Relation of postoperative pain medication to return for unplanned care after ureteroscopy.

To determine whether the US Drug Enforcement Agency (DEA) class of narcotics prescribed to patients after ureteroscopy impacts their rate of return for unplanned care, a retrospective analysis of patients from February 2014 through March 2016 was performed. Data were collected for the first 90 days after surgery. Patients were divided into groups based on the narcotics schedule prescribed after surgery. Results showed that there was no statistical difference in return for unplanned care when comparing the groups based on their prescribed pain medication. Among the 475 patients, 17% returned to the emergency department after ureteroscopy, 12% contacted the clinic due to discomfort/pain, and 8% were readmitted to the hospital within 90 days of surgery. The data indicated that patients who were not prescribed a narcotic after surgery sought unplanned care at a slightly higher rate than those who were. In conclusion, the US DEA class of narcotics prescribed after ureteroscopy did not have a statistically significant impact on the rate of return for unplanned care. These findings may improve opioid stewardship in patients undergoing outpatient ureteroscopy.

Comparison of Recurrence and Postoperative Complications Between 3 Different Techniques for Surgical Repair of Idiopathic Hydrocele.

OBJECTIVE: To determine if recurrence rates and complication rates differ between 3 different techniques for treatment of idiopathic hydrocele: Jaboulay's bottleneck, hydrocelectomy, or Lord's technique. METHODS: All surgeries for idiopathic hydrocele in the health system were reviewed from 2000 to 2011. Recurrence rate, complication rate, and other surgical data were collected and analyzed. RESULTS: The 276 surgeries were performed using the following techniques: 70 (26%) Jaboulay's repair, 127 (46%) hydrocelectomy, and 79 (28%) Lord's repair. 18 (6%) hydrocele procedures required repeat surgery for recurrence, and there were no statistical differences between all techniques. Complications occurred in 32 (11.6%) of 276 surgeries and included hematoma, postoperative testalgia, and infection. Lord's repair had a significantly lower overall complication rate and rate of hematoma (P = .0016, P = .023). There was no difference between the groups with regard to infection or pain. The median volume of fluid removed with the Jaboulay's approach was 200 mL, and the volumes were 270 mL for each of the hydrocelectomy and Lord's repair, respectively. The largest volume hydrocele treated was 2.4 L and was performed with Lord's repair. CONCLUSION: Overall recurrence rate after open hydrocele surgery was 6%, and did not differ between the surgical techniques analyzed. The overall rate of complications and the rate of postoperative hematoma were lowest with Lord's repair. This data reaffirms the existing literature on hydrocele repair technique, and suggests that Lord's repair is an efficacious and safe choice in treating hydroceles.

Comparison of utilization of pressurized automated versus manual hand irrigation during ureteroscopy in the absence of ureteral access sheath.

This study compared patient outcomes following irrigation applied using an automated pressure system (AP) to hand irrigation utilizing a syringe (HI) during ureteroscopy. Retrospective chart review was performed to evaluate ureteroscopy procedures without a ureteral access sheath. Procedures in which irrigation was applied by AP were compared to those with HI. Statistical analyses included chi-squared tests and Student's t tests. The AP group contained 206 procedures and the HI group, 25. The AP and HI groups were 54.9% and 36% male, respectively. Mean ages were 53.7 ± 18.9 years in the AP group and 44.0 ± 18.5 years in the HI group. Complication rates were 11.2% in the AP and 8.3% in the HI group (P > 0.99). One stone retrieval failure and one stone recurrence occurred in the HI group; one patient had residual stone in the AP group. No urinary tract infections occurred in the HI group; in the AP group, urinary tract infections occurred in 1.9% of cases. The postoperative pain incidence was equivalent (P = 0.498). The AP group had one subcapsular hematoma; no calyceal ruptures occurred in either group. In conclusion, irrigation applied by an automated setup appears safe, with similar outcomes to irrigation applied with a handheld syringe.

Ex-vivo ureteroscopy of deceased donor kidneys.

INTRODUCTION: When encountered, the ideal management of lithiasis in deceased donor kidneys is not well-defined. With advances in endourological techniques, minimally invasive treatments are becoming an increasingly viable option. We set out to describe our experience performing ex-vivo ureteroscopy on cadaveric donor kidneys, including one in which the procedure was completed on-pump. METHODS: A retrospective chart review was undertaken to identify patients who had undergone ex-vivo ureteroscopy prior to cadaveric renal transplant. Four patients were identified, including one in which the procedure was done with the kidney remaining on-pump. The surgical technique and subsequent data were reviewed. RESULTS: Ex-vivo ureteroscopy was successfully completed in all four instances without intraoperative complication. All kidneys were endoscopically stone-free. Creatinine nadirs ranged from 0.8-1.4. All four patients remained stone-free at a mean followup of 13 months. CONCLUSIONS: Our series provides further evidence as to the safety and efficacy of ex-vivo ureteroscopy prior to transplantation in cadaveric renal transplants and describes a novel technique in the form of on-pump ex-vivo ureteroscopy.

Mantle cell lymphoma of the prostate gland treated with holmium laser enucleation.

Mantle cell lymphoma of the prostate is rare and is seldom encountered in general urologic practice. It either arises primarily from the prostate or is a result of metastatic spread from another site. This specific type of lymphoma has an aggressive course and may respond poorly to traditional chemotherapy with frequent relapses. Mantle cell lymphoma occurs in middle age or older, which is also when symptoms of benign prostatic enlargement begin in men. This overlap makes the diagnosis of lymphoma of the prostate difficult and makes the treatment more complex. We describe a case of mantle cell lymphoma of the prostate that caused significant enlargement and bladder outlet obstruction with urinary retention. The obstruction was treated with holmium laser enucleation of the prostate with good functional results.