Microscopic subinguinal varicocelectomy with video telescopic operating microscope (VITOM) telescope: outcome analysis.

Conventional techniques of varicocele repair are associated with substantial risks of hydrocele formation, ligation of the testicular artery, and varicocele recurrence. The advantages of the microscopic approach to varicocele repairs are detailed identification and preservation of the vascular structures. In this study, our purpose is to review the outcome of all patients that underwent microscopic subinguinal varicocelectomy with the video telescopic operating microscope (VITOM). Hence, a retrospective review of 23 varicocele patients who underwent microscopic subinguinal varicocelectomy at the center from the year 2019 until 2021 was done. They, ranging between 18 to 58 years of age, comprising one case of right varicocele, fifteen cases of left varicocele, and seven cases of bilateral varicocele, were all having symptoms (pain and swelling) and clinically palpable varicocele. Ultrasounds were done to confirm the diagnosis and measure the testicular size. The surgery was performed by a single surgeon, under spinal anesthesia. The operation was performed using the VITOM telescope system, with an average operative time of one hour. The patients were followed-up at one month postoperatively to review the wound and symptoms. Phone call evaluations of all 23 patients were done to detect any recurrence or complications. All patients were discharged one day after surgery. Post-operative, all of them have a well-formed scar at the previous subinguinal region incision wound during the clinic visits. None of the 23 patients reported with varicocele recurrence, testicular pain, hydrocele formation or sexual dysfunction. The previous testicular pain or discomfort they encountered prior to the surgery was resolved as well. In conclusion, microscopic subinguinal varicocelectomy using the VITOM telescope is feasible and could achieve good outcomes.

Giant Prostatic Stones and a Massive Bladder Stone Leading to Obstructive Uropathy: A Rare Case Report.

Giant prostatic calculi are rare with less than 20 cases reported in the literature so far. Here, we discuss the presentation, diagnosis, and surgical management of a 25-year-old male patient with giant prostatic stones associated with a large bladder stone resulting from an underlying neurogenic bladder secondary to spina bifida. The patient had a history of congenital spina bifida, hydrocephalus, and non-compliance with clean intermittent self-catheterization. The stones were diagnosed through imaging and cystoscopy, and open cystolithotomy was performed for stone removal. The patient had a successful postoperative recovery with improved renal function. The case highlights the association between prostatic calculi and bladder outlet obstruction, emphasizes the importance of addressing underlying conditions to prevent stone recurrence, and underscores the role of open surgery in managing large bladder stones accompanied by renal impairment.