Tubulovillous Adenoma in the Bladder in a Dual Pancreas-Kidney Transplant Patient.

Background: A rare report of a tubulovillous adenoma arising in the setting of a dual pancreas-kidney transplant patient. Case Presentation: This adenoma was discovered in a 60-year-old male with a dual pancreas-kidney transplant that presented with urinary retention and gross hematuria. Management of this patient required both transurethral resection of the tumor as well as a laparotomy after recurrence. Follow-up with cystoscopy has shown no further recurrence of the tumor. Conclusion: This case adds to the few cases documented of adenomas arising in bladders augmented with gastrointestinal tract tissue. The tumor may reflect growth from donor duodenal graft tissue, however, the metaplasia of urothelial tissue cannot be fully ruled out. Based on this case, our understanding of these rare tumors and their clinical course is deepened.

Initial Canadian experience with robotic simple prostatectomy: Case series and literature review.

INTRODUCTION: Robotic-assisted simple prostatectomy (RASP) has been touted as an alternative to open simple prostatectomy (OSP) to treat large gland benign prostatic hyperplasia. Our study assesses our institution's experience with RASP and reviews the literature. METHODS: We performed a retrospective chart review from January 2011 to November 2013 of all patients undergoing RASP and OSP. Operative and 90-day outcomes, including operation time, intraoperative blood loss, length of hospital stay (LOS), transfusion requirements, and complication rates, were assessed. RESULTS: Thirty-two patients were identified: 4 undergoing RASP and 28 undergoing OSP. There was no difference in mean age at surgery (69.3 vs. 75.2 years; p = 0.17), mean Charlson Comorbidity Index (2.5 vs. 3.5; p = 0.19), and mean prostate volume on TRUS (239 vs. 180 mL; p = 0.09) in the robotic and open groups, respectively. There was a significant difference in the mean length of operation, with RASP exceeding OSP (161 vs. 79 min; p = 0.008). The mean intraoperative blood loss was significantly higher in the open group (835.7 vs. 218.8 mL; p = 0.0001). Mean LOS was shorter in the RASP group (2.3 vs. 5.5 days; p = 0.0001). No significant differences were noted in the 90-day transfusion rate (p = 0.13), or overall complication rate at 0% with RASP vs. 57.1% with OSP (p = 0.10). CONCLUSIONS: Our data suggest RASP has a shorter LOS and lower intraoperative volume of blood loss, with the disadvantage of a longer operating time, compared to OSP. It is a feasible technique and deserves further investigation and consideration at Canadian centres performing robotic prostatectomies.

A prospective analysis of consultation for difficult urinary catheter insertion at tertiary care centres in Northern Alberta.

BACKGROUND: Difficult urinary catheterization (DUC) is a frequent reason for urologic consultation. Literature regarding DUC is limited. The objective of the study is to examine the current practice pattern of DUC and identify strategies to reduce its incidence and related adverse events. METHODS: This is a prospective observational study of consultation for DUC at tertiary care centres in Edmonton, Alberta between October 2010 and February 2011. All urologic consultations for DUC in adults at the 2 tertiary hospitals were enrolled. Patients were managed according to the current regional standard of care established prior to the study. A clinical encounter questionnaire (CEQ) was completed by the urology service regarding details of the consultation and patient factors. CEQ results were tabulated and analyzed for trends, areas of strengths and weakness in the consultation process. RESULTS: In total, 89 patients were accrued to the study. Mean age was 67 years and 91% were male. Seventeen percent of patients had history of previous DUC and 65% had urologic history. Forty-two percent of patients had catheter placement without any auxiliary tools. Adverse events, including urosepsis, bladder perforation, hydrouterus, paraphimosis and urethral trauma, were experienced by 37% of patients. Significant urethral injury as a result of catheterization attempts occurred in 32%. Forty-one percent of consultations were classified as inappropriate and 53% occurred between 5 pm and 6:30 am. CONCLUSION: DUC is associated with significant patient morbidity and may often be preventable. This study highlights the need for implementation of preventive strategies, widespread education and increased awareness regarding catheter care.