Need For Further Surgical Intervention Research Articles

Does time from previous surgery predict subsequent treatment failure in Chronic Rhinosinusitis with Nasal Polyps?

When considering the introduction of biological treatments for Chronic Rhinosinusitis with nasal polyps (CRSwNP), treatment guidelines must consider not only which patients will best respond to biologicals, but also which patients derive least benefit from current treatment pathways. Using data collected as part of the National Audit of Surgery for Chronic Rhinosinusitis and Nasal Polyps, we sought to evaluate if patients with a history of prior surgery are more likely to need a further revision operation, and whether the interval between surgery may help predict the need for further surgical intervention. In the original study, patients were prospectively and consecutively enrolled at the time of sinus surgery in multiple centres in England and Wales. Follow-up captured symptomatic outcomes and revision surgery rates at 3, 12, 36 and 60 months after surgery. Revision surgery rates 5 years after the index procedure, in patients with CRSwNP were analysed with regards to baseline demographics. Complete data were available for 980 subjects, with a 5 year revision rate of 15.1%. 45.9% had a history of previous surgery before the index procedure, and this group had significantly higher rates of additional surgery compared with those undergoing their first sinus surgery (20.2% versus 9.8%). Patients with an interval of 3 years or less between their previous surgery and the index procedure had the highest rates of further surgery. In a multiple regression, time interval between previous operations was a better prediction of subsequent revision surgery than asthma. Having N-ERD was the strongest predicator of need for further surgery while more extensive surgery was associated with lower revision rates. Patients presenting with a symptomatic recurrence within 3 years of surgery have a high risk of treatment failure, defined as the need for further surgery. Time to failure after previous surgery may be used to help select patients who may not benefit from current treatment pathways and may be good candidates for alternative strategies, including biologicals.

Factors Affecting Posterior Glottic Stenosis Surgery Outcomes: Systematic Review and Meta-analysis.

To investigate surgical adjuncts (stents) and previous surgeries on outcomes from posterior glottic stenosis (PGS). PubMED/Medline, CINAHL, EMBASE, and Web of Science were searched for publications on adult patients undergoing surgery for PGS. Decannulation and need for additional surgeries were evaluated as outcomes. Linear mixed-effects (with random effects and fixed effects) models were used for multivariate testing. In total, 516 abstracts were reviewed and 26 articles were considered for systematic review. Of these, 19 articles with 140 pooled patient cases were extracted for meta-analysis. On multivariate meta-analysis analysis accounting for study-specific variation and use of open procedures, prior surgeries were associated with additional surgeries (RR = 3.76 [1.39-3.86], P = .038) and the use of a stent was associated with a lower likelihood of decannulation (RR = 0.42 [0.09-0.98], P = .044). Minimizing repeat surgery is a predictor for avoiding additional future surgeries and use of a stent was correlated with poor outcomes. These 2 findings may assist providers in patient counseling regarding the need for further surgical interventions. Further, this study is the first to compare the efficacy of surgical approaches for the resolution of PGS, and highlights the importance of avoiding repeat procedures and stents for the management of PGS.

Endoscopic full-thickness resection of polyps involving the appendiceal orifice: a multicenter international experience.

Endoscopic resection of lesions involving the appendiceal orifice remains a challenge. We aimed to report outcomes with the full-thickness resection device (FTRD) for the resection of appendiceal lesions and identify factors associated with the occurrence of appendicitis. This was a retrospective study at 18 tertiary-care centers (USA 12, Canada 1, Europe 5) between November 2016 and August 2020. Consecutive patients who underwent resection of an appendiceal orifice lesion using the FTRD were included. The primary outcome was the rate of R0 resection in neoplastic lesions, defined as negative lateral and deep margins on post-resection histologic evaluation. Secondary outcomes included the rates of: technical success (en bloc resection), clinical success (technical success without need for further surgical intervention), post-resection appendicitis, and polyp recurrence. 66 patients (32 women; mean age 64) underwent resection of colonic lesions involving the appendiceal orifice (mean [standard deviation] size, 14.5 (6.2) mm), with 40 (61 %) being deep, extending into the appendiceal lumen. Technical success was achieved in 59/66 patients (89 %), of which, 56 were found to be neoplastic lesions on post-resection pathology. Clinical success was achieved in 53/66 (80 %). R0 resection was achieved in 52/56 (93 %). Of the 58 patients in whom EFTR was completed who had no prior history of appendectomy, appendicitis was reported in 10 (17 %), with six (60 %) requiring surgical appendectomy. Follow-up colonoscopy was completed in 41 patients, with evidence of recurrence in five (12 %). The FTRD is a promising non-surgical alternative for resecting appendiceal lesions, but appendicitis occurs in 1/6 cases.

A cellular fibroepithelial tumor of the breast: A case report

Introduction: Fibroepithelial breast lesions are biphasic neoplasms characterized by proliferation of both stromal and epithelial cells. They encompass a spectrum of tumors ranging from benign fibroadenoma to potentially fatal malignant phyllodes tumor, with tumors of borderline clinical significance in-between. It is important to correctly characterize each lesion, as this defines management and thus risk of local recurrence and potential distant metastasis in case of malignancy. Case Report: A 48-year-old woman presented with a palpable retro-areolar lump in the left breast. After core biopsy, the initial pathology report initiated tumorectomy. When the final report stated a borderline phyllodes tumor with incomplete resection, reintervention was needed with wide surgical margins to avoid local recurrence. The local re-excision showed scarring and steatonecrosis as a result of the previous procedure, but no residual lesion. Consequently, there was no need for further surgical intervention. Conclusion: Fibroepithelial lesions (FEL) of the breast are a wide variety of lesions with distinct management based on the exact pathologic character. Core needle biopsy poses a risk of sampling error due to intratumoral heterogeneity that sometimes may be found in cellular FEL. As a consequence, upgrading at the time of the excision specimen can frequently occur with need of reintervention.

The effectiveness of uterine packing combined with topical tranexamic acid for the management of primary postpartum hemorrhage

Objectives: the aim of the study is to identify the effectiveness of adding topical tranexamic acid to uterine pack to control primary PPH compared to uterine packing alone. Methods: the study included 30 women with intractable primary PPH after vaginal deliveries due to uterine atony in whom the conventional local pathway of management of PPH had failed to control bleeding. In 15 women(the case group), uterine pack impregnated with 20 ml of tranexamic acid(1gm/10ml) was used to control bleeding and compared to 15 women (the control group) in whom uterine pack without tranexamic acid was used, outcome studied include the need for further surgical intervention and need for blood product. Results: although uterine packing impregnated with TXA was successful in controlling bleeding in 13 women out of 15(86.7%) compared to 10 out of 15 cases (66.7%) in women who underwent uterine packing without TXA, however; the difference in effectiveness of both methods is statistically insignificant. The requirement for blood product transfusion was less in TXA group. Conclusion: topical uterine TXA increase the efficiency of uterine tamponade to control PPH, and may decrease the need for more invasive surgical intervention as hysterectomy.

Case Study: Infected Disrupted Perineal Wound Treatment with Negative Pressure Wound Therapy (NPWT) and Wound Reconstruction Using Gracilis Muscle Flap Following the Abdominoperineal Excision (APE) in Patient with Rectum Injury Due to Motorcycle Accident

Blunt trauma sustained in traffic accidents can cause significant rectum injury, either intra or extraperitoneal. Severe injuries have high mortality rates and many complications, including pelvic absesses, sepsis, rectal fistulas, stenosis, and rectal incontinence. Following the initial surgical procedure, many reconstructive methods can be used to treat perineal wounds, including gracilis myocutaneus flap, rectus abdominis flap, gluteal flap, perforator flap, posterior thigh flap, groin flap, and pudendal fasciocutaneous flap. NPWT is used to promote formation of granulation tissue, reduce and prepare tissue gap to be covered, improve perfusion through removal of excessive fluid, and reduce bacterial wound colonization. Some of the complications of this method are pain, skin irritation and maceration, tissue necrosis, bleeding, and infection. The success rate of NPWT depends on multiple factors, including patient characteristics, effectiveness of primary surgical procedure and need for further surgical interventions, size and depth of the wound, and proper NPWT application technique. NPWT has shown to reduce total treatment cost due to shorter patient hospital stay, reduction of complication rates, reduction of further surgical interventions, and lower frequency of dressing change compared with standard dressings. In this case study, I present a 53-year-old motorcyclist who was injured in a traffic accident and sustained fracture of the sacrum, rupture of the pubic symphysis, fracture of L5 vertebrae, and penetrant injury to the rectum. Multiple explorative laparotomies, colostomy, and supportive and drug treatment methods were carried out to obtain a successful outcome.

AN UNCONVENTIONAL CONNECTION: IATROGENIC NEPHROPLEURAL FISTULA AFTER PERCUTANOUS NEPHROLITHOTOMY

SESSION TITLE: Medical Student/Resident Signs and Symptoms of Chest Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: A nephropleural fistula is an abnormal connection between renal parenchyma and pleural lining, it’s a known complication of percutaneous nephrolithotomy (PCNL) which can happen in both immediate and delayed setting (1). We describe a case of 88-year-old female who developed this fistula 2 days after the procedure. CASE PRESENTATION: 87-year-old female with a past medical history of recurrent UTIs and right nephrolithiasis presented with right sided flank pain. CT abdomen pelvis showed 8 mm right ureteral calculus and mild right hydronephrosis. Urine and blood cultures grew E. coli. She was diagnosed with urosepsis and treated with IV ceftriaxone. She required a right ureteric stent and patient was discharged home. A few weeks later, the patient was admitted to the hospital for a cystoscopy and replacement of her right sided JJ stent. She underwent right sided percutaneous nephrolithotomy. On Post-op day 2, the patient started to develop hypoxemia while ambulating, and required 3L nasal canula to maintain oxygen saturation >95%. Chest X ray revealed new bilateral pleural fluid collections. Patients hemoglobin dropped from 11.9 to 6.6. CT scan of the chest showed moderate to large right basilar hemothorax with a communication between right kidney to the right pleural cavity. Thoracic surgery was consulted for evaluation/management of right hemothorax. The patient required a video-assisted thoracoscopic surgery procedure with hemothorax evacuation and intercostal tube placement and drainage. The patient's condition improved, and the chest tube was removed with closure of the nephropleural fistula. Deemed medically fit to be discharged with follow up for the removal of her JJ stent through cystoscopy. DISCUSSION: Iatrogenic nephro-pleural fistula is a very rare but potentially life-threatening complication following PCNL. There are only a handful of case reports in the current literature. Most often occurring in the immediate phase during intraoperative fluoroscopy (1). The direct connection created intra-operatively between the thoracic cavity and renal collecting system allows the build up of fluid and urine into the chest. This can potentially lead to the development of pleural effusions and invariably compromising respiratory function & status. Most fistulas can be managed conservatively with the use of thoracentesis without the need for further surgical intervention. However rarely more aggressive treatment is required including temporary chest tube placement with or without pleurodesis for recurrent/refractory fistulas(2). CONCLUSIONS: This case highlights the importance of a considering a delayed nephropleural fistula following an uneventful PCNL in patients complaining of respiratory symptoms following stent removal. A delayed nephropleural fistula should be considered in any patient that develops shortness of breath, increasing oxygen requirement or evidence of pleural effusions. Reference #1: Kaler, K. S., Cwikla, D., & Clayman, R. V. (2016). Delayed Nephropleural Fistula After Percutaneous Nephrolithotomy. Journal of endourology case reports, 2(1), 99–102. https://doi.org/10.1089/cren.2016.0050 Reference #2: Baugh, A. D., Youssef, E., Hasan, S. S., Siddiqui, N. S., Elsamoloty, H., Shahrour, K., & Javaid, T. (2016). Nephropleural Fistula Effectively Managed with Serial Thoracentesis: A Case Report. Journal of endourology case reports, 2(1), 212–214. https://doi.org/10.1089/cren.2016.0102 DISCLOSURES: No relevant relationships by Sanchit Chawla, source=Web Response No relevant relationships by hussain karimi, source=Web Response

Quality of life, need for retreatment, and the re-equilibration phenomenon after venous sinus stenting for idiopathic intracranial hypertension

BackgroundLong term failure rates after venous sinus stenting (VSS) for idiopathic intracranial hypertension (IIH) are poorly understood.MethodsRetrospective analysis was performed on a prospectively-maintained single center database to identify patients with...

Endoscopic removal of eroded laparoscopic adjustable gastric bands: a preferred approach.

Complications related to laparoscopic adjustable gastric banding (LAGB) have led to an increased number of removals. An uncommon but potentially devastating complication is gastric band erosion into the gastric lumen, which can be managed by open surgical, laparoscopic, and endoscopic approaches. A wide array of management techniques has been reported for removal of LAGB that have eroded into the stomach. We describe the preferred method for successful endoscopic band removal at our institution. Community tertiary-care referral hospital accredited by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. A single-center, retrospective review of a prospectively maintained database was used to identify patients who underwent LAGB removal from 2009 to 2019. We identified the subset of patients with band erosion. We analyzed patient characteristics, presenting symptoms, diagnostic modalities, and method of band extraction. A total of 132 patients underwent LAGB removal, among whom 22 (16.7%) patients were diagnosed with erosion. Seven (32%) patients underwent laparoscopic removal, 14 (64%) patients underwent endoscopic removal, and 1 patient (4%) underwent combined laparoscopic and endoscopic approach. These latter patients had variable amounts of erosion and buckle visibility, but all underwent endoscopic retrieval. We found that using an endoscopic retrograde cholangiopancreatography guidewire with an endoscopic retrograde cholangiopancreatography mechanical lithotriptor for band transection and snare for retrieval have been effective. A standardized, multidisciplinary, and minimally invasive endoscopic approach for LAGB erosion has been found to be successful without the need for further surgical intervention and may be offered to patients upon discovery of erosion.

Testicular regression syndrome: A series of 22 cases at a tertiary care hospital

Testicular regression syndrome (TRS) represents a congenital condition in which no normal testicular tissue can be identified following exploration for a clinically impalpable testis. It is seen in less than 5% of cryptorchidism cases, however accounts for 35-60% of clinically impalpable testis. To study the Clinicopathological spectrum of Testicular regression syndrome (TRS) and review the literature. Study design: The study included 22 patients with nonpalpable testis, who had undergone resection of testicular nubbins. Original diagnosis was studied in context of pathological recognition of TRS and additional sections and stains were examined. Pathological assessment included identification of epididymis and vas deferens, vascularised fibrous nodule (VFN), dystrophic calcification, hemosiderin and pampiniform plexus like veins. Stain for iron and calcium were performed. On secondary review, 21 out of 26 cases of undescended testis (UDT) showed features consistent with the diagnosis of TRS. On microscopy, VFN was observed in 17 (77.3%), calcification in 4 (18.2%), hemosiderin in 15 (68.2%), vas deferens in 13 (59%), epididymis in 11 (50%), prominent vessels in 21 (95.4%) and seminiferous tubules in 6 (27.3%) cases. The presence of dystrophic calcification and hemosiderin deposition with absent viable tissue points to the hypoxic injury to the testis. TRS theoretically carries a long-term risk for malignant degeneration therefore In the typical situation in which a blind-ending spermatic cord without viable testis is submitted for tissue analysis, it is imperative to characterize such cases as consistent with regressed testis thus eliminating the need for further surgical intervention.

Anatomical and Visual Outcomes of Scleral Buckling Surgery in Rhegmatogenous Retinal Detachment.

PURPOSE:The aim of this study is to evaluate the short anatomical and visual outcomes of scleral buckling surgery in relation to the pattern of presentation of rhegmatogenous retinal detachment (RRD) in the presence of different situations and risk factors.METHODS:A total of 206 eyes of 203 patients who underwent scleral buckling surgery for RRD were evaluated in this retrospective study. Information retrieved included patient demographics, duration of symptoms, and presenting vision, lens status, site of a retinal break, extent of retinal detachment, the involvement of the fellow eye, macular involvement, presence of lattice degeneration, and associated refractive errors. Postoperative retinal reattachment, postoperative visual acuity, the need for further surgical intervention, intraoperative, and postoperative complications were also evaluated. Proportions and percentages were used to analyze data.RESULTS:Primary anatomical reattachment was seen in 172 eyes (83.5%) after the complete resolution of the tamponade used. The mean best-corrected visual acuity improved from 2.81 logarithms of the minimum angle of resolution (LogMar) preoperatively to 1.21 LogMar postoperatively, the most important factors that appeared statistically significantly affecting the anatomic and visual outcome were the duration of macular detachment (P = 0.036), the status of the lens; phakic eyes gave better visual outcome than aphakic and pseudophakic eyes (P < 0.05).CONCLUSION:Scleral buckling procedure showed high structural and visual success rates, improvement of visual acuity was found to correlate well with the shorter duration of macular detachment and pseudophakic eyes. We believe that scleral buckling, when done appropriately in the appropriate cases, gives the maximum visual outcome with the least cost and need for consecutive procedures.

1133P - Systemic bevacizumab for the treatment of recurrent respiratory papillomatosis: A retrospective analysis from an academic tertiary care center

BackgroundRecurrent Respiratory papillomatosis (RRP) can result in significant morbidity due to effects on voice and breathing and often requires frequent debulking procedures, which can disrupt quality of life. Responses to current surgical and medical treatments are inconsistent and there are no systemic treatments proven to be consistently effective in managing this disease. Bevacizumab, an anti-angiogenic agent that targets the vascular endothelial growth factor (VEGF) has been used as systemic agent for the treatment of RRP. We present a retrospective analysis of safety, efficacy and clinical outcomes in thirteen patients who were treated with systemic bevacizumab. MethodsWe present a retrospective analysis of patients with severe RRP who received 10mg/kg or 15mg/kg systemic bevacizumab at 3 weekly intervals at a single academic tertiary care center. They were monitored for toxicity and response to treatment as measured by need for further surgical interventions and improvement of symptoms. ResultsTwelve patients received at least 2 doses of systemic bevacizumab for an average of 5 cycles. Overall the treatment was well tolerated with minimal side effects. The most common side effect was hypertension, which was experienced by 4 out of 12 patients. Two patients discontinued treatment due to side effects. One experienced grade 3 epistaxis and another patient developed hypertension and thrombocytopenia. Two other individuals tolerated treatment well however, therapy was suspended due to insurance denial. All patients reported an improvement in symptoms including, improved quality of voice and breathing as well as decreased cough. The average number of surgical interventions in the year prior to administration of systemic bevacizumab was 4, with most individuals requiring intervention at a frequency of 2-4 months. Following treatment, only 4 of the 12 patients required one surgical intervention. ConclusionsSystemic bevacizumab appears to be a safe and well tolerated treatment option for patients with severe RRP. It demonstrates promising efficacy on symptoms including voice quality and improved breathing as well as decreased requirement for surgical therapy. Legal entity responsible for the studyThe author. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

The influence of pleurodesis on the outcome of primary spontaneous pneumothorax in children.

Primary spontaneous pneumothorax (PSP) has a high rate of recurrence, and pleurodesis has been shown to decrease the rate of recurrence in adult PSP. For pediatric PSP patients, there are only a few case series available and evidence on the benefits of pleurodesis is insufficient. This study aimed to analyze the outcome of pleurodesis among pediatric PSP patients via a nationwide population-based cohort in Taiwan. The hospitalization data from the pediatric intensive care sampling file of the National Health Insurance Research Database from January 1 to December 31, 2010, were retrieved and analyzed. Children aged 0-18 years with a discharge diagnosis of PSP (ICD-9: 512, 512.0, and 512.8) were enrolled in the study. Demographic data, management strategies, and clinical outcomes were recorded and analyzed as well. A total of 1005 hospitalization cases were identified and divided into the pleurodesis (409 hospitalizations) and nonpleurodesis (596 hospitalizations) groups. In the univariate analysis, thoracoscopic surgery for PSP decreased the incidence of recurrence (hazard ratio [HR], 0.46; 95% CI, 0.32-0.67) and the need for further surgical intervention (HR, 0.29; 95% CI, 0.18-0.47); however, conventional open surgery did not. A lesser incidence of PSP recurrence (HR, 0.53; 95% CI, 0.37-0.78) and fewer subsequent surgical interventions (HR, 0.32; 95% CI, 0.20-0.52) were found in the pleurodesis group in comparison with the nonpleurodesis group. A multivariate Cox regression analysis revealed that pleurodesis was the only significant factor capable of decreasing the incidence of PSP recurrence (HR, 0.57; 95% CI, 0.38-0.86) and the need for further surgical intervention (HR, 0.40; 95% CI, 0.23-0.69). Pleurodesis reduces the rate of recurrence and the need for further surgical intervention in pediatric PSP. It may be considered as the method of choice for the management of PSP in children.

Outcomes of Superficial and Deep Irrigation and Debridement in Total Hip and Knee Arthroplasty

BackgroundFollowing total knee arthroplasty and total hip arthroplasty, wound-related problems and deep periprosthetic joint infection may present in a similar fashion. Irrigation and debridement (I&D) has a great role in management of patients with early infection. The question that often arises is how to tell the difference between superficial and deep infection. This study evaluated the role and outcomes of both superficial and deep I&D in patients with wound-related issues and/or suspected periprosthetic joint infection. MethodsA retrospective study was conducted evaluating patients who underwent I&D within 28 days of total joint arthroplasty. A total of 176 cases with a minimum of 1-year follow-up were identified, and clinical records were reviewed in detail. Reoperations included superficial (fascia not opened) or deep (fascia opened) I&D. Failure was defined as the need for further surgical intervention within 1 year of initial I&D. ResultsThe overall success for superficial I&D was 84.28% vs 68.86% for deep I&D. The success of both deep and superficial I&D was higher if the I&D was performed closer to the index surgery. Superficial I&D in patients with a positive joint aspiration or evidence of intraoperative purulence or those in whom had no subcutaneous fluid had higher failure rates. ConclusionSuperficial I&D is a viable option in patients with wound-related issues as long as joint aspiration is performed to rule out infection involving the prosthesis. If there are findings of no fluid or purulence, fascia may need to be opened and the deeper tissues explored.

Improved Outcomes of Orbital Reconstruction With Intraoperative Imaging and Rapid Prototyping

Rapid prototyping and intraoperative computed tomography (CT) are increasingly used in orbital reconstruction when placement of implants is indicated and accurate anatomic restoration is mandatory. The purpose of this study was to review the outcomes of orbital reconstructions at a single institution and the influence of intraoperative CT and rapid prototyping on the rate of return to the operating theater. A retrospective cohort analysis was performed from 2013 through 2016 to assess whether rapid prototyping and intraoperative imaging were used and the need for further revision surgery. Clinical notes were reviewed and data were collected for patient gender, age, fracture pattern, preoperative diplopia, and enophthalmos. Also noted were whether rapid prototyping and intraoperative imaging were used, the number of "spins" required, plating systems, postoperative diplopia and enophthalmos, restoration of orbital form, and the need for further surgical intervention. Patients were excluded if no orbital implants were inserted or if they were lost to follow-up. Three hundred thirty-one cases of orbital trauma were reviewed (248 male and 83 female patients; age range, 7 to 96yr; mean age, 37.5yr). In total, 154 orbital reconstructions were performed from 2013 through 2016. Five cases required a return to the operating theater for implant revision. All5 cases did not use intraoperative imaging (P=.0016), and 4 did not have a rapid prototype bio-model (P=.006). Twenty-five of 110 cases (22.7%) using intraoperative CT required intraoperative revision. The present study shows improved outcomes for patients treated for orbital fractures when intraoperative imaging and rapid prototyping bio-modeling are used. As a result, postoperative imaging and the morbidity of revision surgery can be avoided. These technologies should be availableand considered standard of care to any surgeon performing reconstruction of orbital fractures.

Early Transcatheter Arterial Embolization for the American Association for the Surgery of Trauma Grade 4 Blunt Renal Trauma in Two Institutions.

To evaluate the efficacy of early transcatheter arterial embolization for hemodynamically stable patients with The American Association for the Surgery of Trauma (AAST) grade 4 blunt renal trauma. The medical records of consecutive patients with grade 4 blunt renal trauma who were transported to our two critical care centers in Japan and treated with early transcatheter arterial embolization (TAE) between 2001 and 2013 were retrospectively reviewed. Treatment failure was defined as the need for further surgical intervention or re-embolization after initial embolization. We divided these cases into two groups, a group who survived and a group who died, investigating the factors that led to death. Seventeen patients underwent early TAE, with an average time between presentation and embolization for renal trauma of 125 minutes (66-214 minutes). There was no case of treatment failure. Three of the patients died, but none solely because of renal injury. Significant factors associated with patient death were the number of concomitant injured organs (p=0.04), the presence of pelvic fractures (p<0.01), and the presence of visceral injuries (p<0.01). The presence of lumber fractures (p=0.09) also tended to be associated with patient death. Early TAE is an effective treatment and should be actively performed for hemodynamically stable patients with grade 4 blunt renal injuries without multiple concomitant organ injuries.

Functional outcome and quality of life in patients undergoing salvage radical prostatectomy (SRPE).

212 Background: Salvage radical prostatectomy is one option for patients with locally recurrent disease with proven long term oncologic control. There are concerns about worse functional results due to fibrotic tissue after radiotherapy and patients are treated with palliative systemic androgendreptivation. We retrospectively analyzed continence and quality of life in patients undergoing SRPE. Methods: After biopsy proven local recurrent prostate cancer 138 patients were offered SRPE and extended lymphadenectomy. Continence and quality of life had been collected before 6 and 12 months after surgery. Validated questionaires with ICIQ and EORTC qlq 30 had been used. Results: Präoperatively at 6 monts and 12 months the feed back was available in 93, 84 and 82 patients respectively. Präoperatively there was no or mild incontinence in 38(40.8%), moderate in 33 (35.5%) and strong incontinence in 22 (23.7%) of the patients. There is a significant decrease in the rate of continence after 6 and 12 months to no or mild in 19 (23.1%), moderate in 19 (23.2%) and strong incontinence in 44 (53.7%) of the patients. In 5 patients an artifitial sphinkter was implanted. Quality of life did not change significantly before and 12 months after surgery. Median value of Question 30 was 6 and five respectively. Conclusions: Patients need to be informed about a worse functional outcome and the potential need for further surgical interventions as artificial sphinkter implantion compared to primary radical prostatectomy. Quality of life seems to be affected only moderatly. Nevertheless there is already a rather high rate of any incontinence before surgery that needs to be taken into account.

The need for further surgical intervention following primary hysteroscopic morcellation of submucosal leiomyomas in women with abnormal uterine bleeding.

Intrauterine hysteroscopic morcellators have been studied as an alternative method for removing submucosal leiomyomas. To assess the long-term efficacy of hysteroscopic morcellation of submucosal leiomyomas in women with abnormal uterine bleeding (AUB). We conducted a prospective cohort study including all women with AUB who underwent a hysteroscopic resection with mechanical morcellation of a benign submucosal leiomyoma confirmed at histopathology. Need for further surgery, patient satisfaction, symptom resolution and post-operative complications were documented by direct patient contact after a minimum of six months of follow-up. A total of 73 women were included in the study with a mean length of follow-up of 32±13months. Mean total size of pathology at the time of index surgery was of 42±20mm. A total of 9/73 (12%) women required subsequent hysterectomy and 20/73 (27%) any subsequent related surgery (operative hysteroscopy, abdominal myomectomy or hysterectomy) with the estimated three-year cumulative incidence being 30±6%. Satisfaction rate of participants was 84%. In multivariate Cox proportional analyses, only a total size of pathology of 50mm or more was found to be significantly associated with the risk of requiring further surgical procedures (hazard ratio=2.9, P=0.02). Hysteroscopic morcellation of submucosal leiomyomas is an effective method to manage women with AUB, although women with larger pathology have an increased risk of requiring subsequent surgical procedures.

RETRACTED: Amniotic Band Syndrome With Pseudoarthrosis of Tibia and Fibula: A Case Report

Constriction of the lower limb by a congenital amniotic band has been proposed to explain the development of pseudoarthrosis of the tibia and fibula. We report a case of amniotic band syndrome in a preterm female infant with pseudoarthrosis of the tibia and fibula. She was born at 29weeks of gestation with congenital amniotic bands and was noted to have a severely edematous left foot distal to the constricting band with rudimentary digits. The skin was pink and well perfused with palpable pulses. Radiography demonstrated pseudoarthrosis of the tibia and fibula. The limb deformities were managed with splints, positioning, and physiotherapy. She underwent Z-plasty with soft tissue release on the left lower leg on day 7 of life. At 36weeks of postmenstrual age, a repeat radiograph showed markedly improved growth of the tibia and fibula with mature new bone formation, which avoided the need for further surgical intervention. During the follow-up period, she underwent left Syme's amputation at 18months. At 29months of age, the child was able to walk and run without support. The findings from our case confirm the potential for bone growth in patients with amniotic band syndrome, once the constricting band has been released. Simple release of the constriction band with Z-plasty resulted in growth of mature bone, replacing the pseudoarthrosis and, hence, the patient did not require surgical amputation. Thus, one should be cautious when deciding on surgical amputation, even in the presence of pseudoarthrosis, especially in preterm infants. Early limb-preserving surgery with release of the constricting band with an intention to salvage the limb appears appropriate.

Transurethral incision of ureterocele: Does the time of presentation affect the need for further surgical interventions?

Ureterocele management is considered to be one of the famous debates in pediatric urology. Despite some considering transurethral ureterocele incision (TUI) as a temporary line of treatment, others have reported good results in terms of being a definitive treatment. The present study evaluated the feasibility of TUI as a definitive line of management. Moreover, it studied the impact of presentation on the outcomes. The charts of patients who had ureteroceles from 1995 to 2015 were retrospectively reviewed. Patients who had undergone initial TUI were included. The initial presentation and timing were recorded. All ultrasounds, voiding cystourethrograms (VCUG) and dimercaptosuccinic acid scans (DMSA) pre-TUI and post-TUI were reviewed. Moreover, the occurrence of febrile urinary tract infections (FUTI) and any secondary surgical intervention were recorded. RESULTS (FIG. A): A total of 51 patients with 53 ureteroceles were included. Of these, 51% presented antenatally, while others had FUTI at the time of presentation. Thirty-nine ureteroceles were associated with duplex system ureterocele (DSU), while the remaining ones had single system ureterocele (SSU). The median follow-up was 44 months. The incidence of de-novo reflux into ureterocele was 44% of SSU and 23% of DSU (P=0.22). Reflux into ureterocele after TUI (four SSU and seven DSU) carried a high risk of surgical interventions (3/4 SSU and 6/7 DSU). Hydronephrosis was improved in 64% of both DSU and SSU patients. Secondary surgery was performed in 51% of DSU and 35.7% of SSU. Twelve patients (67%) presented postnatally with DSU and had subsequent interventions after incision in comparison with 38% (eight patients) of those who presented antenatally. The DSU had improved renal function (by DMSA) in 26%, while the remaining had stable renal function. All patients with delayed ureterocele presentation had FUTI, while 1/3 of antenatally presenting patients had FUTI during follow-up. Notably, the age at subsequent interventions was apparently the same despite different ages at presentation. Study limitations included the retrospective chart review. Additionally, the pre-operative and postoperative investigations, such as laboratory and radiological results, were present and reviewed in most, but not all, patients. Two thirds of SSU and approximately half DSU patients had no surgical intervention after TUI. However, those who presented antenatally had a lower risk of FUTI and lesser probability of being re-operated. VUR into ureterocele, regardless the system duplicity, had a high re-operation rate. After ureterocele incision, 26% of DSU patients had renal function improvement.