Saleh Binsaleh

Laparoscopic Nephrectomy with Intact Specimen Extraction for Polycystic Kidney Disease

PURPOSE We present our technique and evaluate the experience of laparoscopic nephrectomy with intact specimen extraction for patients with autosomal dominant polycystic kidney disease (ADPKD). MATERIALS AND METHODS We retrospectively reviewed 16 laparoscopic nephrectomies performed by one laparoscopic surgeon in a university hospital between April 2004 and March 2006. Preoperative, intraoperative, and postoperative follow-up data are presented. A 3- to 4-port transperitoneal laparoscopic approach was used to dissect the involved kidney, which was then removed intact through a Pfannenstiel or infraumbilical midline incision. RESULTS A total of 16 patients were included in this study over a 2-year period. The average patient age was 49 years (range 29-67 years), and the average body mass index was 26.9 kg/m(2) (range 19.1-38.3 kg/m(2)). Eleven (69%) patients were receiving dialysis. The mean preoperative creatinine level was 520 mumol/L (range 108-976 mumol/L). Ten right (63%) and six left (37%) nephrectomies were performed. No patient had preoperative embolization. The mean operative time was 167 minutes (range 95-233 min). The mean blood loss was 76 mL (range 10-200 mL). No patient received a blood transfusion. The mean kidney pathologic size was 23 cm (range 16-35 cm), while the mean extraction size was 10.4 cm (range 8-12 cm). There were no deaths. There was one intraoperative complication (6.25%) and three postoperative ones (19%). No procedure was converted to an open approach. The mean length of hospital stay was 4 days (range 2-11 d). CONCLUSIONS Laparoscopic nephrectomy for ADPKD is technically feasible and clinically safe. In addition to its low morbidity, other advantages of laparoscopic surgery are the ability to remove the dissected kidney through a small incision, short hospital stay, excellent cosmesis, and fast recovery.

Gartner duct cyst simplified treatment approach

We present two patients with Gartner’s duct cyst managed with simple marsupialization and successful long-term follow up.

Jejunal perforation during percutaneous nephrolithotrypsy.

Colonic and duodenal perforations, albeit rare, are known complications of PCNL; however, to our knowledge, jejunal perforation has never been reported. We report a case of an 83-year-old man, underwent left PCNL for a 2cm stone in the renal pelvis, confirmed to have a jejunal perforation. He was successfully managed conservatively. His diagnostic work up and management will be discussed.

Defining a Hba1c Value That Predicts Increased Risk Of Penile Implant Infection

To re‐evaluate the role of diabetes mellitus (DM) as a risk factor for penile implant infection by exploring the association between glycated haemoglobin (HbA1c) levels and penile implant infection rates and to define a threshold value that predicts implant infection.

Erect Penile Dimensions in a Cohort of 778 Middle Eastern Men: Establishment of a Nomogram

INTRODUCTION Accurate data regarding the size of the erect penis are of great importance to several disciplines working with male patients, but little high-quality research exists on the subject, particularly in different ethnic groups and for erect penis size. AIM The aim of this study was to create a nomogram of erect penile dimensions in a large sample of Middle Eastern men. METHODS A retrospective cohort study of 778 men (mean age 43.7; range 20-82) attending urological outpatient clinics in Saudi Arabia was conducted. Exclusion criteria were age under 18 years, a presenting complaint of small or short penis, Peyronies disease or complaint of congenital curvature, clinical hypogonadism, and previous penile surgery or trauma. MAIN OUTCOME MEASURES Three erect penile dimensions following induction of erection using intracavernosal injection of Quadrimix. RESULTS Mean patient body mass index (BMI) was 29.09 (standard deviation [SD] 5.76). The mean suprapubic skin-to-penile tip erect length was 12.53 cm (SD 1.93); the mean erect length from the symphysis pubis to the penile tip was 14.34 cm (SD 1.86); and the mean erect shaft circumference was 11.50 cm (SD 1.74). A nomogram was constructed and statistical analysis performed, demonstrating a weak negative correlation between BMI and erect penile length measured from the suprapubic skin (r = -0.283, P < 0.000) but not from bone to tip, and a weak negative correlation between age and both erect penile length measurements (skin to tip r = -0.177, P < 0.0005; bone to tip r = -0.099, P = 0.006). CONCLUSION A nomogram for Middle Eastern men can be used as a standard when advising men with small penis anxiety. The importance of measuring erect size and allowing for infra-pubic fat interference in measurement is emphasized. We envisage that this tool can be used to educate and reassure concerned men about the size of their penises.

Varicocelectomy May Benefit Men With a Sertoli Cell-Only Pattern on Microsurgical Testicular Sperm Extraction: A Case Report

Men with testicular failure (TF) often undergo an extensive microsurgical dissection of the testicles to identify sperm (TESE procedure). Frequently no sperm is found. Although a varicocelectomy results in improved spermatogenesis in some men with TF, the role of varicocelectomy in the setting of a failed TESE is unknown. We present a case of recovery of spermatogenesis after varicocelectomy in a man who had a previous failed TESE. This case demonstrates that patients with a failed TESE may gain some benefit from a varicocelectomy and that this procedure may be offered as an alternative to donor insemination or adoption.

Association of the modified frailty index with adverse outcomes after penile prosthesis implantation

Abstract Objectives: To investigate frailty as a predictor of surgical outcome in elderly patients undergoing penile prosthesis implantation. Material and methods: A total of 54 elderly patients, above 60 years of age, underwent penile prosthesis implantation between 2012 and 2014. Their data were collected and retrospectively analyzed. A modified frailty index (mFI) was calculated for each patient based on 11 risk factors from the Canadian Study of Health and Aging Frailty Index. The 1-year adverse outcomes were correlated with mFI, patients’ and procedure’s risk factors. Results: Mean age was 64.9 ± 5.2 years. No mortality was reported in our patients, however, one-year adverse outcomes were encountered in 43 (79.6%) patients. Among all studied variables, the 1-year adverse outcomes was not significantly association with mFI, but with preoperative glycosylated hemoglobin A1c (HbA1c) (p = 0.031) and associated Peyronie’s disease (PD) (p = 0.000). HbA1c, dyslipidemia, hypertension, PD and duration of the procedure were predictive of infection complications (p < 0.05). Only PD and HbA1c sustained an independent significant impact. Conclusions: mFI is not a predictive of post-penile prosthesis implantation adverse outcomes in elderly patients with impotence. Degree of diabetic control and association with PD was associated with the 1-year adverse outcomes and infection complications.

A Prospective Randomized Study of Pfannenstiel Versus Expanded Port Site Incision for Intact Specimen Extraction in Laparoscopic Radical Nephrectomy

PURPOSE To compare intra- and postoperative outcome of patients undergoing laparoscopic radical nephrectomy with intact specimen extraction through a Pfannenstiel (PFN) transverse suprapubic or expanded port site (EPS) incision in a prospective randomized fashion. PATIENTS AND METHODS Patients undergoing laparoscopic transperitoneal radical nephrectomies for suspected renal tumors were randomized for intact renal specimen extraction via a PFN or EPS incision. Operative, perioperative, 1 week, 6 weeks, and 6 months postoperative parameters were prospectively recorded and analyzed including specimen weight, size in maximum diameter, incision length, total operative time, extraction time, estimated blood loss, length of hospital stay, pain score in the postoperative holding area and on the first post operative day, narcotic consumption, time to fluid intake/full diet intake, unassisted ambulation, cosmesis, and wound-related complications. A postoperative quality-of-life questionnaire was also filled out by all the patients. RESULTS Our series included 51 patients: 26 in the PFN group and 25 in the EPS group. The two groups were similar in demographic characteristics and intraoperative and postoperative parameters apart from a longer PFN incision (P<0.00). First postoperative day pain score was significantly less in the PFN group than in the EPS group (P=0.023). Complication rate was less in the PFN group, although not statistically significant. Hospital stay was significantly shorter in the PFN than in the EPS group (P=0.01). Mean cosmesis and operative satisfaction scores at week 1, week 6, and 6 month visits were not significantly different between both groups. Compared with the EPS group, PFN group patients significantly will choose the same operation if they would do it again (P=0.004). CONCLUSIONS PFN incision has less morbidity, pain score, and hospital stay compared with EPS incision for intact specimen extraction after transperitoneal laparoscopic radical nephrectomy. Both incisions are associated with high operative satisfaction, good cosmesis, and a low rate of wound complications.

Sibutramine for the Treatment of Recurrent High-Flow Priapism

High-flow priapism most often occurs following perineal and penile trauma. We report the case of a 29-year-old man who presented with recurrent priapism and was initially treated with corporal aspiration and intracavernosal injections on multiple emergency department visits and then condition-controlled with sibutramine while on treatment for weight loss. His condition relapsed after the medication was withdrawn from the market, necessitating medical intervention.

Noninvasive treatments for iatrogenic priapism: Do they really work? A prospective multicenter study.

Objectives: Intracorporeal injections (ICIs) of vasoactive substances during penile Doppler ultrasound (PDU) are a common investigation for erectile dysfunction (ED) diagnosis. ICI can be responsible of priapism, a pathological condition of prolonged penile erection not related to sexual stimulation. The aim of our study is to investigate the effectiveness of physical exercise and medical treatment as noninvasive therapy to restore detumescence in prolonged erections after ICI. Materials and Methods: Data were prospectively collected on men undergoing PDU in three urological centers. Three hundred and sixty-nine patients underwent PDU for the investigation of ED. All the participants received an ICI of quadrimix; prostaglandine E1, papaverine, phentolamine, and atropine. The data of the patients have been analyzed to record their comorbidities, results of PDU, and the complications encountered. Results: Fifty-three patients (14.4%) developed prolonged erections. Physical exercise alone was successful in reversing prolonged erection within 30 min in 21 (39.6%) patients. Out of the remaining 32 patients, oral salbutamol induced detumescence in 18 (34%) within the observation period of 60 min. Nonresponders were managed successfully with aspiration and irrigation of corpora with saline (11 patients, 20.75%) or with Phenylephrine (three patients, 5.66%). Conclusions: Physical exercise and oral salbutamol are safe and effective in restoring detumescence of pharmacologically-induced priapism. Noninvasive therapy may save a significant number of these patients an invasive treatment.