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Buckland BC, Heijkoop B, Tronidjaja J, Chong PG. Diagnostic precision in proximal penile fracture: the use of MRI and the perineal approach. ANZ J Surg 2024. [PMID: 38426598 DOI: 10.1111/ans.18915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/11/2023] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Benjamin C Buckland
- Department of Urology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Bridget Heijkoop
- Department of Urology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Jaw Tronidjaja
- Department of Radiology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Peter G Chong
- Department of Urology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
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2
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Heijkoop B, Chislett B, Perera M, Esler S, Bolton D, Webb DR. PCNL in neurogenic bladder: A challenging population for both clinical management and analysis. BJUI Compass 2023; 4:695-700. [PMID: 37818030 PMCID: PMC10560620 DOI: 10.1002/bco2.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 10/12/2023] Open
Abstract
Objectives To review the management of patients with neurogenic bladder undergoing percutaneous nephrolithotomy (PCNL) at our institution with the aim of assessing peri-operative morbidity. Subjects/patients and methods We conducted a retrospective review of all neurogenic bladder patients who underwent PCNL at our hospital in the last decade with the aim of assessing peri-operative morbidity. Results A total of 298 PCNL were performed during the study period of which 58 were in patients with a neurogenic bladder or urinary diversion, 33 of which were in SCI patients. Preoperative demographic and stone characteristics, intraoperative data and postoperative length of stay and complications are summarised in table form. Conclusion PCNL remains an acceptably safe and efficacious treatment for upper tract stone disease in patients with neurogenic bladders and will continue to have a valuable role where SCI prevents alternative approaches such as ureteroscopy.
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Affiliation(s)
| | | | | | | | - Damien Bolton
- Austin HospitalHeidelbergVictoriaAustralia
- Department of UrologyAustin HealthHeidelbergVictoriaAustralia
- Department of SurgeryUniversity of MelbourneMelbourneVictoriaAustralia
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3
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Heijkoop B, Lahoud J, Wong ELH. Endoscopic stone management in an ectopic ureter inserting into the prostatic urethra. BMJ Case Rep 2023; 16:e254927. [PMID: 37770237 PMCID: PMC10546127 DOI: 10.1136/bcr-2023-254927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
We report a case of successful endoscopic stone management in a patient with ectopic ureteric insertion. The patient had a complete duplex collecting system, with the upper moiety ureter inserting ectopically into his prostatic urethra, and an obstructing ureteric stone in the distal portion of the ectopic ureter. This made both characterisation of the patient's anatomy and initial emergency stone management challenging.The case offers several learning points for clinicians who may encounter similar situations. By describing the challenges of managing this patient's presentation, we highlight considerations in imaging interpretation and operative approach that may help the reader manage a similar presentation to their practice. Additionally, we remind the urologist to consider the implications of an ectopic duplex ureter on future procedures, such as transurethral resection of the prostate or radical prostatectomy.
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Affiliation(s)
- Bridget Heijkoop
- Urology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Urology, Campbelltown Hospital, Campbelltown, New South Wales, Australia
| | - John Lahoud
- Urology, Campbelltown Hospital, Campbelltown, New South Wales, Australia
| | - Eddy Lee Hao Wong
- Urology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Urology, Campbelltown Hospital, Campbelltown, New South Wales, Australia
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4
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Heijkoop B, Bolton D, Katz D, Ryan A, Epstein J, Appu S. Cystic papillary adenoma of the seminal vesicle – A distinct histological entity. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01082-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Background Primary Seminal Vesicle (SV) tumours are a rare entity, with most SV masses representing invasion of the SV by malignancy originating in an adjacent organ, most often the prostate. Previously reported primary SV epithelial tumours have included adenocarcinoma and cystadenoma, with limited prior reports of inracystic papillary structures.
Case presentation A 35-year-old male presented with azoospermia, intermittent macroscopic haematuria, and mild right iliac fossa and groin pain. A papillary appearing seminal vesicle mass was found on imaging and seminal vesicoscopy. The mass was robotically excised with diagnosis of benign cystic papillary adenoma made. Conclusion In this manuscript we describe a rare case of a benign cystic papillary adenoma of the seminal vesicle, a unique histological entity differentiated from cystadenoma of the Seminal Vesicle by its papillary component.
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Affiliation(s)
| | - D Bolton
- Austin Health, Melbourne, Australia
| | - D Katz
- Men's Health Melbourne, Melbourne, Australia
| | | | - J Epstein
- Johns Hopkins Hospital, Baltimore, USA
| | - S Appu
- Austin Health, Melbourne, Australia.,Department of Surgery, Monash University, Melbourne, Australia
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Heijkoop B, Perera M, Kelly BD, Bolton D. Metastatic neuroendocrine tumour presenting as a testicular mass. BMJ Case Rep 2021; 14:14/2/e240042. [PMID: 33541948 PMCID: PMC7868227 DOI: 10.1136/bcr-2020-240042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In this manuscript, we describe a rare case of neuroendocrine tumour metastatic to the testicle, presenting with testicular mass as an isolated symptom. We describe the investigations and management leading us to this uncommon histological diagnosis and explore its significance and impact on further management.
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Affiliation(s)
| | - Marlon Perera
- Urology, Austin Health, Heidelberg, Victoria, Australia
| | - Brian D Kelly
- Urology, Austin Health, Heidelberg, Victoria, Australia
| | - Damien Bolton
- Urology, Austin Health, Heidelberg, Victoria, Australia
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Heijkoop B, Galiabovitch E, York N, Webb D. Consensus of multiple national guidelines: agreed strategies for initial stone management during COVID-19. World J Urol 2020; 39:3161-3174. [PMID: 33226444 PMCID: PMC7681178 DOI: 10.1007/s00345-020-03491-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 10/07/2020] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To review the existing available information regarding urolithiasis management and the impact of COVID-19 on this, and propose recommendations for management of emergency urolithiasis presentations in the COVID-19 era. METHODS Review of published guidelines produced by Urological Governing Bodies, followed by the literature review regarding urolithiasis management during the COVID-19 pandemic. RESULTS Consistent recommendations across guidelines and literature were that urolithiasis with concurrent sepsis or renal failure remains a urological emergency warranting urgent intervention within the pandemic environment. Ureteric stenting and percutaneous nephrostomy are considered equivalent for decompression in this setting, with both ideally to be performed under local anaesthesia where possible to spare ventilators and reduce aerosol-generating procedures. Greater utilization of medical expulsive therapy and dissolution chemolysis may occur during the pandemic, and longer indwelling stent times may be accepted while definite stone clearance is deferred. CONCLUSIONS Urolithiasis will continue to be a source of emergency presentations requiring urgent intervention during the COVID-19 pandemic. However, it is possible to limit these interventions to decompression of the collecting system in the setting of concurrent obstruction or infection, performed under local anaesthesia to limit use of resources and minimise aerosol-generating procedures, with deferral of definitive management.
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Affiliation(s)
- B Heijkoop
- Austin Health, The University of Adelaide, Heidelberg, VIC, Australia.
| | - E Galiabovitch
- Austin Health, The University of Adelaide, Heidelberg, VIC, Australia
| | - N York
- Auckland Regional Urology Service, Auckland, New Zealand
| | - D Webb
- Austin Health, The University of Adelaide, Heidelberg, VIC, Australia
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Heijkoop B, Kahokehr AA. Buccal mucosal ureteroplasty for the management of ureteric strictures: A systematic review of the literature. Int J Urol 2020; 28:189-195. [DOI: 10.1111/iju.14426] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 10/07/2020] [Indexed: 12/16/2022]
Affiliation(s)
| | - Arman A Kahokehr
- SA Health Adelaide South Australia Australia
- Flinders University Adelaide South Australia Australia
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David R, Heijkoop B, A Kahokehr A. Surgical Locker room Environment: Understanding the Hazards (SLEUTH) study. ANZ J Surg 2020; 90:1943-1946. [PMID: 32648297 DOI: 10.1111/ans.16109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/19/2020] [Accepted: 06/06/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Anecdotal evidence reveals that medical equipment are easily found in hospital changing rooms. Access to potentially lethal drugs and intravenous access equipment may put vulnerable medical staff at risk. The aims are to quantify the burden of medical equipment found in this environment, calculate the associated cost burden and to raise clinician awareness about a potential health hazard. METHODS We prospectively collected data on the medical paraphernalia found in surgical changing rooms from one private and two public hospitals in South Australia over 2 months. We systematically searched open surgical lockers, benches and floors in male and female lockers rooms. Item costs were calculated from Imprest and the Pharmacy Department. RESULTS During the study period, we found a total of 537 items. There were 280 sharps, including 185 scalpels found in one open locker. There were 78 items of intravenous paraphernalia, 38 surgical tapes, 70 bandages and 73 miscellaneous items. In addition, there were six medications found including 3 × 5 mL vials of 1% lignocaine, one vial of lignocaine with adrenaline, one ketorolac suppository and 5 mL fentanyl. There were 529 (98.5%) items within their date of expiry. The total cost of the items was 2358 Australian dollars (AUD), with an estimated annual cost of 14 148 AUD over the three sites and 424 400 AUD over South Australia. CONCLUSION The burden of available medical supplies found in the theatre changing room is high and worrisome. Strategies for appropriate disposal and safe storage of medical equipment are required.
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Affiliation(s)
- Rowan David
- Division of Surgery, Urology, Lyell McEwin Hospital, Adelaide, South Australia, Australia.,Flinders University, Adelaide, South Australia, Australia
| | - Bridget Heijkoop
- Division of Surgery, Urology, Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Arman A Kahokehr
- Division of Surgery, Urology, Lyell McEwin Hospital, Adelaide, South Australia, Australia.,Flinders University, Adelaide, South Australia, Australia.,The University of Adelaide, Adelaide, South Australia, Australia
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10
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Heijkoop B, Nadi S, Spernat D, Kiroff G. Extended versus inpatient thromboprophylaxis with heparins following major open abdominopelvic surgery for malignancy: a systematic review of efficacy and safety. Perioper Med (Lond) 2020; 9:7. [PMID: 32158540 PMCID: PMC7053065 DOI: 10.1186/s13741-020-0137-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 01/29/2020] [Indexed: 02/02/2023] Open
Abstract
Background Patients undergoing open abdominopelvic procedures for malignancy are at high risk of postoperative venous thromboembolism (VTE). This risk can be mitigated with prophylaxis; however, optimum duration in this population remains unknown. Our objective was to conduct a systematic review of contemporary literature on the use of heparin thromboprophylaxis following major open pelvic surgery for malignancy, comparing the efficacy and safety of extended duration to inpatient treatment. Methods A study protocol describing search strategy and inclusion and exclusion criteria was developed and registered with PROSPERO. A literature review was conducted in accordance with the protocol. Results Literature review identified only 4 studies directly comparing extended and inpatient duration prophylaxis, with a combined population of 3198 and 3135 patients for VTE rate and bleeding events, respectively. Despite many studies reporting lower VTE rates in patients receiving extended prophylaxis, no statistically significant difference in rates of postoperative VTE (p = 0.18) or bleeding complications (p = 0.43) was identified between patients receiving extended duration prophylaxis and those receiving inpatient only prophylaxis. Conclusion On the review of contemporary literature, no significant difference was found in rates of postoperative VTE or bleeding complications between patients receiving extended duration heparin VTE prophylaxis and those receiving inpatient prophylaxis after open abdominopelvic surgery for malignancy. This raises the question of how extended duration prophylaxis has become common practice in this population, and whether this needs to be re-evaluated.
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Affiliation(s)
- B Heijkoop
- 1The Queen Elizabeth Hospital, Woodville, SA Australia.,2Discipline of Surgery, The University of Adelaide, Adelaide, Australia
| | - S Nadi
- 2Discipline of Surgery, The University of Adelaide, Adelaide, Australia.,3Research and Evaluation, Incorporating ASERNIP-S, Royal Australasian College of Surgeons, Adelaide, Australia
| | - D Spernat
- 1The Queen Elizabeth Hospital, Woodville, SA Australia.,2Discipline of Surgery, The University of Adelaide, Adelaide, Australia
| | - G Kiroff
- 1The Queen Elizabeth Hospital, Woodville, SA Australia.,2Discipline of Surgery, The University of Adelaide, Adelaide, Australia
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11
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Kinnear N, Heijkoop B, Bramwell E, Frazzetto A, Noll A, Patel P, Hennessey D, Otto G, Dobbins C, Sammour T, Moore J. Communication and management of incidental pathology in 1,214 consecutive appendicectomies; a cohort study. Int J Surg 2019; 72:185-191. [PMID: 31683040 DOI: 10.1016/j.ijsu.2019.10.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/08/2019] [Accepted: 10/23/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Important incidental pathology requiring further action is commonly found during appendicectomy, macro- and microscopically. We aimed to determine whether the acute surgical unit (ASU) model improved the management and disclosure of these findings. METHODS An ASU model was introduced at our institution on 01/08/2012. In this retrospective cohort study, all patients undergoing appendicectomy 2.5 years before (Traditional group) or after (ASU group) this date were compared. The primary outcomes were rates of appropriate management of the incidental findings, and communication of the findings to the patient and to their general practitioner (GP). RESULTS 1,214 patients underwent emergency appendicectomy; 465 in the Traditional group and 749 in the ASU group. 80 (6.6%) patients (25 and 55 in each respective period) had important incidental findings. There were 24 patients with benign polyps, 15 with neuro-endocrine tumour, 11 with endometriosis, 8 with pelvic inflammatory disease, 8 Enterobius vermicularis infection, 7 with low grade mucinous cystadenoma, 3 with inflammatory bowel disease, 2 with diverticulitis, 2 with tubo-ovarian mass, 1 with secondary appendiceal malignancy and none with primary appendiceal adenocarcinoma. One patient had dual pathologies. There was no difference between the Traditional and ASU group with regards to communication of the findings to the patient (p = 0.44) and their GP (p = 0.27), and there was no difference in the rates of appropriate management (p = 0.21). CONCLUSION The introduction of an ASU model did not change rates of surgeon-to-patient and surgeon-to-GP communication nor affect rates of appropriate management of important incidental pathology during appendectomy.
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Affiliation(s)
- Ned Kinnear
- Dept of Surgery, Lyell McEwin Hospital, Adelaide, Australia; Dept of Surgery, Port Augusta Hospital, Port Augusta, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia.
| | | | - Eliza Bramwell
- Dept of Surgery, Port Augusta Hospital, Port Augusta, Australia
| | - Alannah Frazzetto
- Dept of Surgery, Port Augusta Hospital, Port Augusta, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Amy Noll
- Dept of Surgery, Port Augusta Hospital, Port Augusta, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Prajay Patel
- Dept of Surgery, Port Augusta Hospital, Port Augusta, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | | | - Greg Otto
- Dept of Surgery, Lyell McEwin Hospital, Adelaide, Australia
| | | | - Tarik Sammour
- Dept of Surgery, Royal Adelaide, Hospital, Adelaide, Australia; Dept of Surgery, Faculty of Medical and Health Sciences, University of Adelaide, Adelaide, Australia
| | - James Moore
- Dept of Surgery, Royal Adelaide, Hospital, Adelaide, Australia; Dept of Surgery, Faculty of Medical and Health Sciences, University of Adelaide, Adelaide, Australia
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Kinnear N, Heijkoop B, Bramwell E, Frazetto A, Noll A, Patel P, Hennessey D, Otto G, Dobbins C, Sammour T, Moore J. Communication and Follow-Up Of Incidental Pathology In 1,214 Consecutive Appendicectomies. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2019.09.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Kinnear N, Heijkoop B, Hua L, Hennessey D, Spernat D. The Impact of Intra-Operative Cell Salvage During Open Radical Prostatectomy. European Journal of Surgical Oncology 2019. [DOI: 10.1016/j.ejso.2019.09.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kinnear N, Hua L, Heijkoop B, Hennessey D, Spernat D. The Impact of Intra-Operative Cell Salvage during Open Nephrectomy. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2019.09.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Heijkoop B, Parker N, Kiroff G, Spernat D. Effectiveness and safety of inpatient versus extended venous thromboembolism (VTE) prophylaxis with heparin following major pelvic surgery for malignancy: protocol for a systematic review. Syst Rev 2019; 8:249. [PMID: 31666130 PMCID: PMC6822405 DOI: 10.1186/s13643-019-1179-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 10/07/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) is a common postoperative complication associated with significant morbidity and mortality. The use of prophylactic heparin postoperatively reduces this risk, and the use of extended duration prophylaxis is becoming increasingly common. Malignancy and pelvic surgery both independently further increase the risk of postoperative VTE and patients undergoing major pelvic surgery for malignancy are at particularly high risk of VTE. However, the optimum duration of prophylaxis specifically in this population currently remains unclear. METHODS We will conduct a systematic review of literature in accordance with the Cochrane Handbook for Systematic Reviews of Interventions (Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0.,2011) to evaluate current evidence of the effectiveness and safety of inpatient versus extended VTE prophylaxis with heparin (all forms) following major pelvic surgery for malignancy. We will search PubMed, EMBASE, and the Cochrane Library. Regarding safety, Food and Drug Administration (FDA), and Therapeutic Goods Administration (TGA) websites will be searched, including all levels of evidence. Results will be the postoperative timeframe in which a VTE event can be considered to have been provoked by the surgery, and the number of patients needed to treat with both inpatient and extended prophylaxis to prevent a VTE event in this timeframe, comparing these to determine if there is a significant benefit from extended prophylaxis. DISCUSSION This systematic review will aim to identify the postoperative period in which patients undergoing major pelvic surgery for malignancy are at further increased risk of VTE as a result of their surgery and the optimum duration of heparin VTE prophylaxis with heparin to reduce this risk. Determining this will allow evidence-based recommendations to be made for the optimum duration of heparin VTE prophylaxis post major pelvic surgery for malignancy, leading to improved standards of care that are consistent between different providers and institutions. SYSTEMATIC REVIEW REGISTRATION In accordance with guidelines, our systematic review was submitted to PROSPERO for consideration of registration on 16/12/17 and was registered on 12/1/18 with the registration number CRD42018068961 , and it was last updated on December 1, 2018.
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Affiliation(s)
- Bridget Heijkoop
- Urology Department, The Queen Elizabeth Hospital, The University of Adelaide, Level 7A, 28 Woodville rd, Woodville South, SA 5011 Australia
| | - Natalie Parker
- Urology Department, The Queen Elizabeth Hospital, The University of Adelaide, Level 7A, 28 Woodville rd, Woodville South, SA 5011 Australia
| | - George Kiroff
- Urology Department, The Queen Elizabeth Hospital, The University of Adelaide, Level 7A, 28 Woodville rd, Woodville South, SA 5011 Australia
| | - Daniel Spernat
- Urology Department, The Queen Elizabeth Hospital, The University of Adelaide, Level 7A, 28 Woodville rd, Woodville South, SA 5011 Australia
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Abstract
In this manuscript, we present a rare case of massive haemoptysis secondary to rupture of a pulmonary artery aneurysm, which was unusual for having occurred in the absence of tuberculosis or a vasculitis. We describe the emergency management of this that ultimately resulted in the patient's survival from both an anaesthetic and surgical perspective, as well as discuss the role of interventional radiology in this situation.
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Affiliation(s)
- Bridget Heijkoop
- Department of Surgery, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Heather Gillespie
- Department of Anaesthesia, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - George Kiroff
- Department of Upper GI Surgery, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
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17
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Heijkoop B, Parker N, Spernat D. Fournier's gangrene: not as lethal as previously thought? A case series. ANZ J Surg 2018; 89:350-352. [DOI: 10.1111/ans.14760] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 05/23/2018] [Accepted: 06/01/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Bridget Heijkoop
- Urology DepartmentThe Queen Elizabeth Hospital Adelaide South Australia Australia
| | - Natalie Parker
- Urology DepartmentThe Queen Elizabeth Hospital Adelaide South Australia Australia
| | - Daniel Spernat
- Urology DepartmentThe Queen Elizabeth Hospital Adelaide South Australia Australia
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Kinnear N, Hua L, Heijkoop B, Hennessey D, Spernat D. The impact of intra-operative cell salvage during open nephrectomy. Asian J Urol 2018; 6:346-352. [PMID: 31768320 PMCID: PMC6872782 DOI: 10.1016/j.ajur.2018.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 02/23/2018] [Accepted: 04/13/2018] [Indexed: 11/19/2022] Open
Abstract
Objective To assess the impact of intra-operative cell salvage on outcomes in open nephrectomy. Methods A retrospective cohort study was performed of all patients undergoing open nephrectomy for suspected malignancy from 1 October 2013 to 1 October 2017. Patients were grouped and compared based on whether they received intra-operative cell salvage (ICS). Primary outcomes were allogeneic transfusion rates (ATRs), and if histology confirmed cancer, disease recurrence. Secondary outcomes were complications and transfusion-related cost. Results Forty patients underwent open nephrectomy for suspected malignancy during the enrolment period. Sixteen patients received ICS while 24 did not (standard group). Compared with the standard group, ICS patients had similar median age (63.5 vs. 61.0 years; p = 0.83) but fewer females (19% vs. 58%; p = 0.013). The groups were similar in pre-operative and discharge haemoglobin, Charlson Comorbidity Index, length of hospital stay and proportion with thoracoabdominal surgical approach. The ICS group had a smaller proportion undergoing partial nephrectomy (19% vs. 54%; p = 0.025) and shorter median follow-up (278 vs. 827 days; p = 0.0005). Histology was malignant for 14 ICS and 15 standard patients. The ICS group had more frequent ≥T2 disease (79% vs. 27%; p = 0.005). There were no positive margins. Both groups had similar ATRs (6% vs. 4%; p = 0.96), complication rates (19% vs. 29%; p = 0.46) and recurrence rates (18% vs. 7%; p = 0.40). Transfusion costs were higher amongst ICS patients (AUD $878.18 vs. $49.65 per patient). Conclusion ICS appears safe, with low rates of recurrence and complication. Both groups had low ATRs, and therefore cost benefit for ICS was not seen.
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Affiliation(s)
- Ned Kinnear
- Department of Urology, The Queen Elizabeth Hospital, Adelaide, Australia
- Corresponding author.
| | - Lina Hua
- Department of Urology, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Bridget Heijkoop
- Department of Urology, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Derek Hennessey
- Department of Urology, Craigavon Area Hospital, Portadown, UK
| | - Daniel Spernat
- Department of Urology, The Queen Elizabeth Hospital, Adelaide, Australia
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Kinnear N, Heijkoop B, Hua L, Hennessey DB, Spernat D. The impact of intra-operative cell salvage during open radical prostatectomy. Transl Androl Urol 2018; 7:S179-S187. [PMID: 29928615 PMCID: PMC5989116 DOI: 10.21037/tau.2018.04.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background To examine the effect of intra-operative cell salvage (ICS) in open radical prostatectomy. Methods In this retrospective cohort study, all patients undergoing open radical prostatectomy for malignancy at our institution between 10/04/2013 and 10/04/2017 were enrolled. Patients were grouped and compared based on whether they received ICS. Primary outcomes were allogeneic transfusion rates, and disease recurrence. Secondary outcomes were complications and transfusion-related cost. Results Fifty-nine men were enrolled; 30 used no blood conservation technique, while 29 employed ICS. There were no significant differences between groups in age, pre- or post-operative haemoglobin, Charlson comorbidity index, operation duration or length of stay. Tumour characteristics were also similar between groups, including pre-operative prostate specific antigen, post-operative Gleason score, T-stage, nodal status and rates of margin positivity. Compared with controls, the ICS group had longer follow up (945 vs. 989 days; P=0.0016). The control and ICS groups were not significantly different in rates of tumour recurrence (6 vs. 3 patients; P=0.30) or complications (10 vs. 5 patients; P=0.16). While the proportion of patients receiving allogenic transfusion was similar (9 vs. 6 patients; P=0.41), fewer red blood products transfused (40 vs. 12 units) meant transfusion related costs were lower in ICS patients (AUD $47,666 vs. $37,429). Conclusions ICS reduced transfusion related costs, without affecting allogeneic transfusion rates, tumour recurrence or complication rates. These findings extend the literature supporting ICS in oncological surgery. Prospective randomised studies are needed to confirm the existing level III evidence.
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Affiliation(s)
- Ned Kinnear
- Department of Urology, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Bridget Heijkoop
- Department of Urology, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Lina Hua
- Department of Urology, The Queen Elizabeth Hospital, Adelaide, Australia
| | | | - Daniel Spernat
- Department of Urology, The Queen Elizabeth Hospital, Adelaide, Australia
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