Andrew Symes

Percutaneous versus open tendo achillis repair.

A retrospective analysis was conducted comparing open and percutaneous repair of ruptured Achilles tendon, over a 14-year period. One hundred and eight patients were identified; 70 underwent traditional open repair and 38 had a modified Ma & Griffith repair. The mean operating time with percutaneous repair was 28.5 minutes compared to 45.9 in the open group (p = < .0001). Comparable results were obtained in a subjective analysis of range of movement, stiffness, and power in both groups at time of discharge from clinic. In the open group there were four cases of rerupture (5.7%), four deep infections (4.7%), two palpable suture knots (2.9%), and one sural nerve lesion (1.4%). Complications with percutaneous repair included one rerupture (2.6%), five palpable suture knots (13.2%), four transient sural nerve lesions (10.5%), and no wound infections. There was no statistical significance between the two groups. The authors advocate percutaneous repair, in experienced hands, as a suitable alternative to traditional open techniques.

Virtual stone clinic – the future of stone management?

Objectives: Increasing demands on the urology outpatient department at Brighton and Sussex University Hospitals (BSUH) have posed a significant challenge on the provision of a timely service for patients with stone disease. This study aimed to evaluate the patient outcomes and waiting times achieved with a newly implemented virtual stone clinic (VSC). Materials and methods: All new stone referrals received between August 2016 to January 2017 at BSUH were discussed in the VSC. Patients were reviewed within seven days of referral by a multidisciplinary team led by a consultant stone surgeon. A prospectively collected database was generated with primary outcomes including discharge to primary care, need for further diagnostics, re-review at VSC, direct booking for treatment and referral to a traditional outpatient stone clinic. Waiting times between the VSC and previously used outpatient stone clinic were also compared. Results: A total of 526 cases were reviewed in the VSC. One-quarter of patients were discharged following initial VSC review with a further two-thirds discharged after re-review. Treatment was offered to 101 patients, primarily in the form of lithotripsy (65%). Eighty-six patients required formal outpatient clinic appointments. Waiting lists for stone appointments were cleared within two months of implementation of the VSC. Outcomes were very favourable, with only three patients requiring emergency admission for management of their stone disease. Conclusion: The VSC model provides a clinically and cost-effective method of managing patients with urinary tract stones with significantly reduced waiting times and overall improved patient satisfaction. Level of evidence: Not applicable for this multicentre audit.

MP12-08 GEOGRAPHICAL AND PREVALENCE TRENDS IN UROLITHIASIS IN ENGLAND: A TEN-YEAR REVIEW

and GeneSpring 7.2 (Silicon Genetics). Cell Intensity files were processed into expression values for all the 55,000 probe sets (transcripts) on each array and following the respective normalization step. Differentially expressed genes were classified according to the Gene Ontology functional category (GenMAPP v2) and functional significance of differentially expressed genes was determined using Ingenuity Pathways Analysis Software (Ingenuity Systems, http://www.ingenuity. com). Cluster and Heatmap images were generated using BRB-Array tools30. Changes in gene expression were further validated by relative quantitative RTPCR. Protein expression was monitored by Western Blot analysis, immune-histochemical and immunofluorescence methods. RESULTS: Gene Set Enrichment of the Transcriptome of human renal epithelial cells upon oxalate exposure revealed that oxalate exposure was associated with positive enrichment of genes associated with immune response, immune system processes and inflammatory response. Identification of lipopolysaccharide (LPS) gene set enrichment signature prompted us to evaluate activation of Toll-like receptor 4 (TLR4) pathway as one of the key. Oxalate induced nuclear translocation of the transcription factor NF-?B and activation of p38 MAP kinase in renal epithelial cells. Moreover, inhibition of TLR4 as well as p38 MAP kinase blocked NF-?B activation. At the protein level, effects of oxalate on expression of proinflammatory cytokines and chemokine IL-6 were similar to that of LPS treatment in renal epithelial cells. CONCLUSIONS: These results show for the first time that oxalate and COM crystals engage TLR4 a member of the pattern recognition receptor system. Given the roles played by TLR4, we hypothesize that elevated levels of oxalate promote renal tubular inflammation by activating TLR4

Congenital absence of the prostate presenting as primary retrograde ejaculation

An 18-year-old man presented with a history of anejaculation. Secondary sexual characteristics were normal and examination found normal testicles and cords. Aged 12 the patient had a right nephrectomy for a dysplastic kidney. Otherwise the patient’s development was normal, with normal virilisation at puberty. Past medical history was uneventful. Post-orgasm urine cytology confirmed multiple healthy spermatozoa. Routine blood tests were normal. Cystoscopic findings were a normal anterior urethra, normal external sphincter and normal verumontanum. There was no other prostatic tissue. The right ureteric orifice was ectopic with retrograde study confirming its opening proximal to the verumontanum. The left ureteric orifice and bladder were normal. Magnetic resonance imaging showed no prostatic tissue (Figure 1). The left vas and seminal vesicle were absent. The right vas and seminal vesicle were present but abnormal. The left kidney and ureter showed no abnormality.

Haemophagocytic syndrome after intravesical bacille Calmette-Guérin instillation.

Abstract Intravesical bacille Calmette–Guérin (BCG) is used to treat high-risk superficial bladder cancer. This article reports a case of secondary haemophagocytosis after intravesical BCG instillation in a 70-year-old man with bladder cancer and presents a literature review of this very rare but potentially fatal complication of intravesical BCG treatment.

Tuberculosis, AIDS, and Other Uncommon Urinary Tract Infections

This chapter looks at uncommon urinary tract infections such as TB, fungal, and parasitic; it discusses the significance of conditions such as sterile pyuria and how to investigate this finding.

Renal Stone on USS/X-Ray

The lifetime prevalence of kidney stones in the UK is thought to be approximately 5–12 %. Men are affected two to three times more commonly than women. Peak incidence occurs in the mid-20s and in the fourth to sixth decades. Following a stone episode, 50 % of patients will form another stone within 10 years. Stone formation depends on a number of extrinsic factors such as geography, climate, season, water intake, diet, and occupation. Treatment will depend on symptoms, size, anatomy, infection, and etiology. Not every renal stone, particularly those that are small and asymptomatic, necessarily needs a urological referral. Rather, patients can be effectively managed and followed up by the GP. Some renal stones will need emergency admission if, for example, there is sepsis associated with the stone or if there is pain. We propose a simple algorithm to help facilitate the decision-making process for community practitioners in managing renal stones. Symptomatic patients, patients with stones size >5 mm, or those with certain risk factors will need referral to the local urologist. We feel asymptomatic patients with a solitary nonobstructing renal stone <5 mm could be managed in the community and be monitored with an easy route into secondary care if necessary.