Transrectal ultrasound-guided extraction of impacted prostatic urethral calculi: a simple alternative to endoscopy.

Urethral stones can become impacted in the posterior urethra, typically presenting with varying degrees of acute urinary retention and lower urinary tract symptoms. These are traditionally treated in the inpatient setting, with external urethrotomy or endoscopic push-back of the calculus into the urinary bladder followed by cystolitholapaxy or cystolithotripsy. However, these methods are invasive, involve general anesthesia, and require radiation. In this report, we describe a simple, minimally invasive, and safe alternative technique to visualize and remove impacted prostatic urethral stones under the real-time guidance of transrectal ultrasonography (TRUS). The urologist can accomplish this procedure in the office, avoiding radiation exposure to the patient and hospital admission.

Management of nonpalpable testicular tumors.

OBJECTIVES: To report our series of nonpalpable testicular tumors with a review of published studies. Radical orchiectomy remains the reference standard in the treatment of a solid testicular mass. Testis-sparing surgery has recently been advocated for a select group of patients with nonpalpable tumors. METHODS: Between 1998 and 2002, a nonpalpable testicular mass was discovered in 9 patients. Ultrasonography was performed for infertility evaluation (5 patients), testicular pain (3 patients), and retroperitoneal lymphadenopathy (1 patient). RESULTS: Radical orchiectomy was performed in 7 of 9 patients and testis-sparing surgery with microsurgical excision of tumor in 1 patient. One patient decided against surgery. A benign testicular tumor was found in 6 and a malignant tumor in 2 of the 8 patients. CONCLUSIONS: A high incidence of benign nonpalpable tumor and an advanced microsurgical technique justifies organ-sparing surgery as an alternative for radical orchiectomy in a select group of patients. Testicular preservation in patients with a malignant nonpalpable testicular tumor is a feasible, but still controversial, approach.

Treatment of bilateral fibroepithelial polyps in a child.

Ureteral fibroepithelial polyps are extremely rare benign lesions composed of stroma with a surface of normal transitional epithelium. Traditionally, symptomatic polyps were treated with open exploration and segmental resection. We describe the first case of bilateral polyps in a child. One was removed by segmental resection and the other by ureteroscopic laser surgery.

Effect of freezing parameters (freeze cycle and thaw process) on tissue destruction following renal cryoablation.

BACKGROUND AND PURPOSE: Renal cryoablation is a successful nephron-sparing treatment alternative for selected patients with small renal tumors. The purpose of this study was to compare the effects of the number of freeze cycles (one v two) and the thaw process (active v passive) on renal tissue following cryodestruction. MATERIALS AND METHODS: Sixteen female mongrel dogs (19.9 +/- 2.1 kg) were randomly divided into four groups and underwent transabdominal laparoscopic access by standard techniques. Tissue freezing was performed using argon gas following interstitial cryoprobe (3 mm) placement into the upper and lower poles of the left kidney. Single active (SA), single passive (SP) double active (DA) or double passive (DP) 15-minute treatment cycle(s) were carried out via the CRYOcare Cryosurgical Unit (Endocare, Irving, CA) on eight kidneys each. An active thaw process with helium gas or a passive thaw process was initiated after each freeze period. The cryoprobe was removed when the temperature reached 0 degrees C. Four weeks following cryosurgery, animals were sacrificed, and the renal tissue was evaluated grossly and histologically. RESULTS: Interstitial cryoprobe temperatures decreased from 31.3 degrees C +/- 1.4 degrees C to -142 degrees C +/- 1.0 degrees C following the 15-minute freeze cycle. The temperature reached 0 degrees C significantly faster following active thaw than with the passive process (2.13 +/- 0.24 min/freeze cycle and 15.18 +/- 2.97 min/freeze cycle, respectively; P < 0.0001). Grossly, each lesion consisted of a central area of necrosis surrounded by a rim of white tissue. On microscopic examination, each lesion consisted of a central area of liquefaction necrosis (LN) surrounded by various degrees of fibrosis and granulation tissue admixed with residual parenchyma. The size of the LN was significantly different in tissues subjected to double and single freeze cycles when compared across both thaw processes (active and passive). There was no significant difference in the overall lesion volume following DA, DP, SA, or SP. CONCLUSIONS: Renal cryodestruction via laparoscopic access achieves complete tissue ablation without complications. The double freeze cycle produced significantly larger areas of LN than the single freeze regardless of the thaw process. The type of thaw process did not affect the amount of tissue damage. Utilizing a double 15-minute freeze cycle with the faster active thaw process will effectively cryoablate renal tissue as well as significantly reduce overall operative time.