Evaluation of a needle disinfectant technique to reduce infection-related hospitalisation after transrectal prostate biopsy.

OBJECTIVES: To determine whether a needle disinfectant step during transrectal ultrasonography (TRUS)-guided prostate biopsy is associated with lower rates of infection-related hospitalisation. PATIENTS AND METHODS: We conducted a retrospective analysis of all TRUS-guided prostate biopsies taken across the Michigan Urological Surgery Improvement Collaborative (MUSIC) from January 2012 to March 2015. Natural variation in technique allowed us to evaluate for differences in infection-related hospitalisations based on whether or not a needle disinfectant technique was used. The disinfectant technique was an intra-procedural step to cleanse the biopsy needle with antibacterial solution after each core was sampled (i.e., 10% formalin or 70% isopropyl alcohol). After grouping biopsies according to whether or not the procedure included a needle disinfectant step, we compared the rate of infection-related hospitalisations within 30 days of biopsy. Generalised estimating equation models were fit to adjust for potential confounders. RESULTS: During the evaluated period, 17 954 TRUS-guided prostate biopsies were taken with 5 321 (29.6%) including a disinfectant step. The observed rate of infection-related hospitalisation was lower when a disinfectant technique was used during biopsy (0.60% vs 0.90%; P = 0.04). After accounting for differences between groups the adjusted hospitalisation rate in the disinfectant group was 0.85% vs 1.12% in the no disinfectant group (adjusted odds ratio 0.76, 95% confidence interval 0.50-1.15; P = 0.19). CONCLUSIONS: In this observational analysis, hospitalisations for infectious complications were less common when the TRUS-guided prostate biopsy included a needle disinfection step. However, after adjusting for potential confounders the effect of needle disinfection was not statistically significant. Prospective evaluation is warranted to determine if this step provides a scalable and effective method to minimise infectious complications.

A Case of Urinary Sepsis Secondary to Streptococcus sanguinis.

We report a case of a 71-year-old male with a history of BPH who presented with flank pain, fever, chills, abdominal pain, and nausea. He had a dental cleaning 1 month prior to admission and flosses daily. Laboratory data revealed both urine and blood cultures to be positive for streptococcus sanguinis. Computed tomography revealed a 10 mm right ureteral stone, and an ultrasound demonstrated moderate right hydronephrosis. He underwent an ureteroscopy with stent placement. A transesophageal echocardiogram was negative for endocarditis. He completed 2 weeks of IV ceftriaxone and made a complete recovery.

Y-type urethral duplication in the male.

OBJECTIVE: To present a single series of Y-type duplication with an analysis of the presenting features, the management and outcome, as complete Y-type urethral duplication in the male is a rare congenital anomaly that presents many challenges. PATIENTS AND METHODS: We retrospectively reviewed patient charts, identifying those with urethral duplication, and then those with complete Y-type duplication. The age at presentation, investigations, management and outcomes were reviewed. RESULTS: Of 49 patients with a diagnosis of urethral duplication, 13 had the complete Y-type. Three were lost to follow-up and were therefore excluded from the study. The median (range) age at presentation was 2 months (birth to 10 years). All patients had other comorbidities, with anorectal malformations in seven, renal agenesis in four, sacral agenesis/partial agenesis in two, and unilateral/bilateral cryptorchidism in four. Presenting features included passage of urine perineally or rectally in seven, and dribbling from the orthotopic urethral meatus in one. The diagnosis was confirmed by micturating cysto-urethrography. A mean of 14 procedures was required to achieve a final complete repair, and included urethral reconstruction, repair of fistulae, urethral dilatation, and evaluative cystoscopy. Excluding cystoscopy and urethral dilatation, a mean (range) of 3 (1-5) reconstructive procedures was required in each patient. The median follow-up was 8 years. Five boys developed urethral strictures and one developed multiple fistulae. The best outcomes were in boys who had a staged urethral reconstruction. CONCLUSION: Due to the strong association with other congenital anomalies we recommend that all patients should be evaluated thoroughly, including a detailed physical examination, renal tract ultrasonography and spinal radiography. Surgical management remains a significant challenge, requiring many procedures with unpredictable outcomes, the goals of which should be to maintain continence and reconstruct the urethra with good cosmesis. The optimum management scheme must be individualized in this rare condition.

The role of unilateral nephrectomy in the treatment of nephrogenic hypertension in children.

OBJECTIVES: To define the efficacy of unilateral nephrectomy in a large series of patients presenting with renal disease and hypertension, as the latter may be a prominent finding in children with nephrourological disease (renal parenchymal disease, renovascular disease, obstruction, renal dysplasia and cancer). PATIENTS AND METHODS: We retrospectively reviewed the hospital and outpatient records of 118 children who presented for evaluation with hypertension, and who had a nephrectomy between 1968 and 2003. Patients included in the study were those who had a unilateral nephrectomy for benign renal hypertension with a normal contralateral kidney; in all, 21 had complete records and follow-up were evaluated. The hypertension was associated with primary renal disease, obstruction and renovascular disease. Blood pressure and medication requirements were compared before and after surgery, the blood pressure values also being compared with published nomograms. RESULTS: Patients were diagnosed with hypertension at a median age of 5 years and had a nephrectomy at a median of 11 months after the diagnosis. The median follow-up after surgery was 39 months. Most patients responded well and became normotensive, or there was a reduction in the need for medication. The median time to normalization was 2, 10 and 11 days in patients with primary renal disease, obstruction and renovascular disease, respectively. CONCLUSION: Nephrectomy is successful in normalizing blood pressure in children with benign renal hypertension and with a normal contralateral kidney.

Kinematics of prey capture and chewing in the lizard Agama agama (squamata: Agamidae).

High speed video recordings (200 fields per second) of prey capture and food processing in Agama agama permit the identification of strikes, chews and transport movements. Ten variables from strike movements and seven variables from chewing sequences are digitized; transport movements are inspected only. Univariate and multivariate statistical analyses disclose significant interindividual differences for three variables (maximum gape distance, maximum head angle, and maximum throat distance); but neither these nor principal components analysis show differences between strikes and chews for any of the gape change and hyoid depression variables. However, strikes and chews obviously differ in tongue protrusion and body movements. Chewing may be divided into four stages, comparable to those of transport cycles of other lizards and the generalized tetrapod model. Transport differs from chewing by having a shorter power stroke and relatively more cranial and less jaw movement. The kinematics of feeding in Agama agama are compared with those of other lizards studied previously.