RESUMO
We report a case of ureteric injury during transvaginal oocyte retrieval (TVOR), which was identified immediately (on the operation table) and managed successfully in the same sitting. A 28-year-old woman with primary infertility underwent in-vitro fertilisation (IVF) in a private centre. Because of the policy of doing an ultrasonography post-procedure, she was diagnosed immediately with vaginal vault haematoma and ureteric injury. A double-J catheter was inserted under cystoscopic guidance. A major complication was averted by the timely diagnosis of ureteric injury and its appropriate management. To conclude, given the elective nature of TVOR and IVF, patients should be informed about all potential complications, including ureteric injury. Early diagnosis of complications (by knowing and anticipating potential risks of procedure) leads to efficient management by timely intervention.
RESUMO
BACKGROUND: Laparoscopy is the best available method to manage impalpable undescended testes. We performed our first laparoscopic orchiopexy in June 1992 and found good results in consecutive cases with laparoscopic orchiopexy over last 20 years. MATERIALS AND METHODS: From June 1992 to May 2012, 241 patients with 296 impalpable testes were operated upon by laparoscopic approach. One-stage laparoscopic orchiopexy was performed in 152 cases, while two-stage Fowler - Stephens laparoscopic orchiopexy was performed in 55 cases. Laparoscopic orchiectomy was required in 20, and in 21 patients testes were absent. One-sided laparoscopic orchiopexy was performed in a male pseudo hermaphrodite. RESULTS: None of the testis atrophied after two-stage Fowler - Stephens laparoscopic orchiopexy, while in 152 cases of single-stage orchiopexies one testes atrophied. One patient developed malignant change in the testis, 6 years after orchiopexy. CONCLUSIONS: Laparoscopy is the best way to diagnose impalpable undescended testes. No other imaging investigation was required. Single-stage laparoscopic orchiopexy for low level undescended testis has very good results. For high-level undescended testis and when one-stage mobilisation is difficult, two-stage Fowler - Stephens orchiopexy has excellent results. Minimum 4 months should separate first and second stage of laparoscopic Fowler - Stephens procedure. Even when open orchiopexy is being done for intra-canalicular testes in a child, it is advisable to be ready with laparoscopy if necessary, at the same time, in case open surgery fails to mobilise the testicular vessels adequately.
RESUMO
BACKGROUND: For many surgical procedures skin marking is required well before surgery and induction of anesthesia. In some cases, the patient may need to be standing or sitting while the skin area is marked. Marking of perforators and varicosities in chronic venous diseases, marking of stoma sites for urinary or fecal diversions are some examples. The side of surgery should ideally be marked preoperatively to avoid wrong side surgery. Marks made with conventional marking pens fade or disappear with preoperative skin preparation, whereas marks made with henna paste, which is orange to dark brown in color, last for up to 3 weeks in spite of regular showers and skin cleansing, even with ethanol. This property of henna encouraged us to use it as a preoperative skin marker. METHODS: Henna paste was used as a preoperative skin marker in 250 patients. In 154 patients with chronic venous diseases, perforators and varicosities were marked during duplex scanning. Henna was used to mark the colostomy site in 28 patients with carcinoma of the rectum prior to abdominoperineal resection of the rectum (APR) (four of them laparoscopic APR) and the aspiration site in 11 patients with liver abscesses and 4 patients with pleural empyemas, under ultrasonographic (USG) guidance. In addition, henna was used to mark the correct side of surgery in 47 patients undergoing unilateral inguinal hernia surgery. Marking was done from 1 to 8 days before surgery. RESULTS: The marking with henna was clearly visible in all the cases even after preoperative skin preparation with ethanol up to 8 days after application. There were no complications associated with the marking. All marks disappeared 4 weeks after application. In terms of successful execution of the desired procedure, the use of henna marking was successful in all the cases. CONCLUSIONS: Henna is an ideal substance for use as a preoperative skin marker. It can be safely and effectively used as a marker for varicose vein surgery, ultrasound-guided identification of lesions, establishing the ideal site for stomas on the abdominal wall, and to identify the correct side of surgery. Markings made with henna are durable and do not fade with routine bathing or preoperative skin preparation. In most cases there are no associated complications. Henna is cheap, safe, and convenient, and indications for its use can be ubiquitous.
