Retrospective audit of CT scans performed at a hospital for surgical patients.

Introduction: Easy accessibility, high sensitivity and specificity of CT scans have markedly increased its usage in developed countries. Its importance is undeniably considered integral for the diagnosis of various pathologies. However, sometimes this costly resource is wasted when used unnecessary. This paper is an audit on CT scans performed to look for surgical pathologies between July 2018 and April 2019 recapitulating the numbers of CT scan's abnormal and normal findings. Methodology: Anonymized record of all the patients seen by the surgical team in the emergency department was reviewed. Retrospective data of every patient who had the CT scan was taken through Mckesson Radiology software of an Irish Hospital. Analysis was done using SPSS. Findings of 102 CT scans was broken down in to three different groups depending at which departmental level CT was performed, namely:Emergency department, Inpatient and Outpatient. Results: 102 CT Scans were performed of which 51 (50%) patients out of all the three groups had unremarkable. Conclusions: Adequate history, proper clinical examination and strong clinical knowledge may bring down the number of unnecessary CT scans.

Leiomyosarcoma of the spermatic cord: a rare paratesticular neoplasm case report.

BACKGROUND: Primary soft tissue sarcomas contribute to only 2% of all malignancies arising from the male genitourinary tract. Leiomyosarcoma (LMS) is a malignant soft tissue neoplasm which originates from the mesenchyme and has a characteristic smooth muscle differentiation. Usually, it presents as a painless, firm, slow-growing unilateral scrotal mass. Investigations include imaging, tumor markers, and histopathology. CASE PRESENTATION: A 65-year-old gentleman known diabetic and beta-thalassemic trait was referred to the Urology OPD at Letterkenny University Hospital. His presenting complaint was a left groin lump that appeared 1 year ago and was growing larger in size gradually. According to the patient, his lump was slightly painful (localized) initially that later became painless. He did not report any testicular trauma/infection or UTI. There was no significant history of malignancies running through his family. Clinical examination revealed a soft and lax abdomen, normal testes. There was a non-tender 2cm x 2cm well-circumscribed, mobile, firm to cystic irreducible left inguinoscrotal mass and appeared to be attached to the spermatic cord. Cough impulse was indiscernible. Ultrasound left groin showed 1.8 cm transverse x 1.4 cm AP x 1.9 cm sagittal) well-circumscribed ovoid nodular subcutaneous lesion present in the upper left inguinal area just lateral to the left pubic tubercle that appeared solid with heterogeneous internal echotexture and no internal calcification. Some internal vascularity is demonstrated with color Doppler assessment. CONCLUSION: Because of its rareness, LMS represents a management conundrum. There is no standard protocol for treatment. We present a case and discuss the available evidence from the literature to date to help identify LMS of the spermatic cord that is highly unusual.

Predictive Ability of Preoperative CT Scan in Determining Whether the Adrenal Gland is Spared at Radical Nephrectomy.

INTRODUCTION: The aim of this study was to assess whether preoperative multiple detector computed tomography (MDCT) accurately predicts adrenal involvement for patients undergoing non-adrenal sparing radical nephrectomy for renal cell carcinoma. METHODS AND MATERIALS: A retrospective observational study based on a composite patient population of two university teaching hospitals who underwent radical nephrectomy. Sensitivity, specificity, overall accuracy, positive and negative predictive values and likelihood ratios were calculated from radiological reports. RESULTS: Total 579 patients underwent radical nephrectomy, of which 199 (34.4%) patients underwent a non-adrenal sparing radical nephrectomy, in which 128 (64.3%) were male and 118 (59.3%) were left side tumors. Mean tumor size was 8.2 cm (range 1.4-20cm). MDCT was found to have a sensitivity of 100% and specificity of 95.2% for identifying adrenal invasion. Total 179 patients (89.9%) had a radiographically normal ipsilateral adrenal gland, of which none were found to have adrenal involvement. Therefore, the negative predictive value of preoperative cross-sectional imaging for identification of adrenal involvement was 100%. CONCLUSION: Cross- sectional MDCT imaging accurately predicts adrenal involvement and the decision to remove or spare the adrenal gland should be made preoperative planning regardless of tumour size or location at the time of multi-disciplinary discussion unless there is intraoperative evidence of adrenal invasion.

A Case of Migrating "Saf-T-Coil" Presenting With a Vesicovaginal Fistula and Vesicovaginal Calculus.

Intrauterine devices (IUDs) are reliable method for contraception. Although, they are generally regarded as safe, serious consequences may occur in case of uterine perforation or intravesical migration. We present a rare case of a 74 year old lady with a forgotten IUD for 42 years resulting in intravesical migration, formation of vesicovaginal fistula (VVF) without uterine perforation, complete urinary incontinence, recurrent urinary tract infections (UTIs) and a large vesicovaginal calculus.

Are Adult Ureteroscopes Safe in the Management of Urolithiasis in a Pediatric Population?

INTRODUCTION: Debate remains regarding the optimal caliber of ureteroscopes in the management of pediatric urolithiasis, ranging from pediatric scopes to standard scopes. The aim of this study was to assess the safety and efficacy of stone management in a pediatric population using standard adult ureteroscopes. METHODS: A retrospective review of all ureteroscopic procedures in patients under the age of 16 years was carried out. Standard adult 7.5 French semi-rigid and 6 French flexible ureteroscopes were used. RESULTS: During the study period, 8 patients underwent 21 ureteroscopic procedures. Two patients had rigid ureteroscopy, seven had flexible ureterorenoscopy and one had a subsequent open procedure. No patients required ureteric dilation. Double J ureteric stents were utilized in 7 patients. There were no complications. All patients required extra corporeal shock wave lithotripsy. Stone clearance was achieved in all patients. CONCLUSION: Our series demonstrates that, in skilled hands, adult ureteroscopes can be use safely for the treatment of urolithiasis in pediatric patients.

On-table urethral catheterisation during laparoscopic appendicectomy: Is it necessary?

INTRODUCTION: Laparoscopic appendicectomy (LA) is the most commonly performed surgical emergency procedure. The aim of this study was to highlight a series of iatrogenic bladder injuries during LA and suggest a simple method of prevention. METHODS: A retrospective review was carried out of all LA performed in a university teaching hospital over a two year period 2012-2013. Iatrogenic visceral injuries were identified and operative notes examined. RESULTS: During the study period 1124 appendicectomies were performed. Four iatrogenic bladder injuries occurred related to secondary trocar insertion. No patient was catheterised preoperatively. One of the injuries was identified intra-operatively, another in the early postoperative period where as two re-presented acutely unwell post-discharge from hospital. Three were repaired by laparotomy and one laparoscopically. CONCLUSION: Iatrogenic secondary trocar induced bladder injuries are a rare but preventable and potentially serious complication of LA. Urethral catheterisation during LA is a safe and simple method which can prevent this complication.

YouTube as an educational tool regarding male urethral catheterization.

OBJECTIVE: Urethral catheterization (UC) is a common procedure carried out on a daily basis. The aims of this study were to assess the quality of YouTube as an educational tool regarding male UC and to assess the experience of newly qualified doctors regarding UC. MATERIALS AND METHODS: YouTube was searched for videos containing relevant information about male UC. A checklist for evaluating content for male UC was devised. The top-ranked video was shown to interns and they were questioned regarding their experience of UC and the usefulness of the video. RESULTS: A total of 100 videos was screened and 49 unique videos were identified. The median length of video was 7 min 15 s (range 1 min 44 s to 26 min 44 s). Regarding the Safe Catheter Insertion Score, the mean score was 5.18 ± 1.64. 9 (18.4%) deemed useful, 24 (49%) somewhat useful and 16 (32.7%) not useful. There was no difference in the number of views (p = 0.487), duration of video (p = 0.364) or number of days online (p = 0.123) between those categorized as useful, somewhat useful and not useful. Twenty-six interns (89.7%) attended the UC teaching session. All reported the video to be a useful educational adjunct. Nine of the respondents (42.9%) had independently inserted a urinary catheter before the educational session. CONCLUSIONS: The quality of videos on YouTube regarding male UC is widely variable. Preselected videos are deemed useful by junior doctors regarding male UC and can be used as an educational adjunct before performing hands-on tasks.

Papillary thyroid carcinoma with tuberculous cervical lymphadenopathy mimicking metastasis.

OBJECTIVE: To determine the frequency of tuberculous cervical lymphadenopathy mimicking metastasis from papillary thyroid cancer. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Surgical Unit-I, Ward-3 of Jinnah Postgraduate Medical Centre, Karachi, from March 2005 to March 2010. METHODOLOGY: All patients above 12 years of age of either gender diagnosed on investigations as papillary thyroid cancer (PTC) were included in the study. Ultrasound and fine needle aspiration cytology (FNAC), neck of solitary thyroid nodules (STN) and cervical lymph nodes were done. Total thyroidectomy and excision biopsy of cervical lymph nodes was performed, histopathological results were recorded and patients were managed accordingly. RESULTS: A total of 55 patients had PTC and 25 had cervical lymphadenopathy. Eighteen patients of PTC with cervical lymphadenopathy were diagnosed after investigations as cases of tuberculous cervical lymphadenopathy (TCL) initially considered as metastasis from PTC; 5 patients had metastasis from PTC. Two patients proved to be of reactive hyperplasia which initially showed tuberculous cervical lymphadenopathy on FNAC. So 80% patients of cervical lymphadenopathy with PTC were due to benign disease and 20% had metastasis in lymph node due to PTC. CONCLUSION: PTC with cervical lymphadenopathy due to co-existent tuberculosis is common. Metastasis from PTC in lymph nodes were less common than tuberculous lymphodenitis in this study. Tuberculosis should be considered before deciding for neck dissection in cases of PTC.