Incidence of Infection Following Local Anesthetic Transperineal Prostate Biopsy: A Single-Centre Experience.

Background Local anesthetic transperineal prostate biopsy (LATP) is a widely used diagnostic procedure for prostate cancer. As a diagnostic procedure, it should carry minimal risk. However, morbidity resulting from prostate biopsy is frequent. Prostate biopsy, like any other intervention, carries a significant risk of various infections, ranging from urinary tract infections (UTIs) to potentially life-threatening conditions like sepsis. Aim This study examined the rate of infections following a prostate biopsy at a single center and sought to identify risk factors that could increase the likelihood of developing an infection. Methods A retrospective review was conducted on all 168 patients who underwent LATP biopsy between 01/04/2022 and 01/04/2023. Data were collected from the Clinical Record and Reporting System (CRRS). Patient characteristics, including age, prostate-specific antigen (PSA) levels, prostate volume, the main indication for the biopsy, number of cores taken, antibiotic prophylaxis, and comorbidities were analyzed. The inclusion criteria encompassed all patients receiving this procedure within the specified timeframe, without restrictions on age, underlying health conditions, or medical history. No exclusion criteria were applied, aiming to comprehensively analyze and capture the full spectrum of patient outcomes and characteristics associated with these biopsies during the study period. Results In terms of socio-demographics, all patients were male with an average age (mean) of 65.5 years, a mean PSA level of 13.9 ng/dL, and an average prostate volume of 66.1 mL. On average, 23.2 biopsy cores were taken. All patients received antibiotic prophylaxis, mainly ciprofloxacin. Despite this, 1.78% of patients (n=3) developed post-biopsy infections. Two of these patients had diabetes mellitus, and two had a large prostate volume of 95 mL.

Submarine canyon systems focusing sub-surface fluid in the Canterbury Basin, South Island, New Zealand.

This work uses a high-quality 3D seismic volume from offshore Canterbury Basin, New Zealand, to investigate how submarine canyon systems can focus sub-surface fluid. The seismic volume was structurally conditioned to improve the contrast in seismic reflections, preserving their lateral continuity. It reveals multiple pockmarks, eroded gullies and intra-slope lobe complexes occurring in association with the Waitaki Submarine Canyon. Pockmarks are densely clustered on the northern bank of the canyon and occur at a water depth of 500-900 m. In parallel, near-seafloor strata contain channel-fill deposits, channel lobes, meandering channel belts and overbank sediments deposited downslope of the submarine canyon. We propose that subsurface fluid migrates from relatively deep Cretaceous strata through shallow channel-fill deposits and lobes to latter seep out through the canyon and associated gullies. The new, reprocessed Fluid Cube meta-attribute confirms that fluids have seeped out through the eroded walls of the Waitaki Canyon, with such a seepage generating seafloor depressions in its northern bank. Our findings stress the importance of shallow reservoirs (channel-fill deposits and lobes) as potential repositories for fluid, hydrocarbons, or geothermal energy on continental margins across the world.

A machine learning tool for interpretation of Mass Transport Deposits from seismic data.

Machine learning is a tool that allows machines or intelligent systems to learn and get equipped to solve complex problems in predicting reliable outcome. The learning process consists of a set of computer algorithms that are employed to a small segment of data with a view to speed up realistic interpretation from entire data without extensive human intervention. Here we present an approach of supervised learning based on artificial neural network to automate the process of delineating structural distribution of Mass Transport Deposit (MTD) from 3D reflection seismic data. The responses, defined by a set of individual attributes, corresponding to the MTD, are computed from seismic volume and amalgamated them into a hybrid attribute. This generated new attribute, called as MTD Cube meta-attribute, does not only define the subsurface architecture of MTD distinctly but also reduces the human involvement thereby accelerating the process of interpretation. The system, after being fully trained, quality checked and validated, automatically delimits the structural geometry of MTDs within the Karewa prospect in northern Taranaki Basin off New Zealand, where MTDs are evidenced.

Serum 25-hydroxyvitamin D level in patients with chronic liver disease and its correlation with hepatic encephalopathy: A cross-sectional study.

BACKGROUND: Hepatic encephalopathy (HE) is an established clinical manifestation in chronic liver disease (CLD). It is associated with various factors including gastrointestinal bleed, constipation, and dyselectrolemia. Recently 25-hydroxyvitamin D (25-OHD) deficiency has been identified as one of the factors associated with the development of HE. The current study was aimed to assess the level of 25-OHD in patients with CLD and hepatic encephalopathy and the relationship between 25-OHD deficiency and hepatic encephalopathy. MATERIALS AND METHODS: This cross-sectional study included 100 subjects of either sex between 18 and 60 years of age, diagnosed as CLD on the basis of ultrasonography with hepatic encephalopathy and 50 age, sex-matched CLD subjects without encephalopathy. Hemogram, hepatic and renal functions, serum electrolytes, coagulation profile, and serum 25-hydroxyvitamin D levels were recorded. RESULTS: The baseline variables were matched for age, sex, hepatic and kidney function, and coagulation profiles. The hemoglobin (P = 0.002) and platelet count (P = 0.0003) were significantly lower in subjects with HE. The mean level of 25-OHD was significantly lower in subjects with HE as compared to the control group (25.62 ± 21.94 nmol/L vs 37.44 ± 18.61 nmol/L, P < 0.001). The mean 25-OHD level was 30.64 ± 21.64 nmol/L in grade 1 HE, 12.03 ± 11.05 nmol/L in grade 3 with P < 0.0001, and 18.8 ± 16.88 nmol/L in grade 4 with P < 0.0001 when compared to grade 1. Moderate and severe deficiency of 25-OHD level was significantly associated with higher grades of HE, i.e. grades 3 and 4 (P < 0.0001). There was a significant negative correlation between 25-OHD levels and worsening grades of hepatic encephalopathy (person's correlation coefficient r = -0.354; P = 0.0003). CONCLUSION: In this cohort of North Indian population, serum 25-OHD level was significantly lower in patients with CLD and HE. The levels of 25-OHD showed a significant negative correlation with hepatic encephalopathy.

Association of high-sensitivity C-reactive protein (hs-CRP) with non-alcoholic fatty liver disease (NAFLD) in Asian Indians: A cross-sectional study.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is an important etiology for the development of chronic liver disease worldwide. Its pathophysiology includes chronic low-grade inflammation. There are limited studies on the association of inflammatory markers with NAFLD. Hence, in the present research, we aimed to study the association of one such inflammatory marker hs-CRP with NAFLD in north Indian population. MATERIALS AND METHODS: For this cross-sectional study, 100 subjects of either sex above 18 years of age, being diagnosed as a case of NAFLD on the basis of ultrasonography and age, sex and BMI matched subjects fulfilling the inclusion and exclusion criteria were included. Anthropometric profile, high-sensitivity C-reactive protein (hs-CRP), HbA1c, and hepatic function tests were recorded. RESULTS: The baseline variables were matched for age, weight, BMI, waist-hip circumference ratio, and blood pressure. The HbA1c (P < 0.001), alanine aminotransferase (P = 0.002), alkaline phosphatase (0.002), and hs-CRP (P < 0.001) were elevated in subjects with NAFLD. The mean level of hs-CRP was significantly higher in subjects with NAFLD as compared to the control group (3.12 ± 1.42 mg/L vs 1.05 ± 0.44 mg/L, P < 0.001). The mean hs-CRP level was 1.42 ± 0.55 mg/L in grade 1, 0.98 ± 0.72 mg/L in grade 2 with P < 0.001, and 4.5 ± 1.11 mg/L in grade 3 with P < 0.001 when compared to grade 1.The comparative value of hs-CRP in the control group was found to be 1.05 ± 0.44 mg/L. On univariate analysis waist-hip circumference ratio (P = 0.035), HbA1c (P < 0.001), and hs-CRP (P < 0.001), showed a significant association with NAFLD. On logistic regression hs-CRP was found to have significant association with NAFLD even after adjusting waist-hip circumference ratio and HbA1C (odds ratio 1.311, 95% confidence interval 1.146-1.488, P < 0.001). CONCLUSION: In this cohort of north Indian population, hs-CRP showed independent relationships with NAFLD. Thus, hs-CRP may be used as a surrogate marker for the disease severity in NAFLD.

Hyperglycemia-induced posterior reversible encephalopathy syndrome: A rare cause of reversible blindness.

Posterior reversible encephalopathy syndrome (PRES) is an amalgam of clinical and radiological entities, which is reversible if diagnosed and treated promptly. It is characterized by varying neurological manifestation of seizure, headache, visual loss with typical magnetic resonance imaging findings of symmetric distribution of changes involving the parietooccipital lobes, which reflects vasogenic edema. The common causes include hypertension, renal failure, eclampsia, preeclampsia, sepsis, diabetic ketoacidosis, sepsis, cytotoxic drugs, and autoimmune disorders. Although it has been reported in association with diabetic ketoacidosis in few cases, its association with hyperglycemia in the absence of any other clinical or metabolic derangements is extremely rare. We report here a case of reversible blindness caused by hyperglycemia-induced PRES in a 21-year-old female.

A rare presentation of imperforate hymen: a case report.

Introduction. Acute urinary retention in a child is rare. Haematocolpos can cause a mechanical obstruction, resulting in acute urinary retention. Case Report. A 12-year-old girl presented to the surgical department with a one-day history of acute urinary retention and suprapubic tenderness. She had not started menses but had described period-like pains every month for the past six months. On examination, she had a palpable bladder with over 500 mls of residual urine and a bluish-grey bulge posterior to her urethral meatus. An US scan showed a large mass posterior to her bladder resembling a haematocolpos, and this was confirmed with an MRI scan. She was catheterised and eventually underwent a hymenectomy using a cruciate incision. She made a good recovery postoperatively. Conclusion. In the case of a peripubertal female presenting with acute urinary retention, haematocolpos should be considered as a diagnosis.

Supine percutaneous nephrolithotomy (PCNL): 'in vogue' but in which position?

UNLABELLED: Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Supine percutaneous nephrolithotomy (PCNL) has been described for over a decade and has equivalent success rates when compared with the more widely used prone position. The supine position offers a shorter operative duration with better access to the airway for the anaesthetist and also allows for simultaneous retrograde intra-renal surgery (RIRS). Various supine positions have been described but there is little data regarding their differing benefits and disadvantages. The present study looks at the different supine PCNL positions and compares the strengths and weaknesses of each. Each of the previously described supine PCNL positions have some limitations, e.g. ease of puncture under image guidance, the ability and ease of making and dilating multiple tracts, and allowing simultaneous RIRS. The new 'Barts flank-free modified supine position' is described, which seems to offer a good compromise and addresses some of these issues. It is important to highlight that one supine position does not fit all and the endourologist should familiarise themselves with these positions so the appropriate position can be used for the right patient and stone burden. OBJECTIVE: • To discuss the relative merits of the different described supine positions for percutaneous nephrolithotomy (PCNL) and highlight the new 'Barts flank-free modified supine position', as the last decade has seen the emergence of various supine positions for PCNL. MATERIALS AND METHODS: • We reviewed English publications on supine PCNL to look at the different positions being used to carry out PCNL and their relative merits. • We describe the new 'Barts flank-free modified supine position', which we think will add significantly to the armamentarium of the endourologist. RESULTS: • Five different supine positions are discussed. • These include the complete supine, the Valdivia, the Galdakao modified Valdivia, the Barts modified Valdivia and the herein described Barts flank-free modified supine position • These positions all differ in regard to ease of puncture under image guidance, operative field availability, ability to make multiple tracts and the ease of combining retrograde intra-renal surgery. CONCLUSIONS: • All of the supine positions decrease operative duration, as there is no need for repositioning and allow quick access to the airway for the anaesthetist. • However, one supine position does not fit all and the right one must be chosen for the right patient with the right stone burden. It is important for endourologists of today to familiarise themselves with these positions to be able to make these judgements.

Drugs for pain management in shock wave lithotripsy.

Objective. With this review, we provide a comprehensive overview of the main aspects and currently used drugs for analgesia in shockwave lithotripsy. Evidence Acquisition. We reviewed current literature, concentrating on newer articles and high-quality reviews in international journals. Results. No standardized protocols for pain control in SWL exist, although it is crucial for treatment outcome. General and spinal anaesthesia show excellent pain control but are only recommended for selected cases. The newer opioids and nonsteroidal anti-inflammatory drugs are able to deliver good analgesia. Interest in inhalation anaesthesia with nitrous oxide, local anaesthesia with deep infiltration of the tissue, and dermal anaesthesia with EMLA or DMSO has recently rekindled, showing good results in terms of pain control and a favourable side effect profile. Tamsulosin and paracetamol are further well-known drugs being currently investigated. Conclusion. Apart from classically used drugs like opioids and NSARs, medicaments like nitrous oxide, paracetamol, DMSA, or refined administration techniques for infiltration anaesthesia show a good effectiveness in pain control for SWL.

Clinical management of chronic testicular pain.

AIM: To review the causes and principles and recent concepts in the management of testicular pain. INTRODUCTION: Chronic testicular pain is a common presenting symptom in genitourinary surgery. Due to increased awareness of testicular cancer and in men's health more cases are likely to be referred. MATERIAL AND METHODS: A literature search was made for abstracts, original papers and review articles in the Cochrane Database, Medline and medical textbooks using the words 'testicular pain' and orchialgia to find the causes and mechanisms of testicular pain. The management and algorithm have been structured on evidence-based management strategies. RESULTS: The management of chronic testicular pain remains essentially based on clinical assessment. In recent years there have been advances in the non-surgical management of testicular pain mainly because of the emergence of pain relief as a specialty. However, in some cases pain control is a problem and may ultimately conclude with orchiectomy. CONCLUSIONS: The management of chronic testicular pain includes a careful assessment of testicular and extratesticular causes. Relief of symptoms is not always possible and gaining an insight into the patient's concerns and empathizing with their condition is paramount in helping them cope with their symptoms. Surgery should not be undertaken lightly for there is no guarantee that there will always be resolution of symptoms and the patient should be counseled accordingly.

Management of post-radical prostatectomy anastomotic stricture by endoscopic transurethral balloon dilatation.

OBJECTIVE: Anastomotic strictures are seen more commonly with increasing treatment of prostate cancer by means of radical prostatectomy. In view of the proximity to the sphincter, anastomotic strictures need careful management to avoid making the patient incontinent. We describe our experience with a novel method. MATERIAL AND METHODS: Nine patients who had developed anastomotic strictures were treated with endoscopic transurethral balloon dilatation. A catheter was left in place for 24 h postoperatively. RESULTS: Eight patients were treated successfully and remained well after a median follow-up period of 33 months. There were no complications and all patients remained continent. CONCLUSION: This is a safe and effective procedure that should be used as a first-line treatment for the management of anastomotic strictures, with transurethral incision being reserved for non-responders.

Samuel Pepys: a patient perspective of lithotomy in 17th century England.

PURPOSE: Bladder stones have plagued mankind since ancient times with the oldest stone found in an Egyptian mummy dating from circa 4800 B.C. Lithotomy has also been practiced since antiquity with accounts describing the operation as risky and difficult. There are no contemporary details of the patient description of this ordeal. Samuel Pepys was a notable diarist of the 17th century who described his personal experience of having a bladder stone and subsequent undergoing lithotomy. MATERIALS AND METHODS: A comprehensive review of the medical literature, the diaries of Pepys, biographies and historical texts was performed to compile this historical review. RESULTS: The diaries of Samuel Pepys chronicle life in the 17th century in London. The diaries provide great insight into the contemporary political climate and London life. Stones afflicted Pepys from an early age and continued to trouble him, such that he finally decided to undergo lithotomy in 1658 for bladder stone. He provided a lucid account of his experiences in his diary. CONCLUSIONS: Pepys survived through the skill of an early urologist or lithotomist, the prayers of his family and probably his own strong constitution. He then went on to write his diary during the next decade, giving perhaps unwittingly an insight into his world and times to later generations as well as the personal story of his lithotomy.