Laparoscopic Excision of an Extra-Adrenal Pheochromocytoma (Paraganglioma) of the Organ of Zuckerkandl.

Background: Paraganglioma of the organ of Zuckerkandl (OZ) is a rare surgically challenging tumor because of its critical location and the nature of catecholamine secretion. We describe the technique of laparoscopic excision as well as provide a literature review to confirm its feasibility. Case Presentation: In a 23-year-old male patient, laparoscopic excision of a 5 × 4 cm tumor located at the aortic bifurcation and indenting the vertebral column was performed. Preoperatively, the patient received α- and ß-adrenergic blockers as well as underwent sperm banking. The patient was put in the lateral position, five ports were used: four in the midline and one in the left iliac fossa. The tumor was approached by the reflection of the colon. Ureter, gonadal vein, and sympathetic chain were preserved. Dissection of the tumor from the inferior mesenteric artery was done followed by control of three feeding arteries and two draining veins posteriorly and inferiorly. The procedure was completed laparoscopically with minimal blood loss. Intraoperatively, three episodes of hypertension developed and required stoppage and the administration of vasodilators. The patient recovered on the second day postoperatively and all antihypertensive medications were stopped. At 1 year of follow-up, the patient is tumor-free but developed anejaculation for which he is under current treatment. Conclusion: Laparoscopic excision of paraganglioma located at the OZ is safe and feasible.

Infected penile prosthesis: literature review highlighting the status quo of prevention and management.

INTRODUCTION: Erectile dysfunction affects over 50% of men 70 years and above, and penile prosthesis (PP) is its third-line treatment. Complications of PPs include infection, however, no formal guidelines exist for its management. METHODS: We performed a literature search and reviewed 53 recent published literatures of experiences with management of PP infections, prevention, and treatment. RESULTS: Acute infection can present early with pain and discharge and detection of early signs is of utmost importance. MRI studies are more sensitive than CT studies to diagnose and plan surgical intervention. Introduction of antibiotic impregnated devices attributed to the reduction of infection rates with superiority proven for certain types; the no-touch technique had further reduced this rate. The Mulcahy salvage remains the most widely used surgical approach for treatment despite modifications and novel techniques described; conservative management of PP infections is recently reported with promising results. CONCLUSIONS: Despite absence of strict guidelines for the management of infected PPs, we reviewed and discussed numerous panel opinions and suggestions throughout literature. More research into the pathology, prevention, conservative management and advances in surgical treatment of this condition are called for to produce guidelines that unite the efforts to tackle these infections.

Complex posterior urethral injury.

OBJECTIVE: To assess treatment strategies for seven different scenarios for treating complex pelvic fracture urethral injury (PFUI), categorised as repeat surgery for PFUI, ischaemic bulbar urethral necrosis (BUN), repair in boys and girls aged ⩽12 years, in patients with a recto-urethral fistula, or bladder neck incontinence, or with a double block at the bulbomembranous urethra and bladder neck/prostate region. PATIENTS AND METHODS: We retrospectively reviewed the success rates and surgical procedures of these seven complex scenarios in the repair of PFUI at our institution from 2000 to 2013. RESULTS: In all, >550 PFUI procedures were performed at our centre, and 308 of these patients were classified as having a complex PFUI, with 225 patients available for follow-up. The overall success rates were 81% and 77% for primary and repeat procedures respectively. The overall success rate of those with BUN was 76%, using various methods of novel surgical techniques. Boys aged ⩽12 years with PFUI required a transpubic/abdominal approach 31% of the time, compared to 9% in adults. Young girls with PFUI also required a transpubic/abdominal urethroplasty, with a success rate of 66%. In patients with a recto-urethral fistula the success rate was 90% with attention to proper surgical principles, including a three-stage procedure and appropriate interposition. The treatment of bladder neck incontinence associated with the tear-drop deformity gave a continence rate of 66%. Children with a double block at the bulbomembranous urethra and at the bladder neck-prostate junction were all continent after a one-stage transpubic/abdominal procedure. CONCLUSION: An understanding of complex pelvic fractures and their appropriate management can provide successful outcomes.

Acute Urine Retention Caused by Hematocolpos After Failed Hymenotomy in 23 Year Old Female.

Mechanical obstruction by hematocolpos can result in acute urinary retention.(1) Imperforate hymen is a rare condition that presents mainly with primary amenorrhea, cyclic abdominal pain and rarely, urine retention in pubertal girls.(2) This is a 23-year old female who presented with acute urine retention. She had history of previous vaginal repair of imperforate hymen. On examination patient was found to have imperforate hymen. After fixing a catheter, an US scan showed hematocolpos that was confirmed CT. She was eventually underwent hymenectomy. We conclude that in peripubertal female with acute urinary retention, hematocolpos should be considered.