Reconstruction of urethral strictures in patients with a long history of blind urethral dilatation.

PURPOSE: To compare urethral reconstructions in patients after several years with or without blind urethral dilatation. MATERIALS AND METHODS: A retrospective study of 107 patients with urethral reconstructions was performed. Sixty patients with a long history of blind urethral dilatation (group 1) were compared with 47 patients without prior dilatations (group 2). RESULTS: The type of surgery planned according to urethrography and endoscopy findings was appropriate in 37/60 (61.6%) patients in group 1 and in 39/47 (83%) patients in group 2(P < .03). Anastomotic repairs were more frequent among the patients in group 2 (P < .001).Eighty five out of 107 patients were available for the 24 months follow-up. The success rate was higher in group 2 (91.4%) than patients in group 1 (70%) (P < .04). The greatest improvement in symptoms and quality of life occurred three months after the surgery (P < .05).Postoperative infection was persistent in 20/107 (18.7%) patients. CONCLUSION: Urethral strictures with a long history of blind dilatation are separate entity.They are more difficult to image, require more augmentation and staged procedures and have a lower success rate.

Holmium laser enucleation versus transurethral resection of the prostate: a comparison of clinical results.

Holmium laser enucleation of the prostate (HoLEP) represents a great potential alternative technique to standard transurethral resection of the prostate (TURP). We present 12-month follow up results of a randomized clinical trial, comparing HoLEP with TURP. A total of 40 patients with BPH and prostate volume < 50 g, have been randomized for HoLEP (n = 20) or TURP (n = 20). Urinary tract ultrasound with postvoid residual urine (PVR), International Prostate Symptom Score (IPSS) and Single Question Quality of Life (QoL) Score were evaluated preoperatively and during the follow-up period at 1, 3, 6, and 12 mo postoperatively. Intra- and perioperative data as well as early and late complications were assessed. Operative time was longer in the HoLEP group (p < 0.001); catheterisation time (p < 0.05) and hospital stay (p < 0.05) shorter. Hemoglobin levels drop (p < 0.001) was higher in the TURp group. Early and late postoperative complications were more frequent in the TURp group (p < 0.001). Follow-up data favored the HoLEP group, both regarding IPSS at 6-month (p < 0.05) and 12-month (p < 0.01), and single question QoL score, at 6-month (p < 0.01) and 12-month (p < 0.05). PVR was lower in the HoLEP group at 6-month (p < 0.01). HoLEP demonstrates superiority to TURp in regards to perioperative parameters and follow-up data and has a great potential to become the new gold standard in the surgical treatment of BPH.

[Results of the modification of antireflux subserosal and submucosal implantation of the ureter into the rectosigmoid urinary reservoir after total cystectomy].

INTRODUCTION: Uretero-intestinal anastomisis has a large influence on derivation quality. OBJECTIVE: The aim of the study was to present the modified serous lined extramural Abol-Enein method of implantation of low quality ureter into the sigma-rectum pouch and comparison of the results with Le Duc implantation. METHODS: From 1995 to 2009, 62 dilated ureter units were implanted in the detubularized rectosigmoid urinary reservoir. In 28 units Le Duc, and in 34 Abol-Enein method was done. Urinary fistula and ileus were considered as early complications, while late complications included stenosis and reflux pyelonephritis. Frequency of urination was considered as a parameter of functionality. RESULTS: Transitory urine fistulae occurred only in the ureters implanted according to Le Duc technique in 4/28 (14.2%); the difference between the examined groups was close but still below the level of statistical significance (p = 0.07). Iieus occurred with nearly equal frequency in both groups. Stenosis on the ureteral implantation place was significantly more frequent (p = 0.04) in the Le Duc group 5/28 (21.7%) than in the Abol-Enein group 0/34 (0%). Refluxive pyelonephritis occurred in 3/34 (8.8%) of the Abol-Enein group, and in 5/28 (21.7%) of patients in the Le Duc group. Concerning the daily frequency, there was no difference between the examined groups. CONCLUSION: Uretero-intestinal anastomisis of dilated ureters through a serous-lined extramural tunnel decreases the risk of reflux in a considerable number of patients, with an acceptable level of complications. There are several advantages in comparison with Le Duc method.

Simultaneous correction of anterior and apical vaginal prolapse with the modified placement of the transobturator-guided mesh (Anterior Prolift™) set.

AIM: Modified placement of the Anterior Prolift™ (MODAP) in patients with prolapse of the anterior and middle vaginal compartment is described. It was performed in order to achieve simultaneous tension-free correction of the anterior and middle vaginal compartment without excessive use of the mesh. MATERIAL AND METHODS: MODAP was performed in 32 patients. The anterior part of the mesh was placed transobturatorily. Surplus of the central part of the mesh was longitudinally divided and fixed around the cervix. Posterior mesh arms were passed through the sacrospinous ligament. All patients were analyzed regarding anatomy and symptoms 1 year after surgery. RESULTS: Cure of pelvic organ prolapse was achieved in 28 of 32 (87.5%) patients. The position of Ba and C points was significantly corrected (p = 0.00). Deterioration of the posterior compartment occurred in 1 case. Symptoms of pelvic organ prolapse were significantly corrected (p = 0.05 up to p = 0.00) except for rectal emptying. CONCLUSION: MODAP makes an improvement of both anatomy support and symptoms in cases with mixed insufficiency of the anterior vaginal wall and apical vaginal support.

Optimal primary minimally invasive treatment for patients with stress urinary incontinence and symptomatic pelvic organ prolapse: tension free slings with colporrhaphy, or Prolift with the tension free midurethral sling?

OBJECTIVE: Comparison of procedures in patients with concomitant stress urinary incontinence (SUI) and pelvic organ prolapse (POP) was performed. Tension free vaginal tape (TVT) or transobturator tape (TOT) with colporrhaphy was compared with fixed mesh (Prolift) applied with a tension free suburethral sling. STUDY DESIGN: A total of 76 women with both SUI and POP were evaluated. TVT or TOT with colporrhaphy was performed in 39 patients and Prolift with the midurethral sling in 37 patients. Anatomy, symptoms and quality of life (QOL) were evaluated prior to, and at 1, 6 and 12 months after surgery. RESULTS: Continence was achieved in both groups equally (p=0.57). The better anatomic outcome regarding the correction of POP was in the Prolift group but with a higher rate of additional procedures and complications. QOL was better in patients with grade III-IV POP corrected with Prolift (p=0.05) and equal in both groups with grade I-II POP during the follow-up. Impairment of sexual life was present in both groups before surgery. After surgery, there was no improvement in sexual life regardless of correction of both anatomy and incontinence. CONCLUSION: Both procedures are effective and safe. TVT or TOT performed with colporrhaphy looks a better primary choice for grade II POP and SUI. Results for grade III-IV POP and SUI are better with the Prolift with the sling. Sexual life could not be improved effectively with these types of surgery.

Bilateral fused pelvic kidney ectopia with a single draining ureter solved by craniolateral displacement of the kidney and Boari-modified bladder-calyceal anastomosis with bladder augmentation.

A pelvic cake kidney with hydronephrosis and renal failure with the single draining ureter was reported. Frequent urination related to compression of the bladder was the most important symptom. The kidney was craniolaterally displaced, the malfunctioning ureter was replaced with the Boari-like tubularization of the bladder, and the neoureter was anastomosed with the calyx. The bladder was enlarged by intestinal augmentation.

Possibilities and limitations of fibrin glue usage in nephron-sparing surgery: experimental study.

INTRODUCTION: The possibilities and limitations of fibrin glue (FG) usage in nephron-sparing surgery were studied. MATERIALS AND METHODS: A prospective experimental study was carried out in 50 pigs: 30 with polar resection, and 20 with mediorenal wedge resection of the kidney. Hemostatic sutures, FG, and FG with a muscle 'cup' in animals with polar resection of the kidney were compared. FG and sutures in animals with the wedge resection of the kidney were studied as well. Bleeding, hot ischemia time, complication rate, and additional scarring were also analyzed. RESULTS: Suture hemostasis is safe but with significant adverse effects in both polar and wedge resection of kidney. FG was not efficient as a sole hemostatic agent for polar resection. It was as efficient as hemostatic suture for wedge resection of the kidney. FG with a muscle 'cup' on a pole of the kidney achieved good results in animals with polar resection of the kidney. Histological analysis confirmed better results with FG because of both the less intense and smaller area of additional scarring. CONCLUSION: FG is a reliable and efficient hemostatic agent for nephron-sparing surgery whenever both sided gluing is possible.

Infestation of the human kidney with Dioctophyma renale.

Human infestation with Dioctophyma renale is presented. Clinical signs and diagnostic findings are unspecific. They are discussed and a conservative therapeutic approach is suggested.

[Preoperative radiologic evaluation of tumors of the renal parenchyma]. / Preoperaciona radioloska procena tumor parenhima bubrega.

Renal cell carcinoma is frequently a matter of urological interest. In recent years there were significant improvements regarding the earlier diagnosis, more precise preoperative staging and appropriate therapy. One hundred patients (42-78 years old) with the preoperative diagnosis of renal cell carcinoma were analyzed. Preoperative radiological evaluation included: transabdominal ultrasound, intravenous urography, computer-assisted tomography, and angiography. In all patients after radical nephrectomy pathohistological diagnosis was established and patients with the confirmed renal cell carcinoma tumour staging was performed. All histological findings were compared with the preoperative results of radiological examinations. Reliability of all of them is separately determined. Our results confirmed that the most efficient method of preoperative staging was computer-assisted tomography (accuracy 93%). Diagnostic methods that were previously used like intravenous urography and angiography, were not useful for routine diagnostic purposes. Ultrasound is a precise but not an enough informative diagnostic tool (accuracy 87%). Combine used of both ultrasound and contrast computer-assisted tomography is cost-effective, and an enough precise combination for everyday use.