Foley Catheter Placement Research Articles

Extracranial-intracranial bypass using a cephalic vein graft for iatrogenic internal carotid artery injury during functional endoscopic sinus surgery: illustrative case.

Injury to the internal carotid artery (ICA) during functional endoscopic sinus surgery is a rare but potentially fatal complication. Although treatment algorithms have been developed, guidelines for effectively managing iatrogenic ICA injury have not been established. A case of ICA perforation during functional endoscopic sinus surgery treated with cerebral bypass utilizing a cephalic vein graft is presented. A woman in her late 50s presented with a left cavernous ICA injury that had occurred during endoscopic nasal polypectomy at an outside hospital. Hemostasis was achieved with intranasal Foley catheter placement. Left common carotid artery angiography revealed a high-flow carotid-cavernous fistula. Cerebral revascularization was chosen as the optimal procedure. The initial intent was to use a radial artery graft, but the radial artery was found to be occluded intraoperatively. Postoperatively, the patient experienced decreased vision and left eye movement but was otherwise neurologically intact. Postoperative angiography showed complete resolution of the fistula. In cases involving ICA injury and carotid-cavernous fistula formation, microsurgical trapping with high-flow bypass is a favorable treatment option. The cephalic vein is a viable graft option when unexpected challenges arise with a radial artery graft. https://thejns.org/doi/10.3171/CASE24222.

Surgical abortion service reorganization in response to the COVID-19 pandemic: a unique experience of attending second trimester D&E procedures under spinal anesthesia as emergency procedures.

The COVID-19 pandemic created a massive shift in how health care systems interact with COVID testing for patients. To avoid delay in accessing second trimester surgical abortion at our hospital (St. Paul's Hospital Millennium Medical College) during this pandemic, dilation and evacuation (D&E) procedures were attended as emergency cases, instead of as elective surgical procedures, which then required adherence to the universal preoperative COVID-19 testing protocol. This study aimed at documenting the experience of this unique abortion service adjustment in response to the COVID-19 pandemic. This was a retrospective descriptive study conducted at St. Paul's Hospital Millennium Medical College (SPHMMC) in Addis Ababa, Ethiopia, from April 1, 2021 to July 31, 2021. We reviewed second trimester surgical abortion cases managed with D& E procedures, performed under spinal anesthesia using the emergency COVID-19 pre-operative testing protocol. Data were analyzed using SPSS version 23 and simple descriptive statistics were applied. Percentages and proportions were used to present the results. Nineteen cases of second trimester D&E cases were reviewed. The median gestational age of the abortion clients was 21.57 weeks. Eight of 19 cases had cervical preparation with overnight intra-cervical Foley catheter placement while the rest 11 (57.9%) cases had their cervical preparation with Laminaria. The median time interval from initial evaluation of the abortion client to time of doing D& E procedure was 21.83 h. Surgical abortion service reorganization enabled abortion clients to access dilation and evacuation procedures within 24 h of their initial presentation. This prevented significant delays in accessing abortion care that could otherwise have occurred as a result of adhering to the preoperative COVID-19 testing protocols applied to elective surgeries.

Male Foley Catheter Placement and Removal for Surgery

Male Foley Catheter Placement and Removal for Surgery

Comparison of digital and speculum-guided methods of transcervical Foley catheter insertion in primigravida undergoing cervical ripening at term gestation: a noninferiority randomized clinical trial

BackgroundFoley catheter insertion is frequently utilized for cervical ripening during the induction of labour. However, the insertion failure, safety, maternal side effects, complications and satisfaction of digital compared to speculum-guided Foley catheter placement have not been evaluated in a large trial involving primigravida. ObjectivesThe study aimed to compare the insertion failure rate of digital and speculum-based transcervical Foley catheter placement in primigravida. The co-primary outcome was insertion-associated pain. The secondary outcomes were time required for successful insertion, maternal satisfaction, and maternal complications within 24 hours of Foley insertion. MethodsThis randomized, open-label, parallel-arm, non-inferiority clinical trial was performed in a large tertiary care university hospital. Primigravida >18 years of age with term gestation (≥37 weeks) were included in this study. Additional inclusion criteria for enrolment in this study were singleton pregnancy with a cephalic presentation, intact membrane, Bishop score ≤5 and reassuring pre-induction foetal heart rate tracing. All women planned for cervical ripening were assessed for eligibility and were randomized into digital or speculum arms. Foley catheter insertion was performed in a supine lithotomy position. Vaginal and cervical cleaning were performed before insertion. A 22-French Foley balloon catheter was guided digitally or via speculum to position the bulb at the level of the internal os using water-soluble lubricant. Insertion-associated pain was measured using visual numeric rating scale (VNRS) and maternal satisfaction was assessed using a set of questions. Results469 pregnant women were assessed for eligibility, and 446 patients were enrolled and randomized. The median age of the parturients was 24 (19-40) and 24 (18-38) years, respectively. The body mass index, gestational age at randomization, incidence of post-dated pregnancy and pre-randomization Bishop scores were comparable. Insertion failure was observed in 24 (10.8%) and 17 (7.6%) of women in digital and speculum arm, respectively (RR= 1.41; 95% CI, 0.78-2.55; P=0.25). Requirements of more than one attempt (5.4% vs 3.6%) followed by change in hands (3.6% vs 2.7%) were the most common reasons for insertion failure. The median (interquartile range) VNRS was comparable (6.00 (2-9) vs 5.00 (2-10); p=0.15). The time taken for successful insertion was similar (58 (12-241) vs 54 (10-281); p=0.30). 9.4% and 10.8% of women required additional methods of cervical ripening. More women in the speculum group (41.7% vs 33.2%; P=0.06) felt a medium level of discomfort than digital group. ConclusionInsertion failure and insertion-related pain in the digital approach were comparable to the speculum-guided approach for transcervical Foley catheter insertion in primigravida for cervical ripening. Nevertheless, maternal satisfaction was higher in the digital group due to a lesser level of discomfort.

Ultrasound-guided suction curettage followed by cervico-isthmic placement of foley threeway catheter for cesarean scar pregnancy's treatment. Retrospective study

ObjectivesCesarean scar pregnancy (CSP) is a rare dangerous condition with still no consensus on standard treatment. Suction curettage has been used as the first-line treatment for CSP with controversial outcomes. This study evaluates efficacy of ultrasound-guided suction curettage (UGSC) followed by cervical-isthmic placement of silicon semirigid three-way foley catheter. Materials and methodsThis study included 24 women with CSP. Preoperative ultrasound study was conducted. UGSC followed by placement of catheter was performed in all patients. The success rate and incidence of major complication, surgical time and hospital stay were recorded. ResultsThe success rate of UGSC followed by placement of foley catheter was 100 %, effectively reduced major complications and none of the patients had a blood loss higher than 900 ml. Median hospital stay was 2 days and median foley stay was 1 day. Surgery had limited last with a median of 17 min. ConclusionUGSC followed by foley placement is a safe effective treatment for CSP with a clinical resolution of 100 %. The catheter is easy to place under ultrasound guidance and prevents bleeding, reducing major procedures to solve the bleeding. Suction curettage in CSP treatment should be performed under ultrasound guidance and followed by cervical-isthmic placement of foley balloon.

Self bladder emptying compared with Foley catheter placement for planned cesarean delivery: a randomized controlled trial

BackgroundThe global cesarean delivery rate is high and continuing to increase. A bladder catheter is usually placed for the cesarean section as a distended bladder is assumed to be at higher risk of injury during surgery and to compromise surgical field exposure. Preliminary data suggest that self-bladder emptying (no catheter) at cesarean delivery may have advantages and be safe. ObjectiveTo evaluate self-bladder emptying to indwelling foley bladder catheterization for a planned cesarean on rate of postpartum urinary retention and maternal satisfaction. Study DesignA randomized controlled trial was conducted in a tertiary university hospital from January 10 2022 to March 22 2023. 400 participants scheduled for planned cesarean were randomized: 200 each to self-bladder emptying or indwelling foley catheter. The primary outcomes were postpartum urinary retention (overt and covert) and maternal satisfaction with allocated bladder care. Analyses were performed using t test, Mann-Whitney U and Chi-Square or Fisher exact test as appropriate. Logistic regression was used to adjust for characteristic differences. ResultsPostpartum urinary retention rates were 1/200 (0.6%) vs 0/200 p>0.99 (a solitary case of covert retention) and maternal satisfaction score (0-10 visual numerical rating scale) median [interquartile range] 9 [8-9.75] vs 8 [8-9] p=0.003 for self-bladder emptying vs indwelling foley catheter respectively. Of the secondary outcomes, for self-bladder emptying, recovery to flatus passage, satisfactory ambulation, urination, satisfactory urination, satisfactory breastfeeding, post-cesarean hospital discharge was quickened. Pain score at first urination was decreased and no lower urinary tract symptom was more likely to be reported. Surgical field view, operative blood loss, duration of surgery, culture-derived urinary tract infection, postvoid residual volume and pain score at movement were not different. There was no bladder injury. ConclusionSelf-bladder emptying increased maternal satisfaction without adversely impacting on postpartum urinary retention. Recovery was enhanced and urinary symptoms were improved. The surgeon was not impeded at operation. No safety concern was found

Foley Catheter Placement: Indications, Maintenance, Complications, and Demonstration on a Preoperative Male Patient

Foley Catheter Placement: Indications, Maintenance, Complications, and Demonstration on a Preoperative Male Patient

Assessing Health Care Utilization and Feasibility of Transurethral Catheter Self-Discontinuation

ABSTRACT Common issues after pelvic reconstructive surgery are incomplete bladder emptying and urinary retention, often resulting in placement of an indwelling transurethral Foley catheter, which then remains until a patient returns to the office. Catheterization is significantly distressing for women undergoing these procedures and burdensome due to travel to the office during the postoperative period. In addition, in-office voiding trials add to the workload of health care professionals and staff. A potential alternative is at-home self-discontinuation of the Foley catheter. This study's primary aim was the comparison of the rates of health care utilization (calls, messages, office visits, and emergency department [ED] visits) and postoperative complications within 30 days of surgery among patients with voiding trials on the day of surgery, versus those with Foley placement and void trials on postoperative day 1. Secondary objectives included identifying risk factors for unsuccessful voiding trials and exploring any complications associated with catheter self-discontinuation. This study was designed as a prospective observational cohort study at 1 academic institution and included outpatient women undergoing outpatient urogynecologic or minimally invasive gynecological surgery for benign indications between August 2021 and January 2022. Qualifying patients included cisgendered English-speaking women of at least 18 years of age who exhibited postoperative urinary retention on the day of surgery. Excluded were patients with any preoperative degree of urinary retention (defined as any observation of a postvoid residual more than 200 mL), known upper motor neuron disease, and patients undergoing surgeries with concomitant extra pelvic procedures or minor procedures not requiring a postoperative voiding trial. Based on the exploratory nature of this study, primarily for determining safety and feasibility, the convenience sample size of 50 was set, and patients were recruited at the time of their unsuccessful voiding trials on the day of surgery. On the day of surgery, medical staff performed voiding trials in the postoperative anesthesia care unit, backfilling the bladder with 200 mL of sterile fluid. The void trial was successful if this was followed by a patient void of at least 150–200 mL, otherwise the voiding trial was marked as unsuccessful. Unsuccessful trials resulted in the insertion of an indwelling Foley catheter, followed by verbal and written instruction for performing a home-based, patient-led catheter self-discontinuation at 6:00 am on postoperative day 1. Instructions for catheter removal included pictures and written information. After removal, if the patient failed to void 150 mL within 6 hours, they were instructed to return to the office for additional care. Perioperative data collected from charts included age, parity, body mass index, self-reported race, surgical location, smoking status, periprocedural antibiotics, operative indication, procedures performed, operative time, surgeon type, anesthesia type, estimated blood loss, and intraoperative complications. Results of the study demonstrated 140 patients eligible for day 0 postoperative voiding trials. Of these, most patients were postmenopausal, White, and one third were obese. A majority (82.8%) had a urogynecologist perform their surgery, and the overall rate of voiding trial failure on the day of surgery was 35.7%. The majority of patients (48/50) proceeded with at-home voiding trials according to protocol. Of these, 39 had no further voiding difficulty. Of the 9/50 (18.8%) requiring additional assessment, 6 had a repeat void trial in the office of which 4 were successful, 1 voided spontaneously in the office, 1 required prolonged clean intermittent self-catheterization, and 1 was successful with repeat Foley self-discontinuation on day 3 postoperatively. Only 2 of the 39 patients with successful self-discontinuation on postoperative day 1 had retention later, with 1 presenting to an ED and 1 presenting to the office. Patients with unsuccessful postoperative day 0 void trials had an average of 1 additional call or message to the office, and patients with unsuccessful postoperative day 1 void trials had an average of 1 additional office visit. Although both of these comparisons to those with successful day of surgery void trials were statistically significant, they did not indicate excessive care requirements. Risk factors for failure of day of surgery void trial included older age (also a risk factor for failure on the following day), smoking history, and vaginal hysterectomy. Strengths of the study include its diverse population of women undergoing a wide array of minimally invasive gynecological and urogynecologic surgeries, as well as its prospective nature. Limitations of the study include a lack of control groups, the singular institution in which the study was performed, and the small sample size that limited the potential identification of rare complications. These factors also limit the generalizability of the findings to other settings. Ultimately, catheter self-discontinuation was largely straightforward and efficient for patients and office staff, with low subsequent retention rates. Although further research is required, data currently point to catheter self-discontinuation as a safe and feasible option for women undergoing advanced gynecological surgery, providing a valuable management option for acute postoperative voiding dysfunction.

Complex reimplantation of an inflatable penile prosthesis with scar tissue excision and distal corporal defect repair with Tutoplast® pericardium allograft

AbstractBackgroundPatients with inflatable penile prostheses (IPP) may experience erosions after years of use or after indwelling Foley catheter placement. IPP erosions should be managed as an infection with the entire IPP removed. Replacing IPPs in erosion patients can be challenging due to extensive scarring development. Using proper graft materials may be necessary to close and reinforce the corporal defect after difficult corporal dilation or significant scar removal for the long‐term success of IPP reimplantation.Case PresentationHerein we report a patient with a history of IPP placement in 2007 for erectile dysfunction and Peyronie's disease, presenting in 2018 with dysuria and a feeling of IPP displacement following Foley catheter placement for coronary artery bypass graft surgery. The left cylinder of the IPP was observed by physical examination and a defect near the fossa navicularis was discovered during office cystoscopy. A complete explantation of IPP was then performed. Reimplantation of the IPP was performed in 2021 which required excision of corporal scar tissue and repair of a left distal corporal defect using a Tutoplast® pericardium allograft. The procedure was successful with proper IPP position and good function without any penile deformity.ConclusionThe use of graft materials in the management of corporeal defects should be considered in the setting of complex IPP revision. The Tutoplast® pericardium allograft reinforcement can provide long‐term durability, flexibility, and a lower risk of infection.

Risk factors for a failed trial without catheter following convective water vapor thermal therapy (CWVTT-Rezum).

Convective water vapor thermal therapy (CWVTT-Rezum) is a minimally invasive surgical therapy that is being increasingly utilized for bladder outlet obstruction. Most patients leave the site of care with a Foley catheter in place for a mean reported duration of 3-4 days. A minority of men will fail their trial without catheter (TWOC). We aim to identify the frequency of TWOC failure following CWVTT and its associated risk factors. Patients who underwent CWVTT at a single institution from October 2018 to May 2021 were retrospectively identified and pertinent data extracted. The primary endpoint was TWOC failure. Descriptive statistics were performed, and rate of TWOC failure was determined. Potential risk factors for failed TWOC were assessed through univariate and multivariate logistic regression. A total of 119 patients were analyzed. Seventeen percent (20/119) had a failed TWOC on their first attempt. Of those, 60% (12/20) failed in a delayed fashion. In patients who failed, the median number of total TWOC attempts required for success was two (interquartile range [IQR] = 2-3). All patients eventually had a successful TWOC. The median preoperative postvoid residual for successful and failed TWOC was 56 mL (IQR = 15-125) and 87 mL (IQR = 25-367), respectively. Preoperative elevated postvoid residual (unadjusted odds ratio [OR] 1.02, 95% CI: 1.01-1.04; adjusted OR 1.02, 95% CI: 1.01-1.04) was associated with TWOC failure. Seventeen percent of patients failed their initial TWOC after CWVTT. Elevated postvoid residual was associated with TWOC failure.

Omitting Foley Catheter Use in Mastectomy Patients With or Without Immediate Reconstruction.

Foley catheter placement is often advised in surgeries anticipated to exceed 3 hours; however, this time cutoff does not take into account the type of surgery. Complications from Foley catheter placement include urinary tract infections and genitourinary trauma that may be costly to healthcare systems. Our objective was to determine whether mastectomy with or without reconstruction can be done without Foley use, without an increase in urinary retention risk. One hundred eighty-seven patients who underwent unilateral or bilateral mastectomies with or without reconstruction in 2020 and 2021 were reviewed. Chart review included intraoperative fluids given, estimated blood loss, lymph node dissection, and duration of procedure. After excluding patients with case duration under 180 minutes, 145 remained. Ninety-four patients did not have a Foley and 51 patients had an intraoperative Foley. None of the patients without a Foley experienced postoperative urinary retention, including 3 patients who also underwent lymphatic microsurgical preventive healing approach. Eighty-six percent of patients were discharged on the day of surgery. Patients with or without a Foley did not differ significantly in terms of race, rate of axillary lymph node dissection, body mass index, rate of same-day discharge, presence of hypertension or diabetes, estimated blood loss, or age. Patients undergoing unilateral and bilateral mastectomies with or without reconstruction or lymphatic microsurgical preventive healing approach may avoid Foley catheter placement without increased risk of urinary retention, even if the case is anticipated to exceed 3 hours. Advantages include elimination of catheter-associated urinary tract infections and their associated hospital costs, as well as avoiding genitourinary trauma.

MP62-12 PARIETEX MINI MALE SLING FOR STRESS URINARY INCONTINENCE AT THE TIME OF THREE PIECE PENILE PROSTHESIS: TECHNIQUE AND OUTCOMES

You have accessJournal of UrologyCME1 Apr 2023MP62-12 PARIETEX MINI MALE SLING FOR STRESS URINARY INCONTINENCE AT THE TIME OF THREE PIECE PENILE PROSTHESIS: TECHNIQUE AND OUTCOMES Shirin Razdan, Alexandra Siegal, and Robert Valenzuela Shirin RazdanShirin Razdan More articles by this author , Alexandra SiegalAlexandra Siegal More articles by this author , and Robert ValenzuelaRobert Valenzuela More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003320.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Male stress urinary incontinence (SUI) and climacturia are often comorbid with erectile dysfunction (ED) post prostatectomy. While the inflatable penile prosthesis (IPP) is the gold standard surgical option for ED, there are many surgical options for male SUI as well as climacturia including bulking agents, Virtue® male sling, AdVance™ male sling, mini Jupette with IPP, and artificial urinary sphincter (AUS). We present our technique and outcomes for mini male sling (MMS) with IPP insertion for mild SUI and climacturia using a hydrophilic monofilament polyester mesh. METHODS: After obtaining IRB approval, a retrospective review of all IPPs performed by a single high volume surgeon was performed. Those men who underwent IPP insertion with concomitant MMS were analyzed. The technique of MMS placement involves measurement of an approximately 5x3cm Parietex™ mesh (Covidien, MN) and overlying this ventrally over the bulbar urethra. The Parietex™ mesh includes a hydrophilic absorbable collagen film to minimize tissue reaction and risk of erosion. The lateral edges of the mesh are sutured to the 3- and 9 o’clock positions on the left and right corporal bodies, respectively, using a nonabsorbable, braided suture in an interrupted fashion. Mesh is sutured just proximal to the corporotomy sites. Tightness of mesh was measured using the proximal end of a Debakey forceps, with ease of passage when IPP deflated and inability to pass forceps when IPP inflated indicative of proper sizing. RESULTS: A total of 63 men underwent IPP with MMS between January 2018 and October 2022. All patients had ED after radical prostatectomy. Average patient age was 67 years old, and average IPP size was 21cm with 1cm rear tip extender (RTE). A total of 59 men had SUI, with average pad per day (PPD) of 1.5. Twenty-five men with SUI had comorbid climacturia, and 4 men had preoperative climacturia without SUI. Average PPD post IPP with MMS was 0.1. Of the 29 men with preoperative climacturia, only one did not have resolution of his symptoms post MMS. There was only one reported complication of acute urinary retention requiring temporary foley catheter placement. Two patients required subsequent AUS insertion for persistent SUI. There were no reported cases of infection or mesh erosion. CONCLUSIONS: The hydrophilic Parietex™ mesh is a safe, easy to use, nonreactive, and effective material for mini male sling insertion at the time of IPP placement for men with ED and mild/moderate SUI or climacturia. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e866 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shirin Razdan More articles by this author Alexandra Siegal More articles by this author Robert Valenzuela More articles by this author Expand All Advertisement PDF downloadLoading ...

Impact of intravesical administration of tranexamic acid on gross hematuria in the emergency department: A before-and-after study

IntroductionLocal applications of tranexamic acid (TXA) have been effective in treating various hemorrhagic conditions. In patients with gross hematuria, the main treatment in the emergency department (ED) is continuous bladder irrigation (CBI). However, CBI has no pharmacological effects except blood clot removal from dilution. The aim of this study was to evaluate the impact of the intravesical TXA injection before CBI. MethodsThis study was a before-and-after, retrospective, and single-center study. The target population was hematuria patients who received CBI via a 3-way Foley catheter. As the intervention procedure, 1000 mg of TXA was injected through the Foley catheter and after 15 min, the Foley catheter was declamped and CBI started. Since the intervention started in March 2022, the patients from March 2022 to August 2022 were assigned to the after group and the patients from March 2021 to August 2021 were assigned to the before group. The primary outcomes were the length of stay in the ED and duration of Foley catheter placement. The secondary outcomes were the admissions and the revisits for CBI within 48 h after discharge. ResultsThe numbers of patients in the before group and after group were 73 and 86, respectively. The median length of stay in the ED was shorter in the intervention group than in the group not treated with TXA (274 min vs. 411 mins, P < 0.001). The median duration of Foley catheter placement was also shorter in the intervention group than not treated with TXA (145 min vs. 308 mins, P < 0.001). The revisits after ED discharge were lower in the after group than in the before group (2.3% vs. 12.3%, P = 0.031). There was a trend for lower admissions in the TXA treatment group than before group (29.1% vs. 45.2%, P = 0.052). ConclusionAfter the TXA intervention, reduction in the length of stay in the ED, the duration of Foley catheter placement, and the revisits after ED discharge was observed.

Catheterized urine color change.

What caused the abrupt change in color of catheterized urine after several days of Foley catheter placement?

Advanced Urology Boot Camp: A Simulation-based Curriculum to Enhance Fourth-year Medical Student Procedural Competency.

Simulation-based medical education continues to gain popularity as the clinical environment requires exemplary patient safety while simultaneously maximizing the learner's educational experience. There is a current lack of urology-focused medical student education curricula in the literature. Here, we present the findings of a didactic and simulation-based medical student advanced "urology boot camp" curriculum, which was designed for learners interested in pursuing careers in urology. Twenty-nine fourth-year urology-dedicated medical students completing their subinternship at our institution during the 2018-2019 academic year participated in an advanced hands-on simulation "boot camp," which taught both simple and advanced Foley catheter placement, manual and continuous bladder irrigation, and diagnostic cystoscopy. Knowledge acquisition was assessed through quizzes administered before and after completing electronic modules, and a post-simulation survey assessing learners' confidence in their knowledge and skill set, as well as their satisfaction with the curriculum. Medical students demonstrated significant gains in knowledge from pre-test (mean 73.7%) to post-test (mean 94.5%, P < .001), which was consistent across each simulation procedure. Participants self-reported significant improvement in confidence with the procedures from before to after the educational intervention (P < .001). Students also found the curriculum to be beneficial to their understanding of the subject matter (P < .001), would recommend this curriculum to other medical students (P < .001), and thought it better prepared them to meet expected ACGME (Accreditation Council for Graduate Medical Education) milestones (P < .001). Findings from our advanced "boot camp" simulation curriculum demonstrated successful gains in knowledge and confidence following learning modules and hands-on simulation, indicating that this type of educational intervention could be beneficial in improving exposure to skills and developing confidence prior to urology internship and junior residency.

Every TURP Is not Just BPH

Abstract Introduction/Objective Transurethral resection of prostate is a common specimen in surgical pathology practice. These specimens usually demonstrate benign prostatic hyperplasia. However, occasionally incidental prostate cancer is identified. Finding a true mesenchymal tumor in these specimens is exceedingly rare. We present a unique case of prostatic adenocarcinoma Gleason score 3 + 4 =7 and concurrent solitary fibrous tumor identified on a TURP specimen. Solitary fibrous tumor in this anatomical location is rare with approximately 50 cases reported in the English language literature. Methods/Case Report An 86-year-old male presented with symptoms and signs of urinary retention. On clinical evaluation the prostatae was profoundly enlarged with a calculated volume of 283cc; firm in consistency. He was given trial of medical management including finasteride, tamsulosin and Foley catheter placement. Subsequently, the patient underwent transurethral resection of prostate. Complete morcellation was not possible at the initial surgery due to hard consistency of the gland. Pathologic evaluation showed prostatic adenocarcinoma Gleason grade 3 + 4=Score 7 (Grade group 2) involving 10% of submitted tissue in addition to the changes of benign prostatic hyperplasia. Additionally, the background stroma demonstrated short plump oval to spindle cells with inconspicuous nucleoli and collagenous background, arranged in a haphazard (‘‘patternless’’) pattern. Immunohistochemical stains showed these lesional cells to be positive for STAT6 and CD34 and negative for desmin, S100, SOX-10, CD 117, DOG-1 and NKX 3.1. Morphology and immunohistochemical profile were compatible with solitary fibrous tumor involving the prostate. The patient is alive and symptom-free 9 months after the procedure. Results (if a Case Study enter NA) NA. Conclusion This case highlights the value of thorough evaluation of prostatic tissue in TURP specimens not only for prostate cancer but other tumors as well. It also reminds the practising pathologist to keep an eye out for the stromal lesions of the prostate gland. Also finding one lesion should not dissuade one from looking for additional concurrent lesions.

7331 Surgical Removal of Mucinous Cystadenoma Arising from Urachal Remnant Initially Mistaken for Ovarian Mass

<h3>Study Objective</h3> The objectives of this study are to describe diagnosis, surgical excision and follow up of a mucinous cystadenoma arising from a urachal remnant. <h3>Design</h3> Case report of one patient. <h3>Setting</h3> Patient was admitted in ambulatory surgery for laparoscopic resection of 12.9 cm cystic lesion originally read on MRI to be arising from the left ovary with concern for epithelial neoplasm. On laparoscopic survey the mass was found to be arising from and densely adhered to the bladder. <h3>Patients or Participants</h3> This is a case report of a 50-year-old P0 with a pelvic mass on physical exam. <h3>Interventions</h3> Laparoscopic resection of the mass was conducted with intentional cystotomy and bladder dome resection. The bladder was reapproximated laparoscopically in two layers. <h3>Measurements and Main Results</h3> The patient was discharged with Foley catheter in place on post operative day zero, patient passed trial of void on post operative day ten. Pathologic diagnosis described a mucinous cystadenoma of low malignant potential likely arising from urachal remnant. <h3>Conclusion</h3> Urachal remnants exist in up to 32% of adults. Due to the rarity of this condition, malignant transformations of the urachal remnant can be mistaken for ovarian tumors. Understanding the etiology to this condition can aid in diagnosis and management.

8778 Laparoscopic Low Anterior Resection of Endometriosis Pelvic Mass with Side-to-End Colorectal Anastomosis

<h3>Study Objective</h3> To perform resection of a recto-vaginal endometriosis mass and end-to-side bowel resection with minimally invasive surgery. <h3>Design</h3> Case study. <h3>Setting</h3> General endotracheal anesthesia. Foley catheter in place. Patient in modified lithotomy with both arms tucked, all pressure points padded and all extremities in neutral position. The patient received preoperative antibiotics and sequential compression devices were placed. The abdomen was prepped and draped in the usual sterile fashion. <h3>Patients or Participants</h3> Patient with endometriosis involving the rectum and vagina desiring minimally invasive surgery. <h3>Interventions</h3> Laparoscopic low anterior resection with side-to-end colorectal anastomosis, trachelectomy, bilateral oophorectomy, lysis of adhesion, flexible sigmoidoscopy, cystoscopy. <h3>Measurements and Main Results</h3> surgery performed without complications; patient recovery was uncomplicated. <h3>Conclusion</h3> We show in this surgical video the possibility to resect a recto-vaginal endometriosis mass and to perform end-to-side bowel resection using minimally invasive surgery without intra-operative or post-operative complications.

EDITORIAL COMMENT

In this article, “Urology Boot Camp: A Pilot Medical Student Curriculum For Common Bedside Urologic Procedures,” the authors developed a novel, urology-specific (catheter placement and irrigation) "boot camp" for third year medical students. The boot camp was very thoughtfully designed to minimize in-person instruction time, and included an online module that students needed to view ahead of time, followed by a single hands-on session. The intervention was incredibly well-received by students, who said they would recommend repeating it for others and reported increased comfort with Foley catheter placement and irrigation. As urologists we have a vested interest in exposing medical students to the most basic and fundamental urologic procedures for multiple reasons; not only can this early exposure pique interest in our fantastic field, but knowledge of basic bladder management can be utilized in every field of medicine. The intervention reported on in this article is simple and reproducible. The logical next step is how it can be scaled to reach more students. There are 192 medical schools in the US (MD and DO), and rather than every institution re-inventing the wheel to develop their own curriculum, this is an opportunity ripe for standardization and facilitation of such skill and educational sessions. The American Urological Association has been, and should continue to be, a driver in these efforts to standardize educational sessions and afford their broad availability. Simulation allows for exposure and repetition of skills in a low-stress and low-risk environment. If cost prohibits model-based simulation of the skills discussed in this article, consideration can be given to low-fidelity simulation of the same skills, as a rudimentary lower urinary tract can certainly be simulated without a costly human model. We applaud the authors for addressing an unmet need in medical education and are encouraged by the interest in empowering the next generation of physicians to gain confidence and competence in basic urologic skills.

AUTHOR REPLY

The reviewer's editorial comment is graciously received and emphasizes many of the same points we wanted to express and execute with our Urology Boot Camp. In organizing this curriculum we aimed to create a pilot medical student simulation that was easily accessible, highly applicable, and reproducible at other institutions. By focusing on common urologic bedside procedures such as foley catheter placement and irrigation, we hoped that not only could these concepts be applied to a broad range of medical specialties that a student could pursue, but they also allotted time and exposure to the incredible field of urology.