Laparoscopic appendectomy is one of the most common emergency surgeries. There is a paucity in the literature regarding the incidence and management of iatrogenic bladder injuries. We reviewed a ...series of iatrogenic bladder injuries during laparoscopic appendectomy to determine incidence, preventable risk factors and management.
We performed a retrospective review of laparoscopic appendectomy at two large regional teaching hospitals over a five-year period from February 2014 to February 2019. The outcomes measured included intra-operative data, such as type of port used and surgeon experience, incidence of iatrogenic bladder injury, mechanism and time of bladder injury recognition, management and clinical outcome.
A total of 1147 patients underwent laparoscopic appendectomy. Two iatrogenic bladder injuries secondary to port placement were identified (0.17%). Both procedures were performed after-hours by surgical trainees. There was no previous history of abdominal surgery. Neither patient had an indwelling catheter (IDC) during the procedure. There were no other visceral or major vascular injuries. Both bladder injuries were identified in the early post-operative period. One case was managed conservatively, whilst the other required laparoscopic repair of the bladder perforation.
Bladder injury should be suspected in patients with abdominal pain, elevated creatinine and anuria following laparoscopic surgery. Although iatrogenic bladder injury during laparoscopic appendectomy is rare, it has the potential for considerable patient morbidity. Therefore, adequate laparoscopic supervision and specific counselling on port access injuries for surgical trainees, adequate bladder decompression with an IDC, and early detection and management guided by the location of injury are essential.
Background: A number of assessment methods for the pelvic floor have been described. Male pelvic floor ultrasound is an accessible, noninvasive assessment tool. Objective: To evaluate current ...published literature on anatomical parameters on pre- and postoperative ultrasound imaging of the male pelvic floor and correlation with continence status following radical prostatectomy (RP). Methods: A comprehensive literature search was conducted using the PRISMA guidelines to identify publications up to November 2022. Exclusion criteria consisted of animal studies, non-English articles, case reports, reviews and abstracts or reports from conferences. A full-text review was performed on 12 papers using ultrasound to assess pelvic floor anatomy and correlation with continence status following RP. Results: A total of 18 anatomical parameters were evaluated using US. Membranous urethral length (MUL), striated urethral sphincter (SUS) morphology and activation were most commonly studied. Shorter pre- and postoperative MUL, decreased preoperative SUS thickness and vascularity, postoperative discontinuity of SUS muscle fibres and decreased SUS activation are associated with post-prostatectomy incontinence (PPI). There is a paucity of data comparing anatomical changes in men prior to and following RP. The benefits of transperineal ultrasound are that it is minimally invasive, accessible, provides dynamic imaging of all three striated muscle complexes simultaneously and includes a bony landmark to reference measures of pelvic floor muscle displacement. Conclusions: Ultrasound evaluation of the male pelvic floor is an evolving field as there is development in technology and understanding of pelvic floor anatomy. It is an accessible and dynamic imaging modality, which allows both morphological and functional assessment of pelvic floor anatomy and its role in PPI. MUL and SUS morphology and activation are associated with continence status following RP. Several other anatomical parameters that may predict PPI were identified. Current literature is limited by small, single-centre studies with heterogeneous cohorts and methodologies.
Personalized medicine requires accurate molecular profiling for targeted therapy decisions. Insufficient tissue yield or tumor heterogeneity frequently limits the correct tissue biomarker ...determination. As a noninvasive complement to traditional tissue biopsies, liquid biopsies detect and track cancer driver mutations from biofluids (e.g., blood, urine). Here we present the analytical validation of Target Selector™ ctDNA assays capable of single mutant DNA copy detection.
The Target Selector ctDNA assay applies a patented Switch-Blocker technology to suppress amplification of background (wild-type) WT alleles, while allowing specific amplification of very low frequency mutant alleles. In contrast to allele specific enrichment technologies like ddPCR, one Switch-Blocker inhibits amplification of a DNA target up to 15 bp in length (e.g., one Switch-Blocker covers all KRAS exon 2, codon 12 and 13 variants). Target enrichment is achieved through a quantitative PCR reaction; subsequent DNA sequencing confirms mutation identity. Analytical validation with cancer cell line DNA was conducted by three independent operators using five instruments across five days.
A total of 3086 samples were tested on EGFR, BRAF and KRAS Target Selector ctDNA assays, with EGFR WT as a reference. All assays showed >99% analytical sensitivity and specificity. Single mutant copy detection is confirmed by experimental data and theoretical estimates. In the presence of 14000 WT DNA copies, limits of detection were: EGFR Del19, 0.01%; EGFR L858R, 0.02%; EGFR T790M, 0.01%; BRAF V600E, 0.01%; KRAS G12C, 0.02%. Inter- and intra-assay analyses showed r2>0.94, suggesting consistent performance among operational variables. Healthy donor samples (100 tests) showed clinical specificity at >99%. Finally, Target Selector clinical experience data of >2200 patient samples is consistent with published tissue mutation prevalence.
Highly sensitive Target Selector ctDNA assays with single mutant copy detection and limit of detection at 0.02% or better enable accurate molecular profiling vital for disease management.
ObjectivesPost-prostatectomy incontinence (PPI) is a common condition, but the underlying mechanisms are not completely understood. Transperineal ultrasound (TPUS) assessment of voluntary pelvic ...floor muscle (PFM) function may be associated with PPI. This study investigates the relationship between PPI and pre- and postoperative displacement of anatomical landmarks related to PFM function.MethodsThis was a prospective longitudinal cohort study of 40 patients undergoing robotic-assisted radical prostatectomy (RARP) by a high-volume single surgeon. All patients underwent PFM training pre- and postoperatively. TPUS was used to obtain sagittal images of pelvic structures during maximal voluntary PFM contractions: (1) preoperatively, (2) 3 weeks postoperatively, and (3) 6 weeks postoperatively. TPUS images were analyzed to calculate displacement of anatomical landmarks associated with activation of striated urethral sphincter (SUS), bulbocavernosus muscle (BC), and puborectalis muscle (PR). Continence was assessed at 3 and 6 weeks postoperatively, defined as use of ≤ 1 pad/day. The relationship of continence to the displacement of SUS, BC, and PR was analyzed.ResultsSUS, BC, and PR displacement decreased significantly 3 weeks postoperatively (P = 0.042, P = 0.002, P < 0.001, respectively). Continent men exhibited significantly greater SUS displacement (median, 5.13 mm) than incontinent men (median, 3.90 mm) 3 weeks postoperatively (P = 0.029). Between 3 and 6 weeks following RARP, there was significant increase in SUS, BC, and PR displacement (P = 0.003, P = 0.030, P < 0.001, respectively).ConclusionsA significant decrease in PFM function occurs following RARP, with a subsequent recovery of postoperative PFM function between 3 and 6 weeks post-procedure in men who undergo PFM training. SUS activation was significantly greater in continent patients compared to incontinent patients at 3 weeks following RARP.
Background: The prevalence of neonatal abstinence syndrome is increasing, but the number and quality of clinical practice guidelines available are unknown. This systematic review aimed to identify, ...appraise and evaluate clinical practice guidelines for neonatal abstinence syndrome. Methods: A systematic search of databases and the grey literature was conducted between 1 June and 1 July 2022. Full-text guidelines published by national or state-wide institutions were included. The recommendations from each guideline were extracted. The AGREE-II instrument was used to assess guideline quality. Sufficient-quality scores were defined as >60 and good-quality scores were >80 for each domain of AGREE-II. Results: A total of 1703 records were identified, and 22 guidelines from the United States, Australia, Canada and the United Kingdom, published between 2012 to 2021, were included. The quality scores were low, with median scores of 37/100 for stakeholder involvement, 33/100 for methodology, 34/100 for applicability and 0 for editorial independence. Scope and purpose scored 72/100, and presentation scored 85/100. Sixteen (73%) guidelines did not meet the cut-offs for clinical use. Conclusion: Many guidelines were of insufficient quality to guide clinical practice for neonatal abstinence syndrome. This emphasises the need for high-quality studies to inform clinical practice guidelines, improve care and reduce the risk of poor outcomes in these high-risk infants.
Renal colic is a common emergency department (ED) presentation. Variations in assessment and management of suspected renal colic may have significant implications on patient and hospital outcomes. We ...developed a clinical practice guideline to standardize the assessment and management of renal colic in the ED. We subsequently compared outcomes before and after guideline implementation.
The guideline standardizes the analgesia regimen, urology consult criteria, imaging modality, patient education, and followup instructions. This is a single-center, observational cohort study of patients presenting to the ED with renal colic prospectively collected after guideline implementation (December 2018 to May 2019) compared to a control group retrospectively collected before guideline implementation (December 2017 to May 2018). A total of 528 patients (pre-guideline n=283, post-guideline n=245) were included. Statistical analysis was performed with SPSS using multivariate linear regression.
ED length of stay (LOS) was significantly shorter after guideline implementation (pre-guideline 295.82±178.8 minutes vs. post-guideline 253.2±118.2 minutes, p=0.017). The number of computed tomography (CT) scans patients received was significantly less after guideline implementation (pre guideline 1.35±1.34 vs. post-guideline 1.00±0.68, p=0.034). Patients discharged for conservative management had a lower re-presentation rate in the post-guideline group (12.6%) than the pre-guideline group (17.2%); however, this did not reach statistical significance (p=0.18).
Implementation of a clinical practice guideline for ureteric stones reduces the ED LOS and the total number of CT scan in patients who present with renal colic. Standardizing assessment and management of ureteric stones can potentially improve patient and hospital outcomes without compromising the quality of care.
Objectives: To evaluate the correlation between 3- and 6-week postoperative 24-hour pad weight, daily pad number, and the International Consultation on Incontinence Questionnaires for Male Lower ...Urinary Tract (ICIQ-MLUTS), ICIQ-Short Form (ICIQ-SF) and UCLA Prostate Cancer Index (UCLA-PCI) in patients undergoing robotic-assisted radical prostatectomy (RARP). Methods: This prospective study included patients undergoing RARP between February and November 2019. Patients completed a 24-hour pad test, assessing pad weight and number, and 3 validated patient-reported outcome measures (PROMs); the ICIQ-MLUTS, ICIQ-SF and UCLA-PCI, preoperatively and at 3 and 6 weeks postoperatively. Results: A total of 47 patients were included in the study. There was a strong correlation between 24-hour pad weight and the ICIQ-SF at 3 weeks (r = 0.71, P < 0.001) and 6 weeks (r = 0.68, P < 0.001). There was a strong correlation between 24-hour pad weight and ICIQ-MLUTS incontinence (r = 0.80, P < 0.01) and incontinence QoL burden (r = 0.79, P < 0.01) at 6 weeks. There was a moderate correlation between the 24-hour pad weight and UCLA-PCI urinary function (r = 0.58, P < 0.001) and urinary QoL burden (r = 0.66, P < 0.001) at 6 weeks. The correlation between pad number and 24-hour pad weight was weak at 6 weeks (r = 0.34, P < 0.001). Conclusion: PROMs may be used as a substitute for the 24-hour pad weight test for post-prostatectomy incontinence (PPI) assessments in the early post-RARP period. The ICIQ-SF and UCLA-PCI urinary function and QoL scores correlate with 24-hour pad weight. However, the ICIQ-MLUTS incontinence and QoL scores provide the strongest correlation with PPI.
ObjectivesTo evaluate the correlation between 3- and 6-week postoperative 24-hour pad weight, daily pad number, and the International Consultation on Incontinence Questionnaires for Male Lower ...Urinary Tract (ICIQ-MLUTS), ICIQ-Short Form (ICIQ-SF) and UCLA Prostate Cancer Index (UCLA-PCI) in patients undergoing robotic-assisted radical prostatectomy (RARP). MethodsThis prospective study included patients undergoing RARP between February and November 2019. Patients completed a 24-hour pad test, assessing pad weight and number, and 3 validated patient-reported outcome measures (PROMs); the ICIQ-MLUTS, ICIQ-SF and UCLA-PCI, preoperatively and at 3 and 6 weeks postoperatively. ResultsA total of 47 patients were included in the study. There was a strong correlation between 24-hour pad weight and the ICIQ-SF at 3 weeks (r = 0.71, P < 0.001) and 6 weeks (r = 0.68, P < 0.001). There was a strong correlation between 24-hour pad weight and ICIQ-MLUTS incontinence (r = 0.80, P < 0.01) and incontinence QoL burden (r = 0.79, P < 0.01) at 6 weeks. There was a moderate correlation between the 24-hour pad weight and UCLA-PCI urinary function (r = 0.58, P < 0.001) and urinary QoL burden (r = 0.66, P < 0.001) at 6 weeks. The correlation between pad number and 24-hour pad weight was weak at 6 weeks (r = 0.34, P < 0.001). ConclusionPROMs may be used as a substitute for the 24-hour pad weight test for post-prostatectomy incontinence (PPI) assessments in the early post-RARP period. The ICIQ-SF and UCLA-PCI urinary function and QoL scores correlate with 24-hour pad weight. However, the ICIQ-MLUTS incontinence and QoL scores provide the strongest correlation with PPI.
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