Orthotopic genital sparing radical cystectomy in pre-menopausal women with muscle-invasive bladder carcinoma: A prospective study.

INTRODUCTION: Invasive cancer bladder is a life-threatening disease that is best treated with radical cystectomy and a suitable urinary diversion. The aim of this study was to evaluate the oncological outcome, voiding and sexual functions after genital sparing radical cystectomy with orthotopic bladder reconstruction in pre-menopausal women with bladder cancer. MATERIALS AND METHODS: 18 pre-menopausal women who underwent radical cystectomy and orthotopic urinary diversion with preservation of genital organs were included for this study. The patients were followed-up clinically and radiologically to assess their oncological outcome in addition to their voiding and sexual function. RESULTS: Mean age of the patients was 37.8 years, and the median follow-up after surgery was 70 months. One patient was lost to follow-up at 12 months post-operatively. The surgery was completed as planned in all patients, with a mean operative time of 290 min and an average blood loss of 750 mL. 14 patients were able to void satisfactorily, being continent day and night, while four patients needed clean intermittent catheterization. Sexual life remained unchanged in 15 cases, while three patients reported dysparunea. Till the last follow-up, there was no local recurrence while distant metastases were detected in three cases, two of whom died. CONCLUSIONS: Genital sparing cystectomy is a valid option for managing carefully selected women with muscle-invasive bladder cancer with good functional and sexual outcomes.

Combined laser acupuncture and desmopressin for treating resistant cases of monosymptomatic nocturnal enuresis: a randomized comparative study.

OBJECTIVE: Monosymptomatic nocturnal enuresis (MNE) is a common sociomedical problem affecting children that may persist until adulthood despite various lines of therapy. The aim of this study was to assess the efficacy of combined laser acupuncture and desmopressin in managing patients with resistant MNE, compared with their efficacy when used as monotherapy. MATERIAL AND METHODS: The study included 186 patients with a mean age of 15.7 years (range 10-21 years) presenting with persistent MNE. All patients were evaluated clinically and investigated with urine analysis, plain X-ray of the urinary tract and abdominal ultrasonography. They were randomized into three equal groups based on the line of management: group A, managed with laser acupuncture alone; group B, managed with desmopressin alone; and group C, managed with a combination of laser acupuncture and desmopressin, with a treatment course of 3 months and follow-up period of 6 months to record the efficacy of therapy, side-effects and bladder capacity. RESULTS: A statistically significant higher cure rate was reported in group C patients, being reported in 33, 35 and 46 patients in groups A, B and C, respectively. Improvement was reported in 18, 17 and 13 cases in groups A, B and C, respectively, but the difference was not statistically significant. Bladder capacity significantly increased only in patients receiving acupuncture (groups A and C). CONCLUSION: Combined laser acupuncture and desmopressin is a promising and valid option to manage resistant cases of MNE.

Dilemma of adolescent varicocele: long-term outcome in patients managed surgically and in patients managed expectantly.

OBJECTIVE: To evaluate outcomes of adolescent varicocele in the case of surgical versus conservative management. METHODS: 173 adolescent patients presenting with varicocele were evaluated clinically and sonographically to define varicocele grade and testicular volume. The patients were divided into 2 groups: A (53) with testicular size discrepancy >20% and bilateral varicoceles; B (120) unilaterally affected patients with testicular size discrepancy <20%, who were randomly allocated into 2 equal sub-groups (B1 & B2) of 60 patients. Group A & B1 patients underwent 3× loupe magnified inguinal varicocelectomy while B2 patients were conservatively managed. RESULTS: Mean patient age was 14.3 years with mean testicular volume of 11.75 mL and 10.15 mL for right and left testicles, respectively. There were no significant differences between sub-groups B1 & B2 for age, mean testicular volume, size discrepancy and varicocele grade. Mean follow-up of group A & B1 patients was 78 months showing grade I varicocele recurrence (4 cases), catch-up growth in 70% of cases and normal semen analysis in all cases. Mean follow-up of group B2 patients was 79 months showing catch-up growth in 50% of cases and normal semen analysis in all but 1 case. Four cases were shifted to surgical treatment due to reduction of testicular size (2 cases), varicocele upgrade (1 case) and oligoasthenospermia (1 case). At the last follow-up, the mean testicular volume for groups A, B1 & B2 was 16.2, 16.45 & 16.3 mL for right testes and 14.7, 15.6 & 15.2 mL for left testes, respectively. There was significantly better catch-up growth in sub-group B1 compared to B2 but the testicular volume was not statistically different. CONCLUSIONS: Although adolescent varicocelectomy was associated with a higher percentage of patients showing testicular catch-up growth, the mean testicular volume was not significantly different. Further studies are needed to report on paternity among those patients.