Perineal urethrostomy: surgical and functional evaluation of two techniques

Introduction. PU is an option to manage complex and/or recurrent urethral strictures and is necessary after urethrectomy and/or penectomy. PU is generally assumed to be the last option before abandoning the urethral outlet. Methods. Between 2001 and 2013, 51 patients underwent PU. Mean age (+/- standard deviation) was 60 +/- 15 years. Only 13 patients (25.5%) did not undergo previous urethral interventions. PU was performed according to the Johanson (n = 35) or Blandy (n = 16) technique and these 2 groups were compared for surgical failure, maximum urinary flow (Q(max)), urinary symptoms, and quality of life (according to the International Prostate Symptom Score). Results. Both groups were similar for patient's and stricture characteristics. Only follow-up duration was significantly longer after Johanson PU (47.9 months versus 11.1 months; P = 0.003). For the entire cohort, 11 patients (21.6%) were considered a failure (9 or 25.7% for Johanson group and 2 or 12.5% for Blandy group; P = 0.248). There was a significant improvement of Q(max) in both groups. Quality of life after PU was comparable in both groups. Conclusions. PU is associated with a 21.6% recurrence rate and the patient should be informed about this risk

Ureteral stents in urolithiasis

Ever since the ureteral stent design was fitted with a curl on both sides to prevent it from migrating up or down the ureter some 40 years ago, its use has gained tremendous momentum, aiding in the rise and evolution of endourology and has confidently kept its place in modern time urology. Over the past four decades, several designs, coating and biomaterials have been developed, trying to reduce infection, encrustation and other stent related symptoms. As the ideal stent has not yet been discovered, different ways of helping patients with their complaints have been researched. This review will cover these aspects of stent use in urolithiasis. Keywords: Ureteral stent, Prosthesis, Urolithiasis, Stent-related symptom, Alpha-blocke

Bijzondere methoden van suïcide: casuïstiek en literatuur

Suïcide wordt aanzien als een belangrijk gezondheidsprobleem. In de sterftestatistieken van Vlaan- deren kan men opmerken dat bijna 8% (2010 – 84 op 1.066 suïcides) van de methoden bij suïcide weinig tot niet omschreven is. Toch bestaat er een vermoeden dat bijzondere methoden meer voorkomen dan vroeger, wat mogelijk mee bepaald wordt door de media. In dit artikel worden aan de hand van enkele casussen en een literatuuroverzicht een paar bij- zondere methoden beschreven. Zo komt suïcide door middel van nicotine-intoxicatie, heliuminha- latie, koolstofdioxide-intoxicatie via een brandblusapparaat en koolstofmonoxide-intoxicatie via een barbecuetoestel aan bod. Daarnaast wordt de dubbele invloed van internet op suïcide besproken. De opzet van dit artikel is om de kennis, de bespreekbaarheid en de registratie van deze bijzondere vormen te verhogen

Erectile Implants in Female-to-Male Transsexuals: Our Experience in 129 patients

BACKGROUND: The combination of a neourethra and erection prosthesis in a single neophallus in the female-to-male transsexual remains a challenge. No good data are available on this subject. OBJECTIVE: To report the outcome in 129 female-to-male transsexuals with a neophallus after the implantation of an erectile prosthesis. DESIGN, SETTING, AND PARTICIPANTS: From March 1996 until October 2007, 129 female-to-male transsexuals with a neophallus underwent the implantation of an erectile prosthesis. The mean follow-up was 30.2 mo (range: 0-132 mo). INTERVENTION: A Dynaflex prosthesis was implanted initially in 9 patients, a three-piece hydraulic device (AMS CX or AMS CXM) in 50 patients, and a CX Inhibizone, Ambicor, and Coloplast/Mentor prosthesis in 17, 47, and 6 patients, respectively. MEASUREMENTS: Data on outcome in these patients were retrospectively evaluated. RESULTS AND LIMITATIONS: Of 129 patients, 76 patients (58.9%) still have their original implant in place. Fifty-three patients (41.1%) needed to undergo either removal or revision of the prosthesis due to infection, erosion, dysfunction, or leak. Forty-one patients underwent a replacement of the prosthesis, nine needed a second revision, five needed a third revision, and one patient needed a fourth revision of prosthesis. Malposition of prosthesis was corrected by surgical repositioning so that removal or revision could be avoided. Of 185 prostheses used in 129 patients, 108 (58.4%) still remain in place, with a total infection rate of 11.9%, a total protrusion rate of 8.1%, a total prosthesis leak rate of 9.2%, a total dysfunction rate of 13%, and a total malposition rate of 14.6%. The period of follow-up in the more recent types of prostheses (Ambicor, Coloplast/Mentor) is much shorter; therefore, comparison with earlier types is difficult to make. CONCLUSIONS: Despite high complication rates, implantation of a hydraulic erectile prosthesis remains the best option for achieving the possibility of sexual intercourse in female-to-male transsexuals

Abiraterone and spironolactone in prostate cancer : a combination to avoid

Objectives: Disease progression in metastatic castration-resistant prostate cancer (mCRPC) is dependent on androgen signaling. This case describes the complex adaptive androgen signaling mechanisms in mCRPC and illustrates that caution should be exercised when treating these patients with drugs influencing the androgen axis. Methods: Single case report and review of the literature. Results: We report the case of an 86-year-old?man with mCRPC, treated with the secondary antihormonal agent abiraterone acetate. Following association of spironolactone to deal with symptoms related to mineralocorticoid excess, biochemical and radiographic disease progression occurred. Spironolactone was discontinued and 8?months after withdrawal, the patient continues to show a?biochemical response to abiraterone. Conclusions: Although spironolactone generally exerts anti-androgenic?effects, experimental evidence exists that it acts as an androgen receptor agonist in an androgen-depleted?environment, capable of inducing prostate cancer proliferation. This is supported by the observations described in this case report. Therefore, spironolactone should be avoided in prostate cancer patients suffering from treatment-associated?side effects of abiraterone