Polyacrylamide hydrogel bulking agent (Bulkamid® [Axonics, Irvine, California, USA]) injection is used as a minimally invasive treatment for stress and mixed urinary incontinence in females. Several studies have demonstrated the short- and medium-term efficacy and safety of Bulkamid. However, there are limited data available on the long-term safety of this procedure. The authors report an unexpected and late complication associated with Bulkamid periurethral injection. An 80-year-old female, who had undergone Bulkamid periurethral injection for stress urinary incontinence 10 years previously, was referred to the authors’ clinic with recurrent lower urinary tract symptoms and dysuria. Investigations with ultrasound and cystoscopy confirmed a single 2 cm bladder stone adhered to an exposed Bulkamid agent at its injection site. Exposed intravesical Bulkamid can act as a foreign body with lithogenic potential to cause urinary bladder stone formation. This article highlights urinary bladder stone formation as a late potential complication of Bulkamid periurethral injection.

Background Enhanced recovery programmes are associated with improved short-term outcomes following liver surgery. The impact of enhanced recovery programmes on medium- and long-term outcomes is incompletely understood. This study aimed to assess the impact of an enhanced recovery programme on long-term survival in patients undergoing surgery for colorectal liver metastases. Methods At a tertiary hepatobiliary centre, we analysed short-, medium- and long-term outcomes in consecutive patients undergoing liver resection for colorectal liver metastases. A five-year retrospective review was carried out comparing the enhanced recovery programme to standard care. Results A total of 172 patients were included in the analysis: 87 on standard care and 85 on an enhanced recovery programme. Open surgery was performed in 122 patients: 74 (85.1%) and 48 (56.5%) patients in the standard care and enhanced recovery programme, respectively (p < 0.001). There was a significant reduction in the median (IQR) length of hospital stay in the enhanced recovery programme compared with standard care (7 (5) days vs. 8 (3) days, p = 0.0009). There was no significant difference in survival between standard care and the Enhanced Recovery Programme at one (p = 0.818), three (p = 0.203), and five years (p = 0.247). Conclusion An enhanced recovery programme was associated with a reduced length of hospital stay. There was no effect on the one-, three- and five-year survival.

We report a 79-year-old gentleman with an asymptomatic intra-ureteric encrusted suture thread. He was found to have calcification in the left renal pelvis and thickening of the upper ureteric wall on a follow-up computerised tomography (CT) scan ten years after a radical cystoprostatectomy and ileal conduit formation for bladder and prostate cancer. These incidental CT scan findings raised the possibility of either ureteric stone or tumour. Subsequently, the patient underwent a ureterorenoscopy, which revealed a calcified 6cm length thread thought to be a suture that slipped intraoperative during his initial radical surgery ten years earlier.

Aims The Enhanced Recovery Programme for Liver Surgery (ERPLS) has been shown to promote functional recovery and reduce hospital stay. However, its effect on long term survival has yet to be established. The aim of this study was to determine the effect of the ERPLS on 5-year patient survival. Methods This was a retrospective study of patients who underwent liver resection for colorectal liver metastasis (CRLM) between January 2011 and December 2016 at a regional hepatobiliary centre. The cohort comprised of 60 pre-ERPLS and 60 post-ERPLS patients. The primary outcome was 5-year patient survival. The secondary outcomes were length of stay (LOS), postoperative complications and 90-day readmission rates. Multivariate analysis was performed to identify independent predictors of overall survival. Results There was no significant difference in the age (p = 0.960), gender (p = 0.332) and type of resection (p = 0.198) between both groups. ERPLS was not an independent predictor for overall survival (Gehan Wilcoxon Test, p = 0.828). There was no significant difference in the LOS (p = 0.874) and 90-day readmission rates (p = 0.349). Major postoperative complications (&gt;3a Clavien-Dindo classification) were significantly less in the ERPLS group (p = 0.02). On multivariate analysis, positive resection margins and major postoperative complications were independent predictors for overall survival. Conclusions ERPLS does not seem to have an effect on long term patient survival. However, it appears to reduce the rate of major postoperative complications. LOS and 90-day readmission rates were not influenced by ERPLS.