Amod Kumar Dwivedi

Mechanical Suction: An Effective and Safe Method to Remove Large and Tenacious Clots From the Urinary Bladder

OBJECTIVE To describe an alternative technique for removing tenacious and chronic clots by applying stronger suction pressure through the cystoscope sheath in patients who had failed clot evacuation using the traditional Ellik evacuator. METHODS In this method, either the 25-F cystoscope sheath or 26-F resectoscope sheath was directly attached with the tubing from centralized suction source, and moderate negative pressure (up to 250 mm Hg) was applied. RESULTS This technique was used in 15 adult patients with clot retention. Average duration for clot retention was 36.5 hours (range 22-60 hours). All patients were rendered clot free in an average operative period of 88 minutes (range 60-120 minutes). At the end of the procedure, apart from punctuate hemorrhagic spots on the bladder mucosa, no complications were encountered. CONCLUSIONS Clots that are old, large, and tenacious can be effectively and safely evacuated by applying moderate suction pressure from central suction source directly through the cystoscope sheath.

Cross-leg lithotomy: is it a better position for digital rectal examination of the prostate?

Objectives To evaluate whether “cross-leg lithotomy” (CL) is better position for digital rectal examination (DRE) than left lateral (LL) position from urologist and patients perspective. Materials and methods Two urologists performed DRE in 120 patients in LL and CL positions. Each patient was randomised, sequentially examined in both positions and responses were objectively assessed using a questionnaire and statistically analysed. Results Men found DRE uncomfortable [LL (81.7%), CL (85.0%)] and embarrassing [LL: (81.7%), CL (78.3%)] in both the positions. DRE was painful [LL (11.7%), CL (8.3%)] with a mean pain score of 1.92 and 1.85 respectively. Patient apprehension regarding pain was significantly higher [LL (62.5%) vs. CL (21.7%), p < 0.001] in LL position. Overall, men preferred CL to LL position [CL (78.3%), LL (21.75%), p < 0.001] for DRE. From urologist perspective, the extent of prostate felt in CL position was significantly higher (CL: 11.15 ± 1.96/12 vs. LL: 9.25 ± 2.50/12, p < 0.001). Withdrawal response was significantly higher in LL and urologist had to sit down to perform DRE in LL position. Conclusions Men preferred CL to LL position for DRE and CL allowed more complete examination of the prostate from urologist perspective. CL position is a better alternative for performing DRE of the prostate.