Ali Thwaini

Outcome of Glansectomy and Skin Grafting in the Management of Penile Cancer

Purpose. To report outcome data for patients with penile cancer treated surgically with glansectomy and skin grafting. Materials and Methods. We retrospectively reviewed data on all patients undergoing surgical management of penile cancer by a single surgeon between 1998 and 2008. Outcomes in patients who underwent glansectomy and skin grafting were analysed. Results. Between 1998 and 2008 a total of 25 patients with a mean age 60 (39–83) underwent glansectomy and skin grafting. Six patients had carcinoma in situ (CIS); the stage in the remaining patients ranged from T1G1 to T3G3. Mean followup for patients was 28 months (range 6–66). Disease specific survival was 92% with 2 patients who had positive nodes at lymph node dissection developing groin recurrence. One patient developed a local recurrence requiring a partial penectomy. Conclusions. Penile preserving surgery with glansectomy and skin grafting is a successful technique with minimal complications for local control of penile carcinoma arising on the glans. Careful followup to exclude local recurrence is required.

Greenlight prostatectomy: A challenge to the gold standard? A review of KTP photoselective vaporization of the prostate

The use of lasers to carry out resection of the prostate gland is an ever-evolving field which has seen several different modalities of laser light used with varying success. This review looks at what makes the traditional transurethral resection of prostate the gold standard and provides the evidence on the evolution of the laser prostatectomy in trying to usurp it as the favored procedure for symptomatic benign prostatic hyperplasia. In particular, we show how the latest laser technology in the form of the Greenlight laser is challenging not only other lasers such as the holmium laser, but may form a strong contender to replace the transurethral resection of prostate.

Long-Term Follow-Up after Retroperitoneal Laparoscopic Decortication of Symptomatic Renal Cysts

Introduction: The purpose of this study was to present our long-term experience of retroperitoneal laparoscopic decortication (RLD) for patients with severely symptomatic simple renal cysts. The feasibility, safety and efficacy of this technique is reported, along with immediate and long-term clinical outcomes. Materials and Methods: Over a 6-year period, 22 consecutive patients with symptomatic simple renal cysts underwent RLD by a single surgeon. Demographic data, perioperative blood loss, length of operative procedure, length of hospital stay and complications were analyzed. Follow-up included clinical review and renal ultrasonography, at 6-monthly intervals for 1 year, and then annually. Results: The mean patient age was 45 (range 31–63) years. RLD was successfully performed in all 22 patients – no open conversions were required. There was no mortality and there were no perioperative complications. Mean duration of surgery was 101.9 min (59–117 min) and operative blood loss was <150 ml in all cases (10–150 ml). Mean length of hospital stay was 3.2 (2–6) days and return to normal activities was achieved after a mean of 15 (10–30) days. At a mean follow-up of 60 (22–93) months, 17 patients (77%) were completely relieved of symptoms, while 5 (23%) patients complained of some pain not requiring any analgesia. Renal ultrasonography showed an absence of radiological recurrence of the symptomatic renal cyst in all cases. Conclusion: RLD is a safe and effective method to treat symptomatic renal cysts, with an immediate postoperative symptomatic relief, a short convalescence period and effective 5-year clinical and radiological outcome.

Botox in urology.

Lower urinary tract dysfunction is one of the challenging problems facing urologists and patients. Several treatment trials have been introduced in the literature, but none has proven to be as effective as being a gold standard treatment for such conditions. We reviewed the literature regarding the use of botulinum toxin (BTx) type A as a current treatment of lower urinary tract conditions described below. The toxin has been shown to be safe and effective in the treatment of conditions caused by increased muscle tonicity. Indications for the urological use of BTx and future applications are also considered.

Testicular metastasis of transitional cell carcinoma of the urinary bladder : An unusual site

Abstract  We present a 74‐year‐old man with a testicular metastasis originating from a transitional cell carcinoma of the urinary bladder. Initially, radical cystectomy and ileal‐conduit urinary diversion were performed. Three years later, he presented with a tumor in the left testicle, proved to harbor transitional cell carcinoma.

THE PHOSPHODIESTERASE INHIBITORS AND NON‐ARTERITIC ANTERIOR ISCHAEMIC OPTIC NEUROPATHY: INCREASED VIGILANCE IS NECESSARY

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Gonadotropins and Prostate Cancer – Revisited

Luteinizing hormone and follicle-stimulating hormone are called gonadotropins, because they stimulate the gonads – in males the testes and in females the ovaries. They are not necessary for life, but are essential for reproduction. In addition, the association of these hormones with prostate cancer has been the interest of many researchers. Their detection in the human prostate has been investigated using different methods, including immunologic and RT-PCR techniques. In addition, the increasing evidence of paracrine/autocrine functions of the gonadotropic glycoprotein hormones, their allocation to the superfamily of cystine knot growth factors, and luteinizing hormone/chorionic gonadotropin receptor gene expression in non-gonadal tissues led many researchers to investigate intraprostatic glycoprotein hormones and their receptor gene expression. We aim in this review to shed light on the physiology of the gonadotropins and their association with prostate cancer and highlight the future possibilities of their use as targets in treating this disease.

Subclavian vein thrombosis: an unusual presentation of renal cell carcinoma

Subclavian vein thrombosis is an uncommon clinical condition which is often associated with venous catheterization or secondary to excessive effort. We present a 54-year-old female with subclavian vein thrombosis as a first presentation of renal cell carcinoma. Although this is an unusual presentation, malignancy should be considered in the differential diagnosis. Hypercoagulability as part of a paraneoplastic syndrome was considered a possible etiology. In patients with otherwise unexplained subclavian vein thrombosis, full systemic examination and radiological evaluation of the abdomen, retroperitoneum and pelvis should be pursued. A review of the literature relevant to this unusual case is provided.

Vesico-vaginal fistula post cold cup bladder biopsy: mini review

Introduction We report a case of a vesico-vaginal fistula (VVF) post cold cup biopsy; to our knowledge this is the only reported case. We present the clinical history/presentation, investigation and the outcome of the treatment. VVFs are among the most distressing complications of gynecologic and obstetric procedures. The risk of developing a VVF is more than 1% after radical surgery and radiotherapy for malignancies. Management of these fistulas has been better defined and standardized over the last decade. Methods and results A case of low grade superficial bladder cancer was treated with multiple resections of bladder tumor and a single installation of mitomycin post initial resection which successfully cleared her bladder cancer, but nevertheless led to a small size and scarred bladder. In addition there was a long history of smoking with its effects on tissue integrity and healing. VVFs are very rare and are an unpleasant outcome post a cold cup biopsy, adding to the psychological and social effects of the surgical treatment. Conclusion Although cold cup biopsy is a normal day procedure performed by both residents and consultants, consensus should exist on how to treat a patient who has a bladder with defective integrity and small capacity. The rate of successful fistula repair reported in the literature varies between 70% and 100% in nonradiated patients, with similar results when a vaginal or abdominal approach is performed, the mean success rates being 91% and 97%, respectively.

Oral complications after buccal mucosal graft harvest for urethroplasty

Sir, We read with great interest this article [1] reporting the oral complications after buccal mucosal grafting for urethroplasty. They rightly highlighted and emphasised that it is necessary to mention the oral complications at the time of obtaining consent from the patient for buccal mucosal urethroplasty. Interestingly, there were two abstracts presented at the Annual meeting of AUA in 2004 that assessed the morbidity of harvesting the buccal mucosal graft. In the report by Greenwell et al. [2], a retrospective study of 110 men of whom 48 responded, 82% had associated immediate postoperative pain, but 89% resumed a normal diet within a week. Difficulty in opening their mouth initially was noted in 66% of the patients, but persisted in only 7% after 6 months. These results prompted the authors to conduct a prospective study of 20 patients each, where they compared closing or not closing the donor site on postoperative pain. The mean pain score for closing and not closing was 3.42 and 2.61 respectively ( P < 0.01, unpaired t -test), i.e. statistically significant. They concluded that the donor site can be left unsutured to lessen pain. Another study by Jang et al. [3] compared the morbidity of harvesting of mucosa from the lower lip (group 1) and the cheek (group 2); they reported 12% with pain in group 1, whereas there was no pain in group 2 after 3 months. At 6 months there were minimal neurosensory deficits in 65% of patients in group 1 and none in group 2. There were no neuromotor or major neurosensory deficits in either group. These results are in contrast with those from the study by Dublin and Stewart [1], who reported persisting neurosensory and neuromotor deficits in many patients (16% with numbness, 32% with tightness). It could be concluded that not closing the harvest site is a promising modification to reduce morbidity at the donor site. However, the effect on delayed symptoms such as numbness, tightness of opening the mouth and other motor deficits needs to be assessed.