Outcomes of Holmium Laser Enucleation of the Prostate in the Re-Treatment Setting.

PURPOSE: Holmium laser enucleation of the prostate can also be applied in the re-treatment setting when other benign prostatic hyperplasia therapies fail. We compared outcomes in men who underwent holmium laser enucleation of the prostate in the primary vs the re-treatment setting. MATERIALS AND METHODS: We retrospectively reviewed the records of 2,242 patients who underwent holmium laser enucleation of the prostate at a total of 4 academic hospitals between 2003 and 2015. Patient demographics, and operative and perioperative outcomes were compared between re-treatment and primary holmium laser enucleation of the prostate. RESULTS: Of the 360 of 2,242 men (16%) who underwent re-treatment holmium laser enucleation of the prostate the procedure was done for residual urinary symptoms in 71%. The most common primary procedure was transurethral resection of the prostate in 42% of cases. Mean time between prior benign prostatic hyperplasia surgery and re-treatment was 68 months (range 1 to 444). There were no significant differences in age, prostate size, AUA (American Urological Association) symptom score or average flow rate between the cohorts. Perioperatively, re-treatment holmium laser enucleation of the prostate was associated with significantly shorter operative time, reduced blood loss, lower specimen weight and shorter length of stay. The AUA symptom score improved in both groups, although it remained higher in men who underwent re-treatment (6.5 vs 5.0, p <0.001). The likelihood of clot retention (4.7% vs 1.8%, p = 0.01) and urethral stricture (3.3% vs 1.5%, p = 0.043) was slightly higher in the re-treatment group. CONCLUSIONS: Immediate perioperative outcomes of holmium laser enucleation of the prostate performed in the re-treatment setting were no different from those in the primary setting. While re-treatment was associated with an increased likelihood of clot retention, urethral stricture and higher AUA symptom score, these minimal differences must be considered against the overall favorable symptom improvement across both cohorts.

Mechanisms of testicular torsion and potential protective agents.

Testicular torsion is a urological emergency most commonly seen in adolescence, involving a decrease in blood flow in the testis resulting from torsion of the spermatic cord that can result in gonad injury or even loss if not treated in time. Testicular ischaemia-reperfusion injury represents the principle pathophysiology of testicular torsion, with ischaemia caused by twisting of the spermatic cord, and reperfusion on its subsequent release. Many cellular and molecular mechanisms are involved in ischaemia-reperfusion injury following testicular torsion. Studies have investigated the use of pharmacological agents as supportive therapy to surgical repair in order to prevent the adverse effects of testicular torsion. Numerous substances have been proposed as important in the prevention of post-ischaemia-reperfusion testicular injury. A range of chemicals and drugs has been successfully tested in animal models for the purpose of mitigating the dangerous effects of ischaemia-reperfusion in testis torsion.

Local or spinal anesthesia in subinguinal varicocelectomy: a prospective randomized trial.

OBJECTIVE: To determine whether local anesthesia (LA) is an acceptable alternative to spinal anesthesia (SA) for varicocelectomy. METHODS: A total of 60 men with varicocele were included in the present study. The evaluation of pain during and after surgery was determined using the visual analog scale. The secondary outcome measures of the present study were the interval to the first postoperative analgesic requirement, total analgesic consumption, and the incidence of side effects. RESULTS: The mean postoperative visual analog scale score was 2.56 ± 1.85 for the SA group and 2.77 ± 1.94 for the LA group (P = .659). Patients in the SA group experienced significantly less pain during surgery than those in the LA group (P = .017). However, the pain scores between the 2 groups did not differ significantly at 2, 4, 6, 8, 12, or 24 hours after surgery. In addition, a positive correlation was found between the duration of symptoms and the visual analog scale score at 24 hours postoperatively. The mean dosage of injected diclofenac was 46.5 ± 23.3 mg and 32 ± 28.15 mg in the SA and LA groups, respectively (P = .018). The SA group developed more postoperative complications, such as urinary retention, postspinal backache, headache, hypotension, and delayed mobilization, in the postoperative period. CONCLUSION: LA is an effective, reliable, reproducible, simple, and safe alternative anesthetic method for subinguinal varicocelectomy.