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HOW I DO IT


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  • How I Do It: The pudendal nerve block for pediatric ambulatory urologic surgery

    Okoro Chinonyerem, Cannon Shannon, Low Daniel, Lendvay S. Thomas, MD Department of Urology, University of Washington Medical Center, Seattle, WA

    Regional analgesia is an important adjunct for perioperative pain management in the setting of pediatric penile surgeries. Caudal epidural analgesia (CEA) is the most common analgesic technique performed, but it has limitations and associated morbidity. The pudendal nerve block (PNB) is an effective alternative to CEA with a lower risk profile; in prior examination of the approach, PNB has been demonstrated to have similar postoperative pain control outcomes. We describe our technique and highlight observations made as we have transitioned from CEA to PNB for many patients.

    Keywords: pudendal nerve block, regional anesthesia, pediatric urology, pain management,

    Apr 2021 (Vol. 28, Issue 2 , Page 10648)
  • DNA analysis for prostate specimen verification: How I Do It

    Salib Andrew, Mark Ryan J., MD Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA

    Prostate cancer is the most common malignancy affecting men. Prostate biopsy remains the key clinical tool for selecting appropriate treatment options. The process of specimen collection and diagnosis is multistep and vulnerable to human error along every stage. Specimen provenance testing (SPT) aims to provide certainty that biopsy results can be trusted when recommending life changing treatments and has emerged as a necessary tool in medicine to counteract human error and specimen contamination. In this study we report our practice's experience using the Know Error test to verify prostate biopsy specimens. In this study, we retrospectively reviewed the results of a specific SPT known as Know Error which is used in our institution for specimen verification during prostate biopsy. Over a period of 16 months, we identified 445 patients with a total of 921 specimens. The percentage of patients who had 1, 2 or 3 specimens analyzed was 29%, 38%, and 30%, respectively. Our cohort's rate of specimen verification was 92.8% with a 2.8% contamination rate. The pathology reports for 445 patients were then examined to determine Gleason Grade Group (GG) showing 180 GG1 and 148 GG2 patients. Cross reference of pathology reports and Know Error reports showed 8 GG1 and 9 GG2 patients had contaminated biopsy specimens. Specimen provenance complications such as contamination can negatively impact patient counselling and treatment modalities leading to unnecessary intervention and detrimental patient outcomes.

    Keywords: DNA analysis, specimen contamination, prostate biopsies, specimen provenance complications,

    Feb 2021 (Vol. 28, Issue 1 , Page 10568)
  • How I Do It: Modification of technique to safely position patients with super obesity in dorsal lithotomy for ureteroscopic management of kidney stones

    Allen Jordan, Streeper M. Necole, MD Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA

    Obesity is a known risk factor for recurrent nephrolithiasis and it can be challenging to provide safe surgical intervention in the super obese population. Despite high weight limits on surgical beds, these often do not take into account positioning the patient on the end of the bed for dorsal lithotomy, which can risk an unsteady bed. In addition, depending on patient habitus the leg stirrups may not accommodate. There is limited literature that discusses the technical approach for positioning super obese patients in dorsal lithotomy when the weight limit approaches or exceeds the capacity of equipment available. In this article, we present a modified positioning technique to improve bed stability, which also provides an alternative if the patient's legs are not supported by available leg stirrups. From our experience, this modified dorsal lithotomy positioning for ureteroscopy is feasible and safe in patients with super obesity. Surgical intervention on this population requires appropriate planning and teamwork to ensure safe positioning.

    Keywords:

    Dec 2020 (Vol. 27, Issue 6 , Page 10488)
  • How I Do It: Anticoagulation management for common urologic procedures

    Glick Lydia, Chandrasekar Thenappan, Hubosky G. Scott, Teplitsky Seth, Shah Mihir, Leong Joon Yau, Ouma Geoffrey, Mark R. James, MD Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA

    Appropriate perioperative management of antithrombotic medications is critical; for every patient, the risk of bleeding must be balanced against individual risk of thrombosis. There has been a rapid influx of new antithrombotic therapies in the past 5 years, yet there is a lack of clear and concise guidelines on the management of anticoagulant and antiplatelet therapy during urologic surgery. Here we describe our approach to perioperative antithrombotic counseling, including the timing of stopping and restarting these medications. These practice guidelines have been developed in consultation with the Vascular Medicine service at our institution as well as after a review of current literature, and apply to common urologic procedures. Many cases are complex and require medical consultation or a multidisciplinary approach to management. We believe that by presenting our systematic method of antithrombotic management, including when to involve other discplines, we can increase knowledge and comfort amongst urologists in managing these medications in the perioperative period.

    Keywords:

    Dec 2020 (Vol. 27, Issue 6 , Page 10480)
  • Next-generation DNA sequencing for infected genitourinary implants: How I do it

    Chung H. Paul, Leong Joon Yau, Teplitsky Seth, Shenot J. Patrick, Das K. Akhil, Gomella G. Leonard, MD Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia Pennsylvania, USA

    Infection of artificial urinary sphincters or inflatable penile prostheses is one of the most devastating complications after prosthetic surgery and can have a significant impact on a quality of life. Patients undergoing revision surgery with or without device replacement may have increased risk for infection when compared to initial primary surgery. As such, surgeons may utilize traditional culture results to direct antimicrobial therapy for these patients. Unfortunately, culture results can be inconclusive in up to one-third of the time even in the setting of active device infection. Next-generation sequencing (NGS) of DNA is an emerging technology capable of sequencing entire bacterial genomes and has the potential to identify microbial composition in explanted devices. Herein, we describe our institutional experience on NGS utilization in patients with genitourinary prostheses. We also highlight our methods and techniques to inform readers on the potential practices that can enhance the utility and diagnostic yield of this new and upcoming technology.

    Keywords: urethral stricture, inflatable penile prosthesis, IPP, artificial urinary sphincter, AUS, NGS, infection,

    Oct 2020 (Vol. 27, Issue 5 , Page 10418)
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April 2021, Vol.28 No.2
canadian journal of urology