case report of testicular sparing surgery in a patient with dermoid cyst of testis

Dermoid cyst of testis is very rare in post-pubertal age which testicular sparing surgery can be done. There are different methods of treatment [radical orchiectomy, partial orchiectomy] for these cases. In this study, we present a case of dermoid cyst of testis which responded to partial orchiectomy. An 18 year old man referred to hospital with a painless left testicular mass [1.5 to 2 cm nontender firm mass in center of left testis] since one year prior to admission. Sonography showed a 1.5 to 2 cm hypoechoie mass in left testis and blood tumor markers [alpha.F. protein and beta H.C.G] were normal. Patient was operated by a left inguinal incision and there was a thick wall encapsulated, whitish keratin filled cyst, which only cyst was enucleated and testis was saved. Pathology report was dermoid cyst and up to 2 years after surgery patient had no recurrence. In patients with tumor of testis and all work-ups are in favor of benign lesion, testicular sparing surgery can be done

Evaluation of sperm parameters in patients with varicocele before and after sperm processing

Varicocele is one of the causes of male infertility. It changes with temperature and drainage of testicular veins that due to spermatogenesis disturbance and decrease of fertility in these patients. However varicocelectomy is a treatment for varicocele, but there are other methods of treating this disease including assisted reproductive technology [ART], Sperm processing and swim up. This interventional study was performed on 155 cases in fertility and infertility Center of Babol University of medical sciences in 2004. Sperm parameters in varicocele patients was assessed before and after sperm processing. The mean age of patients was 31.8 years. Sperm motility before sperm processing in grade III and IV was 53.9% and 12.9%, respectively but after sperm processing in grade III and IV changed to 78.7% and 56.8%, respectively. Total motility before sperm processing was 40% and changed after processing to 80%. The results show that with sperm processing and collection of appropriate sperms, we are able to increase fertility

Study of major trauma of genitourinary system in patients referred to emergency center of Babol Shahid Beheshti Hospital [1998-2003]

Trauma is a dynamic process and involves different systems of body according to its severity. Genitourinary system injury is seen in trauma process. This study was done to evaluate the major trauma of genitourinary system with special attention to multiple trauma patients. This descriptive and cross-sectional study was performed on records of 293 patients with genitourinary system trauma who referred to emergency center of Shahid Beheshti hospital from 1998-2004. One hundred and two patients suffering from major trauma of genitourinary system who operated were included in this study. Then necessary information such as sex, age, pattern of trauma, type and mechanism of trauma, involved organ, clinical findings, associated lesions, surgical procedure, laboratory findings, duration of hospitalization and year of admission were obtained and studied. From 102 patients, 92.2% were male and 7.8% were female with mean age of 29.4 +/- 13 years. 33.3% of patients had multiple trauma and 98% of them had blunt trauma. Mean duration of hospitalization was 6.2 +/- 4.4 days. From 13 patients [12.7%] with major kidney trauma, 5 cases had shattered kidney that went under nephrectomy. Only 1 patient [1%] had ureter trauma with final diagnosis of left middle ureter transection. Five patients [4.9%] had intraperitoneal rupture of bladder in which 3 cases had rupture in dome area. Five patients [49%] had urethral injury with clinical findings such as blood at meatus and inability to void. In 50 patients [49%] with penile trauma, 49 patients had penis Fx and 1 case had total amputation of penis and left testis. Fifteen patients [16.7%] had testis trauma in which clinical findings were pain, swelling and ecchymosis. Eleven patients [10.8%] had major trauma of scrotum. According to the results of this study, the most common organ involved in major trauma of genitourinary system was penis. Accurate history and complete physical examination should be considered in patients with multiple trauma

etiologies of hydronephrosis in neonates

Hydronephrosis is defined as abnormal dilation of pyelocaliceal system. There is a controversy about the etiologies and follow up in antenatal and neonatal hydronephrosis. This study was done to determine the etiologies of hydronephrosis in neonates who were born with this disorder. This study was carried out on all neonates who were referred to nephrology department and clinic of Amirkola children hospital, Babol Medical University from 1998 to 2004. In whom it was diagnosed hydronephrosis before or after birth; VCUG [voiding cystourethrography], IVP [Intravenous pyelography] and/or DTPA [diethylene triamine-pentaacetic acid] were used as needed. Then all data were evaluated according to their etiologies. Of 42 neonates, 38 [90%] were male and 4[10%] were female. Twenty-four [57%] and 17 [40%] patients had UPJO [ureteropelvic junction obstruction] and VUR [vesicouretral reflux], respectively. Twenty-six [62%] had been diagnosed before birth. The most common causes of admission were prenatal diagnosis [57%] and UTI [24%]. Among 54 hydronephrotic kidneys unites in 42 neonates, 30 [55.5%], 23 [42.5%] and 1 had VUR, UPJO and UVJO respectively. The most common cause of hydronephrosis in neonates was UPJO, It is needed to give more attention to male neonates who showed higher prevalence of hydronephrosis and also early prenatal sonographic diagnosis

Total amputation of Penis and left testis; case report

Penile amputation is one of the rare complications of genitourinary tract injuries. Most cases of penile amputation are the result of self mutilation in patients suffering from psychiatric diseases. Penile amputation with less common causes is accidental trauma and felonious assault. In this paper we present a case with total amputation of penis and left testis who was treated by a complete team of surgery. A 44 year old man who was injured by combine farm machine and developed total penile amputation from the base and total amputation of left testis from spermatic cord in inguinal area. Patient with hypovolemic shock due to severe bleeding was admitted to emergency ward. After resuscitation of patient and stabilization of vital signs he underwent open cystostomy, perineal urethrostomy and right testis fixation based on severity of trauma, necrosis of amputated segment and nonvisualization of proximal of penis. Now, patient has complete urinary continence and is candidated for penile prosthesis or repair via radius or gracilis muscles but he refuses this procedure. However total amputation of penis and testis in accidental trauma is very rare, a complete surgical team including urologist, microsurgeon and plastic surgeon should be organized and replantation should be performed if distal part of penis is viable

[Incidental perforation of peptic ulcer after trans-urethral resection of bladder tumor: a case report]

Peptic ulcer is relatively common and in 2% of patients may present with sudden perforation without previous history of peptic ulcer disease. Early diagnosis and management can save the patient. A 79-year-old man was presented to emergency room with gross hematuria and clot uninary retention. A 3-4 cm vegetative mass was in left lateral wall of bladder in cystoscopy. Under spinal anesthesia, transurethral resection was performed without any complication. The day after surgery, patient had developed generalized abdominal pain and guarding and hematuria with urinary retention. Emergency abdominal sonography revealed free fluid in pelvis with possible bladder perforation. Laparotomy was performed and there was no bladder perforation except a little extra and intra peritoneal clear fluid. With a cystectomy tube and two intra and extra peritoneal drains laparotomy was closed. Two days after the second surgery, liquid diet was started for patient, but it was associated with fecal oderous leakage from the drains. After consultation with general surgeons with diagnosis of trauma to rectum or lieum again laparotomy was performed. In re-exploration there was a perforation in stomach [anterior aspect of pylores], so it was repaired and a few days later with normal general condition patient was discharged. Although peptic ulcer disease is relatively common. Its perforation with association of other surgeries in these patients is very rare and can mimic the complication of T.U.R.B.T. So close observation of patients and proper management can save the patients

Modern status of laparoscopic surgery in the urology of iran and world

First, we would like to introduce laparoscopic procedures conducted at Labbafinejad Medical Center [1057 cases], some of which were performed for the first time in Iran and some others were conducted for the first time worldwide, by which Iran has been known as a leading country among Mediterranean countries in laparoscopic urology. 1. Laparoscopic ileocystoplasty [to extend bladder by ileum with intestinal anastomosis] simultaneously with laparoscopic Malon to control stool incontinence [First case in the world] [9 cases] 2. Laparoscopic urethrocystoplasty [First case in the world] [2 cases] 3. Radical laparoscopic prostatectomy by an innovative technique with no suture [35 cases] 4. Laparoscopic antireflux in children by Lich method [40 cases] 5. Laparoscopic retroperitoneal and pelvic lymphadenectomy [10 cases] 6. Laparoscopic pyeloplasty [to repair pelvic obstruction] [60 cases] 7. Laparoscopic donor Nephrectomy [220 cases] 8. Laparoscopic Nephrectomy [71 cases] 9. Laparoscopic adrenalectomy [14 cases] 10. Laparoscopic adrenalectomy [25 cases] 11. Laparoscopic surgery of retrocaval ureter [3 cases] 12. Laparoscopic removal of ureteral and pelvic stones [140 cases] 13. Nephropexy [1 cases] 14. Varicocelectomy [110 cases] 15. Laparoscopic repair of hydrocele and hernia [32 cases] 16. Laparoscopic therapy of renal cyst [30 cases] 17. The detection and treatment of ectopic testis [247 cases] 18. Partial adernalectomy [4 cases] 19. Histrosalpingoanorectomy [4 cases]

[Ileal substitution for ureteral loss]

Background and Objective: In patients with unilateral or bilateral loss with high length [More than 10cm] and with different etiologies, ileal substitution is good alternative when other procedures are not suitable. The objective of this study was to survey the effects and complications of ileal substitution for ureteral loss

Cases: Sixteen patients were operated in urologic ward of Shahid Labbafinejad hospital with ileal substitution for ureteral loss during 1994-1999. Twelve patients were male and four were female with mean age 28 years [3-47 years]. Etiology was complications of surgery and ureteroscopy in 11 and TB in 2 and ureteral avulsion in one due to trauma. Follow up was 9-60 months and 3 patients missed follow up. Pre.op sonography, IVP and DTPA isotope scan in all patients revealed severe hydronephrosis in 11 patients. Post.op sonography and scan showed much improvement of kidney function. In 2 patients, hydronephrosis persisted that nephrectomy was performed

Conclusion: In cases with high ureteral loss, which other procedures like uretero-ureterostomy or transuretero-ureterostomy or autotransplant or kidney descending or Boari-Flap cannot be done, ileal substitution is good alternative with low complication

[Report of two cases of adrenal pheochromocytoma]

Background and Objective: Less than 1% of pheochromocytoma account for hypertensive vascular diseases. The goal of this report is early diagnosis of this tumor since it is surgically treatable and preventive for lethal complication. In this study, two cases of patients with hypertension due to adrenal pheochromocytoma who were treated by surgical adrenalectomy were reported

Cases: The first patient was a 45-year-old female who presented with hypertension, headache, abdominal pain, sweating weight loss and diabetic mellitus. An 8×6 cm[2] mass was reported in her left adrenal by CT scan. She was operated adrenalectomy. She immediately got a normal blood pressure and controlled diabetic mellitus. The second patient was a 61-year-old male who presented with hypertension and elevated level of 24-hour urinary catecholamine. He was surgically treated by adrenalectomy of right adrenal pheochromocytoma after a 7×6 cm[2] mass was detected on CT scan in his right adrenal as the same of first patient, he got a normal blood pressure and controlled diabetic mellitus immediately after operation

Conclusion: Although pheochromocytoma is a rare cause of elevation of arterial pressure it should be always considered as a cause of elevation of blood pressure. So after the diagnosis it was recommended administration of phenoxybenzamine as an irreversible ? blocker, to prevent hypertensive crisis and cardiac arrhythmia, and for symptom relief of the patients before, during and after the operation, respectively