ABSTRACT
PURPOSE: To describe the fundus findings, ultrasonography, and fluorescein angiography of a testicular mixed germ-cell tumor metastatic to the choroid and to report prompt resolution of the choroidal lesion with systemic chemotherapy. METHODS: Observational case report. A 21-year-old man presented with a 10-cm testicular tumor. Ophthalmic examination revealed a large, dome-shaped choroidal lesion in the left eye, filling the entire superotemporal quadrant and extending into the macula. Ultrasonography showed a 10.3 mm in thickness hyperechoic mass. The patient was started on vinblastine, mesna, ifosfamide, and cisplatin. RESULTS: On ophthalmic examination 6 weeks after initiation of chemotherapy, the choroidal lesion had completely resolved, leaving only pigmentary changes. Final ophthalmology follow-up 8 months after presentation demonstrated no recurrence of choroidal metastases. CONCLUSION: Testicular germ-cell tumors have now been well described to metastasize to the choroid. These choroidal metastases can show a prompt, favorable response to chemotherapy.
ABSTRACT
BACKGROUND AND PURPOSE: With the improvement of medical therapy and minimally invasive surgical treatments for benign prostatic hyperplasia, the number of transurethral resections of the prostate (TURPs) done in training is decreasing. With fewer TURPs being performed, proficiency in this basic urologic technique has decreased, causing longer resection times. This often leads to a higher risk of fluid absorption, water toxicity, and hyponatremia (TUR syndrome). We examined the safety of bipolar electrocautery TURP (saline TURP) with the Gyrus PlasmaKinetic system using normal saline as irrigant. PATIENTS AND METHODS: Twenty-one men aged 54 to 85 years (median 70.0 years) underwent saline Plasma- Kinetic TURP from June 2002 to August 2003. Serum sodium, chloride, hemoglobin, and hematocrit were measured 1 hour prior to and 1 hour after TURP. Resection time, tissue weights, hospital stay, and catheter time were recorded and analyzed. RESULTS: The median preresection and postresection sodium concentrations were 139.0 mEq/mL and 140.0 mEq/L, respectively (ranges 130-142 mEq/L and 134-143 mEq/L). The corresponding chloride values were 106.5 mEq/L and 109.0 mEq/L (ranges 102-114 mEq/L and 106-116 mEq/L), and the hemoglobin and hematocrit values were 13.4 g/dL and 40.1 g/dL (8.7-15.2 g/dL and 33.7-46.7 g/dL) and 12.0 g/dL and 36.6 g/dL (8.2-14.4 g/dL and 27.5-43.7 g/dL), respectively. The median resection time was 65 minutes (range 45-140 minutes), and the median resected tissue weight was 20 g (range 5-61 g). There was no statistically significant difference between the preresection and postresection sodium concentrations, and no patient exhibited any clinical sign of TUR syndrome. CONCLUSION: Gyrus PlasmaKinetic TURP using normal saline as the irrigant is a safe alternative to and is technically no different from traditional monopolar TURP. The system also provides the longer time needed to train urology residents without compromising patient safety.
