O. Storme

A Multi-institutional Evaluation of the Management and Outcomes of Long-segment Urethral Strictures.

OBJECTIVE To evaluate the treatment options and surgical outcomes of long-segment urethral strictures-a review of the largest, international, multi-institutional series. METHODS A retrospective review was performed of patients treated with strictures ≥8 cm at 8 international centers. Endpoints analyzed included surgical complications and recurrence. RESULTS Four hundred sixty-six patients were identified. Treatment intervals ranged from December 27, 1984 to November 9, 2013. Dorsal onlay buccal mucosal graft (BMG) was the most common procedure (223, 47.9%); others included first- and second-stage Johanson urethroplasty (162 [34.8%] and 56 [12%], respectively), fasciocutaneous (FC) flaps (8, 1.7%), and a combination flap and graft (17, 3.6%). Overall success was achieved in 361 patients (77.5%) with a mean follow-up of 20 months. Second-stage Johanson urethroplasty was found to have a higher recurrence rate compared with that of 1-stage BMG urethroplasty (35.7% vs 17.5%, respectively; P <.01). This was also true in cases of lichen sclerosus (14.0% vs 47.8%, respectively; P <.01). Otherwise, success rates were similar. Urethroplasties performed with FC flaps had a higher complication rate compared with those without (32% vs 14%, respectively; P = .02). Prior dilation or urethrotomy, higher number of prior dilations or urethrotomies, abnormal voiding cystourethrogram, and skin grafts all portend a higher recurrence rate. On logistic regression analysis, only second-stage Johanson had an increased odds ratio of recurrence compared with that of BMG (2.82 [1.41-5.86]). CONCLUSION Long-segment strictures can be treated with high success rates in experienced hands. BMG was more successful than second-stage Johanson urethroplasty. FC flaps, although successful, had high complication rates.

Estudio prospectivo que compara la litotricia extracorpórea y la ureteroscopia en el tratamiento de la litiasis de uréter distal

Resumen Objetivos Comparar los resultados en el manejo de la litiasis de ureter distal entre la litotricia extracorporea (LEC) y ureteroscopia (URS) y asi evaluar la mejor alternativa de tratamiento en esta afeccion. Material y metodos Un total de 104 pacientes con diagnostico de litiasis de ureter distal, que requerian tratamiento quirurgico. Se realizo un enrolamiento y seguimiento prospectivo. Se utilizo en LEC un litotriptor Modulix SLX Storz, en la URS se utilizo un ureteroscopio semirrigido Storz 33 cm, diametro de 7,5 a 9,5 Fr, optica 6°. Del total de pacientes, 54 fueron a LEC y 50 a URS, y 62 eran varones y 42, mujeres, con una edad promedio de 49,72 anos para LEC y de 52,16 anos para URS. En la LEC el promedio de tamano fue 8,29 mm y en la URS, de 8,96 mm. Se establecio una significacion estadistica p Resultados El tiempo del procedimiento para la LEC, separado por sexo, fue de 55 min en el caso de los varones y de 45 min en las mujeres. Para la URS fue de 80 min para los varones y de 55 min para las mujeres. El tiempo de hospitalizacion promedio para la LEC fue de 4,8 h (todos los procedimientos ambulatorios). En el caso de la URS, fue de 22 h. Las complicaciones en el caso de la LEC fueron del 7% y para la URS, del 7,9%. De los pacientes tratados por LEC, el 74,3% presento stone free a los 30 dias, a diferencia de la URS, que presento un porcentaje de stone free del 92,3% (p Conclusiones Basados en los resultados de este estudio, la URS es el metodo mas adecuado para el manejo de la litiasis de ureter distal, tanto en resultados de stone free como en la falta de significacion en la comparacion de complicaciones.

Traumatic testicular dislocation.

IntroductionTraumatic testicular dislocation is a rare entity. It occurs after a direct blunt scrotal trauma causing the testicle to migrate outside the scrotum, most frequently to the superficial inguinal region.Materials and methodsA review of the diagnostic database of our two institutions was performed searching for complex genital trauma between 1990 and 2012.ResultsSeven cases of traumatic testicular dislocation were identified (four on the left side; one on the right side and two bilateral) for a total of nine testicles. Six were motorcycle accidents, and the other case suffered a pelvic crush injury. All victims had significant associated injuries, one case had an open dislocation and two were killed by the accident. The testicle was located at the inguinal region in four cases at the suprapubic area in four, and the other was an open dislocation. Diagnosis was suspected with the physical examination and confirmed by Doppler ultrasound; however, in one case, the diagnosis was missed during several weeks. In one case, the testicle was reduced into the scrotum immediately at the emergency department. Two cases were operated shortly after admission, performing testicular reduction into the scrotum and standard orchidopexy. Two other cases underwent delayed intervention, and both needed release of peri-testicular adhesions. Two cases (both bilateral) died at the accident site and were diagnosed by autopsy. In all surviving cases, it was possible to obtain a satisfactory orchidopexy with gonadal preservation.ConclusionsTraumatic testicular dislocation is rare and diagnosis can be elusive. It should be suspected in motorcycle and high-energy accidents around the groin area and depends on a careful physical examination. With proper management, prognosis is excellent.

Initial human feasibility study of DC Ablation as a treatment for benign prostatic hyperplasia: 6 month follow-up data

Direct current (DC) ablation is a novel non-thermal technology that causes focused coagulative necrosis in the lateral lobes of the prostate to treat benign prostatic hyperplasia (BPH). The necrosis is caused by a zone of non-physiologic pH which is created in a predictable pattern around each electrode in which a direct current is applied during treatment. The objective of this study was to optimize treatment parameters and assess treatment tolerability using transurethral DC ablation as an office-based treatment for BPH.