Abdominoscrotal hydrocele with bilateral hydronephrosis in an adult: case report.

Abdominoscrotal hydrocele is a rare entity with unclear etiology which may be diagnosed with general examination and ultrasound imaging. During examination it may misinterpreted as acute urinary retention of the bladder (globe-like) especially if associated with hydronephrosis. It should be treated surgically. Here we present a case of left abdominoscrotal hydrocele with accompanying left grade 2 and right grade 1 hydronephrosis.

Laparoscopic-endoscopic single-site surgery retroperitoneal ureterolithotomy: technique and initial experience.

OBJECTIVE: Laparoscopic-endoscopic single-site surgery (LESS) is a nearly scarless surgical technique. The aim was to assess the results of our initial LESS retroperitoneal ureterolithotomy (LESS-RU) experience and our technique. MATERIAL AND METHODS: Primary indication for LESS-RU procedure in this study was obstructive or impacted ureteral stone(s) larger than 15 mm and located in the middle or upper part of the ureter in those patients in whom prior interventions have failed. Eighteen patients underwent LESS-RU for upper or middle ureteric stone by one experienced laparoscopist, between December 2008 and December 2009. Patient characteristics, operative details, complications, use of analgesic medication and time to return to work were recorded. RESULTS: Eighteen cases were successfully accomplished. The mean patient age was 40.1 yr (19-60 yr), and median BMI was 27.7 kg/m2 (21-32). The mean operative time was 69.9 min (50-150 min), and the mean blood loss was 31.9 mi (20-70 mi). Mean stone size was 18.1 mm (range: 16-22). No patient required morphine for pain relief and the main use of oral analgesics was for two days. In postoperative follow-up there was a minimally scar and good cosmetic results were detected. CONCLUSIONS: LESS-RU proved to be safe and feasible. We think that LESS-RU will take place of laparoscopic ureterolithotomy in the near future with better cosmetic results. Further clinical investigation in comparison to the established techniques should take place to evaluate the outcome of LESS-RU.

Robotic malfunction during live robotic urologic surgery: live surprise in a robotic surgery congress.

BACKGROUND: Robotic-assisted laparoscopic radical prostatectomy (RARP) has increasingly become a preferred treatment of choice. Since it is a device dependant surgery, robotic surgery may be a challenging procedure due to failure. METHODS: We report how we managed to complete successfully a case of RARP with laparoscopic approach in spite of right robotic arm failure during live surgery. RESULTS: A 56-year-old male patient diagnosed with localized prostate cancer (PCa) (Gleason score 3 + 3 = 6) with a serum prostate specific antigen (PSA) level of 7.6 ng/mL was elected for a live RARP case during the 1st Turkish National Robotic Surgery Congress in 2011. Following 120 minutes from starting the RARP procedure, the right robotic arm failed surprisingly with a "recoverable fault" message appeared on the screen. Pressing "recover fault" button did not work and the right arm operated for few seconds more but the fault repeated again. We replaced the robotic instruments, shut down and restarted the system again that were all useless. Finally, all of the arms were out of order and we were not able to use the robot anymore. Therefore, we laparoscopically completed the procedure successfully without converting to open surgery. CONCLUSIONS: Although da Vinci surgical system failure rarely occurs, surgical team should be prepared to convert to open or complete the procedure laparoscopically. Having previous laparoscopic experience seems to be an advantage in order to complete the procedure without converting to open. Patients should be informed about the possibility of robotic failure and about its consequences before the surgery.

Incidence of ureteral stricture after ureterorenoscopic pneumatic lithotripsy for distal ureteral calculi.

BACKGROUND AND PURPOSE: We investigated the incidence of ureteral stricture in patients treated with ureterorenoscopic pneumatic lithotripsy for distal ureteral calculi. PATIENT AND METHODS: Between April 2006 and January 2009, 154 patients requiring ureterorenoscopic pneumatic lithotripsy for distal ureteral calculi were enrolled into the study. We evaluated the stone size, impaction of a stone, the need for ureteral orifice dilatation and the need for application of double-J stent. RESULTS: A total of 154 patients underwent URS-PL for ureteral calculi. Mean calculi diameter was 12.17 +/- 2.54 (range: 5-20 mm). Stone free rates after the first URS-PL operation were 97.4% of patients. In 2 patients (1.29%), ureteral perforation occurred as an early complication. We observed deep mucosal injury in 9 patients (5.84%). Partial stricture (partial obstruction) was observed in 9 patients (5.84%). Of 9 patients who had an ureteral stricture postoperatively, 7 patients had ureteral calculi > or = 10 mm, 2 patients had calculi < 10 mm. We observed ureteral stricture in 2 (8.69%) out of 23 patients who had calculi < 10 mm, and in 7 (5.34%) out of 131 patients who had calculi > or = 10 mm (p > 0.05). Ureteral stricture was observed in 2 (13.33%) out of 15 patients who had impacted calculi, and in 7 (5.03%) out of 139 patients who did not have impacted calculi (p < 0.05). We observed ureteral stricture in 3 (6.25%) out of 48 patients who required ureteral dilatation, and in 6 (5.66%) out of 106 patients who did not require ureteral dilatation (p > 0.05). Ureteral stricture was observed in 6 (15%) out of 40 patients who required ureteral double-J catheter placement, and in 3 (2.63%) out of 114 patients who did not require ureteral double-J catheter placement (p < 0.05). CONCLUSION: The results of our study have demonstrated that the success rate was not related to the stone dimension, but the time of operation was found to be increased with larger stones. Main risk factors for formation of ureteral stricture were impacted ureteral calculi and reasons which merits double-J catheter placement like mucosal damage, perforation, impacted calculi and high stone burden.

Laparoendoscopic single-site surgery versus standard laparoscopic simple nephrectomy: a prospective randomized study.

BACKGROUND AND PURPOSE: Laparoendoscopic single-site surgery (LESS), an attempt to further enhance the cosmetic benefits of minimally invasive surgery while minimizing the potential morbidity associated with multiple incisions, has been developed recently. Our aim was to compare LESS simple nephrectomy (LESS-SN) and conventional transperitoneal laparoscopic simple nephrectomy (CTL-SN). PATIENTS AND METHODS: In this randomized study that was conducted between December 2008 and September 2009, 27 patients who needed simple nephrectomy were randomized to either LESS-SN or CTL-SN. All procedures in both groups were performed by the first author, who is experienced in laparoscopic surgery. Patient characteristics, perioperative details, and time to return to work were recorded. Postoperative evaluation of pain and use of analgesic medication were recorded. RESULTS: There was no difference in median operative time (117.5 vs 114 min, P = 0.52), blood loss (50.71 vs 47.15 mL, P = 0.60), transfusion rates (0% for both), and hospitalization time (2.07 vs 2.11 days, P = 0.74) between the LESS-SN and CTL-SN groups. Time to return to normal activities was shorter in the LESS-SN group compared with the CTL-SN group (10.7 vs 13.5 days, P = 0.001). Both the visual analogue scale and the postoperative use of analgesics were significantly lower during postoperative days 1, 2, and 3 in patients who underwent LESS-SN, compared with patients who underwent CTL-SN. There were no intraoperative or postoperative complications in both groups. Compared with CTL-SN, LESS-SN was more expensive, but all patients undergoing LESS-SN were very pleased with the cosmetic outcome (no visible scars). CONCLUSION: The early experience described in this study suggests that LESS-SN is a safe and effective alternative to CTL-SN that provides surgeons with a minimally invasive surgical option and the ability to hide the surgical incision within the umbilicus; however, a larger series is necessary to confirm these findings and to determine if there are any benefits in pain, recovery, or cosmesis.

Increased testicular 8-hydroxy-2'-deoxyguanosine (8-OHdG) and inducible nitric oxide synthetase (iNOS) and nuclear factor κB (NF-κB) expressions in experimental rat varicocele.

OBJECTIVES: To assess nuclear factor-kappaB (NF-kappaB), inducible NO synthase (iNOS) immunohistochemically, and 8-hydroxy-2'-deoxyguanosine (8-OHdG) biochemically, which are sensitive biological markers of oxidative damage and stress, in testes with experimental varicocele. MATERIALS AND METHODS: Adult rats were randomly divided into three groups. Control group (n: 10), sham group (n: 10), varicocele group (n: 10). Of 14 rats undergoing partial ligation of the left renal vein, 10 rats had developed dilation of the left spermatic vein when evaluated 3 months after varicocele-inducing surgery. The rats were sacrificed after 3 months of the varicocele-inducing surgery. Ipsilateral and contralateral testes were examined for 8-hydroxy-2'-deoxyguanosine (8-OHdG) biochemically, inducible NO synthase (iNOS) and nuclear factor-kappaB (NF-kappaB) expression immunohistochemically. RESULTS: Inducible NO synthase (iNOS), nuclear factor-kappaB (NF-kappaB) expressions and 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels in both testes of varicocele group were markedly higher compared with control and sham groups (p < 0.01). There was no difference between control and sham groups (p > 0.05). CONCLUSIONS: Regarding to our results, we suggest that varicocele may produce oxidative stress in both of testes, and we believe that this stress may play a role in male fertility.

Alfuzosin induced thrombocytopenia after treatment for benign prostatic hyperplasia.

We report on 1 case of alfuzosin induced thrombocytopenia after treatment for benign prostatic hyperplasia. This side effect has been recognized 3 months after the alfuzosin treatment. The diagnosis was made by complete blood count (CBC). Peripheral blood smear of the patient was referred to an hematologist to exclude pseudothrombocytopenia and review of the peripheral smear confirmed the decreased platelets with no clumping. Manual count of platelets was similar to the result of complete blood count. After cessation of alfuzosin treatment thrombocytopenia improved and thrombocyte count reached to normal on week 2 following the discontinuation of treatment. Recovery of thrombocytopenia after discontinuation of alfuzosin treatment and recurrent depletion of platelet count after initiation of alfuzosin, supports our thoughts about drug-induced thrombocytopenia (DITP) caused by alfuzosin. The patient was prescribed different alfa blocker and he faced no problem.

Stone formation in prostatic urethra after potassium-titanyl-phosphate laser ablation of the prostate for benign prostatic hyperplasia.

We report three cases of stone formation at the prostatic urethra after 80 W potassium-titanyl-phosphate laser ablation of the prostate for benign prostatic hyperplasia. These complications occurred several months after the procedure. The diagnosis was made by ultrasonography, plain radiography of the kidneys, ureters, and bladder, and cystoscopy in patients who were being evaluated after presenting with irritative voiding symptoms. The patients were treated by cystolithotripsy and resection of the calcified prostatic tissue.