Cardiovascular optimization using esophageal Doppler significantly improved postoperative markers of gastrointestinal function.

A radical cystectomy (RC) with pelvic lymph node dissection is the gold standard treatment for muscle-invasive bladder carcinoma. The morbidity associated with RC is clearly lower than that in the previous decades; it still continues to remain higher than 30% in the early postoperative period associated with and remains the most effective method for local control. We present current strategies being developed to further enhance recovery in patients undergoing RC and stratifying these into pre, intra, and post operative. We present our current strategies to enhance revcovery in patients undergoing RC which includes a combination of a through preoperative assessment with cardiopulmonary exercise (CPX), preoperative carbohydrate loading drinks, and intraoperative fluid monitoring with the trans-oesophageal Doppler probe (TODP) that may enhance recovery following radical cystectomy. We conclude that using these strategies may not only help in reducing peri/post operative morbidity and the duration of inpatient stay but may also help in enhancing the patient's long-term recovery.

Flexible cystoscopy has revolutionized the field of diagnostic urology. It can be done under local anaesthesia in the outpatient setting and is thus a highly useful tool. Its role in therapeutic urology is more limited but it still has a place in the management of certain conditions.

Pelvi-ureteric junction (PUJ) obstruction occurs when there is delayed or impaired drainage of urine at the PUJ. 1 Since 1993 when the first reports of laparoscopic pyeloplasty (LP) surgery were published, 2,3 laparoscopic/robotic pyeloplasty is considered the gold-standard surgical treatment for patients with PUJ obstruction. 4 AbstractObjective: The objective of this article is to review the outcomes of our updated single-centre extended experience of an innovative enhanced recovery pathway to perform catheter-and drain-free laparoscopic pyeloplasties, achieving safe discharge within 23 hours of surgery. Patients and methods: We conducted a retrospective review of patients who underwent a standard trans-peritoneal laparoscopic pyeloplasty repair over an antegrade stent in our centre by a single surgeon, between 1 September 2007 and 1 February 2015.Patients who had a urinary catheter and/or peri-nephric drain inserted intraoperatively and were not planned for day-case discharge were excluded.Data were collected for duration of in-patient stay, readmission rates and reasons for these. Successful outcome was deemed both in subjective improvement of patient symptoms and/or objective improvement in post-operative MAG-3 renogram curve. Results: Fifty-eight patients were included. A total of 74% (n = 43) were successfully discharged as day-case, and four of these were readmitted. Fifteen patients required in-patient stay, of whom two were readmitted. Successful outcome was recorded in 93% (n = 54). Conclusion: The insertion of a drain and catheter are not essential in laparoscopic pyeloplasty. Avoidance of unnecessary tubes facilitates day-case surgery with no adverse effect on outcome.At our institute all patients are now offered the enhanced recovery protocol for laparoscopic pyeloplasty with resulting benefits both to patients and the local health economy.

An 80-year-old woman presented to our department with visible haematuria and stage II acute kidney injury (AKI). She had stage IIB cervical cancer, for which she received chemotherapy and external beam radiotherapy in 2003. Four years later, she had a left dynamic hip screw for an extracapsular neck of femur fracture following a fall. In 2010, she underwent a right total hip replacement owing to osteoarthritis, and it was subsequently revised in 2012 owing to a right acetabular component failure. In this admission, her AKI improved with intravenous fluid administration and her haematuria settled following catheterisation with a three-way catheter and bladder irrigation with saline. She underwent a flexible cystoscopy which revealed that a part of her right hip prosthesis was in the bladder, having eroded through the right bony pelvis. However, she declined any surgical interventions.