Prostate metastasis of malignant melanoma

Metastatic malignant melanoma of the prostate is extremely rare in clinical practice, and only one case has been reported in the English literature in the past 30 years. We report a case of malignant melanoma that metastasized to the prostate and review the current literature. A 50-year-old man with a history of malignant melanoma metastasis to the left axilla, which was excised 3 years ago, presented with lower urinary tract symptoms and gross hematuria. He underwent cystoscopy and transurethral resection of the prostate. The pathological examination showed metastatic malignant melanoma of the prostate gland. The patient died 6 months after the transurethral resection

Perineal üretroplastide suprapubik sistoskopi kullanımı

Objective: Posterior urethral strictures are difficult cases to treat for urologists. Anastomotic open urethroplasty is the major surgical treatment option, and various modifications/manipulations to the procedure have been recommended in the literature. We aimed to assess the advantages of performing antegrade endoscopy through the suprapubic cystostomy tract during perineal urethroplasty. Material and methods: Thirty-six perineal urethroplasties combined with suprapubic cystoscopy were performed in 33 adult male patients between 2005 and 2011. Pre-and peri-operative records of the patients were evaluated, with a particular focus on suprapubic cystoscopy findings during urethroplasty. Results: The mean patient age was 41 years, and the mean lesion length was 2.6 cm (range 1-10 cm). Lesions were secondary to pelvic trauma in 21 patients, to a history of prostatic surgery in 8 patients, and to other miscellaneous causes in the 4 remaining patients. In 23 cases with normal bladder necks, the anastomosis was created under the guidance of antegrade cystoscopy with fluoroscopy. In 10 cases, stiff guide wires or paddles were used in addition to endoscopic light to identify the correct anastomosis site. In two procedures, fistula openings were identified during endoscopy, and fistula repair was performed along with anastomosis. In one case involving the longest lesion with involvement of the bladder neck, a combined perineal-transpubic urethroplasty was performed. The mean follow up duration was 19 (3-38) months. The overall success rate was 91%, and the re-operation rate was 9%. Conclusion: Suprapubic cystoscopy is an easy-to-perform adjunctive modality in perineal urethroplasty. This method provides the benefits of supplementary endoscopic findings and feasibility of certain maneuvers that facilitate debridement and anastomosis formation concurrent with perineal urethroplasty.Amaç: Posterior üretra darlıkları ürologlar için tedavisi zor olgular arasında yer almaktadır. Cerrahi tedavide temel seçenek olan anastomotik açık uretroplasti için literatürde çeşitli manuplasyonlar ve modifikasyonlar tanımlanmıştır. Bu çalışmada perineal uretroplasti sırasında suprapubik sistostomi traktından uygulanan antegrad endoskopinin avantajlarını değerlendirmeyi amaçladık. Gereç ve yöntemler: 2005-2011 yılları arasında toplam 36 seans suprapubik sistoskopi yardımlı perineal uretroplasti operasyonu uygulanan 33 yetişkin erkek hastanın, özellikle uretroplasti sırasındaki sistoskopik bulgular başta olmak üzere, operatif verileri incelendi. Bulgular: Hastaların ortalama yaşı 41 yıl ve lezyon uzunluğu 2,6 (1-10) cm idi. Etyolojik faktör olarak 21 hastada travma, 8 hastada prostat cerrahisi, ve 4 hastada diğer nedenler saptandı. Yirmi üç olguda mesane boynu normaldi ve antegrad sistoskopun ışığı kılavuzluğunda anastomoz gerçekleştirildi. On olguda doğru anastomoz hattını saptamak için, ilaveten, sert kılavuz tellerden ve iğnelerden yararlanıldı. İki olguda endoskopi sırasında fistül saptandı ve anastomoza ilave olarak fistül onarımı uygulandı. Mesane boynunu da kapsayacak şekilde, en uzun darlığa sahip olan 1 olguda combine perineal-transpubik onarım uygulandı. Hastaların ortalama takip süresi 19 (3-38) ay idi. Genel başarı oranı %91 ve re-operasyon oranı %9 idi. Sonuç: Suprapubik sistoskopi perineal uretroplasti sırasında yararlanılabilecek kolaylıkla uygulanabilen bir yardımcı yöntemdir. Bu yöntem perineal uretroplasti sırasında debridman ve anastomoz safhalarını kolaylaştıracak destekleyici endoskopik bulgular sağlaması ve çeşitli manevralara imkan tanıması açısından avantaj sağlar

Histopathology of surgically managed renal tumors: analysis of 178 cases

Amaç: Malignite şüphesiyle cerrahi olarak tedavi edilen böbrek kitlelerinin patolojik değerlendirmesini yaparak serimizdeki benign lezyonların sıklığını ve uygulanan tedavi yöntemlerini tespit etmek. Gereç ve Yöntemler : Şubat 2005 ile Aralık 2010 arasında malignite şüphesi nedeniyle ameliyat edilen 188 böbrek kitleli hastanın (120 erkek,68 kadın hasta) kayıtları retrospektif olarak incelendi. Bulgular: Toplam 188 hastanın 178 inin kayıt bilgileri eksiksizdi. Bu hastalardan 142 sine radikal nefrektomi (% 79), 28 ine nefron koruyucu cerrahi (%15), 4 üne sadece böbrek biyopsisi (%3) ve 4 üne de nefroüreterektomi (%3) yapıldı. 178 tümörün 66 sının (37%) tanısı insidental olarak konuldu. İnsidental saptanan kitlelerin 43 ünün (%66) boyutu 7 cm den küçüktü. Patolojik değerlendirmede 156 (%88) hastada malignite saptanırken, 22 (%12) hastada benign patolojiler bulundu. Benign kitleler sırasıyla onkositom (n=11), anjiomiyolipom (n=6), kistik nefroma (n=2), ksantogranülomatöz pyelonefrit (n=2) ve metanefrik adenom (n=1) idi. 7 cm den küçük 91 böbrek kitlesinin 22 sinde (%24) benign patoloji saptandı. Benign kitlelerin hiçbiri 7 cm den büyük değildi. Sonuç: Preoperatif malign olarak şüphe edilen kitleler, radyolojik görüntüleme yöntemlerindeki teknolojik gelişmelere rağmen, benign çıkabilmektedir. İnsidental olarak saptanan ve boyutu 7 cm den küçük olan böbrek kitlelerinde nefron koruyucu cerrahi ön planda tutulmalıdır.Objective: To review the pathologic findings of a contemporary series of surgically treated renal tumors suspicious for malignancy to assess the frequency of benign disease and treatment modality. Materials and Methods: The records of 188 patients (120 male, 68 female) underwent surgery for suspicious renal mass for malignancy between February 2005 and December 2010 were reviewed retrospectively. Results: Of 188 cases, records of a total of 178 cases were available for analysis. 142 patients underwent radical nephrectomy (79%), 28 nephron sparing surgery (15%), 4 renal biopsy (3%) and 4 nephroureterectomy (3%). Of 178 tumors, 66 (37%) were discovered incidentally. Forty three (66%) of incidentally diagnosed renal masses size were less than 7 cm. The pathologic evaluation demonstrated malignancy in 156 (88%) and benign disease in 22 (12%). Benign masses were oncocytoma (n=11), angiomyolipoma (n=6), cystic nephroma (n=2), xanthogranulomatous pyelonephritis (n=2) and metanephric adenoma (n=1). Of 91 renal masses with size of less than 7 cm, 22 (24%) had benign pathology and none of benign masses were bigger than 7 cm. Conclusion: Inspite of great technological development in the radiological imaging modalities, benign lesions may still be detected pathologically in the patients with preoperative diagnosis of renal cancer. Nephron sparing surgery should be kept in mind for the renal masses less than 7 cm, if possible

Descriptive technique and initial results for robotic radical perineal prostatectomy reply

WOS: 000383696400081PubMed ID: 27370778

Perineural invasion association with tumor volume and tumor positive core locations in TRUS biopsy

Amaç: TRUS biyopsideki perinöral invazyonun (PNI) tümör pozitif olan korlar ve bu korlardaki tümör hacmi ile ilişkisini araştırmak. Gereç ve Yöntemler: TRUS biyopsi yapılan ve patoloji sonucu prostat adenokarsinomu saptanan 85 hastanın bilgileri değerlendirildi. Biyopside herhangi bir korda gözlemlenen perinöral invasyon, raporda “PNI(+)” olarak rapor edildi ve ayrıca her kordaki tümör hacmi “yüzdelik oranda” belirtildi. Hastalar patoloji raporuna göre PNI(+) ve PNI(-) olmak üzere iki gruba ayrıldı. İki grup yaş, PSA, prostat hacmi, Gleason skoru, biyopsi alınan kor sayısı, kanser pozitif kor sayısı, kanser pozitif kor lokalizasyonu, korlardaki tümör yüzdesi bulgularıyla istatistiksel olarak karşılaştırıldı. Bulgular: 85 hastanın 42’si (%49,4) PNI(+) ve 43’ü (%50,6) PNI(-) idi. Bununla beraber median PSA değeri, Gleason skoru ve tümör pozitif kor sayısı PNI(+) grupta anlamlı derecede yüksekti. Transizyonel zon hariç (P:0.217) diğer tüm korlarda PNI(+) gruptaki tümör hacmi anlamlı derecede fazlaydı (P:0.00). PNI(+) gruptaki tümör hacmi PNI(-) grubun yaklaşık 4 katı idi. Biyopsideki PNI varlığının tümör pozitif korlar ile ilişkisi değerlendirildiğinde, PNI(+) grupta Transizyonel zon hariç diğer tüm korlardaki tümör pozitifliğinin PNI(-) gruba göre anlamlı derecede yüksek olduğu tesbit edildi.Sonuç: PNI pozitifliği olan hastaların pozitif kor sayılarını ve biyopsi korlarındaki tümör hacimlerini anlamlı derecede yüksek bulduk ve bunu kantitatif olarak sunduk. Bu bulguların tedavi yöntemini ve yapılacaksa cerrahi yöntemi yönlendirecek ipuçları taşıdığını düşünmekteyiz.Objectives: To explore the association of perineural invasion with tumor positive cores and tumor volume in TRUS biopsy. Material and Methods: 85 patients, diagnosed with prostate adenocarcinoma via TRUS biopsy were evaluated. Of any observed perineural invasion in any core for each patient was reported as “PNI(+)”. Also the amount of tumor in the each core was reported by percentage. Patients were divided into two groups due to their pathology reports which were PNI(+) or PNI(-). Age, PSA, prostate volume, Gleason score, number of biopsy cores, the number of cancer-positive cores, cancer-positive core localizations, percentage of tumor in each core findings were compared statistically between two groups. Results: Of patients 42(49,4%) were PNI(+) and 43(50,6%) were PNI(-).Median PSA, gleason score and number of tumor positive cores were significantly higher in PNI(+) group. Also the percentage of tumor in each core was significantly higher in PNI(+) group (p:0.00), except transition zone (P:0.217). Approximately, tumor percentage in PNI(+) group was 4 fold of PNI(-) was. By the association between PNI and tumor positivity in the cores; tumor was being higher in whole cores in PNI(+) group then the other, except transition zone.Conclusion: It was presented quantitatively in our study that number of tumor positive biopsy cores and the percentage of tumor in that cores were significantly higher in PNI(+) group. We suppose that these findings are to be carried hints to guide treatment and surgical methods

Radikal perineal prostatektomi spesmenlerindeki gizemli izler: Bir anatomohistolojik çalışma

Aim: An anatomohistological evaluation of tissue found on specimens of radical perineal prostatectomy which could influence oncological and functional outcome. Material and Method: A certain surgeon's batch of 41 RPP (Radical perineal prostatectomy) specimens were evaluated. The RPP specimens were dissected from apex to basis. The following slices were dissected: 1 from the Apex, 2 from the center of the prostate, and 1 from the basis. Totaling 4 selected slices. Tissue surrounding these slices were anatomohistologically evaluated working from the following 7 parameters determined in light of latest anatomical and pathological insight on the prostate:"Dorsal venous complex(DVC)", "Striated muscle(Rhabdosphincter)", "Periprostatic fascial tissue (PPFT)", "Neurovascular bundle(NVB)", "Bladder neck smooth muscle", "Surgical margins" and "Capsular incision". Results: Whilst no DVC was found in the dissected Apex slices, muscle striation was found with 39 (95,1%) of the patients. PPFT within central prostate sections was found with 36 (87,8%) of the patients, predominantly within posterior quadrants. Again within central prostate sections NVB was found with 23 (56%) of the patients. All basis slices were found to have bladder neck smooth muscle. Surgical margin positivity was found with only 5 (12,1%) of the patients. Capsular incision was found with 15 (36,5%) of the patients. Discussion: Our study provides a quantitative report of the extent to which other anatomi-cal structures are extracted when removing the prostate from the perineum employing the RPP technique. That the specimen show no trace of DVC is significant in terms of pubovesical complex sparing.Amaç: Radikal perineal prostatektomi spesmenleri (RPP) üzerinde bulunan, onkolojik ve fonksiyonel sonuçları etkileyebilecek dokuların anatomohistolo-jik değerlendirmesi. Gereç ve Yöntem: Tek cerrahın serisi olan 41 RPP spes-meni incelendi. Spesmenler apeksten basise doğru dilimlendi. Apeksten 1, orta prostattan 2 ve basisden 1 adet olmak üzere toplam 4 adet dilim seçildi. Bu dilimleri çevreleyen dokular, prostatın güncel anatomik ve patolojik veri-leri ışığında belirlenmiş 7 parametre açısından anatomohistolojik olarak de-ğerlendirildiler; “Dorsal venöz kompleks”, “Çizgili kas (rabdosfinkter)”, “Perip-rostatik fasiyal doku”, “Damar sinir paketi”, “Düz kas (mesane boynu)”, “Cer-rahi sınır” ve “Kapsüler insizyon”. Bulgular: Apeksten alınan dilimlerde dorsal venöz kompleks hiç gözlenmezken 39 (%95,1) hastada çizgili kas vardı. Orta prostattan alınan dilimlerde periprostatik fasiyal doku, özellikle rektum tara-fında bulunan posterior kesitlerde olmak üzere, 36 (%87,8) hastada gözlendi. Yine orta prostatta damar sinir paketi 23 (%56) hastada gözlendi. Tüm basis dilimlerinde mesane boynuna ait düz kas lifleri vardı. Cerrahi sınır pozitifliği sadece 5 (%12,1) hastada vardı. Kapsüler insizyon 15 (%36,5) hastada göz-lendi. Tartışma: Çalışmamız, RPP tekniği uygulanırken prostatla birlikte baş-ka hangi dokuların çıktığını kantitatif olarak ortaya koymuştur. Spesmenlerin dorsal venöz kompleksi içermiyor olması pubovesikal kompleksin korunuyor olması açısından anlamlıdır

The use of suprapubic cystoscopy in perineal urethroplasty

OBJECTIVE: Posterior urethral strictures are difficult cases to treat for urologists. Anastomotic open urethroplasty is the major surgical treatment option, and various modifications/manipulations to the procedure have been recommended in the literature. We aimed to assess the advantages of performing antegrade endoscopy through the suprapubic cystostomy tract during perineal urethroplasty. MATERIAL AND METHODS: Thirty-six perineal urethroplasties combined with suprapubic cystoscopy were performed in 33 adult male patients between 2005 and 2011. Pre-and peri-operative records of the patients were evaluated, with a particular focus on suprapubic cystoscopy findings during urethroplasty. RESULTS: The mean patient age was 41 years, and the mean lesion length was 2.6 cm (range 1–10 cm). Lesions were secondary to pelvic trauma in 21 patients, to a history of prostatic surgery in 8 patients, and to other miscellaneous causes in the 4 remaining patients. In 23 cases with normal bladder necks, the anastomosis was created under the guidance of antegrade cystoscopy with fluoroscopy. In 10 cases, stiff guide wires or paddles were used in addition to endoscopic light to identify the correct anastomosis site. In two procedures, fistula openings were identified during endoscopy, and fistula repair was performed along with anastomosis. In one case involving the longest lesion with involvement of the bladder neck, a combined perineal-transpubic urethroplasty was performed. The mean follow up duration was 19 (3–38) months. The overall success rate was 91%, and the re-operation rate was 9%. CONCLUSION: Suprapubic cystoscopy is an easy-to-perform adjunctive modality in perineal urethroplasty. This method provides the benefits of supplementary endoscopic findings and feasibility of certain maneuvers that facilitate debridement and anastomosis formation concurrent with perineal urethroplasty

Obesity might not be a disadvantage for SWL treatment in children with renal stone

WOS: 000314292500002PubMed ID: 23299862Although the management of urinary stones in obese patients is a challenge and the impact of the patient-related parameter has been well studied in adults: No study has evaluated the possible impact of obesity in terms of body mass index related SWL success in pediatric population. In this present study, we aimed to evaluate the safety and efficiency of SWL in obese children in a comparative manner with the cases in normal BMI value limits. A total of 66 children (45 boys and 21 girls, M/F:2.1) with renal calculi were treated with SWL. Depending on the BMI values, the children were divided into two groups as; Group 1 (n:50) children with normal BMI values (mean: 16.1) and Group 2 (n:16) obese children with higher BMI values (mean: 20.3). The success rates, complications, and need for auxiliary procedures after SWL were evaluated between two groups of patients in a comparative manner. While majority of the cases were treated under general anesthesia (n:61), a limited number of cases were treated under neurolept anesthesia with PiezoLith 3000 (Richard Wolf GmbH) lithotripter. Evaluation of efficiency was based on radiological examinations using abdominal radiography, ultrasonography, or CT scan when needed. Both the mean age and mean stone size values were similar in both groups. While the mean age was 62 months (24-148) in Group 1, this value was 68 months (24-137) in Group 2. Again mean stone size was 10.26 mm(5-25 mm) in Group 1 and 10.12 mm (6-20 mm) in Group 2. The mean number of SWL sessions and the number of SW's applied were similar in both groups (2.06 vs. 2.0 and 1975 vs. 1835, respectively). Evaluation of success rates after 3-months again did not show any statistically significant difference with respect to stone-free rates in both groups (47/50-94 %, 16/16-100 %, respectively). However, 3 children in Group 1 did show residual fragments (a parts per thousand currency sign3 mm) which were followed closely with regular visits without any problem. In another 3 cases, again fragments migrated to involved ureter after lithotripsy and these fragments were successfully treated in situ with further SWL. With respect to auxiliary procedures, there was no specific procedure has been done in Group 2, but 3 cases did undergo further SWL for ureteral stones in Group 1. Stone location did not affect the final outcome of the procedure in a significant manner in both groups. Lastly, no serious complication could be demonstrated in both groups either during or after SWL procedures. In the light of the successful treatment outcomes with limited need for auxiliary procedures in both groups, we may say that obesity might not be a disadvantage for SWL in children with renal stones

Resultados de la prostatectomía radical perineal sobre la función eréctil a largo plazo

Introduction: Although many patients are being treated by radical prostatectomy (RP), there is still insufficient information about the changes in tong-term erectile function after RP. Our aim is to examine long term, up to 5 year erectile function status of patients after Radical Perineal Prostatectomy (RPP). Materials and methods: One hundred and thirty-two patients, who underwent bilateral nerve-sparing Radical Perineal Prostatectomy (RPP) in between January 2012 and January 2017, with preoperative age = 21 and patients whose IIEF-5 scores were between 16 and 20 but responded as "yes" to the "Sexual Encounter Profile (SEP) - 2" and "SEP-3" questions were accepted as having normal erectile function. Results: Out of the 132 patients, 96 (72.7%) of the patients were found to be potent in the first postoperative year. A total of 118 patients were evaluated at the end of 5 years. Eighty seven (73.7%) patients had normal erectile function according to our criteria. Discussion: According to the results of our study, short term and long term erectile function outcomes of patients undergoing RPP were favorable and there was no statistically significant difference between short and long term results.Introducción Aunque muchos pacientes son tratados mediante prostatectomía radical (PR), existe poca información acerca de los cambios de la función eréctil a largo plazo tras una PR. Nuestro objetivo fue examinar el estatus de la función eréctil a largo plazo, de hasta cinco años, de los pacientes tras una prostatectomía radical perineal (PRP). Materiales y métodos Incluimos en el presente estudio a ciento treinta y dos pacientes sometidos a PRP bilateral con preservación de nervios entre enero de 2012 y enero de 2017, con edad preoperatoria ≤ 70, volumen prostático < 80 g, puntuación de Gleason (GS) de biopsia transrectal ecoguiada (TRUS) (GS)< 7, valor de antígenos específicos prostáticos (PSA) < 10 ng/ml, y estadio cT ≤ 2 (N0, M0). Los criterios de exclusión fueron enfermedades cardiovasculares previas, insuficiencia renal crónica y/o hepática graves, enfermedades neurológicas, diabetes mellitus incontrolada, y enfermedades pulmonares graves. También se excluyó del grupo de estudio a los pacientes que recibieron tratamiento adicional (hormonal y/o radioterapia) tras PRP. La función eréctil fue evaluada antes de la cirugía y a los 3, 12 y 60 meses postoperatorios. Los pacientes cuya puntuación IIEF-5 (International Index of Erectile Function) fue ≥ 21 y los pacientes cuyas puntuaciones IIEF-5 se situaron entre 16 y 20 pero respondieron “sí” a las preguntas SEP-2 (Sexual Encounter Profile) y SEP-3 fueron aceptados como pacientes con función eréctil normal. Resultados De los 132 pacientes, 96 (72,7%) de ellos reflejaron potencia durante el primer año postoperatorio. Se evaluó a un total de 118 pacientes al cabo de cinco años. Ochenta y siete (73,7%) pacientes tuvieron función eréctil normal con arreglo a nuestros criterios. Discusión En virtud de los resultados de nuestro estudio, los resultados de la función eréctil a corto y largo plazo de los pacientes sometidos a PRP fueron favorables, no existiendo diferencia estadísticamente significativa entre los resultados a corto y largo plazo