Green light laser (KTP, 80 W) for the treatment of benign prostatic hyperplasia.

AIM: An attractive alternative for the management of benign prostate hyperplasia (BPH) is the use of 80 W potassium titanyl phosphate (KTP). We evaluated the efficacy and safety of this procedure in patients with bladder outlet obstruction (BOO). METHODS: A total of 171 patients with obstructive BPH underwent the 80 W potassium-titanyl-phosphate laser procedures. Preoperatively the international prostate symptom score (IPSS), the maximal urinary flow rate (Qmax), prostate volume and the post-void residual urine volume (PVR) were determined. Perioperative complications and postoperative blood loss, hospitalization, catheterization time, Qmax and PVR were also assessed. RESULTS: From the 171 patients, who underwent KTP laser procedure, 143 have been evaluated. The mean preoperative prostate volume was 43.9+/-17.1 (15-76). Eighty-nine patients (62.2%) were on chronic oral anticoagulant therapy (Coumarin or Aspirin 100). The mean applied energy was 170+/-65 kJ (100-275). There was no significant blood loss or fluid absorption during the KTP procedure. The mean Qmax values preoperatively and postoperatively were 3.4+/-4.3 and 16.3+/-7.3, respectively. PVR decreased from 74+/-47.7 mL preoperatively, to 16.6+/-21.5 mL postoperatively. Catheteriza-tion time was 1.4+/-0.8 days (0-5). CONCLUSION: KTP laser for the prostate represents a safe and effective treatment for patients with BPH. The procedure has a low rate of postoperative complications. It can be used for high risk patients especially for them who are receiving oral anticoagulation therapy.

Pain level and anal discomfort during transrectal ultrasound for guided prostate biopsy. Does intrarectal administration of local anesthetic before periprostatic anesthesia makes any difference?

AIM: The aim of this study was to evaluate the anal discomfort and pain level, during transrectal ultrasound probe insertion and before the periprostatic anesthesia in young patients (<65 years of age). METHODS: This study enrolled 147 patients, who underwent prostate biopsy and were divided in two groups: 74 patients received perianal local anesthesia with lidocaine cream 2% (first group), while 73 received only lubricant gel as perianal local anesthesia (second group) prior the insertion of ultrasound probe. Patients in both groups received periprostatic anesthesia. Pain and discomfort due to the probe and due to the biopsy were estimated with visual analogue scale. Patients' characteristics, complications, and surgical data were analyzed for both groups. RESULTS: No serious intraoperative and postoperative complications were noted in both groups. The mean pain score for pain and anal discomfort was 1.7 and 5.7 for the first and second group, respectively. During biopsy, patients in the first group reported also less pain but there was no significant difference. CONCLUSIONS: The intrarectal introduction of lidocaine cream 2% can significantly reduce anal discomfort and pain before the probe insertion for ultrasound guided biopsies in young patients. Considering that these patients could undergo repeated biopsies, a higher level of local anesthesia is desired.

[Cryoablation of prostate cancer]. / Die Kryoablation des Prostatakarzinoms.

Because of continuous technical development for more than half a century, followed by better clinical results with minimal side effects, cryoablation of the prostate for localized prostate cancer has evolved as a true alternative therapeutic option in selected cases. Today's form of cryotherapy has almost nothing in common with those versions established in the 1970s and further developed in the 1990s. Nowadays it shows minimal invasiveness and high efficacy for treatment of high-risk carcinomas and failures of other therapeutic modalities. Cryoablation of the prostate is indicated if there are absolute or relative contraindications for radical surgery. In localized prostate cancer, cryoablation is the therapy of choice for salvage cases; standardisation of the procedure, definition of freeze-thaw cycles, and structured training programs have led to this status.

Intrauterine device migration to the urinary bladder causing sexual dysfunction: a case report.

BACKGROUND: Intravesical migration represents an uncommon complication of intrauterine device (IUD) insertion. We present the case of an IUD that migrated to the urinary bladder, causing significant sexual complaints. CASE REPORT: A 38-year-old woman presented with complaints of gradually evolving dyspareunia and recurrent urinary tract infections during the past 12 months. She reported an IUD insertion 18 months before. Further detailed evaluation revealed disorders in all sexual domains. Imaging and cystoscopy detected the presence of IUD in the urinary bladder. Under anesthesia, the IUD was removed out of the bladder without any complications. In her follow-up evaluation after six months, her sexual function was significantly improved and she had no urinary symptoms. CONCLUSION: Sexual difficulties in a woman with an IUD should raise the suspicion of device dislodgement or dislocation. Hippokratia 2016, 20(1): 70-72.