There was little perceived difference between ALSB and LSB, showing that ALSB are at least noninferior as an educational tool. In view of the numerous ethical and logistical issues with LSB, we would advocate ASLB as the educational tool of choice for future surgical demonstration at conferences.

We report the prenatal identification of lower-limb venous hypoplasia to support a provisional prenatal diagnosis of Klippel-Trénaunay syndrome (KTS). Ultrasound assessment of a fetus with marked lower-limb edema, cystic areas in the abdomen CASE REPORTA 32-year-old woman was referred after her secondtrimester ultrasound examination demonstrated that the fetus had two abnormal feet. First-trimester screening had identified the pregnancy as high risk (1 in 134 chance) for trisomy 21. Amniocentesis had been declined by the patient at this time.The initial tertiary examination at 24 + 2 weeks' gestation demonstrated a male fetus with marked edema of the lower limbs, with the right leg being worse than the left (Figure 1). Large pockets of fluid/cystic spaces were evident in the lower limbs, pelvis and inferior retroperitoneum. Differential diagnoses of chromosomal (trisomy 21 or 18) or genetic syndromes or structural abnormalities such as lymphangioma were considered. An amniocentesis was performed, showing a karyotype of 46,XY. Counseling with the obstetric/pediatric surgical team considered a range of possible outcomes including significant disability. The parents decided to continue with the pregnancy.Ultrasound examinations were performed at 26 + 2, 28 + 2 and 30 + 2 weeks' gestation. Over these examinations there was minimal change to the edema and the cystic spaces did not change or show vascularity. However, the feet deformities became more apparent. The right foot was markedly hypertrophied with fusion of the second and third toes (Figure 2). The left side appeared less affected. It was not possible to make a definitive diagnosis, but the most likely diagnosis appeared to be Klippel-Trénaunay syndrome (KTS). Magnetic resonance imaging (MRI) was performed at 32 weeks, confirming the features observed on ultrasound examination.An ultrasound examination at 32 + 2 weeks included a targeted examination of the lower-limb vascular system. The external iliac veins were present, and the great saphenous vein could be demonstrated on the left side (Figures 1a and b). The femoral/popliteal veins could not be demonstrated in either limb (Figures 1b and c), however, the position of the fetus limited evaluation of the right superficial venous system. The lateral thigh area was examined on both sides for congenital embryonal veins but these were not seen. The major arteries were present. Hypoplasia/aplasia of the deep venous system was suspected, making a diagnosis of KTS much more likely.Elective Cesarean section was performed at 38 + 3 weeks' gestation and postnatal clinical examination confirmed the ultrasound findings. In addition, there were marked bilateral dark purple superficial capillary

Urinary retention is commonly diagnosed based on history and examination along with bedside bladder scan. However, in patients where clinical examination is unreliable (patients with obesity, anasarca, and ascites) and diagnosis is uncertain, the bladder scan findings should be interpreted with caution and definitive imaging is mandatory before further intervention is instituted.

The scoring system was a reliable tool for assessing the performance of LN and accurately predicts the level of experience of the surgeon. This system could be a useful supplementary tool for assessing the baseline skill and progress of trainees.

Purpose. To assess the risks and benefits of early urethral catheter removal following laparoscopic radical prostatectomy. Materials and Methods. Between June 2009 and April 2011, 114 patients underwent laparoscopic radical prostatectomy for clinically organ-confined prostate cancer. Candidates for early removal of the urethral catheter were selected intraoperatively on the basis of the integrity of the vesicourethral anastamosis and the ease of recatheterisation. In the selected cohort of patients, the urethral catheter was removed at day 2. Recatheterisation rates within this group were recorded and analysed. Results. Of the 114 patients who underwent laparoscopic prostatectomy, 64 (56%) were deemed suitable for removal of catheter on second postoperative day prior to discharge. The first 20 patients selected for early removal of urethral catheter were covered with a suprapubic catheter inserted at the time of surgery. Out of 64 patients deemed suitable for early removal of urethral catheter, 53 (83%) were able to pass urine without complication. 11 patients (17%) developed urinary retention that necessitated recatheterisation. In all cases, reinsertion of catheter was performed easily and successfully without the need for cystoscopic guidance or adjuncts. Conclusions. Removal of the urethral catheter at day 2 following laparoscopic prostatectomy is a safe procedure in carefully selected patients.