Fracture of the penis: treatment and complications.

Fracture of the penis is an unusual blunt traumatic injury of the erect penis. Twenty-five such cases, treated at the 2 main urological departments in the town of Varna between 1984 and 1999, were analyzed retrospectively. The average annual incidence in this series was 0.33 per 100,000 inhabitants. Most of the injuries occurred during vigorous sexual intercourse. Clinical diagnosis was mainly based on the patient's history and the physical findings. The diagnosis was verified by ultrasonography. In a few cases retrograde urethrography and cavernosography were used as additional diagnostic tools. Cavernosography was complicated by postprocedural priapism in 1 case. Unilateral tear of the corpora cavernosa was found in 24 cases. In 3 cases, partial (in 2) or complete (in 1) disruption of the corpus spongiosum and the urethra was found as well. The trauma was bilateral in 1 case in which 2/3 of the entire circumference of the penis was ruptured, including both corpora cavernosa and the urethra. Seventeen patients received immediate surgical repair. Most of them experienced an uneventful postoperative period with no serious consequences affecting their sexual function. Surgery was delayed in 6 and rejected in 2 cases. In all cases in which conservative (nonsurgical) management was the first treatment option, late complications (penile aneurysm, induration, penile curvature, erectile dysfunction) were observed and the final results were assessed as satisfactory or poor. We recommend immediate surgical treatment of all cases of penile fracture. Emergency surgical repair offers a chance for complete recovery and is the best method for providing a good functional prognosis.</p

Prognostic value of biological markers in superficial bladder tumors

The early identification of urinary bladder cancer patients, who are at a high risk of developing recurrences and tumor progression, is of utmost importance, because they require a more aggressive therapeutic approach and close follow-up. The routine use of new prognosticators, more specific and reliable than the established clinicopathologic factors, is therefore mandatory. The present work reviews some of the most significant biological tumor markers (cell cycle proteins, blood group antigens, tumor suppressor genes, oncogenes, CD44 gene transcripts, etc.) defined immunohistochemically in bladder cancer patients. It summarizes most of the recently published results of the clinical trials, using these markers as predictors of the tumor growth, invasion and metastasis. It is also an attempt to highlight the present state of the problem, the still existing controversy and some of the hypotheses concerning the predictive potential of the recently detected tumor markers.Biomedical Reviews 1995; 4: 85-94

`ACUTE SCROTUM`: UNSOLVED DIAGNOSTIC AND THERAPEUTIC PROBLEMS

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An 18-kg giant variant of a well-differentiated retroperitoneal liposarcoma of the kidney

Well-differentiated liposarcoma (WDLS), the most common type of liposarcoma is a slow growing, painless tumor usually located in the retroperitoneum or the limbs.In this abstract we present a case of a 71-year-old male who presented in our clinic with a diagnosis of a giant WDLS. We performed a CT scan from which we found a giant abdominopelvic mass originating from the right kidney. This mass was pushing almost all organs and structures from the right abdominal cavity across the midline to the left side, which includes the IVC, aorta and the right ureter, all bowels were also pushed and were above this mass. A large 18-kg fibro-fatty mass was extirpated. The histopathological findings reported low-grade differentiated liposarcoma. The CT scan, which was done 3 months after the operation, determined that the patient was free from recurrence

MODERN DIAGNOSIS AND TREATMENT OF SUPERFICIAL BLADDER TUMORS

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Laparoscopic radical cystectomy - initial experience

Introduction: Radical cystectomy with extended pelvic lymph node dissection is the standard treatment for muscle-invasive bladder cancer. The aim of this study is to report our initial experience of our series of 22 patients who underwent laparoscopic radical cystectomy with different urinary diversion.Materials and Methods: Between March 2015 and March 2016, 22 patients underwentlaparoscopic radical cystectomy with different types of extracorporeal urinary diversion. Patients were aged 54 to 85 (average age 66.3) with different clinical stages of the disease.Transperitoneal laparoscopic radical cystectomy with five ports in all cases was performed with bilateral extended pelvic lymph node dissection.Results: In 5 cases we performed radical cystectomy with subsequent ureterocutaneostomy, in 7 cases we performed ileal conduit according to the method of Bricker, and in 10 cases we formed orthotopic bladder from ileal loop by the method of Hautmann. All operations were performed with an average blood loss of 270 ml, with an average operating time of 5 hours, and an average hospital stay of 7 days. No conversion was required in any case. The patients were observed postoperatively. Early complications (within 30 days) occurred in 2 patients, and late complications occurred in 3 patients.Conclusion: Laparoscopic radical cystectomy is possible, although technically difficult, with significant reduction in patient morbidity. With more experience and an improvement of the surgical technique, laparoscopic radical cystectomy with different types of derivation becomes an alternative surgical method for treating patients with localised muscle invasive bladder carcinoma

Laparoscopic nephropexy: Treatment outcome and quality of life

INTRODUCTION: Surgical treatment of nephroptosis is rarely performed nowаdays and is done only in symptomatic patients. Here we present the results of our laparoscopic nephropexy in patients with symp­tomatic nephroptosis.MATERIALS AND METHODS: For a period from March 2014 to March 2015, a total of 8 women at an av­erage age of 54 years were operated on in our clinic . Four of the patients were with nephroptosis of the left kidney, three of the right one and one had bilateral nephroptosis. Most of the patients complained of pain and discomfort in active movement, only one individual had complaints consisting of intermittent macro­scopic hematuria. One patient had been operated on in the past by a classic open method of the same kidney. Preoperatively, for all patients, intravenous urography in supine and standing position was performed. All patients were operated on trans-peritoneally through 3 ports: 1x10 mm and 2x5 mm. The kidney was com­pletely mobilized and kidney fat was dissected. The upper and middle pole of the kidney were fixed to mus­culus psoas major, using a single non-absorbable suture and intracorporeal technique for tying.RESULT: All operations were performed with minimal blood loss, an average operating time of 45 minutes and a hospital stay of 4 days. No conversion was required in any of the cases. Postoperatively, patients were tracked and monitored by ultrasound examination. At 3 months we did IVP, which showed the correct loca­tion of the kidney. All patients remained asymptomatic for an average of 11 months after surgery.CONCLUSION: Laparoscopic transperitoneal nephropexy is a safe and effective procedure and a promising method for correction of symptomatic nephroptosis

Ileal substitution of a radiologically injured duplex female ureter via novel antireflux technique

A 34-year-old female patient underwent total hysterectomy and pelvic irradiation for uterine malignancy, which led to iatrogenic fibrotic injury of the distal ureter. Reconstructive surgery was performed, and the ureter was replaced by an isolated ileal segment. Ureteroileal anastomosis was created using the antireflux serous-lined extramural tunnel technique, while the distal end of the isolated ileal segment was widely anastomosed with the bladder. Within a 1-year follow-up, excellent results were achieved, with complete recovery of the patient's renal function and previous quality of life. This technique could be a viable option when large ureteral defects are encountered

Is vitamin D associated with testosterone in benign prostate hyperplasia?

Introduction. Benign prostate hyperplasia (BPH) affects about 50% of male population between 51-60 years and almost 90% of 81-90 aged males. It is considered that BPH pathogenesis involves epithelial cells and stromal tissue proliferation inside prostate gland and testosterone is one of the promoting factors of prostate cell growth. Evidences about the antiproliferative effects of vitamin D and the widespread vitamin D deficiency and insufficiency among Bulgarian population suggest a possible relation between vitamin D and testosterone in BPH patients.Aim. To evaluate the vitamin D status and total testosterone (TT) levels in BPH patients and their associations with laboratory parameters such as prostate specific antigen (PSA) for prostate growth.Materials and methods. A total of 37 male BPH patients (mean age 67,14±7,77 years) were enrolled in the study. In all patients, BPH was histologically proven. PSA and ТТ levels were analyzed immunochemically. The circulating form of vitamin D, 25-hydroxyvitamin D (25OHD) was assayed by liquid chromatography with mas-spectrometry detection (LC-MS/MS). Other covariates (BMI, age,) were collected by interview at the time of hospitalization. Classical biochemical parameters were assayed by routine spectrophotometric tests. Descriptive statistics, variation and non-parametric correlation analysis were used. The level of significance was set at p<0.05.Results. The mean level of 25OHD for BPH patients was close to the lower reference limit of 50nmol/L recommended by the US Endocrine Society Guideline. The majority of BPH patients (56.8%) display 25OHD levels above 50nmol/L, 43.2% of them were vitamin D deficient (25OHD < 50nmol/L), 8.1% - with severe vitamin D deficiency (25OHD <25nmol/L), and only 6 patients (16.2%) had optimal 25OHD levels above the limit of 75 nmol/L. The mean serum TT levels of BPH patients were 10.74 ± 4.026 nmol/L, close to the lower limit of 10.4 nmol/L for normal TT, according to the recommendations of the Endocrine Society. A significant seasonal variations were found for 25OHD levels (p<0.05) between the cold and warm season. Similar seasonality was not established for TT. Two-thirds of BPH patients (62.9%) were with PSA values below the upper limit of the reference interval of 4 ng/ml. Higher 25OHD levels (59.21 ± 3.756 nmol/l, p= 0.06) were established for the group with PSA below the threshold of 4ng/ml. A moderate negative correlation (Spearman r= -0.6707, p<0.01) was found only for the vitamin D deficient group. In case of vitamin D sufficiency, a weak positive trend was detected.Conclusion. Our study indicated vitamin D insufficiency in BPH patients according to the criteria of the Endocrine Society. Strong negative correlation between 25OHD and TT levels was found for vitamin D deficient BPH patients. Higher 25OHD were associated with lower PSA values indicating a potential favorable effect of 25OHD on slackening of BPH

Laparoscopic treatment of large hydatid kidney cyst

Въведение: Участието на бъбреците е много рядка клинична проява в случаите на ехинококова инфекция, дори много по-рядко се наблюдава изолирано ангажиране само на бъбреците. Пациентите най-често са асимптоматични или имат болки в лумбалната област, при някои от тях се наблюдава хематурия и хидатидурия. Хирургичното лечение е основният терапевтичен подход, който най-често се извършва по класически отворен метод, при възможност със запазване на бъбрека. Минимално инвазивни хирургични техники са описани наскоро и са въведени като възможност за лечение от първа линия в някои страни.В този доклад представяме рядък случай на първична бъбречна ехинококоза, изразяваща се с голяма киста на десния бъбрек, лекувана чрез лапароскопския метод (фенестрация).Материал и методи: Представяме пациентка на 21 год., приета в нашата клиника по повод на неспецифични болки в дясна лумбална област с продължителност от една година. Пациентката не съобщава за други симптоми като гадене, повръщане или фебрилитет. След извършената абдоминална ехография ние установихме голяма киста на десния бъбрек, което наложи извършването на компютърна томография (КТ) с интравенозен контраст на гръдния кош, корема и малък таз. От направения КТ се потвърди ехографската диагноза: голяма хидатидна киста на десен бъбрек с размери 10х10 см, причинявайки мас ефект на бъбрека и околните структури, включително черния дроб. Преди операцията пациентката бе консултирана с паразитолог с оглед находката от КТ, който назначи да се започне консервативно лечение с антипаразитен медикамент два пъти дневно 400 мг Albendazole. След 10-дневен прием на медикамента и предоперативна подготовка пациентката бе оперирана чрез трансперитонеален лапароскопски метод под обща анестезия в лявата странична позиция.Резултати: Операцията се извърши с минимална загуба на кръв, оперативното време бе 60 мин. Ранният следоперативен период премина гладко и без усложнения. Контактният дрен бе отстранен 24 часа след процедурата. Пациентката бе изписана клинично здрава на четвъртия ден след операцията.Заключение: Лапароскопско лечение на големи хидатидни кисти на бъбреците е минимално инвазивен безопасен метод. След щателна подготовка на пациента и правилна хирургична техника, за да се предотврати десиминация, както и запазване на бъбреците, когато това е технически възможно, трябва да се направи на всички пациенти поради доброкачествеността на заболяването.Introduction: The involvement of the kidneys is very rare clinical manifestation in cases of hydatid infection even rarer isolated (alone) engaging only the kidneys. Patients most often are asymptomatic or they have pain in the lumbar region, haematuria, hyda- tiduria. Surgery is the main therapeutic approach, which is most often performed with classic open method with preserving of kidney if possible. Minimally invasive surgical techniques are described and introduced as a treatment option in the recent yearend in the some countries.In this abstract we present a rare case of primary renal hydatid cyst of the right kidney treated by laparoscopic method (fenestration).Material and methods: We present 21 years female patient, admitted in our clinic with right nonspecific flank pain from duration of one year. the patient does not have other symptoms like nausea, vomiting or fewer. After ultrasonography we found large cyst on the right kidney, which required to performed computed tomography (CT) scan with i.v contras, of the chest, abdomen, and pelvis, which finds large hydatid cyst 10Ñ…10 cm, on the right kidney, causing mass effect on the kidney and surrounding structures including the liver. Before the operation patient started twice a day 400 mg Albendazole, which was prescribeded form parasitologist. After preoperative preparation patient was operated by transperitoneal laparoscopic approach. The patient was operated under general anesthe-sia in the left lateral position, the pneumoperitoneum was made with Veres needle. Four laparoscopic trocars were used 2x5mm and 2x10 mm, and they were inserted under optic vision. After dissection the attachments of the mseocolon to the kidney, incision is made along the white line of Told, to reflect the colon off the cyst. After placing the well-moistened 30% solution of sodium chloride around the cyst, we used large bore needle to make puncture and aspiration of fluid from the cyst. Two hundred milliliters of Braunol were gradually injected in the cyst for 15 min, in two consecutive intervals, and the cyst was then completely emptied carefully followed by aspiration and evacuation of all scolexes. Again we repeat flushing with 200 ml of solution of Braunol placed in the cyst for 15 min. Suturing of the opening of the cyst, and placing the contact drain.Results: The operation was done with minimal blood loss, for operating time of 60 min. Early postoperative period went smoothly and without complications. Drain was removed on 24 hours after the procedure. The patient was clinically healthy discharge four days after surgery.Conclusions: Laparoscopic treatment of large hydatid cysts of the kidney is safe feasible method. After preparation of the patient and respect for the surgical technique in order to prevent desimination, preserving the kidney should be made to all patients where technically is possible because to the benign of the disease