V. Hanchanale

Impact of hospital provider volume on outcome for radical urological cancer surgery in England.

Introduction: Complex surgical procedures are associated with higher mortality and morbidity. There is a paucity of data supporting a volume-outcome relationship in the United Kingdom. We analysed Hospital Episode Statistics (HES) to contemplate the association of hospital provider volume and short-term outcomes (mortality rate and hospital stay) for 3 radical urological procedures in England. Materials and Methods: The HES database was extracted for radical prostatectomy (RP), radical cystectomy (RC) and radical nephrectomy (RN) using ICD-10 and OPCS-4 codes for 7 years. Hospitals were divided into quartiles depending on the annual hospital volume. The impact of hospital provider volume was analysed for outcomes. Results: Overall 43,946 patients were included in the study. RP patients had the lowest mortality rate (0.2%) and shorter in-patient stay (7 days). Mortality from RC and RN were 475 (5.3%) and 537 (2.6%), respectively. There was no significant difference for mortality following RP in four volume groups (p = 0.76). The mortality rate for RC decreased from 6.9% in the very low-volume group to 4.1% in the high-volume group (p < 0.001) without change in the in-hospital stay. The proportion of patients treated at high-volume centres for RP, RC and RN has increased from 0 to 42, 22 to 35 and 10 to 38%, respectively, over a 7-year study period. Conclusion: In England, hospital provider volume has a significant impact on outcome measures for radical pelvic urological procedures with a lower mortality (RC) and shorter in-patient stay (RP). Thus HES data from England support the hospital volume-outcome relationship and emphasise the centralisation of care for radical urological procedures.

Raman spectroscopy and its urological applications

Purpose: The Raman spectroscopic technology can be utilized for the detection of changes occurring at the molecular level during the pathological transformation of the tissue. The potential of its use in urology is still in its infancy and increasing utility of this technology will transform noninvasive tissue diagnosis. The Nobel laureate, Sir C.V. Raman is credited for the discovery of the principles of Raman spectroscopy. Materials and Methods: Applications of Raman spectroscopy in the bladder, renal, prostate, and other urological disorders were gathered from Medline and abstracts from recent international urological meetings. Current status and future directions of Raman spectroscopy in urology were also reviewed. Results: Raman spectroscopic technology is used to interrogate biological tissues. The potential use of this technology in urology has shown encouraging results in the in vitro diagnosis and grading of cancers of the bladder and the prostate. Raman microprobes have been used for the characterization and identification of renal lithiasis. Technology may be available for the urologists to determine the margin status intraoperatively during partial nephrectomy and radical prostatectomy. The future would see the development of optical fiber probes to incorporate them into catheters, endoscopes, and laparoscopes that will enable the urologist to obtain information during the operation. Conclusion: Raman spectroscopy is an exciting tool for real-time diagnosis and in vivo evaluation of living tissue. The potential applications of Raman spectroscopy may herald a new future in the management of various malignant, premalignant, and other benign conditions in urology.

Incisional hernia around the suprapubic catheter: an unusual complication

Hernia through the suprapubic catheterization (SPC) site is rare. Attention is required for such hernias as they get obstructed due to the narrow neck. We report this rare presentation in an elderly gentleman with obstructed incisional hernia through the SPC site, which was reduced and subsequently had a successful mesh repair.

An unusual cause of acute loin pain during cystometry

We report two cases of inadvertent ureteric catheterization by cystometry catheter causing acute loin pain. Ultrasound of kidneys in the first patient showed the presence of air in the pelvicalyceal system. In the second patient, injection of contrast media confirmed the presence of contrast in the ureter. In both patients, further investigations did not show any evidence of vesico-uretric reflux.

A costly sting! Preputial gangrene following a wasp sting

Penile injuries due to bites and stings are under-reported. The extent of injury depends not only on the initial trauma but also on the secondary injuries due to toxins and bacterial infections transmitted by the bite. Wasp bites are on the increase worldwide as humans encroach on their habitat. We report a case of wasp bite to the preputial skin of the penis leading to severe phimosis, difficulty in micturition and localized gangrene requiring emergency circumcision. Analysis of such cases can provide important information on the determinants of severe morbidity that may then be used in injury prevention.

Renogluteal fistula: An unusual complication of genito-urinary tuberculosis

Involvement of the genitourinary organs is the most common site of extra-pulmonary tuberculosis. Genitourinary tuberculosis (GUTB) almost always starts from the kidney. A wide spectrum of complications can arise from the kidney being affected by GUTB. A rare complication of GUTB in the form of renogluteal fistula is described. Excision of the fistula with nephroureterectomy combined with anti-tubercular treatment has resulted in cure.