Ioannis Adamakis

Implementation and external validation of Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score for predicting complications in 74 consecutive partial nephrectomies.

Study Type – Prognosis (case series)

Giant adrenal myelolipoma, a rare urological issue with increasing incidence: a case report.

IntroductionAdrenal myelolipomas are relatively rare, non-functioning benign tumours composed of mature fatty and active hematopoietic elements. They can be asymptomatic, even if their size is massive. Diagnosis is relatively simple using ultrasound, computed tomography and magnetic resonance imaging. Surgical resection through an extraperitoneal approach is advocated in cases of symptomatic or large myelolipomas exceeding 5-cm in diameter. Their low incidence seems to be increasing from 0.2% to 10% during the last decade.Case presentationWe present a case of a giant adrenal myelolipoma in a 68-year-old Caucasian male, who was presented with left lumbar pain. Renal ultrasound, CT and MRI demonstrated a well demarcated mass, with a maximum diameter of 10-cm. The differential diagnosis comprised the adrenal myelolipoma, the retroperitoneal liposarcoma and the renal angiomyolipoma. Thus, the patient was subjected to a left adrenalectomy.ConclusionMultiple theories have been proposed for the increasing frequency and natural course of the adrenal myelolipoma, with chronic adrenal stimulation and the contemporary stressful lifestyle to be the most appealing. Surgical treatment is advocated through an extraperitoneal approach because of the quicker recovery of the patient and the smaller postoperative complication rate.

Early removal of nasogastric tube is beneficial for patients undergoing radical cystectomy with urinary diversion.

PURPOSE Examine the beneficial effect of early nasogastric tube (NGT) removal in patients undergoing radical cystectomy with urinary diversion. PATIENTS AND METHODS 43 consecutive patients underwent radical cystectomy with urinary diversion and were randomized into 2 groups. In the intervention group (n = 22), the NGT was removed 12 hours after the operation. Comparatively, in the control group (n = 21), the NGT remained in place until the appearance of the first flatus. The appearance of ileus, patient ambulation, time to regular diet, and hospital discharge of the two patient groups were assessed. Patient discomfort due to the NGT was also recorded. RESULTS The 2 groups showed statistical homogeneity of their baseline characteristics. Two patients (9.09%) from the intervention and 3 patients (14.3%) from the control group developed postoperative ileus and were treated conservatively. No significant differences in intraoperative, postoperative, bowel outcomes or other complications were found between the two groups. All patients preferred the NGT to be removed first in comparison to their other co-existing drains. CONCLUSIONS This is the first randomized, prospective study, to our knowledge, to assess early NGT removal after radical cystectomy. We advocate early removal, independently of the selected type of urinary diversion, since it is not correlated with ileus and is advantageous in terms of patient comfort and earlier ambulation.

Recurrent urethrovesical anastomotic strictures following artificial urinary sphincter implantation: a case report

IntroductionThe management of an anastomotic stricture after a radical prostatectomy can become a complex and difficult situation when an artificial urinary sphincter precedes the formation of the stricture. The urethral narrowing does not allow the passage of the routinely used urological instruments and no previous reports have suggested alternate approaches.Case presentationWe present the case of a 68-year-old Greek man diagnosed as having a recurrent anastomotic stricture approximately two years after a radical prostatectomy and three years after the implantation of an artificial urinary sphincter, and propose novel alternate methods of treatment. Our patient was first subjected to stricture incision with the use of a rigid ureteroscope with a holmium:yttrium-aluminium-garnet laser fiber, which was followed by a second successful attempt with the use of a pediatric resectoscope. After a one-year follow-up, our patient is doing well, with no evidence of recurrence.ConclusionsTo the best of our knowledge, this is the first report of the management of recurrent urethral strictures following an artificial urinary sphincter implantation. Minimal invasive techniques with the use of small caliber instruments may offer efficient treatment options, diminishing the danger of urethral corrosion.

S70 Benign renal tumor prevalence and its correlation with patient characteristics and pathology report data

Objectives: To correlate the incidence of benign renal tumours with parameters associated with patient characteristics and pathology. Materials and Methods: The files of 192 patients who underwent radical or partial nephrectomy were reviewed. The investigated variables consisted of tumour size, kidney and renal pole location, age and gender. Tumour size was categorized according to the TNM system. The incidence of malignant renal tumours and their subtypes was also calculated. Results: We recorded 31.5% of benign and 69.5% of malignant tumours with a diameter < 4cm (p<.001). Between 4.1-7 cm, 90% were malignant and 10% were benign. For tumours measuring 7.1-10 cm, 94.4% were malignant and 5.6% were benign. For tumours larger than 10cm, the percentages were 92.3% and 7.7%, respectively. No other variable was presented as a considerable independent factor. Conclusions: 30% of the renal lesions measuring < 4 cm proved to be of benign histology. Tumour size seems to be correlated with benign renal tumour frequency, assisting the physician, along with the surgical experience and the imaging modalities, in deciding the optimum management.