Pelvic Collections Research Articles

Endoscopic Ultrasound-Guided Drainage of Pelvic Fluid Collections with Lumen-Apposing Metal Stents

Introduction: A pelvic abscess is a potential life-threatening condition that should be managed conservatively whenever possible. Currently, computed tomography or ultrasound-guided percutaneous drainage is still the gold standard approach for pelvic fluid collections (PFCs) requiring intervention. More recently, endoscopic ultrasound (EUS) drainage using lumen-apposing metal stents (LAMSs) has been used off-label in PFCs with similar efficacy, a favorable safety profile, better quality of life, and generally a shorter duration of treatment when compared to the gold standard treatment. Methods: An observational retrospective analysis of 6 patients who underwent EUS-guided PFC drainage with LAMS at our institution was conducted. Records were reviewed to identify etiology, size of the collection, number of endoscopic procedures required until complete resolution, stent indwelling time, concomitant surgical or percutaneous associated procedures, successful removal and resolution. Results: The 6 patients included had an average age of 69 years old and 5 (83.3%) were male. The average size of the PFCs was 72.5 mm. All patients (100%) had successful drainage following LAMS placement, though 1 patient had an early recurrence. The mean stent indwelling time in our study was 6.7 days. An additional percutaneous or surgical drainage intervention was not required in any of the participants. Also, no adverse events related to the procedure were reported during the follow-up period. Conclusion: EUS-guided drainage of PFCs with LAMS is a safe and minimally invasive technique, which allows rapid PFC resolution, with no need for percutaneous or surgical drainage interventions.

S3987 Novel Endoscopic Approach of Transluminal Drainage for Deep Pelvic Collections in Acute Necrotizing Pancreatitis

S3987 Novel Endoscopic Approach of Transluminal Drainage for Deep Pelvic Collections in Acute Necrotizing Pancreatitis

A Preliminary Phenomenological Exploration of Experiences of the Empty Pelvis Syndrome Derived From a Modified-Delphi: The Price of Survival Following Pelvic Exenteration for Advanced Pelvic Cancer.

The empty pelvis syndrome (EPS) is common after pelvic exenteration (PE), causing fluid collections, bowel obstruction, perineal sinuses, and fistulas. The best approach to fill the pelvis to mitigate this remains controversial, and the impact of EPS on health-related quality of life (HrQoL) is unknown. This study is the first to begin to explore lived-experiences of EPS complications. Unstructured EPS virtual focus group meetings were conducted with a convenience sample of patients who underwent PE, as an extension of a modified-Delphi study. Interpretative phenomenological analysis was conducted on verbatim transcripts to generate group experiential themes. Twelve patients (eight UK, one Dutch, and three Belgian) participated in four focus groups. Eight EPS complications were reported, (two pelvic collections, five chronic perineal sinuses, and one bowel obstruction). Group experiential themes were 'Out of Options', depicting patients forced to accept complications or limited survival; 'The New Normal', with EPS potentially delaying adaptation to post-PE HrQoL; 'Information Influencing Adaptation,' emphasising the significance of patients understanding EPS to cope with its effects; and 'Symptoms,' reporting manifestations of EPS, the resultant physical limitations, and an intangible feeling that patients lost part of themselves. EPS may influence patient decision-making, regret, adaptation, and information-seeking. It can cause a variety of unpleasant symptoms and physical limitations, which may include phantom phenomenon. This work supports ongoing purposeful HrQoL research to better define these themes.

The Ghost Of Hip Arthroplasties Past: It Takes A Geriatrician To Mine For Metal

Abstract Background An 84-year-old female presented to Geriatric Medicine out-patient clinic with many years of persistent right hip pain, generalised myalgia; and several months of constipation, weight loss and persistent elevation of C-reactive protein and Erythrocyte Sedimentation Rate. The General Practitioner's concern was occult neoplasm. History of right hip arthroplasty in 2011. 6 years prior, she had wide local excision and adjuvant radiotherapy for a grade 3, “triple negative”, invasive ductal carcinoma of the right breast. Serial imaging identified a right parasternal, internal mammary chain neurofibroma. A Rheumatologist had administered intra-articular steroid to both glenohumeral joints for plain X-ray confirmed osteoarthritis, in the absence of serological vasculitic or autoimmune rheumatological disease. Benefit was transient. Her Oncologist had arranged MRI spine for “sciatica” demonstrating L3/4 and L4/5 stenosis and a large right adnexal cyst. Subsequently, the Gynaecology team assessed and planned interval MRI pelvis as initial MRI suggested a right partial hydrosalpinx, left internal chain lymphadenopathy and nodule adjacent to sacroiliac joint. Methods History, examination and imaging results were checked against the Medical Device Alert number 18 from the Medicines and Healthcare products Regulatory Agency (UK) in 2017. Oxford Hip Score Assessment was 29. Lymphatic drainage from medial hip joint is towards right iliac chain. Results In the absence of Gadolinium based contrast agents within 96hours, metal testing demonstrated: Serum Cobalt was 232nmol/L or 13.7 ug/L; Serum Chromium was 78.8nmol/L or 4.1ug/L; Chromium Urine: Creatinine Urine Ratio was 24.54nmol/mmol; and Cobalt Urine: Creatinine Urine Ratio73.96nmol/mmol. These elevated blood and urine results confirmed metal-on-metal hip disease. Conclusion Consider symptomatic metal-on-metal hip disease with soft-tissue involvement in patients presenting with post-hip arthroplasty joint pain, generalised myalgia and raised inflammatory markers; particularly if there is unexplained ipsilateral internal iliac chain lymphadenopathy and pelvic fluid collections. If confirmed, metalwork explanation is the treatment.

Safety assessment of basiliximab using real-world adverse event data from the FDA Adverse Event Reporting System Database: A retrospective observational study.

This study analyzed adverse drug events (ADEs) associated with basiliximab, sourced from the Food and Drug Administration Adverse Event Reporting System (FAERS) database, spanning the first quarter of 2004 to the fourth quarter of 2023. We collected ADE data for basiliximab from 2004 Q1 to 2023 Q4. After standardization, we employed several signal quantification methods for analysis, such as the Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propensity for Neural Networks (BCPNN), and empirical bayes geometric mean (EBGM). In this analysis of 1520 ADEs reports citing basiliximab as the primary suspect, we identified 295 preferred terms across 24 system organ classifications (SOCs). The 3 most prevalent SOCs were investigated (n = 1403, ROR 2.84, PRR 2.54, IC 1.34, EBGM 2.54), infections and infestations (n = 1198, ROR 2.85, PRR 2.59, IC 1.37, EBGM 2.59), and renal and urinary disorders (n = 903, ROR 6.01, PRR 5.48, IC 2.45, EBGM 5.47). Increased blood creatinine and pyrexia were the most frequently reported adverse events (AEs) associated with basiliximab, and cytomegalovirus infection also demonstrated significant signal intensity. Notably, this study revealed some adverse reactions beyond basiliximab drug instructions, such as mitral valve calcification, diastolic dysfunction, pelvic fluid collection, testicular swelling, soft tissue necrosis, and muscle necrosis. Although basiliximab offers therapeutic benefits, it carries the risk of several adverse reactions. Clinicians should monitor patients for signs of increased serum creatinine level, fever, cytomegalovirus infection, anaphylactic shock, mitral valve calcification, diastolic dysfunction, pelvic fluid collection, testicular swelling, soft tissue necrosis, muscle necrosis, and other events during clinical use.

Association of Crowd-Sourced Assessment of Technical Skills and Outcomes of Robotic-assisted Radical Prostatectomy

ObjectiveTo investigate if use of the Crowd-Sourced Assessment of Technical Skills (CSATSTM) platform and video peer review with constructive feedback is associated with improvement in technical skill and patient outcomes for robotic-assisted laparoscopic prostatectomy (RALP). MethodsFive fellowship-trained urologists voluntarily submitted RALP cases for CSATSTM Global Evaluative Assessment of Robotic Skills (GEARS) scoring and expert narrative review between April 15, 2022 - April 30, 2023. Surgeon-selected and randomly-selected cases were reviewed. Surgeons underwent local peer review of videos with constructive feedback. Change in GEARS scores and frequency of post-operative outcomes over the 12-month periods before and during the study were analyzed in logistic regression models. Bias was assessed with sensitivity analysis comparing surgeon-selected to randomly-selected cases. ResultsGEARS scores for randomly-selected versus surgeon-selected cases did not differ significantly. Overall GEARS score correlated positively with annual surgical RALP volume (r=0.39, p=0.003) and negatively with years in practice (r=-0.34, p=0.01). After adjusting for confounders, there was no significant improvement in overall GEARS Score (0.01±0.02/month, p=0.48); but likelihood of sepsis (Odds Ratio 0.07, 95% CI 0.01-1.00, p=0.05) and pelvic fluid collection (Odds Ratio 0.09, 95% CI 0.01-0.99, p=0.049) were significantly decreased during the intervention period (n=165) compared to the prior 12 months (n=144). No outcome increased in likelihood (p>0.05). ConclusionsIntegration of CSATSTM and local video peer review is associated with significant improvement in patient outcomes after RALP, despite no significant change in surgeons’ GEARS scores. This is the first study demonstrating improvement in patient RALP outcomes after implementation of such a paradigm in practicing surgeons.

Laparoscopic drainage versus interventional radiology for management of appendicular abscess: a randomized controlled trial

Background Laparoscopic drainage of appendicular abscess has become a novel technique due to its advantages over interventional radiology like a complete exploration of the abdomen, exclusion of other pathologies, excision of the appendix at the same session, better cosmesis, decreased incidence of wound infection, better visualization of surgical field, fine handling of edematous tissue and drainage of multiple collections. Patients and methods This randomized controlled clinical trial included all patients who developed the manifestations of appendicular abscess and were referred to the Zagazig University Hospital Emergency Department between January 2020 and February 2022. The study was prospectively approved by the Zagazig University Faculty of Medicine Institutional Review Board (Approval Number: 9871/26-9-2022), and was retrospectively submitted to clinicaltrials.gov in June 2022 (ClinicalTrials.gov ID: NCT05419440). The sample size was 172 patients divided into two equal groups, a laparoscopic group involved 86 patients (group 1) and an interventional radiology group involved 86 patients (group 2). Results Group 1 (laparoscopic drainage group) included 86 patients: 55.8% were males, with a mean age of 41.2 SD 12.2 years-old, while group 2 (interventional radiology group) included 86 patients: 51.2% were males, with a mean age of 36.8 SD 10.9 years-old. The incidence of reported complications in group (1) was 1 (1.2%) for bowel injury, 3 (3.5%) for fecal fistula, 0 (0%) for recurrence, 0 (0%) for pelvic collection and 0 (0%) for mortality while in group (2) were 5 (5.8%) for bowel injury, 0 (0%) for fecal fistula, 3 (3.5%) for recurrence, 8 (9.3%) for pelvic collection and 1 (1.2%). The incidence rates of quality of life in group (1) were 48 (55.8%) for excellent quality of life, 38 (44.2%) for good quality of life and 0 (0%) for poor quality of life, unlike group (2), the incidence rates of quality of life were 12 (14%) for excellent quality of life, 59 (68.6%) for good quality of life and 15 (17.4%) for poor quality of life. Conclusion Laparoscopic management of appendicular abscess was safely applied in a good experienced hand without the need for interval appendectomy.

The empty pelvis syndrome: a core data set from the PelvEx collaborative.

Empty pelvis syndrome (EPS) is a significant source of morbidity following pelvic exenteration (PE), but is undefined. EPS outcome reporting and descriptors of radicality of PE are inconsistent; therefore, the best approaches for prevention are unknown. To facilitate future research into EPS, the aim of this study is to define a measurable core outcome set, core descriptor set and written definition for EPS. Consensus on strategies to mitigate EPS was also explored. Three-stage consensus methodology was used: longlisting with systematic review, healthcare professional event, patient engagement, and Delphi-piloting; shortlisting with two rounds of modified Delphi; and a confirmatory stage using a modified nominal group technique. This included a selection of measurement instruments, and iterative generation of a written EPS definition. One hundred and three and 119 participants took part in the modified Delphi and consensus meetings, respectively. This encompassed international patient and healthcare professional representation with multidisciplinary input. Seventy statements were longlisted, seven core outcomes (bowel obstruction, enteroperineal fistula, chronic perineal sinus, infected pelvic collection, bowel obstruction, morbidity from reconstruction, re-intervention, and quality of life), and four core descriptors (magnitude of surgery, radiotherapy-induced damage, methods of reconstruction, and changes in volume of pelvic dead space) reached consensus-where applicable, measurement of these outcomes and descriptors was defined. A written definition for EPS was agreed. EPS is an area of unmet research and clinical need. This study provides an agreed definition and core data set for EPS to facilitate further research.

Endoscopic management of complex colorectal anastomotic leakage with a pelvic collection and rectovaginal fistula.

Endoscopic management of complex colorectal anastomotic leakage with a pelvic collection and rectovaginal fistula.

Value of total leucocytic count and pelvic-abdominal ultrasound in distinguishing complicated from noncomplicated acute appendicitis

Background Complicated appendicitis is associated with elevated rates of morbidity and mortality compared with noncomplicated appendicitis. In this study, we aimed to investigate the role of combining total leucocytic count (TLC) and abdominal ultrasound (US) in distinguishing simple from complicated appendicitis. Patients and methods This is a prospective study that included patients with acute appendicitis who underwent appendectomy. The patients’ data regarding demographic characteristics, clinical, laboratory, and US findings, as well as intraoperative findings and postoperative complications, were recorded and analyzed. Results This study included 80 patients. Overall, 48 (60%) patients had noncomplicated appendicitis, and 32 (40%) had complicated appendicitis. Patients with complicated appendicitis had significantly higher ages and TLC. Concerning the US findings, significantly higher cases of visualized blind-ended loop (P = 0.042), right iliac fossa fluid (P = 0.006), and pelvic collection (P < 0.001) were shown in the complicated group. Multiple regression analysis revealed that TLC and the presence of pelvic collection by the US were the only variables significantly predicting complicated appendicitis. Adopting either a TLC cut-off value of 12.95×109/l and/or the presence of pelvic collection for the diagnosis yielded a sensitivity of 90.6%, a specificity of 77.1%, and an accuracy of 82.5%. Conclusion The presence of a TLC cut-off value of 12.95×109/l and/or a pelvic collection in abdominal ultrasound seems to be reproducible for the preoperative prediction of complicated acute appendicitis.

267 Perforated Meckels diverticulitis; a cautionary tale highlighting the importance of accurate vetting information in the selection and interpretation of radiological investigations

Abstract Background Failure of the vitelline duct involution process during the 7th week of gestation gives rise to the most common congenital anomaly of the GI tract; Meckel’s diverticulum. Clinical presentation is extremely variable. We present an unusual case of a perforated Meckel’s diverticulitis and a cautionary tale highlighting the importance of accurate clinical information when requesting radiological investigations. Case report An 18 year old gentleman presented acutely with 24 hours of rectal pain and associated fever. There were no urinary or penile symptoms. Examination revealed lower abdominal tenderness. Rectal and prostatic examination were normal. Abdominal ultrasound revealed a dilated appendix with surrounding free fluid. Diagnostic laparoscopy revealed pus in the right iliac fossa with a submerged and mildly injected appendix. A separate cause was sought – a perforated small bowel diverticulum was found in a 600mL pelvic collection. The procedure was converted to a Laparotomy with small bowel resection and side-side anastomosis plus appendicectomy and washout. Post-operative histology revealed a perforated Meckel’s diverticulitis. Discussion This unusual case highlights the importance of using the correct radiological investigation at the correct time for the correct clinical query. Clinical information supplied to radiologists, particularly ultrasonographer's, drastically alters the extent of examination and interpretation of imaging. Conclusion Providing accurate clinical information to Radiologists is key for accurate interpretation of imaging. Inaccurate information impacts the ability to arrive at the correct diagnosis, give the correct treatment and, in a surgical setting, complete the correct consent process for the patient.

Cervical Os Marsupialization in the Initial Management of a Rare Case of Obstructive Uterine Didelphys with Ipsilateral Renal Agenesis

Introduction: Uterine didelphys is an uncommon Mullerian anomaly that often is associated with obstructive pathology. Without early intervention, obstruction can progress to potentially fatal complications including pyometra and sepsis. Due to the rarity and variability of this condition, treatment options have not been systematically studied. Case Description: In this case report, we discuss a 16-year-old female who presented with acute sepsis secondary to pyometra in the setting of chronic dysmenorrhea and purulent vaginal discharge. On imaging, she was found to have uterus didelphys with right renal agenesis and a hypoplastic right cervix along with a pelvic fluid collection. During exam under anesthesia, no obstructing hemivagina was found, however the right cervical os was identified with purulent material draining from it and identified as the site of obstruction. The right cervical os was extended and its edges marsupialized. The patient recovered well postoperatively with a course of antibiotics and continued to be followed in an outpatient setting, where she was started on Depo Provera for menstrual suppression. She remained asymptomatic for months, but after discontinuing the Depo for some time, began to experience pelvic pain and purulent vaginal discharge again. While she agreed to resume Depo treatment, definitive treatment with right hemihysterectomy was discussed and eventually undertaken. Discussion: Although hemihysterectomy may be required in many cases, the technique of marsupialization of a cervical os is unique and may be a new approach to patients with non-classic anatomic presentations of obstructive symptoms with uterine didelphys.

Pilot Study on the Influence of Incentive Spirometry on Percutaneous Image-Guided Intra-Abdominal Drainage Catheter Pressure: A Potential Method to Enhance Drainage.

To report the evaluation of incentive spirometry (IS)-induced pressure changes in intra-abdominal drainage catheters and consider its use for maintaining catheter patency and enhancing drainage. Prospective study of patients with indwelling intra-abdominal drainage catheters for abdominal fluid collections who had their intra-abdominal pressures measured while performing incentive spirometry. Patients were instructed in the use of an incentive spirometer. Within a week after initial drainage, pressure changes with IS were evaluated three times at 1500 cc and three times at maximum inspiratory effort. Intra-abdominal pressure (IAP) was measured using a pressure monitor connected to the drainage catheter. Twenty patients (men, 12; women, 8). Fluid collection locations were pelvis, Right-upper quadrant (RUQ), Left-upper quadrant (LUQ), Left-lower quadrant (LLQ), and Right-lower quadrant (RLQ). A total of 16 of 20 patients showed an elevation of IAP with IS. At 1500 cc, the pressure increased by an average of 41.24 mmH2O. At maximal inspiratory effort, the pressure increased by an average of 48.26 mmH2O. Pressure increase was greater in upper abdomen catheters. Four patients with lower abdominal and pelvic collections showed minimal pressure changes with IS. IS increases IAP and fluid flow through abdominal drainage catheters. Future studies are warranted to determine whether the use of IS enhances catheter performance and facilitates drainage via its effect on IAP.

Clinical Prospective Study of Post-Operative Morbidity and Mortality After Low Anterior Resection with Preventive Diverting Loop Ileostomy in Patients of Rectal Cancer

Background: Rectal cancer continues to be devastating malignancy worldwide. Faecal diversion is an important tool in the surgical management of rectal cancer. The presence of stoma may also increase the risk of complications related to stoma itself (high stoma flow, retraction, prolapse, kidney failure, skin excoriation etc.). Aims: To measure postoperative morbidity and mortality after low anterior resection with preventive diverting loop ileostomy in patients of rectal cancer Material and methods: This is a prospective study and was carried out between december 2021 to November 2022. Total 28 patients who underwent LAR with Diversion stoma were included according to pre-defined inclusion and exclusion criteria. Results: Male to female ratio was 1.8:1.Mean age was 57.92±15.85 years. 1 (3.57%) patient had anastomotic leak, 3 (10.71%) had wound infection, 6 patients (21.42%) had chest infection, 1 (3.57%) patients pelvic collection, 9(32.15%) patients had electrolyte imbalance, 2(7.14%) patients had ileus. Mean hospital duration during primary surgery of patients was 11.46±2.47. Mean Post stoma closure hospital stay was 5.84 (±1.57) days. Out of total 28 patients 1(3.57%) patient died, 25 (89.29%) patients underwent subsequent stoma closure. Rest 2(7.14%) patients had their ileostomy as a permanent stoma. Conclusions: Decision to create or not to create diversion stoma should be on case to case basis upon operating surgeon’s discretion with shared information to patient and his/her family with their involvement in decision making.

OC-097 A THREE LAYERED REPAIR OF A LARGE PERINEAL HERNIA- CASE REPORT AND REVIEW OF THE LITERATURE

Abstract Background A symptomatic perineal hernia is an uncommon complication after abdominoperineal resection (APR). Repairs of such hernias can be achieved by usage of autologous flaps, synthetic mesh or biologic mesh. Studies have shown that prophylactic repair of the pelvic floor with biologic mesh, reduces the incidence of perineal hernia. Data of perineal hernia repair methods are scarce and of poor quality. Aim In this paper we aim to share our experience using a non-conventional technic for the repair of A perineal hernia, as it appears to be a surgical challenge without a clear evidence based recommended technique. Methods A 71-year-old woman, after extended APR with primary closure of pelvic floor with a biosynthetic absorbable mesh, presented to our clinic with a symptomatic, extensive perineal hernia. The patient underwent an open reconstruction of the pelvic floor using a synthetic composite mesh in an underlay intraperitoneal position and a bilateral gluteal muscle flap closure. Results In post-operative-day 11 the patient developed a pelvic fluid collection and surgical site infection. The collection was surgically drained showing clear fluid negative for bacteria and antibiotic treatment was initiated. 3 months after surgery the wound had completely healed and A CT scan showed no recurrence of the hernia. Conclusion Considering the increased incidence of perineal hernia after APR and the superiority of a synthetic mesh in minimizing recurrence rates- a primary closure of the pelvic floor with a synthetic mesh or autologous flap might be justified.

P-004 APPENDICITIS CAUSING CHRONIC MESH INFECTION: A CASE SERIES OF TWO PATIENTS

Abstract Aim To discuss appendicitis as a cause of chronic mesh infection. Methods This study reports two patients with previous inguinal hernia repair who presented with recurrent groin infections resulting from appendicitis. Results Patient 1 had a history of laparoscopic bilateral inguinal hernia repair, followed by an open repair of a unilateral recurrence. He presented twice with groin pain and discharge. Sinugram demonstrated a superficial tract, but intra-operatively the sinus tract extended to the deep ring where the appendix was adherent and inflamed. There was also a meshoma of the preperitoneal mesh. He underwent appendicectomy and excision of meshoma. Patient 2 presented with perforated appendicitis with a large pelvic collection extending into the anterior abdominal wall. This was treated with percutaneous drainage and antibiotics. Further presentations with recurrent abscesses prompted a laparoscopy where an inflamed appendix was found adherent to the previous mesh through a hole in the peritoneum in a pre-peritoneal abscess cavity. He underwent appendicectomy and washout without mesh removal. Both patients remain symptom free at 10 months and 1 month respectively. Conclusion Literature review found reports of mesh-related appendicitis but no cases of appendicitis causing chronic mesh infection. Whilst rare, appendicitis causing chronic mesh infection should be considered in patients presenting with recurrent groin pain and abscesses having previously undergone inguinal hernia repair. Whilst we do not have long term follow up data, our experience indicates that these patients can be managed with or without mesh removal, providing the appendix is removed and the source of sepsis controlled.

V08-08 ENDOSCOPIC URETHRAL STUMP CLOSURE WITH A NOVEL SUTURE DEVICE

You have accessJournal of UrologyCME1 Apr 2023V08-08 ENDOSCOPIC URETHRAL STUMP CLOSURE WITH A NOVEL SUTURE DEVICE Bridget l. Findlay, jayson P. Kemble, Felicia L. Balzano, and Jonathan N. Warner Bridget l. FindlayBridget l. Findlay More articles by this author , jayson P. Kemblejayson P. Kemble More articles by this author , Felicia L. BalzanoFelicia L. Balzano More articles by this author , and Jonathan N. WarnerJonathan N. Warner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003306.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Symptomatic lymphoceles are a rare occurrence following pelvic lymph node dissection. Persistent lymphoceles can affect scarring and closure of the urethral stump following radical cystectomy. While this is a rare occurrence, traditional management includes endoscopic fulguration of the proximal urethral stump. Herein, we aim to describe a novel endoscopic technique for urethral stump closure in a patient with persistent urethral drainage in the setting of a recurrent pelvic lymphocele following radical cystectomy. METHODS: A 60-year-old male with history of muscle invasive small cell carcinoma of the bladder underwent robotic assisted radical cystectomy with pelvic and para-aortic lymph node dissection and Indiana pouch creation in November 2021 following neoadjuvant chemotherapy. He developed a symptomatic lymphocele in February 2022 with persistent urethral drainage. He underwent aspiration of the pelvic fluid collection and endoscopic urethral fulguration without improvement. He was then referred for second opinion, where he elected to proceed with endoscopic fulguration and closure using a laparoscopic suture device (RD-180; LSI Solutions, Rochester, NY) and novel endoscopic sheath (JNW UrtractTM; LSI Solutions, Rochester, NY). Prior to surgery, a pigtail drain was placed in the pelvic fluid collection. The proximal stump was fulgurated using the bipolar plasma band via a 27 Fr cystourethroscope (Olympus Surgical Technologies America, Westborough, MA) to facilitate scarring. The stump was closed using the RD-180 under direct visualization in a figure of eight fashion both proximally at the opening and 1cm distally. Knots were fashioned using the Ti-Knot fastener (LSI Solutions, Rochester, NY). RESULTS: Total operative time was 37 minutes and the patient discharged same day. His follow-up CT scan locally 2 months postoperatively demonstrated resolution of the pelvic fluid collection, and his drain was removed. He remains asymptomatic without recurrence of urethral drainage 4 months postoperatively. CONCLUSIONS: To our knowledge, this is the first described case of endoscopic closure of a urethral stump in the setting of persistent drainage from a pelvic lymphocele. Fulguration with endoscopic closure using a novel device is both a safe and efficacious alternative to performing urethral fulguration alone. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e751 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bridget l. Findlay More articles by this author jayson P. Kemble More articles by this author Felicia L. Balzano More articles by this author Jonathan N. Warner More articles by this author Expand All Advertisement PDF downloadLoading ...

Sexual, urinary, and intestinal dysfunction after rectal surgery: pre-, intra-, and post-operative predictors and trends over time in a single high-volume center.

The incidence of long-term complications after rectal surgery varies widely among studies, and data regarding functional sequelae after transanal surgery are lacking. The aim of this study is to describe the incidence and change over time of sexual, urinary, and intestinal dysfunction in a single-center cohort, identifying independent predictors of dysfunction. A retrospective analysis of all rectal resections performed between March 2016 and March 2020 at our institution was conducted. Validated questionnaires were administered to assess post-operative function. Predictors of dysfunction were assessed by univariate and multivariate analysis. Latent class analysis was used to distinguish different risk profile classes. One hundred and forty-five patients were included. Sexual dysfunction at 1month rose to 37% for both sexes, whereas urinary dysfunction reached 34% in males only. A significant (p < 0.05) improvement in urogenital function was observed between 1 and 6months only. Intestinal dysfunction increased at 1month, with no significant improvement between 1 and 12months. Independent predictors of genitourinary dysfunction were post-operative urinary retention, pelvic collection, and Clavien-Dindo score ≥ III (p < 0.05). Transanal surgery resulted an independent predictor of better function (p < 0.05). Transanal approach, Clavien-Dindo score ≥ III, and anastomotic stenosis were independent predictors of higher LARS scores (p < 0.05). Maximum dysfunction was found at 1month after surgery. Improvement was earlier for sexual and urinary dysfunction, whereas intestinal dysfunction improved slower and depended on pelvic floor rehabilitation. Transanal approach was protective for urinary and sexual function, although associated with a higher LARS score. Prevention of anastomosis-related complications resulted protective of post-operative function.

Low-Dose CT Fluoroscopy-Guided Drainage of Deep Pelvic Fluid Collections after Colorectal Cancer Surgery: Technical Success, Clinical Outcome and Safety in 40 Patients

To assess the technical (TS) and clinical success (CS) of CT fluoroscopy-guided drainage (CTD) in patients with symptomatic deep pelvic fluid collections following colorectal surgery. A retrospective analysis (years 2005 to 2020) comprised 43 drain placements in 40 patients undergoing low-dose (10-20 mA tube current) quick-check CTD using a percutaneous transgluteal (n = 39) or transperineal (n = 1) access. TS was defined as sufficient drainage of the fluid collection by ≥50% and the absence of complications according to the Cardiovascular and Interventional Radiological Society of Europe (CIRSE). CS comprised the marked reduction of elevated laboratory inflammation parameters by ≥50% under minimally invasive combination therapy (i.v. broad-spectrum antibiotics, drainage) within 30 days after intervention and no surgical revision related to the intervention required. TS was gained in 93.0%. CS was obtained in 83.3% for C-reactive Protein and in 78.6% for Leukocytes. In five patients (12.5%), a reoperation due to an unfavorable clinical outcome was necessary. Total dose length product (DLP) tended to be lower in the second half of the observation period (median: years 2013 to 2020: 544.0 mGy*cm vs. years 2005 to 2012: 735.5 mGy*cm) and was significantly lower for the CT fluoroscopy part (median: years 2013 to 2020: 47.0 mGy*cm vs. years 2005 to 2012: 85.0 mGy*cm). Given a minor proportion of patients requiring surgical revision due to anastomotic leakage, the CTD of deep pelvic fluid collections is safe and provides an excellent technical and clinical outcome. The reduction of radiation exposition over time can be achieved by both the ongoing development of CT technology and the increased level of interventional radiology (IR) expertise.

The Pelvis Collection in Kiel and the Quantification of Difficult Birth

Since the 17th century, malformations of the female pelvis have been known to cause severe birth complications. In the 19th century, the so-called narrow pelvis became a central object of research in medical obstetrics. Extensive collections of female pelvic specimens were created. This paper examines the origins and uses of the so-called Kiel obstetric pelvic collection, which was established from the 1830s onward as part of research into the narrow pelvis by the obstetrician Gustav Adolf Michaelis. He developed a widely applicable technique for measuring the pelvis and studied the problem by means of statistical analyses on hundreds of his patients. As the article shows, this pioneering metric-quantitative approach to the phenomenon had its origins in the administrative practices of the Kiel maternity hospital, which was a poor relief institution. In clinical practice, however, the limitations of birth planning based on pelvic measurement immediately became apparent, foreshadowing the failure of the method. Nevertheless, Michaelis and his collection were appropriated by a positivistic-hagiographic medical historiography.