A rare case report of renal vein embolization after failed selective angioembolization to treat delayed complication of percutaneous nephrolithotomy.

INTRODUCTION: Percutaneous nephrolithotomy (PCNL) has been considered the standard procedure for renal caliculi for its safety, shorter operative time, and cost-effectivity. Despite being minimally invasive, rare complications may still occur. This case presented a rare case of renal venous pseudoaneurysm after PCNL. PRESENTATION OF CASE: A 34-year-old male was diagnosed with left lower calyx renal stone sized 14x13x8 mm with 388-571 Hounsfield Unit (HU). He underwent left mini PCNL with standard protocol. However, on two-weeks follow-up, gross haematuria was presented on emergency department admission. Patient underwent two times cystoscopy and blood clot evacuation. Postoperative contrast-enhanced CT showed saccular lesion sized 6.7 mm × 4.8 mm in the interlobar vein of left kidneys' lower pole. Patient was then consulted to Cardiothoracic-Vascular division, and undergone selective angiography and left renal artery embolization-coiling (VortX Diamond-18). Complaints and haemoglobin decline persists; thus, another attempt of embolization was performed with a different approach. Follow-up arteriography and venography showed complete obliteration of the aneurysm sac, followed by cessation of symptoms. This study is reported in line with SCARE criteria. DISCUSSION: This is a rare case where a second embolization attempt (specifically via vein) was needed to overcome PCNL postoperative complication. Reviewing vascular complications risk factors after PCNL is crucial. This case report suggests complication management could be handled appropriately through procedures of selective angiography and embolization. CONCLUSION: Coil embolization targeting the vein is a potentially effective and safe for selective cases of renal vein pseudoaneurysm. This case shows the importance of multidisciplinary approach and collaboration for better patient management.

Transperitoneal vs extraperitoneal radical cystectomy: A systematic review and meta-analysis.

BACKGROUND: One of the most complex surgeries including radical cystectomy (RC) has a high rate of morbidity. The standard approach for the muscle-invasive bladder is conventional transperitoneal radical cystectomy. However, the procedure is associated with significant morbidities like ileus, urinary leak, bleeding, and infection. The aim of this study is to compare the transperitoneal RC approach with the extraperitoneal RC approach in the treatment of bladder cancer patients. The outcomes of this study are Operative time, Estimated Blood Loss, Hospital Stay, Post-Operative Ileus, Infection, and Major Complication (Clavien-Dindo Grade 3-5). METHODS: PubMed, Cochrane Library, and Science Direct were systematically searched for different publications related to the meta-analysis. Keywords used for searching were Radical Cystectomy AND Extraperitoneal AND Transperitoneal up until 31st August 2022. The studies were screened for our eligibility criteria. Demographic parameters, perioperative variables, and postoperative complications were recorded and analyzed. The Newcastle-Ottawa Scale was used to evaluate the risk of bias in each study. The Review Manager (RevMan) software version 5.4.1 was used for statistical analysis. RESULTS: Eight studies (3 laparoscopic and 5 open methods) involving 1207 subjects (588 patients using the extraperitoneal approach and 619 using the transperitoneal approach) were included. The incidence of postoperative ileus is significantly lower after the extraperitoneal approach compared to the transperitoneal approach (p < 0.00001). The two techniques did not differ in operative time, estimated blood loss, duration of hospital stay, total infection, and major complication events. CONCLUSION: This meta-analysis shows that extraperitoneal radical cystectomy benefits in terms of reduced postoperative ileus.

Comparison of the Effectiveness of Pre-urodynamic Single-dose Levofloxacin with Post-urodynamic Levofloxacin for Three Days Related to the Incidence of Urinary Tract Infection: A Randomized Control Trial.

PURPOSE: The current study aims to compare the effectiveness of pre-urodynamic single-dose levofloxacin and post-urodynamic levofloxacin for three days related to the incidence of urinary tract infections post-urodynamic examination. MATERIALS AND METHODS: This is a single-blind randomized clinical trial conducted in three outpatient urology centers in Jakarta: Cipto Mangunkusumo General Hospital, Siloam Asri Hospital, and Persahabatan General Hospital using a consecutive sampling method between July 2019 - February 2022. The outcome of the study is the incidence of urinary tract infections in both treatment groups. Urinary tract infection was defined as a patient with one or more clinical symptoms of lower urinary tract infection and one or more urinalysis parameters positive for urinary tract infections. Chi-square was used to evaluate the association where p < 0.05 was used to determine statistical significance. RESULTS: A total of 126 patients (63 patients in each arm) were included in the evaluation and analysis. Overall, urinary tract infections were detected in 25 cases (19.8%), 12 patients from the pre-urodynamic antibiotic group (9.5%) and 13 patients from the post-urodynamic antibiotic group (10.3%) (P = .823). E.coli was the most common bacteria found in the urine culture. CONCLUSION: There is no significant difference between a single dose of 500 mg of Levofloxacin administered one hour before the urodynamic study and a once-daily dose of 500 mg of Levofloxacin for three days following the urodynamic study related to urinary tract infections prevention post-urodynamic examination.

Biofeedback-assisted pelvic floor muscle training and pelvic electrical stimulation in women with overactive bladder: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: This meta-analysis aims to compare biofeedback-assisted pelvic muscle floor training (PFMT) and pelvic electrical stimulation (ES) as an intervention group, with PFMT or bladder training (BT) as the control group, in women with an overactive bladder (OAB). METHOD: PubMed, Cochrane, CINAHL, EMBASE, and Scopus were systematically searched for randomized controlled trials (RCTs) published up to November 2021. The RCTs were screened for our eligibility criteria and quality was evaluated using the Cochrane Risk Index of Bias tools. The outcomes were changes in quality of life (QoL), episodes of incontinence, and the number of participants cured/improved. RESULTS: Eight studies involving 562 patients (comprising 204 patients with biofeedback-assisted PFMT, 108 patients with pelvic ES, and 250 patients who received PFMT alone or BT and lifestyle recommendations only, as the control group) were included. The ES group showed significant differences in terms of changes to QoL (mean difference [MD]: 7.41, 95% confidence interval [CI]: 7.90-12.92, p = 0.008), episodes of incontinence (MD: -1.33, 95% CI: -2.50 to -0.17, p = 0.02), and the number of participants cured or improved (risk ratio [RR]: 1.46, 95% CI: 1.14-1.87, p = 0.003), while the biofeedback group resulted in nonsignificant changes in QoL (MD: 0.13, 95% CI: 7.87-8.12, p = 0.98), episodes of incontinence (MD: 0.01, 95% CI: -0.89 to 0.90, p = 0.99), and the number of participants cured or improved (RR: 1.15, 95% CI: 0.99-1.33, p = 0.08), both compared to the control group respectively. CONCLUSION: This meta-analysis shows that low-frequency pelvic ES appears to be sufficient and effective as an additional intervention for women with OAB in clinical practice according to improvements in the subjects' QoL and reduction of symptoms. Meanwhile, biofeedback-assisted PFMT does not appear to be a significant adjuvant for conservative OAB therapy.

"Why couldn't we do this more often?": exploring the feasibility of virtual and distributed work in product design engineering.

Lower costs and higher employee satisfaction are some of the benefits driving organizations to adopt dispersed and virtual working arrangements. Despite these advantages, product design engineering teams-those who develop physical products-have not widely adopted this working style due to perceived critical dependence on physical facilities and the belief that it is ineffective to communicate technical details virtually. This paper uses the mass shift in working conditions caused by the COVID-19 pandemic to explore the feasibility of virtual and distributed work in product design engineering. We conducted 20 semi-structured interviews with product design engineers working virtually to uncover current challenges of, and the beginning of promising strategies for, effective virtual engineering work. We categorize and analyze Tangible Design activities, Intangible Design activities, and Communication and Project Management activities throughout the product design process. Contrary to present opinions, we found that much of a product design engineer's work is realizable in a virtual and distributed setting. However, there are still many challenges, especially when attempting Tangible Design activities-those that require physical products and tools-from home. These challenges, missing from existing virtual product design engineering literature, include but are not limited to individuals' lessened sense of accountability, fewer de-risking opportunities before product sign-off, and limited supervision of production staff. Product design engineers described novel strategies that emerged organically to mitigate these challenges, such as creating digital alternatives for engineering reviews and sign-offs and leveraging rapid prototyping. Recent advances in technology, an increased commitment to reducing environmental impact, and better work-life balance expectations from new generations of workers will only push society faster towards a distributed working model. Thus, it is critical that we use this opportunity to understand the existing challenges for distributed product design engineers, so that organizations can best prepare and become resilient to future shocks.