Prophylactic contralateral styloidectomy was considered, but the patient was deemed a poor surgical candidate
given his underlying cardiomyopathy and anticoagulation.
Indications for laser treatment have included being a poor surgical candidate
(one patient had a history of bleeding complications), having multiple tumors (one patient had Curry-Jones syndrome) --or simply wishing to not undergo surgery.
Surgical tendon repair is theoretically feasible in birds, but, in this case, the patient was deemed a poor surgical candidate
because of the pathophysiology of the tendon rupture in heavy meat-type poultry, the chronic nature of the disease with concurrent tendon luxation and bone malformation, its obese condition, a bilateral disease presentation, and the secondary pressure sores occurring in multiple anatomical sites that were expected to worsen with recovery time.
 reported a 73-year-old patient with three-compartment prolapse who had been using an 80 mm PVC ring pessary for 10 years (poor surgical candidate
Comorbidity can also influence the decision, favoring nonsurgical intervention if an acute or chronic medical condition or overall health status makes a patient a poor surgical candidate
If the bleeding source is unclear or if the patient is a poor surgical candidate
, the use of visceral arteriography has been advocated to identify intraluminal leakage of contrast medium or vascular disease and, at the same time, to provide control of the gastrointestinal bleeding with embolization or selective infusion of vasopressin (8).
A pattern of decompensation to using primitive defense mechanisms to handle stress suggests that the patient may have a personality disorder and might be a poor surgical candidate
. Ability to use relatively mature defense strategies in stressful times suggests a good candidate.
As the patient also had underlying hypertension and ischaemic heart disease, making him a poor surgical candidate
, but was haemodynamically stable with no contraindication to aortic stenting, the decision was made to undertake an endovascular repair of the thoracic pseudo-aneurysm.
Currently, American Urological Association guidelines suggest the use of ablative treatments in patients with significant comorbidities who are poor surgical candidates
and in patients with a solitary kidney who are at high risk for total loss of renal function after nephron-sparing surgery (4).
Medical therapies, typically progestin-based treatments, can be employed, particularly when fertility preservation is desired or among patients who are poor surgical candidates
. However, the most definitive therapy remains surgery with total hysterectomy for two reasons: CAH is associated with a 28% risk for the development of invasive cancer, and occult invasive cancer frequently coexists with CAH.
(5) These could be an alternative treatment for poor surgical candidates
or stabilized patients prior to surgery.
This may reflect selection bias, as patients who develop intractable multiple organ failure select themselves out as poor surgical candidates
and do not undergo such aggressive surgery.