OBJECTIVE
To report the clinical spectrum seen in young abusers of street‐ketamine (regular recreational abusers of street‐ketamine, for its hallucinogenic effects) in Hong Kong, presenting with ...significant lower urinary tract symptoms (LUTS) but with no evidence of bacterial infection.
PATIENTS AND METHODS
We retrospectively analysed the clinical presentations, pelvic pain and urgency/frequency scores, video‐urodynamic studies, cystoscopy findings, histological features of bladder biopsies and radiological findings of 59 ketamine abusers who were referred to the urology units of Princess Margaret and Tuen Mun Hospital, Hong Kong, from March 2000 to December 2007.
RESULTS
Of the 59 patients, all had moderate to severe LUTS, i.e. frequency, urgency, dysuria, urge incontinence and occasionally painful haematuria. Forty‐two (71%) patients had a cystoscopy that showed various degrees of epithelial inflammation similar to that seen in chronic interstitial cystitis. All of 12 available bladder biopsies had histological features resembling those of interstitial cystitis. Urodynamically, either detrusor overactivity or decreased bladder compliance with or without vesico‐ureteric reflux was detected to some degree in all of 47 patients. Thirty patients (51%) had unilateral or bilateral hydronephrosis on renal ultrasonography, and four (7%) showed features suggestive of papillary necrosis on radiological imaging. Eight patients had a raised serum creatinine level.
CONCLUSION
A syndrome of cystitis and contracted bladder can be associated with street‐ketamine abuse. Secondary renal damage can occur in severe cases which might be irreversible, rendering patients dependent on dialysis. The present data do not establish the precise cause nor the incidence. Street‐ketamine abuse is not only a drug problem, but might be associated with a serious urological condition causing a significant burden to healthcare resources.
Aim
The aim of the present study was to evaluate the feasibility of the use of the video microsurgery platform and fluorescence imaging exoscope system for microsurgical subinguinal varicocoelectomy ...(MSV) with intraoperative indocyanine green angiography (ICGA).
Patients and Methods
Two patients with three varicoceles had MSV and intraoperative ICGA performed in August 2018. A video telescopic operating microscope (VITOM) 3‐D system and a VITOM II ICG system were connected to a modular FULL HD IMAGE1 S camera platform. Both telescopes were mounted for convenient positioning and switch between the telescopes.
Results
The VITOM 3‐D system provided excellent, high‐definition image quality and anatomical details necessary for the procedure of MSV. The system offered a more ergonomic working environment for the operating surgeons. The addition of VITOM II ICG system allowed intraoperative ICGA for better identification of the testicular artery. Testicular arteries were clearly identified and preserved. The setup with holding arms and a camera platform facilitated quick switch between the video systems.
Conclusions
The procedure of MSV with intraoperative ICGA can be performed efficiently with the utilization of the video microsurgery platform.
Objective
The aim of the present study was to evaluate the feasibility to expand the use of indocyanine green (ICG) to lymphatic‐sparing microsurgical subinguinal varicocelectomy (MSV) in addition to ...ICG angiogram by using video microsurgery platform.
Patients and Methods
Seven patients with 12 varicoceles had MSV and intraoperative ICG lymphography performed from July 2019 to February 2020. Intraoperative ICG lymphography was employed to confirm and preserve lymphatics after intra‐parenchymal testicular injection of ICG.
Results
Lymphatic vessels were clearly identified on ICG lymphography in all varicocele units with intra‐parenchymal testicular injection. ICG lymphography did not significantly interfere with the quality of subsequent ICG angiography in the majority of patients. All patients were discharged uneventfully within 24 h after the operation. No complications were reported with a median follow up duration of 9 months.
Conclusions
The use of intraoperative ICG lymphography consistently provides objective assessment of lymphatic vessels during the procedure of MSV.
Microsurgical subinguinal varicocelectomy (MSV) is generally considered the gold standard nowadays in view of the lower risk of complications and recurrence. To achieve complete ligation of veins ...while preserving testicular artery (TA) during the procedure remains challenging despite the application of high power optical magnification and micro-Doppler ultrasonography. The use of intraoperative indocyanine green angiography (ICGA) with infrared fluorescence operative micro-scope in MSV potentially lowers the incidence of TA injury and shortens the learning curve of nov-ice surgeons. We present our initial experience in the application of the technique in nine patients and explore the potential of the new adjunct.
Spontaneous rupture of renal angiomyolipoma (AML) during pregnancy is a rare but life‐threatening condition. In the present study, we report two of our cases and provide a literature review of 23 ...case reports. We retrospectively reviewed two pregnant women who presented with spontaneous ruptured AML; both failed conservative management. In our first case, a 36‐year‐old woman at 9 weeks’ gestation had selective renal arterial embolization with pelvic shield performed successfully. The pregnancy was continued to term, and the baby was delivered by elective Caesarean section. In our second case, a 33‐year‐old woman, pregnant with twins, at 32 weeks’ gestation had emergency Caesarean section performed uneventfully. On‐table selective renal arterial embolization was performed immediately afterwards, and the patient stabilized afterwards. Taken together with the 23 case reports in the literature, we conclude that embolization is a safe option of active intervention for ruptured AML in pregnancy when conservative management fails. It has the advantages of being minimally invasive and nephron‐sparing. The risk of radiation to the foetus is acceptable if proper measures are taken to minimize foetal radiation exposure.
Aim
The aim of the present study was to compare the safety and early postoperative outcomes of bipolar transurethral enucleation and resection of the prostate (TUERP) and transurethral resection of ...the prostate (TURP) in patients with prostates larger than 80 g.
Patients and Methods
Between January 2014 and December 2016, 41 and 61 patients had bipolar TUERP and bipolar TURP performed at our unit for the treatment of prostates larger than 80 g. All patients were evaluated preoperatively by digital rectal examination, transrectal ultrasonography and laboratory studies, including measurement of haemoglobin and prostate‐specific antigen levels. Patients were reassessed postoperatively at 3 months.
Results
The preoperative parameters between bipolar TUERP and TURP were comparable. Bipolar TUERP is more efficient in tissue removal, with more tissue retrieved per minute of theatre time (0.73 g/min vs 0.64 g/min, P = 0.022). The hospitalization time between the groups was comparable. Bipolar TUERP achieved a lower serum prostate‐specific antigen level (1 ng/mL vs 1.8 ng/mL, P < 0.001), lower transrectal ultrasonography volume (18.3 cm3 vs 23.8 cm3, P < 0.001) and higher peak flow rate (23.1 mL/s vs 16.9 mL/s, P = 0.026) compared with bipolar TURP at 3 months postoperatively. Postoperative complications due to urinary tract infection were more common in the bipolar TURP group, while the readmission rate due to transient haematuria was higher among bipolar TUERP patients. The transfusion rate was low in both groups, and postoperative urethral stricture was uncommon.
Conclusions
Bipolar TUERP is a safe technique for the surgical treatment of large prostates. More complete removal of adenoma can be achieved without an increase in theatre time. Bipolar TUERP results in better early postoperative functional outcomes in terms of higher peak flow rate compared with bipolar TURP. The complication rate is not increased with bipolar TUERP.
Summary Objective To retrospectively review our experience of managing patients with emphysematous pyelonephritis (EPN). Methods Case notes of patients with EPN were reviewed. The patients' ...demographic data, clinical presentation, investigation findings, treatment, and outcome were studied. Results Twelve patients were diagnosed with EPN. Majority (66.7%) of them had diabetes mellitus. All patients had been evaluated by computed tomography (CT). Using the classification proposed by Wan et al, five patients had type 1 EPN, whereas six, two, and four patients had Huang and Tseng CT class 2, 3a, and 3b EPN, respectively. Immediate nephrectomy was performed in six patients, whereas conservative treatment was adopted in the other six. In the nephrectomy group, one patient died of disseminated sepsis after a protracted course. Conservative treatment failed in three patients, who succumbed despite salvage nephrectomy in two of them. Analysis revealed that severe hyperglycemia and radiological CT class (both Wan and Huang systems) were significant predictors of mortality from EPN. Conclusion Severe hyperglycemia and CT class of EPN are significant risk factors for death. CT is the investigation of choice for correct diagnosis of EPN. Additional intervention should be offered to EPN patients with Wan type 1 and Huang and Tseng class 3 CT features.
This randomised trial showed that en bloc resection of the bladder tumour (ERBT) led to a significant reduction in the 1-yr recurrence rate in patients with non–muscle-invasive bladder cancer. With ...superiority in treatment efficacy, our study provided the best evidence to support ERBT as the first-line surgical treatment for patients with bladder tumours of ≤3 cm. The multicentre setting also showed that ERBT is generalisable with a comparable safety profile to standard resection.
Conventionally, standard resection (SR) is performed by resecting the bladder tumour in a piecemeal manner. En bloc resection of the bladder tumour (ERBT) has been proposed as an alternative technique in treating non–muscle-invasive bladder cancer (NMIBC).
To investigate whether ERBT could improve the 1-yr recurrence rate of NMIBC, as compared with SR.
A multicentre, randomised, phase 3 trial was conducted in Hong Kong. Adults with bladder tumour(s) of ≤3 cm were enrolled from April 2017 to December 2020, and followed up until 1 yr after surgery.
Patients were randomly assigned to receive either ERBT or SR in a 1:1 ratio.
The primary outcome was 1-yr recurrence rate. A modified intention-to-treat analysis on patients with histologically confirmed NMIBC was performed. The main secondary outcomes included detrusor muscle sampling rate, operative time, hospital stay, 30-d complications, any residual or upstaging of disease upon second-look transurethral resection, and 1-yr progression rate.
A total of 350 patients underwent randomisation, and 276 patients were histologically confirmed to have NMIBC. At 1 yr, 31 patients in the ERBT group and 46 in the SR group developed recurrence; the Kaplan-Meier estimate of 1-yr recurrence rates were 29% (95% confidence interval, 18–37) in the ERBT group and 38% (95% confidence interval, 28–46) in the SR group (p = 0.007). Upon a subgroup analysis, patients with 1–3 cm tumour, single tumour, Ta disease, or intermediate-risk NMIBC had a significant benefit from ERBT. None of the patients in the ERBT group and three patients in the SR group developed progression to muscle-invasive bladder cancer; the Kaplan-Meier estimates of 1-yr progression rates were 0% in the ERBT group and 2.6% (95% confidence interval, 0–5.5) in the SR group (p = 0.065). The median operative time was 28 min (interquartile range, 20–45) in the ERBT group and 22 min (interquartile range, 15–30) in the SR group (p < 0.001). All other secondary outcomes were similar in the two groups.
In patients with NMIBC of ≤3 cm, ERBT resulted in a significant reduction in the 1-yr recurrence rate when compared with SR (funded by GRF/ECS, RGC, reference no.: 24116518; ClinicalTrials.gov number, NCT02993211).
Conventionally, non–muscle-invasive bladder cancer is treated by resecting the bladder tumour in a piecemeal manner. In this study, we found that en bloc resection, that is, removal of the bladder tumour in one piece, could reduce the 1-yr recurrence rate of non–muscle-invasive bladder cancer.
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