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Copyright of Romanian Journal of Urology is the property of Romanian Journal of Urology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction. Radical cystectomy is the main therapeutical procedure for the treatment of invasive bladder tumors. The standard technique requires a transperitoneal approach. In order to reduce morbidity, we have studied the results of extraperitoneal radical retrograde cystectomy with primary ligature of the dorsal vein complex. Surgical technique. Median suprapubic incision of about 15 cm in length. Entering the Retzius space, the peritoneum is dissected off the pelvic walls and the iliac vessels, after cutting the vas deferens. Standard lymph node dissection is performed, ligation and section of the superior vesical artery, isolation and downwards dissection of the ureters to the bladder. The endopelvic fascia is incised laterally to the prostate and the dorsal venous complex is ligated and sectioned. The urethra is sectioned at the apex of the prostate. Ligation and sectioning of the lateral prostatic pedicles, isolation of the seminal vesicles and ligation/ sectioning of the bladder pedicles are performed. The bladder, en-bloc with the prostate and seminal vesicles is dissected off the peritoneum. The urachus can be dissected up to the umbilicus, where it is sectioned. Sectioning of the ureters with frozen section examination of the margins. Results. During December 2009 - September 2010 we performed this procedure on 22 male patients, mean age 65.5 years (54-77). Tumor stadialization: T1 (2), T2 (14), T3 (3), T4 (3); N+ (3); U+ (4). Comorbidities: heart failure (2), hypertension (6), major bundle branch block (3), systemic atherosclerosis (5), aortoiliac l thrombosis (2), thrombosed aortic aneurism (1), common iliac artery aneurism thrombosis (1), chronic bronchitis (1), operated laryngeal cancer (1), stroke (1). We performed the following urinary diversions: orthotopic bladder substitution (6: 5 Camey, 1 Studer), Bricker (2), cutaneous ureterostomy (14). Pelvic lymph nodes dissection: standard 18cases, extensive 1, limited 3 cases. There were not intraoperative complications. Immediate postoperative complications: prolonged lymphatic drainage (2), acute renal failure (1), mean time for radical cystectomy: 2 hours, blood loss: 300-500 ml, mean hospitalization: 15.2 days (7- 25), cutaneous ureterostomy: 13.6 days, Bricker diversion: 12 days, orthotopic bladder substi-tution: 20.6 days. Conclusions. The radical extraperitoneal cystectomy technique maintains the integrity of the peritoneal bag, with early resuming of bowel function; reduces postoperative complications and hospitalization. Extraperitoneal ureterointestinal anastomosis avoids complications related to the procedure. Parietal incision with preservation of the peritoneum decreases the incidence of eventrations. [ABSTRACT FROM AUTHOR]

Background: Varicocele represents the most common cause of male infertility. Open surgical approach and minimally invasive procedures have been performed for varicocelectomy with significant difference in the postoperative complications and pregnancy rates. Many reports suggest that microsurgical varicocelectomy has the advantages of no hydrocele formation, lower incidence of varicocele recurrence, and better improvement in sperm quality compared with other treatments modalities. Purpose: To evaluate the effects of microscopic assisted subinguinal varicocelectomy (MSV) on sperm quality and pregnancy rate. Design: Prospective longitudinal study. Materials and Methods: In a 2-year period (2008 - 2010) a standard MSV was performed in 104 patients with palpable varicocele. Inclusion criteria were: unilateral or bilateral clinical palpable varicocele, normal reproductive blood hormones levels (FSH, LH and Testosterone) and at least one abnormal semen parameter. The single exclusion criteria was vasectomy. At least 2 sperm analysis were obtained both preoperatively and at follow up visit. The main outcome measures were sperm count, total motile sperm count, sperm morphology and pregnancy rate. The follow-up visit was scheduled at 3, 6 and 12 months postoperatively. Statistical analysis was performed using the paired t test to compare mean preoperative with postoperative sperm parameters and p value < 0.05 was considered significant. A postoperative increase of sperm count, TMSC and sperm morphology with at least 50% of preoperative value was considered success. The patients were divided into 4 groups according to pre and postoperative sperm count: group 1 (0-1milion/ml) and group 2 (1-5 million/ml) - indication for in vitro fertilization, group 3 (5-20 million/ml) - indication for intrauterine insemination, and group 4 (>20 million/ml) - indication for natural pregnancy. Results: 70 patients completed at least one follow up visit. The mean sperm count, TMSC and sperm morphology increased from 19 to 35.6 million/ml, from 41.7 to 44 million and from 53.1% to 76.7%. The difference was statistically significant for sperm count (p = 0.0001). The success of varicocelectomy to increase each sperm parameter with at least 50% of preoperative sperm count, TMSC and sperm morphology were 57.1%, 27.1% and 32.8%. 70.3% of patients from group 1 and 2 migrated postoperative into groups 3 and 4; 64.2% of patients from group 3 migrated postoperative in group 4. Conclusions: Microscopic assisted subinguinal varicocelectomy (MSV) is very effective in increasing sperm count and offer a good natural pregnancy rate; depending on the sperm count, couples can benefit of less invasive techniques for achieving pregnancy after MCV.A systematic preoperative check of genetic abnormalities of male patients and fertility potential of female partner would improve the overall results. [ABSTRACT FROM AUTHOR]

Copyright of Romanian Journal of Urology is the property of Romanian Journal of Urology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Romanian Journal of Urology is the property of Romanian Journal of Urology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Romanian Journal of Urology is the property of Romanian Journal of Urology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Romanian Journal of Urology is the property of Romanian Journal of Urology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Romanian Journal of Urology is the property of Romanian Journal of Urology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Romanian Journal of Urology is the property of Romanian Journal of Urology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Urinary tract infections (UTIs) are among the most common bacterial infections worldwide and have become more difficult to treat over the years. Inappropriate antibiotic use has led to increased antibiotic resistance., Materials and Methods: We examined 1921 urine culture samples from a single hospital and analyzed them for bacterial spectrum and antibiotic susceptibility. We further analyzed changes in the rates of detected bacteria and of the sensitivity of these uropathogens to antibiotics over the years., Results: In our hospital-based analysis, cystitis was the most frequently diagnosed UTI in women (76%) and men (79%). Escherichia coli (48%) was the most commonly identified uropathogen. Samples demonstrated an increase in the proportion of E. coli (p   <  0.001) and a decrease in Enterococcus faecalis (p   <  0.001) over the study time period. Antimicrobial susceptibility analysis showed an increase over time in the number of isolates with resistance to ampicillin/sulbactam (p   <  0.001) and to third-generation cephalosporins cefotaxime (p   =  0.043) and ceftazidime (p   <  0.001)., Conclusions: Ampicillin/sulbactam and third-generation cephalosporins are antibiotics frequently used in the treatment of UTIs. When selecting an optimal antimicrobial treatment regimen for patients with UTIs, it is imperative to understand regional and timedependent differences in the prevalence of various uropathogens and antimicrobial resistance patterns. Therefore, continuous surveillance of local pathogen and antimicrobial susceptibility patterns for frequently used antibiotics should be prioritized., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc.)

Objective: Endoscopic extraperitoneal radical prostatectomy (EERPE) and robot-assisted laparoscopic prostatectomy (RALP) are minimally invasive surgical techniques to treat localized prostate cancer. We report the outcome and complications of these two techniques conducted by one individual surgeon., Patients and Methods: 86 patients underwent EERPE between January 2008 and June 2011, and 100 patients underwent RALP between August 2011 and October 2012. All surgeries were performed by one single surgeon., Results: The patients of the EERPE and RALP groups had similar clinical characteristics in PSA, prostate volume and D'Amico classification, and were significantly different in their age and BMI as well as in the number of prior surgeries. RALP surgeries were significantly slower (183 vs. 157 min) but also involved lower blood loss (147 vs. 245 ml). Pathological stages and positive surgical margins were similar in both groups. Complications were assessed by the Clavien-Dindo classification. 6 patients in the EERPE group and 3 patients of the RALP group suffered major complications (IIIb-IV)., Conclusion: Altogether our results indicate that the learning curve for RALP was short after experience with EERPE. We hypothesize that this is more a result of the surgical experience of the surgeon with the EERPE than on the robotic technique., (© 2015 S. Karger AG, Basel.)

Objective: The present study proposes to present the importance of perioperative therapeutic management in survival prolongation and the quality of life for patients that have undergone surgery for cerebral metastases secondary to pulmonary tumors., Method: During 2001-2009, 40 patients with ages between 43-74 years have been diagnosed in our clinic with pulmonary tumor and cerebral metastases. The patients presented single cerebral lesion (excepting one patient with 2 cerebral metastases) and pulmonary tumor. Intracranial pressure (ICP) was high in all cases. All patients have undergone operation with general anesthesia., Results: For all patients the reduction of ICP and keeping an optimal CPP (cerebral perfusion pressure) was pursued. In 38 cases, general anesthesia was performed with Sevoflurane and opioids (fentanyl, remifentanyl, sufentanyl) and in 2 cases the TIVA (total intravenous anesthesia) technique was used with propofol and remifentanyl. 14 of the patients required intraoperative depletive treatment through administering mannitol 20%. 37 patients (92%) have been discharged with improved neurological condition without showing signs of intracranial hypertension, convulsive seizures and with partially or totally remitted hemiparesis and one patient had worse postoperative neurological status., Conclusion: Pulmonary tumor with cerebral metastases represent an important cause for death rate. To solve secondary cerebral lesions, the perioperative management must include assesment and choosing an anesthesia technique with a proper intraoperative management.