ABSTRACT
Introduction: Pelvic organ prolapse (POP) is a prevalent condition among parous women, often warranting surgical intervention. This case accentuates the complications associated with mesh in POP surgeries, iterating the imperative need for an evidence-based approach towards its utilization and exhaustive patient counselling. Case presentation: A 60-year-old female, post-mesh-augmented POP repair, embarked on a 13-year journey characterized by persistent pelvic pain and multiple interventions. Despite undergoing several surgeries across different countries, involving mesh and stone removals, her symptoms, notably pelvic pain and dyspareunia, persisted. Clinical examinations revealed mesh erosion into the perivesical tissue, bladder, and associated stones, which were addressed through multiple interventions, albeit with transient success. Discussion: The complex journey of this patient exemplifies the intricate challenges mesh poses in POP surgeries. While mesh application offers a minimally invasive approach and has proven successful in numerous cases, it simultaneously opens a Pandora's box of potential severe complications, necessitating thorough patient counselling and post-surgery management. Conclusion: The case delineates the challenging path that clinicians and patients tread when navigating through mesh-associated complications post-POP repair. Although mesh has been heralded as a revolutionary approach in POP surgeries, its potential drawbacks necessitate judicious application, ensuring clinicians are well-versed with its associated risks and are adept in managing ensuing complications.
ABSTRACT
This case report describes a rare occurrence of ectopic adrenal cortical tissue (EACT) in the undescended testis (UDT) of an adult male patient. The patient presented with an empty left scrotum since birth, and a magnetic resonance imaging (MRI) confirmed the diagnosis of left-side UDT. Orchidectomy was performed, and a microscopic examination revealed a UDT with EACT. The patient had no significant medical or surgical history and had a normal preoperative hormonal profile. EACT is usually found incidentally during surgical procedures and is more common in children than adults. This case emphasizes the importance of investigating adrenal rests due to the potential of neoplastic transformation or hormonal activity. The case report concludes that EACT of the UDT is still a possibility in the adult patient population.
ABSTRACT
Bladder perforation due to indwelling catheters is regarded to be a very rare incident. Most cases of catheter-induced rupture were in patients with chronic catheterization due to chronic bladder diseases. An 80-year-old male with neurogenic bladder on chronic catheterization presented to the emergency room with abdominal pain and anuria. On CT, the tip of the catheter was eroding through the bladder into the peritoneum. The patient underwent a laparotomy with adhesiolysis. The tip of the Foley catheter was seen eroding through the bladder dome. A new open tip catheter was inserted per urethra to prevent the catheter tip from eroding again through the bladder wall. Bladder erosion or rupture is associated with high morbidity and mortality. Our case demonstrates the deleterious effects of chronic catheterization and the need for a high level of suspicion when dealing with such cases.
ABSTRACT
29-year-old male patient with infertility, presented to emergency room with recurrent testicular pain. Patient had MRI done with suspicion of TTE. Laparoscopic exploration showed right spermatic vessels crossing the midline toward the left side with normal course of left vas. Inguinal exploration was carried out and showed common cord. Biopsy was sent and identified the presence of sperm in left testis only.
ABSTRACT
OBJECTIVES: To study the prevalence of urinary tract infections (UTI), or sepsis secondary to trans-rectal ultrasound-guided (TRUS) biopsy of the prostate, the pathogens involved, and patterns of antibiotic resistance in a cohort of patients. METHODS: This is a descriptive study of a consecutive cohort of patients who underwent elective TRUS biopsy at King Abdulaziz Medical City, Riyadh, Saudi Arabia between January 2012 and December 2014. All patients who underwent the TRUS guided prostate biopsy were prescribed the standard prophylactic antibiotics. Variables included were patients' demographics, type of antibiotic prophylaxis, results of biopsy, the rate of UTI, and urosepsis with the type of pathogen(s) involved and its/their antimicrobial sensitivity. RESULTS: Simple descriptive statistics were used in a total of 139 consecutive patients. Urosepsis requiring hospital admission was encountered in 7 (5%) patients and uncomplicated UTI was observed in 4 (2.8%). The most common pathogens were Escherichia coli (90.1%) and Klebsiella pneumoniae (9.1%). Resistance to the routinely used prophylaxis (ciprofloxacin) was observed in 10 of these patients (90.9%). CONCLUSION: This showed an increase in the rate of infectious complications after TRUS prostate biopsy. Ciprofloxacin resistance was found in 90.9% of patients with no sepsis.
