scholarly journals DIRECT VISUAL INTERNAL URETHROTOMY (DVIU) FOR UNTREATED BULBAR URETHRAL STRICTURES. A SOLUTION?

2021 ◽  
pp. 15-16
Author(s):  
Abhiyutthan Singh Jadaon ◽  
Chitra Champawat ◽  
Chandra Pal Singh
Keyword(s):  
Treatment Failure ◽  
Urethral Stricture ◽  
Cox Regression ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Care Hospital ◽  
Internal Urethrotomy ◽  
Urethral Strictures ◽  
Alternative Approach

Introduction :Urethral stricture diseases have been treated with numerous approaches. Though open urethroplasty is considered a one-time solution [1], The direct visual internal urethrotomy (DVIU) is still considered an alternative approach in the stepladder of treatment [2,3]. Here we report our experience at a tertiary care hospital with DVIU in a homogeneous series of patients with bulbar urethral stricture who underwent strict follow-up and present a multivariable analysis of the results to identify signicant predictors of treatment failure. We wish to offer new insights into DVIU. Materials and method: We performed a retrospective analysis of patients who underwent internal urethrotomy. Patients who underwent DVIU for untreated bulbar urethral strictures with minimum follow-up of 12 months were included. Patients with traumatic stricture and stricture length >4 cm were excluded.The primary outcome was treatment failure. Multivariable Cox regression analyses by Stata v.12.0 were used to test the association between predictors:- Stricture etiology, stenosis length, preoperative maximum ow [pQmax]) and treatment failure. Results: 215 patients were included. Median follow-up was 35 months. At 5-yr follow-up the failure-free survival rate was 54.4%. On multivariable analysis pQmax was the only signicant predictor of treatment failure. Conclusions: DVIU success rate for untreated bulbar urethral strictures was signicantly associated with preoperative maximum ow rate. The patients with a pre- operative maximum ow lesser than 6 ml/s have a low probability of success and may be considered for alternative treatments such as open urethroplasty, especially when affected by long urethral strictures.

scholarly journals Challenges in the Diagnosis and Management of Acquired Nontraumatic Urethral Strictures in Boys in Yaoundé, Cameroon

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
F. F. Mouafo Tambo ◽  
G. Fossi kamga ◽  
C. Kamadjou ◽  
L. Mbouche ◽  
A. S. Nwaha Makon ◽  
...  
Keyword(s):  
Surgical Management ◽  
Urethral Stricture ◽  
Pediatric Surgery ◽  
Tertiary Hospital ◽  
Internal Urethrotomy ◽  
Urethral Catheterization ◽  
Diagnosis And Management ◽  
Urethral Strictures ◽  
Surgery Department

Introduction. Urethral strictures in boys denote narrowing of the urethra which can be congenital or acquired. In case of acquired strictures, the etiology is iatrogenic or traumatic and rarely infectious or inflammatory. The aim of this study was to highlight the diagnostic and therapeutic difficulties of acquired nontraumatic urethral strictures in boys in Yaoundé, Cameroon.Methodology. The authors report five cases of nontraumatic urethral strictures managed at the Pediatric Surgery Department of the YGOPH over a two-year period (November 2012–November 2014). In order to confirm the diagnosis of urethral stricture, all patients were assessed with both cystourethrography and urethrocystoscopy.Results. In all the cases the urethra was inflammatory with either a single or multiple strictures. The surgical management included internal urethrotomy (n=1), urethral dilatation (n=1), vesicostomy (n=2), and urethral catheterization (n=3). With a median follow-up of 8.2 months (4–16 months) all patients remained symptoms-free.Conclusion. The authors report the difficulties encountered in the diagnosis and management of nontraumatic urethral strictures in boys at a tertiary hospital in Yaoundé, Cameroon. The existence of an inflammatory etiology of urethral strictures in boys deserves to be considered.

scholarly journals Outcomes of Barotrauma in Critically Ill COVID-19 Patients With Severe Pneumonia

2021 ◽  
pp. 088506662110233
Author(s):  
Victor P. Gazivoda ◽  
Mudathir Ibrahim ◽  
Aaron Kangas-Dick ◽  
Arony Sun ◽  
Michael Silver ◽  
...  
Keyword(s):  
New York ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Severe Pneumonia ◽  
Care Hospital ◽  
Mechanically Ventilated ◽  
Design And Methods

Background: Pneumomediastinum and pneumothorax are complications which may be associated with barotrauma in mechanically ventilated patients. The current literature demonstrates unclear outcomes regarding barotrauma in critically ill patients with severe COVID-19. The purpose of this study was to examine the incidence of barotrauma in patients with severe COVID-19 pneumonia and its influence on survival. Study Design and Methods: A retrospective cohort study was performed from March 18, 2020 to May 5, 2020, with follow-up through June 18, 2020, encompassing critically ill intubated patients admitted for COVID-19 pneumonia at an academic tertiary care hospital in Brooklyn, New York. Critically ill patients with pneumomediastinum, pneumothorax, or both (n = 75) were compared to those without evidence of barotrauma (n = 206). Clinical characteristics and short-term patient outcomes were analyzed. Results: Barotrauma occurred in 75/281 (26.7%) of included patients. On multivariable analysis, factors associated with increased 30-day mortality were elevated age (HR 1.015 [95% CI 1.004-1.027], P = 0.006), barotrauma (1.417 [1.040-1.931], P = 0.027), and renal dysfunction (1.602 [1.055-2.432], P = 0.027). Protective factors were administration of remdesivir (0.479 [0.321-0.714], P < 0.001) and receipt of steroids (0.488 [0.370-0.643], P < 0.001). Conclusion: Barotrauma occurred at high rates in intubated critically ill patients with COVID-19 pneumonia and was found to be an independent risk factor for 30-day mortality.

Infection and Predictors of Outcome of Cirrhotic Patients after Emergency Care Hospital Admission

2018 ◽  
Vol 17 (5) ◽  
pp. 0-10
Author(s):  
Wajima Safi ◽  
Mayada Elnegouly ◽  
Raphael Schellnegger ◽  
Katrin Umgelter ◽  
Fabian Geisler ◽  
...  
Keyword(s):  
Cox Regression ◽  
Care Center ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Scoring Systems ◽  
First Episode ◽  
Care Hospital ◽  
Cox Regression Analysis ◽  
Cirrhotic Patients ◽  
The Impact

Introduction and aims: We aimed to explore the impact of infection diagnosed upon admission and of other clinical baseline parameters on mortality of cirrhotic patients with emergency admissions. Material and Methods: We performed a prospective observational monocentric study in a tertiary care center. The association of clinical parameters and established scoring systems with short-term mortality up to 90 days was assessed by univariate and multivariable Cox regression analysis. Akaike’s Information Criterion (AIC) was used for automated variable selection. Statistical interaction effects with infection were also taken into account. Results: 218 patients were included. 71.2% were male, mean age was 61.1 ± 10.5 years. Mean MELD score was 16.2 ± 6.5, CLIF-consortium Acute on Chronic Liver Failure-score was 34 ± 11. At 28, 90 and 365 days, 9.6%, 26,0% and 40.6% of patients had died, respectively. In multivariable analysis, respiratory organ failure (Hazard Ratio (HR) = 0.15), albumin substitution (HR = 2.48), non-HCC-malignancy (HR = 4.93), CLIF-C-ACLF (HR = 1.10), HCC (HR = 3.70) and first episode of ascites (HR = 0.11) were significantly associated with 90-day mortality. Patients with infection had a significantly higher 90-day mortality (36.3% vs 20.1%, p = 0.007). Cultures were positive in 32 patients with resistance to cephalosporins or quinolones in 10, to ampicillin/sulbactam in 14 and carbapenems in 6 patients. Conclusion: Infection is common in cirrhotic ED admissions and increases mortality. The proportion of resistant microorganisms is high. The predictive capacity of established scoring systems in this setting was low to moderate.

scholarly journals Sachse Laser in post-trauma urethral stricture. A valid alternative before urethroplasty.

2018 ◽  
Vol 2 (2) ◽  
Author(s):  
Astrit Mustafa ◽  
Evisa Zhapa ◽  
Francesco Saverio Grossi
Keyword(s):  
Urethral Stricture ◽  
Holmium Laser ◽  
Internal Urethrotomy ◽  
Urethral Strictures ◽  
Before And After ◽  
Cold Knife ◽  
Multiple Treatments ◽  
Voided Volume

Background: The most commonly used treatment modality for urethral strictures is the direct visual internal urethrotomy method according Sachse cold knife, but with low long-term success rate. Alternative method after failure is isurethroplasty with preputial flap or Buccal mucosa. The aim of this presentation is to report the efficacy of the Internal Urethrotomy with Holmium Laser (Sachse laser).Material and methods: We report three cases of urethral stenosis after trauma which treated with Internal Urethrotomy with Holmium Laser (Sachse laser) after failure of multiple treatments with Sachse cold knife. We evaluated and compared the uroflowmetry parameters before and after Sachse laser.Results: The average of uroflowmetry parameters before incision were: Q max 4.5 ml/sec, Q med 3 ml/sec. Voided Volume 323 cc, while after incision with Sachse laser were: Q max 30 ml/sec, Q med 12 ml/sec. Voided Volume 363 cc.No patients relapsed during follow-up time from 3 to 24 months.Conclusion: Even though these are only a few cases, we think that Sachse laser is a valid alternative after unsuccessful Sachse cold knife and before Urethroplasty, even in patients with urethral stricture after trauma.

scholarly journals Direct Vision Internal Urethrotomy (DVIU) and Regular Clean Self Intermittent Catheterization (CSIC) For Short Bulbar Urethral Strictures: A Durable Solution

2020 ◽  
Vol 3 (2) ◽  
pp. 13-16
Author(s):  
Pankaj Trivedi
Keyword(s):  
Tertiary Care ◽  
Study Data ◽  
Direct Vision ◽  
Hypospadias Repair ◽  
Internal Urethrotomy ◽  
Common Cause ◽  
Urethral Strictures ◽  
One Year ◽  
Good Success Rate

Background: To evaluate durability of DVIU results and recurrence of stricture if the CSIC was done regularly up to one year and weekly thereafter. Subjects and Methods: This retrospective study was conducted in the Department of Urology at tertiary care teaching hospital of Rajasthan, India. Files of all patients operated between January 2015 and July 2018 for single bulbar urethral strictures of less than 1-1.5cm size in length, iatrogenic, idiopathic, traumatic or inflammatory origins were evaluated. Patient with multiple or complicated strictures of post urethroplasty, post hypospadias repair, previous radiation or multiple DVIU were excluded from the study. Data of all patients who were on CSIC following direct vision internal urethrotomy were evaluated at 3, 6, 12 and 24 months. Results: Mean age of patients was 41.13 years with range in between 26-74 years. Most common cause of urethral strictures were idiopathic 66 (58.92%) followed by iatrogenic 27 (24.11%) causes. After 24 months of follow up 95 (84.82%) patients maintained urethral caliber up to 16 Fr. Failure or recurrence was found in 17 (15.18%) patients who required intervention. Conclusion: Direct vision internal urethrotomy (DVIU) with regular clean intermittent self-catheterization (CSIC) was found good success rate in bulbar urethral strictures upto 1 cm in selected patients.

Chemo-prophylaxis of COVID-19 with hydroxychloroquine: a study of health care workers attitude, adherence to regime and toxicities/side effects (Preprint)

2020 ◽  
Author(s):  
Debajyoti Bhattacharyya ◽  
Neeraj Raizada ◽  
Bharathnag Nagappa ◽  
Arvind Tomar ◽  
Prateek Maurya ◽  
...  
Keyword(s):  
Side Effects ◽  
Health Care Workers ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Perceived Threat ◽  
Care Hospital ◽  
Care Workers ◽  
Perceived Danger ◽  
Structured Questionnaire

BACKGROUND There are apprehensions among healthcare worker (HCWs) about COVID-19. The HCWs have been given hydroxychloroquine (HCQ) chemo-prophylaxis for seven weeks as per Government of India guidelines. OBJECTIVE To assess the apprehensions among HCWs about COVID-19 and to document accessibility, adherence and side effects related to HCQ prophylaxis in HCWs. METHODS A longitudinal follow up study was conducted in a tertiary care hospital. HCQ was given in the dose of 400 mg twice on day one, and then 400 mg weekly for seven weeks. 391 HCWs were interviewed using semi structured questionnaire. RESULTS 62.2% HCWs expressed perceived danger posted by COVID-19 infection. Doctors (54%) showed least acceptance and paramedics (88%) showed highest acceptance to chemo-prophylaxis. 17.5% participants developed at least one of the side effects to HCQ. Females and nursing profession were significantly associated with adverse effects. Common side effects were gastro-intestinal symptoms, headache and abnormal mood change. Most of these were mild, not requiring any intervention. Gender, professions and perceived threat of COVID-19 were significantly associated with acceptance and adherence to HCQ prophylaxis. CONCLUSIONS Two third of HCWs had perceived danger due to COVID-19. Three fourth of the HCWs accepted chemo-prophylaxis and four out of five who accepted had complete adherence to prophylaxis schedule. One out of five had developed at least one of side effects; however, most of these were mild not requiring any intervention.

scholarly journals Incidence of valvular regurgitation and leaflet perforation by using automated titanium fasteners (CORKNOT®) in heart valve repair or replacement: less usual than reported

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Faizus Sazzad ◽  
Ong Zhi Xian ◽  
Ashlynn Ler ◽  
Chang Guohao ◽  
Kang Giap Swee ◽  
...  
Keyword(s):  
Heart Valve ◽  
Operative Time ◽  
Tertiary Care ◽  
Paravalvular Leak ◽  
Valvular Regurgitation ◽  
Care Hospital ◽  
Valve Repair ◽  
Replacement Surgery ◽  
Triple Valve

Abstract Background CORKNOT® facilitates a reduction in cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time and operative time, but reported to be associated with other complications. We aim to quantify the incidence of valvular complications related to CORKNOT® and determine the feasibility of its use between different valvular surgeries. Methods Patients who underwent heart valve repair or replacement surgery via the use of automated titanium suture fasteners (CORKNOT®) in a tertiary care hospital were included in the study. This single-centre retrospective study was conducted on 132 patients between January 2016 and June 2018. Results In our study, the overall mean operative time was 320.0 ± 97.0 min, mean CPB time was 171.4 ± 76.0 min and the calculated mean ACC time was 105.9 ± 54.0 min. Fifty-eight patients (43.9%) underwent minimally invasive valve replacement or repair surgery and 66 patients (50.0%) underwent concomitant procedures. A total of 157 valves were operated on, with 112 (84.8%) single valve surgeries, 15 (11.4%) double valve surgeries and 5 (3.8%) triple valve surgeries. After reviewed by the cardiologist blinded towards the study, we report trivial and/or mild paravalvular leak (PVL) in immediate post-operative echocardiography was found in 1 (1.01%) patients. There were no reported cases of valvular thrombosis, leaflet perforation, device dislodgement or embolization, moderate and/or severe PVL during hospitalization and follow-up echocardiography within 1 year. Single mitral valve and aortic surgeries had comparable incidences of post surgical complications. Conclusion We conclude the feasibility of CORKNOT® utilisation in mitral and aortic valve surgeries. Additionally, incidence of CORKNOT® related complications in heart valve repair or replacement surgery is less usual in our setting than previously reported. These results motivate the use of CORKNOT® as a valid alternative with complete commitment.

scholarly journals 99. Effectiveness of Antibiotic Prophylaxis Among Patients Undergoing Elective Transurethral Resection of the Prostate in the Era of Antibiotic Resistance

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S179-S180
Author(s):  
Thana Khawcharoenporn ◽  
Pimjira Kanoktipakorn
Keyword(s):  
Antibiotic Resistance ◽  
Antibiotic Prophylaxis ◽  
Transurethral Resection ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Prophylactic Antibiotics ◽  
Care Hospital ◽  
Extended Spectrum Beta Lactamase ◽  
Observational Cohort

Abstract Background Data existing on effectiveness of antibiotic prophylaxis (AP) for transurethral resection of the prostate (TURP) are limited in the era of antibiotic resistance. Methods A 4-year prospective observational cohort study was conducted among patients undergoing TURP in an academic tertiary-care hospital during 2016–2019. Patients were excluded if pre-operative (pre-op) urine cultures were not sent or grew mixed (&gt;2) organisms, or they had pre-op urinary tract infection (UTI) or lost follow-up after TURP. Appropriateness of AP was defined as 1) correct dosing and duration and narrowest spectrum according to the hospital AP guidelines and local epidemiology and 2) being active against uropathogens isolated from the pre-op culture. Primary outcome was the rate of UTI within 30 days post TURP compared between appropriate antibiotic prophylaxis (AAP) and inappropriate antibiotic prophylaxis (IAP) groups. Results 342 patients were screened and 61 were excluded. Of the 281 patients included, 139 (49%) received AAP and 142 (51%) received IAP. The reasons for IAP were prescribing too broad-spectrum antibiotics (57%), inactive antibiotics (41%) and incorrect dosing (2%). Pre-op urine cultures were no growth in 148 patients (53%). Among the 133 positive urine cultures with 144 isolates, Escherichia coli (52%) was the most commonly isolated. Thirty-one percent of these 144 isolates produced extended-spectrum beta-lactamase (ESBL) and 23 (16%) isolates were multidrug-resistant. The resistant rates of Enterobacteriaceae were 73% for ciprofloxacin, 65% for TMP-SMX and 46% for ceftriaxone. The two most commonly prescribed prophylactic antibiotics were ceftriaxone (51%) and ciprofloxacin (34%). The rate of UTI within 30 days post-TURP was significantly higher in IAP group compared to AAP group (47% vs 27%; P&lt; 0.001). Prescribing inactive prophylactic antibiotics was the independent factor associated with 30-day post-TURP UTI (adjusted odds ratio 2.88; P=0.001). Conclusion Appropriate antibiotic prophylaxis significantly reduced UTI within 30 days of elective TURP. Obtaining pre-op urine culture and prescribing an active prophylactic agent are critical for preventing post-TURP UTI in the era of antibiotic resistance. Disclosures All Authors: No reported disclosures

scholarly journals 1147. Short Course of Voriconazole Therapy as a Risk Factor for Relapse of Invasive Pulmonary Aspergillosis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S600-S601
Author(s):  
Dong Hoon Shin ◽  
Seung-Jin Yoo ◽  
Jongtak Jung ◽  
Kang Il Jun ◽  
Hyungjin Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cox Regression ◽  
Tertiary Care ◽  
Invasive Pulmonary Aspergillosis ◽  
Care Hospital ◽  
Pulmonary Aspergillosis ◽  
Treatment Termination ◽  
Duration Of Therapy ◽  
Short Course ◽  
Life Threatening

Abstract Background Invasive pulmonary aspergillosis (IPA) is a life-threatening opportunistic infection which usually occurs in immunocompromised patients. Recommended duration of voriconazole therapy is a minimum of 6-12 weeks for IPA, despite the lack of any firm evidence. In addition, risk factors for relapse of IPA are still unclear. Here, we explored risk factors for IPA relapse after initial treatment. Methods All patients with proven or probable IPA who had finished voriconazole treatment between 2005 and 2019 in a tertiary-care hospital were reviewed. IPA relapse was defined as re-diagnosis of proven or probable IPA at the same site within 1 year after treatment termination. Short course of voriconazole treatment was defined as a treatment less than 9 weeks, which is a median of the recommended minimum duration of therapy from the Infectious Disease Society of America. The radiological response was defined as a reduction in IPA burden by more than 50% on chest computed tomography (CT). Results Of 87 patients who had completed voriconazole treatment, 14 (16.1%) experienced IPA relapse. Multivariable Cox regression identified that short voriconazole treatment duration (adjusted hazard ratio [aHR], 3.7; 95% confidence interval [CI], 1.1–12.3; P=0.033) and radiological non-response (aHR, 4.6; 95% CI, 1.2–17.5; P=0.026) were independently associated with relapse of IPA after adjusting for several clinical risk factors. Conclusion Less improvement in CT, and short duration of voriconazole therapy were the independent risk factors for relapse after treatment of IPA. Longer duration of therapy should be considered for those at higher risk of relapse. Disclosures All Authors: No reported disclosures

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