Enrique Rijo

Superficial dorsal penile vein thrombosis: a little-known complication of subinguinal varicocelectomy.

Study Type – Therapy (case series)
Level of Evidence 4

Does mechanical morcellation of large glands compromise incidental prostate cancer detection on specimen analysis? A pathological comparison with open simple prostatectomy

ObjectiveThis study sought to compare the incidental prostate cancer (iPCa) detection rate between pathological specimens from green laser enucleation of the prostate (GreenLEP) and open simple prostatectomy (OSP).Materials and methodsIn two institutions, the charts of all consecutive patients who underwent OSP between January 2005 and December 2010 were retrospectively reviewed, and the data of all consecutive patients who underwent GreenLEP with tissue morcellation between July 2013 and January 2018 were also collected. Preoperative demographics and pathological findings were recorded. iPCa detection rate was retrospectively compared between the GreenLEP and OSP groups in a propensity score model, including all predetermined variables: Age, preoperative PSA level and prostate volume.ResultsOf 738 patients, 402 were included in the propensity-score matching analysis, and they were equally distributed among groups. The overall iPCa detection rates were similar in both groups (9.9% vs. 8.5%; p = 0.73), and there were no statistically significant differences in terms of tumour stage, Gleason score or the rate of clinically significant iPCa, although the number of cassettes analysed was significantly higher in the morcellation group than in the OSP group. No predictive factors for iPCa were identified.ConclusionsThe results of the present study suggest that the mechanical morcellation of large glands had no influence on iPCa detection. Compared with a specimen from standard OSP, a large morcellated tissue sample allows adequate pathological evaluation and does not alter a pathologist’s ability to detect iPCa.

Recommendations for Safe and Efficient Morcellation After Endoscopic Enucleation of the Prostate

OBJECTIVE Background:After EEP (HoLEP, ThuLEP, GreenLEP or bipolar) the enucleated tissue is removed through a process of mechanical morcellation. Morcellation is the last, and very important, step in EEP procedures. It introduces additional time, and the possibility for complications exists. Although this is not a difficult procedure, it requires a learning curve that can pose a challenge for inexperienced surgeons. There are two types of morcellation systems: oscillating and reciprocating (depending on blade movement). OBJECTIVE To demonstrate tips and tricks for safe and efficient morcellation after EEP and to share our experience with the oscillating morcellation system. MATERIAL AND METHODS Four hundred and thirty-six patients were treated with green laser enucleation of the prostate by 3 surgeons with the en bloc technique between June 2013 and November 2016. After completing the enucleation procedure we removed the adenoma with an oscillating mechanical morcellator (Piranha, Richard Wolf, Germany). We have reported our experience (including the learning curve) and collected multiple videos exemplifying not only proper techniques for safe morcellation, but also possible problems and their solutions. The authors have compiled their collective experience to offer tips and tricks as well as a practical approach to trouble shooting and problem solving of the morcellation procedure. RESULTS The median morcellation time was 5.00 minutes (3.00; 10.0) and the median morcellation efficiency was 11.0 g/min (7.70; 16.0). Complications included 2 cases of superficial bladder injuries and no bladder perforations. CONCLUSION Morcellation is a safe and appropriate procedure to remove the adenoma after endoscopic enucleation of the prostate. However, without taking proper precautions major complications can occur. This video serves as a guide for safe morcellation after EEP and also offers practical advice to help avoid the most common complications in this procedure.

MP73-01 PREDICTIVE FACTORS OF URINARY INCONTINENCE AFTER GREENLIGHT® LASER ENUCLEATION OF THE PROSTATE (GREENLEP)

Hypothesis / aims of study Post-operative, although it is most often transient, is usually regarded as a major drawback of endoscopic enucleation of the prostate. Several studies have aimed to assess de novo urinary incontinence and its predictors after Holmium Laser enucleation of the prostate. Greenlight® laser enucleation of the prostate (GreenLEP) has recently been described and has been shown as a promising way to perform endoscopic enucleation of the prostate. The aim of the current study was to assess de novo urinary incontinence after GreenLEP and to seek its predictors.

Complex vesico-vaginal fistula repair with posterosuperior bladder flap

Introduction: Vesicovaginal fistulae (VVF) remain one of the most challenging problems in modern female urology. VVF are classified as simple and complex. Complex fistulae are fistulae of large size (greater than or equal to 3 cm in diameter); those recurring after prior attempts at closure; those associated with a history of prior radiation therapy or with malignancy; those occurring in a compromised operative field owing to poor healing or host characteristics and those involving the trigone, bladder neck and/or urethra. Materials and Methods: From November 1985 to September 2010, 58 cases of VVF were repaired at our institution with the Gil-Vernet technique, without the necessity of interposition of any autologous or heterologous material. We present the case of a 44-year old woman with a previous history of cesarean, who presented with vaginal urine leakage after bladder injury with an initial attempt of primary closure during laparoscopic hysterectomy for uterine myoma. This video describes the VVF repair using a autoplasty closure with posterosuperior vesical flap “The GilVernet technique. Results: In 99.41% cases closure of the fistula was achieved at the first sur gical attempt. Conclusion: In our experience, the Gil-Vernet technique has been successful in most cases and we recommend this technique for repair of complex VVF.

URORECTAL FISTULAE FOLLOWING THE TREATMENT OF PROSTATE CANCER: LETTERS

The paper by Mundy et al . [ 1 ] provides an excellent revision of the literature about URF and their experience in URF surgical management, but suggested that ‘ The York Mason procedure is now obsolete ’ based on the two standard colo-rectal surgery textbooks [ 2,3 ] , ‘ at least in part because of the high incidence of fecal incontinence [ 2,3 ] and fi stulation ’ [ 4,5 ] . The four references cited by Mundy et al . [ 1 ] are 10 years old or more and no mention is made of recent publications by centres with successful experience with the York Mason approach [ 6 – 12 ] ( Table 1 ).

Retrourethral transobturator sling AdVance® for the treatment of male SUI after radical prostatectomy

Introduction: Despite improved surgical techniques, exist an increasing number of patients suffering post-prostatectomy stress urinary incontinence (SUI). Some 2-5% of the patients with incontinence after radical prostatectomy exhibit a persistent incontinence for >1 yr postoperatively despite conservative therapy attempts. For these patients surgical treatment is recommended and the artificial urinary sphincter is still the gold standard. The retro-urethral transobturator sling (AdVance®) represents a non-obstructive, functional therapeutic approach. Methods: A 64-year-old male had an elevated PSA level of 6 ng/ml. The DRE findings were negative for palpable nodules and subsequent TRUS-guided needle biopsy of the prostate showed right-sided prostatic adenocarcinoma, Gleason score 7(3+4). The patient underwent a transperitoneal LRP, the tumor was confined to the prostate with negative surgical margins (stage T1cNxMx). The follow-up PSA level was undetectable and 14 months later presented moderate SUI (3-4 pads/daily), despite conservative therapy. A previous urethrocystoscopy was performed to evaluate the sphincter function and the mobility of the posterior urethra (changes achieved by perineal pressure). The AdVance® sling (American Medical Systems) was placed for the treatment of SUI according to the Rehder and Gozzi method, with a total operative time of 40 min and estimated blood loss of 70 mL. The hospital course was uneventful and the patient was discharged on the first post-interventional day. This video demonstrates the surgical technique (step-by-step). Results: After 1 year, complete continence (no pads) was achieved and quality-of-life score improved significantly. Conclusions: The AdVance® represents an effective, safe and minimally invasive treatment option for mildto-moderate SUI post-radical prostatectomy. Int Braz J Urol. 2010; 36 (Video #7): 518_9 Available at: www.brazjurol.com.br/videos/july_august_2010/Rijo_518_519video.htm Correspondence address: Dr. Enrique Rijo Universitat Autonoma de Barcelona Department of Urology. Hospital del Mar Passeig Maritim 25-29 Email: rijo_enrique@yahoo.es doi: 10.1590/S1677-55382010000400030