[Photovaporization of the prostate with Greenlight HPS laser as outpatient major surgery]

OBJECTIVE

To assess the efficacy and safety of photovaporization of the prostate with Greenlight HPS laser as major outpatient surgery.

MATERIALS AND METHODS

A prospective study was conducted of a cohort of 50 patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia who underwent photovaporization with Greenlight HPS laser (120 W) as major outpatient surgery from May 2008 to February 2009. Inclusion criteria were moderate to severe obstructive lower urinary tract symptoms (IPSS of 10 or more and flowmetry with Qmax of 10 ml/sec or less due to benign prostatic hyperplasia with prostate volume less than 80 ml. Preoperative assessment included IPSS; flowmetry; physical examination; ultrasound examination of the kidney, bladder, and prostate (retropubic and transrectal); and measurement of postvoid residue and PSA levels. Surgical data were assessed (vaporization time, operating time, joules, complications during and after surgery). Patients were followed up 1 and 3 months after surgery (PSA, flow rate, IPSS questionnaire).

RESULTS

No patient admission or readmission was required, and bladder catheter was successfully removed from all patients within 24 hours of surgery. Mean patient age was 66.75 years. Mean prostate volume was 44.5 ml (SD + or - 21). Twenty patients (40%) had prior catheterization. Qmax and postvoid values significantly improved. Major complications at follow-up included voiding syndrome-urgency in 6 patients (12%) and mild transient hematuria in 3 patients (6%).

CONCLUSIONS

Photovaporization of the prostate with Greenlight HPS laser may be safely and successfully performed as a major outpatient surgical procedure, which undoubtedly represents a change in care, for surgical treatment of patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia.

[Complex renal cyst. Laparoscopic treatment]

The difference between the simple renal cysts, that doesn't require surgical treatment, and those that need it, sometimes is difficult. The laparoscopic surgical treatment (laparoscopic cyst decortication -laparoscopic partial nefrectomy or radical laparoscopic nefrectomy) its becoming the gold standard technique, recommending this procedure in Bosniak cyst type III or IV, and in the symptomatic renal cyst type I/II and in any patients with Bosniak cyst renal II. We present a case report in which a renal cell carcinoma was found after laparoscopic cyst decortication of Bosniak cyst type II with laparoscopic radical nefrectomy posteriorly.

[Unilateral agenesis of structures dependent on the mesonephric duct. Presentation of a case]

The mesonefric duct plays an essential role in the development of the genitourinary tract. From that duct derive structures as the ureter, the vas deferens and the seminal vesicles. Also, the ureteral bud interact with the mesonefric blastema and induce its conversion to renal tissue. The origin of these anomalies of the embrionary development is unknown. In some cases, mutations on the gene of the cystic fibrosis (CFRT) could play a role, assuming that there is a relationship between the congenital absence of the vas deferens and the cystic fibrosis. Usually, the absence of these structures has a silent course. Thus, the most important diagnostic factor is the clinical suspicion. The knowledge of this association can lead to the diagnosis of other congenital abnormalities. In addition, it is important to know that these anomalies could be present isolated as expression of other non-urological diseases, specially the cystic fibrosis, the most common hereditary disease between the Caucasian race.

[Usefulness of the dynamic sentinel node technique in patients with penile carcinoma]

OBJECTIVE

To explain and analyse when and how to use the new staging technique used in patients with squamous carcinoma of the penis, through the procedure of dynamic biopsy of the sentinel lymph node.

PATIENTS AND METHODS

We demonstrate the technical application of the dynamic biopsy of the sentinel lymph node, in a 40-year-old patient, diagnosed as suffering from squamous carcinoma of the penis. We use preoperative lymphatic visualization through lymphogammagraphy, together with intraoperative detection through gamma scanning, in order to detect and identify the sentinel lymph node.

CONCLUSIONS

We consider the dynamic biopsy of the sentinel node by the individual pattern of the lymphatic drainage as a new applicable Nuclear Medicina technique. It is an extremely useful technique in order to achieve early dissemination, by allowing us to identify patients with sub-clinic lymphatic spread, who will be candidates to regional lymphatic dissection.

[Treatment by a modified plication of the tunica albuginea in patients with congenital penile curvature]

OBJECTIVE

To evaluate the results obtained with management by modified plication of the tunica albuginea in patients with congenital penile incurvation.

MATERIAL AND METHODS

Between January 1992 and December 1996, a modified plication technique of the tunica albuginea was used to correct congenital and acquired penile incurvations; the procedure was performed in 27 cases of patients with congenital penile incurvation and 17 patients with de la Peyronie's disease. Mean age was 22.8 years (range 15-40 years), single ventral incurvation being the most frequent (51.8%) type. A modified technique of tunica albuginea plication was used.

RESULTS

Complete correction of the incurvation was achieved in all patients (100%), with a low rate of complications.

CONCLUSIONS

Modified plication of the tunica albuginea is a simple and effective surgical technique to achieve correction of congenital penile incurvations.

[Treatment of ureteral stenosis complicated by endourethral prosthesis. Long-term results]

OBJECTIVE

To evaluate the long-term results obtained in the treatment of urethral stenosis complicated with urethral endoprosthesis.

MATERIAL AND METHODS

Between March 1991 and December 1996, 40 endourethral prosthesis were implanted in 36 patients; 2 prosthesis were placed in 4 patients. Of the 40 prosthesis implanted, 37 were UroLume and 3 Ultraflex. All, with the exception of 2, were patients with recurrent stenosis after earlier failures of prior internal urethrotomy and/or repeat urethral dilations.

RESULTS

Immediate post-operative symptomatic relief was achieved in 97.2% patients. Only one patient required removal of the endoprosthesis. In 4 patients (11.1%) urethral restenosis develop distal or proximal to the endoprosthesis. No patient developed restenosis due to endoprosthetic fibrosis.

CONCLUSIONS

The long-term results obtained in the treatment of bulbar urethral stenosis complicated with endoprosthesis demonstrate the efficacy and stability over time of this technique, which shows a low complications rate when patients are strictly selected.

[Rare origin of a retroperitoneal mass: Castleman's disease]

Castleman's disease (angiofollicular hyperplasia of the lymphatic nodes) can exceptionally appear as a retroperitoneal mass of difficult differential diagnosis relative to other malignant retroperitoneal masses. Because of its rarity, one case report of a retroperitoneal mass with histologic study corresponding to Castleman's disease is contributed. A revision of the different histologic varieties of Castleman's disease, specific treatment and prognosis is included.