A case of Carney complex presenting as acute testicular pain.

We describe the case of a 7-year-old boy who presented with testicular pain but was found to have bilateral testicular lesions later confirmed as Sertoli cell tumors. Genetic testing confirmed a PRKAR1A gene mutation consistent with Carney complex, a rare genetic disorder characterized by skin lesions, myxomas, and multiple endocrine neoplasms. A review of the condition is made highlighting the association with testicular tumors, particularly of Sertoli cell origin.

Point of technique: reducing wrong-side errors for endourology procedures.

OBJECTIVE: To describe a simple novel technique for reducing the likelihood of wrong-side surgery in endourology. METHOD: A radiopaque adhesive SKINTACT ECG electrode is placed in the corresponding groin on the side of the intended procedure and provides a visual aid to the surgeon on the fluoroscopy image to ensure the correct side is being performed. RESULTS: The electrode is placed in the groin at the end of the surgical checklist in view of and in collaboration with the whole surgical team before commencing the procedure. The electrodes are widely available, nonintrusive, and easily removed. CONCLUSION: Wrong-side surgery unfortunately still does occur despite universal precautionary measures put in place to prevent this. Certain surgical specialties are more prone to wrong-side surgery, such as orthopedics and urology. Such an adverse event can have a significant and negative impact both on the surgeon and the patient. It is almost always due to human error and any measure to prevent this should be welcomed. The method described provides an additional safeguard against this occurring.

Raised white cell count in renal colic: Is there a role for antibiotics?

AIMS: To determine the use of antibiotics in patients with renal colic and an elevated white cell count (WCC) in the absence of other features of infection. MATERIALS AND METHODS: A retrospective audit of patients presenting to an emergency department with renal colic caused by a solitary ureteric stone over a 6 month period. STATISTICAL ANALYSIS USED: Student's t-test. RESULTS: Fifty patients met the inclusion criteria for this study. In 42 patients (84%) the urinalysis showed hematuria only and all urine culture results were negative for microbial growth. The mean WCC was 11.5 × 10(9) (4-22.1) and was raised in 34 patients (80.9%). The mean neutrophil count was 8.75 × 10(9)/L (2.3-18.6) and C-reactive protein (CRP) 15.9 (1-192). Antibiotics were commenced in 34 patients (80.9%) based solely on the raised WCC. In eight patients (16%) there were leucocytes and/or nitrites on urinalysis and all urine cultures were positive for growth (coliforms in five, streptococcus in two and candida in one specimen). The mean WCC was 10.5 × 10(9)/L (7.7-16.5) and was raised in four patients. The mean neutrophil count was 8.4 × 10(9)/L (4.9-15.2) and CRP 40.79 (3-86). One patient had pyrexia. All eight patients were commenced on antibiotics based on the WCC and/or urinalysis result. CONCLUSIONS: Over three-quarters of the patients (80.9%) in this study who presented with renal colic were unjustifiably commenced on antibiotics based solely on an elevated WCC. Antibiotic use in renal colic should be reserved for when there are features of sepsis or the urinalysis is positive. Further work is required to determine the significance of the observed results and the threshold for starting antibiotics.

Segmental testicular infarction following cysto-prostatectomy.

Segmental (partial) testicular infarction is a very rare condition of unknown cause in more than 70% of cases. Several predisposing conditions have been described, but to our knowledge, this is the first documented case and often overlooked complication occurring as a result of cysto-prostatectomy. It usually presents in an acute manner resembling testicular torsion or epididymo-orchitis and is confirmed using ultrasonography. In some cases, it may present insidiously with no pain and may be confused with a testicular tumor due to the hypo-echoic features on imaging. In unclear situations, Doppler sonography shows vascularity and a magnetic resonance scan can be useful to distinguish between the two conditions.