ABSTRACT
BACKGROUND: Rezum™ is a relatively new bladder outflow obstruction (BOO) procedure that uses thermal energy through water vapour to cause necrosis of prostatic tissue. The standard delivery of this treatment is in an operating theatre under a general or spinal anaesthetic, or under local anaesthetic with sedation that requires patient monitoring. METHODS: We propose an outpatient daycase method of delivering Rezum™ under local anaesthetic without sedation, using a prostatic local anaesthetic block and cold local anaesthetic gel instillation into the urethra. RESULTS: Preliminary results of our first thirteen patients demonstrate the feasibility of this new technique, with a mean pain score of 2.1 out of 10 on a visual analogue scale, a successful trial without catheter in all 13 patients (one patient voided successfully on second trial), a reduction in mean International Prostate Symptom Score (IPSS) from 20.6 to 5.4, and improvement in maximum flow from 8.8 ml/s to 14.4 ml/s. The complications were minor (Clavien-Dindo less than III) and included a UTI, minor bleeding not requiring admission, and retrograde ejaculation. CONCLUSIONS: We demonstrate that an outpatient local anaesthetic daycase service without sedation is feasible. This can be delivered in a clinic setting, reduce waiting times for BOO surgery, and increase availability of operating theatre for other general anaesthetic urological procedures.
Subject(s)
Prostatic Diseases , Prostatic Hyperplasia , Humans , Male , Anesthesia, Local , Anesthetics, Local , Feasibility Studies , Pain , Prostatic Diseases/complications , Prostatic Hyperplasia/surgeryABSTRACT
Losing a needle during laparoscopic surgery is an uncommon but potentially challenging scenario for the surgeon. The prolonged operative time to search for a small retained foreign body such as a needle can cause clinical and medicolegal complications. As a result, it is considered a 'never event'. This report describes a case of a lost needle during a laparoscopic prostatectomy, when a meticulous and systematic search for the foreign body was initiated and completed with the use of x-rays, only to find it in an unusual place.
Subject(s)
Foreign Bodies/diagnosis , Laparoscopy/instrumentation , Needles , Prostatectomy/instrumentation , Foreign Bodies/etiology , Humans , Laparoscopy/adverse effects , Male , Middle Aged , Prostatectomy/adverse effects , Prostatic Neoplasms/surgery , Suture Techniques/instrumentationABSTRACT
This study investigated the frequency of Escherichia col, Shigella and Salmonella species in stool specimens from patients with diarrhoea presenting to health centres in Hamedan province, Islamic Republic of Iran. From 144 samples, Shigella strains were isolated in 17 cases (11.8%): 10 Sh. flexneri, 3 Sh. sonnei, 2 Sh. boydii and 2 untyped strains. No Salmonella strains were isolated. Using molecular diagnostic methods, diarrheogenic E. coli were detected in 37 cases (25.7%), the majority were enterotoxigenic (ETEC) (22 cases) and Shiga toxin-producing (STEC) strains (15 cases). In 14 cases (9.7%) there was co-infection.
Subject(s)
Diarrhea , Dysentery, Bacillary/complications , Escherichia coli Infections/complications , Salmonella Infections/complications , Acute Disease , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Child , Child, Preschool , Community Health Centers/statistics & numerical data , Comorbidity , Diarrhea/epidemiology , Diarrhea/microbiology , Dysentery, Bacillary/microbiology , Escherichia coli Infections/microbiology , Escherichia coli O157/genetics , Escherichia coli O157/isolation & purification , Female , Humans , Infant , Iran/epidemiology , Male , Middle Aged , Molecular Epidemiology , Population Surveillance , Salmonella Infections/microbiology , Serotyping , Sex Distribution , Shigella boydii/genetics , Shigella boydii/isolation & purification , Shigella flexneri/genetics , Shigella flexneri/isolation & purification , Shigella sonnei/genetics , Shigella sonnei/isolation & purificationABSTRACT
This study investigated the frequency of Escherichia coli, Shigella and Salmonella species in stool specimens from patients with diarrhoea presenting to health centres in Hamedan province, Islamic Republic of Iran. From 144 samples, Shigella strains were isolated in 17 cases [11.8%]: 10 Sh. flexneri, 3 Sh. sonnei, 2 Sh. boydii and 2 untyped strains. No Salmonella strains were isolated. Using molecular diagnostic methods, diarrheogenic E. coli were detected in 37 cases [25.7%], the majority were enterotoxigenic [ETEC] [22 cases] and Shiga toxin- producing [STEC] strains [15 cases]. In 14 cases [9.7%] there was co- infection
