Genitalia strangulation--fireman to the rescue!

The incidence of metallic rings causing genitalia strangulation has been widely reported. The removal of the constricting rings can be challenging and might need resources not usually available in the hospital. We report one such case where the assistance of a fire crew was required to remove the ring.

Have stent-related symptoms anything to do with placement technique?

PURPOSE: To determine whether incorrect placement of an indwelling stent plays any role in the causation of irritative voiding symptoms and loin pain. PATIENTS AND METHODS: Sixty patients with ureteral calculous disease were prospectively requested to analyze the symptoms that they encountered 1 week after stent insertion via a questionnaire handed out at their discharge from the hospital. The answers were analyzed with reference to the intravenous urogram performed at presentation and the plain radiograph taken immediately after stent insertion. RESULTS: Stents crossing the midline in the bladder and having incomplete loops at the lower end give rise to higher morbidity. CONCLUSION: The present series suggests that the position and completeness of the lower loop do influence symptom severity. Proper attention to detail whilst placing a stent should help reduce the incidence and severity of stent-related symptoms.

The issue of prophylactic antibiotics prior to flexible cystoscopy.

OBJECTIVE: The aim of this study was to determine whether single-dose parenteral antibacterial therapy significantly alters the rate of infection in patients undergoing flexible cystourethroscopy. PATIENTS AND METHODS: 162 patients were studied prospectively having either received parenteral antibacterial chemoprophylaxis prior to flexible cystourethroscopy or not. Pre- and postprocedure mid stream samples of urine (MSSU) were obtained to objectively evaluate the presence of infection. RESULTS: Gentamicin prophylaxis reduced the rate of post-cystoscopy-positive MSSUs from 21 to 5%. CONCLUSION: The surprisingly high rate of infection after flexible cystoscopy was significantly reduced by a single dose of gentamicin.

To stent or not to stent? That is still the question.

BACKGROUND AND PURPOSE: Most patients are stented after ureteroscopy for stone extraction. This practice necessitates a second procedure to remove the stent, with its inherent morbidity. The aim of our study was to determine whether routine stenting of the ureter is really necessary after ureteroscopy. PATIENTS AND METHODS: This prospective study evaluated 26 men and 18 women admitted for elective distal ureteral stone fragmentation. The stones ranged in size from 6 mm to 1 cm. Of the series, 16 patients (10 men) had been stented prior to ureteroscopy. A 9F semirigid ureteroscope was used in 31 cases, and a 7.5F semirigid ureteroscope was used in the other 11 cases; there was no need for ureteral orifice dilatation with either ureteroscope. Ballistic intracorporeal lithotripsy was performed in all cases with the Swiss Lithoclast; all stone fragments were retrieved with a 3F helical basket. The patients were followed up as inpatients for 24 hours and reviewed in the clinic 1 week later with a request to report if they felt significant discomfort or loin pain or became feverish. RESULTS: Only one patient (male) had to be readmitted with loin pain. Two others (both women) complained when they attended for follow-up of having had dull lower abdominal pain and some frequency. CONCLUSIONS: The low incidence of complications in this preliminary study suggests that routine stenting is not necessary after ureteroscopy. The chief exception to this statement is patients who had a difficult and prolonged stone fragmentation.