Rare case of acute renal failure secondary to Erdheim-Chester disease.

In this report we describe the clinical journey of a 62-year-old male that presented with acute kidney injury secondary to Erdheim-Chester disease, a non-Langerhans variant of histiocytosis rarely encountered by urological surgeons. ECD can uncommonly cause acute renal failure and management includes decompression of the collecting system. A multi-disciplinary approach is required to facilitate adequate investigation to determine the specific ECD subtype and most appropriate treatment options, particularly as the available targeted therapies have only recently been utilised.

The evolution of image guidance in robotic-assisted laparoscopic prostatectomy (RALP): a glimpse into the future.

OBJECTIVES: To describe the innovative intraoperative technologies emerging to aid surgeons during minimally invasive robotic-assisted laparoscopic prostatectomy. METHODS: We searched multiple electronic databases reporting on intraoperative imaging and navigation technologies, robotic surgery in combination with 3D modeling and 3D printing used during laparoscopic or robotic-assisted laparoscopic prostatectomy. Additional searches were conducted for articles that considered the role of artificial intelligence and machine learning and their application to robotic surgery. We excluded studies using intraoperative navigation technologies during open radical prostatectomy and studies considering technology to visualize lymph nodes. Intraoperative imaging using either transrectal ultrasonography or augmented reality was associated with a potential decrease in positive surgical margins rates. Improvements in detecting capsular involvement may be seen with augmented reality. The benefit, feasibility and applications of other imaging modalities such as 3D-printed models and optical imaging are discussed. CONCLUSION: The application of image-guided surgery and robotics has led to the development of promising new intraoperative imaging technologies such as augmented reality, fluorescence imaging, optical coherence tomography, confocal laser endomicroscopy and 3D printing. Currently challenges regarding tissue deformation and automatic tracking of prostate movements remain and there is a paucity in the literature supporting the use of these technologies. Urologic surgeons are encouraged to improve and test these advanced technologies in the clinical arena, preferably with comparative, randomized, trials.

Uretero-duodenal fistula: Risk factors and management.

In this case report we explore the clinical journey of a 66-year-old female patient that developed a uretero-duodenal fistula. This urological complication is extremely rare and to our knowledge, this is only the third female described in the literature with this finding. We discuss the risk factors associated with uretero-duodenal fistula and its management in the acute setting.

Lost and forgotten: A case of intravesical migration of an intrauterine device.

In this report we explore the clinical journey of a female patient that presented with a history of failed contraception and more recently recurrent urinary tract infection (UTI). Renal tract ultrasound was done to investigate the cause of UTI and a bladder calculus was seen. During cystolithotripsy an intrauterine device (IUD) was seen embedded in the calculus. The risk factors for intravesical migration of an IUD are discussed.

Bladder infusion versus standard catheter removal for trial of void: a systematic review and meta-analysis.

PURPOSE: To compare the efficacy and time-to-discharge of two methods of trial of void (TOV): bladder infusion versus standard catheter removal. METHODS: Electronic searches for randomized controlled trials (RCTs) comparing bladder infusion versus standard catheter removal were performed using multiple electronic databases from dates of inception to June 2020. Participants underwent TOV after acute urinary retention or postoperatively after intraoperative indwelling catheter (IDC) placement. Quality assessment and meta-analyses were performed, with odds ratio and mean time difference used as the outcome measures. RESULTS: Eight studies, comprising 977 patients, were included in the final analysis. Pooled meta-analysis demonstrated that successful TOV was significantly higher in the bladder infusion group compared to standard TOV (OR 2.41, 95% CI 1.53-3.8, p = 0.0005), without significant heterogeneity (I2=19%). The bladder infusion group had a significantly shorter time-to-decision in comparison to standard TOV (weighted mean difference (WMD)-148.96 min, 95% CI - 242.29, - 55.63, p = 0.002) and shorter time-to-discharge (WMD - 89.68 min, 95% CI - 160.55, - 18.88, p = 0.01). There was no significant difference in complication rates between the two groups. CONCLUSION: The bladder infusion technique of TOV may be associated with a significantly increased likelihood of successful TOV and reduced time to discharge compared to standard TOV practices.