Sarcoidosis of the spermatic cord - case report and literature review.

BACKGROUND: Sarcoidosis is a multi-system disease characterized by the formation of non-caseating granulomas in various organs. The lungs remain the most frequently affected organ, whereas lesions in the genitourinary system affect around 0.2% of patients. The primary site found in the spermatic cord is extremely rare. CASE PRESENTATION: We present a patient's case where the spermatic cord involvement was the first manifestation of sarcoidosis. For several months, a number of tests had been performed, which showed, among others, non-caseating granulomas in pathomorphological material, bilateral hilar lymphadenopathy, and leukopenia with lymphopenia. Tumor markers were normal. Infection with urogenital pathogens (including Chlamydia Trachomatis, Neisseria gonorrhea, Mycoplasma hominis) was excluded. The patient did not report any general symptoms such as fever, excessive fatigue, weight loss. He denied swelling, shortness of breath. At the same time, a complete differential diagnosis was carried out, and the extent of the disease was assessed. Due to interdisciplinary management, the patient's quality of life and fertility is preserved. In the discussion, we present the diagnosis, treatment, and prognosis of such patients. CONCLUSION: Sarcoidosis is a multi-system disease, which should not be omitted in the differential diagnosis. Selective excision of the lesion with intraoperative examination plays a significant role while establishing a diagnosis. However, in the primary site in the genitourinary system, the diagnosis is challenging.

RéSUMé: CONTEXTE: La sarcoïdose est une maladie multisystémique caractérisée par la formation de granulomes non caséeux dans divers organes. Les poumons restent l'organe le plus fréquemment touché, alors que les lésions du système génito-urinaire affectent environ 0,2% des patients. La découverte d'un site principal dans le cordon spermatique est extrêmement rare. PRéSENTATION DU CAS: Nous présentons le cas d'un patient où l'atteinte du cordon spermatique a été la première manifestation d'une sarcoïdose. Pendant plusieurs mois, un certain nombre de tests ont été effectués, qui montraient, entre autres, des granulomes non caséeux dans le matériel pathomorphologique, une lymphadénopathie hilaire bilatérale, et une leucopénie avec lymphopénie. Les marqueurs tumoraux étaient normaux. Une infection par des agents pathogènes urogénitaux (y compris Chlamydia Trachomatis, Neisseria gonorrhea, Mycoplasma hominis) a été exclue. Le patient n'a signalé aucun symptôme général tel que fièvre, fatigue excessive, ou perte de poids. Il a nié toute œdème ou essoufflement. Dans le même temps, un diagnostic différentiel complet a été effectué et l'étendue de la maladie a été évaluée. Grâce à la prise en charge interdisciplinaire, la qualité de vie et la fertilité du patient ont été préservées. Dans la discussion, nous présentons le diagnostic, le traitement et le pronostic de ces patients. CONCLUSION: La sarcoïdose est une maladie multisystémique, qui ne doit pas être omise dans le diagnostic différentiel. L'excision sélective de la lésion, avec examen peropératoire, joue un rôle important lors de l'établissement d'un diagnostic. Cependant, en cas de localisation du site primaire dans le système génito-urinaire, le diagnostic est difficile.

The Important Role of Endothelium and Extracellular Vesicles in the Cellular Mechanism of Aortic Aneurysm Formation.

Homeostasis is a fundamental property of biological systems consisting of the ability to maintain a dynamic balance of the environment of biochemical processes. The action of endogenous and exogenous factors can lead to internal balance disorder, which results in the activation of the immune system and the development of inflammatory response. Inflammation determines the disturbances in the structure of the vessel wall, connected with the change in their diameter. These disorders consist of accumulation in the space between the endothelium and the muscle cells of low-density lipoproteins (LDL), resulting in the formation of fatty streaks narrowing the lumen and restricting the blood flow in the area behind the structure. The effect of inflammation may also be pathological dilatation of the vessel wall associated with the development of aneurysms. Described disease entities strongly correlate with the increased migration of immune cells. Recent scientific research indicates the secretion of specific vesicular structures during migration activated by the inflammation. The review focuses on the link between endothelial dysfunction and the inflammatory response and the impact of these processes on the development of disease entities potentially related to the secretion of extracellular vesicles (EVs).

Transurethral anatomical enucleation of the prostate with Tm:YAG support (ThuLEP): review of the literature on a novel surgical approach in the management of benign prostatic enlargement.

PURPOSE: Retrograde transurethral anatomical enucleation of the prostate is gaining momentum as a new concept in transurethral surgery of benign prostatic hyperplasia. Its adaptation is boosted by the familiarity of urologists with the finger-assisted anatomical enucleation of the adenoma during open prostatectomy and the combination of this well-established concept with the minimal invasive characteristics of transurethral surgery. The thulium laser appears as an ideal energy source for such operation. In this work, current evidence on thulium laser-assisted anatomical enucleation of the prostate (ThuLEP) is being reviewed. MATERIALS AND METHODS: A comprehensive literature review was performed on Medline, PubMed, and Cochrane databases retrieving all literature on thulium laser-assisted prostatectomy between 2006 and 2015. Experimental studies, review articles and editorial comments as well as studies on thulium laser-assisted approaches other than ThuLEP (i.e., ThuVEP, ThuVAP or ThuVARP) were excluded from the analysis. RESULTS: In total, six original articles on either surgical technique or clinical outcomes were retrieved. With regard to functional results, ThuLEP presented no significant differences toward the standard treatment (TURP/HoLEP) arm in two randomized controlled trials and favorable outcomes in available prospective cohorts. Observed morbidity was minimum and comparable with the rest of transurethral literature. CONCLUSIONS: ThuLEP literature is still very limited. Based on the available data, the approach is safe and effective, demonstrating favorable outcomes, comparable with the current standard treatment options. Further documentation of ThuLEP outcomes is necessary to define the optimum indications of this novel technique.

Interobserver variability of Clavien-Dindo scoring in urology.

OBJECTIVES: To assess the interobserver variability of Clavien-Dindo scoring in urology. METHODS: A thematic survey was carried out simultaneously in nine Polish urological centers among 171 responders - 81 urologists and 90 urologists-in-training, made up of 16 women and 155 men. After Clavien-Dindo classification was presented, respondents were asked to grade nine typical urological complications according to Clavien-Dindo classification. Interobserver agreement, reproducibility of answers, as well as the influencing factors were analyzed. Questions in the survey related to complications of variable severity after basic urological operations, including four open, one laparoscopic and four endourological. RESULTS: Agreement on the grade of complication was moderate (κ = 0.45) and it was noticed in 69% of respondents (range 38-87%). No effect of surgical approach (classic vs endoscopic, 70% vs 67%, P = 0.64), or physician professional experience (resident vs urologist, 71% vs 66%, P = 0.77) was observed. The most significant discrepancies were found in cases of local complications after transurethral surgery (accordance in 39%) and laparoscopic radical prostatectomy (accordance in 55%), and in cases of severe general complications after Bricker operation (accordance in 58%). CONCLUSIONS: The variability of Clavien-Dindo classification scoring among urologists is significant. Thus, the Clavien-Dindo classification might require detailing before its eventual implementation in urology, together with appropriate training of specialists. However, despite some disadvantages, the simplicity, reproducibility and logical scheme of the Clavien-Dindo classification make it a promising tool for quality assessment in different fields of urology.

Thulium laser enucleation of the prostate (TmLEP) vs. transurethral resection of the prostate (TURP): evaluation of early results.

INTRODUCTION: The first decade of XXI century it is a time of the thulium laser implementation to a benign prostatic hyperplasia treatment. OBJECTIVE: The objective of this paper is a comparative assessment of early results thulium laser enucleation of the prostate (TmLEP) versus transurethral resection of the prostate (TURP) in 3-months observation. MATERIALS AND METHODS: PATIENTS WERE RANDOMIZED TO BPH SURGICAL TREATMENT: research group (TmLEP - 54 men) or control group (TURP - 52 men). Between 02.2007-09.2009 non-consecutive patients were examined before, one month, and 3-months after surgery. Perioperative data (age, PV, time of surgery, use of laser, morcellation, catheterization, hospitalization, used energy, Hgb loss and removed tissue weight) were assessed. Before and after surgery IPSS, QoL, Qmax and PVR were controlled. RESULTS: Hemoglobin loss was twice lower during TmLEP than TURP [0.95 ±0.77 (0-3.2) vs. 1.81 ±0.97 (0.1-4.7) g/dl, p <0.0001]. Surgery time TmLEP was longer than TURP [102.2 ±38.7 (25-210) vs. 74.5 ±22.8 (25-140) min. p <0.0001]. Without morcellation time [28.1 ±17.9 (5-80) min.], surgery time of both procedures was comparable. Weight of resected tissue was lower in TmLEP than TURP [24.8 ±14.8 (2-65) vs. 34.8 ±14.1 (12-68)g]. without consideration of vaporized tissue. In both groups we noticed a distinct improvement in all parameters: IPSS, QoL, Qmax and PVR, but without any statistically significant differences between them. Complications after surgery were similar in TmLEP and TURP group. CONCLUSIONS: The thulium laser enucleation of the prostate is safe and efficient BPH treatment method, comparable to the transurethral electroresection in 3-months observation. Lack of long-term research does not allow to form wider conclusions.