Mechanical failure with a malleable penile prosthesis is very rare. To the best of our knowledge, this is the first case reporting on a bilateral AMS 650 rod mechanical failure. We present a 50-year-old man with organic erectile dysfunction who experienced bilateral AMS 650 rod fracture after 14 years. The rod fracture of the left side was confirmed via X-ray preoperatively. The surgical exploration revealed a fracture of both rods. After the removal of both rods, we implanted a new malleable device during the same session. At the 6-month follow-up, the patient was satisfied with his prosthesis.
Introduction: To evaluate the effect of gemcitabine-cisplatin as adjuvant chemotherapy in patients underwent radical cystectomy. Patients and Methods: A total of 25 patients with advanced bladder cancer with or without lymph node metastases (tumor stages pT2, pT3, pT4 and/or pN1, pN2) were evaluated between January 2001 and February 2006 for effectivity, toxic side-effects and overall survival. Patients received 4 cycles of a combination of gemcitabine 1,000 mg/ m2 on days 1, 8, 15 and cisplatin 70 mg/m2 on day 2, repeated every 4 weeks. Results: Median follow-up was 28.2 months. An average of 4.12 cycles of chemotherapy was administered. The median duration of survival for all the evaluable patients was 27.8 months. The overall survival was 86.4% at 1 year, 69.2% at 2 years and 54.5% at 3 years. Neutropenia and thrombocytopenia were clinically significant toxicities. Neutropenic fever was seen in 2 patients, and none died of sepsis. Conclusions: Better understanding of factors associated with postoperative outcomes associated with different types of chemotherapy in locally advanced bladder cancer is necessary. We conclude that gemcitabine-cisplatin regimen in adjuvant setting after cystectomy is feasible with a tolerable toxicity. But, randomized controlled trials will be required for the assessment of long-term benefit.
Our aim was to compare the outcomes and satisfaction rates of men undergoing penile prostheses implantation (PPI) secondary to radical prostatectomy (RP) and other causes of vasculogenic erectile dysfunction (ED). A total of 142 patients, of whom 60 underwent PPI due to ED following RP (Group 1) and 82 underwent PPI due to ED with other vasculogenic causes (Group 2) were included in this study. The preoperative erectile status was evaluated with the International Index of Erectile Function (IIEF). The satisfaction of patients and partners were evaluated by a telephone interview using Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire and Erectile Dysfunction Inventory of Treatment Satisfaction Partner Survey. Preoperative mean IIEF scores were significantly lower in Group 1 (17.5 ± 6.4 vs. 24.2 ± 5.1, p = 0.01). For Groups 1 and 2, the mean EDITS scores of the patients were 58 ± 10 and 71 ± 8, respectively, and that for the partners were 46 ± 8 and 65 ± 7, respectively. Group 1 had significantly lower scores both for the EDITS and the EDITS Partner Survey (p = 0.03, p = 0.01, respectively). Patients who had undergone RP and their partners were found to have lower satisfaction rates compared to patients with other causes of vasculogenic ED who had penile implant surgery. From this point of view, it is important to know the patient's expectations about the treatment outcomes and a preoperative psychological and sexual counseling should be managed for possible treatment alternatives after RP.
Objective: To evaluate the success rates of different ureteroscopic lithotripsy techniques in the management of ureteral stones at different locations. Patients and Methods: A total of 1,909 ureteroscopic procedures were performed between May 1992 and November 2005. Atotal of 1,567 patients underwent ureteroscopic lithotripsy for treatment of ureteral stones at different locations; ultrasonic, electrohydraulic, pulsed-dye laser and pneumatic lithotripsy were used as ureteroscopic procedures. Results: The overall success rate was 89.0% for all procedures. The success rate of ultrasonic, electrohydraulic, pulseddye laser and pneumatic lithotripsy were 79.6, 72.0, 87.6 and 96.1%, respectively. Significant complications which were defined as ureteral perforation and strictures, occurred in 9 of 866 patients (0.9%) currently, compared to 30 of 701 (4.3%) previously. Conclusion: Among different procedures, pneumatic lithotripsy was the most effective method with low failure rates.
Objective : Ureteral stents are widely used in endo-urological procedures. However, ureteral stents can be forgotten and cause serious complications, including fragmentation, migration and urosepsis. There are few reports about forgotten and fragmented ureteral stents with stone formation. We aimed to present this rare case with successful combined endo-urological management.
Background: The aim of this study is to adapt the two most common grading
systems of surgical complications; the Satava system for perioperative complications,
and the modified Clavien grading system for the postoperative complications
on the surgical complications of penile prosthesis surgery. Methods and Findings: Between Oct 1990 and Dec 2011, 422 patients were
treated with penile prosthesis implantation (PPI). We categorized the procedures as
follows: A: Malleable PPI, B: Inflatable PPI, (B1: for 2 piece inflatable penile prosthesis
(IPP), B2: for 3 piece IPP), C: Dual implantation with an artificial urinary sphincter
(AUS), synchronously or metachronously (C1: A+ AUS, C2: B1+ AUS and C3: B2+
AUS). We classified the intraoperative complications according to the Satava system
and the postoperative complications according to the modified Clavien grading
system. The mean age was 58(40-74). The numbers of overall intraoperative and
postoperative complications were 21 and 45, respectively. The distribution of intraoperative
complications was; 13/21(62%), 6/21(29%) and 2/21(9%) for Grades
1, 2 and 3, respectively. The distribution of postoperative complications were; 0,
5, 1, 39, 0, 0 and 0 for Grades I, II, IIIa, IIIb, IVa, IVb and V, respectively. Conclusion: Satava grading system works well for classifying intraoperative complications
of PPI but the modified Clavien classification cannot afford a reproducible
and even grading system for classifying postoperative complications. A standard
method for classifying postoperative complications of PPI surgery is lacking and
deserves more investigation.
<i>Objectives:</i> To evaluate the association of p53 nuclear accumulation with recurrence and progression in transitional cell carcinomas of the bladder and to examine the distribution of p53 in low-grade and high-grade transitional cell carcinomas according to the World Health Organization/International Society of Urological Pathology classification. <i>Patients and Methods:</i> Nuclear accumulations of p53 were examined in a total of 99 patients with transitional cell carcinoma between May 1995 and October 1999. The mean age was 64 years. There were 94 (95%) men and 5 (5%) women. Following resection, surgical specimens were examined, and p53 accumulation with a 20% cutoff value was accepted as positive staining. Of the 99 patients, 52 (53%) had histologically superficial bladder tumors, and 47 (47%) had invasive tumors. Data concerning grade, stage, number of recurrences, and disease progression were available for each patient. <i>Results:</i> The median follow-up period was 55 months. 60 of the 99 patients (61%) had p53 overexpression. The difference for p53 overexpression between low-grade and high-grade tumors was significant (p < 0.05). In low- and high-grade tumors, there was no significant relationship for recurrence between p53-positive and p53-negative groups. But there was a statistically significant relationship between progression and histological grade of the tumors. p53 had no significant relationship with tumor recurrences (p > 0.05), but its relationship with progression was statistically significant (p < 0.05). <i>Conclusions:</i> We did not find a correlation between tumor recurrence and p53 overexpression, but p53 overexpression has a predictive value in determining tumor progression. High-grade tumors had higher p53-positive values than low-grade tumors. This group of patients should be considered for radical therapies on the basis of other prognostic parameters.
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