Ileal conduit obstruction secondary to tethering of the small bowel anastomosis to the pubic bone.

We present the case of a late 60s male who presented to hospital 3 years postradical cystectomy and ileal conduit diversion with polyuria and acute kidney injury. CT of the kidneys, ureters and bladder (KUB) revealed mild hydronephrosis of a solitary left kidney and a 3-cm calculus in the ileal conduit. The patient subsequently underwent a laparotomy which revealed the cause of obstruction to be tethering of the small bowel anastomosis to the pubic bone. The conduit was excised with the calculus in situ and a new conduit was fashioned. The patient recovered from surgery without complication, and his kidney function improved.

Are we underestimating urinary retention following intravesical onabotulinumtoxinA in women with overactive bladder and a history of prior pelvic surgery?

AIMS: This study's purpose is to review the rates of urinary retention requiring intermittent catheterization (IC) post intravesical OnabotulinumtoxinA (BTN/A) injection for idiopathic overactive bladder from a single practicing specialist urological surgeon. METHODS: We performed a retrospective review of a single Australian urologist to identify the rate of intermittent catheterization in our clinical setting. Logistic regression was used to assess associations between requirement of IC and risk factors for urinary retention. RESULTS: Ninety-four patients were included after inclusion and exclusion criteria were applied and the average age was 69.7 years (SD 17.2) and all participants were female. Thirty-six percent (n = 34) of patients required IC. Of patients requiring IC, 32% had a prior urethral sling, 35% had prior vaginal prolapse surgery, and 29% had a preoperative urinary tract infection (UTI). There was strong evidence of univariate associations between IC and prior sling (odds ratio [OR]: 5.26, 95% confidence interval [CI]: 1.64-16.55, p = 0.005), preoperative UTI (OR: 4.25, 95% CI: 1.31-13.08, p = 0.016) and prior vaginal prolapse surgery (OR: 4.91, 95% CI: 1.64-14.72, p = 0.005). Evidence that prior sling patients were more likely to require IC remained strong in a multivariable model (OR: 7.35, 95% CI: 1.59-34.11, p = 0.011). CONCLUSION: Prior urethral sling surgery, prior vaginal prolapse surgery, and positive preoperative UTI, despite treatment, were found to be associated with a higher rate of initiation of intermittent catheterization. The rate of IC initiation of 36% was higher than reported in prior clinical trials.

Clinical Utility of a Single-Use Flexible Cystoscope Compared with a Standard Reusable Device: A Randomized Noninferiority Study.

Objective: A noninferiority assessment of single-use digital flexible cystoscopy (FC) compared with standard reusable FC for bladder cancer surveillance, and investigation of lower urinary tract symptoms. Patients and Methods: Patients requiring FC who met inclusion criteria were randomly assigned to have their procedure performed using a single-use cystoscope (Ambu® aScope™ 4 Cysto System) or a standard reusable cystoscope (Olympus CYF-VH flexible video cystoscope). Primary outcomes were noninferiority of the single-use cystoscope, in terms of effective procedure completion rate, image quality, light quality, and maneuverability. Secondary objectives compared safety, operative, and perioperative time. The noninferiority margin was set at -10%. Results: One hundred one patients completed the study (n = 50 trial, n = 51 control). All primary outcomes demonstrated noninferiority of the single-use cystoscope, compared with standard reusable FC. Effective completion rate, image quality, light quality, and maneuverability between single-use and reusable cystoscopes were 100% and 98% (confidence interval [CI]: -0.059 to 0.019); 96% and 100% (CI: -0.014 to 0.092); 98% and 100% (CI: -0.018 to 0.058); and 98% and 100% (CI: -0.018 to 0.058). There was no difference in operation time (p = 0.415) or total theater use time (p = 0.441) between groups. Adverse event rates were 4.08% and 4.16% in the trial group and control groups, respectively. Conclusion: The single-use Ambu flexible cystoscope is noninferior to standard FC in terms of procedure completion and light quality, image quality, and maneuverability. Single-use flexible cystoscopes are an effective and safe alternative to reusable flexible cystoscopes and may act as a suitable alternative or adjunct in the urologist's armamentarium.