Hybrid open/closed resection procedure for ancient retroperitoneal Schwannoma: case report and review of the literature.

BACKGROUND: Retroperitoneal, ancient Schwannomas are rare tumors that arise from neural sheath Schwann cells. Due to their location and size, these benign tumors can become symptomatic and need surgery. Laparoscopic resection is rarely performed for retroperitoneal Schwannomas. Based on a case report and review of the literature the advantages of a laparoscopic approach are discussed. METHODS: A case of laparoscopic resection of a retroperitoneal Schwannoma is reported. An extensive literature search was done in relation to this pathology, 16 papers were included for in depth analysis. RESULTS: Laparoscopic surgery facilitates the dissection of the tumor from surrounding tissues due to a magnified view and optimal visualization of the tumor. Shorter hospital stay, faster recovery, better cosmetic result, less blood-loss and post-operative pain are all advantages of a laparoscopic resection. Disadvantages are a steep learning curve, higher cost and prolonged operation duration. CONCLUSIONS: Laparoscopic resection of, even large, retroperitoneal Schwannomas is feasible. In case of vertebral invaded tumors a hybrid approach is recommended.

Penoscrotal Incision for the Primary Implantation of an Artificial Urinary Sphincter.

BACKGROUND: The artificial urinary sphincter (AUS) has become the gold standard to treat severe stress urinary incontinence in men. The traditional placement of an AUS requires 2 incisions. The cuff is placed through a perineal incision and the reservoir and pump are placed via an inguinal incision. The implantation of an AUS is also possible via a single penoscrotal approach. OBJECTIVES: The objective is to demonstrate that the penoscrotal approach is not inferior to the perineal approach. METHODS: Retrospective review of a single surgeon database from 2014 to 2019 was performed. A total of 40 patients have undergone implantation of an AUS via a penoscrotal incision. The outcome of patients was followed for an average of 31.3 months for adverse outcomes. RESULTS: A primary American Medical Systems 800 sphincter was placed in 40 patients via a penoscrotal incision. The average age was 72 years. The average operating time was 35 minutes. The average cuff size was 4 cm. There were no infections of the prothesis so far. Three patients required a revision, 2 other patients needed an explant of the AUS, 1 patient underwent a cystectomy because of persistent radiocystitis. After activation of the sphincter, 33 patients (82.5%) were completely dry or using 1 pad per day for accidents. The remainder were all improved. CONCLUSIONS: AUS implantation via a single penoscrotal approach is not inferior to the perineal approach and has several advantages. The operating time is shorter and the procedure requires only 1 incision which both reduce the risk of infections, while the continence results are similar for both approaches.

Clinical Outcome: Patient and Partner Satisfaction after Penile Implant Surgery.

BACKGROUND: Erectile dysfunction (ED) is a common disorder, which affects at least 50% of males aged 50-70 years. According to EAU Guidelines on male sexual dysfunction, implantation of an inflatable penile prosthesis (IPP) is a valid, third-line therapeutic option for treatment of ED. OBJECTIVE: We conducted a retrospective single centre study to analyze mechanical reliability, complication rate, patient satisfaction and quality of life after penile prosthesis implantation. MATERIALS AND METHODS: A total of 126 electronic patient files after primary implantation of an IPP during a 5-year period were investigated. A structured telephone interview concerning patient and partner satisfaction was conducted at least 1 year after implant surgery. RESULTS: We found that 15 patients (11.9%) had revision surgery for various reasons. Mechanical failure occurred in 7.14% of the patients and was the main reason for revision surgery. Other major complications and complaints were loss of penile length (18.53%), postoperative pain (11.9%) and altered sensation (8.73%). No patients required explantation for infection, and 1 patient (0.79%) underwent revision surgery for an imminent erosion. One year or more after surgery, the patient and partner satisfaction rates, were 83.2 and 85.4%, respectively. We observed very high patient and partner satisfaction rates for the implantation of an IPP, with improvement of the general quality of life. These rates are negatively influenced by the occurrence of postoperative complications and complaints such as postoperative penile length shortening, pain and floppy glans syndrome. Most patients regain sexual function 6 weeks after surgery with no or minimal effect on the orgasm. CONCLUSION: The implantation of a 3-piece IPP has proven an effective, third-line treatment for patients with ED.

Fungal Bezoars Mimicking an Enterovesica Fistula: A Unique Case Report.

Fungal colonization or infection of the urinary tract system is relatively common in patients with diabetes or a compromised immune system. However, fungal intravesical bezoars are extremely rare. We present a unique case with multiple, gas-holding fungals bezoars and emphysematous cystitis caused by Candida tropicalis.

The Advantages of Transurethral Resection of the Prostate in Patients with an Elevated or Rising Prostate Specific Antigen, Mild or Moderate Lower Urinary Tract Symptoms, Bladder Outlet Obstruction and Negative Prostate Cancer Imaging or Prostate Biopsies: A Prospective Analysis in 105 Consecutive Patients.

OBJECTIVE: To investigate elevated or rising prostate specific antigen (PSA) as a marker for bladder outlet obstruction (BOO) in patients with minor lower urinary tract symptoms (LUTS) and without prostate cancer. MATERIALS AND METHODS: One hundred and five consecutive patients were prospectively analyzed between 2005 and 2013. All patients were referred to the principal investigator by their general practitioner as a result of an elevated and/or rising PSA. Only patients with minor LUTS [International Prostate Symptom Score (I-PSS) 0-19] and without suspicion for prostate cancer were included. All patients had BOO, shown by full urodynamics, and underwent transurethral resection of the prostate. The resected tissue was histologically examined and PSA and I-PSS were evaluated after 3, 6 and 12 months and later on yearly. RESULTS: Mean pre-operative PSA and I-PSS values were 8.8 ng/ml and 11.1, respectively. The mean detrusor pressure at maximum flow was 93.6 cmH2O. The mean resected volume was 52 g and the mean prostate biopsy rate was 1.8. Eighty-three of 105 patients (79%) had no malignancy and were diagnosed with BOO due to benign prostate hyperplasia (subgroup 1). Their mean PSA decreased from 9.2 to 0.7 ng/ml and 0.9 ng/ml after 6 and 12 months post-operation, respectively. The mean I-PSS declined from 11 to 3 after 6 and 12 months. Sixteen of 105 patients (15%) were treated for prostate cancer (subgroup 2). Radical prostatectomy was performed in 11 patients, brachytherapy in 3 patients and external beam radiotherapy in 2 patients. Six of 105 patients (5.7%) had active surveillance (subgroup 3). CONCLUSION: BOO can cause an elevated or rising PSA in patients with minor LUTS and negative screening for prostate cancer. Transurethral resection of the prostate is an adequate treatment for these patients.

Clinical Importance of Histopathological Inflammation in Patients with Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: A Prospective Study of 222 Patients.

OBJECTIVE: To investigate the relationship between the severity of histopathological prostatic inflammation with lower urinary tract symptoms and prostate specific antigen (PSA) levels. METHODS: We prospectively included 222 consecutive patients eligible for transurethral resection of the prostate in a non-academic referral center by a single surgeon. Patients with proven urinary tract infection or prostate cancer were excluded. Preoperative assessment included PSA levels, International Prostate Symptom Score (IPSS), mean peak flow, mean resected prostate weight and post-residual volume. Finally, the presence and severity of inflammation was determined histopathologically. RESULTS: Mean patient age was 69.1 ± 8.6 years with mean preoperative PSA levels of 4.7 ± 5.4 ng/mL and IPSS of 15.7 ± 6.9. Mean peak flow was 10.7 ± 6.5 ml/s and the mean resected prostate weight 39.4 ± 27.3 g. Positive correlations between PSA (log) and prostate weight (r = 0.54, p < 0.001) and between PSA (log) and active (r = 0.30, p < 0.0001) and chronic inflammation (r = 0.19, p = 0.005) were observed. No correlations were found between IPSS and PSA (log) (r = -0.14, p = 0.040) or between IPSS and active inflammation (p = 0.659) or chronic inflammation (p = 0.125). CONCLUSION: The study showed a weak correlation between PSA and the active or chronic inflammation. It also showed that there was no correlation between the active or chronic histopathological inflammation and IPSS.

The Benefit of a Surgical Resection of a Solitary Pulmonary Metastasis of Prostate Cancer after Radical Prostatectomy.

Historically, a solitary pulmonary metastasis of prostate cancer was considered as metastatic or disseminated disease and could only be treated systemically. However, some patients may benefit from surgical metastasectomy of a solitary pulmonary metastasis. We present an uncommon case of resection of a solitary pulmonary metastasis of prostate cancer after previous radical prostatectomy, resulting in un-detectable prostate specific antigen.

Evaluation of conservative approach in the management of ureteroenteric strictures following radical cystectomy with Bricker ileal conduit: a single-center experience.

OBJECTIVE: The aim of this study was to evaluate the risk factors and treatment options for ureteroenteric strictures (UES) following radical cystectomy (RC) and ileal conduit (IC) formation, and specifically to comment on the conservative management of UES in asymptomatic patients. MATERIALS AND METHODS: The datasheets were reviewed of 304 consecutive patients who were treated with an RC and IC between January 2001 and May 2011 in a Belgian tertiary center and who followed a strict follow-up protocol. Long-term treatment outcomes were retrospectively analyzed. RESULTS: Twenty-two patients (7.2%) were diagnosed with UES (affecting 27 ureters in total), when a new-onset hydroureteronephrosis or increase of the pre-existing hydroureteronephrosis was detected by ultrasound or computed tomography. A retrograde loopogram was then performed to confirm the UES. The mean follow-up time was 33 months. A decline in renal function, the presence of flank pain and urinary tract infections were indications for interventional treatment. Six patients underwent double-J stent placement, two patients received percutaneous nephrostomies as a definitive treatment and two patients underwent ureterointestinal reimplantation. Asymptomatic patients with a UES and a favorable renal function were conservatively managed. They remained asymptomatic during follow-up and required no active treatment. CONCLUSIONS: No clinical variable was independently associated with an increased risk of UES. These long-term data suggest that a selected patient population of asymptomatic patients with good renal function at the time of UES diagnosis can be safely managed conservatively.