A rare case of hyperchloraemic normal anion gap metabolic acidosis due to absorption of normal saline irrigation fluid during holmium laser enucleation of prostate.

Holmium laser enucleation of the prostate (HoLEP) is the preferred technique for surgical management of benign prostatic hyperplasia in prostates over 80 cc in size. A 72-year-old male underwent a HoLEP for catheter-dependent urinary retention in the context of a 204 cc prostate. At the end of the procedure he was clinically overloaded and had developed a combined respiratory and hyperchloremic normal anion gap metabolic acidosis secondary to excessive absorption of normal saline irrigation fluid.

Reducing last-minute cancellations of elective urological surgery-effectiveness of specialist nurse preoperative assessment.

Last-minute cancellations in urological surgery are a global issue, resulting in the wastage of resources and delays to patient care. In addition to non-cessation of anticoagulants and inadequately treated medical comorbidities, untreated urinary tract infections are a significant cause of last-minute cancellations. This study aimed to ascertain whether the introduction of a specialist nurse clinic resulted in a reduction of last-minute cancellations of elective urological surgery as part of our elective recovery plan following the Coronavirus disease 2019, the contagious disease caused by severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2 pandemic.

Stone Formation Due to Migration of Hemostatic Clip After Robot-Assisted Laparoscopic Radical Prostatectomy: A Late and Rare Presentation.

A very rare complication of robot-assisted laparoscopic radical prostatectomy (RALP) is bladder stone formation from a hemostatic clip as a nidus. A 70-year-old man presented 11 years after a RALP with recurrent UTI, worsening lower urinary tract symptoms, and visible haematuria. A flexible cystoscopy revealed a large 3.

Interventions to improve tolerability of local anesthetic intradetrusor Botulinum toxin injections: A systematic review.

Introduction: Intradetrusor BotulinumtoxinA (BTA) injections are recommended for patients with overactive bladder (OAB) refractory to lifestyle changes and medical intervention. It is preferable to perform injections using a flexible cystoscope under local anesthetic (LA) rather than under spinal or general anesthetic owing to the associated anesthetic risks, increased costs, and need for repeated inpatient admission. Injections under LA can be difficult to tolerate for some patients.

Prostate cancer metastasis mimicking a primary urothelial carcinoma of the bladder.

We report on a 79-year-old male patient who presented with asymptomatic elevation of prostate-specific antigen and a concurrent papillary lesion, which raised the suspicion of synchronous bladder and prostatic malignancies. He underwent a trans-perineal prostate biopsy as well as transurethral resection of bladder tumour, which revealed a Gleason 9 adenocarcinoma of prostatic origin. While synchronous bladder and prostate cancer is a possibility, differential diagnosis in a patient presenting with lesions of the bladder neck should include advanced prostate cancer.

Retained Urethral Catheter in the Ureter Following Misplaced Insertion in a Postpartum Female.

Urethral catheterization is a common procedure, with a low complication rate. Aberrant catheterization into a ureter is a rare complication. We present a case of an aberrant urethral catheterization into the right ureter in a postpartum female.

Assessing the Learning Curve of Holmium Laser Enucleation of Prostate (HoLEP). A Systematic Review.

We systematically assessed the learning curve of Holmium laser enucleation of the prostate using the available literature to identify, as our primary outcome, the average number of cases required to reach competency. A computerized search of PubMed and Scopus for articles published from inception through to January 2018 was performed including 24 studies with a total of 5173 patients. Even though different outcome measures require varying case-loads to reach a plateau, Holmium laser enucleation of prostate has an acceptable learning curve with a proposed figure approximating 25-50 cases, with a structured mentorship programme aiding for faster progress.

Keratinising squamous cell metaplasia: when is it safe to stop looking?

Keratinising squamous cell metaplasia (KSCM) is an uncommon diagnosis in the West. Patients typically present with lower urinary tract symptoms: haematuria (visible and non-visible), dysuria, urgency and frequency. Investigation is rigid cystoscopy.

Malignant ureteric obstruction decompression: how much gain for how much pain? A narrative review.

Over the last thirty years, the management of Malignant Ureteric Obstruction (MUO) has evolved from a single disciplinary decision to a multi-disciplinary approach. Careful consideration must be given to the risks and benefits of decompression of hydronephrosis for an individual patient. There is a lack of consensus of opinion as well as strong evidence to support the decision process.

Analgesia for patients undergoing shockwave lithotripsy for urinary stones - a systematic review and meta-analysis.

Background: Shock wave lithotripsy (SWL) is the first line treatment modality for a significant proportion of patients with upper urinary tracts stones. Simple analgesics, opioids and non-steroidal anti-inflammatory drugs (NSAIDs) are all suitable agents but the relative efficacy and tolerability of these agents is uncertain.

Objectives: To determine the efficacy of the different types of analgesics used for the control of pain during SWL for urinary stones.

A late presentation of isolated lymph node tuberculosis postintravesical BCG therapy for superficial bladder cancer: a novel case.

Intravesical BCG immunotherapy is commonly used in the treatment of superficial bladder cancer. We recount the case of an 82-year-old British man who completed a course of BCG immunotherapy in 2011 for superficial bladder cancer, and presented in January 2013 with a loss of appetite, loss of weight and severe back pain. CT scanning, followed by MRI displayed a 5.

Omental Torsion: An Unusual Cause of Right Iliac Fossa Pain and Role of Laparoscopic Management.

Omental torsion is a rare cause of acute abdomen. It usually presents with acute onset right-sided abdominal pain. Adult male between 40 and 50 years of age and obesity are the most common risk factor amongst others.

A new mechanism for bile acid diarrhea: defective feedback inhibition of bile acid biosynthesis.

Background & Aims: Primary (idiopathic) bile acid malabsorption (BAM) is a common, yet underrecognized, chronic diarrheal syndrome. Diagnosis is difficult without selenium homocholic acid taurine (SeHCAT) testing. The diarrhea results from excess colonic bile acids, but the pathogenesis is unclear.

Exploring possible mechanisms for primary bile acid malabsorption: evidence for different regulation of ileal bile acid transporter transcripts in chronic diarrhoea.

Objectives: Chronic diarrhoea resulting from primary idiopathic bile acid malabsorption (IBAM) is common, but its aetiology is largely unknown. We investigated possible mechanisms, first looking for common sequence variations in the cytoplasmic ileal bile acid-binding protein (IBABP, gene symbol FABP6), and secondly, determining the expression of ileal mucosal transcripts for the apical sodium-linked bile acid transporter (ASBT), IBABP, the putative basolateral transporters, OSTalpha and OSTbeta, and regulatory factors.

Methods: Genomic DNA was prepared from two cohorts of patients and two control groups; the promoter and exonic regions of FABP6 were sequenced.