The use of tamsulosin to prevent postoperative urinary retention in laparoscopic inguinal hernia repair: a randomized double-blind placebo-controlled study.

PURPOSE: The rate of postoperative urinary retention (POUR) in laparoscopic inguinal hernia repairs is 1-22%. POUR may cause patient anxiety, discomfort, and increased hospital costs. Currently there is no standard prophylaxis for POUR. Preoperative administration of tamsulosin has been shown to decrease POUR rates in urologic studies. This study aims to evaluate the efficacy of tamsulosin on the incidence of POUR in patients undergoing totally extraperitoneal (TEP) LIHR. METHODS: A randomized, double-blinded, placebo-controlled trial was initiated and accrued patients from 2017 to 2019. A total of 169 males undergoing elective TEP LIHR were included. Patients were administered tamsulosin 2 h before surgery and followed for up to 24 h postoperatively for episodes of POUR. Analysis was performed to quantify the association between patient, surgical, and perioperative factors with POUR. RESULTS: The overall rate of POUR was 9%. There was no difference in the rate of POUR between the placebo (9.9%) and tamsulosin groups (7.9%) (p = 0.433). Univariate analysis showed a trend toward POUR in patients with history of benign prostatic hypertrophy (BPH) (p = 0.058). Previously reported risk factors of older age, total IVF, length of procedure and opioid use were not associated with increased rates of POUR. Tamsulosin reduced the time to discharge by 4 to 68 min when compared to placebo. CONCLUSIONS: This study suggests that preoperative administration of tamsulosin may not reduce the risk of POUR in males undergoing elective TEP LIHR. Further study with a larger sample size may be needed to show a statistically significant difference.

Bouveret syndrome: A series of cases that illustrates a rare complication of chronic cholelithiasis.

Bouveret syndrome is defined as gastric outlet obstruction secondary to the impaction of a large gallstone in the proximal gastrointestinal tract. The obstruction occurs as result of a bilio-enteric or bilio-gastric fistula. This clinical entity is a rare variant of the more commonly recognized gallstone ileus, which tends to cause small bowel obstruction of the terminal ileum. The typical presentation of Bouveret syndrome consists of nausea, vomiting and abdominal pain secondary to obstruction. Diagnosis often requires radiographic imaging with computed tomography, which typically shows pneumobilia or a cholecystoduodenal fistula. Herein is a series consisting of three cases of Bouveret syndrome involving a bilioenteric, cholecystoduodenal, and choledochoduodenal fistula, respectfully, all of which required operative management. A discussion of the current literature regarding management of this rare syndrome follows.

Type A Aortic Dissection Complicated by Pheochromocytoma.

This report presents a case of aortic dissection as the patient's initial presentation of an undiagnosed pheochromocytoma. A 36-year-old man presented with substernal chest pressure and abdominal pain. Computed tomography revealed type A aortic dissection with a 3.6-cm left adrenal mass. Elevated catecholamine levels were diagnostic of pheochromocytoma. Type A aortic dissection caused by uncontrolled hypertension secondary to pheochromocytoma is a rare entity. This can complicate surgical planning. Although this situation is rare, it is important to consider pheochromocytoma in the differential diagnosis of uncontrolled hypertension in the setting of type A aortic dissection.