[Potential cognitive alterations after treatment of benign prostate syndrome. Investigations on transurethral electroresection and 180 W GreenLight XPS laser therapy]. / Potenzielle kognitive Veränderungen nach Behandlung des benignen Prostatasyndroms. Untersuchungen zu transurethraler Elektroresektion oder 180-Watt-XPS-Greenlight-Laserung.

OBJECTIVE: The study was carried out to detect possible changes in cognition after transurethral resection of the prostate (TURP) and 180 W GreenLight-XPS laser treatment of the prostate. METHODS: Cognitive capacity was assessed by the mini-mental state examination (MMSE) and the clock test preoperatively and on postoperative day 2 in addition to documentation of clinical parameters, such as patient age, prostate size, duration of surgery, comorbidities, co-medications and alterations in hemoglobin (Hb) and sodium concentrations. RESULTS: Patients treated with TURP (n = 88) and 180 W GreenLight-XPS laser treatment of the prostate (n = 114) were comparable regarding age, prostate size and duration of surgery. Baseline characteristics of the patients treated by laser showed an increased potential for postoperative cognitive changes with an average of 3.8 comorbidities (TURP 3.11, p = 0.005) and were using an average of 6.79 multiple medications (TURP 5.24, p < 0.001); however, neither the MMSE nor the clock test demonstrated a decrease in the average postoperative score (difference between postoperative and preoperative MMSE + 0.6 ± 1.6 for 180 W GreenLight-XPS laser treatment and + 0.6 ± 1.6 for TURP, p = 0.944; difference postoperative and preoperative clock test + 0.43 ± 1.44 for 180 W GreenLight-XPS laser treatment and 0.13 ± 1.17 for TURP, p = 0.097). Neither postoperative hemoglobin nor sodium concentrations, as safety relevant parameters, demonstrated clinically relevant changes. The differences between the surgical procedures were not statistically significant. DISCUSSION: Neither 180 W GreenLight-XPS laser treatment of the prostate nor TURP demonstrated changes in cognition by comparing the preoperative MMSE and the clock test scores. In this study, the baseline characteristics of laser-treated patients showed a higher number of comorbidities and a higher use of medications, particular those with anticholinergic potency; therefore, 180 W GreenLight-XPS laser treatment of the prostate appears particularly safe for elderly patients.

[How Useful is a Geriatric Assessment Prior or Urological Surgery with Regard to Cognitive Changes?]. / Wie hilfreich ist ein geriatrisches Assessment vor urologischen Operationen im Hinblick auf kognitive Veränderungen?

OBJECTIVE: Detection of changes in cognition after transurethral resection (TURP) or 180-Watt green-light XPS laser treatment (GLL) of the prostate is required by the German "Krankenhausbedarfsplan" which demands an interdisciplinary dialogue including special aspects of the operating discipline. This has as yet not been investigated in Germany or in Europe. METHODS: Assessments of the cognitive capacity were made by application of the "Mini Mental State Examination" and the "Uhrentest" preoperatively and on postoperative day 2 in addition to documentation of clinical parameters such as patient age, prostate size, duration of surgery, comorbidities, co-medication, changes in haemoglobin and sodium. RESULTS: Patients treated with transurethral resection (n=88) or GLL (n=114) were comparable regarding age, prostate size and operative time. Baseline characteristics of the patients who would be treated with laser showed an increased potential for postoperative cognitive changes: they had an average of 3.8 comorbidities (TURP: 3.11, p=0.005) and were to a greater extent using multiple medications 6.79 (TURP: 5.24, p<0.001). However neither the MMSE nor Uhrentest demonstrated a decrease in the average postoperative score (difference post-preop. MMSE+0.6±1.6 for the GLL and+0.6±1.6 for TURP, p=0.944; difference post- and preoperative Uhrentest+0.43±1.44 for the GLL and 0.13±1.17 for the TURP, p=0.097). Neither the postoperative haemoglobin nor the postoperative sodium, as safety-relevant parameters, demonstrated clinically relevant changes. The differences between the surgical procedures were not statistically significant. 28.6% of the patients with a preoperatively impaired cognition measured by an MMSE-score of≤23.7 incurred a further decline of their cognitive capability in comparison with patients without preoperative cognitive impairment with a further decline in 19.2%. CONCLUSIONS: Neither the GLL nor transurethral prostate resection demonstrated changes in cognition by comparing the preoperative Mini Mental State Examination or the Uhrentest. In this study, the baseline characteristics of lasered patients showed a higher number of comorbidities and a higher use of medication, in particular, with anticholinergic potency. Patients with a preoperatively impaired cognition had an increased risk of further worsening of their cognitive capabilities and should be treated carefully.

[Thrombosis of an extraspermatic blood vessel--first description as a cause of acute scrotum]. / Thrombosierte extrafunikuläre Skrotalvene--Erstbeschreibung einer Ursache des akuten Skrotums.

Testicular torsion is a well known emergency situation in clinical urology. Usually cases with torsion of the testis, epididimis or Morgagni's hydatid present for operative emergency procedures due to an "acute scrotum". Also Amyand's hernia, anterior wall abscess, tumours of the testis or cholesterol granulomas have been described as mimicking a testicular torsion. We present the first case of thrombosis of an extraspermatic blood vessel as an unusual cause of an acute scrotum in 15-year-old boy.