You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology II (MP43)1 May 2024MP43-02 AN INTEGRATED GUIDEWIRE URETHRAL CATHETERISATION DEVICE (UCD®) FOR DIFFICULT URETHRAL CATHETERISATION IN THE EMERGENCY DEPARTMENT Alexander Combes, George McClintock, Nicola Jeffery, Dinh Michael, Smith Hanratty Brendan, Boothroyd Christopher, and Saartje Berendsen Russell Alexander CombesAlexander Combes , George McClintockGeorge McClintock , Nicola JefferyNicola Jeffery , Dinh MichaelDinh Michael , Smith Hanratty BrendanSmith Hanratty Brendan , Boothroyd ChristopherBoothroyd Christopher , and Saartje Berendsen RussellSaartje Berendsen Russell View All Author Informationhttps://doi.org/10.1097/01.JU.0001008720.96896.83.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethral Catheterisation (UC) is performed in approximately 25% of hospitalised patients. Catheter Associated Urethral Injury (CAUI) occurs in 13.4 per 1000 male UCs, leading to patient morbidity and incurring large financial costs. This study assessed the use and cost-effectiveness of an integrated guidewire urethral catheterisation device (UCD®, Urethrotech Ltd) in male patients with Difficult Urethral Catheterisation (DUC) in the Emergency Department (ED). METHODS: A prospective, multicenter study of adult male patients who failed first line UC was conducted in ED at a tertiary referral hospital and a regional hospital (1 hr from on-site urology service). A DUC protocol was implemented and ED nurses and doctors were trained in use of the UCD® (Figure 1). The UCD® is a TGA approved device that makes the Seldinger technique for DUC accessible to non-urologist frontline workers. RESULTS: UCD® was required in 20 patients with DUC and was successful in 13 patients (65%). Of the 7 remaining patients (35%), 2 required a flexible cystoscopy, identifying urethral strictures and 1 underwent emergency suprapubic catheter insertion prior to UC by Urology (Figure 2). Immediate costs required for urgent UC by urology was approximately $2500 per patient, including cost of inter-hospital transfer ($800 - $1300) and urology call-back ($540). The UCD® avoided urology call-back in 4 patients and avoided inter-hospital transfer in 4 patients. CONCLUSIONS: The UCD® is an effective technique for DUC and can reduce the complications and costs of CAUI. It fills a particular niche in Australian regional hospitals without on-site urology, to prevent patient care delays and costs associated with inter-hospital transfer. Download PPTDownload PPT Source of Funding: Nil © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e692 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Alexander Combes More articles by this author George McClintock More articles by this author Nicola Jeffery More articles by this author Dinh Michael More articles by this author Smith Hanratty Brendan More articles by this author Boothroyd Christopher More articles by this author Saartje Berendsen Russell More articles by this author Expand All Advertisement PDF downloadLoading ...

When localised prostate cancer recurs after treatment, it occurs predictably in sites such as the prostatic bed, pelvic lymph nodes, spine, lung, and liver. Urethral metastasis of prostate cancer is exceedingly rare. We report a case of urethral recurrence of prostate cancer presenting as new lower urinary tract symptoms in an 82-year-old male 10 years after robotic radical prostatectomy with a very low PSA level of 0.05μg/L. This rare case highlights the need to maintain a degree of suspicion for prostate cancer recurrence in patients with a late onset of or changing lower urinary tract symptoms after radical prostatectomy.

BACKGROUND:Surgical bootcamps provide hands-on learning opportunities for junior doctors and trainees in low-pressure, non-clinical environments. Participants develop skills, knowledge, and confidence in preparation for their registrar years. A number of international urology-specific bootcamps have demonstrated improvements in these technical and non-technical domains. However, there was no such opportunity for Australian doctors. In the first urology bootcamp in Australia, we aimed to assess participants' knowledge, technical skills, and confidence in managing urological conditions pre- and post-bootcamp. METHODS:Twenty-five early-career medical officers attended the bootcamp and completed a comprehensive written survey at the beginning and end of the bootcamp. RESULTS:Results showed that self-perceptions of knowledge, confidence, and technical skill all improved at the conclusion of the bootcamp (P = 0.01). All participants reported the bootcamp to be 'useful' or 'very useful' in furthering their urological training. CONCLUSION:This study demonstrates the success of an inaugural Australian urology bootcamp in preparing junior doctors and unaccredited registrars for their registrar training years.

Objective: The treatment of large intra renal stones with concomitant ureteropelvic junction obstruction (UPJO) can be managed with concurrent procedures. Endoscopic assisted robotic pyelolithotomy and pyeloplasty has been demonstrated to be safe and effective yet the use of a ureteric access sheath in such cases is not well documented. This article emphasises the use and advantages of a ureteric access sheath (UAS) to improve the control, decrease infection rates and minimise intrarenal pressures during endoscopic management in robotic pyelolithotomy and pyeloplasty. Patients and Surgical Procedure: A 46-year-old female with a left ureteropelvic junction obstruction (UPJO) underwent an endoscopic assisted robotic pyelolithotomy and pyeloplasty for management of her UPJO and removal of stones. The renal pelvis was identified, incised, and a ureteric access sheath (UAS) was inserted through a robotic port into the renal pelvis and controlled using a robotic arm. Flexible pyeloscopy and subsequent basket removal of the stones was performed minimising any potential spillage of irrigation fluid into the abdominal cavity. The pyelotomy was closed using an Anderson-Hynes dismembered pyeloplasty. Results: The operative time was 150 min and blood loss <50 ml. The patient was discharged on post-operative day 2 without any complications and a stable serum creatinine. Conclusion: Endoscopic assisted robotic pyelolithotomy and pyeloplasty with a UAS is a safe and effective procedure for managing a concurrent UPJO and intra renal stones. This technique gives the surgeon maximal control of UAS positioning and location and may also decrease intrarenal pressures and reduce the risk of infection.

IntroductionRenal angiomyolipomas (AMLs) are vascular tumours that while histologically benign, carry a risk of rupture and potentially life-threatening haemorrhage. Selective arterial embolisation (SAE) has been demonstrated as effective treatment; however, given most tumours are asymptomatic, the challenge facing the radiologist is selection of which AML should undergo treatment. This study considers presence and size of intratumoural aneurysm, to advance the readers treatment decision-making beyond historical size criteria. MethodsRetrospective cohort analysis of all SAE-treated AML at a quaternary-level institution in the last 10 years was completed independently by two radiologists. Computerised tomography (CT) and angiographic imaging were reviewed to evaluate tumour size, presence of intratumoural aneurysm and aneurysm size. Univariant and multivariant statistical analyses were used to identify predictors of spontaneous rupture and haemorrhage. ResultsTwenty-seven renal AML underwent SAE. Five tumours had presented with haemorrhage. Twenty-two were asymptomatic or without CT/angiographic detectable haemorrhage. There was no statistically significant size difference between ruptured (mean 7.8 cm, range 6.1-12.0 cm) and unruptured AML (7.5 cm, 3.3-21.7 cm) in the study population. Eighty percent of ruptured AML and 27% of unruptured AML contained at least one intratumoural aneurysm (P-value < 0.05). Mean aneurysm size in ruptured AMLs was 5.4 mm, versus 4.6 mm among unruptured AML (P-value > 0.05). ConclusionThe presence of intratumoural aneurysm is a useful predictor for AMLs that are at risk of spontaneous rupture and haemorrhage. Intratumoural aneurysm should therefore be considered when selecting patients to undergo SAE.

Objective: The objective was to determine whether giant renal angiomyolipomas (AMLs) can be managed through selective angioembolisation (SA) and compare outcomes to nephron-sparing surgery (NSS) and nephrectomy. Methods: A retrospective case series was compiled from a prospectively maintained database, commenced in 2011 of renal AMLs that underwent SA. We extracted patient demographics, size of AMLs, intervention and outcomes. A literature review of case reports and case series was performed on the management of giant renal AMLs managed through SA, NSS or nephrectomy. Results: Of 30 AMLs that underwent SA, 6 patients met the inclusion criteria. The mean diameter of AMLs prior to embolisation was 14.3 cm. All embolised AMLs decreased in size post-embolisation by an average of 18% (mean: 39-month follow-up). There were no complications in our cohort’s follow-up period, including no rise in any patients’ creatinine associated with SA. Our literature review of 284 articles found 82 articles pertaining to 102 giant renal AMLs. Our review identified SA, NSS and nephrectomy to all be effective management pathways for giant AMLs with minimal complications. Total nephrectomy did result in five patients requiring dialysis post-procedure. Conclusions: SA is an effective intervention for giant AMLs with comparable outcomes to NSS and nephrectomy and should be considered a suitable management option for giant renal AMLs. Level of evidence: Not applicable

IntroductionDemand for donor kidneys far exceeds the availability of organs from deceased donors. Living donor kidneys are an important part of addressing this shortfall, and laparoscopic nephrectomy is an important strategy to reduce donor morbidity and increase the acceptability of living donation. AimTo retrospectively review the intraoperative and postoperative safety, technique, and outcomes of patients undergoing donor nephrectomy at a single tertiary hospital in Sydney, Australia. MethodRetrospective capture and analysis of clinical, demographic, and operative data for all living donor nephrectomies performed between 2007 and 2022 at a single University Hospital in Sydney, Australia. ResultsFour hundred and seventy-two donor nephrectomies were performed: 471 were laparoscopic, two of which were converted from laparoscopic to open and hand-assisted nephrectomy, respectively, and one (.2%) underwent primary open nephrectomy. The mean warm ischemia time was 2.8 min (+/- 1.3 SD, median 3 min, range 2-8 min) and the mean length of stay (LOS) was 4.1 days (+/- 1.0 SD). The mean renal function on discharge was 103 mu mol/L (+/- 23.0 SD). Seventy-seven (16%) patients had a complication with no Clavien Dindo IV or V complications seen. Outcomes demonstrated no impact of donor age, gender, kidney side, relationship to the recipient, vascular complexity; or surgeon experience, on complication rate or LOS. ConclusionLaparoscopic donor nephrectomy is a safe and effective procedure with minimal morbidity and no mortality in this series.

Purpose Renal angiomyolipoma (AML) is the most common benign renal tumor. Whilst generally asymptomatic, they can cause life-threatening bleeding. Selective angioembolization (SAE) may be used to treat large symptomatic and asymptomatic AMLs. We aimed to evaluate the efficacy of SAE for symptomatic and asymptomatic renal AMLs and determine characteristics that predict spontaneous bleeding. Patients and Methods Data were retrospectively collected from a prospectively maintained database from July 2011 to April 2022. Patients were included if AML was >4cm and they underwent subsequent SAE. Follow-up imaging was analyzed to calculate mean reduction in AML size. Clinical notes were reviewed to analyze lesion characteristics including vascularity, fat content and presence of aneurysm as well as post-procedural complications. Results 26 patients with 30 AMLs were identified. Interval of follow-up imaging ranged from 1 to 60 months. 25 AMLs were embolized electively with 5 emergency embolizations performed for bleeding. Mean reduction in AML volume was 41% at 3 months (p=0.013) and 63% at 12 months (p=0.007). All 5 bleeding AMLs had a rich vascularity with 60% also having either aneurysms or a low fat content. Complications included post-embolic syndrome (n=9), segmental renal parenchyma devascularization (n=3), acute bleeding requiring re-embolization (n=2), nephrectomy for ongoing bleeding (n=1) and delayed bleeding managed conservatively (n=1). No deterioration in renal function was observed. Conclusion SAE is an effective procedure for managing symptomatic and asymptomatic renal AML, with minimal significant complications. AML vascularity, fat content and aneurysms may be useful characteristics to assess future risk of bleeding in patients with renal AML.

Basal cell carcinoma (BCC) is rare on non-sun exposed skin such as the scrotum and thus diagnosis is often delayed. This case highlights an approach to scrotal skin lesions, risk factors and diagnostic features of BCC. Importantly, scrotal BCCs are more likely to metastasise than non-scrotal BCCs. Management should consist of wide local excision and recommended follow up with thorough clinical history, skin examination and imaging in high-risk patients.

Prostate cancer is the most common cancer and the second leading cause of cancer death in men. The imaging assessment and treatment of prostate cancer has vastly improved over the past decade. The introduction of PSMA PET-CT has improved the detection of loco-regional and metastatic disease. PSMA PET-CT also has a role in the primary diagnosis and staging, in detecting biochemical recurrence after curative treatment and in metastasis-directed therapy. In this paper we review the role of PSMA PET-CT in prostate cancer.

A 33-year-old male presented with a one-centimetre lesion at the penoscrotal junction which was excised and revealed to be an epithelioid sarcoma (ES). A wide local excision of the lesion and subsequent neoadjuvant radiotherapy followed, with transposition of the patient's testicles laterally to protect fertility. At 3-year followup, the patient has no local or distant recurrence but does have a low sperm count. The patient has also had intermittent haematospermia since his treatment for which a cause has yet to be identified. This case highlights that ES of the penis can be managed successfully with surgical excision and local radiotherapy.

A 64-year-old female of Filipino ethnicity presented to her local emergency department with a 1-week history of lower abdominal pain, localizing to her right iliac fossa. On examination, she was tender in her lower abdomen, maximally in her right iliac fossa. Her biochemical results were mostly unremarkable with a normal white cell count of 8.9 × 10 and only her C-reactive protein being elevated to 52. A computed tomography (CT) scan of her abdomen was performed showing circumferential caecal thickening suggestive of malignancy with local lymphatic invasion and potential peritoneal disease (Fig. 1). She had never undergone a colonoscopy and denied unintentional weight loss, anaemia or significant family history of colorectal malignancy. She subsequently underwent an uncomplicated open right hemicolectomy, recovering within 3 days. Histopathology showed intestinal schistosomiasis with many calcified schistosome eggs within the submucosa indicating chronic disease with no malignancy found (Fig. 2). She was managed with two doses of praziquantel 60 mg/kg, and discharged home later that week with follow-up in the infectious diseases clinic. Schistosomiasis is a disease caused by blood flukes (trematode worms) of the Schistosoma species. These parasites are found in freshwater snails and infection can occur with even a single exposure to contaminated water. Approximately 220 million people are infected with highest prevalence being in sub-Saharan Africa. There are five schistosome species that can cause infection in humans, with the three most common being Schistosoma mansoni, Schistosoma japonicum and Schistosoma haematobium. In this case, the patient’s background of growing up in rural Philippines was the most likely source of her exposure to the schistosomiasis parasite with the most likely species being S. japonicum. Most individuals with schistosomiasis are asymptomatic; however, acute infection is seen when the hosts immune system responds to migrating eggs. Acute infection can present in multiple areas of the body with acute intestinal schistosomiasis presenting with any or all of the following: fever, intermittent abdominal pain, diarrhoea, anorexia and melaena or haematochezia. In extreme cases, an inflammatory mass can occur causing obstruction or perforation. The gold standard for detection of intestinal schistosomiasis is the identification of schistosome eggs in a stool sample. Serological markers are somewhat useful with schistosome antigen serology, 6–12 weeks after the acute infection, often used for patients with low parasite burden in the acute phase or negative stool samples but with high suspicion of disease. Colonoscopy is another diagnostic option, which can show oedematous changes, yellowish schistosomal nodules similar to those found in pseudomembranous colitis or granulomatous polyps secondary to schistosomal eggs becoming embedded in the submucosa causing an inflammatory response.

ANZ Journal of SurgeryVolume 90, Issue 9 p. 1774-1776 IMAGES FOR SURGEONS Small bowel intussusception secondary to Meckel's diverticulum containing polypoid lesion in pregnancy Alexander D. Combes MBBS, Alexander D. Combes MBBS orcid.org/0000-0002-9893-886X Department of Surgery, St George, Shoalhaven and Sutherland Hospitals, Sydney, New South Wales, AustraliaSearch for more papers by this authorAlexandra M. Limmer MBBS (Hons), Alexandra M. Limmer MBBS (Hons) orcid.org/0000-0001-6653-4409 School of Medicine, Department of Surgery, Liverpool Hospital and Western Sydney University, Sydney, New South Wales, AustraliaSearch for more papers by this authorKurt Verschuer FRACS, Kurt Verschuer FRACS Department of Surgery, Shoalhaven District Memorial Hospital, Nowra, New South Wales, AustraliaSearch for more papers by this author Alexander D. Combes MBBS, Alexander D. Combes MBBS orcid.org/0000-0002-9893-886X Department of Surgery, St George, Shoalhaven and Sutherland Hospitals, Sydney, New South Wales, AustraliaSearch for more papers by this authorAlexandra M. Limmer MBBS (Hons), Alexandra M. Limmer MBBS (Hons) orcid.org/0000-0001-6653-4409 School of Medicine, Department of Surgery, Liverpool Hospital and Western Sydney University, Sydney, New South Wales, AustraliaSearch for more papers by this authorKurt Verschuer FRACS, Kurt Verschuer FRACS Department of Surgery, Shoalhaven District Memorial Hospital, Nowra, New South Wales, AustraliaSearch for more papers by this author First published: 12 December 2019 https://doi.org/10.1111/ans.15626Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume90, Issue9September 2020Pages 1774-1776 RelatedInformation