INTRODUCTION: We aimed to compare the real-world data and our clinical experience with metallic stents (MSs) and conventional polymeric stents (PSs) in the management of both malignant and benign chronic ureteric obstruction (CUO), in terms of clinical outcomes and costs. METHODS: Clinical data from our institution, including outcomes for all ureteric stents inserted for long-term management of CUO from all causes from 2014 to 2017, were retrospectively reviewed and compared between the MS and PS episodes. RESULTS: A total of 247 stents were placed in 63 patients with CUO over the 4-year study period. Of these, 45 stents were MSs. There was no significant difference in all baseline characteristics between the MS and PS groups, except for the aetiology of obstructive cause. Mean indwelling stent duration was significantly greater for MS than for PS (228.6 ± 147.0 vs. 146.1 ± 66.0 days, P < 0.001), thereby leading to lower average number of stent changes per year in the MS group compared to the PS group (1.4 vs. 6.3 times, respectively). Despite the higher unit cost of MS compared to PS, there was no significant mean cost difference overall (cost per dwelling day SGD 7.82 ± SGD 10.44 vs. SGD 8.23 ± SGD 20.50, P = 0.888). CONCLUSION Resonance MS is a better option than PS to manage CUO from malignant and benign causes because its significantly longer indwelling time mitigates the higher unit cost of the stent. It potentially reduces the number of procedures and operations in patients. Thus, it should be considered for all patients with CUO requiring long-term ureteric drainage.
Humans ; Ureteral Obstruction/economics* ; Female ; Male ; Retrospective Studies ; Stents/economics* ; Middle Aged ; Aged ; Treatment Outcome ; Chronic Disease ; Ureter/surgery* ; Metals ; Adult ; Aged, 80 and over

COVID-19 ; Child ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation ; Liver ; Liver Transplantation ; Living Donors ; SARS-CoV-2

INTRODUCTION: Childhood radiation exposure is a known risk factor for thyroid malignancy and dysfunction. However, local data are limited and there is no consensus on the modality and frequency of screening in this high-risk group. METHODS: Retrospective analysis study evaluating patients with childhood radiation exposure in 2006-2016 and minimum of 1-year follow-up. RESULTS: Of the 132 childhood cancer survivors in the study, thyroid malignancy was detected in 2 cases (1.5%) and thyroid nodules in 13 (9.8%). The earliest thyroid malignancy was detected 5 years post-radiotherapy via ultrasound. Of the 84 patients who had screening thyroid function test, 26 (31.0%) were detected with abnormal test results post-radiation, majority being subclinical hypothyroidism. CONCLUSION Regular screening via clinical examination for thyroid nodules should be performed at least annually. Where feasible and if resources permit, consideration should be given to using ultrasound for thyroid nodule(s) and malignancy screening at 5 years post-radiation therapy. Screening for thyroid dysfunction can be considered from 6-12 months post-radiotherapy.

INTRODUCTION: We aimed to review the necessity of conventional interventions in renal transplant for preventing complications arising out of the use of wound drains, ureteral stents and stapled skin closures. METHODS: We reviewed a series of 33 patients who received stentless, tubeless/drainless and suture-apposed living donor renal transplants (STAR group) and compared the results to a control non-STAR group of 36 patients in whom all three interventions of drains, stents and skin staples were used. RESULTS: No significant differences in demographics and clinical characteristics were observed between the two groups. With regard to the overall surgical complications, no significant differences in terms of wound infection, seroma, perinephric collections, urinoma, bacteriuria or vascular complications were observed between the groups. When analysed according to the interventions specific for preventing complications, although slightly more asymptomatic perinephric collections were observed and two lymphoceles required treatment in the STAR group, these differences were not statistically significant. Similarly, no significant differences in ureteric or skin-related complications were observed between the groups. Both groups had comparable good outcomes for renal function, graft survival and patient survival. CONCLUSION The routine use of ureteric stents, drains or skin staples may not be necessary for uncomplicated renal transplants. Potential complications associated with the placement of these interventions can be avoided without compromising on the safety of patients and/or the outcome of transplants.

COVID-19/prevention & control* ; Communicable Disease Control ; General Surgery/organization & administration* ; Guidelines as Topic ; Health Care Rationing ; Health Services Needs and Demand ; Health Workforce ; Humans ; Practice Guidelines as Topic ; SARS-CoV-2 ; Singapore/epidemiology* ; Surgical Procedures, Operative ; Triage

Kidneys of paediatric deceased donors were previously considered suboptimal for older recipients. An 18-month-old deceased donor was made available via Singapore's Medical (Therapy, Education and Research) Act. To the best of our knowledge, she is the youngest local donor. We herein report a case of successful kidney transplantation, using the en bloc technique, to a 15-year-old girl with renal failure secondary to bilateral cystic dysplastic kidney.
Adolescent ; Age Factors ; Female ; Humans ; Infant ; Kidney Diseases, Cystic ; surgery ; Kidney Transplantation ; methods ; Renal Insufficiency ; surgery ; Tissue Donors ; Tissue and Organ Procurement ; methods

Adult polycystic kidney disease (APKD) accounts for 2% of end-stage renal disease in Singapore and is a major indication for kidney transplantation. We report synchronous nephrectomy with unilateral cadaveric dual kidney transplantation (DKT) in a patient with APKD. Simple nephrectomy of the right native 27-cm polycystic kidney was performed to provide adequate space for unilateral DKT. Right donor kidney transplantation was performed at the site of native nephrectomy. End-to-side anastomosis of the right donor renal vein to the distal inferior vena cava and the right donor artery to the common iliac artery were performed. Left donor kidney was transplanted below the right kidney, with its vessels anastomosed to the right external iliac vessels. Ureter anastomosis was performed after perfusion of both kidneys. Lich-Gregoir anastomosis of the left donor ureter to the bladder and direct right donor ureter to native ureter anastomosis was established. This case illustrates that synchronous nephrectomy with DKT is feasible to facilitate implantation on the same side.
Adult ; Anastomosis, Surgical ; Humans ; Kidney ; surgery ; Kidney Failure, Chronic ; surgery ; Kidney Transplantation ; methods ; Male ; Middle Aged ; Nephrectomy ; methods ; Polycystic Kidney, Autosomal Dominant ; surgery ; Tomography, X-Ray Computed ; Ureter ; surgery

Adenocarcinoma ; diagnosis ; secondary ; surgery ; Aged ; Biopsy ; Cystoscopy ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Laparoscopy ; Male ; Prostatic Neoplasms ; diagnostic imaging ; pathology ; surgery ; Radiography ; Transurethral Resection of Prostate ; methods ; Ureteral Neoplasms ; diagnosis ; secondary ; surgery ; Ureteroscopy ; Urethral Neoplasms ; diagnosis ; secondary ; surgery ; Urothelium ; pathology