Bladder leiomyoma in male patient presenting with renal oncocytoma: Are the two conditions related?

A 64-year-old male patient with a large pelvic mass and a right renal mass was referred to our facility. The patient underwent a right radical nephrectomy and pelvic mass excision. A histopathological examination led to a diagnosis of renal oncocytoma and urinary bladder leiomyoma.

Testicular cancer in Down syndrome with spinal cord metastases.

A 22-year-old male patient with Down syndrome was referred to our hospital with a vast left testicular mass. He underwent a left radical inguinal orchiectomy, and a histopathological examination of the mass showed a yolk sac tumor invading the epididymis. The patient was discharged in a satisfactory condition. Sixteen days later, the patient presented again complaining of lower limb weakness. Magnetic resonance imaging of the spine showed metastatic lesions compressing the dorsal spine, and he underwent emergency surgical decompression. The histopathology of the metastatic lesions revealed a yolk sac subtype which was identical to his primary testicular tumor.

Effects of Previous Hernia Repair on Extraperitoneal Robot-Assisted Radical Prostatectomy: A Matched-Pair Analysis Study.

PURPOSE: To evaluate results of an extraperitoneal robot-assisted laparoscopic radical prostatectomy (e-RALP) series considering patients with previous laparoscopic inguinal hernia repair (LIHR). METHODS: We investigated our e-RALP database between March 2008 and August 2014. Age, prostate-specific antigen, prostate volume, and Gleason score were considered as criteria of matched pair analyses. Group 1 consisted of 32 patients who underwent e-RALP with previous LIHR using mesh, and Group 2 consisted of a similar 32 patients without previous LIHR. In addition, preoperative, perioperative, and postoperative data were recorded. Complications were evaluated according to the Clavien-Dindo classification. Significance was P ≤ 0.05. RESULTS: Mean follow-up was 20.3 ± 3.2 months. In total, 987 patients underwent e-RALP. Preoperative parameters were similar between groups. There were significantly more peritoneum openings, time of anastomosis, trocar placement, preparing Retzius space, pelvic lymph node dissection (PLND), and operative time observed in group 1 than group 2 (respectively, P=0.01, P=0.05, P=0.004, P=0.001, P=0.01, P=0.002). Mean estimated blood loss and time for endopelvic dissection were comparable between groups. In addition, there was no open conversions and pelvic vessel injury. There were, however, two bladder injuries that were treated by using V-loc suture, simultaneously. The most common complication was postoperative fever (Clavien I). CONCLUSION: PLND can be performed safely during e-RALP in patients with previous LIHR. Surgeons should consider careful dissections and possible bladder injury during PLND. Thus, first steps of operation including PLND, could take a longer time in patients with previous LIHR.

Comparative study for evaluating the cosmetic outcome of small-incision access retroperitoneoscopic technique (SMART) with standard retroperitoneoscopy using the Observer Scar Assessment Scale: are small incisions a big deal?

AIM: To compare the scars and cosmetic results of trocars of 3, 5, and 10 mm in cases by small-incision access retroperitoneoscopic technique pyeloplasty (SMARTp) and standard laparoscopy pyeloplasty (SLp). METHODS: Between January 2012 and October 2013, 20 pyeloplasties were performed: 12 with SMARTp and 8 with SLp techniques. A 5-mm homemade balloon trocar was used to create the retroperitoneal space. In SMARTp, 3- and 5-mm trocars were used and in SLp, 5- and 10-mm trocars were used. All patients underwent a ureteral (Double-J) stent placement preoperatively. The study included a total of 72 trocar-site scars: 3 mm (24 scars), 5 mm (24 scars), and 10 mm (24 scars). Cosmetic outcome was assessed at the 3rd, 12th, and 24th month of surgeries by the Observer Scar Assessment Scale (OSAS). RESULTS: Mean age was 34.7±10.5 (19-52) years, and mean follow up was 18.7±9.2 months. Fifteen patients (75%) underwent Y-V plasty, and 5 (25%) underwent Anderson-Hynes pyeloplasty. Mean operative time was 125.4±28.7 minutes. There was only minimal blood loss, no need for conversion to standard laparoscopic or open pyeloplasty, no intraoperative complications, and only two postoperative complications were recorded: retroperitoneal hemorrhage and wound infection and both were treated conservatively. There were significant differences between objective questions of "vascularization" in a 3-mm trocar and "thickness" in a 10-mm trocar. Twenty-four months after surgery, the cosmetic data assessed by OSAS showed statistically significant differenecs in favor of the 3-mm trocar sites versus the 10-mm trocar sites (OSAS: 13.8±3.9 vs 24.6±1.7; p=0.006) with no statistically significant difference between 3- and 5-mm port sites. CONCLUSIONS: The SMARTp is proved to be an efficacious and tolerable procedure with better cosmetic results and can be used for the treatment of ureteropelvic junction obstruction (UPJO) in suitable patients. We believe that this technique is likely to become an established procedure.