Intraurethral catheter placement does not change the external circumferential measurement of the urethra during AUS placement: A prospective observational trial.

AIMS: Measuring the urethral circumference accurately during artificial urethral sphincter (AUS) placement is an important technical aspect to optimize the selection of cuff size. Differing methods exist for this step with some experts recommending measurement with no urethral catheter in place. In this prospective observational trial, we compared urethral measurements with and without an indwelling catheter to determine if the presence of a catheter affects the circumferential measurement. METHODS: With IRB approval, we prospectively collected data on consecutive cases of transperineal male AUS implantation. Urethral circumference was measured with no urethral catheter (0 French [Fr]), 12Fr, and 16Fr Foley catheters in the urethra. The final measurements and cuff size chosen were recorded. A comparison was made between each measurement using Spearman's correlation coefficient. RESULTS: A total of 54 patients were included, the majority of whom (92.6%) underwent AUS placement for postprostatectomy incontinence. The three urethral circumference measurements were highly correlated (0Fr vs 12Fr, ρ = 0.96, P < .001, mean difference 1 mm) (0Fr vs 16Fr, ρ = 0.94, P < .001, mean difference 2 mm) (12Fr vs 16Fr, ρ = 0.96, P < .001, mean difference 1 mm). Patients with a history of radiation had a lower mean urethral circumference than those who had never been radiated (4.78 cm vs 5.3 cm, P = .01). CONCLUSIONS: Urethral circumference measurement during AUS implantation is not influenced by the presence of a 12 or 16Fr Foley catheter when compared to no catheter in the urethra. Measurement of the urethral circumference can, therefore, be accurately performed with or without a catheter in place, depending on the surgeon's preference.

Which laser works best for benign prostatic hyperplasia?

The advantages offered by lasers compared to older technologies for endoscopic surgery for symptomatic benign prostate hyperplasia (BPH) are reviewed. Laser treatments for the endoscopic management of patients with bladder outlet obstruction (BOO) resulting from BPH can be divided into three basic techniques. These techniques are vaporisation (removal of tissue), resection of tissue (excision of small chips and subsequent irrigation from bladder) and enucleation (dissection of the adenoma from the surgical capsule and subsequent morcellation). The decision to offer a transurethral laser approach to patients with BPH depends on their comorbidities, the surgeon's expertise with the different procedures, and the availability of the relevant technology.

Intraperitoneal wound in abdominal surgery.

The intraperitoneal wound is often forgotten after transperitoneal surgery. This review is a on the peritoneum and the implications of peritoneal injury after surgery. This review will focus on the intraperitoneal wound response after surgical injury.

Perioperative fluid therapy in elective colectomy in an enhanced recovery programme.

BACKGROUND: Although intraoperative fluid restriction is thought to provide clinical benefits, it may not be suitable for patients with significant co-morbidities, who may ultimately require greater amounts of intravenous fluid (IVF) post-operatively. This study investigates whether intraoperative fluid restriction can be implemented uniformly in patients undergoing elective colectomy within an Enhanced Recovery after Surgery (ERAS) protocol and investigates the association between fluid administration and clinical outcomes. METHODS: A retrospective review of prospectively collected data was conducted for all patients who underwent elective colectomy from September 2006 to 2010 within our ERAS programme. Patients received intraoperative fluid restriction with post-operative fluid administered as per clinical indications. Demographic data, American Society of Anaesthesiology (ASA) status, IVF administered and clinical outcomes were recorded. RESULTS: There were 227 patients (ASA 1: 47; ASA 2: 108; ASA 3: 72) with a median age of 71 years. Patients received a median of 2000 mL of crystalloid intraoperatively. There were no statistically significant differences between post-operative IVF amounts. Patients who experienced complications received significantly greater amounts of IVF post-operatively (5000 mL versus 2000 mL; P < 0.01) and post-operative IVF administration was the strongest predictor of complications in a logistic regression model. There was a trend suggesting higher median post-operative IVF prior to patients experiencing major complications (3000 mL versus 2000 mL; P= 0.07). CONCLUSION: Intraoperative fluid restriction can be employed uniformly in ASA 1-3 patients undergoing colectomy. Post-operative administration of greater fluid volumes was associated with adverse outcomes.

Impact of gastrografin in clinical practice in the management of adhesive small bowel obstruction.

BACKGROUND: Gastrografin (GG) has been shown to accelerate the resolution of adhesive small bowel obstruction (ASBO) and decrease length of stay (LOS) in hospital. Consequently, we instituted a protocol recommending the routine use of GG in patients with ASBO. This study reviews patient outcomes after protocol implementation. METHODS: We conducted a retrospective review of all patients with ASBO from January 1997 to December 2007. Data were categorized by admission date and use of GG. The outcomes reviewed were protocol uptake, median LOS in hospital and operative rate. Results were analyzed using the Mann-Whitney U test and the 2-tailed Fisher exact test. RESULTS: There were 710 patients with ASBO overall. Sixteen of 376 (4.3%) patients received GG before institution of the protocol (period 1), whereas 195 of 334 (58.4%) received GG thereafter (period 2). In period 2, use of GG was limited to between 58% and 69% of all potentially eligible patients per year. Fifty-seven of 710 (8%) patients required surgery. In period 1, there were no significant differences in median LOS in hospital (p=0.29) and operative rate (p=0.65) between patients who received GG and those who were managed without GG. In period 2, patients receiving GG had a greater median LOS in hospital (3 [range 2-5] v. 2 [range 1-5] d, p=0.048) but significantly lower operative rates (5.1% v. 12.9%, p=0.018). Overall, the median LOS decreased over time (period 1: 4 [2-7] d v. period 2: 2 [1-5] d, p=0.010). The operative rate did not vary substantially between periods (7.7% v. 8.4%, p=0.42). CONCLUSION: The introduction of a protocol has increased the proportion of eligible patients receiving GG. However, protocol nonadherence and factors other than GG usage have influenced LOS in hospital and operative rates. Demonstrated benefits from previously published clinical trials have thus not been replicated within our setting.