Transurethral enucleation prostate with plasmakinetic energy. A new technique of enucleation

We present a new technique of transurethral prostatic enucleation. METHODS. We use an Olympus resectoscope with two electrodes; one has a button or "mushroom" shape to vaporize and enucleate, and the other one the shape of a conventional "cutting loop electrode"to resect. With the button-shaped electrode, we vaporize transversally at the level of the veru montanum, extending the dissection towards the lateroapical lobes, looking for the capsular plane. Once it is found, we ascend vaporizing up to the 3 and 9 in the clock following the capsular plane. Subsequently, we vaporize longitudinally the anterior commissure and keep going down to join the previously vaporizatized area. Then enucleation is achieved by pushing the adenoma with the button-shaped electrode, from distal to proximal, at the capsular plane level. Before the enucleated lobe falls inside the bladder, we can proceed, with the help of the conventional cutting loop electrode, to its resection, which is very fast and bloodless. If there is middle lobe, enucleation is initiated with it, performing two lateral grooves lengthways down to the veru montanum. RESULTS. We have carried out 45 procedures since October 2011, with excellent functional results. Prostate volumes range between 40-120 gr, with an operating time of 30-90 minutes. Hospital stay was 24-48 h. and the catheter is removed in 4-5 days. Blood transfusions were not needed in any case, and we have not recorded complications within this first year of follow-up. CONCLUSIONS. This technique makes possible the enucleation of the adenoma with a good haemostasis control. It also provides a good visualization of the capsular plane. Vaporization of the prostatic tissue is similar to the use of other energy forces. We don't need to use a "morcellator" to extract the enucleated prostatic tissue. It is an economical and easily reproducible procedure, with a short learning curve.

[Testicular germ cell tumours: descriptive study of 13 years of experience in the health care area of Badajoz]

OBJECTIVES

To describe the incidence of germ cell testicular tumors in our Center, their characteristics and therapy results.

METHODS

Retrospective study of 66 cases of germ cell testicular tumors diagnosed in the Health Area of Badajoz between 1993 and 2005.

RESULTS

Mean age of the time of diagnosis was 32 years (range 16-80 years), presenting a younger age patients with non seminomatous germ cell tumors (NSGCT) (mean age 30 years). 86.5% of the patients did not have risk factors associated with the diagnosis of germ cell testicular tumor. Testicular mass was the most frequent symptom, and a higher proportion of tumors were located in the left testicle (51.5%). Non seminomatous germ cell tumors were the most frequent histological type (64.8%). Stage I (72%) was the most frequent stage in the group of seminomatous tumors, in comparison with 68.5% of non seminomatous tumors. Stages II-III appeared in 34.4% of the NSGCT and 28% of seminomatous, having worse prognosis. 92% of the patients received adjuvant treatment with chemotherapy and/or radiotherapy, and curative surgery was the only treatment in the remainder 8%. Residual mass surgery was undertaken in five patients (stages IIa, IIc and IIIa). Eight of the 66 cases were lost for follow-up. Fifty-three of the 58 patients with follow-up are disease-free, 18 of them with more than five years of follow-up.

CONCLUSIONS

An increased incidence of germ cell testicular tumors have been verified over last years, mainly NSGCT Nevertheless, the diagnosis of advanced stages of the disease has diminished in favour of initial stages, which have a better prognosis for the patient. Oncologycal treatment protocols have high cure rates, although a long-term follow-up is needed due to the natural history of these tumors.

[Non venereal sclerosing lymphangitis of the penis. Case report]

OBJECTIVE

We report a clinical case with a diagnosis of nonvenereal sclerosing lymphangitis of the penis and revision of the literature existing on this pathology.

CLINICAL CASE

We describe the case of a 28 years old man who has presented for 10 days an induration of cartilaginous consistence next to the sulcus coronarius penis and symptomatic during the erections, compatible with the diagnosis of sclerosing lymphangitis.

RESULTS

Sexual abstinence was recommended and we kept an expectating attitude so ceasing the process after 4 weeks.

CONCLUSIONS

Nonveneral sclerosing lymphangitis of the penis is a process of unknown etiology, related to an increase of sexual activity, which is during the erection and it has a self-limited character, so the initial treatment is conservative.

[Follicular cystitis. Case report and bibliographic review]

OBJECTIVE

To report one case of chronic follicular cystitis and to perform a bibliographic review on this pathology.

CASE REPORT

We report a case of a 70-year-old woman with an irritative voiding syndrome over an eight-month period, with several previous episodes of urinary tract infection treated by her family doctor. Bullous lesions were found in the bladder mucosa on cystoscopy. Histological tests showed lymphoid follicles at the level of the bladder mucosa, leading to the diagnosis of follicular cystitis.

RESULTS

Medical treatment was carried out with ciprofloxacin, vitamin A, and prednisone, which led to symptom remission.

CONCLUSIONS

Follicular cystitis is an entity that belongs to the group of chronic cystopathies; it is a non-specific chronic inflammatory disease characterized by the presence of large number of plasmatic cells and lymphocytes in lymphoid follicles within the bladder mucosa and submucosa; pathologic study is necessary for the final diagnosis of this entity.