Notes

Results of fetal number on acute cycle healthy proteins, cortisol, as well as hematological details inside ewes through the periparturient period.
In the era of managed healthcare, the measuring and reporting of surgical outcomes is a universal mandate. The outcomes should be monitored and reported in a timely manner. Methods for measuring surgical outcomes should be continuous, free of bias and accommodate variations in patient factors. The traditional methods of surgical audits are periodic, resource-intensive and have a potential for bias. These audits are typically annual and therefore there is a long time lag before any effective remedial action could be taken. To reduce this delay the manufacturing industry has long used statistical control-chart monitoring systems, as they offer continuous monitoring and are better suited to monitoring outcomes systematically and promptly. The healthcare industry is now embracing such systematic methods. Radical cystectomy (RC) is one of the most complex surgical procedures. Systematic methods for measuring outcomes after RC can identify areas of improvements on an ongoing basis, which can be used to initiate timely corrective measures. We review the available methods to improve the outcomes. Cumulative summation charts have the potential to be a robust method which can prompt early warnings and thus initiate an analysis of root causes. This early-warning system might help to resolve the issue promptly with no need to wait for the report of annual audits. This system can also be helpful for monitoring learning curves for individuals, both in training or when learning a new technology.Urothelial bladder tumour in childhood is extremely rare, and almost all the reported cases have been low-grade tumours with a favourable outcome. Here we review 57 reports comprising 127 cases, and we report two new cases.
To evaluate the single scrotal-incision orchidopexy (SSIO) technique in patients with an undescended testis palpable in the inguinal canal or below the external inguinal ring.

Between January 2011 and December 2013 we performed 100 SSIOs in 89 patients. The mean (range) follow-up was 9 (3-36) months.

In 88 testes the SSIO was performed with no difficulties. In four patients an additional dissection by opening the external ring and canal was necessary; none of these patients developed an inguinal hernia after surgery. In eight patients conversion to an inguinal approach was necessary because of difficulty in controlling the hernial sacs and inadequate mobilisation. At the follow-up assessment, of the 89 patients, none developed testicular atrophy, one (1%) had wound dehiscence and four (5%) had a scrotal haematoma. There was no statistically significant difference between the testicular size at baseline and that during the follow-up. At 3months after surgery the overall cosmetic result was excellent.

The SSIO is minimal-access surgery allowing less dissection, less discomfort for the patient, rapid healing, excellent cosmetic results and a good success rate. This technique is safe and effective for undescended testes palpable in the inguinal canal or below the external inguinal ring.
The SSIO is minimal-access surgery allowing less dissection, less discomfort for the patient, rapid healing, excellent cosmetic results and a good success rate. This technique is safe and effective for undescended testes palpable in the inguinal canal or below the external inguinal ring.
To evaluate the efficacy of tamsulosin for promoting ureteric stone expulsion in children, based on the confirmed efficacy of tamsulosin as a medical expulsive therapy in adults.

From February 2010 to July 2013, 67 children presenting with a distal ureteric stone of <1cm as assessed on unenhanced computed tomography were included in the study. The patients were randomised into two groups, with group 1 (33 patients) receiving tamsulosin 0.4mg and ibuprofen, and group 2 (34) receiving ibuprofen only. They were followed up for 4weeks. Endoscopic intervention was indicated for patients with uncontrolled pain, recurrent urinary tract infection, hypersensitivity to tamsulosin and failure of stone passage after 4weeks of conservative treatment.

Sixty-three patients completed the study. There were no statistically significant differences between the groups in patient age, body weight and stone size, the mean (SD) of which was 6.52 (1.8) mm in group 1 vs. 6.47 (1.79) mm in group 2 (P=0.9). The mean (SD) time to stone expulsion in group 1 was 7.7 (1.9)days, vs. 18 (1.73)days in group 2 (P<0.001). The analgesic requirement (mean number of ketorolac injections) in group 1 was significantly less than in group 2, at 0.55 (0.8) vs. 1.8 (1.6) (P<0.001). The stone-free rate was 87% in group 1 and 63% in group 2 (P=0.025).

Tamsulosin used as a medical expulsive therapy for children with ureteric stones is safe and effective, as it facilitates spontaneous expulsion of the stone.
Tamsulosin used as a medical expulsive therapy for children with ureteric stones is safe and effective, as it facilitates spontaneous expulsion of the stone.
To evaluate a new technique, the rectal balloon (RB), to control blood loss after transvesical prostatectomy (TVP).

Over 2years 100 patients were prospectively randomised into two equal groups. All patients underwent TVP for their benign prostatic hyperplasia but a RB (a balloon fixed to a three-way Foley catheter tip by a plaster strip, making it airtight) was used in group 2. The RB was placed in the rectum opposing the prostate and inflated (pressure controlled) for 15min. Haemoglobin levels were assessed before and after TVP. Blood transfusion, the amount of saline used for irrigation, duration of catheterisation, hospital stay, and rectal complaints were recorded. Patients were followed up at 1 and 3months after TVP.

The enucleated adenoma weight was 102g in group 1 and 106g in group 2. There was a significant difference between groups 1 and 2 in haemoglobin loss within the first 24h after TVP, and in total loss, of 0.9g and 0.2g (P=0.008), and 1.9g and 1g (P=0.001), respectively. There was also a significant difference between the groups in the saline volume used for irrigation (11.4 vs. 2.5L), catheter duration (5.7 vs. 4.3days), and hospital stay (6.2 vs. 5.1days), favouring group 2. Blood transfusions were needed in four patients in group 1 and one in group 2. There were no rectal complaints.

The use of an inflated RB after TVP is a simple and safe procedure with no specific operative technique, that reduces postoperative blood loss, the incidence of blood transfusion, the volume of saline for irrigation, and shortens the catheterisation period and hospital stay, with no rectal complications.
The use of an inflated RB after TVP is a simple and safe procedure with no specific operative technique, that reduces postoperative blood loss, the incidence of blood transfusion, the volume of saline for irrigation, and shortens the catheterisation period and hospital stay, with no rectal complications.
To evaluate the outcome of an intraprostatic injection of botulinum toxin-A (BTX-A) in men with refractory chronic prostatitis-associated chronic pelvic-pain syndrome (CP/CPPS) and to compare the efficacy of the transurethral and transrectal routes.

In an uncontrolled randomised clinical trial conducted in men with refractory CP/CPPS, the patients were classified into two groups according to the route of BTX-A injection; transurethral (group 1, 28 patients) and transrectal ultrasonography-guided (group 2, 35 patients). The chronic prostatitis symptom index (CPSI), maximum urinary flow rate (Q max) and white blood cell (WBC) count in expressed prostatic secretion (EPS) were measured before and at 3, 6 and 12months after the injection. A significant clinical improvement (SCI, defined as a reduction of 4 points or a 25% decrease in total CPSI score) was correlated with patient age, prostate volume and symptom duration.

In group 1, the pain and quality-of-life domain scores improved, but statistically signitients with refractory CP/CPPS. It is more effective in patients with a small prostate and short symptom duration. The transrectal route provided better results than the transurethral route. More prospective longer term studies are needed.A JJ stent is inserted antegradely after percutaneous renal procedures like percutaneous nephrolithotomy (PCNL) for renal calculus disease, and for endopyelotomy for pelvi-ureteric junction obstruction. We describe a technique for antegrade stent insertion after PCNL.
To evaluate the outcome of the expectant management of ureteric stones and to determine the factors predictive of the spontaneous passage of stones.

We retrospectively reviewed the medical records of patients who had ureteric stones of ⩽10mm and who were treated conservatively at our institutions during the period 2008-2013. The stone-passage rate and time, and different clinical, laboratory and radiological variables, were analysed.

In all, 163 patients with ureteric stones were enrolled in the study, of whom 127 (77.9%) passed their stones spontaneously, with a mean (SD) passage time of 24.0 (8.09)days. The cumulative stone-passage rate was 1.6%, 15%, 41.7%, 72.4%, 89.8% and 98.4% at 7, 14, 21, 28, 35 and 42days from the first presentation, respectively. Patients with a high pain-scale score, stones of ⩽5mm, a lower ureteric stone, a high white blood cell count and those with absent computed tomography (CT) findings of perinephric fat stranding (PFS) and tissue-rim sign (TRS) had a higher likelihood of spontaneous stone passage. Patients with stones of ⩽5mm, stones in the lower ureter and those with no PFS had a shorter spontaneous passage time. Selleck JNJ-64619178 In a multivariate analysis the absence of PFS and TRS were the only significant predictors for spontaneous stone passage (P<0.001 and 0.002, respectively).

The spontaneous ureteric stone-passage rate and time varies with different factors. The absence of CT findings of PFS and TRS are significant predictors for stone passage, and should be considered when choosing the expectant management.
The spontaneous ureteric stone-passage rate and time varies with different factors. The absence of CT findings of PFS and TRS are significant predictors for stone passage, and should be considered when choosing the expectant management.
To compare the results of balloon dilatation (BD) vs. telescopic metal dilators (TMDs) in establishing the tract for percutaneous nephrolithotomy (PCNL) in patients with calyceal stones or staghorn stones, but with no hydronephrosis.

Data from selected patients over 4years were recorded retrospectively. Patients with complex staghorn stones, an undilated targeted calyx, or the stone filling the targeted calyx, were included in the study. In all, 97 patients were included, of 235 undergoing PCNL between March 2010 and March 2014, and were divided into two groups according to the technique of primary tract dilatation. Group A included patients who had BD and group B those treated using TMDs.

In group A (BD, 55 patients) dilatation was successful in 34 (62%). The dilatation failed or there was a need for re-dilatation using TMD in 21 patients (38%). In one of these 21 patients the dilatation failed due to extravasation. In group B (TMD, 42 patients) dilatation was successful in 38 (90%) patients, with incomplete dilatation and a need for re-dilatation in four (10%) patients, and no failed procedures.
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