Η συμβολή της διουρηθρικής θερμοθεραπείας μικροκυμάτων με τη συσκευή prostalund compact στην αντιμετώπιση της αποφρακτικής καλοήθους υπερπλασίας του προστάτου

The aim of this study was to evaluate the effectiveness and to investigatethe complication rates of Transurethral Microwave Thermotherapy (TUMT)with the ProstaLund Compact Device in the treatment of obstructive benignprostatic hyperplasia (BPH).From March 2000 to November 2002 we treated 38 patients using the newProstaLund Compact device, 19 of whom had an indwelling catheter. Theage was 72.6 ± 8.2 years ( 55-90 ). The prostatic mass was 63.5 ± 30 ml.The treatment investigation tests included TRUS, urodynamics andcystoscopy for all the patients, and flow rate with urine residue, IPSS andQOL for those without catheter. A réévaluation with a new flow rate, IPSSand QOL was performed after 3 months. At 6 and 12 months a urodynamicinvestigation was repeated with cystoscopy and TRUS as well.The treatment duration was 43.1 ± 17.1 min ( 12-70 ). The maximalintraprostatic temperature was 58.7 ± 7.2 °C ( 44.8-70.4 ). The calculateddestructed prostatic tissue was 18.4 ± 14.3 gr ( 0-54 ).In the group of the 19 patients without catheter the IPSS improvement at 3months was 55.3% [ 3 mo vs. base, p50% improvement ) was73.7%. The maximum flow rate ( Qmax ) improved by 115% [ 3 mo vs.base, p 15ml/sec or >50% improvement ) of 84.2%. The urine residue( RU ) decreased by 66% [3 mo vs. base, p50% decrease ) of 73.7%.Significant drop of the median PdetQmax was seen both at 6 month and 12month values versus baseline [ base: 87.5 ± 15 cmH20; 6mo: 48.5 ± 18.3cmH20; 12 mo: 48.4± 16.4 cmH20 , p 15ml/sec ) was 25%. The urine residue was at 3months 43.4 ± 43.2 ml. At 6 months it increased by 38.8% [ 6 mo vs. 3 mo,p 15ml/sec ) ήταν 25%. ΤοΥπόλειμμα ούρων ήταν στο 3μηνο 43.4 ± 43.2 ml. Στους 6 μήνες αυξήθηκεκατά 38.8% [ 6μη vs. 3μη, ρ50% βελτίωση ) ήταν 73.7%. Η μέγιστη ροή ούρων ( Qmax )βελτιώθηκε κατά 115% [ 3 μη vs. πριν, ρ 15ml/sec ή >50% βελτίωση ). Τουπόλειμμα ούρων μειώθηκε κατά 66% [ 3 μη vs. πριν, ρ50% ελάττωση ). Σημαντικήπτώση της πίεσης του εξωστήρα στη μέγιστη ροή ( Pdet Qmax )διαπιστώθηκε τόσο στο 6 μηνο όσο και στο 12 μηνο έναντι της αρχικήςτιμής [ πριν: 87.5 ± 15 cmH20; 6 μη: 48.5 ± 18.3 cmH20; 12 μη: 48.4 ±± 16.4 cmH20 , ρ< 0.001 και στις δύο συγκρίσεις ]. Η ποιότητα ζωής( QOL ) παρουσίασε ένα ποσοστό ανταπόκρισης 94.7% ( QOL< 2 )

Mini percutaneous nephrolithotomy in the treatment of renal and upper ureteral stones: Lessons learned from a review of the literature

The aim of this review is to present the most recent data regarding the indications of mini percutaneous nephrolithotomy (PCNL), the results and the complications of the method. Medline was searched from 1997 to January 2014, restricted to English language. The Medline search used a strategy including medical subject headings and free-text protocols. PCNL is a well-established treatment option for patients with large and complex renal calculi. In order to decrease morbidity associated with larger instruments like blood loss, postoperative pain and potential renal damage, a modification of the technique of standard PCNL has been developed. This is performed with a miniature endoscope via a small percutaneous tract (11-20 F) and was named as minimally invasive or mini-PCNL. This method was initially described as an alternative percutaneous approach to large renal stones in a pediatric patient population. Furthermore, it has become a treatment option for adults as well, and it is used as a treatment for calculi of various sizes and locations. However, the terminology has not been standardized yet, and the procedure lacks a clear definition. Nevertheless, mini-PCNL can achieve comparable stone-free rates to the conventional method, even for large stones. It is a safe procedure, and no major complications are reported. Although less invasiveness has not been clearly demonstrated so far, mini-PCNL is usually related to less blood loss and shorter hospital stay than the standard method

Pulmonary Embolism following Percutaneous Nephrolithotomy: An Uncommon and Life-Threatening Complication

High risk pulmonary embolism is a rare and life-threatening complication following percutaneous nephrolithotomy. We report the case of a previously healthy, 44-year-old male, who developed acute pulmonary embolism following right percutaneous nephrolithotomy. On the 1st postoperative day, the patient presented with hemodynamic instability, acute respiratory distress, hypoxia, and loss of consciousness. He was urgently intubated and placed on mechanical ventilation. Clinical findings set the suspicion of pulmonary embolism with shock. Chest computed tomography scan confirmed the diagnosis. The patient underwent urgent thrombolysis in the cardiac care unit. On the 2nd postoperative day, the patient was admitted to the intensive care unit due to hemodynamic instability and fever. The postoperative course was complicated by right renal bleeding on the 3rd postoperative day, which was managed through angiography and angioembolization of the lower segmental right renal artery, followed by recurrent respiratory and urinary tract infections. The patient was transferred back to the urology department on the 66th postoperative day and was discharged seven days later

Multiple and Bilateral Sporadic Renal Cell Carcinomas: A Surgical Challenge

Sporadic, synchronous, bilateral, or unilateral Renal Cell Carcinomas constitute a rare clinical entity. We report the case of a 68-year-old male patient who presented in our department due to incidentally discovered multiple, bilateral renal tumors. Magnetic Resonance Imaging demonstrated cT1b renal tumors at the lower pole of each kidney and a cT1a renal tumor at the upper pole of the right kidney. The patient underwent transperitoneal, laparoscopic left partial nephrectomy with renal artery occlusion, histology revealed high-grade, pT1b, clear-cell renal cell carcinoma; however we observed decline of patient’s estimated glomerular filtration rate postoperatively. Forty days postoperatively, he underwent open partial nephrectomy for the right sided tumors with manual compression of the renal parenchyma and no use of ischemia. Histology revealed high-grade, pT1a, clear-cell renal cell carcinoma at the upper pole of the right kidney and low-grade, pT1b, clear-cell renal cell carcinoma at the lower pole of the right kidney. There was no additional decline in the serum creatinine value postoperatively. The patient avoided permanent or temporary dialysis and 6 months postoperatively he demonstrated no recurrence on imaging and his renal function remained stable

A Rare Case of Localised Isolated Penile Fournier’s Gangrene and a Short Review of the Literature

Penile Fournier’s gangrene (FG) is very rare clinical entity, which is also known as penile necrotizing fasciitis or wet gangrene of the penis. It is associated with increased morbidity and mortality and in the majority of the described cases it affects not only penis but also the adjacent organs and tissues (e.g., bladder, muscles, rectum, testis, and scrotum). We report a rare case of a previously healthy 68-year-old male, who presented with acute isolated penile Fournier’s gangrene. Pus culture was identified with pathogens Enterococcus faecalis, Streptococcus gordonii, and Prevotella melaninogenica. Prompt surgical exploration, fluid resuscitation, antibiotic treatment, and diligent postoperative care are the cornerstone in the successful treatment of this emergency with high mortality

A Rare Case of Localised Isolated Penile Fournier’s Gangrene and a Short Review of the Literature.

Penile Fournier&apos;s gangrene (FG) is very rare clinical entity, which is also known as penile necrotizing fasciitis or wet gangrene of the penis. It is associated with increased morbidity and mortality and in the majority of the described cases it affects not only penis but also the adjacent organs and tissues (e.g., bladder, muscles, rectum, testis, and scrotum). We report a rare case of a previously healthy 68-year-old male, who presented with acute isolated penile Fournier&apos;s gangrene. Pus culture was identified with pathogens Enterococcus faecalis, Streptococcus gordonii, and Prevotella melaninogenica. Prompt surgical exploration, fluid resuscitation, antibiotic treatment, and diligent postoperative care are the cornerstone in the successful treatment of this emergency with high mortality

Synchronous Malignant Peripheral Nerve Sheath Tumor and Adenocarcinoma of the Prostate: Case Report and Literature Review

Malignant Peripheral Nerve Sheath Tumors (MPNSTs) of the prostate are extremely rare. A very unusual case of simultaneous adenocarcinoma and MPNST of the prostate is reported. A 60-year-old Caucasian male presented for annual urologic examination. Digital rectal examination revealed a painless, toughish, and asymmetrically enlarged prostate. Serum prostate-specific antigen was 1 ng/mL. Radiologic examinations demonstrated a large mass, which was arising from the left peripheral lobe of the prostate. The patient underwent transrectal ultrasound-guided biopsy of the prostate which revealed a smooth muscle tumor of uncertain malignant potential. Radical retropubic prostatectomy with en bloc removal of the mass and the seminal vesicles was performed and histology demonstrated low-grade MPNST and adenocarcinoma of the prostate. To the best of our knowledge, this is the first report of simultaneous prostatic adenocarcinoma and MPNST in the English literature

Macroscopic Appearance of Giant Adrenal Myelolipoma During Laparoscopy: An Adjunct in Differential Diagnosis

Giant adrenal myelolipoma is a rare, benign, sizable, mesenchymal tumor. Preoperative differential diagnosis from retroperitoneal liposarcoma may be challenging. A 66-year-old female patient was admitted because of a sizable tumor at the right retroperitoneal space, incidentally discovered during abdominal ultrasonography for screening purpose. Preoperative imaging studies were indicative for the diagnosis of a giant adrenal myelolipoma (11.7 x 12.9 cm in size); however, a retroperitoneal liposarcoma could not be excluded. We decided to proceed with tumor&apos;s surgical removal by using laparoscopic transperitoneal approach and three-dimensional high-definition camera. Intraoperatively, the tumor did not infiltrate surrounding tissues and was surrounded by a thin capsule under which there were sparse, orange-colored spots that resembled adrenal cortex. This finding reinforced the initial and most possible diagnosis of adrenal myelolipoma and we easily enucleated the mass. Postoperative course was uneventful, and the patient demonstrated no recurrence on imaging six months postoperatively. Histology confirmed the diagnosis of giant adrenal myelolipoma, measuring 16.5 x 15 x 6.5 cm

Laparoscopic Resection of a Non-functional, Extra-adrenal Paraganglioma: A Case Report and Literature Review

Non-functional, extra-adrenal, retroperitoneal paraganglioma is a rare, neuroendocrine, and potentially malignant tumor. Its diagnosis and treatment may be challenging. A 69-year-old female patient was admitted because of a left para-aortic, solid, 4.4-cm mass, incidentally discovered during abdominal ultrasonography for screening purposes. Her clinical examination was unremarkable. Preoperative differential diagnosis based on cross-sectional imaging included tumor of neuroendocrine or mesenchymal origin. Hormonal investigation with 24-hour urinary catecholamines and metanephrines and plasma-fractionated metanephrines was in the normal range. Following consultation with the endocrinologist and anesthesiologist, the tumor was removed by using the three-dimensional (3D) laparoscopic transperitoneal surgical approach. The perioperative course was uneventful and the patient was discharged on the third postoperative day. Histopathologic findings were consistent with the diagnosis of retroperitoneal extra-adrenal paraganglioma of 5 cm in maximum diameter