A Fatal Case of Massive Incarcerated Genital Prolapse.

Genital prolapse is usually seen as a benign condition warranting treatment only when bothersome. We report the case of a 77-year-old woman who presented with massive incarcerated pelvic organ prolapse, which led to bladder necrosis, cystectomy with bilateral cutaneous ureterostomy, and death from medical complications 5 weeks after the initial presentation. This first case report of death from bladder necrosis after incarcerated genital prolapse could warrant treatment of massive prolapse even when apparently well tolerated.

Prospective evaluation of ambulatory laser vaporization of the prostate for benign prostatic hyperplasia.

BACKGROUND AND OBJECTIVE: Photoselective vaporization of the prostate (PVP) is an alternative to transurethral resection of the prostate in the surgical treatment of benign prostatic hyperplasia (BPH). Our objective was to prospectively evaluate the feasibility, safety, and efficacy of ambulatory photoselective vaporization of the prostate for benign prostatic hyperplasia. MATERIALS AND METHODS: We prospectively collected data of all consecutive patients who underwent ambulatory PVP with the Greenlight(®) laser 180-W XPS at two centers between May 2012 and June 2013. Patients' characteristics, perioperative data, postoperative outcomes, complications, and patient's satisfaction were evaluated. Successful ambulatory care procedure was defined as the ability to leave the hospital in the evening of the operation. RESULTS: The ambulatory procedure was intended in 134 patients. Mean age was 67 years. Mean prostate volume was 54 ml, and Median American Society Anesthesiologists (ASA) score was 2. Ambulatory procedure was successful in 121 patients (90%). At 3 months, International Prostate Symptom Score (7.3 ± 4.9), maximal urinary flow rate (20.8 ± 7.6 ml/s), postvoid residual urine (19.2 ± 71 ml), and quality of life (1.6 ± 1.4) were significantly improved (P < 0.001). Fourteen patients (10.5%) had complications that were all minor (Clavien ≤ 2). Two patients had to be readmitted to the hospital. The majority of patients (89%) were satisfied with ambulatory care. Failure to complete ambulatory procedure was mostly related to logistical problem (70% of the cases). CONCLUSIONS: Ambulatory PVP is feasible with functional results and complications comparable to that of traditional hospitalization. Ambulatory care yields high patient's satisfaction.

The use of a ureteral access sheath does not improve stone-free rate after ureteroscopy for upper urinary tract stones.

PURPOSE: To evaluate the impact of a ureteral access sheath (UAS) on stone-free (SF) rate after flexible ureteroscopy for upper urinary tract stones. MATERIALS AND METHODS: We retrospectively reviewed 280 patients who underwent flexible ureteroscopy (URS) for upper urinary tract stone between 2009 and 2012. Patients were divided into two groups based on whether a UAS was used (n = 157) or not (n = 123). SF rate was evaluated at one and three months after surgery by abdominal imaging. Quantitative and qualitative variables were compared with Student's t test and χ2 test, respectively. A logistic regression model was used to determine the predictive factors of SF status. RESULTS: Stone size was similar in both groups (15.1 vs. 13.7 mm, p = 0.21). SF rates at one and 3 months were comparable in UAS and non-UAS groups (76 vs. 78% and 86 vs. 87%, p = 0.88 and 0.89, respectively). Complication rates were similar in both groups (12.7 vs. 12.1%, p = 0.78). In multivariable analysis, stone size was the only predictive factor of SF rate (p = 0.016). CONCLUSION: The routine use of a UAS did not improve SF rate in patients undergoing flexible URS for upper urinary tract calculi.