Navigating the Complexities of Symptomatic Hydronephrosis in Pregnancy.

The management of symptomatic hydronephrosis presents substantial challenges due to the absence of consensus within clinical guidelines concerning pain management, diagnostic approaches, therapeutic interventions, and follow-up protocols. This literature review focuses on complexities involving diagnostic challenges that arise from the difficulty in distinguishing physiological from pathological obstruction and treatment complexities that involve deciding on the most appropriate pain management medications and safe interventions while minimizing risks to both the mother and foetus. To address these challenges, a comprehensive search of electronic databases, including PubMed, Embase, and Google Scholar, was conducted for the terms "hydronephrosis", "hydronephrosis in pregnancy", "ionising radiation in pregnancy", and "safe analgesia in pregnancy". Moreover, Mendeley software was used to collect and organize the references. Diagnostic complexities involve selecting the appropriate imaging modality that balances accurate diagnosis with minimal radiation to the foetus. Ultrasound remains the first-line option. However, it has limitations in delineating the underlying aetiology. MRI avoids ionizing radiation but has restricted utility due to foetal movement artifacts. CT provides the highest diagnostic accuracy but raises foetal radiation exposure concerns, though ultra-low dose protocols (<1 mGy) are deemed acceptable by most guidelines. Management includes either a conservative approach, which is a safe option in the majority of cases, or intervention with a percutaneous nephrostomy or ureteric stent insertion, both with comparable symptom control. However, there is no consensus on the optimal frequency for drain changes to prevent rapid encrustation. Definitive procedures like ureteroscopy and percutaneous nephrolithotomies remain controversial. Most guidelines suggest limiting these interventions to specialist centres during the second trimester if required.

Selective Histopathology Examination for Circumcision Specimens: A Retrospective Observational Study.

Background Circumcision is a widely performed surgical procedure all over the globe. This can be for religious, cultural, or medical reasons. Routine histological examination of circumcision specimens is a standard practice in many healthcare systems, despite the relatively low incidence of premalignant or malignant lesions. The primary objective of this study was to evaluate the necessity of routine histopathological examination of foreskin specimens following adult circumcision. Secondary objectives included determining the frequency of malignancy in these specimens, comparing malignancy rates between clinically suspicious and non-suspicious cases, and assessing the correlation between preoperative clinical suspicion and histopathological findings. Aim This study aimed to evaluate the necessity of routine histopathological evaluation for the foreskin after circumcision. We investigated the frequency of malignancy upon histopathological examination, in clinically suspicious cases compared to non-suspicious cases. Method A retrospective observational study was conducted at the Royal Bournemouth Hospital, analyzing data from 334 consecutive adult male patients who underwent circumcision between January 2012 and December 2016. The cohort was retrospectively divided into two groups: those with preoperative suspicious clinical features and those without it. Clinical records on electronic patient records (EPR) were used for follow-up and to identify the percentage of malignancy after final histopathological examinations in both groups. Results Among the 334 patients, only nine patients (2.7%) were deemed as having suspicious clinical features preoperatively, of which, only three (0.9% of the total study sample) showed malignancy upon histological examination. The other six patients in this group were found to have balanitis xerotica obliterans (BXO). The other 325 patients (97.3%) were without clinically suspicious lesions preoperatively, and none were found to have any malignant lesions upon histopathological examination. Conclusion The low incidence of malignancy in circumcision specimens indicates that routine histological examination may not be essential for all cases. Among 334 samples, only three (0.9%) were malignant, and all were clinically suspected. Routine histopathological examination of the remaining 331 cases did not impact management or follow-up. Selectively submitting specimens for histology based on clinical suspicion could reduce opportunity costs and time, optimize resource allocation, and maintain appropriate diagnostic evaluation.

An Extremely Rare Case of a 24-Year-Old Female Diagnosed With High-Grade Muscle-Invasive Urothelial Carcinoma in the Bladder.

Bladder cancer most commonly affects older adults. Although extremely rare, it can still be detected in the younger population. Bladder cancer often exhibits distinct behavior in these cases, typically manifesting as a low-grade, non-muscle-invasive disease. We documented a remarkable case involving a 24-year-old female diagnosed with high-grade muscle-invasive bladder cancer. Our report emphasizes the distinctive challenges encountered by clinicians in the journey of diagnosis, treatment, and follow-up of bladder cancer in young patients.

Incidence of Infection Following Local Anesthetic Transperineal Prostate Biopsy: A Single-Centre Experience.

Background Local anesthetic transperineal prostate biopsy (LATP) is a widely used diagnostic procedure for prostate cancer. As a diagnostic procedure, it should carry minimal risk. However, morbidity resulting from prostate biopsy is frequent. Prostate biopsy, like any other intervention, carries a significant risk of various infections, ranging from urinary tract infections (UTIs) to potentially life-threatening conditions like sepsis. Aim This study examined the rate of infections following a prostate biopsy at a single center and sought to identify risk factors that could increase the likelihood of developing an infection. Methods A retrospective review was conducted on all 168 patients who underwent LATP biopsy between 01/04/2022 and 01/04/2023. Data were collected from the Clinical Record and Reporting System (CRRS). Patient characteristics, including age, prostate-specific antigen (PSA) levels, prostate volume, the main indication for the biopsy, number of cores taken, antibiotic prophylaxis, and comorbidities were analyzed. The inclusion criteria encompassed all patients receiving this procedure within the specified timeframe, without restrictions on age, underlying health conditions, or medical history. No exclusion criteria were applied, aiming to comprehensively analyze and capture the full spectrum of patient outcomes and characteristics associated with these biopsies during the study period. Results In terms of socio-demographics, all patients were male with an average age (mean) of 65.5 years, a mean PSA level of 13.9 ng/dL, and an average prostate volume of 66.1 mL. On average, 23.2 biopsy cores were taken. All patients received antibiotic prophylaxis, mainly ciprofloxacin. Despite this, 1.78% of patients (n=3) developed post-biopsy infections. Two of these patients had diabetes mellitus, and two had a large prostate volume of 95 mL.