Bilateral Spermatic Vein Thrombosis Following COVID-19 Infection

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An Unusual Case of Stercoral Perforation in a Patient with 86 cm of Small Bowel

A 77-year-old male who previously had extensive enterectomy due to ischaemic gut with loss of all but 86 cm of jejunum in addition to a right hemicolectomy presented to the emergency department (ED) with abdominal pain and constipation of 12-day duration. Abdominal imaging with X-ray and CT revealed pneumoperitoneum in addition to a grossly redundant and faecally loaded colon. At laparotomy, rectal perforation was found. In view of the patient’s advanced age, comorbidities, and the absence of intraperitoneal faecal contamination, manual disimpaction followed by wedge resection and primary closure of the perforation was done. On postop day 11, a perforation in the sigmoid colon with free subdiaphragmatic gas was picked up on CT after a work up for abdominal tenderness. In the absence of peritonism and other signs of deterioration, conservative management was chosen with subsequent uneventful recovery for the patient

Outcomes of robotic modified Freyer's prostatectomy in an Australian patient cohort

Abstract Introduction The study aims to demonstrate the feasibility, safety and efficacy of robotic simple prostatectomy (RSP) using the modified Freyer's approach in an Australian patient cohort. Although RSP is performed in several Australian centres, there is a paucity of published Australian data. Methods We reviewed prospectively collected perioperative and outcomes data for patients who underwent a robotic modified Freyer's prostatectomy (RMFP) from June 2019 to March 2022. Statistics were completed using SPSS statistics v27.0 and reported as mean and range with a p value of <0.05 considered statistically significant. Results There were 27 patients who underwent RMFP over the study period with a mean age of 67 years and prostate volume of 159.74 cc (100–275). The mean console time was 168 min (122–211), blood loss of 233 ml (50–600) and average length of hospital stay of 3.8 days (3–8). The preoperative versus postoperative outcome means were as follows: serum prostate‐specific antigen was 9.69 versus 1.2 ng/mL, IPPS score was 17.1 versus 1.25, quality of life (QOL) score 3.4 versus 0.4, postvoid residual volume: 223.6 versus 55.9 ml, Q‐max 7.86 versus 29.6 ml/s. These were all statistically significant (p < 0.001). The mean weight of resected tissue was 74 g (43–206) with 25 patients having benign histopathology and two being diagnosed with prostate cancer (Gleason 3 + 3 = 6 and 3 + 4 = 7). No patients returned to theatre or required a blood transfusion. Conclusions Data from our patient cohort demonstrate the feasibility, safety and efficacy of RMFP for benign prostatic hyperplasia in an Australian patient cohort. Our outcomes compare favourably with published studies on RSP

Necrotising myofasciitis as the initial presentation of a vesico-urethral anastomotic leak after radical prostatectomy

Necrotising soft tissue infections present as acute or sub-acute necrotising variants of cellulitis, fasciitis or myositis. Fulminant tissue destruction and systemic toxicity with a mortality rate of 14–59% is common. Risk factors for NF include diabetes, recent surgery, peripheral vascular disease, alcohol abuse and immunosuppression. Learning points are as follows: (1) In at-risk patients, VUAL can lead to necrotising myofasciitis, therefore, a low threshold for diagnosing NF is recommended. (2) In patients with multiple co-morbidities, a more conservative approach in the management of any VUAL, including urine cultures at IDC removal should be considered. (3) Dorsal venous complex haemorrhage can present significant intra-operative challenges during RRP

Comparison of cost of care for tethered versus non-tethered ureteric stents in the management of uncomplicated upper urinary tract stones

Background: Many surgeons use a stent after ureteroscopic lithotripsy (URSL). For short-term stenting purposes, a surgeon has the choice of either a tethered or a non-tethered stent. Stents may be associated with complications that entail an additional cost to their use. There is a paucity of data on the direct healthcare cost of using stent type after either primary or secondary URSL. Methods: We retrospectively reviewed medical records for patients who underwent URSL for uncomplicated urolithiasis between January 2013 and December 2013 at two tertiary referral hospitals. Costs data was sourced from the costing department with complete data available for 134 patients. The overall medical care cost was estimated by computing the cost of surgery, stent-related emergency department presentations, re-admissions and stent removal. Results: A total of 113 patients had tethered stents and 21 had non-tethered stents, with similar age and gender composition between the two groups and complications rates. The mean cost of URSL and stent placement was A$3071.7 ± A$906.8 versus A$3423.8 ± A$808.4 (P=0.049), mean cost of managing complications was A$309.4 ± A$1744.8 versus A$31.3 ± A$98.9 (P=0.096), mean cost of out-patient clinic stent removal was A$222.5 ± A$60 versus A$1013.6 ± A$75.4 (P<0.001) for endoscopic stent removal, overall mean cost of care was A$3603.6 ± A$1896.7 versus A$4468.1 ± A$820.8 (P=0.042) for tethered and non-tethered stents, respectively. Conclusion: It is cheaper to use a tethered ureteric stent compared with non-tethered stents for short-term stenting after uncomplicated URSL, with a mean cost saving of A$864.5