectively. The largest volume hydrocele treated was 2.4 L and was performed with Lord's repair. CONCLUSION: Overall recurrence rate after open hydrocele surgery was 6%, and did not differ between the surgical techniques analyzed. The overall rate of complications and the rate of postoperative hematoma were lowest with Lord's repair. This data reaffirms the existing literature on hydrocele repair technique, and suggests that Lord's repair is an efficacious and safe choice in treating hydroceles.

Serious complications from a single-incision midurethral sling placement.

BACKGROUND: The single-incision midurethral sling has been introduced as an alternative to the traditional midurethral sling. Complications have been reported rarely. CASE: A 57-year-old multiparous woman with history of osteogenesis imperfecta type I underwent single-incision midurethral sling placement for stress urinary incontinence. She developed bladder mesh erosion, vaginal mesh exposure, and an urethrovaginal fistula. CONCLUSION: This case raises awareness of the potential complications that can arise after single-incision midurethral sling placement and emphasizes the importance of patient selection and preoperative evaluation before undergoing minimally invasive procedures.