Subhasis K. Giri

Efficacy of Wedge Resection With Phenolization in the Treatment of Ingrowing Toenails

BACKGROUND Ingrowing toenail is a common condition treated by general surgeons. Our aim was to analyze the effectiveness of wedge resection with phenolization in the surgical treatment of ingrowing toenails. METHODS We retrospectively audited 100 patients who underwent wedge resection with phenolization for the treatment of ingrowing toenail between January 2000 and June 2004 by a single surgeon. We reviewed all charts and attempted to contact all patients for a telephone interview to assess patient satisfaction. Outcome measures were: 1) recurrence rate, 2) duration of analgesic use, 3) postoperative complications including wound infection, 4) time to return to normal activities, and 5) satisfaction with the procedure. RESULTS A total of 168 wedge resection with phenolization procedures were performed on 100 patients. There was only one recurrence (0.6%). Two patients (2%) had wound infection and were treated with oral antibiotics. The average time for a single wedge resection with phenolization procedure was 7.3 minutes. The mean time to return to normal activities was 2.1 weeks. The patient response rate for the telephone interview was 60%. Most respondents (93.3%) were satisfied with the overall outcome. CONCLUSIONS Wedge resection with phenolization is a very effective mode of therapy in the surgical treatment of ingrowing toenail, with a very low recurrence rate and minimal postoperative morbidity. Wedge resection with phenolization should be considered as a good alternative technique in the treatment of ingrowing toenail.

Current concepts in female stress urinary incontinence.

Urinary incontinence is a social burden for up to one-third of the adult female population. Careful assessment, a methodical approach and appropriate treatment can lead to long-term success in the management of these patients. This article gives an outline of current concepts in the evaluation and treatment of stress urinary incontinence.

Evaluation of Endoscopic Laser Excision of Polypropylene Mesh/Sutures Following Anti-Incontinence Procedures

PURPOSE We reviewed our experience with and outcome of the largest series to our knowledge of patients who underwent endoscopic laser excision of eroded polypropylene mesh or sutures as a complication of previous anti-incontinence procedures. MATERIALS AND METHODS A total of 12 female patients underwent endoscopic laser excision of suture/mesh erosions at 1 center during a 10-year period. Primary outcome variables were the requirement of additional endoscopic or open surgery to remove mesh/sutures. Secondary outcome variables were persistence of urinary symptoms, postoperative complications, continence status and requirement of additional anti-incontinence procedures. RESULTS The mean interval from previous surgery to erosion was 59 months (range 7 to 144) and the duration of presenting symptoms ranged from 3 to 84 months (mean 19). Ten patients underwent endoscopic excision of the mesh/suture with the holmium:YAG laser and 2 underwent excision with the thulium laser. Mean operative duration was 19 minutes (range 10 to 25) and followup was 65.5 months (range 6 to 134). Postoperatively 6 patients remain asymptomatic and 2 required a rectus fascial sling for recurrent stress urinary incontinence. Four patients underwent a second endoscopic excision due to minor persistence of erosion. Only 1 patient ultimately required open cystotomy to remove the eroded biomaterial. No intraoperative complications were recorded and all patients are currently asymptomatic. CONCLUSIONS Endoscopic laser excision is an acceptable first line approach for the management of eroded biomaterials due to its high long-term success rate and minimally invasive nature.

A magnetic resonance imaging‐based study of retropubic haematoma after sling procedures: preliminary findings

To determine, using magnetic resonance imaging (MRI), the incidence of retropubic haematoma and any associated clinically significant effects after a xenograft (porcine dermis) sling (XS) or the tension‐free vaginal tape (TVT) procedure.

Choriocarcinoma with teratoma arising from an intra-abdominal testis in patient with persistent Müllerian duct syndrome

Persistent Mullerian duct syndrome (PMDS) is a rare form of internal male pseudohermaphroditism caused by failure of the fetal testis to produce Mullerian-inhibiting substance or failure of the tissues to respond to this hormone. Patients usually present in childhood with cryptorchidism or with an inguinal hernia. As with undescended testes, these gonads are at an increased risk of malignant transformation. We discuss a rare case of PMDS presenting with advanced metastatic choriocarcinoma with teratoma arising from an intra-abdominal testis after failed bilateral orchidopexy in childhood.

Day‐case sling surgery for stress urinary incontinence: feasibility and safety

To prospectively assess the feasibility for discharge 10 h after a porcine dermal pubovaginal sling procedure (PVS), to examine the surgical factors (postoperative complications) affecting discharge, and to measure the short‐term cure rate for stress urinary incontinence (SUI).

Postoperative magnetic resonance imaging characterization of slings for female stress urinary incontinence

The aim was to characterize different types of slings such as autologous rectus fascia (ARF), porcine dermis (PD) and tension‐free vaginal tape (TVT) in the early postoperative period with regard to its visibility and location by using magnetic resonance imaging (MRI).

Comparative effectiveness of adrenal sparing radical nephrectomy and non-adrenal sparing radical nephrectomy in clear cell renal cell carcinoma: Observational study of survival outcomes

INTRODUCTION We compare the survival outcomes of patients with clear cell renal cell carcinoma (RCC) treated with adrenal sparing radical nephrectomy (ASRN) and non-adrenal sparing radical nephrectomy (NASRN). METHODS We conducted an observational study based on a composite patient population from two university teaching hospitals who underwent RN for RCC between January 2000 and December 2012. Only patients with pathologically confirmed RCC were included. We excluded patients undergoing cytoreductive nephrectomy, with loco-regional lymph node involvement. In total, 579 patients (ASRN = 380 and NASRN = 199) met our study criteria. Patients were categorized by risk groups (all stage, early stage and locally advanced RCC). Overall survival (OS) and cancer-specific survival (CSS) were analyzed for risk groups. Survival analysis was performed using Kaplan-Meier curves and Cox proportional hazards regression. RESULTS The median follow-up was 41 months (range: 12-157). There were significant benefits in OS (ASRN 79.5% vs. NASRN 63.3%; p = 0.001) and CSS (84.3% vs. 74.9%; p = 0.001), with any differences favouring ASRN in all stage. On multivariate analysis, there was a trend towards worse OS (hazard ratio [HR] 1.759, 95% confidence interval [CI] 0.943-2.309, p = 0.089) and CSS (HR 1.797, 95% CI 0.967-3.337, p = 0.064) in patients with NASRN (although not statistically significant). Of these patients, only 11 (1.9%) had adrenal involvement. CONCLUSIONS The inherent limitations in our study include the impracticality of conducting a prospective randomized trial in this scenario. Our observational study with a 13-year follow-up suggests ASRN leads to better survival than NASRN. ASRN should be considered the gold standard in treating patients with RCC, unless it is contraindicated.

Hospital burden of long-term genitourinary and gastrointestinal toxicity after radical radiotherapy for prostate cancer

INTRODUCTION Treatment options for prostate cancer (PCa) include radical radiotherapy (RT) and radical prostatectomy, both of which have comparable oncological outcomes. The aim of this study was to investigate the hospital burden of long-term genitourinary and gastrointestinal toxicity among patients with PCa who were treated with radiotherapy at our institution. METHODS The radiotherapy department database was used retrospectively to identify all patients who underwent radiotherapy for PCa from January 2006 to January 2008. The patient administration system from each public hospital in the region was interrogated and all patient points of contact were recorded. Minimum follow up was 5 years. Individual patient charts were reviewed and factors that might influence outcomes were documented. RESULTS We identified 112 patients. The mean age at diagnosis was 66 (44-76) and the median PSA was 12.1 (3.2-38). The mean duration of follow-up was 7.8 yrs. Twenty-three patients (20%) presented to the Emergency Department (ED) with late onset toxicity. Nine patients had more than 2 ED attendances. Twenty-five patients (22%) were investigated for genitourinary toxicity. Forty-seven patients (42%) underwent investigation for gastrointestinal side-effects and 45% of these required argon therapy (21/47). CONCLUSION We found a significant hospital burden related to the management of gastrointestinal and genitourinary toxicity post radical radiotherapy for prostate cancer. As health care reforms gain momentum, policy makers must take into account the considerable longitudinal health care cost related to radiotherapy. It is also important that patients are counselled carefully in relation to potential long-term side-effects.

Increasing detection of significant prostate cancer in younger men – ten year trends in prostate cancer risk profile in the Mid-West of Ireland

Introduction Although PSA (prostate specific antigen) based screening for prostate cancer (PCa) is controversial, an increasing number of men are undergoing Transrectal Ultrasound Guided prostate biopsy (TRUSPB) through primary care-based PSA testing and referral to hospitals. The aim of our study was to investigate presenting risk profiles of PCa over the last decade in a cohort of men in Ireland and to examine any change in the same over this time period. Material and methods The hospital patient administration system was analysed for patients who underwent TRUSPB from January 2005 to December 2015. Clinically significant PCa was defined as Gleason score of 7 or above. Results Complete data was available on 2391 TRUSPB patients: number of biopsies increased by 53%, median age decreased by 0.9%, median PSA decreased by 6% (p = 0.001, ANOVA) and abnormal DRE increased by 9% (p = 0.001, chi square). Overall positive biopsy was 44% and significant cancer rate was 21%. There was a significant change in trend of detection (p = 0.02) with average annual increase in significant cancer of 3%. The median age of the significant cancer cohort reduced by 1% and the PSA at diagnosis reduced by 9%. In younger men (<50 years), the rate of significant cancer detection increased by 18%. Conclusions Significant PCa detection increased across all age groups but recently, a younger patient profile was diagnosed with high-grade disease. This paves the way for future research on early-onset PCa. Younger patients with significant disease would result in increasing number of patients being eligible for radical treatment with implications on health resource planning and provision.