Radiation exposure in emergency ureteric stenting: A subgroup analysis by operator.

Objectives: To review radiation exposure during emergency ureteric stent insertion to identify differences based on operator experience, specialty operator and stone characteristics. Patients and methods: A retrospective audit over 10 years was performed for patients who underwent emergency stent insertion for urolithiasis with intraoperative fluoroscopy. Outcomes measured included operator experience, radiation exposure (mGy), dose area product (Gy/cm2), fluoroscopy time, stone characteristics and patient BMI. Analysis was performed in IBM SPSS Version 28. p < 0.05 was considered statistically significant. Results: Four hundred ten patients were identified, with a median age of 57 years, 64.6% male and a median BMI of 30. Urolithiasis was left-sided in 50.8%, with a median size of 7 mm and predominantly proximal (49%) followed by mid (34.5%) and distal (12.1%) location. Median radiation exposure was 12.6 mGy, 2.94 Gy/cm2 and fluoroscopy time 44.5 s, with no significant difference between consultants and registrars. No significant association between radiation exposure for subgroups of stone location, gender, size, laterality or specialty registrar (general surgery vs. urology). Conclusion: No significant difference in radiation exposure was identified between registrars and consultants or between subspecialty registrars. We suggest formal radiation safety education for all health professionals involved with intra-operative fluoroscopy and personal dosimeters.

Transrectal ultrasound-guided prostate needle biopsy remains a safe method in confirming a prostate cancer diagnosis: a multicentre Australian analysis of infection rates.

PURPOSE: Worldwide, transrectal ultrasound-guided prostate needle remains the most common method of diagnosing prostate cancer. Due to high infective complications reported, some have suggested it is now time to abandon this technique in preference of a trans-perineal approach. The aim of this study was to report on the infection rates following transrectal ultrasound-guided prostate needle biopsy in multiple Australian centres. MATERIALS AND METHODS: Data were collected from seven Australian centres across four states and territories that undertake transrectal ultrasound-guided prostate needle biopsies for the diagnosis of prostate cancer, including major metropolitan and regional centres. In four centres, the data were collected prospectively. Rates of readmissions due to infection, urosepsis resulting in intensive care admission and mortality were recorded. RESULTS: 12,240 prostate biopsies were performed in seven Australian centres between July 1998 and December 2020. There were 105 readmissions for infective complications with rates between centres ranging from 0.19 to 2.60% and an overall rate of 0.86%. Admission to intensive care with sepsis ranged from 0 to 0.23% and overall 0.03%. There was no mortality in the 12,240 cases. CONCLUSION: Infective complications following transrectal ultrasound-guided prostate needle biopsies are very low, occurring in less than 1% of 12,240 biopsies. Though this study included a combination of both prospective and retrospective data and did not offer a comparison with a trans-perineal approach, TRUS prostate biopsy is a safe means of obtaining a prostate cancer diagnosis. Further prospective studies directly comparing the techniques are required prior to abandoning TRUS based upon infectious complications.

A rare case - Escalation of care for high risk emphysematous pyelonephritis in rural Australia.

Emphysematous Pyelonephritis (EP) is a rare necrotizing renal parenchymal infection characterised by gas within the kidney parenchyma. Management with emergency nephrectomy has transitioned to a graded medical, radiological intervention and surgical approach. We present a rare case of high-risk emphysematous pyelonephritis, outlining key high risk factors and demonstrating staggered care escalation within a rural Australian referral hospital.

Giant testicular tumour with major choriocarcinoma component.

Giant testicular tumour, with volume greater than 10 times a normal testicle, is a rare presentation of testicular cancer. This is of particular note in nations where public health campaigns and high literacy rates generally lead to early detection and cure. We present a 22 year old male, with 14 month history of increasing scrotal swelling. Orchidectomy revealed a mixed germ cell tumour (choriocarcinoma 40%, teratoma 30%, and yolk sac 30%), 250 x 150 × 150mm in size. This case details the largest testicular tumour recorded in Australia, and one of the largest mixed germ cell tumours globally.

Paraneoplastic bullous pemphigoid - A sign of clear cell renal carcinoma.

Paraneoplastic bullous pemphigoid is a rare paraneoplastic syndrome. Rash is pruritic, with erythematous eruption of large subepidermal bullae over skin and often mucosal surfaces. We present an 84y woman with a three week history of erythematous rash, and 48hrs of bullae. A left clear cell renal cell carcinoma was identified on CT imaging during the presentation. Subsequent removal of the tumour resulted in resolution of bullous pemphigoid symptoms. This first-of-kind case and successful result strengthens the association between renal cell carcinoma and paraneoplastic bullous pemphigoid, arguing for a high degree of clinical suspicion in unexplained presentations of bullous pemphigoid.