From an urologist view: are we safe with endoscopic surgery? Overview of ergonomic problems encountered by the urologist during video endoscopic surgery.

BACKGROUND: The importance of minimally invasive surgery in urology has constantly increased in the last 20 years. Endoscopic resection of prostate and bladder tumors is actually a gold standard with many advantages for patients. AIM: To analyze the problems related to the ergonomic conditions faced by urologist during video endoscopic surgery by review of the recent literature. METHODS: All evidence-based experimental ergonomic studies conducted in the fields of urology endoscopic surgery and applied ergonomics for other professions working with a display were identified by PubMed searches. Data from ergonomic studies were evaluated in terms of efficiency as well as comfort and safety aspects. Constraint postures for urologists are described and ergonomic requirements for optimal positions are discussed. RESULTS: The ergonomics of urological endoscopic surgery place urologists at risk for potential injury. The amount of neck flexion or extension, the amount of shoulder girdle adduction or abduction used, and stability of the upper extremities during surgery; which are maintained in a prolonged static posture; are the main risk factors. All these constraints may lead to muscle and joint fatigue, pain, and eventual musculoskeletal injury. Moreover, these issues may impact surgical accuracy. CONCLUSION: Urologist posture, operating period, training are important ergonomic factor during video surgery to prevent musculoskeletal disorders.

Nutcracker syndrome as an incidental finding on computed tomography scan after blunt abdominal trauma.

BACKGROUND: The nutcracker syndrome refers to compression of the left renal vein between the aorta and the superior mesenteric artery. It may be asymptomatic for long period and constitute casual findings. AIM: To report a new case diagnosed by radiological exploration after an abdominal trauma. The diagnosis and treatment of nutcracker syndrome are discussed. CASE: A 32-year-old man was a victim of traffic accident causing leg and abdominal trauma. Three days after orthopedic surgery, he presented an isolated gross hematuria. Abdominal computed tomography showed that the left renal vein was compressed between the aorta and the superior mesenteric artery. The diagnosis of nutcracker syndrome was established. Surveillance was indicated with excellent evolution. CONCLUSION: The nutcracker syndrome is a rare entity. It may be asymptomatic. Its diagnosis is the privilege of medical imaging. Its treatment is controversial and should be discussed case by case.

Testicular cancer patterns in Tunisian men : diagnosis problems, pathological types and prognosis. About 41 patients.

AIM: To analyze the testicular cancer (TCa) incidence, diagnosis aspects, pathologic grade, stage, and survival in Tunisian men. METHODS: We studied all patients who had histopathologically confirmed TCa treated in La Rabta University-Hospital between 1991 and 2010. Baseline demographic data included age at diagnosis, year of diagnosis, clinical symptoms, stage at diagnosis, histologic type, management strategies and survival were analyzed. RESULTS: The incidence of TCa among Tunisians is very low; we collected only 41 cases over a period of 20 years with an average incidence of 2 new cases per year. Peak age incidence was 30-49 years. Testicular swelling was the principal complaint in 25 patients. 58.5% of tumours were rightsided and 39% were left-sided. There was bilateral involvement in only one case. The mean interval between onset of symptoms and presentation was 16.5 months (1-120). Most patients presented at stages T2 and T3 (63.4% and 26.8% respectively). Treatment consisted of radical orchidectomy in all patients and cisplatin-based chemotherapy and radiotherapy in respectively 11 and 12 patients (association in 5 patients). One patient with a tumour in an intra-abdominal testis underwent laparotomy. The most common histological types were seminomas (n=20) and mixed germ cell (n=8). Three patients died within 48 months, while half were lost to follow-up. CONCLUSIONS: The incidence of TCas in Tunisia remains low. Late presentation and treatment are major challenges to management. Better health funding and education regarding testicular self examination is essential.

[Local anesthesia in transrectal ultrasound-guided prostate biopsy: apical periprostatic nerve block versus endorectal lidocaine gel. A randomized controlled trial of 100 patients]. / L'anesthésie locale pour les biopsies prostatiques echoguidées: blocage nerveux périprostatique au niveau de l'apex versus gel de lidocaine intrarectal. Etude randomisée sur 100 malades.

BACKGROUND: Intrarectal lidocaine application and apical periprostatic nerve block are a safe technique that significantly reduces pain during transrectal prostate biopsy. AIM: We compare prospectively the effectiveness of intrarectal lidocaine gel versus periprostatic lidocaine injection during transrectal ultrasound -guided prostate biopsy. METHODS: From June 2005 to February 2006, 100 consecutive patients underwent prostatic biopsies. Patients were randomized to receive 10 cc of 2% lidocaine gel in endorectally (Group I), 10 cc of 1% lidocaine solution injected into the prostate apex to induce bilateral periprostatic nerve block (Group II), or intrarectal 10 cc of ultrasound gel as placebo (Groupe III). Pain was evaluated by a 10-point linear visual analogue pain scale (VAS), and a 5-point digital visual scale (DVS). The side effects of the drugs and complications were also evaluated. RESULTS: The three groups counted respectively: 33, 33 and 34 patients and were statically comparable as the age, prostate volume, PSA level and the number of biopsies. The mean pain score on the VAS was respectively 4,1;4,6 and 3,5 for the three groups. The DVS score was 2,5; 2,8 and 2,15 (p < 0.001). Pain scores were significantly lower in Group 3 and equivalent between Groups 1 and 2. There is no difference in complication rate between the three groups. CONCLUSION: Compared to intrarectal lidocaine application, apical periprostatic nerve block is a safe technique that significantly reduces pain during transrectal prostate biopsy, with no increase in the complication rate.

[Bladder neck sclerosis after surgical or transurethral resection of the prostate: a report of 40 cases]. / La sclerose secondaire du col vesical apres traitement chirurgical ou endoscopique de l'hypertrophie benigne de la prostate: a propos de 40 cas.

AIM: To describe diagnostic and therapeutic particularity of complication through a sample of 40 patients. METHODS: We collected 40 cases of secondary bladder neck sclerosis after surgical or endoscopic treatment for patients with benign hypertrophic prostate. Mean age was 71.5 years. RESULTS: This complication followed a prostate resection trought bladder in 52% it a urethral resection in 48%. Mean follow up of to observe this complication was 46.5 months. All patients had obstructive urinary signs revealed by clinical examination and, showing blader distension in 15 patients. Treatment was based on resection of sclerosis lesions in 27 patients, and incision of sclerosis tissues in 13 patients. After mean follow up of 32 months, 11 patients had recurrence of bladder neck sclerosis treated endoscopically. three patients had several endoscopic treatment followed by urinary incontinence. CONCLUSION: secondary sclerosis of bladder neck is a rare late complication of benign hypertrophic prostate surgery. It was very because of recurrence. Treatment needs endoscopic procedures.