David Pan

Long-Term Outcomes of External Sphincterotomy in a Spinal Injured Population

PURPOSE External sphincterotomy is an accepted option for treating patients with detrusor-sphincter dyssynergia. However, long-term outcome data are limited. We ascertained the outcome of treatment results for this procedure. MATERIALS AND METHODS A database was reviewed for patients undergoing external sphincterotomy at a large tertiary referral spinal injuries center. RESULTS For 84 primary sphincterotomies the mean duration of successful outcome was 81 months. A second procedure was required in 30 patients and mean duration of success thereafter was 80 months. Recurrent symptomatic episodes of urinary tract infection, recurrent detrusor-sphincter dyssynergia or upper tract dilatation eventually ensued in 57 of 84 patients (68%). Renal failure did not develop in any patients. CONCLUSIONS External sphincterotomy protects the upper renal tracts and provides extended periods of satisfactory bladder emptying. However, it may require ongoing revision and should potentially be regarded as a staged intervention.

Outcome from percutaneous nephrolithotomy in patients with spinal cord injury, using a single-stage dilator for access.

The use of percutaneous nephrolithotomy to treat renal calculi in patients with spinal cord injury is described by authors from Melbourne. This is the first contemporary series reported for over 13 years, and the authors describe various unique features about their series and compare their results to previously reported studies.

Patient knowledge about prostate-specific antigen (PSA) and prostate cancer in Australia.

•  To assess whether men undergoing prostate biopsies for raised prostate‐specific antigen (PSA) concentrations were adequately counselled before their first PSA test.

Implications of amyloidosis on prostatic biopsy

Abstract  Transrectal ultrasound‐guided biopsy of the prostate is an integral step in the investigation of patients at risk of prostate adenocarcinoma. With an increasing number of biopsies being performed, uncommon forms of prostatic pathology will be identified more frequently. Amyloidosis of the prostate and/or the seminal vesicles may be noted on transrectal ultrasound‐guided biopsy of the prostate and the implications of this histological diagnosis must be understood. We present our experience of two such cases of amyloidosis and review the literature regarding their management.

Isolated scalp nodule in patient with undiagnosed RCC.

An unexpected diagnosis of metastatic RCC after excision biopsy of a skin nodule can bring uncertainty. A case of isolated scalp metastasis from undiagnosed RCC was noted and a review of the literature was undertaken to aid management. RCCs often present with distant disease involving multiple organ systems. Single metastasis to the scalp region without other organ involvement is uncommon. Cytoreductive nephrectomy and limited metastectomy offer survival advantage in physically fit patients with RCC.

Fixed Drug Eruption of the Penis Secondary to Sulfamethoxazole-Trimethoprim

Penile lesions are encountered in a variety of fields from family medicine practice through urology, to sexual health specialists. It is important that practitioners consider and recognize fixed drug eruptions of the penis while being able to initiate appropriate treatment in order to avoid misdiagnosis and avoidable stress. In summary, withdrawal of the offending medication and initiation of corticosteroid therapy remain the cornerstones of treatment of fixed drug eruptions of the penis.

Use of a barbed suture for continuous urethro-vesical anastomosis during robot-assisted laparoscopic radical prostatectomy

A continuous urethro-vesical anastomotic suture (as described by Van Velthoven [1]) is usually employed during robot-assisted laparoscopic radical prostatectomy (RALRP) to provide a watertight repair and, consequently, achieve a lower risk of anastomotic contracture [2]. However, maintaining tension on the suture, thereby ensuring apposition of the bladder and urethra, can be challenging. There is some evidence indicating that the use of a new barbed suture facilitates this procedure and shortens anastomotic time [3–5]. However, the barbed suture is more expensive than conventional sutures, and the results of one study suggest that its use may lead to tissue necrosis and hence a higher rate of urine extravasation post-operatively [6]. We have previously described a method of urethrovesical anastomosis during RALRP which allows a singlesuture reconstruction incorporating posterior and anterior fascial supports as well as the anastomosis proper [7]. Here, we describe the application of a barbed suture to this anastomotic technique and assess the impact of this suture on anastomotic time and risk of complications.