Acute testicular ischaemia following aortoiliac stenting for aortoiliac occlusive disease.

Endovascular treatment is increasingly employed as the treatment for symptomatic aortoiliac occlusive disease. One of the possible complications of aortoiliac stenting is the development of emboli. We present a case of a 60-year-old patient presenting with right scrotal pain immediately following aortoiliac stenting for right common iliac, proximal external iliac and proximal internal iliac arteries thrombosis. He was found to have testicular ischaemia with absent blood flow on duplex ultrasonography. The patient was managed expectantly and reduced blood flow spontaneously returned to the testis over the next few weeks.

Solitary metastasis to the penis from prostate adenocarcinoma - a case report.

Penile metastasis from prostate adenocarcinoma is rare and the disease is usually disseminated at presentation. We present a case of an 83-year-old man with solitary metastasis to the penis from prostate adenocarcinoma. The clinical presentation and imaging features of penile metastasis from prostate cancer and the other primary penile tumors are discussed.

Is excision necessary in the management of adult urachal remnants?: a 12-year experience at a single institution.

OBJECTIVES: To determine the ideal management of uncomplicated adult urachal remnants and to confirm if conservative management with repeated imaging is acceptable. PATIENTS AND METHODS: This is a retrospective review of clinical notes and imaging of 45 patients with a mean age of 54.6 years who had been diagnosed with urachal anomalies at a single urology tertiary centre from January 2005 to December 2016. Patients who underwent surgical intervention and findings from patients managed non-operatively, with a mean follow up of 31 months, were evaluated. RESULTS: Thirty (66.7%) patients had incidental findings, while 15 (33.3%) were symptomatic. Eight underwent excision, one underwent an incision and drainage of abscess, while 34 of the 36 remaining patients elected to undergo surveillance with repeated ultrasound imaging. Two were lost to follow-up. Malignancy was confirmed in three patients. There was interval stability of the urachal remnant in all the patients in the non-operative cohort. The small sample size, limited follow-up, and retrospective nature of the study are recognised limitations. CONCLUSIONS: It was found that simple and asymptomatic lesions can be monitored with ultrasound, but effort must be made on initial diagnosis to ensure that malignancy is excluded using CT imaging and flexible cystoscopy where possible. Long-term follow-up of this cohort is required to assess the natural history of observed urachal anomalies.

Urinary incontinence in female outpatients in Singapore.

INTRODUCTION AND HYPOTHESIS: The aims of this study were to determine the prevalence, symptom characteristics, risk factors and impact on quality of life (QoL) of urinary incontinence (UI) in female outpatients in Singapore, to describe the attitudes of these women towards UI, and to investigate the barriers to healthcare-seeking behaviour in symptomatic women. METHODS: This was a cross-sectional study in a convenience sample and 249 women enrolled from outpatient clinics. A modified self-administered questionnaire which included two validated instruments (the International Consultation on Incontinence Questionnaire-Urinary Incontinence short form and the Incontinence Impact Questionnaire-7) was used. RESULTS: Questionnaires from 230 women were included in the analysis. The overall prevalence of UI was 41.74% (95% CI 35.49-48.26%). Most of the symptomatic women suffered from mild UI and the most common subtype was stress UI. Age (OR 1.03, 95% CI 1.00-1.05), vaginal delivery (OR 2.67, 95% CI 1.43-4.97) and being sexually active (OR 2.41, 95% CI 1.31-4.43) were associated with UI. Among symptomatic women, only 41.25% (95% CI 30.82-52.53%) had sought medical attention before. The most common barrier to healthcare-seeking behaviour was embarrassment. The median QoL score was 33.33, indicating a mild impact of UI on QoL. QoL score was associated with UI severity (p < 0.001). CONCLUSIONS: Despite the high prevalence of UI, only about 41% of UI sufferers had sought medical attention before. Common barriers included embarrassment, fear of surgery and misconceptions. This study emphasizes the need for policy development for UI prevention and management in Singapore.

Inadvertent placement of a urinary catheter into the ureter: A report of 3 cases and review of the literature.

We describe three cases of inadvertent placement of the urinary catheter into the ureter. An 85-year-old gentleman on long-term indwelling catheter (IDC) for neurogenic bladder presented with fever and right flank pain. CT of abdomen and pelvis demonstrated the tip of the IDC to be located within the right vesicoureteric junction with acute right hydronephrosis and acute pyelonephritis. A 74-year-old woman, on long-term IDC for neurogenic bladder was found to have hydronephrosis on ultrasound imaging. Contrast-enhanced CT intravenous pyelography done subsequently showed the IDC was in the right distal ureter. A 47-year-old lady, on IDC for urinary retention and voiding dysfunction likely secondary to schizophrenia and anti-psychotic medications, presented with raised creatinine. A non-enhanced CT of her abdomen and pelvis was done and showed that the tip of the urethral IDC was located up to the left vesicoureteric junction. In all patients, the hydronephrosis resolved after changing the catheter and they were well on discharge. We also review the literature to identify the incidence, outcomes and possible risk factors. To our knowledge, only 20 cases have been reported thus far in the English literature. Although serious complications can occur, the incidence is very low. One risk factor that has been identified is long-term catheterization in patients with neurogenic bladder. We do not recommend routine imaging after catheterization in this group of patients. However, we should still be mindful of the possibility of this occurrence and evaluate and treat as necessary when clinical suspicion arises.

Outcomes of long-term follow-up of patients with conservative management of asymptomatic renal calculi.

OBJECTIVE: • To evaluate the long-term outcomes of patients undergoing observation of asymptomatic renal calculi. PATIENTS AND METHODS: • This is a retrospective review of 50 patients with 85 stones undergoing observation with annual imaging from January 2005 to December 2009. • The incidences of spontaneous stone passage, stone progression and intervention were evaluated and assessed for statistical difference according to initial size and location of stone. • Percutaneous nephrolithotomy, shock wave lithotripsy and ureteroscopy were performed when patients developed complications from the stones. RESULTS: • Patients were followed up for a mean of 46 months. Sixteen percent had bilateral stones and 38% had multiple stones. • The average stone size was 5.7 mm and 31%, 26% and 43% of the stones were located in the upper, middle and lower pole respectively. • Overall incidences of spontaneous passage, progression and intervention were 20%, 45.9% and 7.1% respectively. • Stones measuring 5 mm or less were significantly more likely to pass (P= 0.006). • There was no significant difference in the incidence of passage according to the initial location of the stone (P= 0.092). There was no significant difference in intervention or progression according to the initial size (P= 0.477 and 0.282 respectively) or location of stone (P= 0.068 and 0.787 respectively). CONCLUSIONS: • Patients with asymptomatic renal stones may be managed conservatively in view of low risk of intervention (7.1%). • Annual imaging should be performed as half of these stones will progress in size.