Is it safe to insert a testicular prosthesis at the time of radical orchidectomy for testis cancer: an audit of 904 men undergoing radical orchidectomy.

OBJECTIVE: To compare the complication rate associated with synchronous prosthesis insertion at the time of radical orchidectomy with orchidectomy alone. PATIENT AND METHODS: All men undergoing radical orchidectomy for testis cancer in the North West Region of England between April 1999 to July 2005 and November 2007 to November 2009 were included. Data on postoperative complications, length of stay (LOS), re-admission rate and return to theatre rate were collected. RESULTS: In all, 904 men [median (range) age 35 (14-88) years], underwent a radical orchidectomy during the study period and 413 (46.7%) were offered a prosthesis, of whom 55.2% chose to receive one. Those offered a prosthesis were significantly younger (P < 0.001), with a median age of 33 vs 37 years. There was no significant difference between the groups for LOS (P = 0.387), hospital re-admission rates (P = 0.539) or return to theatre rate (P = 0.999). In all, 33/885 patients were readmitted ≤30 days of orchidectomy, with one of 236 prosthesis patients requiring prosthesis removal (0.4%). Older age at orchidectomy was associated with an increased risk of 30-day hospital re-admission (odds ratio 1.032, P = 0.016). CONCLUSIONS: Concurrent insertion of a testicular prosthesis does not increase the complication rate of radical orchidectomy as determined by LOS, re-admission or the need for further surgery. Prosthesis insertion at the time of orchidectomy for testis cancer is safe and concerns about increased complications should not constrain the offer of testicular prosthesis insertion concurrently with primary surgery.

Renal trauma: case reports and overview.

Introduction. Renal trauma patients are largely managed conservatively but on occasion have to be embolised or taken to theatre for definitive surgical management, usually in the form of emergency nephrectomy. Review. We present an overview of renal trauma as illustrated by three interesting cases of blunt renal trauma who presented in quick succession of each other to the Emergency Department. The first case-a 48-year-old-female passenger in a road traffic accident-was treated with life-saving emergency nephrectomy. The second patient-a 47-year-old man who sustained a high impact injury whilst sledging-was managed conservatively on HDU and subsequently on the urology ward. The third patient-an 18-year-old man involved in a road traffic accident-underwent selective embolisation of a pseudoaneurysm after conservative therapy. Discussion. This case series illustrates the surgical, radiological, and conservative approaches to the management of significant renal trauma, which is potentially life threatening.

Arterial emboli complicating Cisplatin therapy.

We report three cases of arterial emboli in patients with lung cancer treated with cisplatin chemotherapy. All three patients were managed without surgical intervention but subsequent oncological treatment was complicated by the sequelae of arterial emboli. We discuss the issues surrounding these patients and the importance of identifying patients at risk of arterial embolic phenomena with cisplatin treatment.