Giant condyloma acuminatum - Buschke-Lowenstein disease - a literature review.

AIM: Buschke-Lowenstein disease or giant condyloma acuminatum represents a rare, sexually transmitted disorder, with a slow evolution and the tendency to infiltrate in the adjacent tissues; untreated, the outcome is unfavorable. The hallmark is the development of one or various prominent-sized vegetant tumors that usually ulcerate. MATERIAL AND METHODS: The present article summarizes both the etiopathogenic features and the current approach of treatment management. RESULTS: Minimally invasive surgery along with local and systemic therapy is adequate in patients with small-sized lesions or high intraoperative risk. The main treatment remains extensive surgery with wide resection and often reinterventions to complete the excision. CONCLUSIONS: giant condyloma acuminatum represents a continuous surgical challenge, because of the need of exhaustive surgical procedures that should consider both the oncological principles and a better anatomical resolution. No standard treatment protocol can be established, because of the infrequency of the disease. Radical surgery including full thickness excision of the affected areas represents the "gold standard" therapy. Other known forms of treatment present unsatisfactory results without statistical significance, the studies having been conducted on small groups of patients. An adequate, long-term follow-up of Buschke-Lowenstein patients is highly recommended, because of the increased recurrence rate.

Transobturator urethral suspension surgical treatment of urinary incontinence in men.

INTRODUCTION: Urinary incontinence represents involuntary urethral loss of urine and represents a major health problem worldwide, mainly due to the psychosocial implications it determines. The surgical treatment of urinary incontinence in men is needed especially postoperatively, after radical retropubic prostatectomy, transurethral resection or vaporization of prostate, bladder neck incision etc. Surgical indications appear when all the other conservatory means of treatment have failed, including antimuscarinic medication or pelvic floor training. TECHNIQUE: The surgical procedure is similar to the one used for women, TOT to be more precise. The meshes are made of polypropylene, identical to those used for women or especially designed for urinary incontinence in men. The surgical technique can be "in-out" or "out-in" according to surgeon preferences. RESULTS: Postoperative recovery was fast and without major complications. The urethral catheter was removed 24 hours after the procedure and the patients were discharged 48-72 hours after surgery. After 30 days postoperative, urodynamics and abdominal echography showed no vesical residue. Success rate is about 80%. COMPLICATIONS: Intraoperative complications are minimal (urethral, vascular or vesical) and can be avoided in the hands of experienced surgeons. Mesh rejection and rupture or urethral erosion can occur as rare postoperative complications. CONCLUSIONS: Transobturator urethral suspension procedure proved to be efficient. It is a minimally invasive procedure, easy and with relatively short surgical time. Inbound time is short, making this procedure cost-effective.

Paraneoplastic syndrome in primitive retroperitoneal tumours.

INTRODUCTION: Retroperitoneal tumours represent a particular oncological pathology. No other human pathology is so deceiving and scarce in specific clinical symptoms as these tumours. Usually borrowing the symptoms of nearby organs they are discovered in advanced or incurable stages. MATERIAL AND METHOD: We have tried to present to you the challenge of diagnosing some retroperitoneal tumours. One of the rarest signs was by far the paraneoplastic syndrome or the secretion of active biological substances. The study group is composed of histopatologically diagnosed patients. The vast majority were selected from urology and general surgery wards, but there were cases from gynaecology, neurosurgery and even from endocrinology and gastroenterology. RESULTS: Paraneroplastic syndrome represents the secretion of various substances by the tumour, substances that make changes at bioumoral level. In our study we found 3 cases of 32 patients (9,37%) with paraneoplastic syndrome. What is to be noticed is that because of this syndrome the diagnosis was more difficult and was indirectly referred to a retroperitoneal tumour. We would like to present these cases and their particularities. CONCLUSIONS: Every case was a surgical and diagnostic challenge. Biologic active substance secretion or the paraneoplastic syndrome makes the clinical picture even more complicated for primitive retroperitoneal tumours. The clinical symptoms of these tumours require a more careful approach of these patients. Close co-operation with other medical specialties in cases such as ours is mandatory.

[Foreign bodies in the urogenital tract--between iatrogeny and autoerotism]. / Corpi straini la nivelul aparatului uro-genital--între iatrogenie si autoerotism.

INTRODUCTION: Our objective was to evaluate the cause, diagnosis and management of foreign bodies in the urogenital tract reviewing a 7 years experience. MATERIALS AND METHODS: From 2000 to 2007, 12 patients were treated in our department because of foreign bodies localized in the urogenital tract. We retrospectively analyzed the data regarding presentation, diagnosis and management. RESULTS: The foreign bodies from the urogenital tract included: mascara, spray cap, wires, candle, swabs, plastic tube, remnants from JJ ureteral stent and nefrostomy tube. Diagnostic investigations varied from case to case and consisted of: KUB (kidney, ureter and bladder), abdominal ultrasound, urography, computer tomography, and also cystoscopy. The management was endoscopic in 4 (33%) cases, but in the great majority of them--8 (67.6%) it was necessary a classical intervention. CONCLUSIONS: Foreign bodies localized in the urogenital tract, represents a relative rare pathology and in many situations those cases have legal implications. Investigations must include radiologic investigations in order to identify their exact location and size. In many cases the management can not be endoscopic and it is necessary a classic intervention.

Erectile dysfunction post-radical prostatectomy - a challenge for both patient and physician.

Post-radical prostatectomy erectile dysfunction (post RP ED) is a major postoperative complication with a great impact on the quality of life of the patients. Until present, no proper algorithm or guideline based on the clinical trials has been established for the management of post RP ED. According to literature, it is better to initiate a penile rehabilitation program as soon as possible after surgery than doing nothing, in order to prevent and limit the postoperative local hypoxygenation and fibrosis. The results of numerous clinical trials regarding the effectiveness of the phosphodiesterase 5 inhibitors therapy on post RP ED have made them the gold standard treatment. Encouraging results have been achieved in studies with vacuum erectile devices, intraurethral suppositories with alprostadil and intracavernosal injections, but due to their side effects, especially in the cases of intracavernosal injections and intraurethral suppositories, their clinical use was limited therefore making them a second line option for the post RP ED treatment. What should not be forgotten is that penile implant prosthesis has proven very effective, numerous studies confirming high rates of satisfaction for both patients and partners.

Determining factors of diuresis in chronic kidney disease patients initiating hemodialysis.

BACKGROUND: Patients with stage 5 chronic kidney disease (CKD) begin chronic hemodialysis with variable diuresis levels correlated to a comparable low glomerular filtration rate. Residual diuresis influences long-term evolution of the hemodialyzed patient, modifying the prognosis even if optimal Kt/ V is achieved. AIM OF THE STUDY: The present study emphasizes the main determining factors of diuresis in a cohort of stage 5 CKD subjects at the beginning of hemodialysis. MATERIAL AND METHODS: 216 patients with stage 5 CKD starting chronic hemodialysis were included in the study, and were grouped according to their residual diuresis: group A (urine output ≤ 500 mL/ day); group B (urine output between 500-1200 mL/ day); group C (urine output ≥ 1200 mL/ day). RESULTS: Glomerular etiology, cardiac systolic dysfunction, severe malnutrition, emergency dialysis initiation and lack of permanent vascular access were proved to be associated with significant low diuresis. Age, gender, estimated glomerular filtration rate (GFR) and the presence of systemic hypertension did not influence the amount of daily diuresis. CONCLUSIONS: In CKD stage 5 patients, residual diuresis presents large variations in conditions of comparable low GFR. Factors influencing residual diuresis may be distinct from those that influence residual GFR.

Medical nutrition therapy in non-alcoholic fatty liver disease--a review of literature.

BACKGROUND AND AIM: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease worldwide, with a prevalence of 20%-40% in Western populations. The purpose of this article is to review data related to lifestyle changes in patients with NAFLD. METHOD: We searched a public domain database (PubMed) with the following categories: disease (NAFLD, fatty liver, and non-alcoholic steatohepatitis [NASH]) and intervention (lifestyle intervention, diet, nutrition) with each possible combination through 25 September 2014, for relevant articles. Review of articles was restricted to those published in English. We selected the studies involving adult patients only. CONCLUSION: There is no consensus as to what diet or lifestyle approach is the best for NAFLD patients. However, patients with NAFLD may benefit from a moderate- to low-carbohydrate (40%-45% of total calories) diet, coupled with increased dietary MUFA and n-3 PUFAs, reduced SFAs. More CRT are needed to clarify the specific effects of different diets and dietary components on the health of NAFLD patients. ABBREVIATIONS: NAFL = Non-alcoholic fatty liver, NAFLD = non-alcoholic fatty liver disease, NASH = non-alcoholic steatohepatitis, HCC = hepatocarcinoma, BEE = basal energy expenditure, CRT = A small clinical randomized trial showed that short-term carbohydrate restriction is more efficacious in reducing intrahepatic triglyceride, IHT = intrahepatic triglyceride, VLCD = Very low calorie diets, AST = aspartate aminotransferases, SFAs = saturated fatty acids.

[Primary retroperitoneal tumors -- the experience in the Urological Clinic of the Central Military Hospital]. / Tumorile retroperitoneale primitive--experienta Clinicii de Urologie a Spitalului Militar Central.

Is a review of the 10 years experience in Urological Clinic of Central Military Hospital concerning the diagnosis and treatment of retroperitoneal tumors, containing personal conclusions about this relatively rare, heterogeneous entity.

[The indications and limits for the use of stents in urological pathology]. / Consideratii privind indicatiile si limitele utilizarii stent-urilor în patologia urologica.

It is analyzed the authors' experience regarding the drainage of urinary tracts using autostatic ureteral stents, a widespread therapeutic method for a large variety of dysfunction. There were used double J stents 5 and 7 Ch, with variable length (22, 24, 26 cm) in 314 cases suffering the following dysfunction: renoureteral lithiasis--243 cases, obstructive anuria--37 cases, reconstructive surgery after congenital dysfunction--11 cases, acquired dysfunction--23 cases. In 216 cases (68.7%) double J stents were used before applying mini invasive therapeutic methods: ESWL, NPL, URSR, URSA. There are also mentioned some of the encountered complications: ureteral perforation, intrapelvic and intraureteral bend, spontaneous elimination at women, ascending in ureter, lithiasis of a loop and the resolving methods.

[The conversion of endourological operations: a failure or healthy "clinical thinking"?]. / Conversiunea operatiilor endourologice: esec sau "gândire clinica" sanatoasa?

From a lot of 2567 of endourological "low" (TURP, TURB, UIO) and "high" (PNL, URSR, URSA) interventions there are analyzed 48 cases in which there was necessary the conversion to classical surgery. In endourology, just like in laparoscopic surgery, the conversion is divided into conversion of necessity and optional conversion. A reference is made to the way of solving these conversions. The main conclusion is that the urologist has to apply equally and efficiently both classical and endourological procedures.

[Complicated sigmoid neoplasia with vesico-sigmoid fistula]. / Neoplasm sigmoidian complicat cu fistula sigmoido-vezicala.

Being confronting with two apparently similar cases of entero-vesical fistulas, but complete different concerning the etiopathogeny, surgical management and prognosis, we believe that both communities--urologists and general surgeons--must know how to manage such cases. The tumors involving two or many systems or organs make the surgeon's decision be extremely difficult if not familiarized with both pathologies. We expose these unusual cases in order to demonstrate these affirmations.

Surgical treatment for pulmonary metastases in urogenital cancers.

INTRODUCTION: The malignant disease's ability to metastasize remains one of the major obstacles when treating patients with cancer. The indication of metastasectomy is currently limited to patients undergoing treatment of the primary tumor. Resections for lung metastases of high selected patients with urogenital cancer present minimal risks and can prolong survival. Prognostic factors that determine which patients will benefit from surgery are still unclear. MATERIAL AND RESULTS: This article presents a retrospective analysis of patients who underwent lung metastases resection between 2008 and 2013 in our clinic. Among 148 patients, 8 (5.41%) had lung metastases after urologic cancers (UC), 18 (12.16%) after genital cancers (GC), 13 (8.78%) after breast tumors and 109 (73.65%) had lung metastases from other type of tumors. The overall 6 months survival was 100% for UC, 94.44 for GC, 84.62% for BC and 87.16% for others. DISCUSSION AND CONCLUSION: The criteria for surgery proved to have a positive predictive value and what should be considered are the following: prolonged disease-free interval (DFI), unilateral disease, the absence of systemic pathologies, oncological margins resecability and less than 3 radioimagistic detectable metastases. A negative prognosis was observed in those with primary tumor in the cervix, at least 3 metastases and a tumor larger than 3 cm. To determine how to select surgical candidates for pulmonary metastasectomy more precisely, further analysis of prognostic factors is evident and the need for a prospective, randomized, multicenter study is clear.

Echinococcal cyst of the left vas deferens - a case report and literature review.

UNLABELLED: Cystic echinococcosis or hydatid disease is an important public health issue, mainly in developing countries, due to its high prevalence. Echinococcus granulosus, a cyclophyllid cestode, the pathogenic parasite found in humans, their intermediate host in its way to the final host, the members of canidae family. The main sites of infection in humans are the liver and the lungs. There have been recorded Rare locations such as the heart, spleen, muscles or retroperitoneal have also been recorded. CASE PRESENTATION: We present the case of a 29-year-old man, living in rural environment, who was admitted in our Clinic for a pelvic cystic tumor and intermittent ureterohydronephrosis. The blood work showed positive antibodies for Echinococcus granulosus. An urethrocystoscopy and the excision of the tumor were performed. CONCLUSIONS: Although rare, the involvement of the male genitourinary tract in cystic echinococcosis is possible and can pose important diagnostic challenges.

Left renal cyst - left duplex kidney with compromised superior renal unit and ectopic ureteral orifice in the prostatic urethra.

UNLABELLED: The urinary abnormalities are an important health problem. If they are not recognized in due time, they usually lead to the loss of the renal unit function. In many cases, the diagnosis is late and incidental. CASE PRESENTATION: We present the case of M.I., a 74-year-old male admitted in our surgical unit with diffuse left lumbar pain, low urinary tract symptoms and slow increase in abdomen volume in the past 4 years. Computer tomography scan and ecography showed a large left lumbar cyst like mass with a dilated supernumerary ureter with ectopic ureteral orifice in the prostatic urethra and apparently normal anatomic inferior renal unit. The goal was the excision of the "cyst like" mass (superior left renal unit) but because of the anatomical particularities (extensive fibrosis and local topographical changes) total nephrectomy was performed. CONCLUSIONS: Given a normal contralateral kidney, the discovery of a urinary abnormality can be a real challenge, their evolution being a silent one. This type of disease can be suspected only with the development of clinical symptoms. The anatomic particularities (duplex kidney) together with the long evolution of the disease changed the local topography making the preservation of the inferior left renal unit a difficult, almost impossible task for the surgeon.

Day case laparoscopic nephrectomy: initial experience.

RATIONALE: Laparoscopic nephrectomy tends to become the new gold standard surgical technique in a selected population (non-functioning kidney, localised renal cell carcinoma). Day surgery is a popular pathway of care and, procedures of ever-increasing complexity are being considered. OBJECTIVE: The aim of the study was to report the postoperative complications of day case laparoscopic nephrectomy, according to the Clavien system, and, to assess the feasibility of the procedure performed as a day case. MATERIAL AND RESULTS: This study included all the patients considered for day case transperitoneal laparoscopic nephrectomy between May 2008 and November 2009. Sixteen consecutive patients were enrolled in this retrospective study. There were ten procedures on the left hand-side and six on the right hand-side. Age ranges from 22 to 77 years old. Male to female ratio was 9:7. The preoperative diagnosis was non-functioning kidney in 9 cases and kidney tumour in the other 7 cases. All but two patients have been discharged in the same day (87.5%). The readmission rate was of 12.5%. One wheel-chair bonded patient was readmitted four days after the procedure, because of adynamic ileus, and another one three days later because of wound infection. There were two grade I and one grade IV complications (Clavien system). The patient readmitted with grade IV complication, wheel-chair bonded because of cerebral palsy, was not a typical day surgery patient. DISCUSSION: The vast majority of complications were minor and resulted in no residual disability. In our small series, the day case laparoscopic nephrectomy was feasible and safe.