The Role of Laparoscopy in Abdominal Trauma: A 10-Year Review.

Laparoscopy is accepted in penetrating abdominal trauma (PAT), but its role in blunt trauma (BAT) remains a controversial one. Our study assessed the utility of diagnostic laparoscopy (DL) and therapeutic laparoscopy (TL) in abdominal trauma between December 2006 and January 2016. We analysed the indication for laparoscopy, type of lesions, TL, conversion rate, complications and length of hospital stay. 49 patients had a DL: 42 males and 7 females, with a mean age of 36.1+-13.3. We had 20 PAT and 30BAT. The indications for laparoscopy were: diagnosis of penetration in PAT, suspicion of hollow organ injury or diaphragm injury, active bleeding in organ injuries in BAT. 11/48 of preoperative ultrasounds and 4/48 of CT's were false negative. In 3 of 20 PAT, DL was negative and in 4 nontherapeutic. There were 4 TL's and 7 conversions. The main injuries in BAT were: 9 hollow organ perforations, 6 mesenteric lacerations, 2 diaphragmatic and 2 splenic injuries. There were 10 TL's, 9 conversions and 14 TL. The operative time and length of hospital stay was higher in the conversion group. There were 6 complications and 3 mortalities. There were no missed injuries. An unnecessary laparotomy was avoided in 18/49 cases (36.73%). In selected cases of PAT and BAT with equivocal clinical and imaging diagnosis, laparoscopy is a useful tool with therapeutic role, that reduces unnecessary laparotomies, complication rate and hospital stay.

Outcomes for Intravesical Abobotulinumtoxin A (Dysport) Treatment in the Active Management of Overactive Bladder Symptoms-A Prospective Study.

OBJECTIVE: To present the results our active management protocol for bothersome overactive bladder (OAB) symptoms using abobotulinumtoxinA (Dysport) over a 9-year period. MATERIAL AND METHODS: Data from consecutive patients with OAB symptoms due to urodynamically-proven idiopathic detrusor overactivity who had failed maximum-dose pharmacotherapy and bladder drill were reviewed. All patients completed the Overactive Bladder Symptom Score (OABSS) and Likhart quality of life indices before treatment and again at review 6 weeks post-treatment. Two hundred and fifty units of abobotulinumtoxinA were injected under general anaesthesia. Repeat treatment was offered only after failed resumption of pharmacotherapy with bladder drill. RESULTS: The results of 299 treatments in 170 patients were reviewed. OABSS and quality of life indices improved by a mean of 35% (P ˂.001) and 41% (P ˂.001), respectively, with the OABSS improving by 2 or more points in 65% of cases. While urgency incontinence was completely abolished in 26%, the severity of incontinence was reduced in 44%. Pharmacotherapy was resumed after a mean of 10.2 months, and the mean interval between repeat abobotulinumtoxinA injection treatments was 21.3 months. De-novo self-catheterization was required in 18.2% of cases due to high postvoid residuals. CONCLUSION: The use of abobotulinumtoxinA is safe and highly effective treatment option for patients with refractory OAB symptoms. Our data show similar outcomes to onabotulinumtoxinA in terms of symptom score improvement and self-catheterization rates.

Seminoma presented as testicular rupture: Case report and literature review.

Rupture of the testis as a result of blunt trauma is rarely seen in daily urological practice. We report an unusual case of incidental seminoma diagnosed after surgical exploration and subsequent orchidectomy of a severed testis following testicular injury as a result of trivial blunt trauma. This case highlights the inability of investigative tools, such as a scrotal ultrasound, in distinguishing an underlying tumour in the presence of testicular parenchymal damage. We therefore advocate a high index of clinical suspicion for co-existing pathology in cases of testicular rupture secondary to an insignificant blunt trauma to the scrotum.

Searching for the G spot in the urinary bladder: autoerotism and potential complications.

Self-insertion of foreign bodies into the urethra and urinary bladder for autoerotic stimulation is a rather rare urological emergency condition. We present a case of 41-year-old lady who self-inserted a crochet needle into the urethra for sexual pleasure, which was successfully retrieved during examination under general anaesthetic and endoscopic bladder evaluation. Foreign bodies in the urinary bladder are rarely encountered yet represent a urological challenge that requires prompt management in view of possible sequellae if left untreated.