ABSTRACT
There are few reports of radiation associated colorectal-genitourinary tract (CRGU) fistulae causing Fournier's gangrene (FG). We describe a case of FG in a patient with possibly two CRGU fistulae in the context of previous high-dose brachytherapy and external beam radiation therapy for prostate cancer. Unfortunately, CRGU fistulae are not well classified as significant risk factors for the development of FG. Our case demonstrates the rationale for maintaining a broad differential in patients presenting with recurrent urinary tract symptoms or necrotising soft tissue infections to include undiagnosed fistulae.
Subject(s)
Brachytherapy/adverse effects , Colonic Diseases/complications , Fournier Gangrene/etiology , Genital Diseases, Male/complications , Intestinal Fistula/complications , Urinary Fistula/complications , Colonic Diseases/diagnosis , Diagnosis, Differential , Fistula/diagnosis , Fistula/etiology , Fournier Gangrene/diagnosis , Genital Diseases, Male/diagnosis , Humans , Intestinal Fistula/diagnosis , Male , Middle Aged , Prostatic Neoplasms/radiotherapy , Tomography, X-Ray Computed , Urinary Fistula/diagnosisABSTRACT
BACKGROUND: Little research exists regarding factors that contribute to resident fatigue during home call. OBJECTIVE: We objectively tracked the number and type of pages received, as well as residents' sleep time, during home call. We then examined the relationship between paging volume, resident sleep, and resident fatigue. METHODS: A total of 4 of 4 urology residents (100%) at a single institution wore a FitBit Charge HR device from July 2015 to July 2016 to track sleep. Between January and July 2016, pages received by the on-call resident were counted as either floor (urology inpatient unit), clinic (after-hours answering service), or other. Postcall residents were defined as fatigued and excused at noon if they reported they were too tired to safely perform clinical duties. RESULTS: Residents slept an average of 408 minutes per night while not on call, versus 368 minutes while on call but not fatigued, and 181 minutes while on call and fatigued (P < .05). The most senior resident received fewer pages per night on average than the most junior resident. Each page was associated with 4.71 fewer minutes asleep on average for all residents. Pages in the other category were associated with 7.74 fewer minutes asleep per page for all residents, but only the most junior resident had significantly less sleep, 9.02 minutes, per floor page. CONCLUSIONS: Objective sleep data correlate with subjective assessment of resident fatigue and with volume and type of pages received. Senior residents spent less time awake per page and received fewer pages.
Subject(s)
Internship and Residency/organization & administration , Sleep Deprivation , After-Hours Care , Education, Medical, Graduate/methods , Fatigue , Humans , Tertiary Care Centers , Urology/education , WorkloadABSTRACT
Pain occurs in the male genitourinary organs as for any organ system in response to traumatic, infectious, or irritative stimuli. A knowledge and understanding of chronic genitourinary pain can be of great utility to practicing nonurologists. This article provides insight into the medical and surgical management of subacute and chronic pelvic, inguinal, and scrotal pain. The pathophysiology, diagnosis, and medical and surgical treatment options of each are discussed.
Subject(s)
Pain Management , Pelvic Pain/therapy , Testicular Diseases/diagnosis , Testicular Diseases/therapy , Groin , Humans , Male , Pain/etiology , Pelvic Pain/etiology , Urogenital System/physiopathologyABSTRACT
Robotic-assisted ureteral reimplantations were performed on 3 patients at a single institution, 2 with Boari flap and psoas hitch and 1 with psoas hitch alone. These were for urothelial carcinoma of the distal ureter, ureteral obstruction caused by distal ureteral endometriosis, and ureteral transaction during gynecologic surgery. We used intraoperative ureteroscopy to confirm tumor margins as well as a simple technique for retrograde placement of transvesicle wire prior to ureteral anastomosis. Surgery and recovery were uneventful. This illustrates that robotic-assisted ureteral reimplantation with Boari flap and psoas hitch is a safe and viable approach for ureterovesicle reconstruction.
