Use of micromeshed split thickness skin graft for penile skin reconstruction.

We review a case of total penile skin replacement with split-thickness micromesh skin graft (micromesh STSG) due to paraffinoma.

[Questionnaire of the Ryzhikh National Medical Research Centre for Coloproctology is a new tool for assessing chronic pelvic pain and pelvic organ dysfunction]. / Oprosnik NMITs koloproktologii imeni A.N. Ryzhikh ­ novyi instrument otsenki khronicheskoi tazovoi boli i narusheniya funktsii tazovykh organov.

The article presents the work of a multidisciplinary team of experts from various fields of medicine to optimize the «Questionnaire for assessing chronic pelvic pain and pelvic organ dysfunction (QCPPD) of the Ryzhikh National Medical Research Centre for Coloproctology¼ for use in clinical practice. The survey of respondents was conducted from June 28 to September 28, 2021. As a result of this survey, by repeatedly making edits and clarifications during communication with respondents, the final version was obtained, which allows assessing the patient's subjective sensations by the nature and localization of pelvic pain, sensitivity disorders and pelvic organ function. The main objective of this Questionnaire is to differentiate patients with neurogenic pain from a huge number of patients with chronic pelvic pain. This aspect will allow a more targeted approach to the diagnosis and pathogenetically justified treatment of patients, including after appropriate instrumental examinations. The work of a multidisciplinary team implies a higher degree of objectification and terminological accuracy of the Questionnaire under discussion. The presented version of the «Questionnaire for assessing chronic pelvic pain and pelvic organ dysfunction (QCPPD) of the Ryzhikh National Medical Research Centre for Coloproctology¼ will be primarily used in coloproctological patients with pelvic pain problems and anal incontinence and obstructive defecation. Further studies will be directed to the clinical evaluation of the results of the work carried out.

A rare case of urethral hemangioma treated with LASER.

Hemangiomas are benign vascular lesion, most commonly seen in liver and skin. Urethral hemangiomas are very rare benign vascular tumors with varying size and usually present as urethral bleeding or hematuria. We are presenting a 64 years old male, who was admitted to our Urology Department with symptoms of intermittent urethral bleeding for 6 months. We performed flexible cystoscopy under general anesthesia and a single hemangiomatous lesion of 7 mm in diameter located in the navicular fossa was found. The SIRIUS 60W Thulium Fiber Laser for removing the lesion was used.

[Sphenopalatine ganglion stimulation in the treatment of chronic refractory cluster headache. A preliminary multicenter study in Russia]. / Stimulyatsiya krylonebnogo gangliya v lechenii khronicheskoi klasternoi golovnoi boli. Rezul'taty pervogo mul'titsentrovogo opyta v Rossii.

OBJECTIVE: To analyze the results of sphenopalatine ganglion stimulation in treatment of chronic headache. MATERIALS AND METHODS: Medical histories of patients who underwent sphenopalatine ganglion stimulation in 4 clinical centers have been analyzed. The analysis included the type of pain and its characteristics, methods of surgery, CT, MRI, radiography before and after surgery. The follow-up data of patients with implanted pulse generators was collected in an outpatient clinic or by telephone review. RESULTS: The study included 15 patients with chronic refractory headache, including 14 with cluster headache and one female patient with features of trigeminal autonomic cephalgia without a clear definition of the type of pain. Trial stimulation was performed in 10 patients to determine analgesic effect. Among them stimulation was favorable in 7 cases, and 6 of them underwent pulse generator implantation. In total, 11 (73%) patients underwent implantation with a follow-up from 1 to 60 months. Among them only 6 (54%) patients use stimulation, the remaining 5 (46%) cases had device-related complications (migration, infection of system). Cluster headache has a significant improvement in long-term follow-up. CONCLUSIONS: Sphenopalatine ganglion stimulation may have high potential in the treatment of chronic drug-resistant cluster headache. The complication rate demonstrates that operative technique should be improved.

A rare case of isolated lung metastasis in the kidney.

Renal metastases are very rare condition in the clinical practice. The treatment is individualized and it depends on general status of the patient, involving of other organs and also the control of primary tumor. We are presenting a 64 years old woman, who had episodes of intermittent hematuria for two weeks. CT scan showed a large heterogeneous left kidney mass. The patient underwent open transabdominal radical left nephrectomy and the final diagnosis was isolated lung adenocarcinoma metastasis of the kidney.

A rare case of retroperitoneal primitive neuroectodermal tumor (PNET).

Retroperitoneal primitive neuroectodermal tumors (PNET) is a rare neoplastic disease of high malignancy with a tendency towards early metastasis, affect young adults irrespective of the gender. We present 81 year old woman, who was admitted in the Urology Department with symptoms of right flank pain and hematuria. Contrast-enhanced computerized tomography scan (CT-scan) showed a large heterogeneous right kidney mass around 12 cm in diameter. The final diagnosis of primitive neuroectodermal tumor (PNET) was established based on clinical, pathological, and molecular results.

Retroperitoneal cystic lymphangioma-a case report.

Retroperitoneal lymphangiomas (RL) are rare benign cystic tumors of the lymphatic system, which account for 1% of all lymphangiomas, and till now less than 200 cases have been reported. We are presenting a 35 years old woman, who was admitted with symptoms of recurrent left lumbar pain. The preliminary diagnosis from CT scan was retroperitoneal cyst. The patient went under explorative laparotomy and whole cyst mass was removed from the surrounding structures using sharp and blunt dissection.

A rare case of double J stent migration in the kidney.

Double-J stents are among the basic and commonly used tools in urology. There are a lot of complications that can occur during DJ placement. We are presenting 62 years old woman, who was admitted in Urology Department with symptoms of left lumbar pain, irradiating towards inguinal area and hematuria. The computed tomography (CT) scan of abdomen and pelvis defined a propagated DJ stent in the left kidney. Lumenis Holmium laser VersaPulse 100 W was used for resection of the double J stent and after that it was removed from the kidney in pieces.

A rare case of liposarcoma of the spermatic cord.

We present a 42 year old man, who was admitted in the Urology Department with symptoms of unilateral, painless, hard and firm slow-growing mass of the left scrotum for 4 months. Pelvic computed tomography (CT) scan showed a 8 cm3 mass lesion in the left hemiscrotum. Left radical orchiectomy and wide excision were performed and a yellowish soft tissue mass measuring closely attached to the spermatic cord was resected during surgery. Histopathologic evaluation revealed a tumor mass composed of well-differentiated liposarcoma.

A rare case of extramedullary hematopoiesis in adrenal mass.

Extramedullary hematopoiesis (EMH) is a compensatory mechanism for deficient formation or function of red blood cells. Very rarely, extramedullary hematopoiesis is finding out in the kidneys as well as adrenals. We present a 50 year old man, who was admitted in the Urology Department with symptoms of renal colic. A contrast enhanced computed tomography (CT) of the abdomen and pelvis revealed right adrenal lesion of 80/79 mm in coronary size. The final diagnosis was myelolipoma of the right adrenal gland. We presented a rare case of adrenal tumor mass in patient without any haemotological disease that requires surgical excision.

Management and diagnosis of Nutcracker syndrome-a case report.

Nutcracker syndrome (NCS), also known as left renal vein (LRV) entrapment syndrome is a condition that leads to stenosis of the aorto-mesenteric region of the LRV, with dilatation of the distal portion of the vessel. A 43-year-old woman was admitted to the Urology department with symptoms of intermittent painless hematuria and mild to moderate left lumbar pain for the last three months. The patient underwent cystoscopy under general anesthesia. Bloody urine was noticed to appear from the left ureter ostium and an intra-venous contrast CT of the abdomen was performed. The final diagnosis was anterior Nutcracker syndrome.

Management of Leydig cell tumors of the testis-a case report.

We report 1 case of Benign Leydig cell tumor. A 45-year-old male was admitted to the Urology department with a large painless mass in the right testis of 1 year duration. The patient underwent radical high right orchiectomy, with a preliminary diagnosis of right testicular tumor. On the basis of the pathologic and immunohistochemical findings, the testicular mass was diagnosed as a benign Leydig cell tumor. Long-term follow-up is necessary to exclude recurrence or metastasis and also the endocrine profile and imaging investigations need to be repeated periodically.

Late results of bilateral scrotal flap.

We present you a late result of 27 year old man, who was operated in 2009 using bilateral scrotal flap (BSF) for paraffinoma localized to the penis, scrotum and pubic area. In 2010 the patient was operated again, because horseshoe relapse engaged the penis base, doing simple excision.Ten years later, the patient have excellence functional and cosmetic results.

A rare case of Bellini duct carcinoma.

We present a rare clinical case of renal cell carcinoma from the collection tubules-carcinoma of Bellini. A 69 years old patient, enters in our department with symptoms of massive hematuria. From the studies carried out-blood tests, CT and cystoscopy there are no data of neo process of lower urinary tract, but shows horseshoe-shaped kidney, cystic deformation of the left kidney and aortic dissection. A left radical nephroureterectomy was performed, with preoperative diagnosis of renal tumor at stage T3. The histopathological diagnosis was Bellini duct carcinoma of papillary tubular type. The patient currently remains disease -free.

Premature ejaculation-operative management after failure of conservative treatment.

We report 1 case of microsurgical denervation of penis in men with lifelong premature ejaculation after failing to be treated conservatively. Although premature ejaculation is the most common sexual dysfunction in men, it is not well studied. Our aim was to investigate Micro-surgical denervation of penis (MSDP) as a method of treatment in men with lifelong PE after failure of different conservative treatment and to analyse the results. Much improving of ejaculatory control, distress, bother and IELT were identified from PEDT and PEP questionnaires. Furthermore investigations are needed to prove the role of operative treatment in men with lifelong PE.

Classical form of Kaposi sarcoma localized in penis.

We present you a case of 43 year old man with classical form of Kaposi sarcoma (KS) localized to the Penis who was HIV negative. Detailed pathological and immunohistochemistry characteristic of the tumor was done. Pathology reported it as KS with nodular and polypoid form. Classical form of KS with localization in male genitalia is rare identity and serves as a diagnostic challenge.

[The effect of various multimodal analgesia regimens during surgical treatment of patients with spinal stenosis on the rate of failed back surgery syndrome]. / Vliianie razlichnykh mul'timodal'nykh skhem analgezii pri khirurgicheskom lechenii patsientov so stenozom pozvonochnogo kanala na chastotu sindroma neudachnoi operatsii na pozvonochnike.

OBJECTIVE: To determine the effect of various methods of perioperative analgesia on the rate of failed back surgery syndrome in patients operated on for spinal stenosis. MATERIAL AND METHODS: A total of 122 patients were operated on for spinal stenosis in 2010-2016. The patients were assigned to groups according to the type of received analgesia: Group K (n=19) underwent analgesia on-demand. Patients in the PMA group (n=21) received preventive multimodal analgesia (PMA) with ketoprofen, paracetamol and morphine. Patients in the PMA+PG (n=20) and PMA+N (n=20) groups additionally received pregabalin and nefopam, respectively. Patients in the PMA+E group (n=22) received continuous epidural analgesia with a combination of ropivacaine and morphine. In patients in the PMA+I group (n=20), the wound was infiltrated with ropivacaine and ketorolac. RESULTS AND CONCLUSION: In Group K, analgesia was not adequate during five postoperative days. Analgesia with PMA resulted in significant pain reduction during three postoperative days compared to Group K. Wound infiltration in addition to PMA was followed by more significant pain relief during six postoperative hours (compared to the PMA group). Administration of pregabalin or nefopam, as well as epidural analgesia, did not improve quality of postoperative analgesia. Five to seven months after the surgery, 66% (57; 75%) of patients had low back and/or leg pain; 41% (32; 50%) of patients had leg pain. Among patients suffering from pain, 32-41% patients had the severe chronic pain syndrome that resulted in sleep disorder, disability and significant deterioration of quality of life. The rate of failed back surgery syndrome did not depend on the perioperative analgesia regimen.

A rare clinical case of penile gangrene in a patient with chronic renal failure and diabetes mellitus.

We report here a case of penile gangrene due to penile calciphylaxis in a patient with diabetes mellitus and chronic renal failure. Initially the patient demonstrated dry gangrene of the glans penis, which turned to wet after partial amputation. The main cause of the gangrene was considered to be circulatory insufficiency induced by severe arteriosclerosis. Despite high mortality rate associated with ischaemic penile gangrene aggressive management is recommended for those who are not terminal.

[Prognostic models of the severity of acute dynamic pain on the first postoperative day and the likelihood of chronic postoperative pain in spine surgery]. / Prognosticheskie modeli vyrazhennosti ostroi dinamicheskoi boli v pervye sutki posle operatsii i veroiatnosti vozniknoveniia khronicheskoi posleoperatsionnoi boli v khirurgii pozvonochnika.

The risk factors for acute pain as well as chronic pain syndrome (CPS) in spine surgery have not been defined to date. PURPOSE: To define the prognostic parameters of acute pain severity and the risk of CPS in patients operated on for spinal diseases and injuries. MATERIAL AND METHODS: The study included 291 patients operated on for degenerative diseases and injuries of the spine at the Sklifosovsky Research Institute of Emergency Medicine in 2010-2016. Sociodemographic and clinical data and the psychological status of patients were evaluated. A mechanical algometer was used to measure the pain threshold (PT) and pain tolerance. The movement pain intensity was assessed by using a visual analog scale (VAS) on the day of surgery. Pain was considered minor at a median score of 0-4 cm and severe at a median score of 5-10 cm. The presence of CPS was assessed during a telephone survey 5-7 months after surgery. RESULTS: The gender, PT, dynamic pain intensity before surgery, and expectation of postoperative pain are risk factors for severe acute postoperative pain. A multinomial logit regression model (Hosmer-Lemeshow test - 4.322; p=0.827) predicts minor dynamic pain on the 1st postoperative day with an accuracy of 70% (95% CI 63-76). The age and dynamic pain intensity on the 1st postoperative are the risk factors for CPS; the multinomial logit regression model (Hosmer-Lemeshow test - 3.1; p=0.928) predicts CPS with an accuracy of 65% (95% CI 59-71) 5-7 months after surgery. CONCLUSION: The developed software in the form of MS Excel calculators provides a particular patient with preoperative assessment of the risk for minor acute dynamic pain on the 1st postoperative day and CPS 5-7 months after surgery.

[THE CHOICE OF PERIOPERATIVE MULTIMODAL ANALGESIA IN PATIENTS WITH LUMBAR HERNIATED DISC: THE PRELIMINARY RESULTS.]

DESIGN: 129 patients scheduled for elective lumbar discectomy in 2010-2013 were enrolled in prospective study. Group K (n=20) underwent general anaesthesia and postoperative analgesia on-demand. Group PMA+SA (n=23) got subarachnoid block and preventive multimodal analgesia (PMA) including ketoprofen, paracetamol and nalbuphine. At PMA group (n=21) general anaesthesia and PMA were used; at PMA+I (n=21) also bupivacaine wound infiltration was administrated; at PlvL4+S (n=20) - depo-corticosteroid was applied locally on affected spinal nerve root; at PMA+IS (n=24) wound infiltration and local corticosteroids were combined. Patients could use i.v. nalbuphine on-demand by PCA device in addition to PMA post-operatively. 7 days post-operatively, the pain scores using 10 cm VAS at rest and during movement were also recorded. RESULTS: Group K patients had not adequate pain relief during 4 postoperative days. At PMA group the postoperative analgesia was adequate during the whole assessment time, PMA group patients had significant less pain scores than at K group during 4 postoperative days. Patients at PM +SA had better than PMA group pain relief only during 2 hours postoperatively. Groups PMA+I and PMA+IS did not demand nalbuphine at al. Their pain scores were signifcant less than at PMA group during 2 postoperative days. CONCLUSIONS: Postoperative analgesia on-demand is not adequate but the PMA is. Subarachnoid block results in decreasing severity of pain only during first hours postoperatively. The additional bupivacaine wound infiltration in pa- tients with lumbar herniated disc follows avoiding of opioids and significant pain relief during 2 postoperative days.