Topical glyceryl trinitrate produces a successful internal sphincterotomy, which resulted in long-term healing of 59 percent of chronic anal fissures and significant improvement in pain. Internal sphincter spasm is the cause of chronic anal fissure.

Purpose: To evaluate the outcome of endoscopic management of upper-tract transitional-cell carcinoma (TCC). , 40 patients with upper-tract TCC were treated by an endoscopic approach as the primary management: 37 (90.2%) by ureteroscopy and by percutaneous techniques or both approaches in 2 cases each (5%). Follow-up was between 5 and 115 months (mean 41.6 months). Most of the patients, 26 (65%), had a normal contralateral kidney, and the indication for conservative management was low tumor grade or tumor size (Ͻ2 cm) and patient commitment to a rigorous followup protocol. Absolute and relative indications for conservative management such as solitary kidney were met in 14 patients (35%).Results: Treatment consisted of electrocautery only in 15 cases (36.6%), neodymium:YAG or holmium:YAG laser only in 11 (26.8%), and combinations in 15 (36.6%). Most of the patients (74.3%) had an upper-tract recurrence. The renal-preservation rate was 70.7%, and the survival rate was 80%.Conclusions: Conservative treatment is preferred in patients with bilateral disease, a solitary kidney, or comorbidities that contraindicate major surgery. Patients with low-grade, low-stage disease and normal contralateral kidneys also benefit from this approach provided adequate endoscopic follow-up can be achieved and the surgeon has a low threshold for carrying out ablative surgery.

OBJECTIVE To evaluate the efficacy of a fourth‐generation lithotripter, the Sonolith Vision (Technomed Medical Systems, Vaulx‐en‐Velin, France) for treating single previously untreated renal calculi, and to compare the results with the reference standard HM‐3 (Dornier MedTech Europe GmbH, Wessling, Germany) in the same population originally studied by the USA Cooperative Study Group in 1986. PATIENTS AND METHODS The Sonolith Vision uses an innovative electroconductive shock‐wave generator with an elliptical reflector specially designed to give the maximum concentration of energy on the stone. We reviewed the treatment sessions from our prospectively maintained database of the first 1000 consecutive patients with urinary stone disease who were treated with the Sonolith Vision between September 2004 and March 2006. Patients with previously untreated solitary renal calculi in anatomically normal kidneys were included. The outcome was assessed by plain films for radio‐opaque stones, and renal ultrasonography for radiolucent stones, at 1 and 3 months after lithotripsy; the results were analysed according to stone size and location. RESULTS Data from 309 patients who had a complete follow‐up and with 373 renal calculi that matched the above criteria were analysed. The initial fragmentation rate was 94%. The stone‐free rate for stones of <10 mm was 77%, for 11–20 mm was 69% and for >20 mm was 50%. The overall stone‐free rate 3 months after lithotripsy was 75%. Within a month of lithotripsy, 221 patients (59%) became stone‐free. Additional procedures to render patients stone‐free after lithotripsy were needed in only 22 cases (7%). The overall efficiency quotient was 62%. The stone‐free rates for lower, upper, middle calyceal and renal pelvic calculi were 74%, 70%, 78.5% and 75%, respectively. There were no serious complications. CONCLUSIONS When similar populations of stone formers were assessed the Sonolith Vision achieved a high success rate, comparable with that using the HM‐3 machine but with lower analgesia requirements and very low re‐treatment rates. This method of comparison belies the commonly held view that newer lithotripters are less effective than the original spark‐gap machines.

Background: Operating theatre inefficiency and changeover delays are not only a significant source of wasted resources, but also a familiar source of frustration to patients and health-care providers. This study aimed to prove that the surgical registrar through active involvement in patient changeover can significantly improve operating room efficiency and minimize delays. Methods: A two-phase prospective cohort study was undertaken, conducted over the course of 4 weeks at a single institution. The only inclusion criteria comprised patients to undertake endoscopic urological day surgery cases and require general anaesthesia. There were no exclusions. In the first phase (observational, with no intervention), changeover times between cases were documented. The second phase followed a structured intervention, involving the surgical registrar being actively involved in the patient's operative journey. Outcome measures were qualitative measures of operative efficiency. Statistical analysis was undertaken. Results: There were 42 patients included in this study, with 21 patients in each of its arms. A 48% (P-value < 0.01) reduction in overall case changeover times was demonstrated with the utilization of a structured intervention from 27.7 min (95% confidence interval (CI) 22.8-32.7%) to 15.7 min (95% CI 13.2-18.2%). The intervention results were statistically significant (P-value < 0.05) for all markers of efficiency except for the waiting time in the anaesthetic holding bay (P-value 0.13). Conclusion:The surgical registrar can improve operating room efficiency by using a structured intervention, ultimately reducing patient changeover times.

Study Type – Prognosis (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Hypertension and diabetes have long been identified as both initiating and progressing factors in chronic kidney disease, as well as predictors of long‐term renal impairment in individuals undergoing nephrectomy. Radical nephrectomy itself is an independent risk factor for chronic kidney disease and its associated increased risk of morbid cardiac events and death. These data have been used to support the argument for greater use of partial nephrectomy when dealing with small renal masses. Whilst in the past it has always been seen as intuitive that patients with hypertension and diabetes would have worse renal function after removal of a kidney for malignancy, the present study is the first to quantify this fact. This information could be used to identify those patients who would benefit from early intervention to delay the progression of chronic kidney disease, as well as those for whom partial nephrectomy might be a more appropriate surgical option. OBJECTIVE To quantify the effect of hypertension and diabetes – which have been identified as both initiating and progressing factors in chronic kidney disease (CKD), as well as predictors of long‐term renal impairment in patients undergoing nephrectomy – on renal function after unilateral nephrectomy for malignancy. PATIENTS AND METHODS A retrospective analysis was carried out of 80 unilateral nephrectomies performed at the Wagga Wagga Base Hospital, Calvary Private Hospital and Austin Hospital from January 2007 to December 2009. Prognostic variables were patient age, sex and the presence of hypertension or diabetes. The percentage reduction in glomerular filtration rate (GFR) after nephrectomy was measured and compared between variables using a two‐sample Student’s t‐test. RESULTS All patients who had diabetes also had hypertension. Of the 80 patients, 22 (27.5%) fulfilled the criteria for CKD with a preoperative GFR < 60 mL/min. Patients with hypertension and diabetes had a significantly greater percentage reduction in postoperative GFR (36 ± 2%) than those who had neither risk factor (23 ± 2%, P < 0.003). A similar finding was observed for patients with hypertension alone (32 ± 1%, P < 0.009). The difference in postoperative GFR reduction between diabetics and those with hypertension alone was not statistically significant (P= 0.205). The differential reduction in GFR in patients with CKD risk factors persisted at 3–12 months follow‐up. CONCLUSIONS An increased percentage reduction in GFR is seen in patients with hypertension and diabetes undergoing unilateral nephrectomy for malignancy. These data could be used to identify those patients who would benefit from early referral and subsequent intervention to delay the progression of CKD, as well as those for whom nephron‐sparing surgery might be a more appropriate surgical option.