Achaiki Iatriki : official publication of the medical society of western Greece and Peloponnesus

In the current issue, the editorial by Cauchi et al. argues for eco-friendly measures in endoscopy and emphasies the role of healthcare providers in reducing waste. The editorial adeptly employs the three Rs (Reduce, Reuse, Recycle) framework to tackle waste management, offering practical solutions. The editorial by Milionis et al. focuses on the reverse cascade screening for paediatric familial hypercholesterolaemia (FH), which is an upcoming tool for public health. Advantages, practices, and challenges regarding FH are thoroughly discussed. Lastly, the editorial by Fousekis et al. presents the main aspects of a chronic immune-mediated cutaneous disease, dermatitis herpetiformis (DH), which constitutes an extraintestinal manifestation of celiac disease, including its diagnosis, pathogenesis, and management. Moreover, this issue includes three review articles. The review article by Krontira et al. discusses the evolving data on the epidemiology, diagnostic approach and appropriate management of foreign body and caustic substance ingestion, based on updated guidelines published by gastroenterological and endoscopic societies. The review by Halliasos et al. provides data on the clinical presentation, diagnosis, and management of metastatic acute spinal cord compression, focusing on the importance of a multidisciplinary team approach, including spine surgeons, radiation oncologists, medical oncologists, palliative care clinicians, physiotherapists, and psychologists. Lastly, the review by Schinas et al. outlines the potential of immune modulation in the treatment of infections and the need for individualised approaches in the modern world of personalised medicine by examining some of the key strategies and immune-based therapies being developed to combat infectious diseases.peer-reviewe

Clinical experience with ureteral metal stents

Ureteral metal stents (MSs) present a minimally invasive tool to preserve the drainage of renal pelvis whenever ureteral patency is at risk to be obstructed due to extrinsic or intrinsic etiologies. Clinical experience with these stents demonstrates that they impose a promising alternative treatment option in ureteral pathologies that are difficult to be treated via common polymeric stents. Current application of MSs in the treatment of both benign and malignant ureteral obstruction reveals quite promising results. Nevertheless, the ideal MS that would provide uncomplicated long-term effectiveness is still lucking and current MS usage is facing several adverse effects between which stent obstruction, encrustation, infection, migration, and patient discomfort. Ongoing attempts to create more inert stent with sophisticated novel designs are expected to improve current MS efficiency. MSs will play a major role in the future as a routine management of a variety of ureteral pathologies

Laparoendoscopic single-site surgery and cancer

Objectives: To perform a survey of the current state of laparoendoscopic single-site surgery (LESS) and its implementation in the treatment of malignant disease of the urinary tract. Although it is a recent development in the field of laparoscopic surgery with still unproven long-term results, LESS may prove to be more commonly performed in the coming years while managing urologic cancer patients. Materials and Methods: A PubMed search was conducted using the key words laparoendoscopic single-site surgery, LESS, urologic cancer. Relevant articles were reviewed for data on the management of urologic malignancy with LESS. Results: The first articles describing LESS for urologic cancers were published in 2007. Since then, published experience with this technique has increased. LESS has been implemented as an alternative to conventional laparoscopic surgery and open surgery for the treatment of major urologic cancers. The proposed advantages of LESS are the aesthetic benefit of a single incision and a quicker and less painful recovery. Disadvantages are the lack of instrument triangulation, instrument clashing and the steeper learning curve. As this is a fairly recent technical innovation, long-term functional and oncological results for LESS have not yet been published. Conclusions: LESS is a novel technical advance over conventional laparoscopic surgery, and it can be successfully used in the treatment of patients with urologic cancers. Published data support the feasibility and safety of LESS interventions for major urologic cancers, and newer data may assist in finding LESS′s ultimate position among therapeutic options for patients with urologic malignancies

Anatomical landmarks of radical prostatecomy

Introduction: In the present study, we review current literature and based on our experience, we present the anatomical landmarks of open and laparoscopic/endoscopic radical prostatectomy. Methods: A thorough literature search was performed with the Medline database on the anatomy and the nomenclature of the structures surrounding the prostate gland. The correct handling of puboprostatic ligaments, external urethral sphincter, prostatic fascias and neurovascular bundle is necessary for avoiding malfunction of the urogenital system after radical prostatectomy. Results: When evaluating new prostatectomy techniques, we should always take into account both clinical and final oncological outcomes. The present review adds further knowledge to the existing “postprostatectomy anatomical hazard” debate. It emphasizes upon the role of the puboprostatic ligaments and the course of the external urethral sphincter for urinary continence. When performing an intrafascial nerve sparing prostatectomy most urologists tend to approach as close to the prostatic capsula as possible, even though there is no concurrence regarding the nomenclature of the surrounding fascias and the course of the actual neurovascular bundles. After completion of an intrafascial technique the specimen does not contain any periprostatic tissue and thus the detection of pT3a disease is not feasible. This especially becomes problematic if the tumour reaches the resection margin. Discussion: Nerve sparing open and laparoscopic radical prostatectomy should aim in maintaining sexual function, recuperating early continence after surgery, without hindering the final oncological outcome to the procedure. Despite the different approaches for radical prostatectomy the key for better results is the understanding of the anatomy of the bladder neck and the urethra. (c) 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved