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Trans-peritoneal laparoscopic ureterolithotomy is a well-established minimally invasive procedure for management of large impacted ureteric stones since the last 3 decades. We present a case of a 51-year old gentleman, who presented with bilateral large upper ureteric calculi with obstructive uropathy and azotemia, managed successfully with bilateral synchronous 3-port trans-peritoneal laparoscopic ureterolithotomy, and to our knowledge is the first such case to be reported in literature. Supplementary Information: The online version contains supplementary material available at 10.1007/s42399-022-01190-5.
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INTRODUCTION: Bipolar transurethral resection of prostate (B-TURP) was introduced as an alternative procedure to minimize the surgical complications of monopolar TURP (M-TURP). However, there are concerns about increased incidence of stricture urethra (SU) post B-TURP. This study was designed to analyze the incidence of SU among patients undergoing M-TURP versus B-TURP. MATERIALS AND METHODS: This is a randomized controlled, single-blinded study; randomization was performed using a stratified permuted randomization algorithm (1:1 ratio) and only the patients were blinded. Both M-TURP and B-TURP were performed with a 26 Fr resectoscope; the electrosurgical generators were Karl Storz Autocon II 400 and Olympus UES-40 SurgMaster (TUR in saline [TURIS] method), respectively. Follow-up visits were scheduled at 3, 6, and 12 months post surgery and patients with lower urinary tract symptoms and a maximum urinary flow rate of <10 ml/sec on uroflowmetry underwent retrograde urethrography to assess for development of SU. RESULTS: Forty patients were randomised to each arm. None developed SU in the monopolar group, whereas there were three cases in the bipolar group (P = 0.2). Among these three patients, two belonged to the failed medical management subgroup and one to the refractory urinary retention subgroup (P = 1.0). CONCLUSION: The incidence of SU following B-TURP using the TURIS system was comparable to the conventional M-TURP. Moreover, the incidence of SU was same for both the techniques when sub-grouped according to the indication for surgery that is failed medical management versus refractory urinary retention.
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Along with advantages, evolving surgical techniques bring unique complications. A young male developed urinary symptoms a few months after undergoing laparoscopic inguinal hernia repair. On evaluation, mesh erosion into the urinary bladder was found. Removal of mesh with repair of bladder was done. A vesico-cutaneous fistula resulted which was managed with repeat surgery. We review all such cases reported in literature; discuss the etiopathogenesis, presentation, management and possible preventive measures. To the best of our knowledge, this is only the 12th case being reported.
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BACKGROUND: Revascularization is the optimal treatment for critical limb ischemia (CLI). Traditional measures of outcome of intervention are as follows: graft patency, limb salvage rates, and patient survival rates; however, these have little meaning for a patient if he/she cannot ambulate independently or go back to work. This study was undertaken to assess the functional outcome of intervention in these patients. METHODS: Fifty patients with CLI treated over a 3-year period were included in this prospective clinical study. After evaluation, treatment was given to each patient on the basis of the Transatlantic Inter-society Consensus II guidelines. The outcome of treatment and the functional restoration to pre-illness lifestyle were assessed at the end of 1 month, and then at 6 months. RESULTS: Fifty patients with CLI were included in the study; male to female ratio was 9:1, and the mean age at presentation was 45 years. After evaluation, only 38 patients (76%) were found suitable for revascularization. Traditional measures of success showed a graft patency rate of 75%, limb salvage rate of 89.5%, and patient survival rate of 96% at 6 months after treatment. All eight parameters of quality-of-life analysis showed significant improvement as assessed by the Research and Development (RAND) 36-Item Health Survey 1.0 form. However, among the 38 patients who were revascularized, 20 (52.6%) went back to their initial occupation after 6 months, 12 (31.6%) remained at home even though they were ambulant, and five (13.2%) were able to manage only limited activities; one patient succumbed to death. CONCLUSION: With only 53% of revascularized patients returning to work, a salvaged leg does not equate with return to premorbid ambulatory/occupational status, although there might be improvement in quality of life because of other reasons. As surgeons, we need to look beyond leg salvage and graft patency and take on a more holistic approach.
