Search

An ageing general population, increase in average life span and prevailing benign prostatic hypertrophy bring an increasing number of elderly men to surgery for cervico-urethral obstruction. Given the small but significant morbidity of TURP, recently new mini-invasive techniques have been introduced for BPH, laser therapy being the most popular. The authors report on the different methods for delivering laser energy to the prostate, discussing the benefits and defects. They also present their personal experience with 44 patients aged over 75 years subjected to Nd:YAG laser prostatectomy from 1992 until today. In these patients transurethral laser evaporation, as suggested by Narayan and al., produced significant symptomatic and clinical results with low morbidity and invasiveness. The authors therefore believe that this kind of therapy may improve management of the elderly patient with BPH.

There are two important issues in the postoperative management of the urological elderly patient: complications and rehabilitation. Aging is associated with a loss of homeostatic reserve that may lead to postoperative complications due to drug interaction, malnutrition, infection, defects in wound healing, and poor psychological state. Furthermore rehabilitation, if not properly planned or implemented may influence not only the quality of life, but also the whole treatment results. The authors, in relation to pathogenetic aspects, describe what to do to prevent complications and to promote patient recovery. They conclude that both urologists and nurses must have specific geriatric training and that a psychiatrist, dietician, geriatrician and physiotherapist should be part of the team caring for the elderly surgical patient. Finally discharge from hospital must not be the end of therapy: in selected patients nursing management may continue at home reducing morbidity and mortality and helping better rehabilitation.

Since accurate clinical staging is the ideal presupposition for any therapeutic decision in prostate cancer (PC), the aim of this paper is to review sensitivity, specificity and accuracy of the imaging techniques routinely used to diagnose and stage PC. They are highly important parameters for selecting patients in whom the disease is confined to the prostate and who may benefit from radical surgery. This is particularly important when considering the high incidence of progression in patients with extracapsular disease or positive surgical margins and that 40–60% of patients with a clinically confined disease have extracapsular involvement shown at the histological examination.

Laser photocoagulation, due to simplicity and good results, is the main alternative to TURP in BPH. The technical evolution of materials and procedures has favoured vaporisation of the prostate instead of simple coagulation. More energy has thus been required for the treatment, leading to fibre damage or malfunctioning and increasing cost for single treatment. We report our initial experience with the Quadralase fibre that has a specially designed distal cap, which always allows the laser beam to be transmitted through a clean surface. We believe this is a further technical improvement in prostatic vaporisation with Nd:YAG laser, which may reduce operating times and fibre damage.

We report the case of a 56-year-old male suffering from acute urine retention after a period of increasing dysuria. Physical examination, TRUS and CT showed the presence of a multilocular cystic mass in the space above the prostate and behind the bladder. Pathological findings following surgical exploration indicated a Müllerian duct cyst, few cases of which have been reported in literature. We performed surgery because malignancy was suspected and it was impossible to drain off all the cystic fluid due to the multilocular nature of the cyst. Moreover, cystic adenocarcinomas originating from Müllerian duct remnants have been reported. We agree with other authors that a percutaneous approach should be standard treatment in these cases, leaving open surgery for more complex cases.