Influence of photoselective vaporization of the prostate on sexual function: results of a prospective analysis of 149 patients with long-term follow-up.

BACKGROUND: Even though transurethral resection of the prostate remains the gold standard treatment for lower urinary tract symptoms (LUTS) refractory to medical therapy, photoselective vaporization of the prostate (PVP) has become a popular alternative. Early PVP studies seem encouraging, but few data exist regarding the effect of PVP on sexual function at long-term follow-up. OBJECTIVE: Our aim was to evaluate the impact of PVP on erectile function (EF) at long-term follow-up in men with LUTS due to benign prostatic hyperplasia (BPH). DESIGN, SETTING, AND PARTICIPANTS: One hundred forty-nine consecutive patients who underwent a prostate vaporization with the GreenLight laser performed by a single surgeon (FB) were prospectively enrolled in this study. INTERVENTION: All patients underwent PVP with the GreenLight laser performed by one experienced surgeon. MEASUREMENTS: All patients were evaluated by International Index of Erectile Function (IIEF-5) preoperatively and at 1, 3, 6, and 12 mo and then once a year. At each visit, the questionnaires were collected, and each patient's maximum flow rate and postvoid residual volume were measured with ultrasound. Biologic data were also collected at each visit, including prostate-specific antigen, creatinine, and bacterial urine culture. RESULTS AND LIMITATIONS: One hundred forty-nine patients were enrolled in the study. Median patient age was 74 yr. Urinary function was significantly improved over baseline in both men with normal or abnormal preoperative erectile function. Energy used was 255+/-129kJ. Hospitalization stay was 2.2+/-3.1 d. Other than a temporary difference at 1 yr, IIEF-5 scores were comparable preoperatively and postoperatively if we consider all the population. However, considering patients with preoperative IIEF-5 >19, the postoperative IIEF-5 scores were significantly decreased at 6, 12, and 24 mo. CONCLUSIONS: Sexual function appears to be maintained after PVP; however, in patients with normal preoperative EF, we showed a significant decrease in EF after PVP.

Visceral debranching and aortic endoprosthesis for a suspected mycotic pseudoaneurysm of the abdominal aorta involving visceral arteries.

Celiac aortic localization of mycotic pseudoaneurysm is serious. The conventional treatment, resection of infected tissues with in situ revascularization, is associated with a high surgical morbid-mortality rate. We report a case of mycotic pseudoaneurysm of the abdominal aorta involving visceral arteries excluded by an aortic endoprosthesis after visceral debranching. A 69-year-old man developed a celiac mycotic pseudoaneurysm after an acute prostatitis with septicemia (Escherichia coli). He underwent celiac aortic exclusion by an aortic endoprosthesis associated with a retrogade visceral bypass at the same time, under adequate antibiotherapy. Postoperative course was uneventful. After 18-months of follow-up, he was asymptomatic without signs of infection. Hybrid procedure for mycotic celiac aortic pseudoaneurysm seems to be a complementary technique to conventional open repair, especially in emergency. Endovascular approach does not preclude conversion toward conventional surgery, if necessary. This case report raises the matter of aortic endoprosthesis in infected area, the duration of suppressive antibiotherapy, and the conversion in open repair.

Duplication of superficial femoral artery: an uncommon variation of the lower limb arterial system.

The most common anatomical variation of the superficial femoral artery (SFA) is hypoplasia or aplasia, associated with persistent sciatic artery. Duplication of SFA remains uncommon. We report a case of SFA duplication discovered on an angiogram performed for critical limb ischemia, in an 80-year-old man.

Fibrodysplastic popliteal aneurysm and dilatation of pedal artery.

We report a case of an asymptomatic popliteal aneurysm due to fibromuscular dysplasia (FMD), associated with suspected FMD of pedal artery on a 63-year-old woman. The popliteal aneurysm was resected. An in situ interposition of a short segment of hypogastric artery was performed to restore the arterial continuity. Popliteal FMD was confirmed by histological findings. Only 5 cases are reported in literature. FMD of pedal artery was suspected on the CT-scan aspect. FMD is a rare cause of popliteal aneurysm. To our knowledge, this is the first report of suspected fibrodysplastic dilatation of a foot artery.