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Kaposi's sarcoma should be considered in the differential diagnosis in young patients with penile lesions and no risk factors. A 37-year-old heterosexual man with no other medical history applied presented with a non-itchy and painless penile lesion, for three months. The HIV 1-2 serology was negative via ELISA test. Histopathological analysis of the lesion revealed a tumor composed of atypical spindle cells, below a partially ulcerated surface. There was also an abundance of plasma cells admixed within the neoplastic cells. The patient was diagnosed as HIV-negative, HHV-8 positive Kaposi sarcoma. Although penile Kaposi sarcoma is extremely rare, classical Kaposi sarcoma should be considered in the differential diagnosis of penile lesions.
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OBJECTIVE: To measure the force necessary to win the resistance during insertion of ureteral access sheaths (UAS) in an experimental homemade model and to compare the peak force of insertion (PFOI) of different commercially available UASs. METHODS: Three investigators (2 novice and 1 expert) inserted the UASs into 2 different adapters with diameters of 10 Fr and 8 Fr. The force of insertion was continuously measured with a digital force gauge connected to the UAS during each insertion. Four different brands of UAS with different diameters, totally 11 different UASs were used for the experiment. The PFOI of each UAS was compared among each other and adapter diameters. RESULTS: The mean PFOI in adapters 1 and 2 were 1.85 N and 5.32 N, respectively. All of the mean PFOIs were significantly lower in adapter 1 compared to adapter 2, regardless of the novice vs expert surgeons and the UASs. (P <.001) In adapter 1, the mean PFOI was lowest with the UAS-1 and highest with the UAS-8. In adapter 2, the mean PFOI was lowest with the UAS-3 and highest with the UAS-9. For adapters 1 and 2, no statistical difference was found when comparing an expert and the 2 novice surgeons. CONCLUSION: The PFOI during UAS placement is not solely correlated with UAS thickness and adapter diameters. Other factors such as hydrophilic coating, UAS flexibility, inner dilator properties, UAS smoothness, and the actual measured external diameter of UASs should be taken into consideration. The clinical relevance and ureteral injury risk of the UAS PFOI need to be studied.
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Hydatid cyst disease, caused by the Echinococcus granulosus tapeworm larval form, typically affects the liver, lungs, and genitourinary tract. This case report details an unusual manifestation of hydatid cysts in a 62-year-old male with a history of retrovesical hydatid cyst surgery. The patient presented with pain at the root of the penis, and subsequent imaging revealed cysts in the suprapubic, pubic bone, and left pectineus muscle regions. Despite the challenges posed by the COVID-19 pandemic, the patient underwent surgical excision in 2023. The discussion emphasizes the rarity of such localized cysts, diagnostic imaging techniques, and the necessity of surgical intervention. The postoperative period involved a course of albendazole. While rectovesical hydatid cysts are uncommon, this case underscores the importance of considering them in the differential diagnosis of masses, particularly in endemic regions. Surgical excision remains the primary treatment for symptomatic hydatid cysts.
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PURPOSE: To define a peak force of insertion (PFOI) threshold for ureteral damage during ureteral access sheath (UAS) placement on an experimental ureteral orifice model. METHODS: A specially designed water tank using 2 laparoscopic 5 mm ports and 2 different size (10 Fr and 8 Fr) sealing cap adaptors (SCA) as ureteral orifices was used to perform the test. A 10-12 Fr UAS was fixed to a load cell and the force of insertion (FOI) was continuously recorded with a digital force gauge.13 experts in the field of endourology who participated performed 3 UAS insertions. The FOI was recorded initially with 10 Fr followed by 8 Fr SCA. On the final insertion, the orifice was obstructed, leaving a 5 cm length to insert the UAS. The experts were asked to "Stop at the point they anticipate ureteral damage, and they would not proceed in real life". RESULTS: Using 10 Fr SCA the PFOI was 2.12 ± 0.58 Newton (N) (range:1.48-3.48) while 8 Fr SCA showed a PFOI 5.76 ± 0.96 N (range:4.05-7.35). Six of the experts, said they would stop proceeding when they reached above 5.1 N. Three experts had PFOI < 5.1 N and the other 4 stated they would go with PFOIs of 5.88, 6.16, 6.69 and 7.35 N when using SCA of 8 Fr.The highest load they would stop proceeding had a PFOI of 6.09 ± 1.87 N (range: 2.53-10.74). CONCLUSION: The PFOI threshold for ureteral damage inserting UAS of the experts is variable. Although FOI is a subjective perception, experience suggests that ureteral injury may occur at an average of 6.05 N perceived by surgeons' tactile feedback. In-vivo measurement of UAS PFOI may confirm a threshold.
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Uréter , Uréter/lesiones , Humanos , Procedimientos Quirúrgicos Urológicos/métodos , CirujanosRESUMEN
BACKGROUND: The management of kidney stones, particularly those in the renal pelvis, is a critical aspect of urology. The European Association of Urology guidelines recommend Extracorporeal Shock Wave Lithotripsy or Endourology methods, encompassing Percutaneous Nephrolithotomy and Ureterorenoscopy (URS), for stones ranging from 10-20 mm. Robotic-assisted urological procedures have gained prominence in recent years, promising enhanced precision and safety. OBJECTIVE: To provide a detailed account of the technical aspects and outcomes of a robotic URS (robo-URS) procedure in a 63-year-old male patient with a 15-mm renal pelvis stone, serving as a reference for urologists considering this approach. MATERIALS: The patient presented with right flank pain, and an unenhanced computed tomography scan confirmed the presence of a 15 × 12 × 13 mm stone in the right renal pelvis. After assessment and preparation, robo-URS was performed using the Roboflex Avicenna robotic platform (ELMED, Ankara, Turkey) in conjunction with conventional urological instruments and laser technology. RESULTS: The procedure was completed successfully in 50 minutes without any detectable blood loss or intraoperative complications. CONCLUSION: Robo-URS is a promising approach for managing renal pelvis stones. The procedure, demonstrated in this video article, underscores its technical feasibility, safety, and efficacy, making it a valuable resource for urologists seeking to expand their knowledge in stone management techniques.
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Cálculos Renales , Procedimientos Quirúrgicos Robotizados , Ureteroscopía , Humanos , Masculino , Persona de Mediana Edad , Cálculos Renales/cirugía , Ureteroscopios , Pelvis Renal/cirugía , Diseño de EquipoRESUMEN
PURPOSE: Cryptorchidism is a well-defined risk factor for testicular germ cell tumors, whereas the underlying mechanisms have not been fully elucidated. Surgical procedures to reposition undescended testicles into the scrotum (orchidopexy) in early childhood are recommended both to increase fertility potential and to reduce the risk of developing testicular tumors. However, treatment in the post-pubertal period is controversial. The aim of this study is to review the histopathology of orchiectomy specimens and determination of spermatogenesis in post-pubertal patients with non-treated cryptorchidism. METHODS: Retrospective chart review was performed to assess the occurrence of TGCTs and determine spermatogenesis in post-pubertal individuals who underwent inguinal orchiectomy for undescended testis between January 2010 and December 2019. Age at the time of surgery, laterality, location of the undescended testis and pathology results were evaluated. All pathology specimens were reviewed by a blinded pathologist. RESULTS: There were 23 patients in the cohort with a mean age of 21 years (range 13-46 years). All testes were in the inguinal canal. Our results indicated that 1 patient had seminoma. In the histological evaluation of the remaining 22 patients in whom no tumor was detected, normal spermatogenesis was not observed in any patient. Further, seminiferous tubules were not found in 19 patients. Maturation arrest was detected in the remaining 3 patients. CONCLUSION: Testicular germ cell carcinoma was found in 4% of the patients who underwent post-pubertal orchiectomy. In addition, none of the undescended testes had normal spermatogenetic activity. Thus, orchiectomy should be considered in post-pubertal males with unilateral undescended testis that do not need the endocrinological activity of the testis.
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Criptorquidismo , Neoplasias de Células Germinales y Embrionarias , Espermatogénesis , Neoplasias Testiculares , Humanos , Masculino , Criptorquidismo/cirugía , Neoplasias Testiculares/cirugía , Neoplasias Testiculares/patología , Neoplasias de Células Germinales y Embrionarias/cirugía , Neoplasias de Células Germinales y Embrionarias/patología , Estudios Retrospectivos , Adolescente , Adulto , Adulto Joven , Persona de Mediana Edad , Factores de Riesgo , Orquiectomía , Medición de RiesgoRESUMEN
Al-Ghorab procedure is known as open distal shunt for the treatment of ischemic priapism. In the literature, no information in terms of complications is available in three of fourteen studies. In the remaining eleven studies, complications occurred in five studies only. Here we present a case report describing successful treatment of detachment of the incision after Al-Ghorab procedure.
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Priapismo , Herida Quirúrgica , Masculino , HumanosRESUMEN
PURPOSE OF REVIEW: Robotic surgery in urology has already been widely employed in robotic-assisted laparoscopic surgery for minimally invasive procedures (MIS). We wanted to analyse rapidly developing robotic ureteroscopy (RoboURS) for the treatment of renal stone disease. RECENT FINDINGS: A comprehensive literature review was performed for technical aspects and clinical outcomes of RoboURS. RoboURS has made significant breakthroughs with each model proving that this technology improves ergonomics and supports surgeon and instrument longevity while minimising musculoskeletal issues in retrograde intra-renal surgery (RIRS). Further randomised controlled trials are required to compare the efficacy of RoboURS vs manual flexible ureteroscopy (FURS). The cost-effectiveness will also need to be assessed prior to widespread acceptance into urological infrastructure and mainstream practice. RoboURS continues to evolve despite the limitations of infrastructure and cost-effectiveness. It holds the promise of a better future for surgeon longevity, reduced peri-operative morbidity and better workplace environment.
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Cálculos Renales , Laparoscopía , Procedimientos Quirúrgicos Robotizados , Robótica , Humanos , Ureteroscopía/métodos , Cálculos Renales/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: The COVID-19 is an ongoing health problem with millions of cases and deaths worldwide. Although the virus is transmitted with droplets through the respiratory system, the involvement of different organs has been reported. OBJECTIVES: The pandemic caused urological procedures to be postponed when patient is infected with SARS-CoV-2. However, the reliability of 1 month postpone period and long-term complications of the virus, such as a possible erectile dysfunction (ED) is not clarified. We aimed to compare the corpus cavernosum of patients 1 and 7 months after COVID-19 infection with control patients who had not COVID-19 and search for SARS-CoV-2 in tissues using immunohistochemistry and electron microscopy. MATERIALS AND METHODS: Three groups of subjects underwent penile prosthesis implantation and Nesbit procedure for Peyronie's disease 1 and 7 months after COVID-19 infection and control group without previous COVID-19 infection. We searched for SARS-CoV-2 in penile tissue using RT-PCR, electron microscopy and immunohistochemistry. RESULTS: Electron microscopy and immunohistochemical staining showed SARS CoV-2 virus in the penile corpus cavernosum of patients 1 month after COVID-19 recovery. Immunohistochemical staining intensity correlated with the severity of previous infection. Transmission electron microscopy revealed intracellular virtual particles of about 80 nm with a typical morphology of prominent spikes and electron-dense dots of nucleocapsid in addition to vesicles filled with virus-like particles. Cells showed increased membrane trafficking. The 1 month after COVID-19 group showed an increased number of fibroblasts. The 7 months after COVID-19 group had similar morphology and immunoreactivity as control group. DISCUSSION: This is the first study of late post-COVID examination of penis and the second study of early post-COVID examination of corpus cavernosum. For 1 month post-COVID patients, the aetiology of ED could be the viral infection that is also affecting corpora cavernosa. We hypothesize that viral infection affects the endocytic and exocytic pathways, hence the metabolic activity of cells that can be the reason of altered functions in some post-COVID patients. CONCLUSION: This study is important because it did not detect any virus residue in the tissue samples at the seventh month. In addition, we can say that the penile surgeries should be postponed more than 1 month after the COVID infection according to this study. But, there is a need for new studies with large series and high levels of evidence that can show how long the virus remains in the corpus cavernosum. Patients should be followed in this respect.
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COVID-19 , Disfunción Eréctil , Masculino , Humanos , SARS-CoV-2 , COVID-19/complicaciones , Reproducibilidad de los Resultados , Pene , Disfunción Eréctil/etiologíaRESUMEN
PURPOSE: To compare the outcomes of mini-percutaneous nephrolithotomy (mPCNL) and retrograde intrarenal surgery (RIRS) in patients with renal stones sizing 2-3 cm. METHODS: A total of 566 patients from 6 institutions who underwent mPCNL (n = 440) and RIRS (n = 126) procedures were enrolled in our study. The retrospective patient cohort was reviewed and compared. Binary logistic regression analysis was performed to determine factors predicting success in the RIRS group. RESULTS: The stone-free rates were 91.1 and 77% for the mPCNL and RIRS groups, respectively (p < 0.001). The auxiliary procedure rates were 4.5 and 39.7% in the mPCNL and RIRS groups, respectively (p < 0.001). Mean values of hemoglobin decrease, fluoroscopy time, and hospitalization time were significantly higher in the mPCNL group (p < 0.001). While the Clavien grade 1-2 complication rates were 10.9 and 34.1% (p < 0.001) in two groups, these values were 2.7 and 1.6% (p = 0.539), respectively, for Clavien grade 3-4 complication rates. Although three patients in the mPCNL group received blood transfusions, none of the patients in the RIRS groups were transfused. The stone location and stone density parameters were found to be the independent predictive factors for RIRS success. CONCLUSIONS: mPCNL provided a higher stone-free rate, less need for the auxiliary procedure, and lower complication rates compared to RIRS in patients with 2-3 cm stones. Blood loss, radiation exposure, and a hospital stay of mPCNL can be significantly reduced with the RIRS technique in selected patients.
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Cálculos Renales , Nefrolitotomía Percutánea , Nefrostomía Percutánea , Humanos , Cálculos Renales/etiología , Cálculos Renales/cirugía , Nefrolitotomía Percutánea/efectos adversos , Nefrolitotomía Percutánea/métodos , Nefrostomía Percutánea/efectos adversos , Nefrostomía Percutánea/métodos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: To evaluate retrograde intrarenal surgery (RIRS) outcomes and to determine the effect of operative time on complications of RIRS. METHODS: Patients undergoing RIRS for renal stones were evaluated. These patients were divided into two groups according to the operation time (Group 1<60 minutes and Group 2>60 minutes). Peroperative outcomes such as fluoroscopy time, stone-free rates, complications and duration of hospitalization were compared. RESULTS: Group 1 consisted of 264 patients and Group 2 consisted of 297 patients. SFR rates, duration of hospitalization, and postoperative urinary tract infection rates were similar in both groups. Fluoroscopy time was 7.8±7.3 (0-49) sec in group 1 and 13.1±9.8 (0-81) sec in group 2. Complications according to modified Clavien-Dindo classification system (MCDCS) were 13 and 32 patients (Grade 1), 31 and 63 patients (Grade 2), 1 and 1 patient (Grade 3) in group 1 and 2, respectively. There was statistical difference between the two groups in terms of duration of fluoroscopy time and the MCDCS. Although duration of hospitalization and UTI rates were higher in group 2, no statistical significance was observed among groups. CONCLUSION: Limiting the operation time to 60 minutes in RIRS seems to be important in reducing postoperative complications.
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Cálculos Renales , Riñón , Humanos , Riñón/cirugía , Cálculos Renales/complicaciones , Cálculos Renales/cirugía , Tempo Operativo , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate the impact of delay in cystoscopic surveillance on recurrence and progression rates in non-muscle-invasive bladder cancer (NMIBC). MATERIALS AND METHODS: A total of 407 patients from four high-volume centres with NMIBC that applied for follow-up cystoscopy were included in our study prospectively. Patients' demographics and previous tumour characteristics, the presence of tumour in follow-up cystoscopy, the pathology results of the latest transurethral resection of bladder tumour (if tumour was detected) and the delay in cystoscopy time were recorded. Our primary outcomes were tumour recurrences detected by follow-up cystoscopy and progression. Multivariate logistic regression analysis was performed using the possible factors identified with univariate analyses (P values ≤ .2). RESULTS: A total of 105 patients (25.8%) had tumour recurrence in follow-up cystoscopy, and 20 (5.1%) of these patients had disease progression according to grade or stage. In multivariate analysis, the number of recurrences (OR: 1.307, P < .001) and the cystoscopy delay time (62-147 days, OR: 2.424, P = .002; >147 days, OR: 4.883, P < .001) were significant risk factors for tumour recurrence on follow-up cystoscopy; the number of recurrences (OR: 1.255, P = .024) and cystoscopy delay time (>90 days, OR: 6.704, P = .002) were significant risk factors for tumour progression. CONCLUSIONS: This study showed that a 2-5 months of delay in follow-up cystoscopy increases the risk of recurrence by 2.4-fold, and delay in cystoscopy for more than 3 months increases the probability of progression by 6.7-fold. We suggest that cystoscopic surveillance should be done during the COVID-19 pandemic according to the schedule set by relevant guidelines.
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COVID-19 , Neoplasias de la Vejiga Urinaria , Cistoscopía , Humanos , Invasividad Neoplásica , Recurrencia Local de Neoplasia , Pandemias , SARS-CoV-2 , Neoplasias de la Vejiga Urinaria/epidemiología , Neoplasias de la Vejiga Urinaria/cirugíaRESUMEN
OBJECTIVE: To describe the prevalence of Y-chromosome deletions in patients with a sperm concentration of less than 5 million/mL. To also determine a new sperm threshold for Y-chromosome analysis in men with infertility. METHODS: A total of 3023 patients who had a semen concentration of less than 5 million/mL included in this retrospective study. All of these patients had a genetic evaluation, hormonal evaluation, and 2 abnormal semen analyses. RESULTS: Y-chromosome deletions were present in 116 (3.8 %) patients with sperm concentration <5 million/mL. The frequency of a Y-chromosome deletions was 6.8%, 1.0%, 0.15% in azoospermic men, in men with sperm concentrations of 0-1 million /mL, in men with sperm concentrations of 1-5 million/mL. Patients were divided into 2 groups regarding the determined new sperm threshold. The sensitivity and specificity of the Y-chromosome deletions test were 92.2.7% and 49.3 %, 99.1%, and 22.1% in patients with azoospermia and sperm concentrations <1 million/mL, respectively. If the sperm concentration thresholds of azoospermia or <1 million/mL, are applied, the number of tests decreased to 50.5% (1442 tests) and 23.1% (643 tests), respectively. Approximately $108,150 and $48,225 would be saved if the sperm thresholds were azoospermia and <1 million/mL, respectively CONCLUSION: The current threshold of sperm concentration for Y-chromosome deletions is controversial. The new proposed sperm threshold for genetic testing of 1 million/mL would increase sensitivity and more cost-effective compared to the current threshold.
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Pruebas Genéticas/normas , Infertilidad Masculina/diagnóstico , Trastornos de los Cromosomas Sexuales del Desarrollo Sexual/diagnóstico , Recuento de Espermatozoides/normas , Adulto , Deleción Cromosómica , Cromosomas Humanos Y/genética , Humanos , Infertilidad Masculina/genética , Masculino , Guías de Práctica Clínica como Asunto , Valores de Referencia , Estudios Retrospectivos , Aberraciones Cromosómicas Sexuales , Trastornos de los Cromosomas Sexuales del Desarrollo Sexual/genéticaRESUMEN
INTRODUCTION: Novel coronavirus Disease (Covid-19) has emerged in Wuhan, China in December 2019 and became a pandemic in a few weeks. In this review, we aimed to summarize the current urologic practice trends worldwide to help urologist in decision making in disasters particularly in Covid-19 pandemic. MATERIAL AND METHOD: We have performed a PubMed and Internet search by using the keywords: 'Covid', 'new coronavirus', 'coronavirus urology, 'covid urology' without a date restriction. Results: All elective surgeries for benign urological conditions such as urinary tract stone disease that not caused complicated obstruction, benign prostate enlargement, infertility, incontinence and genitourinary prolapse, erectile dysfunction undescendent testis, vesico-ureteral reflux should be postponed till the lasting of Covid-19 outbreak. In obstructing ureteral stone both nephrostomy tube and double-J stent insertion are valid management options. However, one must consider that these procedures must be performed under local anesthesia when possible to spare a ventilator. When deferring urooncological operations and treatments oncological outcomes must be considered. Aggressive cessation or reducing the dosage of immunosuppressant therapy might be an option in renal transplanted patients with severe pneumonia or acute respiratory distress syndrome.