Jonathan Beilan

The postoperative morbidity index: a quantitative weighing of postoperative complications applied to urological procedures

BackgroundThe reporting of post-operative complications in the urological field is lacking of a uniform quantitative measure to assess severity, which is essential in the analysis of surgical outcomes. The purpose of this study was to evaluate the feasibility of estimating quantitative severity weighing of post-operative complications after common urologic procedures.MethodsUsing a large healthcare system’s quality database, complications were identified in eleven common urologic procedures (e.g., insertion or replacement of inflatable penile prosthesis, nephroureterectomy, partial nephrectomy, percutaneous nephrostomy tube placement, radical cystectomy, radical prostatectomy, renal/ureteral/bladder extracorporeal shockwave lithotripsy (ESWL), transurethral destruction of bladder lesion, transurethral prostatectomy, transurethral removal of ureteral obstruction, and ureteral catheterization) from January 1, 2011 to December 31, 2011. Complications were classified by the Expanded Accordion Severity Grading System, which was then quantified by validated severity weighting scores. The Postoperative Morbidity Index (PMI) for each procedure was calculated where an index of 0 would indicate no complication in any patient and an index of 1 would indicate that all patients died.ResultsThis study included 654 procedures of which 148 (22%) had one or more complications. As would be expected, a more complex procedure like radical cystectomy possessed a higher PMI (0.267), while a simpler procedure like percutaneous nephrostomy tube placement possessed a lower PMI (0.011). The PMI of the additional nine procedures fell within the range of these PMIs. These PMIs could be used to compare surgeons, hospitals or procedures.ConclusionsQuantitative severity weighing of post-operative complications for urologic procedures is feasible and may provide exceptionally informative data related to outcomes.

Locally advanced paraganglioma of the urinary bladder: a case report

BackgroundParaganglioma of the urinary bladder is a rare tumor. Herein we sought to describe a case of locally advanced paraganglioma of the urinary bladder managed by partial cystectomy and extended pelvic lymph node dissection.Case presentationThe case of a 43-year old Haitian male with locally advanced paraganglioma of the urinary bladder is presented in detail. Through surgical extirpation, our patient was rendered disease-free. Eighteen months later the patient is doing well without symptoms but is noted to have subcentimeter bilateral pulmonary nodules and retroperitoneal lymph nodes. No further therapy has been initiated at this time.ConclusionsPatients with localized tumors have an extremely favorable prognosis and may be managed by less aggressive modalities, whereas patients with metastatic disease have a significant reduced survival rate despite aggressive treatment.

PD25-11 A BIOMECHANICAL COMPARISON BETWEEN THE AMS LGX 700 AND THE COLOPLAST TITAN

RESULTS: A total of 210 AMS IPP with Conceal reservoirs were included in this study. From this data set, there were four cases (1.9%) with reservoir-related mechanical failure or complication requiring revision surgeries. Of those four, two cases (0.95%) were mechanical failures resulting from the reservoir leaking. In both cases, the cause of leak was identified as an intrinsic point of weakness at the apex of the reservoir caused by inward folding of an unfilled segment. The inward folding of the reservoir was observed at volumes of 60 to 80 mL. In the remaining two cases (0.95%), the reservoir complication observed was refractory abdominal muscle pain related to ectopic location and intra-fascial placement. In both cases, revision surgery with reservoir repositioning resolved the pain. CONCLUSIONS: While ectopic placement of the Conceal reservoir is mechanically reliable, it must be filled in excess of 80 mL to prevent inward reservoir folding and resultant reservoir leakage. Additionally, with surgical consent, it is prudent for the patient to be counseled on the possibility of abdominal muscle pain when the reservoir is placed ectopically, though they should be informed that such pain is a rare side effect.

V9-11 SUPRAPUBIC FAT PAD EXCISION WITH SIMULTANEOUS PLACEMENT OF INFLATABLE PENILE PROSTHESIS

18 items, each on a 5-point Likert scale. Trainee scores were assessed and compared for improvement over the course of the training course. RESULTS: The most common mistakes made by our trainees revolved around sitting position, hand tremor, instrument handling, needle control, suture placement, and knot tying. The errors were most prevalent early on and there were statistically significant improvements across all domains by the end of the MIM training course (Table). CONCLUSIONS: A MIM training program is an effective tool for teaching MIM skills. By incorporating intense supervision and continuous evaluation into an MIM training program, MIM trainees can avoid the development of bad habits that may be difficult to overcome and potentially have a negative impact on surgical outcomes.

Surgical Reconstruction After Penile Cancer Surgery

Purpose of ReviewPenile cancer is a rare condition that can have a severe negative impact on the quality of life of affected individuals. Treatment for this malignancy has improved over the years with regard to modalities the oncologic team is able to offer as well as the reconstructive options available thereafter. The purposes of this manuscript are to perform a critical review of the current scientific literature and highlight the reconstructive techniques at the forefront of the urologic arena.Recent FindingsReconstructive surgery following penile cancer treatment is dependent on the extent of the defect created from local or radical excision of the tumor. Improvements in surgical reconstructive techniques have enabled physicians to minimize post-operative complications such as urethral stricture formation and flap/graft loss.SummaryHerein, we summarize the updates and improvements of reconstructive surgery following procedures for penile cancer. Advancements in current techniques, ranging from resurfacing of the glans to complex reconstructive phalloplasty procedures, have enabled surgeons to improve the outcomes of their primary goals: to maintain or restore the urinary and sexual function of the phallus while creating a cosmetically acceptable result.

Telemedicine for retinal care in developing nations: the ORBIS Cyber-Sight programme, 2003-2011.

ORBIS International has provided a web-based ophthalmic disease consultation service, Cyber-Sight, for developing nations since 2003. The system connects partner physicians with mentor physicians. We have reviewed consultations concerning retinal cases submitted from June 2003 to December 2011. Of 943 retinal consultations reviewed, 117 were excluded, mainly for reasons of technical limitations at the partner sites. Of the 826 included cases, 504 patients were male and 322 were female. The average age of the patients was 43 years (range 2 months to 86 years). Cases were submitted from partner physicians in 30 countries, with five countries accounting for 82% of the cases (India, Vietnam, Indonesia, China, Jordan). There was a rise in the case submission rate to a peak of 251 cases in 2010. The mean consultant response time was 5 days (SD 9). The mean time to case closure was 19 days (SD 92). The most common diagnoses were diabetic retinopathy (n = 101), retinal vascular occlusion (n = 75) and retinal detachment (n = 61). The working diagnosis submitted by the partner did not match the mentors diagnosis in 153 cases (19%). The number of incorrect initial partner diagnoses demonstrates that the teleretinal programme serves a useful diagnostic role for partner physicians. The Cyber-Sight programme is a viable method of delivering advanced retinal expertise to partner institutions and increasing capacity for partner doctors in the developing world.