Genital strangulation caused by metal ring successfully removed using electric saw.

The genital strangulation is uncommon urological emergency, due to self placement of encircling constricting peno-scrotal objects. It represents a great challenge to remove the constricting device. herein, we present a case of peno-scrotal strangulation in a young drug addict man, that we saved by quickly removing the constricting device using a rotating electric saw.

[Factors predicting of failure after conservative treatment in III-V grade renal trauma]. / Facteurs prédictifs d'échec du traitement conservateur du traumatisme rénal grade III­V.

INTRODUCTION AND OBJECTIVES: Surgical exploration of renal injury secondary to major trauma often leads to nephrectomy. The aim of this work was to identify the factors associated with the need for surgery in patients with III-V grade renal trauma who were initially managed conservatively. MATERIALS AND METHODS: We retrospectively reviewed data from patients with Grade III-V kidney injury between June 2005 and June 2015. Demographic, clinical and bio-radiological characteristics at admission and follow-up, as well as management and complications, were recorded. Patient data, including conservative treatment, was a success without recourse to nephrectomy, and those patients who needed surgery were analyzed. RESULTS: Seventy three patients were included in this study. Grade III accounted for 45%, Grade IV: 49% and Grade V: 5%. The success rate for conservative treatment was 79%: 31 patients grade III (94%), 26 grade IV (72%) and no grade V patients. hypotension at admission (P=0.04), hematoma size greater than 3.5 centimeters (P=0.002), grade V (P=0.003), anemia (P=0.04), blood transfusion (P=0.01) and worsening of lesions of the control CT lesions (P=0.001), are the factors considered as predictive of failure of conservative treatment. CONCLUSION: Conservative management is the treatment of choice in III-V grade renal trauma, and the prognostic factors found in this study make it possible to better select patients. LEVEL OF EVIDENCE: 4.

[Oncological results of a series of 93 laparoscopic radical cystectomies: 5 years of follow-up]. / Résultats oncologiques d'une série de 93 cystectomies totales laparoscopiques : 5 ans de suivi.

OBJECTIVE: To report oncological results at 5 years after laparoscopic radical cystectomy (LRC) with lymph node dissection for bladder cancer (BC). PATIENTS AND METHODS: This is a retrospective single-center study of all patients who underwent LRC for BC by the same surgeon from February 2007 to March 2016. Demographic, perioperative and oncologic data were collected. We reported overall survival rate (OS), cancer specific (CSS) and recurrence-free survival (SSR), as primary indicators of oncologycal outcomes. These survival rates were estimated according to the Kaplan-Meier method. Log-rank tests were used to explore overall survival according tumor stage, lymph node involvement and surgical margins status. RESULTS: In all, 93 patients (82 men and 11 women) underwent LRC. Mean age was 59 years. Minor complications (Clavien I-II) occurred in 24.7%. Major complications (Clavien IIIa-V) were observed in 8.6%. No patients received neoadjuvant chemotherapy. Median lymph node (LN) yield was 15 and 26.5% patients had positive LN. The positive surgical margins (SMs) rate was 5.3%. Median follow-up for the entire patients was 50 months (19-84 months). Forty-three patients (46.2%) were followed for at least 71 months. Five year RFS, CSS and OS were 67%, 85% and 79%, respectively. Non organ confined desease, positive LN and positive SMs were associated with poorer OS (P<0.039, P<0.016 and P<0.001). CONCLUSION: LRC was associated with acceptable long-term oncologic outcomes, similar to those currently reported after open cystectomy for BC. LEVEL OF EVIDENCE: 3.

[Evaluation of the learning curve of laparoscopic radical cystectomy for cancer: Morbidity and oncological results]. / Évaluation de la courbe d'apprentissage de la cystectomie radicale laparoscopique pour cancer : morbidité et résultats oncologiques.

INTRODUCTION: The objective of this work was to evaluate the impact of the laparoscopic radical cystectomy learning curve on perioperative and oncological outcomes. PATIENT AND METHODS: This is a retrospective and single-center study of all patients who underwent laparoscopic radical cystectomy for bladder cancer from February 2007 to March 2016, (93 patients) Perioperative and oncological data were collected. We used mixed statistical models to predict the number of patients needed in the learning phase. We compared the perioperative parameters of the patients in the learning phase with those of the rest of the patients. Overall survival was estimated using the Kaplan-Meier method. RESULTS: Thirty-six patients are required for the learning phase (P1). The expertise phase begins after the 36th LRC (P2). In both phases, there was no significant difference in age, ASA score, and tumor stage (P=0.237, P=0.577, P=0.998). Mean operative time was 328.3min and 262.4min in P1 and P2 (P=0.0001), mean blood loss was 333.7mL and 194.3mL in P1 and P2 respectively (P=0.0003). The rate of major complications was high in the learning phase (P=0.042). There was no significant difference in lymph node yield, positive surgical margins and overall survival (P=0.068, P=0.194, P=0.703). CONCLUSION: This learning experience was evaluated without compromising oncological results, but with a significantly higher rate of major complications. LEVEL OF EVIDENCE: 3.