Testicular torsion induced by epididymo-orchitis: A case report

Introduction and importance: Acute scrotum is considered a urological emergency requiring early intervention depending on the cause. There are multiple causes of acute scrotum with testicular torsion being the most feared as delayed treatment leads to testicular loss. However, differentiating between epididymo-orchitis and torsion can be very difficult. Case presentation: We present a case of an 18-year old male patient with 2 separate episodes of acute scrotum. He had epididymo-orchitis as the first presentation followed by testicular torsion 5 days later. To our knowledge this is the first case of testicular torsion secondary to epididymo-orchitis. Clinical discussion: Differentiating between epididymo-orchitis and torsion is challenging but important due to risk of loss of testis with a wrong diagnosis. Once you establish epididymo-orchitis the suspicion for subsequent torsion should be high with close follow up and adequate counselling. Conclusion: He ultimately had orchiectomy, although a rare presentation, enlarged testis due to epididymo- orchitis can predispose an individual to developing testicular torsion thus adequate counselling on warning signs to patients with epididymo-orchitis is of particular importance so as to intervene early and ultimately save the testis

Inadvertent Stone Migration During Pneumatic Lithotripsy: Still a Conundrum in the 21st Century

Currently, an ideal gadget to stop retrograde stone migration remains a holy grail, and the hunt for such a device is still ongoing in the 21st century. The quest for an ideal instrument is driven by the need to reduce cost, minimize ancillary procedure rates, reduce the device\u27s operative time, and improve the stone-free rate. The purpose of the present review is to provide an update on the use of preventive measures that are used to stop retrograde stone migration during pneumatic lithotripsy for ureteric stone management. Currently, an ideal gadget to stop retrograde stone migration remains a holy grail, and the hunt for such a device is still ongoing in the 21st century. The quest for an ideal instrument is driven by the need to reduce cost, minimize ancillary procedure rates, reduce the device\u27s operative time, and improve the stone-free rate. The purpose of the present review is to provide an update on the use of preventive measures that are used to stop retrograde stone migration during pneumatic lithotripsy for ureteric stone management

Overview of Antiretropulsion Devices for Prevention of Inadvertent Stone Migration during Pneumatic Lithotripsy for Ureteric Stone

The purpose of the present chapter is to provide an update about the use of preventive devices used to stop retrograde stone migration during pneumatic lithotripsy for ureteric stone management. The aim to reduce the cost, ancillary procedure, reduce the operative time and improve the stone free rate. The hunt for ideal cadget to stop retrograde stone migration is still continue in 21 century

Validation of the Swahili version of the International Prostate Symptom Score at a private, nonprofit general hospital in Dar es Salaam, Tanzania

Background: Accuracy in translating the International Prostate Symptom Score (IPSS) into different languages is essential to ensure that it is comparable to the original version and acceptable to the target population. We aimed to develop and validate a Swahili version of the IPSS (sIPSS). Methods: We conducted a cross-sectional study involving 53 patients presenting with lower urinary tract symptoms to the Aga Khan Hospital in Dar es Salaam, Tanzania, from April through December 2018. We enrolled 53 patients with confirmed benign prostatic hypertrophy and 32 control patients with suspected or confirmed urolithiasis. We assessed the face validity and discriminative validity of the sIPSS using standard statistical constructs, including Cronbach’s alpha, intraclass correlation coefficients (ICC), the receiver operating characteristic curve, and Spearman’s rank correlation coefficient. Test–retest reliability was assessed by comparing baseline sIPSS scores with those obtained after 1 week for all participants, and sensitivity to change was assessed by comparing baseline scores to those at 4 to 6 weeks after treatment in the BPH group. Results: The sIPSS had excellent internal validity (Cronbach’s alpha, 0.86), comparable to that of the original IPSS. The test–retest reliability of the sIPSS was high (ICC, 0.84), and the mean improvement in sIPSS score 4 to 6 weeks after treatment was 9.7±6.4. Conclusions: For use in the Tanzanian population, the sIPSS is reliable, valid, and sensitive to change

Triggers of blood transfusion in percutaneous nephrolithotomy

Objective: To determine the triggers of blood transfusion in patients undergoing percutaneous nephrolithotomy (PCNL).Study Design: Observational study.Place and Duration of Study: The Aga Khan University Hospital, Karachi, from 1988 to 2007. Methodology: The percutaneous surgery database was retrospectively reviewed to identify patients with postoperative haemorrhage and need for blood transfusion. Blood loss was estimated by the postoperative drop in haemoglobin factored by the quantity of any blood transfusion. Various patients and procedure-related factors were assessed for association with total blood loss or blood transfusion requirement using stepwise univariate, forward multivariate regression analysis.Results: A total of 326 procedures were performed in 316 patients. Two hundred and thirty two procedures were included in the study. There were 167 males and 65 females. The mean age was 41+14 years. The mean haemoglobin drop was 1.68 +1.3 gm/dL. The overall blood transfusion rate was 14.2%. Stepwise multivariate regression analysis showed that female gender (p = 0.003), staghorn stone (p = 0.023), stone fragmentation with ultrasound (p = 0.054) and chronic renal failure (p = 0.001) were significantly predictive of the need for blood transfusion. Conclusion: Chronic renal failure, female gender, presence of staghorn calculi and stone fragmentation using ultrasonic device were predictive of blood transfusion in this cohort of patients

Negative Appendectomy Rate in Urban Referral Hospitals in Tanzania: A Cross-sectional Analysis of Associated Factors

Background: Acute appendicitis (AA) has a lifetime risk of 8.3% with a consequent 23% lifetime risk of emergency appendectomy. In atypical presentation, making a clinical diagnosis is difficult, leading to a high perforation rate (PR) or misdiagnoses and high negative appendectomy rates (NAR). This study aimed to establish NAR and explore the associated factors and possible attainable solutions to reduce it in urban referral hospitals in Tanzania. Methods: This was a crosssectional study with 91 consecutive patients, aged 10 years and older undergoing appendectomy for suspected AA with histological evaluation of specimens. The study was powered to detect the NAR at 95% confidence level and 80% power. Results: The histological NAR was 38.5% and the perforation rate was 25.3%. The Alvarado score (AS) was rarely applied (6%), despite a demonstrated ability in this study to decrease the NAR by half. Females were four times more likely to undergo negative appendectomy than males. Conclusion: The NAR is clinically significant as about two out of every five patients undergoing emergency appendectomy for suspected AA do not require the procedure. The AS is underutilized despite a demonstrated ability to decrease the NAR. We recommend that the AS be incorporated in the management of patients with suspected appendicitis

Postoperative myocardial injury in a patient with left ureteric stone and asymptomatic COVID-19 disease

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified on 8thDecember 2019 in Wuhan, Hubei, China, and has since spread globally to become an emergency of international concern. Patients infected with SARS-CoV-2 may be asymptomatic or present with symptoms ranging from mild clinical manifestations: such as fever, cough, and sore throat to moderate and severe form of the disease such as pneumonia and acute respiratory distress syndrome (ARDS). In some patients, SARS-CoV-2 can affect the heart and cause myocardial injury which is evidenced either by electrocardiographic (ECG) changes or by a rise in serum troponin level. Patients with myocardial involvement are generally at risk of developing severe illness and tend to have a poor outcome. We hereby present a case of a hypertensive male patient with undiagnosed, asymptomatic COVID-19, who underwent an emergency urologic procedure for ureteric calculi. He eventually sustained a postoperative myocardial injury resulting in his demise. This case highlights the importance of detailed preoperative assessment and anticipation of complications during this global pandemic

Lidocaine Jell Instillation During Ureteroscopic Stone Fragmentation Effectively Reduces Stone Migration

introduction: Inadvertent migration of stone during ureteroscopy is a relatively common problem. In this video we are describing a cost-effective technique for prevention of inadvertent stone pushback during ureteroscopy. The current study and our previous work1 studied the efficacy of Lidocaine jelly instillation proximal to the ureteral stone during intracorporeal lithotripsy using a semi rigid ureteroscope for the prevention of retrograde migration and improvement in stone-free rate. The video is on MPEG format and the run time is 10 min. Materials and Methods: The technique described involved Lidocaine jelly instillation proximal to the stone before fragmentation. The jell is instilled either by using an open end ureteral catheter bypassing the stone under Ureteroscopic guidance or by bypassing the stone with the ureteroscope and instilling jell via the working channel of the ureteroscope. The ureteroscopy was performed using an 8F, 7F, or 6.4F semi rigid ureteroscope. A 5F ureteral stent was advanced beyond the stone. Lidocaine jelly (2 mL) was instilled and lithotripsy was performed with a Swiss LithoClast™. Alternatively, fragmentation can also be performed using a holmium laser. After the procedure, either a 5F ureteral catheter was left in place for 24 h or an indwelling Double-J stent is left in place for 2–4 weeks. Patients were followed at 24 h with plain X-ray of the kidneys, ureters, and bladder, and at 2 weeks with noncontrast enhanced computerized tomography of the kidneys, ureters, and bladder. Results: Instillation of jell before laser or pneumatic fragmentation of ureteral stone is associated with significant reduction in inadvertent stone migration during ureteroscopy. Use of jell is not associated with any side effects. However, during fragmentation using pneumatic lithotripsy devise and laser, there is some masking of the devise built in fragmentation sound. In addition, there is some clouding that can affect vision. This deficiency can be effectively countered by liberal use of irrigation, as with jell in place the chances of migration even with liberal irrigation are insignificant. Conclusions: Lidocaine jelly instillation proximal to ureteral calculi during lithotripsy using either pneumatic device or laser is an effective method of preventing retrograde stone displacement as well as significantly improving the stone-free rate

Primary leiomyoma — A rare tumour of ureter

A case of huge primary leiomyoma of the ureter in which nephroureterectomy was performed is presented. To the best of our knowledge, this case is a unique form of leiomyoma of the ureter due to its large size. There have been only twelve cases of primary leiomyoma of the ureter reported since 1955 and eleven of them were very small and one was big in size but smaller than the present case. Our case is considered to be the thirteenth

EFFICACY OF LIDOCAINE JELLY IN PREVENTION OF PROXIMAL MIGRATION OF URETERIC CALCULI DURING INTRACORPOREAL LITHOTRIPSY

introduction & Objectives: To asses the efficaes of lidocaine jelly instillation proximal to the ureteral stone during intra corporeal lithotripsy using semi rigid ureteroscope in the prevention of retrograde migration and stone free rate. Material & Methods: From November 2006 to July 2007, 50 patients with 5-20 mm. Ureteral stones undergoing ureteroscopic removal using had Lidocaine jelly had Lidocaine jelly instilled proximal to stone before start of fragmentation and control group 2 (n=25). Ureteroscopy was performed using a 9.8 or 6.4 Fr semi rigid ureteroscope. A 5F ureteral stent was advanced beyond the stone. Lidocaine jelly (2 mL) was instilled, and lithotripsy was done with a Swiss Lithoclast™. A 5F ureteral catheter was left in place for 24 hours, and patients were followed up at 24 hours with imaging at 2 weeks with intravenous urography or non-contrast-enhanced CT. Results: The two groups were comparable with regard to age and stone size. Stone or stone fragment migration occurred in 4% of group 1 and 28% of the controls (group2), the difference was statistically significant (p _0.002). At 2 weeks followed up with IVU the stone-free rate was 966.0% and 72.0% in the treatment and control groups, respectively, and the difference between the two groups was statistically significant (p 0.045). Although the mean operative time was slightly longer in the treatment group (33.56 versus 35.84 minutes), the difference was not significant (p_ 0.450). Conclusions: Lidocaine jelly installation proximal to the ureteral calculi during lithotripsy is an effective method to prevent retrograde stone displacement, with significant improvement in stone-free rate as well