How many procedures are needed to achieve learning curve of Millin simple laparoscopic prostatectomy?

BACKGROUND: Aim of our study was to evaluate learning curve of the Millin simple prostatectomy analyzing three expert laparoscopic surgeons. METHODS: Learning curve of 3 expert laparoscopic surgeons with excellent radical prostatectomy training was evaluated. Surgeon 1 had more than 20 years of experience, while other surgeons had 10 years of experience. The first 45 procedures of the surgeons were considered for analysis. The cumulative sum (CUSUM) technique, one of the methods developed to monitor the performance and quality of the industrial sector, was adopted to analyze learning curves. The variables included to evaluate learning curve of the surgeons were: operative time (OT), hospitalization (HO) and complication rate. RESULTS: Overall 135 patients were included in the analysis. Median age was 68 (64/74), median prostate volume was 83 (75/97), median Qmax 9 mL/s (6/11) and median IPSS=20 (18/22). Complications included: 9/135 (7%) transfusion, 4/135 (3%) Urinary retention, 3/135 (2%) fever, 1/35 (<1%) reintervention and 1/135 (<1%) conversion. Surgeon 1 presented a lower median operative time when compared to surgeon 2 and 3. No significant differences were recorded in terms of hospitalization, blood loss and transfusion rate as well as postoperative outcomes. According to the CUSUM analysis the number of procedures needed to achieve a plateau in surgical time is 10/15 procedures. CONCLUSIONS: According to our results 15 procedures are needed to reach a plateau in surgical time for trained laparoscopic surgeons.

Laparoscopic simple prostatectomy: a large single-center prospective cohort study.

BACKROUND: The aim of our study was to analyze outcomes and safety of laparoscopic simple prostatectomy (LSP) in a high-volume center. METHODS: A consecutive series of men with lower urinary tract symptoms and large prostates (>80 cc) prospectively enrolled between November 2015 and December 2017 in one center. All patients underwent laparoscopic simple prostatectomy. Outcomes were evaluated considering the trifecta favorable outcome which was defined as a combination of the following items: 1) no perioperative complications; 2) postoperative IPSS <8; 3) postoperative Qmax >15 mL/s. Complications were evaluated according to the modified Clavien classification system. Univariate and multivariate binary logistic regression was performed to identify predictors of a positive trifecta outcome. RESULTS: Overall 272 patients were enrolled. At three months after surgery median IPSS total score was 4 (IQR: 3-7), median IPSS QoL was 1 (IQR:1-2), median prostate-specific antigen was 0.53 (IQR: 0.33-1.00) ng/ml and median Qmax was 23 (IQR: 17-30) mL/s. All these parameters improved statistically when compared to baseline (P<0.001). The overall complication rate was 21% however most of the complications were low grade complications according to modified Clavien-Dindo classification (grade ≤2). Overall, 68% of the patients presented a positive trifecta outcome. On multivariate analysis only preoperative hemoglobin and hospital stay were confirmed predictors of positive trifecta outcome. CONCLUSIONS: LSP represents a safe and effective procedure in the treatment of large adenomas. Although RCTs are needed before reaching definitive conclusions, LSP is a promising technique for patients with LUTS and large prostates.

Parasitic Hematuria: Six Cases in a Row in a Single Centre in Spain.

Most cases of urogenital parasitosis are registered in Africa. However, migration movements and travellers moving from developed to developing countries are responsible for leading to an increased incidence of genitourinary infections caused by parasites in the western world including Spain having serious economic and health implications. The importance of its early detection and treatment also results from its potential risk for infertility, susceptibility for HIV infection and the development of bladder cancer. The most common presentation symptom is terminal haematuria, and when diagnosed, praziquantel is the treatment of choice. We report a series of 6 cases of urinary schistosomiasis that happened in a single centre in Spain and reminds the importance of having the infection in mind in certain cases of haematuria study.

Extranodal Richter's syndrome of the urinary bladder.

Lymphomas of the urinary bladder are rare and can be primary or secondary. The latter group includes Richter's Syndrome-which is a transformation of a chronic low-grade lymphoproliferative syndrome into a common type of non-Hodgkin lymphoma, most commonly localized in the lymph nodes. We report a case of an 84-year-old male, former-smoker with a history of low-grade chronic lymphocytic leukemia, treated with chemotherapy, with a recurrence of the disease to retroperitoneal and iliac lymph nodes, splenomegaly, and thickening of the bladder wall. The hematologist consulted us because of hematuria with coexistent bilateral obstructive uropathy. We performed transurethral resection of the bladder which revealed secondary lymphoma in the bladder, probably the result of a high-grade transformation from chronic leukemia, a very rare location of this transformation.

Deep Vein Thrombosis: A Rare Cause of Acute Testicular Pain. Case Report: Literature Review.

INTRODUCTION: Thrombosis is defined as the formation of a clot in a blood vessel that obstructs the flow of blood to the peripheral tissues. The incidence of thromboembolic disease ranges from 0.7 to 1.2% within urology. CASE REPORT: A 40-year-old warehouse worker male presented to the emergency department with worsening of a month's lasting scrotal pain. Physical examination showed the presence of an enlarged and painful left testicle with no other findings. Right testicle, penis and abdominal examination showed no abnormalities whatsoever. Bilateral varicocele with a partial thrombosis of the left one associated with left inguinal hernia was diagnosed by performing an urgent testicular ultrasound test. Conservative treatment was first given. However, since pain was not relieved, surgery was indicated with left varicocelectomy and a left inguinal hernia repair procedure leading to complete symptoms control and normal testicular flow in the control Doppler ultrasound study 2 months after the surgery. CONCLUSION: Spontaneous thrombosis of the pampiniform plexus is a rare entity where the management remains controversial. The clinical case we report here shows that surgery may be considered an effective option.