Septal Perforation Research Articles

Retrograde Approach via Ipsilateral Septal Collateral Channel in Percutaneous Coronary Intervention for Coronary Chronic Total Occlusion: A Single-Center Experience.

The septal collateral channel (CC) is the preferred channel in retrograde percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). However, reports on the utilization of the ipsilateral septal CC are limited. To evaluate the feasibility and safety of the ipsilateral septal CC in retrograde CTO PCI. Twenty-five patients with successful wire CC tracking via the ipsilateral septal CC in retrograde CTO PCI were retrospectively analyzed. All procedures were performed by experienced CTO operators. Procedures were divided into the left descending coronary artery (LAD)-septal-LAD group and the LAD-septal-left circumflex coronary artery (LCX) group. Procedural complications and in-hospital outcomes were ascertained. Both groups were similar with respect to risk factors and angiographic characteristics of the CTO, except for the collateral tortuosity (86.7% vs 20%, p=0.002). The success rate of microcatheter CC tracking was 96%. Both technical success and procedural success rates were 92%. Procedural complications were found in one case (septal perforation, 4%), which happened in the LAD-septal-LAD group (p=0.250). One postoperative adverse event (Q-wave myocardial infarction, 4%) was observed before discharge. The retrograde approach via the ipsilateral septal CC was feasible, with high success rates and acceptable complications, in the hands of experienced operators.

Outcome of Endoscopic Repair of Nasal Septal Perforation.

The anterior ethmoidal artery (AEA) flap has been demonstrated to be a reliable option for endoscopic repair of symptomatic nasal septal perforations. The purpose of this study is to study the outcome of this technique. A retrospective case series of all consecutive patients who underwent repair of nasal septal perforation utilizing the AEA flap among 2 institutions from August 2020 to July of 2022 was conducted. Demographics and comorbidities were collected preoperatively and postoperatively. The main outcome of this study was to identify the risk factors for surgical failure. Forty-one patients were included. Mean perforation size was 2.2 cm (range 0.5-4.5 cm). Mean age was 42.5 years (range 14-65 years), 53.6% were female, 39% were active smokers, mean body-mass-index (BMI) was 31.9 (range 19.1-45.5), 20% with history of CRS and 31.7% had diabetes mellitus (DM). Etiologies of the perforation included idiopathic (n = 12), iatrogenic (n = 13), intranasal drug use (n = 7), trauma (n = 6), and secondary to tumor resection (n = 3). Overall success rate for complete closure was 73.2%. Active smoking, history of intranasal drug use, and DM were significantly associated with surgical failure (72.7%vs 26.7%, P = .007; 36.4%vs 10%, P = .047; and 63.6%vs 20%, P = .008 respectively). The endoscopic AEA flap is a reliable technique for closure of nasal septal perforation. It may not work when the etiology is intranasal drug use. Close attention to diabetes and smoking status is also needed.

Acute performance of stylet driven leads for left bundle branch area pacing: a comparison with lumenless leads

Abstract Funding Acknowledgements Type of funding sources: None. Background Lumen-less leads (LLL) and stylet driven leads (SDL) are currently used for left bundle branch area pacing (LBBAP). We sought to evaluate the acute performance of SDL during LBBAP in comparison with LLL. Methods This is an observational retrospective study including consecutive patients undergoing LBBAP at our institution.Acute lead performance was evaluated including implant success rate,electrical parameters,ECG characteristics and lead related complications (intraprocedure LBBAP lead dislodgment after having being penetrated into the septum in an stable position needing lead repositioning, septal perforation, coronary venous fistula, development of complete AV block not previously present and LBBAP lead damage during implant).Conduction system capture criteria were assessed before patient discharge during asynchronous ventricular pacing. Ventricular lead position within the septum was evaluated using paced QRS axis, fluoroscopic orthogonal views and post-procedure TTE, and classified as basal,mid or apical septum. Results 451 consecutive LBBAP implants were included, 333 using LLL and 118 using SDL. LBBAP acute success was significantly higher with LLL (91.6% for LLL vs 79.7% for SDL,p=0.001).Among patients with successful LBBAP,LBB capture criteria were achieved in 53.2% for LLL vs 36.4% for SDL,while left ventricular septal pacing (LVSP) was achieved in 39% vs 44.1%,respectively (p<0.0001). A basal lead position was more frequently obtained with LLL (19.8% for LLL vs 13.3% for SDL),while SDL were more frequently located at mid to apical septal positions (86.7% for SDL vs 80.1% for LLL, p=0.003).Paced ECG axis was inferior in 43.9% of LLL vs 28.9% of SDL and superior in 24.5% vs 42.1%, respectively,p=0.001.Intraprocedure lead dislodgment occurred in 9.3% of SDL vs 2.1% of LLL,p=0.001.In 5 cases of SDL (4.2%),lead damage occurred during lead implant needing lead replacement due to helix entrapment or malfunction with no such cases registered among LLL patients.Acute LBBAP lead-related complications were significantly higher for SDL vs LLL (29.1% vs 12.6%, respectively, p<0.0001,table 1),none of them needing additional interventions.Among patients with LBBAP criteria at the end of the procedure,34 (7.5%) experienced loss of r prime wave in V1 with paced QRS widening before hospital discharge,more frequently in patients with SDL (17.8% vs. 9.4%, respectively,p<0.0001) indicative of lead microdislodgment. Conclusions In our experience,acute lead performance is different between LLL and SDL.LBBAP implant success rate is significantly higher with LLL with higher percentage of patients with LBB capture criteria in comparison with SDL.SDL are associated with a more mid to apical and inferior lead position in the septum.A significantly higher rate of lead related complications during the implant procedure as well as higher rates of acute microdislodgment after implantation were also seen in SDL,none of them needing acute re-intervention.

Acute procedural comparison between left bundle branch pacing and left ventricular septal pacing

Abstract Funding Acknowledgements Type of funding sources: None. Background Left bundle branch area pacing (LBBAP) includes both left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP). The implant procedure characteristics of these two pacing modalities have not been yet fully described. We sought to compare 2 different LBBAP implant strategies: the first one accepting LVSP as a procedure endpoint and the second one aiming at achieving LBBP in every patient. Methods Consecutive patients undergoing LBBAP at our centre from January 2020 to October 2022 were included. After our initial LBBAP learning curve, LVSP was accepted as a procedure endpoint in the first 217 patients. Thereafter, LBBP was attempted in every patient with a maximum of 5 lead deployment attempts or > 30 minutes for lead implant even if LVSP had been previously achieved. Definition of LBBP or LVSP was established according to currently accepted criteria. Procedure characteristics including total procedure time, LBBAP lead implant time, radiation exposure parameters, electrical parameters and acute complications were evaluated. Results A total of 422 consecutive patients were included in the analysis (217 patients with LVSP as acceptable endpoint, and 205 patients with LBBP as final endpoint). Baseline characteristics of the patients are described in table 1. In the LVSP group, the final capture pattern was LVSP in 57.6% and LBBP in 29% whereas in the LBBP group the final capture pattern was LVSP in 19.5% and LBBP in 71.2%. Failure of LBBAP occurred in 13.4% of LVSP group and 9.3% of LBBP group. LBBAP lead position in the septum was basal in 12,5% of LVSP group vs. 23,9% of LBBP group and medium in 81.7% and 72%, respectively (Table 2). A discrete LB potential was identified in 21.2% of LVSP group patients and in 45.8% of LBBP patients, p<0.0001. The LBBP strategy was associated with significantly longer LBBAP lead implant time (19±11min vs. 17±10 min, p=0.05), higher number of lead deployment attempts (3.4±1.8 vs 2.9±1.9, p=0.004), higher number of lead turns (22.4±4.3 vs. 18.3±4,1, p<0,0001) and higher fluoroscopy time (13.2±9.5 min vs. 10.6±9.3 min, p=0.003). Incidence of septal perforation was comparable between the 2 groups (10.6% for LVSP group and 7.8% for LBBP group, p=0.4) but development of complete AV block during implant tended to be more frequent in LBBP group (3.9% vs. 1.4%, p=0.13). The final paced QRS width, measured from the pacing spike, was comparable between the 2 groups: 161±18 ms for LVSP group and 158±19 ms for LBBP group, p=0.2. Conclusions LBBP can be achieved in more than 70% of unselected patients with significantly prolonged procedure time, higher number of lead deployment attempts and higher radiation exposure. When LVSP is accepted as an outcome, LBBP can be achieved in up to 29% of cases. The final paced QRS duration is comparable between the two implant strategies. Any potential clinical benefit of LBBP over LVSP in the long-term remains to be proven.

Malposition of a pulmonary artery catheter in the left ventricle: a case report

BackgroundPlacement of pulmonary artery catheters may be associated with a variety of complications. We present a case where a pulmonary artery catheter was accidentally advanced into the left ventricle by perforating the intraventricular septum.Case presentationA 73-year-old woman underwent mitral valve dysfunction. A pulmonary artery catheter could not pass the tricuspid valve under general anesthesia, which was manually advanced via the right ventricle during surgery. After valve replacement, systolic pulmonary artery pressure was higher than radial arterial blood pressure. Transesophageal echocardiography (TEE) revealed the tip of the catheter in the left ventricle. The catheter was withdrawn and then advanced to the pulmonary artery under monitoring of TEE. Transseptal shunt flow gradually decreased and finally disappeared. The surgery was completed without additional procedures.ConclusionsAlthough ventricular septal perforation is rare, it should be recognized as a potential complication of pulmonary artery catheter insertion.

Right Atrial Approach for Ventricular Septal Perforation

症例は84歳男性，2カ月前より全身倦怠感，数日前より安静時呼吸困難となり近医を受診した．心臓超音波検査で心室中隔基部に1.5 cmの欠損孔と左右シャント血流を認めた．亜急性期心筋梗塞による心室中隔穿孔の診断で緊急手術を施行した．右房斜切開すると三尖弁中隔尖の直下に穿孔部位を認めた．ウシ心のう膜パッチを用いたsandwich patch法で穿孔部位を閉鎖した．術後は遺残シャントなく，順調に経過し，第18病日にリハビリ目的で転院となった．

Septal Perforation Repair Quality of Life Outcomes Using the Revised 15-item Glasgow Benefit Inventory.

The 18-item Glasgow Benefit Inventory (GBI) has been widely used to measure patient general health response to otorhinolaryngologic and facial plastic interventions. The GBI was recently reorganized into 15 questions with 5 sub-scale factors (GBI-5F) to improve its utility. Application of the GBI-5F to septal perforation treatments may improve our understanding of quality of life outcomes. The GBI was given to patients seen from August 2018 through October 2021 who were at least 6 months postoperative attempted perforation surgical closure using bilateral nasal mucosal flaps with an interposition graft. Original GBI and GBI-5F scores were computed and subgroup analysis performed in this retrospective medical record review. Of the 98 patients (mean age 45.5 years) who met study criteria, 65 were female. Mean perforation length was 12.9, and height 9.7 mm. The mean postoperative time to GBI completion was 12.7 months. Highest GBI-5F scores were noted in the Quality of Life factor, followed by Self-confidence and Social Involvement. Females reported significantly higher scores than men. Total GBI scores were similar to those recorded for other rhinologic procedures. The GBI-5F provides measurable insight into patient quality of life benefit following septal perforation repair.

Possibilities for nasal septum perforation healing: from the past to the future

The article discusses application of various methods for nasal septum perforation healing (NSP). The types and options of surgical treatment in the historical aspect are described. These operations have a number of disadvantages, such as: the complexity of the material taking, the risk of inflammatory reaction and scar formation, as well as other postoperative complications leading to a relapse of the disease. Effectiveness of various allo- and autografts that used to restore the defect of the nasal septum is observed. Publications of regenerative medicine methods to eliminate perforation of the nasal septum are analyzed. Implantation of stromal cells, scaffolds; growth factors or their combinations is used. Such approaches make possible the restoration of the damaged tissue due to targeted and controlled cell differentiation, accompanied by the synthesis of the intercellular matrix and a decrease in inflammatory processes. In preclinical and clinical studies, special attention is paid to stromal cells. Mesenchymal stromal cells (MSCs) of bone marrow, adipose and other tissues are most often used. The regenerative effects of mesenchymal stromal cells are realized through the secretion of a wide range of anti-inflammatory mediators, cytokines and trophic factors, the positive effects of cell therapy of this type of cells should not be associated with the differentiation of implanted cells into cells of damaged tissues. The use of various materials for the treatment of NSP is also described with an assessment of their effectiveness and future prospects.

Investigation on Filaments for 3D Printing of Nasal Septum Cartilage Implant.

Septoplasty is a widely used method in treating deviated septum. Although it is successfully implemented, there are problems with excessive bleeding, septal perforation, or infections. The use of anatomically shaped implants could help overcome these problems. This paper focuses on assessing the possibility of the usage of a nasal septum cartilage implant 3D printed from various market-available filaments. Five different types of laments were used, two of which claim to be suitable for medical use. A combination of modeling, mechanical (bending, compression), structural (FTIR), thermal (DSC, MFR), surface (contact angle), microscopic (optical), degradation (2 M HCl, 5 M NaOH, and 0.01 M PBS), printability, and cell viability (MTT) analyses allowed us to assess the suitability of materials for manufacturing implants. Bioflex had the most applicable properties among the tested materials, but despite the overall good performance, cell viability studies showed toxicity of the material in MTT test. The results of the study show that selected filaments were not suitable for nasal cartilage implants. The poor cell viability of Bioflex could be improved by surface modification. Further research on biocompatible elastic materials for 3D printing is needed either by the synthesis of new materials or by modifying existing ones.

Effect of Locally Administered Estradiol on Wound Healing in a Nasal Septal Perforation Animal Model.

We aimed to investigate the effect of estradiol on wound healing in an experimental nasal septal perforation (NSP) model created in rats. Twenty-two Sprague Dawley healthy male rats were separated into two groups. NSP, approximately 2 mm in diameter, was created in each animal. The 0.1 mL 0.12% estradiol (12 g/L) (study group) and 0.1 mL 0.9% saline (9 g/L) (control group) were applied topically once a day for 14 days. The rats were sacrificed on the 14th day and the cartilage nasal septum of each animal was excised for histopathological examination. The nasal mucosal epithelial regeneration and degeneration, acute inflammatory cell count, fibroblast number, vascularization, granulation tissue formation, giant cell number, eosinophil number, degeneration and regeneration of the nasal cartilage, and collagen density were examined. The macroscopic closure rate of the perforations and histopathological parameters were evaluated statistically. In this study, the epithelial regeneration, the fibroblast count, the granulation tissue formation, and the amount of collagen were significantly higher in the study group than in the saline group (p < 0.05). The acute inflammatory activity was lower in the estradiol group than in the saline group (p < 0.05). There was no statistically significant difference in the closure rate of perforation between the two groups (p = 0.163). No significant difference was found in other comparisons (p > 0.05). The locally administered estradiol may improve wound healing of the nasal septum in an experimental NSP animal model. LEVEL OF EVIDENCE: Not applicable.

PO-03-049 SUBACUTE MIGRATION OF LEFT BUNDLE BRANCH PACING LEAD INTO THE LEFT VENTRICLE

RV pacing is associated with increased risk for systolic dysfunction. Conduction system pacing has emerged as an alternative. His bundle pacing is limited by higher capture threshold, reducing battery life, and concerns of increasing thresholds over time. LBBP is a promising alternative, however limited data exist on associated complications. We report a case of LBBP complicated by subacute migration into the LV presenting with increasing threshold. A 78 yoM with symptomatic bradycardia and chronotropic incompetence referred for PPM underwent implantation of DC-PPM with left bundle lead. A Medtronic SelectSecure 3830 lead was advanced into a C315 sheath and positioned at the LV septum. Pace mapping defined a candidate site for LBBP (W in V1). Lead was screwed into the septum. Unipolar impedance prior to deployment was 820Ω. After 5 turns paced QRSd 140ms with qR morphology in lead V1, R waves 12.4mV, unipolar impedance 760Ω, threshold 0.75V at 0.4ms. This was accepted as nonselective LBBP. He began to have chest thumping on POD 3. Device showed elevated ventricular threshold, decreasing impedance, and stable sensing. ECG showed broad notched R wave in V1 consistent with LV pacing. CT revealed migration of the lead, coursing through the IVS into the LV myocardium with tip terminating along the inferior LV wall. Lead tip was possibly puncturing through the myocardium and within the epicardial fat. There was no effusion Lead was removed with manual traction in the EP suite. Heart border remained unchanged on fluoroscopy. Transthoracic echo showed no effusion. New lead was positioned with active fixation in the RV apical septum away from the prior position. Lead showed suitable parameters without diaphragmatic stimulation. LBBP can be an alternative to HB, RV, and CRT pacing. LBBP involves placing the lead deep within the IVS and close to the LV subendocardium. Septal perforation is often recognized during the procedure, however, the risk of late perforation must be considered. In our case, timing of lead migration is unclear as parameters during implant suggested adequate LB capture but reported diaphragmatic capture at day 3, before threshold increase. It demonstrates important findings:1.Acute decrease in unipolar impedance may not be a sensitive marker for septal perforation as it did not change appreciably in our case; 2.ECG/CXR in follow up can help identify lead migration; 3.Migrated leads can be safely removed in the EP suite without need for surgical backup

Trilayer temporalis fascia interposition graft: A reliable technique for nasal septal perforation repair

PurposeNasal septal perforation (NSP) repair is a complex procedure with variable techniques and success rates. In this study we describe NSP repair using a trilayer interposition graft of temporalis fascia and thin polydioxanone (PDS) plate without intranasal flaps and report outcomes in our patient population. Materials and methodsIRB-approved retrospective review of 20 consecutive patients presenting to a tertiary medical center with NSP from September 2018 to December 2020 and who underwent NSP repair via our trilayer temporalis fascia interposition graft. De-identified patient data was obtained from the medical record and stored on an encrypted secure server. Descriptive statistics were examined for each variable. ResultsAll 20 NSP repairs demonstrated durable repair with complete mucosal coverage at last follow-up (average 7 months). Complete resolution of preoperative symptoms was achieved in 85 % of patients, with partial resolution in the remaining 15 %. Of the 20 perforations 25 % were small (<1 cm), 50 % medium (1-2 cm), and 25 % large (>2 cm). The only surgical complication was a single intranasal synechiae. No graft harvest site complications were noted. ConclusionThe application of a trilayer temporalis fascia - PDS plate interposition graft without intranasal flaps is highly effective for repair of NSP.

Adult Knowledge About Postoperative Complications of Rhinoplasty in the Western Region of Saudi Arabia.

Background Rhinoplasty, a prevalent cosmetic surgical procedure worldwide, is not exempt from associated risks and complications, as with any other surgery. In light of the surging demand for rhinoplasty amongst young adults, it is imperative to acknowledge that the procedure can engender various complications that can be classified as either early or late complications. Examples of early complications include epistaxis and periorbital ecchymosis, while late complications may manifest as enophthalmos or septal perforation. The present study endeavors to gauge the knowledge of rhinoplasty complications among adult residents of the Western region of Saudi Arabia. Methods To achieve the research objectives, a cross-sectional study design was implemented, utilizing a self-administered online questionnaire. The study targeted male and female adults aged 18 years and aboveresiding in the Western region of Saudi Arabia. The questionnaire comprised of 14 items, categorized into socio-demographic and rhinoplasty postoperative complications sections, respectively. Results The study gathered responses from a total of 968 participants, of which 60.95% fell within the age range of 18-30 years. The majority of participants identified as female (77.89%), and Saudi citizens constituted the vast majority of the respondents (96.28%). Among the participants, 22.62% expressed a desire to undergo rhinoplasty, whereas 77.38% indicated no interest in the procedure. Of those who sought rhinoplasty, the majority favored having the surgery performed by a skilled physician (81.74%). Notably, participants exhibited a relatively high level of awareness regarding the postoperative complications of rhinoplasty, with respiratory issues being the most widely recognized complication (66.63%). Conversely, headache, nausea, and vomiting were the least familiar complications (100%). Conclusion The study findings reveal a considerable knowledge gap among adults residing in the Western region of Saudi Arabia concerning rhinoplasty's possible postoperative complications. The results underscore the pressing need to establish comprehensive educational and awareness-raising programs to equip individuals contemplating the procedure with the requisite information to make informed decisions. Future research endeavors could delve into the underlying determinants that drive the desire for rhinoplasty and assess potential interventions geared toward augmenting individuals' comprehension and knowledge of the procedure.

Woronin body hitchhiking on early endosomes is dispensable for septal localization in Aspergillus nidulans.

The proper functioning of organelles depends on their intracellular localization, mediated by motor protein-dependent transport on cytoskeletal tracks. Rather than directly associating with a motor protein, peroxisomes move by hitchhiking on motile early endosomes in the filamentous fungus Aspergillus nidulans. However, the physiological role of peroxisome hitchhiking is unclear. Peroxisome hitchhiking requires the protein PxdA, which is conserved within the fungal subphylum Pezizomycotina but absent from other fungal clades. Woronin bodies are specialized peroxisomes that are also unique to the Pezizomycotina. In these fungi, multinucleate hyphal segments are separated by incomplete cell walls called septa that possess a central pore enabling cytoplasmic exchange. Upon damage to a hyphal segment, Woronin bodies plug septal pores to prevent widespread leakage. Here, we tested whether peroxisome hitchhiking is important for Woronin body motility, distribution, and function in A. nidulans. We show that Woronin body proteins are present within all motile peroxisomes and hitchhike on PxdA-labeled early endosomes during bidirectional, long-distance movements. Loss of peroxisome hitchhiking significantly affected Woronin body distribution and motility in the cytoplasm, but Woronin body hitchhiking is ultimately dispensable for septal localization and plugging.

Silicone septal splint for recurrent epistaxis in HHT patients: experience of a national referral centre.

To report our experience in the use of silicone septal splint for recurrent severe epistaxis in hereditary haemorrhagic telangiectasia patients (HHT). This is a descriptive analysis carried out at the Otorhinolaryngology Department of Fondazione IRCCS Policlinico San Matteo in Pavia, a reference centre for the treatment and diagnosis of HHT. We retrospectively evaluated HHT patients who underwent silicone septal splint positioning after the endoscopic surgical treatment of epistaxis from 2000 to 2022. Of the 506 patients surgically treated in the period of analysis, 74 patients underwent silicone septal splint positioning and 37 were post-operatively interviewed. With a mean of 2.4 previous surgical treatments and a mean epistaxis severity of 7.38, the majority of patients presented with septal perforation (71.6%). On average, patients maintained the splint in place for 54.5 months, with a good tolerability and a significant reduction in epistaxis severity, need for blood transfusion and improvement of haemoglobin levels. In HHT patients with recurrent severe epistaxis and with septal perforation, the placement of septal splints offers a useful additional strategy in the management of nosebleeds.

MP78-12 OUR EXPERIENCE IN PENILE IMPLANT AFTER ANASTOMOTIC URETHROPLASTY FOR PELVIC FRACTURE URETHRAL INJURY

You have accessJournal of UrologyCME1 Apr 2023MP78-12 OUR EXPERIENCE IN PENILE IMPLANT AFTER ANASTOMOTIC URETHROPLASTY FOR PELVIC FRACTURE URETHRAL INJURY Cora Fogaing, Pankaj Joshi, Daniel Esteban Gomez Zapata, Apurva Anand, Rathish Rajenderan, Shreyas Bhadranavar, Amey Talpallikar, Aryan Gune, and Sanjay Balwant Kulkarni Cora FogaingCora Fogaing More articles by this author , Pankaj JoshiPankaj Joshi More articles by this author , Daniel Esteban Gomez ZapataDaniel Esteban Gomez Zapata More articles by this author , Apurva AnandApurva Anand More articles by this author , Rathish RajenderanRathish Rajenderan More articles by this author , Shreyas BhadranavarShreyas Bhadranavar More articles by this author , Amey TalpallikarAmey Talpallikar More articles by this author , Aryan GuneAryan Gune More articles by this author , and Sanjay Balwant KulkarniSanjay Balwant Kulkarni More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003355.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pelvic fracture urethral injury (PFUI) results from traumatic disruption of the urethra and is treated with anastomotic urethroplasty. Up to 60% of those patients have erectile dysfunction. Majority are treated with medical management. For those who fail, we perform penile implant. We present outcomes for a series of 41 patients who underwent penile implant insertion post anastomotic urethroplasty for PFUI. METHODS: Our centre is a tertiary referral centre and published the world’s largest series of PFUI experience. We analyzed a prospectively maintained database of 41 patients who underwent penile implant insertion post PFUI. Choice of implant was based on patient’s preference and insurance coverage. Functional outcomes using the IIEF-5 questionnaire and complications were analyzed. RESULTS: Mean delay between anastomotic urethroplasty and penile implant was 47 months. Semirigid penile implant was used in 92.7% of patients while three-piece inflatable penile implant was used in 7.3% of patients. Patients reported significant improvement in sexual function post implant with mean IIEF-5 score of 21.88 points compared to 3.27 points before the implant. Intraoperative complications included two septal perforations and one proximal crural perforation. Postoperative complications included two hematomas, two glans extrusion that were salvaged and one proximal urethral erosion that lead to implant removal CONCLUSIONS: Erectile dysfunction is a common occurrence in PFUI patients. Penile implant insertion in those patients is challenging due to ischemia of the corpora. If performed by experts, it is safe and leads to significant sexual function improvement. To date, this is the largest series of penile prosthesis insertion in PFUI patients post anastomotic urethroplasty. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1136 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cora Fogaing More articles by this author Pankaj Joshi More articles by this author Daniel Esteban Gomez Zapata More articles by this author Apurva Anand More articles by this author Rathish Rajenderan More articles by this author Shreyas Bhadranavar More articles by this author Amey Talpallikar More articles by this author Aryan Gune More articles by this author Sanjay Balwant Kulkarni More articles by this author Expand All Advertisement PDF downloadLoading ...

12-Lead Electrocardiogram - A Valuable Tool in Temporary Cardiac Pacing Management

Inadvertent malposition of pacing leads is a recognized complication of temporary cardiac pacing procedure, which can be fatal particularly if lead placement is in the left ventricular (LV) cavity because of the risk of thromboembolic events.1 Malposition leads can be either due to unrecognized congenital heart defects including atrial or ventricular septal defects, patent foramen ovale or due to iatrogenic perforation of interventricular septum but sometimes it may be due to faulty insertion via trans-arterial instead of trans-venous access.2

Comparison of Outcomes After Septoplasty With Non-Absorbable or Biodegradable Synthetic Polyurethane Foam Nasal Packing With a Focus on Pain and Cardiac Factors

Background and Objectives: We compared pain levels, cardiovascular parameters, and complications according to whether patients underwent nasal packing with non-absorbable or biodegradable materials.Methods: Patients who underwent septoplasty from May 2015 to April 2020 were retrospectively reviewed. Numeric rating scale (NRS) scores for pain, blood pressure, and heart rate were measured three times (immediately after surgery, 6 hours later, and on postoperative day [POD] 1). We collected data on complications, including postoperative bleeding, septal hematoma, adhesions, septal perforation, and the recurrence of septal deviation.Results: In total, 200 patients underwent septoplasty, of whom 100 underwent nasal packing with Merocel and 100 underwent packing with Nasopore. The summed NRS scores over the three time points did not differ significantly between the groups. The NRS scores at 6 hours after surgery were highest in both groups. The systolic and diastolic blood pressure and the heart rate immediately after surgery were significantly higher than before surgery in both groups. The blood pressure and heart rate at 6 hours after surgery and on POD 1 did not differ significantly from those before surgery in either group. The incidence of sleep disturbance, postoperative bleeding, septal hematoma, adhesions, septal perforation, and recurrence of septal deviation did not differ significantly between the two groups.Conclusion: Although the level of postoperative pain and the cardiovascular parameters changed over time, we found no significant differences in pain, blood pressure, heart rate, or the complication rate according to whether patients underwent nasal packing with Nasopore or Merocel.

Case report: a rare presentation of nasal septal perforation due to pyoderma gangrenosum

Background: Pyoderma gangrenosum (PG) is a rare dermatologic non-infectious neutrophilic disease that classically affects the lower extremities and is associated with inflammatory bowel disease. Rarely, it could affect the nasal septum, causing nasal septal perforation. Methods: We reviewed the case of a 52-year-old male patient known to have PG with ongoing nasal septal perforation and reviewed his blood tests, computed tomography scan findings and histologic results. Results: A diagnosis of nasal septal perforation due to PG was confirmed after exclusion of other common aetiologies. This was further supported by the presence of extensive ulceration of the nasal squamous mucosa with inflamed granulation tissue and abscess-like areas. These findings were consistent with the diagnosis of PG based on the histology report. Conclusion: Although nasal septal perforation secondary to PG is considered rare, this presentation should still be kept in mind, especially when other possible causes of nasal septal perforation have been excluded and PG has been already well established.

Limited Granulomatosis With Polyangiitis of Nose and Paranasal Sinuses - a Case Report.

Granulomatosis with polyangiitis is a rare disease with involvement of multiple organ system. It classically affects the upper respiratory tract, lower respiratory tract and kidneys. 90% of patients present with upper respiratory diseases like rhinosinusitis, nasal polyposis, nasal septal perforation, serous otitis media, impaired hearing and stridor due to subglottic stenosis. Disease manifests in two forms as limited disease i.e. without renal involvement and generalized disease i.e. with renal involvement. It needs to be differentiated from chronic granulomatous diseases like tuberculosis and delay in the treatment should be prevented. Here we present a case with disease limited to Nose and Paranasal sinuses.