Calculating Optic Nerve Planning Organ at Risk Volume Margins for Stereotactic Radiosurgery Using Optic Nerve Motion determined using MRI.

OBJECTIVES: The combination of sharp dose gradients in stereotactic radiosurgery (SRS) and minute optic nerve motion may significantly increase dose to the optic nerves when treating perioptic lesions. The aim of this study was to calculate optic nerve planning organ at risk volume (PRV) margins for CyberKnife SRS treatment planning. METHODS: MRI scans were taken of 10 healthy volunteers looking left, right, up, down, and straight ahead to measure optic nerve motion. The measured optic nerve motion and the uncertainties in the technical accuracy of CyberKnife were used to calculate optic nerve PRV margins. RESULTS: Two optic nerve PRV margins were calculated: a non-isotropic margin of mL/R,PRV=3mm, mSup/Inf,PRV=2mm and mAnt/Post,PRV=1mm which considers the full range of motion measured in a worst case scenario; and an isotropic margin of mPRV=1mm which considers a scenario where patients are asked to look neutrally during imaging and treatment. Applying these PRVs to 8 historical sphenoid wing meningioma CyberKnife plans showed tolerance levels may be exceeded due to optic nerve motion. CONCLUSIONS: Optic nerve PRV margins may be needed in CyberKnife planning to reduce risk to the optic nerves. The use of a mPRV=1mm PRV to account for organ motion, along with instructing patients to hold their gaze neutrally during imaging and treatment, may be a suitable organ sparing strategy. ADVANCES IN KNOWLEDGE: Measured optic nerve motion and the technical accuracy of the CyberKnife system have been used to calculate optic nerve PRV margins.

A prospective randomised double-blind placebo-controlled trial to assess the effect of diuretics on shockwave lithotripsy of calculi.

OBJECTIVE: To assess the effect of diuretics with shockwave lithotripsy (SWL) on the treatment of renal and upper ureteric calculi. PATIENTS AND METHODS: Adult patients with a solitary non-obstructive radio-opaque renal or upper ureteric calculus with normal renal function were included. They were prospectively randomised to receive either SWL with placebo or SWL with diuretics (40 mg parenteral furosemide) in a double-blind manner with a sample size of 48 patients in each arm. The primary outcomes were the SWL success and failure rates. The secondary outcomes were the number of shocks and sessions. RESULTS: Complete fragmentation was achieved in 89.6% of the patients in the furosemide arm as compared to 81.3% in the placebo arm. Clearance was achieved in 77.1% of the patients in the furosemide arm as compared to 70.8% in the placebo arm. The number of shocks and the number of sessions were higher in the placebo arm. These differences were not statistically significant. CONCLUSION: The use of diuretics along with SWL treatment of renal and upper ureteric calculi does not show a statistically significant improvement in fragmentation or clearance.

Hidden penile fracture: An unusual presentation and review of literature.

Penile fractures, a not so uncommon urological emergency, mostly present with a characteristic history and physical examination. Here, we present an atypical case where even in the absence of physical findings, a characteristic history led us to penile exploration and timely repair, highlighting the importance of careful history-taking in these cases.

A novel computer based stent registry to prevent retained stents: Will patient directed automated short message service and letter generator help?

OBJECTIVE: The objective of this study was to evaluate the feasibility of a computer based stent registry with patient directed automated information system to prevent retained double J stents. MATERIALS AND METHODS: A stent registry system was developed in collaboration with our Computerized Hospital Information Processing Service Department. This computer based stent registry with patient directed automated information system was integrated with the existing clinical work station. We reviewed the records retrospectively and assessed the feasibility of the system in reminding clinicians and patients regarding the stent and its date of removal. RESULTS: In a short run at our department, this new system appeared feasible, with patients promptly responding to the short message service and letter alerts. CONCLUSIONS: Computer based stent registry with patient directed automated information system is feasible in a clinical setting. A prospective study is needed for evaluation of its efficacy in preventing retained stents.

Primary renal angiosarcoma.

Primary angiosarcoma of the kidney is a rare tumor with only a few case reports in the literature. Management is not standardized and the prognosis is poor. However, clinicians need to be aware of this uncommon entity.

Bilateral vesical inguinal hernia: A perineal 'Mickey mouse'.

Bladder being a content of inguinal hernias is a rare event and it being the sole component is extremely uncommon. Usually, elderly obese males are affected and symptomatology depends on the extent of bladder involvement. However, recognition of this entity is important in the treatment of LUTS as well as to avoid inadvertent bladder injury during hernia repair.

Acute gastric dilatation: a rare complication of nephrectomy.

We report the first case of acute gastric dilatation after simple extraperitoneal nephrectomy for benign disease.