Conference abstract 0781 from the Association of Surgeons in Training ASiT Annual International Surgical Conference 2018, Edinburgh, United Kingdom, 6 - 8 April 2018.

Conference abstract 0777 from the Association of Surgeons in Training ASiT Annual International Surgical Conference 2018, Edinburgh, United Kingdom, 6 - 8 April 2018.

Transurethral resection of the prostate (TURP) continues to be an effective intervention for certain indications; and this procedure is still one of the most commonly performed in urology. The use of a 3-way catheter with continuous bladder irrigation (CBI) post-TURP is widely practiced in a bid to prevent clot retention. We report our unique experience with the use of 2-way urethral catheters post-TURP surgery. Methodology Data was prospectively collected for 143 consecutive patients who underwent a bipolar TURP between July 2015 and October 2017. The following outcomes where measured and compared against the literature: resection time, resected weight, haemoglobin level, hospital stay, catheterization days, transfusion rate and complications. Results Two-way 18-French catheters were used in 132/143 (91.7%) patients. The remaining 11/143 (8.3%) patients had a 3-way 22-French catheter and CBI immediately post-TURP. There were no incidences of clot retention requiring a return to theatre. There were 2/132 (1.5%) patients requiring transfusion who received 2-way catheterization. The average resection time was 44.8 (10-100) minutes, with a mean resected weight of 22.8 (2.0-70.0) grams. Post-operatively, we found minimal drop in haemoglobin levels, with a fall of 0.7 g/dL on average, with a range of 0.1-3.4 g/dL. Mean length of stay following TURP was 1.45 days (1-18), and 101/132 (76.5%) of patients had a successful trial without catheter on the first post-operative day. Conclusion Our outcomes compare favorably with the published data. This study suggests it may be possible to reduce the cost and resources associated with the use of 3-way catheters and CBI post-TURP surgery by using a 2-way catheter instead. Despite this, appropriate patient selection for this novel technique needs to be adopted. Our results would suggest that patients with smaller prostates or limited resections might be suitable for a 2-way urethral catheter post-TURP.

A case report of a man with suprapubic and scrotal ecchymosis.

Introduction: Group and save (G&S) sampling is commonplace for patients undergoing transurethral resection of the prostate (TURP) due to the historically high risk of bleeding. However, modern adjustments to the procedure, including the advent of bipolar TURP in saline, have significantly reduced this risk. This study assessed whether routinely performing G&Ss before the modern TURP is still appropriate. Materials and Methods: This study was a retrospective review of all patients who underwent a TURP from January 2009 until December 2019 in one centre. A total of 687 patients were identified during this period. In addition, data was collected on G&S samples, blood products, and postoperative complications such as clot retention or if patients required a blood transfusion. Results: All patients had G&S samples taken before their operation. Only six (0.87%) patients required a blood transfusion. Half were transfused intra-operatively and half post-operatively. Remarkably, none of the transfused patients were below the National Institute for Health and Care Excellence (NICE) threshold to transfuse of <70g/L(8). Six patients were also noted to develop clot retention following the catheter removal. Discussion and Conclusion: This study has determined that patients undergoing a TURP rarely require blood transfusions. We propose that the practice of routinely taking G&S samples before this procedure should be reviewed. This would give a financial benefit and relieve patients of the unnecessary test. We would recommend thorough optimisation of patients before surgery, including review of anticoagulation and correction of any preoperative anaemia.

Case report of an elderly woman with intermittent and progressive abdominal pain resulting from bowel obstruction caused by a gallstone.

The potential complications of pelvic inflammatory disease (PID) make optimizing its management a high priority. A clinical audit of PID against current national management guidelines was conducted in 14 departments of genitourinary medicine in the West Midlands for women presenting with PID between January and December 2005. There were a total of 810 diagnoses of PID made from a total of 49,390 female attendees for that year, giving an incidence of 164 cases per 10,000 attendees. Of these 810 cases, data collection and analysis for this audit were performed on 139. An ofloxacin 400 mg twice daily (b.i.d.) based regimen was prescribed in 91 (65%, 95% confidence interval [CI] 57-73%) cases. Doxycycline 100 mg b. i. d. for 14 days plus metronidazole 400 mg b. i. d. for 5-14 days was prescribed in 44 (32%, 95% CI 25-40%) cases, but a third-generation cephalosporin was only given with this regimen in three cases. Partner notification was performed in 101 (73%, 95% CI 65-79%) cases. A total of 130 male contacts were recorded on the data collection forms, and of these 58 (45%) were traced and 51 (39%), treated. A follow-up appointment was given to 133 (96%, 95% CI 91-98%) women, although in most cases this was for seven days or more, and 104 (78%, 95% CI 67-81%) women attended for follow-up. Adherence to the national guidelines in this cohort of patients did not reach the national standard for choice of treatment regimen nor did it attain the target for proportion of male partners traced. Barriers preventing adherence to the national guidelines need to be explored and appropriate assistance given to physicians to help meet national standards of care.

Approximately 100 cases of polyorchidism have been reported in the literature. Management remains controversial especially if there is no associated abnormality identified. We report a case of triorchidism confirmed by magnetic resonance imaging (MRI). The patient has been managed conservatively and remains under regular radiological follow-up with MRI.

Introduction The aim of this quality improvement project was to analyse the cancellation rates of the template biopsy done at the George Eliot Hospital. The focus was mainly on those due to poor bowel prep whereby manual evacuations have failed. Locally we have sometimes noted the failure rate of transperineal prostate biopsy as a result of the poor quality of the ultrasound due to inadequately evacuated rectum. Unfortunately, there are very limited studies which have looked into this issue hence the significance of this problem is not universally acknowledged. Method Retrospective review of all the template biopsies that were planned from April 2019 to April 2020 using the operation notes and local theatre management software. Results There was a total of 105 planned template biopsies from April 2019 to April 2020. 72 cases were attempted and within this, 7 of these cases required manual evacuations in which 3 resulted in abandonment of procedure. There were 33 cases which were cancelled due various other reasons. Conclusions The results showed that the failure rates due to poor bowel prep were not significant (4%). Based on these findings we have decided not to proceed with the implementation of pre-operative bowel prep with phosphate enema as we felt that the potential benefits were not enough for it be initiated as a routine practice. We aim to address the other reasons identified for cancellations.