Georgios Dimitriadis

Urological symptoms of acute appendicitis in childhood and early adolescence

We present 15 cases of acute appendicitis in ten boys and five girls (age 3–15 years) with cardinal symptomatology coming from the urogenital tract, who were treated in our departments. All the patients presented with right renal colic, dysuria, frequency and urinary retention. The symptoms were attributed to an ongoing appendix inflammatory process in close proximity to the right distal ureter and urinary bladder. All the patients were successfully operated, and postoperative courses were uneventful. As the present patient group is the largest reported to date, a classification of the pathophysiology in relation to the clinical presentation is proposed.

Treatment of Indinavir sulfate induced urolithiasis in HIV-positive patients

Indinavir sulfate is a protease inhibitor used of the treatment of primary HIV infection either as monotherapy or as part of antiretroviral treatment schemes. Approximately 10% of all patients develop urolithiasis with radiolucent stones consisting of indinavir.We present our results of the treatment in 11 HIV positive patients (9 men, 2 women), who developed Indinavir lithiasis after 5–8 months of antiretroviral therapy. Following the initial procedures (spasmoanalgetic drugs, ureteroscopy, double J-stent or nephrostomy), the patients were further treated by increasing diuresis and urinary acidification.All the patients responded well to the treatment, the obstruction was releieved and their renal function was restored to normal.

Complications of Inflatable Penile Prostheses Implantation Classified according to the Modified Clavien System

Introduction. In patients with erectile dysfunction (ED), inflatable penile prosthesis (IPP) surgery is regarded as the gold standard treatment in medically refractory cases or where its conservative treatment options are contraindicated. Despite improvements in surgical technique and implanted materials, IPP surgery retains a substantial complication rate. The aim of the study was to record and grade the postoperative complications of IPP implantation according to a modified Clavien system. Methods. A total of 60 three-piece IPP implantations were performed between 2007 and 2013 by a single surgeon. The primary outcome was to stratify the early (first 30 days) complications into five categories using the modified Clavien-Dindo classification system. A secondary aim was to record the long-term adverse events and to identify possible factors related to complication occurrence. Results. Overall, there were 21 (35%) postoperative complications in 17 of 60 men (28.3%), with 15 adverse events occurring early after surgery. In terms of late complications, there were six (10%) major complications managed by either revision surgery or removal of the prosthesis. Conclusion. This study utilizes a validated morbidity scale thus overcoming problems of previous studies reporting IPP surgery complications. The modified Clavien classification system easily aids in assessing and comparing accurately patients’ postoperative complications, thus improving management and prevention.

Urinothorax—An Underdiagnosed Cause of Acute Dyspnea: Report of a Bilateral and of an Ipsilateral Urinothorax Case

Urinothorax (UT) is a rare and often undiagnosed condition, defined as the presence of urine in the pleural cavity due to the retroperitoneal leakage of urine accumulation, known as urinoma, into the pleural space. UT usually is a transudative pleural effusion that presents in patients with obstructive uropathy and it may occur following surgical procedures in the ureter or kidney such as ESWL, PCNL, and URS. Its diagnosis requires a high degree of clinical suspicion since the respiratory symptoms tend to be absent or mild and the urological signs tend to dominate. However, UT may rarely present with severe and acute dyspnea as well. The objectives of this study are to describe two new cases of this rare entity, a bilateral case and an ipsilateral case focusing on the side that occurs according to the affected renal insult, and to alert the physicians to include UT in their differential diagnosis of pleural effusions especially in patients with recent urinary tract disorders.

Should we expand the indications for varicocele treatment

Current guidelines suggest that treatment of varicocele should be considered in patients with clinically palpable disease and abnormal semen parameters. However, the clinicians are often challenged with the decision whether to treat varicocele in patients with testicular pain or low testosterone levels. Moreover, varicocele is highly associated with DNA fragmentation due to the oxidative stress and it has been demonstrated that surgical repair of varicocele ameliorates oxidative stress markers and consequently the sperm DNA integrity. These new markers could have an adjunctive role to standard semen parameters especially when normal semen analysis is found in adult men with conventional methods. This review presents a contemporary overview of the rationale for varicocele treatment, as well as of the relationship between varicocele and other novel parameters such as DNA fragmentation index and reactive oxygen species. We will also discuss data from several recent series demonstrating that surgical treatment and especially microsurgical approach could resolve testicular pain, increase testosterone levels and fertility rate both in patients with non-obstructive azoospermia as well as in normozoospermia men. The correlation with progressive testicular failure will be also examined. We hope that this overview will provide clinicians with an evidence-based approach to managing these unanswered and conflicting topics.