A matched-pair analysis of patients with medium-sized prostates (50 cc) treated for male LUTS with HoLEP or TURP.

OBJECTIVES: To evaluate perioperative parameters, early functional outcomes, and the safety profile in a matched-pair analysis of lower urinary tract symptom (LUTS) patients treated with holmium laser enucleation of the prostate (HoLEP) or transurethral resection of the prostate (TURP). METHODS: We conducted a retrospective, matched-pair analysis of 2011 men treated for LUTS in our institution from 2013 to 2017. In the final analysis, 197 patients (HoLEP n = 97; TURP n = 98) were matched for prostate size (50 cc), age, and body mass index, and both cohorts were compared for demographic parameters, clinical outcomes, and adverse events according to the Clavien-Dindo classification. RESULTS: The perioperative assessment revealed a significantly higher tissue retrieval percentage of 75.4% (interquartile range [IQR] 64-81.2) after HoLEP in comparison to 47.3% (IQR 40-54.7) after TURP (P <.001). A shorter surgery time was reported for TURP with a median time of 55.5 minutes (IQR 48-70.5), whereas the median time for HoLEP was 62 minutes (IQR 51-85) (P =.006). The median improvements in International Prostate Symptom Score (IPSS) were 11 points (IQR 5.5-17) and 7 points (IQR 3-14) for HoLEP and TURP, respectively (P =.007). Peak urinary flow rate (Qmax ) increased more after HoLEP (12.0 mL/s; IQR 7-23) than after TURP (8.5 mL/s; IQR 5-18.25) (P =.028). With an overall incidence of adverse events of 6% (n = 6) compared to 16% (n = 16%), significantly fewer complications occurred after HoLEP than after treatment with TURP (P <.05). CONCLUSIONS: HoLEP is not only an attractive alternative for the enucleation of larger prostates, but it must be considered a size-independent technique with the potential to outdo the current reference method TURP.

Manejo multidisciplinario en retinoblastoma: experiencia en 37 ojos / Multidisciplinary management of retinoblastoma: Experience in 37 eyes

OBJETIVOS: Reportar los resultados del manejo multidisciplinario de pacientes con retinoblastoma, incluyendo supervivencia global, tasa de enucleación y éxito de la quimiorreducción sistémica. MÉTODOS: Estudio retrospectivo 27 pacientes (37 ojos) con diagnóstico de retinoblastoma, tratados por un equipo multidisciplinario en el Hospital San Juan de Dios. Se incluyeron información demográfica, características clínicas, supervivencia, tratamiento local y sistémico. Se realizó además un subanálisis de tratamiento con quimioterapia intraarterial (QIA). RESULTADOS: Catorce pacientes (52%) fueron de sexo masculino. La mediana de edad al ingreso fue de 8 meses (0,16-90). La mediana ± desviación estándar de seguimiento fue de 33 ± 21 meses. Diez casos (37%) se diagnosticaron después de los 15 meses de edad, con una mediana de 35 meses (24-90). En 17 (63%) pacientes fueron retinoblastomas unilaterales, mientras 10 (37%) tuvieron retinoblastoma bilateral. La leucocoria, aislada o asociada a otros signos, fue el motivo de consulta más frecuente (63%). La tasa global de enucleación fue del 57% (n = 21), siendo el tratamiento primario en 15 (55%) pacientes. La tasa de enucleación en retinoblastoma unilateral fue del 76,5% y en retinoblastoma bilateral del 60% de un ojo y el 10% de ambos. Diecisiete (63%) pacientes recibieron quimioterapia sistémica (media de ciclos: 5,3 ± 2,1). El éxito global de la quimiorreducción sistémica y la terapia focal fue del 68%. Tres pacientes fueron tratados con QIA como terapia de rescate, logrando controlar el tumor en 2 pacientes a 6 meses de seguimiento, siendo los primeros casos en Chile. La supervivencia fue del 100%. CONCLUSIÓN: El manejo multidisciplinario del retinoblastoma permite una supervivencia y una morbilidad comparable con la literatura internacional

OBJECTIVE: To report the results of the multidisciplinary management of patients with retinoblastoma, including survival, enucleation rate, and systemic chemoreduction success. METHODS: A retrospective study was conducted on 27 patients (37 eyes) diagnosed with retinoblastoma, and treated by a multidisciplinary team in San Juan de Dios Hospital. Demographic information, clinical characterization, survival, local and systemic treatments were included in the analysis. Patients treated with intra-arterial chemotherapy (IAC) were also reviewed. RESULTS: The study included14 male patients (52%). The median of age at presentation was 8 months (0.16-90). The median follow-up time was 33 ± 21 months. The diagnosis was made in 10 (37%) cases after 15 months old, with a median of 35 months (24-90). 17 (63%) patients had unilateral retinoblastoma, and 10 (37%) bilateral retinoblastoma. Leukocoria, isolated or associated with other signs, was the most frequent reason for referral (63%). Global enucleation rate was 57% (n = 21), being the primary treatment in 15 (55%) patients. Enucleation rate in unilateral retinoblastoma was 76.5%, and for bilateral retinoblastoma, it was 60% for one eye and 10% for both. Systemic chemotherapy was prescribed in 17 (63%) patients, with a mean number of cycles of 5.3 ± 2.1. The overall success of chemoreduction and focal therapy in order to avoid external radiotherapy and/or enucleation was 68%. Three patients were treated with IAC as a salvage therapy, controlling the tumor in 2 patients at 6 months of follow-up. These are the first cases reported in Chile. Survival rate was 100%. CONCLUSION: Multidisciplinary management of retinoblastoma led to a survival rate and morbidity comparable with international reports

[Porous orbital implants]. / Poröse Orbitaimplantate.

Since the introduction of the first coralline hydroxyapatite porous orbital implant as eye replacement in the early 1980s, numerous other modified porous implants have been developed. Due to the different design of the existing studies concerning long-term safety with, in some cases, relatively short follow-up, a comparison is difficult and none of the implant types can be clearly identified as being superior. Factors affecting the exposure rate of the implant seem to be the implant coating, the surgical technique and the condition of the patient's tissue at the beginning of surgery.

Intraoperative sub-tenon injection increases optic nerve length transection during enucleation.

PURPOSE: To determine the effect of sub-Tenon injection on the length of optic nerve resected during enucleation. METHODS: Case-control laboratory study on 22 orbits of 11 unpreserved, fresh-frozen human cadavers. Each cadaver underwent a conventional enucleation technique on one side and an otherwise identical technique on the contralateral side that included sub-Tenon injection of 2.5 ml normal saline in each oblique quadrant. Resected optic nerve lengths were measured and compared using Student t tests. RESULTS: The mean optic nerve length was 15.2 mm (range, 5.0-21.0 mm) in the sub-Tenon injection group and 11.3 mm (range, 5.0-19.0 mm) in control group (p = 0.015). CONCLUSIONS: Sub-Tenon injection during enucleation allows for significantly longer optic nerve resection lengths in unpreserved, fresh-frozen human cadavers.

[Early surgical rehabilitation due to modified exenteration technique]. / Frühe chirurgische Rehabilitation durch modifizierte orbitale Exenteration.

BACKGROUND: Orbital exenteration is a life intruding surgical procedure with severe functional, aesthetic and psychological consequences. Apart from the correct tumor treatment, early aesthetic and psychosocial rehabilitation is crucial for the well-being of the patient. We discuss reasons leading to exenteration and present new surgical techniques. Local flaps in the anterior socket improve wound healing allowing early placement of the prosthesis and therefore faster social rehabilitation of the patient. PATIENTS AND METHODS: Between 2007 and 2011 seven patients with malignant orbital tumors (1 × plasmocytoma, 1 × melanoma, 1 × sarcoma, 1 × squamous cell carcinoma and 3 × basal cell carcinoma) received a radical orbital exenteration at the Department of Ophthalmology of the Zurich University Hospital. The medical histories were evaluated according to reasons for exenteration, surgical techniques and postoperative follow-up. Reconstruction of the anterior socket border succeeded using local flaps (Mustardé, Glabella and combined with further modified pedicled local full thickness skin flaps). The central defects were covered with split skin graft from the thigh. RESULTS: Three weeks after surgery the anterior border of the socket was completely healed without problems by local flaps with good blood supply. This allowed the early prosthetic fitting and wearing as well as quick social rehabilitation of the patient. CONCLUSIONS: The use of local flaps improves wound healing even in anticoagulated patients. This reduces the time of hospitalization and rehabilitation, and allows an early, satisfactory, social reintegration of the patient.

[Ligation of the retrobulbar vascular-nervous bunch during performance of evisceration and enucleation using titanic clips in ophthalmic surgery].

The efficacy of hemostasis achievement during conduction of a retrobulbar vascular-nervous bunch ligation (RVNBL), using titanic clips while evisceroenucleation performance, was studied up. A comparative analysis of clinical and functional results of surgical treatment of 36 patients, suffering terminal dolorous glaucoma and disaster of a sympathetic ophthalmia complication after an eye penetrating wounding occurrence. In 16 patients (the first group) a standard method of a hemostasis achievement was used while doing evisceroenucleation - a deep orbital tamponade for 5 minutes. In 20 patients (the second group) a procedure of RVNBL was conducted, using titanic clips before the bunch transsection doing. There was established, that while doing a RVNPL using titanic clips, a hemorrhage never occurs, a retrobulbar hematoma do not formated, the soft tissues reaction in the early postoperative period is less pronounced, and the patients postoperative rehabilitation period shortens.

Estudio de la conservación del globo ocular con un abordaje multiterapéutico en el melanoma uveal / Ocular retention in patients with uveal melanoma managed by a multimodality approach

Objetivo: Analizar la supervivencia de los globosoculares afectados de melanoma uveal sometidos atratamiento conservador, en un centro que aplicatodas las modalidades de tratamiento.Métodos: Se han incluido en el estudio los pacientesdiagnosticados de melanoma de úvea tratadosentre septiembre de 1990 y abril de 2007 en la unidadde Oncología Ocular del Hospital Clínico Universitariode Valladolid realizándose un estudio decohortes histórico.Resultados: De los 273 pacientes incluidos en elestudio, se trataron 193 pacientes con terapias conservadoras(70,69%), mientras que se enuclearon deforma primaria 80 (29,30%). Se enuclearon de formasecundaria 14 de los sometidos a tratamientoconservador (7,2%) El análisis de supervivencia deKaplan-Meier reveló que tras la aplicación de untratamiento conservador, la probabilidad de conservacióndel globo ocular a los 5 años es del 88% y alos 10 años es del 83%.Conclusiones: El presente estudio pone de manifiestola seguridad de los tratamientos conservadores en el melanoma uveal, especialmente de la braquiterapiaepiescleral, en cuanto a control local dela enfermedad y a tasa de efectos secundarios(AU)

Objective: to analyze ocular survival in eyes withuveal melanoma treated with conservative therapies,in a centre that applies all treatment modalities.Methods: Patients diagnosed with uveal melanomaand treated between September 1990 and April2007 were included in an historical cohorts study.Results: 273 patients were included. 193 were treatedwith conservative treatments (70.69%) and 80were enucleated as primary treatment. 14 patientswere enucleated after conservative treatment(7.2%). Kaplan-Meier survival analysis showed an88% survival probability of the eye in the first 5years after conservative treatment and 83% at 10years.Conclusions: Conservative treatments for uvealmelanoma, especially brachitherapy, are safe andeffective in relation to tumor control and rate ofsecondary effects(AU)

A new device for ocular globe enucleation.

It is important to perfect the enucleation technique, especially in cases of intraocular malignancy, to obtain an adequate amount of tissue for histologic analysis and to cause a minimum amount of trauma to the remaining orbital structures. This study describes the use of a new device for ocular globe enucleation. The new instrument has been employed in 16 consecutive enucleation procedures with no complications. The new device has promoted good division of the optic nerve and allowed severing of the optic nerve stump at a length of more than 10 mm.

Snare technique for enucleation of eyes with advanced retinoblastoma.

Retrospective analysis of surgical outcomes for enucleation in pediatric retinoblastoma stage 5B using the snare wire loop (n = 55) and standard curved enucleation scissors (n = 22) revealed that a statistically significant longer mean optic nerve length was obtained with the snare (13.35 mm) compared with scissors (11.05 mm; P = .005). Four scissor cases had prolonged bleeding and required thrombin (18.2%), but no snare cases had difficulty with hemostasis (P = .005). More crush artifact was seen with the snare than with scissors (P<.001), but this did not affect the ability to determine tumor involvement at the surgical margin. The enucleation snare should be considered a valuable surgical instrument in the small pediatric orbit since obtaining the longest optic nerve segment has prognostic implications in retinoblastoma.

Orbital implants: potential new directions.

This article reviews orbital implants used to replace an eye after enucleation or evisceration. Advantages of implant placement are described, with discussion of implant and wrap material, and design features that affect clinical outcomes. Implants may be porous or nonporous, pegged for linkage with a cosmetic shell or unpegged, and may be wrapped with a covering material or tissue or unwrapped. Device shape, volume and material qualities affect tissue tolerance and the risk of exposure or extrusion. Limitations of currently available devices are discussed, with factors affecting surgeon and patient choice. Ideally, a device should be easy to insert, avoid the need for wrapping or adjunctive tissues, be light, biointegratable, comfortable after implantation and provide satisfactory orbital volume replacement, movement and cosmesis without requiring further surgery or pegging. This review briefly discusses developments in implant design and aspects of design that affect function, but is not a detailed clinical review; rather, it aims to stimulate thought on optimal design and discusses recent developments. Novel technology in the form of a prototype device with a soft, biointegratable anterior surface is described as an example of newer approaches.

A novel approach for the fixation of enucleated eyes during microsurgical procedures using common household plumbing accessories.

The authors describe a novel approach for the fixation of enucleated eyes during microsurgical procedures using common household plumbing accessories. The device consists of a ring adaptor with 4 round-ended screws placed horizontally at its sides and a plastic hose connector. The enucleated globe is secured in the center of the ring adaptor by gently tightening the screws. The hose connector supports the posterior pole of the globe and is secured onto a styrofoam board that provides a platform for resting the surgeon's hands. The device proved very satisfactory to residents during the teaching of cataract surgery and trabeculectomy on porcine eyes. Our globe fixation device is simple, inexpensive, effective, and readily available. It may be especially useful in developing countries.

Matching set of enucleation retractor and scissors.

Many surgeons encounter difficulty transecting the optic nerve during the enucleation procedure. An inadequate specimen may be obtained or the surrounding orbital tissue may be traumatized. A matching set of enucleation instruments have been developed to improve the visualization and division of the optic nerve while protecting the nearby orbital structures. The new enucleation instruments have been employed in 130 consecutive enucleation procedures. There have been no complications associated with these instruments. These instruments have facilitated the visualization and transection of the optic nerve during the enucleation procedure.

Standardized range of conformers and symblepharon rings.

Conformers and symblepharon rings are routinely used to keep fornices formed after socket surgery or in the presence of conjunctival cicatricial disease. However, there is no accepted standard size or shape of conformers or symblepharon rings. We measured the ideal conformer and symblepharon sizes in patients undergoing socket surgery and designed six conformer and symblepharon sizes. The full set of six conformers and symblepharon rings is available to the surgeon at the end of surgery. We have successfully used these conformers and symblepharon rings in over 600 cases during the last 7 years. These standardized sizes allow more accurate fitting of conformers and symblepharon rings.

Surgical methods and approaches in the treatment of orbital disease.

Many orbital disorders require surgical intervention to establish the diagnossis or to provide the basis for planning the appropriate surgical procedure in these selected cases. The indications for biopsy versus complete surgical excision of orbital lesions are outlined. The nature of the specific techniques, including fine-needle aspiration biopsy, endoscopic biopsy, anterior orbitotomy, lateral orbitotomy, and multidisciplinary combined approaches to the orbit is discussed. Separate sections, with an emphasis on clinical radiographic correlates, are devoted to the commonly encountered surgical disorders, thyroid orbital decompression and acquired anophthalmia (evisceration, enucleation, and exenteration).