Palpable Bladder Research Articles

Amitriptyline overdose—an uncommon cause of acute transient exotropia presenting to the emergency setting: a case report

BackgroundAcute presentations of acquired exotropia or divergent alignment of either or both eyes are commonly observed following intracranial vascular events, trauma, orbital, and endoscopic sinus surgeries.Case presentationThe reported case is about a 16-year-old previously healthy Tamil female who presented to the emergency department with a few hours of reduced responsiveness. With the only clue in the history being about a family conflict the previous day, the examination revealed a noticeable exotropia along with a constellation of anticholinergic findings: a low Glasgow Coma Score, mydriasis, tachycardia, floppy limbs, exaggerated reflexes, and a palpable urinary bladder. Amitriptyline overdose leading to significant neurological involvement was suspected, and she was immediately offered urine alkalinization. Resources for urine and blood toxicological studies were not available. The patient gained consciousness 24 hours later and confirmed an overdose of ten amitriptyline tablets. Exotropia, a unique manifestation of this patient’s neurotoxicity, spontaneously resolved in 36 hours.Discussion and conclusionsThe reported case is about an uncommon clinical finding of exotropia seen in a common toxicological emergency: acute amitriptyline overdose. The importance of having a wide knowledge of various clinical presentations of drug toxicities is highlighted here, as any delay in diagnosis or initiation of life-saving measures could have resulted in fatal consequences.

URETHRAL INJURY IN REGIONAL HOSPITAL IN THE BPJS ERA: A CASE REPORT

ABSTRACT
 Objective: To present a case of urethral injury treated in a male adult. Case(s) Presentation: A 48 year old Asian male patient previously involved in a motor vehicle accident presented to the hospital with a chief complaint of pain and bleeding from the genitalia. On examination, it is revealed bleeding from the urethral meatus, pain in touch, palpable bladder, high riding prostate, and a butterfly-shaped bruising on the perineum. X-ray examination demonstrated soft tissue mass in the right scrotal region. The patient is diagnosed with urethral rupture with urinary retention and then underwent ultrasonography-guided cystostomy and perineal hematoma evacuation. The patient is followed-up 1 month later with a complaint of difficulty in voiding and erectile dysfunction. The patient is then diagnosed with urethral stricture and underwent direct vision urethrotomy. Discussion: Urethral injury is a rare type of injury of genitourinary trauma that may cause long term morbidity such as strictures, incontinence, impotence, and infertility. Urethral injury can be classified into posterior urethral injury which is associated with pelvic fracture and anterior urethral injury which is associated with blunt trauma. The gold standard of radiographic examination in urethral injury is dynamic retrograde urethrography. Prompt diagnosis, staging, and selecting intervention must be done for minimalizing complications. Sequelae may also develop which also affects quality of life. The usage of universal health coverage such as BPJS in In Indonesia can increase the accessibility of medical treatment. Conclusion: Urethral injury is a rare injury that requires prompt and careful management to minimize complications and increase the patient’s quality of life.
 Keywords: Urethral Injury, urethrotomy, urethral stricture.

235 A case of Painless Palpable Gall bladder - a rare Exception of the Courvoisier's Law

Abstract Introduction The Courvoisier's law states that a painless palpable enlarged gallbladder with jaundice is unlikely to be caused by gallstones. There are however various exceptions to the law. We report a rare case of such an exception to make us aware of the clinical condition. Case Description 72-year-old male, otherwise fit and healthy, presented to the Emergency department with epigastric discomfort, along with dark urine and pale-coloured stool. He was clinically examined to have jaundice, and a painless globular palpable gall bladder, with blood results confirming obstructive picture i.e. raised bilirubin (70 μmol/L), ALT (103 U/L) and Alkaline Phosphatase (590 IU/L). Ultrasound abdomen showed acute cholecystitis. CT chest-abdomen-pelvis showed cholelithiasis and choledocolithiasis with dilated common bile duct (CBD), as well as asymmetric gallbladder wall thickening. The MRCP showed concentric and uniform thickening of the entire gallbladder wall, with minimal pericholecystic fluid reflecting acute inflammation. Multiple calculi were noted to be present within the CBD and gall bladder, resulting in dilation of CBD (15.8mm). The patient had ERCP with sphincterotomy and retrieval of multiple stones by balloon trawl. He was discharged the following day and is planned to undergo laparoscopic cholecystectomy as an elective procedure. His liver function test markedly improved at discharge bilirubin of 18 μmol/L and ALP of 364 IU/L. Conclusion This is an unusual case of painless jaundice with palpable gall bladder due to stones impacted in the CBD and not due to periampullary carcinoma, which is an exception to the Courvoisier's Law.

The Outcome of Posterior Urethral Valves among Children in Tertiary Care Hospital–A Prospective Study

Introduction: Posterior Urethral Valve (PUV) is the most common cause of lower urinary tract obstruction in male children. This obstruction in posterior urethra could lead to severe dilatation of upper urinary tract and functional impairment of one or both kidney. The presentations are not always same for all patients. Early diagnosis and appropriate treatment may reduce the progressive damage and helps in recovery. Aim of the Study: The aim of this study was to find out the presentation and to assess the short term functional outcome after fulgaration of the patients with PUV. Methods: This prospective study was conducted at Pediatric urology department, Bangladesh Shishu Hospital and Institute, Dhaka. We included fifty patients with Posterior urethral valve, who were treated at the pediatric urology department from Jan, 2019 to Nov, 2021. Result: Total 50 patients enrolled in the study. In our study we found 50% of our patients were aged between 1 month to 1 year, followed by 36% were more than 1 years old and 14% were less than 1 month old. 76% patients were presented with dribbling of urine. 40%,26%,10% and 6% patients had UTI, poor stream,, retention of urine and palpable bladder respectively. 45 patients had bilateral hydronephrosis ( HDN) at presentation and only 5 had unilateral hydronephrosis in USG. At follow up MCU, 14% patients had unilateral VUR and 10% patients had bilateral VUR. Mean postoperative serum creatinine was 0.585 mg/dl. We found residual Valve in 11(22%) patients during follow up who required repeat Valve ablation. Conclusion: In our study, we found that Cystoscopic valve ablation and follow up is the treatment of choice for PUV patients which may arrest the progressive damage of renal function and facilitate the improvement. Further multicenter study and long term follow up is necessary for understanding the ultimate outcome.

Abstract 15051: A Large Mitral Valve Vegetation in a Patient Presented With Low Back Pain and Lower Limb Weakness- A Success Story of a Multidisciplinary Team

Case presentation: A 58-year-old gentleman presented to A&E with low back pain for a few days and lower limb weakness for 24 hours. His background history was not medically significant. On examination, GCS 14/15, lower limbs power 2/5, and palpable urinary bladder. DRE revealed poor anal tone. MRI spine showed epidural abscess at L3-L4 & L5-S1 level and urgent decompressive spinal surgery was performed. IV antibiotics were started and the patient was admitted to the general HDU for vasopressor support. Since the operation, he developed cold, pale, swollen right leg, with no palpable peripheral arteries. A CT aortogram showed occlusion of the right popliteal artery. Right popliteal artery exploration with anterior and posterior tibial embolectomy and fasciotomies were done. As the patient was slow to wake up post-surgery, he was transferred to ICU. MRI brain showed no pathology. Transthoracic echocardiogram revealed no vegetation. As clinical suspicion of infective endocarditis was high, transoesophageal echocardiogram and real-time 3D analysis was done which showed a large highly mobile echogenic mass attached to the left atrial surface of the anterior mitral leaflet (A1 and A2) causing moderate MR. Urgent surgical mitral valve repair and removal of a 2 cm vegetation were performed. Both the blood culture and the culture of the vegetation tissue confirmed the growth of Staphylococcus aureus (MSSA). After 8 weeks of hospital stay, the patient was discharged home. Discussion: The objective of this case presentation is to reemphasize that infective endocarditis is not a single organ disease and can present to different specialities. Transthoracic echocardiography has reduced sensitivity in the critical care setting. So, there should be a relatively low threshold for transoesophageal echocardiography. Although the mortality rate of infective endocarditis is relatively high in ICU patients, multidisciplinary team management may result in favourable outcomes.

Predictive factors for the success of trial catheter removal for women with urinary retention.

To investigate the outcome, determine the predictors for the success of, and evaluate the efficacy of pharmacokinetic therapy on trial catheter removal for women with urinary retention. Inclusion criteria were female patients with acute urinary retention defined as painful, palpable, or percussive bladder, when the patient is unable to pass any urine, accompanied by postvoid residual (PVR) > 250 ml, and who underwent trial catheter removal between July 2009 and July 2019. Before trial catheter removal, alpha-blockers alone or alpha-blockers and parasympathomimetics (bethanechol or distigmine bromide) were used to facilitate spontaneous voiding in some cases. Fifty-nine of 104 (56.7%) women with urinary retention were catheter-free post trial. There was no significant difference between successful and non-successful trials in average age (p=.392), median ECOG (Eastern Cooperative Oncology Group) performance status (p=.374), diabetes mellitus (p=.842), dementia (p=.801), previous history of cerebrovascular events (p=.592), or intrapelvic surgery (p=.800). Oral medications were administered for 39/59 (66.1%) in the success group and 30/45 (66.7%) patients in the non-success groups (p=.598). Serum albumin (3.2 ± 0.7 g/dl and 2.8 ± 0.8 g/dl, p=.039) and total protein values (6.5 ± 0.8 g/dl and 6.0 ± 1.0 g/dl, p=.038) at diagnosis of urinary retention were higher in the success group than the non-success group, respectively. Multivariate logistic regression found that a serum albumin >3 g/dl was an independent predictor of successful trial catheter removal for women with urinary retention (p=.030, odds ratio [OR] 3.3, 95% confidence interval [CI] of OR 1.1-9.9). Age < 70 years old was a likely predictor of successful trial catheter removal (p=.066, OR 4.8, 95% CI of OR 0.9-25.0). This is the first retrospective study to investigate the predictive factors for successful trial catheter removal in women with urinary retention. A serum albumin value >3 mg/dl at diagnosis of urinary retention was a significant independent predictor of catheter-free status after trial catheter removal, and age < 70 years-old was a possible contributor. There was no evidence that oral medication contributed to catheter-free status.

Acute Urinary Retention in Early Pregnancy: A Case Report

An uncommon obstetric emergency called acute urine retention (AUR) in patients with retroverted uteri necessitates prompt treatment. If left untreated, it could result in major difficulties for the mother or the fetus. Between weeks 9 and 16 of gestation, the frequency of AUR peaked in healthy pregnancies. The female patient, age 31, who came with urinary hesitancy is discussed in this publication. A palpable urinary bladder was found during a physical examination. An intrauterine pregnancy was shown to be viable by obstetric ultrasonography and the uterine was retroflexed. With the implantation of a urinary catheter for one week, prophylactic antibiotics for one week, and follow-up with urology, the patient's symptoms disappeared. The most frequent cause of AUR is a retroverted uterus. Rapid identification and diagnosis are necessary. The risk factors, etiology, and clinical manifestation of AUR in the first and second trimesters of pregnancy should be known to clinicians.

A Case Report On Prune Belly Syndrome

Eagle-Barrett syndrome’ is the other name for prune belly syndrome. The classical triad of urinary tract anomalies,deficient abdominal musculature, and bilateral cryptorchidism. It is a congenital anomaly of unknown aetiology, most commonlyseen in males. It is seen in one and 30,000 live births.96% of them are males. In this case report, we present a boy child born toA 38-year-old multigravida mother with a previous history of three vaginal deliveries. On examination of the baby, the followingfeatures are to be found-hypotonia, deficiency of abdominal muscle, undescended testis, a palpable bladder and kidney. Radiologicalimaging showed gross hydronephrosis on both sides and big ureter. The baby was diagnosed with Prune Belly syndrome.Ultrasound investigations done during the antenatal period, helps in directing anomalies of the kidney which is to be followed inthe postnatal period. The aim of the writing this case report is to establish the importance of antenatal diagnosis of congenitalmalformations including Eagle-Barrett Syndrome among many others. Prenatal diagnosis of PBS should be considered wheneverthe following ultra- sound anomalies are clearly identified: oligohydramnios, urinary abnormalities (dilatation of the urinary tract,megacystis, bilateral hydroureteronephrosis), and the absence of abdominal musculature. Routine screening during the antenatalperiod with ultrasound helps in detecting anomalies of the kidney at an earlier stage . This help in initiating optimal treatment toavoid the fatal cause of Prune Belly Syndrome

Imaging and clinical findings in late presenting posterior urethral valves in a resource-constrained economy

Posterior Urethral Valve (PUV) is the commonest cause of lower urinary tract obstruction in male children. Late presentation with delayed diagnosis is common in our setting. This study aims to review the clinical, biochemical, imaging findings and parental factors in late-presenting posterior urethral valves. A retrospective analysis of patients with PUVs seen at UNTH from 2011-2019 was done. Patients who presented at or later than six months of age were considered late presenters and were studied. Patients’ sociodemographic characteristics, antenatal diagnosis, clinical features, and imaging findings at presentation were retrieved. Data analysis was done using SPSS version 22. Statistical significance was set at a p-value&lt;0.05. Twenty-four cases of PUV with complete clinical data were studied. Mean age 3.3 (SD±2.1) years had a positive association with maternal educational level (p≤0.001). Nineteen (72.9%) had antenatal care, 4 (16.7%) had prenatal Ultrasonography (USS), and were part of those who had antenatal care. None had a prenatal diagnosis. Prenatal USS was associated with higher paternal education (p=0.03). The most common clinical symptom and finding respectively were straining to pass urine 23 (95.8%) and palpable bladder 23 (95.8%). The common electrolyte derangements included hyperkalemia (50%), raised serum urea (70.8%) while postnatal hydronephrosis 23 (95.8%) was the main ultrasound and MCUG findings. Late presentation is common with urinary dysfunction and azotemia. Improved antenatal care including late trimester ultrasound and parental health education will enhance prenatal diagnosis and early presentation.

DIAGNOSIS AND MANAGEMENT OF GALLBLADDER PERFORATION: A SINGLE-CENTER EXPERIENCE

Background: Gall bladder perforation is one of the uncommon serious complications of cholelithiasis and cholecystitis with high morbidity and mortality. Presentation of gall bladder perforation may vary from that of similar to acute calculus cholecystitis, perforation peritonitis, palpable gall bladder mass to gall stone ileus. Here, we present our experience on the diagnosis and management of the case of gall bladder perforation. Methods: This is the retrospective review of the records of 24 patients who received medical and/or surgical treatment with the diagnosis of gall bladder perforation at Chitwan Medical College from January 2016 to December 2020. All the patients with suspicion of gall bladder perforation underwent contrast enhanced CT scan before an operation or prior intervention.The parameters including age, gender, type of perforation, comorbidities, symptoms, diagnostic procedures, treatment modalities, morbidity, and mortality were evaluated. Results: A total of 24 patients were included in the study during the study period. Among them 62.5% (n=15) were male and 37.5% (n=9) were female.The median age of presentation was 69 years. One patient (4.1%) had type I, 87.5% (n= 21) had type II, and 8.3 % (n=2) had type III gall bladder perforation. CT scan visualizes the defect in gall bladder wall and identifies perforation in all cases. Operative management was done in 12.5% (n=3) patients and percutaneous drainage of gallbladder was done in 87.5% (n=21). The comorbid disease was present in 83.3 % (n=20) of the cases. The median duration of hospital stay was 7 days and there was no mortality. Conclusions: Gall bladder perforation is commonly seen in patients with acute cholecystitis and associated comorbidities. Type II gall bladder perforation is the most common type. Contrast-enhanced CT has an important role in diagnosing gallbladder perforation. Early suspicion, diagnosis, and appropriate management are of crucial importance for a better outcome in patients with gall bladder perforation.

Pre-operative Prediction of Difficult Laparoscopic Cholecystectomy

Aim: To evaluate the factors for prediction of difficult laparoscopic cholecystectomy preoperatively. Methods: A Prospective Observational Study conducted at Surgical Unit II, Ghulam Muhammad Mahar Medical College Hospital Sukkur, from February 2020 to January 2021. Data was collected for 580 patients. All the patients fulfilling inclusion criteria were evaluated with following factors: age, gender, BMI, h/o previous GB disease, comorbids, h/o previous abdominal surgery, tender RHC, palpable gallbladder, ultrasonographic findings of gall bladder wall thickness, pericholecystic fluid collection &amp; stone impaction at neck of gall bladder. Patients were assumed to be difficult on presence of one or more of above mentioned risk factors .laparoscopic cholecystectomy was performed by an experienced laparocopic surgeon. Peroperative findings and operative time was noted. Cases were considered difficult if operative time was &gt;60 minutes or if the case was converted to open. All the information was recorded on predesigned proforma. Results: Age ranged from 23 to 70 years (mean age = 46.37 years). 456 patients were female while 124 patients were male. Majority of patients in our study (n=390) had normal BMI(BMI=18.5-24.9)and next majority (n=132) belonged to overweight group(BMI=25-29.9) . On inquiry, 93 patients had history of previous gall bladder disease in form of cholecystitis. Out of 580 patients, 161 patients had one or more comorbids. 39 out of 580 patients had history of previous abdominal surgery. 78 patients had tender right hypochonrium. 62 patients had palpable gall bladder. On ultrasound 73 patients had gall bladder wall thickness &gt;4mm. In 39 patients pericholecystic fluid collection was found. In 33 patients, stone was impacted at the neck of gall bladder. 161 patients were preoperatively labeled as difficult. All the patients underwent laparoscopic cholecystectomy. Mean operative time was 42.56 minutes. 512 patients underwent uneventful laparoscopic cholecystectomy, in 68 patients difficulty was encountered 11 patients were converted to open procedure. Conclusion: We conclude that a careful insight in certain factors can predict the difficult laparoscopic cholecystectomy preoperatively. It acts as an important eye opener for surgeons to get an idea of the potential difficulty to be faced in that particular patient. Keywords: Laparoscopic cholecystectomy, Preoperative, Gall stones, Difficulty

PRESENTATION, MANAGEMENT, AND OUTCOME OF POSTERIOR URETHRAL VALVES IN WESTERN RAJASTHAN

Introduction: Posterior urethral valve (PUV) is the most common cause of bladder outlet obstruction and renal insufciency in male children. The aim of this study was to evaluate the presentation, management, challenges, and outcome of the disease in a Western Rajasthan tertiary health institution. Methods: In a retro-prospective study, 26 male children were included from November 2017 to March 2020 at Dr. S.N.Medical college, Jodhpur. Diagnosis was conrmed by voiding cysto-urethrography (VCUG). Results: A total of 26 patients were managed for PUV.The mean age of presentation was 3.45 years with 65.8% of the patients presenting after 1 year. Voiding dysfunction noted in 23(88.4%) patients was the most common presentation. Most common nding on physical examination was palpable bladder 15(57.6%) while UTI noted in 15 (57.6%) patients was most common complication. Abdominal sonography revealed dilated posterior urethra in 10(38.4%) cases, while VCUG revealed a dilated posterior urethra in 19 (75%) cases.The creatinine value at presentation ranged from 0.4-4.5 mg/dl with a mean of 1.10 ± 0.95 mg/dl. Valve ablation with a diathermy bugbee electrode &amp; holmium laser provided relief of obstructions in the 23 (88.4%) patients who underwent the procedure without immediate complication. The period of follow-up ranged between 1 weeks to 2 years with a mean of 8.2 months. There was sustained improvement in urine stream, reduction in the mean creatinine concentration and incidence of UTI during follow-up. Conclusion: Many patients with PUVpresented late within the reviewed period. Valve ablation provided relief of obstruction in most of the cases. Efforts at improving awareness among general population and early diagnosis and referral among the health team should be encouraged. There is a need to counsel parents on the need for long-term follow-up

AN UNUSUAL CASE OF LARGE PENILE URETHRAL CALCULUS WITH URETHROCUTANEOUS FISTULA IN AN ELDERLY MAN.

Impacted penile urethral calculus complicated with urethrocutaneous stula is a rare condition. Such calculi can form as a result of urethral strictures, meatal stenosis, urethral diverticulum, and migration of stones from the proximal urinary tract. A 65 year old male presented to our emergency department with complaints of fever and urinary dribbling since 2-3 weeks and obstructive lower urinary tract symptoms since 6 months. He showed features of sepsis and a palpable bladder on examination. Xray KUB and penile USG was suggestive of a 2x1.5cm distal penile urethral calculus. In this paper we present our approach to such case.

Clinical characteristics and outcome of high-pressure chronic urinary retention: A systematic review

Background: Although not infrequent, publications on high-pressure chronic urinary retention (HPCR) are limited. Lack of awareness of this condition can lead to delayed diagnosis and suboptimal treatment. This systematic review aimed to describe the clinical characteristics and outcome of HPCR. Methods: Keywords were searched in PubMed, Scopus, EMBASE, LILACS, Cochrane-CENTRAL, APAMED Central and Google Scholar. Relevant articles were added from the list of references of eligible articles. Studies describing any two of the characteristic features related to HPCR were included. Qualitative analysis was performed using the available data. Results: Eight prospective studies with 271 patients ( Mage=66.4 years, range 14–89 years; 263 males) were identified. The commonest presentation was tense painless palpable bladder (99.6%). Late-onset nocturnal enuresis was reported in 68.4%, and resistant hypertension was reported in 41.6%. Elevated levels of serum creatinine were identified in 43–81%. Benign prostatic hyperplasia (64.1%) was the commonest aetiology followed by prostatic malignancy (22.6%). A satisfactory response was seen following the definitive treatment of the underlying aetiology. Initial bladder decompression reversed adverse cardiovascular changes and improved renal function but resulted in post-obstructive diuresis. Heterogeneity of the reported data in available studies was a major limitation. Conclusions: Late-onset nocturnal enuresis, a tense painless and non-tender palpable bladder and treatment-resistant hypertension are important clinical findings which would raise the suspicion of HPCR in the clinical setting. Urinary tract ultrasonography showing upper-tract dilatation and raised serum creatinine support the diagnosis. Definitive treatment targeting the underlying aetiology following careful decompression of the bladder showed satisfactory outcomes. Level of evidence: Level 2a(-).

Determination of predictive factors for difficult laparoscopic cholecystectomy

Background: Cholelithiasis is the most common biliary pathology, with a prevalence of 10 to 15%. It is symptomatic in approximately 1 to 2% of patients. In about 5 to 10% of laparoscopic cholecystectomy, conversion to open cholecystectomy may be needed for safe removal of gallbladder. Laparoscopic cholecystectomy (LC) may be rendered difficult by various problems encountered during surgery. The objective of this study was to predict difficulty of LC before surgery using the clinical and ultrasonographic criteria.Methods: The present study comprised of 45 cases admitted to National Medical College Teaching Hospital (NMCTH), Birgunj (Nepal) for a period of 12 months from 1st August 2013 to 30th September 2014. The cases confirmed by Ultrasonography were evaluated with following risk factors: age &gt;50 years, male sex, BMI 25.1 to 27.5 and &gt;27.5, previous surgery, prior hospitalization, palpable gall bladder, gall bladder wall thickening, impacted stone, pericholecystic collection and presence of adhesions. Each risk factor was given a score. The total score up to 5 predicted easy, 6 to 10 difficult and more than 10 very difficult.Results: The highest age incidence of Cholelithiasis was in the 2nd to 4th decade and was more common in females. Ultrasonography detected gallbladder stones in all patients, wall thickening in 15 and pericholecystic collection in 8. BMI &gt;27.5 presence of adhesions, male sex and pericholecystic collection were significant predictors of difficult laparoscopic cholecystectomy.Conclusions: Numerous clinical, radiological and pre-operative features make LC sometimes difficult. Early determination of these predictive factors decreases the difficulty that we will be facing with LC.

Predictors of Postoperative Urinary Retention Following Pulmonary Resection

To identify predictors of postoperative urinary retention (POUR) following pulmonary resection. Retrospective chart review from a single academic institution of all patients who underwent pulmonary resection between June 2004 and January 2020. The surgical procedures consisted of pneumonectomy, lobectomy and sublobar resections. The primary outcome was occurrence of POUR within 30 days following surgery, defined as painful and palpable bladder, when the patient is unable to pass any urine, and requiring catheterization. A total of 6004 consecutive patients underwent pulmonary resection among which 306 pneumonectomies (5.1%), 3467 lobectomies (57.7%) and 2231 sublobar resection (37.2%). The surgical approach was a thoracotomy (n = 3546; 59.1%), a video-assisted [VATS] (n = 2075; 34.5%) or a robot-assisted thoracoscopy [RATS] (n = 383; 6.4%). POUR occurred in 301 cases (5%). On multivariable logistic regression analysis, male gender (OR 2.30 [1.70-3.17]; P < 0.001), age (OR 1.02 [1.01-1.03]; P < 0.001), benign prostatic hyperplasia (OR 7.08 [4.57-10.83]; P < 0.001), and COPD (OR 1.52 [1.13-2.01]; P = 0.004) were significant predictors of POUR. Conversely, VATS (OR 0.62 [0.46-0.83]; P = 0.001) had a protective effect on the occurrence of POUR. In a large single-center study, we disclosed significant clinical predictors of POUR after pulmonary resection, including age, sex, comorbidities and surgical approach. Prospective studies are necessary to evaluate the efficacy of chemoprophylaxis by perioperative α-blockers in order to prevent POUR.

Adolescent Haematocolpos: Seek and You Shall Find

An adolescent girl presented to the emergency department with a history of abdominal pain, dribbling, and inability to pass urine for the last 24 hours. The initial observations and examination of respiratory, cardiovascular, ears, nose, and throat (ENT), central nervous system (CNS) and musculoskeletal systems were normal. No onset of menses reported by the patient. She was found to have a palpable distended bladder on abdominal examination. A catheter was inserted by the nurse, who reported no abnormalities. The physician did not perform a FAST scan nor conduct a genital examination. The patient was referred to the paediatrics department and the following day an ultrasound examination led to a diagnosis of haematometrocolpos. The patient was the referred to the obstetric and gynaecological department. Corrective surgery was conducted the following day and she was discharged on the fourth day. While the diagnosis and treatment were correct, had a FAST scan and/or genital examination been part of the initial work-up, diagnosis would have been made in the emergency department and an appropriate referral made directly to obstetric and gynaecological team. Rapid diagnosis and treatment would have benefitted the patient, reduced the risks of complications, and cut the length of stay in the hospital by as much as two days.

Predictors of Difficulty in Laproscopic Cholecystectomy -a Retrospective Study from a Tertiary Care Centre of Northern India

Introduction: Laparoscopic cholecystectomy (LC) has become the gold standard treatment for the management of symptomatic gall stone disease but a small yet significant number of LC procedures turn out to be difficult during the procedure. Knowledge of factors that can help in predicting the difficulty can help in better preoperative planning. Aim: To develop and validate a scoring method to predict difficult and very difficult LC preoperatively. Materials and Methods: This was a retrospective study conducted on medical records of 122 patients with gall stone disease. A quantitative tool based on age, gender, hospitalization history, the clinical and sonographic profile was designed to capture relevant information from these 122 patients postoperatively and was analysed. There was a total score of 21 from history, clinical, sonological findings. A score up to 7 was predicted as easy, 8–14 as difficult and > 14 as very difficult. The proposed scoring was compared against the laparoscopic difficulty criteria suggested by Randhawa and Pujahari. Data were analyzed using SPSS 21.0 version. Chi-square test and Independent samples ‘t’-test were used to compare the data. Results : History of hospitalization (p 27.5 kg/m2 (p = 0.017), abdominal scar (p=0.001), palpable gall bladder(p < 0.001), thickened wall of the gall bladder(p = 0.010), Pericholecystic collection (p=0.005) and raised ALP (p = 0.002) were found to be significantly contributing in predicting the outcome of surgery. Conclusion: The proposed scoring system was effective and can be helpful in diagnosing preoperatively into easy, difficult and very difficult cases

Assessment of a Scoring System to Predict Difficult Laparoscopic Cholecystectomy

Introduction Laparoscopic cholecystectomy (LC) has become the procedure of choice for management of symptomatic gallstone disease. It would be useful to have some reliable predictive factors for conversion in LC. Our aim is to predict difficult laparoscopic cholecystectomy preoperatively by using a scoring system.&#x0D; MethodsA total of 136 patients were included. The parameters considered for this study were old age, male sex, history of hospitalization, obesity, abdominal surgery scar, palpable gall bladder, gall bladder wall thickness, pericholecystic collection and impacted stone.&#x0D; ResultsAmong 136 cases, 70.6% were easy, 24.3% were difficult and 5.1% were very difficult intraoperatively. The factors like age &gt;50 years, history of hospitalization for acute cholecystitis, previous abdominal surgery, palpable gall bladder, wall thickness &gt;4mm and impacted stone were found statistically significant in predicting difficult LC. The preoperative scoring is statistically and clinically a good test for predicting the difficult LC (area under the curve = 0.824) with sensitivity of the test being 82.3% and specificity 72.7%. Conversion rate was 3.67%.&#x0D; ConclusionThe factors like age &gt;50 years, history of hospitalization for acute cholecystitis, previous abdominal surgery, palpable gall bladder, wall thickness &gt;4 mm and impacted stone are the preoperative predictors of difficult LC.

Assessment of a Scoring System to Predict Difficult Laparoscopic Cholecystectomy

Introduction: Laparoscopic cholecystectomy (LC) has become the procedure of choice for management of symptomatic gallstone disease. It would be useful to have some reliable predictive factors for conversion in LC. Our aim is to predict difficult laparoscopic cholecystectomy preoperatively by using a scoring system. Methods: A total of 136 patients were included. The parameters considered for this study were old age, male sex, history of hospitalization, obesity, abdominal surgery scar, palpable gall bladder, gall bladder wall thickness, pericholecystic collection and impacted stone. Results: Among 136 cases, 70.6% were easy, 24.3% were difficult and 5.1% were very difficult intraoperatively. The factors like age &gt;50 years, history of hospitalization for acute cholecystitis, previous abdominal surgery, palpable gall bladder, wall thickness &gt;4mm and impacted stone were found statistically significant in predicting difficult LC. The preoperative scoring is statistically and clinically a good test for predicting the difficult LC (area under the curve = 0.824) with sensitivity of the test being 82.3% and specificity 72.7%. Conversion rate was 3.67%. Conclusion: The factors like age &gt;50 years, history of hospitalization for acute cholecystitis, previous abdominal surgery, palpable gall bladder, wall thickness &gt;4 mm and impacted stone are the preoperative predictors of difficult LC.