A randomized controlled trial evaluating sildenafil citrate in relieving ureteral stent-related symptoms.

PURPOSE: To evaluate the role of sildenafil in relieving ureteral stent symptoms. PATIENTS AND METHODS: A randomized controlled trial was conducted between March 2014 and November 2016. It included adult men who underwent unilateral ureteric stent after ureteroscopy. Patients who were taking PDE5-Is, alpha-blockers or anticholinergics, had contraindication to sildenafil or developed postoperative complications were not included. Eligible patients were randomized using sealed closed envelops to one of two groups (S and C). Patients in group S received sildenafil citrate 50 mg tablet once daily. Patients in group C were the control. All patients answered the ureteral stent symptom questionnaire (USSQ) after 2 weeks of stenting. Primary outcome was the difference in total USSQ score between both groups. Secondary outcomes were tolerability of the treatment and the difference in each domain of USSQ score. RESULTS: After randomization, four patients (7.3%) in group C withdraw their consent because of severe symptoms and two patients (3.6%) in group S discontinued treatment because of headache and dizziness. Final analysis was performed for 46 and 48 patients in groups C and S, respectively. Total USSQ score and all domains (except work performance) were significantly lower in group S (P < 0.001). Dysuria and urgency were significantly more in group C (P = 0.012 and 0.007, respectively). Three patients in groups S (6.25%) experienced transient mild adverse effects (dyspepsia, flushing and rhinitis in one patient for each) but they continued sildenafil. CONCLUSIONS: Sildenafil is an effective and well-tolerated treatment option for relieving ureteral stent-related symptoms in men. CLINICALTRIAL. GOV IDENTIFIER: NCT02345980.

Antibiotics Prophylaxis Practice in Arthroplasty Surgeries.

Background Infection in orthopedic surgery is one of the most dreaded complications. It is associated with prolonged morbidity, disability, and increased mortality. One of the cornerstones of the prevention of infections is antibiotic prophylaxis. This study assessed the practice of antibiotic prophylaxis in arthroplasty surgeries in our local hospital. Methods One hundred and seventy-one elective joint replacement patients were retrospectively analyzed for documentation of antibiotic plan in postoperative instruction, choice of antibiotic, dose, and dosage. Compliance with the dosage (duration and frequency) of antibiotic prophylaxis was compared among patients who underwent different operations, among patients whose operation notes had antibiotics plans, and among those patients whose operation notes lacked this information. Results Ninety-six females and 75 males with a mean age of 71.4±9.8 years who underwent hip replacement, knee replacement, or shoulder replacement were included in this study. Preoperative and postoperative antibiotics were received by 100% and 94.7% of patients, respectively. In 19.3%, there was no instruction about postoperative antibiotics while 4% missed at least one postoperative dose. The dosage of postoperative prophylactic antibiotics was variable as 26.3% of the patients experienced delayed administration of doses. Not having intravenous access, failure to prescribe antibiotics, and prescribing antibiotics in the "once only" rather than "regular medication" section of the medication chart were the reasons for improper timing of antibiotic doses. Observing surgical safety checklist was effective in ensuring preoperative antibiotic administration, whereas failing to document antibiotic plan in operation note was associated with poor compliance with postoperative dosage. Interprofessional participation is crucial to compliance with antibiotic prophylaxis practice. Conclusion This study identified key areas for improvement in our antibiotics prophylaxis practice. It resulted in implementing strategies to improve staff's awareness about the importance of timely administration of prophylactic antibiotics and proper documentation by all team members.

Novel use of a bronchoscope and bariatric needle holder for retrieval of retained intramedullary metalwork during total knee arthroplasty.

Retained metalwork during total joint arthroplasties usually occur from accidental misplacement of jig locking pins into the medullary canal via the aperture created for intramedullary referencing. They are associated with significant clinical and financial consequences for the patient, surgeon and health care provider. Hence the imperative to device methods to not only prevent their occurrence but reliably retrieve any trapped foreign body. We describe an easy, reliable, reproducible, fluoroscopy-free and time efficient way to retrieve metalworks trapped in the medullary canal, with the aid of a bronchoscope and a bariatric needle holder.•The described method utilises two instruments which are readily available in theatres - single use flexible bronchoscope and bariatric needle holder.•Prior experience in bronchoscopy or laparoscopic surgery is not required to adapt the instruments for this purpose.•This technique minimises both the stress on the patient and the surgical team.