Holmium laser enucleation of prostate: outcome and complications of self-taught learning curve.

OBJECTIVES: To analyze the self-learning curve of a single surgeon with holmium laser enucleation of the prostate and to evaluate the safety, effectiveness, and outcome of the procedure after 2 years of experience. METHODS: The data from the first 125 patients who underwent holmium laser enucleation of the prostate were retrospectively analyzed. The patients were assessed preoperatively and at 1, 3, 12, and 24 months postoperatively. The patient evaluations included serum prostate-specific antigen measurement, peak urinary flow rate determination, postvoid residual volume measurement, and symptom scores. To assess the effect of the learning curve on the perioperative data and complications, the patients were divided into subgroups of 25 consecutive patients. RESULTS: The mean patient age was 71.4 years. The average prostate volume was 75.8 mL, and the mean weight of the enucleated tissue was 46.7 g. The average operative time was 109.8 minutes. The operative times and enucleation and morcellation efficiency rates improved significantly during the learning process. The mean hemoglobin loss was 1.7 g/dL. The median catheter time and hospital stay was 44 and 30 hours, respectively. Compared with baseline, at 1 year postoperatively, the median postvoid residual urine volume had declined by 99 mL, the mean peak urinary flow rate had increased by 19 mL/s, and the mean American Urological Association symptom score had decreased by 16.5 points. All changes observed were significant and regardless of the prostate size. Persistent stress urinary incontinence (4.8%) occurred with the first enucleations of large-size prostates. Other complications included bladder neck contracture (4%) in small-size prostates and bulbar urethra stricture (1.6%). CONCLUSIONS: Holmium laser enucleation of the prostate is a safe, reproducible and effective surgical modality. Case selection is necessary to avoid the morbidity associated with the first stages of the self-taught learning curve, mainly urinary incontinence.

Tuberous sclerosis complex. Forty-years of follow-up of a patient affected.

OBJECTIVES: To report the case of a patient diagnosed with tuberous sclerosis complex (TSC), describe its clinical features, diagnosis, and to attract attention on the fact that after 40 years of follow-up, the patient has presented practically all the manifestations described in the literature. METHODS: A 42-year-old man diagnosed with.TSC presented the emergency department due to left lumbar pain and self-limited gross hematuria. On clinical examination patient was haemodynamically stable, but with decrease in haemoglobin (6.8 g/dL). Abdominal CT scan showed a 20 cm diameter heterogeneous mass in the left kidney suggesting hemorrhage of an angiomyolipoma. RESULTS: Left radical nephrectomy was performed and the pathological study of the surgical specimen confirmed the diagnosis of angiomyolipoma. Inmunohistochemical staining was positive with HMB-45. CONCLUSIONS: To recommend that patients with TSC be evaluated by a multidisciplinary group of clinicians, including urologists, neurologists and dermatologists. As patients with TSC survive into adulthood they will require more intervention by the urologist. CT scan is usually enough for the diagnosis of angiomyolipomas. Complete nephrectomy is appropriate when the whole kidney has been replaced by angiomyolipoma. The identification of molecular markers (HMB-45) facilitates histopathological diagnosis.

Tuberous sclerosis complex. Forty-years of follow-up of a patient

OBJETIVOS: Presentar un caso singular de un paciente diagnosticado de esclerosis tuberosa, describirsus manifestaciones clínicas, diagnóstico, y llamar la atención sobre el hecho que, tras 40 años de seguimientoel paciente ha presentado prácticamente todas las manifestaciones descritas en la literatura.MÉTODOS: Hombre de 42 años de edad diagnosticadode esclerosis tuberosa que acude a urgencias por dolor lumbar izquierdo y hematuria macroscópica autolimitada.A la exploración física el paciente se presentabahemodinámicamente estable, pero con disminución de la hemoglobina (6.8g/ dL). El TAC abdominal mostrabauna masa heterogénea de 20 cm. de diámetro en el riñón izquierdo que sugirió hemorragia de angiomiolipoma. RESULTADOS: Se realizó nefrectomía radical izquierda y el estudio patológico de la pieza quirúrgica confirmó el diagnóstico de angiomiolipoma. El estudio inmunohistoquímicofue positivo para HMB-45.CONCLUSIONES: Recomendamos que los pacientes con esclerosis tuberosa sean evaluados por un grupo clínico multidisciplinar, que incluyan urólogos, neurólogosy dermatólogos. Como los pacientes con esclerosistuberosa llegan a la edad adulta requerirán más intervención por los urólogos. El TAC es normalmente suficiente para diagnosticar el angiomiolipoma. La nefrectomíatotal es apropiada cuando todo el riñón está reemplazado por el angiomiolipoma. La identificación de marcadores moleculares (HMB-45) facilita el diagnósticohistopatológico

OBJECTIVES: To report the case of a patient diagnosed with tuberous sclerosis complex (TSC), describe its clinical features, diagnosis, and to attract attention on the fact that after 40 years of follow-up, the patient has presented practically all the manifestations described in the literature.METHODS: A 42 year-old man diagnosed with TSC presented the emergency department due to left lumbar pain and self-limited gross hematuria. On clinicalexamination patient was haemodynamically stable, but with decrease in haemoglobin (6.8g/ dL). Abdominal CT scan showed a 20 cm diameter heterogeneous mass in the left kidney suggesting hemorrhage of anangiomyolipoma.RESULTS: Left radical nephrectomy was performed and the pathological study of the surgical specimen confirmed the diagnosis of angiomyolipoma. Inmunohistochemical staining was positive with HMB-45.CONCLUSIONS: To recommend that patients with TSC be evaluated by a multidisciplinary group of clinicians, including urologists, neurologists and dermatologists. As patients with TSC survive into adulthood they will requiremore intervention by the urologist. CT scan is usually enough for the diagnosis of angiomyolipomas. Complete nephrectomy is appropriate when the whole kidney has been replaced by angiomyolipoma. The identification of molecular markers (HMB-45) facilitates histopathological diagnosis