Grade V Renal Injury – Short and Long Term Outcome

Introduction: Over the last few decades, non- operative management (NOM) has become increasingly popular, especially for low-grade (I-III) blunt renal injuries.The published evidence is unclear about the&nbsp; role of NOM for higher grades (IV and V). We took up this study to report our short and long-term outcomes following initial nonoperative management in patients sustaining a grade 5 renal injury secondary to blunt trauma.Materials and Methods: The charts of all patients who presented to our institution with blunt renal trauma between Jan 2000 and Dec 2014 and had grade V renal injury were identifed and analyzed.Results: 114 patients were identified, with grade V renal injury following blunt trauma (BRI). 9/114 patients (7.89%) died following resuscitation in the casualty and emergency services, 4 (3.50%) of whom had&nbsp; deaths that were related to the kidney injury. 36 (34.28%) underwent early surgical exploration (13 – 42 hours) for various indications and nephrectomy was performed in 21 (58.33%). Eight patients who were&nbsp; on non-operative management needed delayed surgical exploration of which two patients (25%)&nbsp; presenting with massive secondary bleeding needed nephrectomy for control of the bleeding.Conclusions: 41.9% of patients with grade V renal injury needed surgical exploration of which 34.28%&nbsp; underwent early, whereas 7.61% underwent delayed exploration. 58.33% of patients undergoing early exploration and 25% of patients undergoing delayed exploration ended up with nephrectomy. Non operative management would be safe in the majority of patients with grade V renal injuries secondary to blunt trauma.</p

Long Term Outcome of Patients with Penile Fracture Undergoing Delayed Repair

Introduction: Fracture of the penis is a rare urological emergency which occurs as a result of abrupt trauma to an erect penis. Immediate surgical repair is the standard of care and is superior to nonoperative management due to excellent long term outcomes. A large percentage of the patients present late for treatment out of fear or embarrassment. We report our series of patients who presented&nbsp;&nbsp; late and underwent delayed repair. We also report the long term outcome in these patients.Materials &amp; Methods: The data was retrospectively collected from hospital records, which included: detailed history, symptoms, type of relationship, mechanism of trauma, sexual position, clinical fi ndings at physical examination, imaging results, presence of urethral injury, outcomes, and long-term complications regarding sexual and voiding functions.Results: Twenty two patients presented to our hospital casualty/emergency services following penile fracture and underwent delayed surgical repair. Heterosexual inter- course was the most common cause&nbsp; of fracture (18 patients, 81.81%). The mean time duration between injury and presentation was 48.77±33.56 hours. The mean time duration between presentation and surgical intervention was&nbsp; 4.31±1.37 hours. MRI was done in 6 cases with positive predictive value of 100%. Seventeen (77.27%)&nbsp; patients experienced erections during the post-operative period in the hospital. At the end of 1 year&nbsp; follow-up all the 22 patients had been having sexual intercourse. Conclusions: Our data suggests that, patients with penile fractures undergoing delayed repair have preservation of erectile potency and overall&nbsp; sexual function is maintained.</p

Primary ureterocalicostomy in children

Introduction: Ureterocalicostomy involves excision of the hydronephrotic lower renal pole parenchyma and anastomosis of the dismembered ureter directly to the lower pole calyx. Ureterocalicostomy offers distinct advantages over conventional Anderson–Hynes pyeloplasty for the primary surgical management of pelvi-ureteric junction obstruction, notably for obstruction secondary to complicating anatomical anomalies of the kidney, such as horseshoe kidney. The present study was aimed to evaluate the outcome of primary laparoscopic ureterocalicostomy as a primary procedure in children. Materials and Methods: The technique of ureterocalicostomy employed was similar in all children and comprised disconnection of the ureter from the renal pelvis and identification of the most dependent portion of the lower pole calyx by instrumentation within the collecting system. Results: Eight children (five males and three females) underwent primary ureterocalicostomy during the study period. The mean age of the children was 11.37 ± 3.67 years. Five of the eight children underwent laparoscopic ureterocalicostomy, whereas in three, it was necessary to convert to open as the dissection was difficult. The mean operating time was 134 ± 12 min, and the mean blood loss was 48 ± 7.48 cc. Conclusions: Our study shows that primary laparoscopic ureterocalicostomy for ureteropelvic junction obstruction is feasible, safe, and associated with minimal morbidity

Overdiagnosis of COPD in subjects with unobstructed spirometry

Background: There are several reports on the underdiagnosis of COPD, while little is known about COPD overdiagnosis and overtreatment. We describe the overdiagnosis and the prevalence of spirometrically defined false-positive COPD, as well as their relationship with overtreatment across 23 population samples in 20 countries participating in the BOLD Study between 2003 and 2012. Methods: A false-positive diagnosis of COPD was considered when participants reported a doctor's diagnosis of COPD, but postbronchodilator spirometry was unobstructed (FEV1/FVC > LLN). Additional analyses were performed using the fixed ratio criterion (FEV1/FVC < 0.7). Results: Among 16,177 participants, 919 (5.7%) reported a previous medical diagnosis of COPD. Postbronchodilator spirometry was unobstructed in 569 subjects (61.9%): false-positive COPD. A similar rate of overdiagnosis was seen when using the fixed ratio criterion (55.3%). In a subgroup analysis excluding participants who reported a diagnosis of "chronic bronchitis" or "emphysema" (n = 220), 37.7% had no airflow limitation. The site-specific prevalence of false-positive COPD varied greatly, from 1.9% in low- to middle-income countries to 4.9% in high-income countries. In multivariate analysis, overdiagnosis was more common among women, and was associated with higher education; former and current smoking; the presence of wheeze, cough, and phlegm; and concomitant medical diagnosis of asthma or heart disease. Among the subjects with false-positive COPD, 45.7% reported current use of respiratory medication. Excluding patients with reported asthma, 34.4% of those with normal spirometry still used a respiratory medication. Conclusions: False-positive COPD is frequent. This might expose nonobstructed subjects to possible adverse effects of respiratory medication.info:eu-repo/semantics/publishedVersio