Deepanshu Sharma

Unplanned 30-day readmission rates in patients undergoing endo-urological surgeries for upper urinary tract calculi

Purpose To see the 30-day unplanned readmission rates in patients underdoing endo-urological surgeries for upper urinary tract calculi we conducted this retrospective study at King Georges Medical University, Lucknow, India. Unplanned readmissions not only add to healthcare costs but also are bothersome for the patients. There are many studies on 30-day unplanned readmissions in general surgical patients. Although similar studies have been done in certain urological procedures, no study has reported readmission rates or its risk factors in patients undergoing surgeries for upper urinary tract calculi. Materials and Methods We retrospectively reviewed our prospectively maintained database from 1st January 2009 to 31st December 2017, for the patients who underwent endo-urological procedures for upper urinary tract calculi and identified the patients who were re-admitted within 30 days of discharge. Results Out of the total 3,209 patients undergoing endo-urological procedures for upper urinary tract calculi 56 were re-admitted. The readmission rate was 1.74% over the study period. The most common etiology for readmission was sepsis followed by hematuria. The significant risk factors for readmission in bivariate analysis included male gender, age >65 years, current smoking, chronic obstructive pulmonary disease, diabetes mellitus, bleeding disorder, prior cardiac disease, and American Society of Anesthesiologists (ASA) class ≥3. In multivariate risk adjusted logistic regression analysis ASA class ≥3 was the only independent risk factor for readmission. Conclusions The readmission rates in endo-urological procedures for urolithiasis are less compared to other procedures. ASA class ≥3 is the most important independent predictor of unplanned 30-day readmissions.

Giant vesicle calculi leading to spontaneous bladder rupture and acute renal failure: an unusual presentation

Spontaneous rupture of the urinary bladder is extremely rare. We report a case of a 70-year-old man with spontaneous bladder rupture secondary to neglected giant vesicle calculi who presented as acute renal failure. The patient was stabilised with per-urethral catheterisation and extravesical drain placement. About 700u2009mL pus mixed with urine was drained through the per-urethral catheter and approximately 2000u2009mL of pus was drained through the extravesical drain. Cystolithotomy showed two large calculi which were removed.

Foreign body urethra misdiagnosed as stricture leading to inadequate management and prolonged treatment duration: a lesson to learn

Misdiagnosis of a urethral foreign body (FB) as urethral stricture leads to inadequate management and prolonged treatment duration. A 55-year-old male patient was referred with complaints of difficulty in voiding and poor urinary stream for 2 months. He initially presented at a primary healthcare centre and was misdiagnosed as urethral stricture and was scheduled for urethroplasty. Surprisingly, intraoperative cystourethroscopy performed by us revealed that the urethra had been obstructed by an FB. The FB was gently pushed into the bladder and retrieved. The postoperative course was uneventful. The present case represents a rare occurrence of polyembolokoilamania or insertion of a FB into any bodily orifice for sexual gratification.

Benign fibroepithelial bladder polyp: a rare cause of childhood haematuria

Haematuria in paediatric population is common yet alarming. It warrants a thorough physical examination and other investigations. Of late, a number of extremely rare aetiology of childhood haematuria have come to forefront. One such uncommon cause is benign fibroepithelial urinary bladder polyp. The presentation is of a child with intermittent haematuria exacerbated by physical/sports activity associated with or without suprapubic pain. Diagnosis is usually made by ultrasonography and cystoscopy and confirmed by histopathological examination. Treatment is surgical and involves cystoscopic transurethral resection of the mass. The exact aetiology of benign fibroepithelial polyp is uncertain with no clear guidelines on long-term surveillance. However, these cases should be subjected to cystourethroscopy if haematuria recurs. Treatment is surgical with good long-term prognosis. Not much is written in literature about benign fibroepithelial bladder polyp.

Delayed pressure urticaria due to non-invasive blood pressure monitoring in a previously non-atopic man

A 68-year-old man presented to us with voiding lower urinary tract symptoms due to benign prostatic hyperplasia for which he underwent photovapourisation of prostate using potassium titanylxa0phosphate laser. The procedure was completed in 104u2009min uneventfully. Eight hours after the procedure, the patient had burning and itching on his left arm circumferentially in the area where the cuff for non-invasive blood pressure (NIBP) monitoring was applied and on his back. We removed the cuff and in that region of his arm there was erythema along with multiple blisters (figure 1). A similar linear lesion was seen on the right side of his back along the 10th rib (figure 2). We recognised it to be some form of urticaria, and immediately gave the patient an antihistamine (pheniramine). The patient had no history of any skin lesion, neither didxa0he give axa0history of any allergies. Both …

Isolated Fournier’s gangrene of the penis with penile autoamputation

A 65-year-old non-diabetic man presented to us with blackish discolouration of his penile shaft for 10 days (figures 1 and 2). He had undergone total thyroidectomy for follicular carcinoma of the thyroid gland 2u2009weeks previously. Intraoperatively, failed attempts were made to catheterise the patient. These attempts were traumatic, and a suprapubic catheter was hence placed. Following this, he developed inflammation and oedema on his penile shaft which then gradually started turning black for which he came to us. A diagnosis of isolated Fournier’s gangrene of penis was made. Debridement was done, and thexa0patient was advised regular dressings. During the initial debridement, the tunica albuginea and corpus cavernosa were not excised although the patient had slight gangrenous changes over the cavernosa. Later, gradually, a line of demarcation developed, and there was autoamputation of the involved shaft, 2 weeks after the initial …

Continent cutaneous diversion pouch calculi

A 62-year-old female patient who presented at our centre with dull aching right flank pain of 6 months duration. She had axa0history of radical cystectomy and cutaneous continent urinary diversion (Indiana pouch) done 20 years ago for muscle invasive urothelial carcinoma of urinary bladder. Thexa0patient followedxa0up regularly since operation. However, for last 3u2009years, thexa0patient was lost to follow-up. On further eliciting the history, she mentioned her inability to perform pouch irrigation and clean intermittent catheterisation regularly during this period.nnOn examination, a lump was palpable in the right lumbar region in the region of continent pouch. It was firm in consistency around 5×5u2009cm in size and did not move with respiration. There was no pain/tenderness on palpation. The stoma was healthy, flush to skin, functioning and easily catheterisable.nnHer complete haemogram including renal function test …

Chronic urinary retention due to diabetic cystopathy masquedering as mesenteric cyst

A 55-year-old previously diabetic manxa0presented with progressive abdominal distension for thexa0last threeu2009months. He denied any bowel/bladder complaints. His medical/surgical history was unremarkable. On examination his vitals were stable and a huge abdominal mass (10×11u2009cm) was palpable. The mass was having side-to-side mobility. There was no hepatosplenomegaly or clinically significant lymphadenoapathy. On evaluation with ultrasonography of abdomen and CT scan, there was evidence of huge, cystic and homogenous mass (13×11u2009cm) with clear margins occupying almost entire abdominal cavity (figure 1). There was no evidence …

Rare cause of voiding dysfunction in an adult man: urethral diverticulum compressing the anterior urethra

A 46-year-old man presented to us with lower urinary tract symptoms that include severe voiding symptoms. He had a history of injury to thexa0perineum 3 years back. A smooth cystic swelling was palpable in the perineum in midline. Uroflowmetry was done andxa0was suggestive of poor urinary flow (Qavg: 2u2009mL/s and Qmax: 6u2009mL/s), with significant postvoid residual urine (PVR). A micturating cystourethrogram (MCU) with retrograde urethrography (RUG) was done and was suggestive of an anterior urethral diverticulum, which was compressing the urethra, along with significant PVR (figure 1). The patient was planned for open excision of thexa0urethral diverticulum. A cystourethroscopy was done preoperatively and clearly showed axa0normal anterior urethra and thexa0opening of the …

Fungal bezoar in an immunocompetent patient: a rare complication of forgotten double J stent

A 38-year-old man presented with intermittent right flank pain, dysuria, passage of turbid urine and low-grade fever forxa0the last 1u2009year. He revealed axa0history of right-sided laparoscopic Anderson-Hynes dismembered pyeloplasty with double J (DJ) stenting performed for right pelviureteric junction obstruction 5 years back at other centre. The discharge card given toxa0the patient advised for DJ stent removal, but the patient was lost to follow-up and never underwent DJ removal. His medical history was unremarkable for diabetes, HIV or steroid intake. On physical examination there was tenderness present in right flank on deep palpation. Blood serum chemistries revealed mildly deranged renal function tests (blood urea nitrogenxa056 mg/dL; serum creatininexa01.5 mg/dL) with normal random blood sugar (92u2009mg/dL) and liver function tests. Urine analysis showed 40–50 pus cells/high power field (HPF), 20 red blood cells/HPF and presence of fungal hyphae and spores. Urine culture revealedxa0>105 …