Thulium Laser Prostate Enucleation in Refractory Urinary Retention: Operative and Functional Outcomes in a Large Cohort of Patients.

OBJECTIVE: To evaluate the functional and operative results of thulium laser enucleation of the prostate (ThuLEP) in patients with indwelling catheters for refractory urinary retention. METHODS: Patients with indwelling catheter, undergoing ThuLEP for benign prostate hyperplasia, were prospectively enrolled. Every episode of urinary retention was treated with urinary catheter positioning followed by at least 2 attempts of catheter removal. Patients were investigated with flowmetry and the self-administered International Prostate Symptom Score questionnaire at 30 and 90 days following ThuLEP. RESULTS: Three hundred eighty-one patients underwent ThuLEP, and 99 of these had indwelling catheters, but only 93 (24%) were eligible according to the inclusion criteria. In 46 patients the bladder catheter was removed on the first postoperative day, in 31 patients on the second postoperative day, in 5 patients on the third postoperative day, in 6 patients on the fourth postoperative day, in 1 patient on the fifth postoperative day, and in 2 patients each on the sixth and seventh postoperative days. The average hospital stay was 2.3 (±1.7) days. No patients undergoing ThuLEP, at the 90-day follow-up, required further catheterization. Flowmetry showed significant improvement in all parameters, and the mean International Prostate Symptom Score dropped from 21.33 preoperatively to 3.2 (P = .004) at 90 days postoperatively. CONCLUSION: This prospective study shows that ThuLEP is a safe and effective approach in refractory urinary retention patients. In our case series, no patients required postoperative intermittent catheterization. All functional outcomes investigated reported a statistical significant improvement.

One day surgery in the treatment of benign prostatic enlargement with thulium laser: A single institution experience.

PURPOSE: Various articles have previously addressed the introduction of new surgical laser therapies for an enlarged prostate gland causing obstructive symptoms. The objective of this study was to report the feasibility of performing the thulium laser vapo-enucleation of the prostate (ThuVEP) procedure for benign prostatic obstruction in a 1-day surgery. MATERIALS AND METHODS: From September 2011 to September 2013, we conducted a prospective study on patients who underwent ThuVEP in a 1-day surgery. The primary outcomes measured perioperatively included operative time, resected tissue weight, hemoglobin decrease, transfusion rate, postoperative irrigation and catheterization time, and postoperative hospital stay. Also, the preoperative and postoperative International Prostate Symptom Score (IPSS) and results of uroflowmetry performed on the 7th and 30th postoperative days were recorded. All perioperative and postoperative complications were monitored. RESULTS: A total of 53 patients underwent the surgical treatment in a 1-day surgery. Seven patients continued antiaggregant therapy with aspirin. Mean preoperative prostatic adenoma volume was 56.6 mL. Mean operative time was 71 minutes. The average catheter time was 14.8 hours. The peak urinary flow rate on day 7 improved from 9.3 to 17.42 mL/s (p<0.001) and the IPSS improved from 18 to 10.2 (p<0.01). Patients were routinely discharged on the day of catheter removal. No complications were recorded. CONCLUSIONS: ThuVEP can be safely conducted as a 1-day surgical procedure. This strategy results in cost savings. ThuVEP shows good standardized outcomes with respect to improvement in flow parameters and length of bladder catheterization.

Are Histological Findings of Thulium Laser Vapo-Enucleation Versus Transurethral Resection of the Prostate Comparable?

We investigated if an adequate histological diagnosis can be made from tissue after Thulium laser vapo-enucleation of the prostate (ThuVEP) and whether it is comparable to transurethral prostate resection (TURP) tissue findings in patients with symptomatic benign prostatic hyperplasia. We analyzed 350 ThuLEP and 100 matched TURP tissue specimens from patients who underwent one of the two procedures between January 2009 and June 2014. Thulium Laser Enucleation of Prostate (ThuVEP) was combined with mechanical morcellation of the resected lobe. Each histological specimen was reviewed by two pathologists. Preoperative prostate ultrasound volume, total serum prostatic specific antigen and postoperative tissue weight were evaluated. Microscopic histological diagnosis was assessed by standard histological techniques and immunohistochemical evaluation. Patients were comparable in terms of age and preoperative total serum prostate specific antigen. Incidental adenocarcinoma and high grade PIN of the prostate were diagnosed in a comparable percent of specimens in the 2 groups (2.5 % in the ThuVEP group versus 3 % in the TURP group). Tissue thermal artifacts induced by the Thulium laser are mostly due to coagulation as that of the conventional monopolar diathermy in TURP. Tissue quality was maintained in the ThuVEP histological specimens. Tissue maintain histological characteristics and proprieties without modification for successive immunoistochemical analysis. The pathologist ability to detect incidental prostate cancer and PIN was maintained even if there is a quoted of vaporized tissue.

Feasibility and outcomes regarding open and laparoscopic radical prostatectomy in patients with previous synthetic mesh inguinal hernia repair: meta-analysis and systematic review of 7,497 patients.

INTRODUCTION: The purpose of this article is to contribute information to the interpretation of the feasibility and outcomes regarding open, laparoscopic and robotic strategies of radical prostatectomy in patients with previous synthetic mesh inguinal hernia repair. MATERIALS AND METHODS: A bibliographic search covering the period from January 1980 to September 2012 was conducted in PubMed, MEDLINE and EMBASE. Database searches yielded 28 references. This analysis is based on the eleven studies that fulfilled the predefined criteria. RESULTS: A total of 7,497 patients were included. In the study group, there were 462 patients. The surgical prostatectomy techniques were open in five studies, laparoscopic in three and robotic in the remaining three. The control group consisted in 7,035 patients. The comparison of the open procedure performed in patients with a previous mesh herniorrhaphy and controls shows that the number of lymph nodes removed resulted significantly lower and hospital stay with catheterization time results statistically longer. The comparison of the laparoscopic procedure does not evidence a statistically significant difference in terms of blood loss, operative time and catheterization time, while the comparison with the robotic group could not be performed for the lack of data. CONCLUSION: All patients need an adequate informed consent regarding the multitude of aspects which may be influenced by the mesh such as the possibility of hernia recurrence, mesh infection, need for mesh explantation, possibility of mesh erosion into the bowel or bladder, bladder neck contractures or postoperative urinary incontinence and a compromised nodal staging.

[Use of zoledronic acid in patients with prostate cancer bone metastases: control of pain and musculoskeletal complications]. / Utilizzo di acido zoledronico in pazienti con metastasi ossee da carcinoma prostatico: controllo del dolore e delle complicanze muscolo-scheletriche.

Background. Patients suffering from prostatic carcinoma are at high risk of having bone complications because of the metastatic progression of the disease to the skeleton and the consequences of androgenic deprivation. Zoledronic acid is a potent inhibitor of the bone resorption mediated by the osteoclasts, and is the only bisphosphonate whose capacity of reducing significantly the skeleton morbidity in patients with bone metastases is statistically proved. Methods. To attest tolerability and efficacy of zoledronic acid in preventing unfavorable skeletal events and in reducing osteomuscular pain, 25 patients - aged 75 years, suffering from hormone-responsive prostatic carcinoma under hormonal therapy with bone metastases, have been followed and subjected to IV monthly infusion of 4 mg zoledronic acid for 12 consecutive months, associated to daily intake of calcium and multivitamin supplementations. Results. At the end of the study, a sensible improvement in their clinical conditions and in their perception of the pain has been recorded in 23 patients and valued through a set of questions (Brief Pain Inventory). Conclusions. Zoledronic acid is therefore confirmed to be an effective medicine in preventing the skeleton complications and in controlling the painful symptoms in patients suffering from prostatic carcinoma with bone metastases.

Massive recurring angiomyxoma of the scrotum in a obese man.

Aggressive angiomyxoma (AAM) is a rare mesenchymal benign myxoid tumor, characterized by locally infiltrative nature and high recurrence rate. AAM occurs almost exclusively in adult females, arising from the soft tissue of the pelvic region: to our knowledge, only 43 cases occurring in men have been reported. We report a case of massive recurrence of scrotal AAM in a 46-year-old obese man, who already underwent surgery for the same disease in 2004 and 2005. The mass had a circumference of 106 cm and weighted 30 kg. It was impossible to appreciate the testes and to find the penis. The patient underwent scrotal resection, bilateral orchidopexia and transposition of the penis, by means of a preputial flap. Residual scrotal skin was modeled in order to create a neoscrotum, where the testes were placed and secured with interrupted sutures. Histologic examination showed diffuse angiomyxoma-like lipomatosis. After three months, the patient presented with local relapse which also involved the external urethral orifice.

Emphysematous pyelonephritis in decompensated diabetes: a case report and review of the literature.

Emphysematous pyelonephritis is a rare and severe renal parenchyma necrotizing infection visible just in diabetic patients which results in gas presence--probably produced through the glucose fermentation process--in the collecting system, renal parenchyma and perirenal tissue. We present a case of a not known diabetic female patient with emphysematous pyelonephritis of the left kidney and emphysematous pyelitis of the controlateral kidney.

[Reconstructive urethroplasty using porcine acellular matrix (SIS): evolution of the grafting technique and results of 10-year experience]. / Uretroplastica ricostruttiva con matrice acellularesuina (SIS): evoluzione della tecnica di impiantoe risultati di 10 anni di esperienza.

INTRODUCTION: Long tract urethral reconstruction still has no other resolution than two-stage techniques or graft and flap procedures, that are neither simple nor trouble-free. Tissue engineering simplifies this surgery using porcine acellular matrix, obtained from small intestine submucosa (SIS): thin but strong, ready for grafting, it is not immunogenic, being deprived of cells. It is a biological bridge for reconstruction, promoting the regeneration of surrounding tissue. We report our experience using SIS for urethroplasty. MATERIALS AND METHODS: After coronal or perineal-scrotal incision and penile degloving, the urethra is rotated of 180° and opened through the entire restricted tract. The graft is sutured dorsally and reinforced by the contact with the cavernous bodies to prevent pouching. From 1999 to 2005 we performed this grafting procedure in 36 men and 4 women. Afterwards, 16 more surgeries performed were with direct ventral graft procedure, without urethra isolation and rotation, with worthy simplification. RESULTS: A 10-year follow-up shows satisfactory urodynamic and subjective outcomes for both procedures, assessed by voiding urethrography, uroflowmetry, International Prostate Symptom Score, and Quality of Life perception. At urethroscopy the graft appears completely homogeneous to the native tissue, as confirmed by the histological examination. The ventral direct graft represents the more consistent innovation: we did not observe pouching and the results remained effective. For penile urethra, in a few patients, periodic dilatations were necessary. CONCLUSIONS: SIS can be considered as an alternative to more difficult grafting procedures, which are probably no more indispensable in urethral enlargement, even for critical strictures

[Single session cystolitholapaxy and PCNL for encrusted DJ stent with large associated stone burden]. / Stent DJ calcifico con litiasi multipla calicopielica e vescicale associata: trattamento con litotrissia vescicale e PCNL in una singola seduta.

INTRODUCTION: Ureteral stent use is commonplace in urology to prevent or relieve ureteral obstruction. If ureteral stents are neglected, they can cause severe morbidity due to migration, occlusion, encrustation, breakage, stone formation, and even death, due to life-threatening urosepsis or complications related to operative intervention. Extracorporeal shockwave lithotripsy, ureterorenoscopy, electrohydraulic lithotripsy, laser lithotripsy, and percutaneous nephrolitholapaxy (PCNL) have been reported for forgotten ureteral stent management, but currently there are no guidelines for this challenging situation and only few algorithms have been introduced by some studies. METHODS: We present a case of a man presenting with an encrusted left double J (DJ) stent, inserted two years before, and bulky radiolucent lithiasis at both ends of the stent. The patient was studied with intravenous pyelogram and non contrast-enhanced computed tomography, and then treated with cystolithotripsy and PCNL in a single session. RESULTS: Complete clearance of the stones was obtained and the DJ stent was removed without breaking from the percutaneous access. CONCLUSIONS: Neglected stents still represent a challenge in urology: while endourology remains the best option for treatment, the management of ureteral stents should be based on follow-up and prevention, using for example a computerized warning and stent retrieval software system.

Open intervascular nephron-sparing surgery for pyelocaliceal transitional cell carcinoma in solitary kidney planned with contrast-enhanced multidetector CT.

A 69-year-old man presented with a tumor involving the right renal pelvis and the middle and lower calyces in a solitary kidney. The patient was determined to preserve left renal function. Intervascular nephron-sparing surgery (NSS) was planned. A contrast-enhanced multidetector computed tomography (MDCT) was performed, providing 3-D reconstructions of the renal artery and collecting system in regard to the tumor. Two trunks of the anterior branch of the renal artery directed to the lower and middle parenchymal segments were identified. After dissection of the renal vessels, the anterior branch of the renal artery was identified. The trunks directed to the middle and lower segments were ligated and sected, producing an ischemic area. In cold ischemia, the renal pelvis and the middle and lower segments and calyces were ablated. An anastomosis between the ureter and the upper calyx was performed. Thirty days after surgery, serum creatinine was 3 mg/dl.