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The efficacy of the transurethral convective interstitial radiofrequency water vapor thermal ablation of the prostate with the Rezūm system for the treatment of male lower urinary tract symptom due to benign prostatic hyperplasia is well proven. The improvement of urodynamic parameters obtained from a simple uroflowmetry cannot measure the effect of water vapor injection on the bladder outlet obstruction.This monocentric retrospective pilot study analyzes the data of pressure-flow studies performed before and after 17 Rezūm procedures to answer the question whether thus obtained ablation of prostate tissue has a disobstructive effect on the bladder outlet.All the functional outcomes were consistently improved after the procedure, with a median flowrate increase of 5.1 ml/s (p = 0.0022) and a median postvoid residual urine (PVR) reduction of 100 ml (p = 0.0042). The prostate volume was reduced by 40% (p 0.0001) and the median Bladder Outlet Obstruction Index (BOOI) reduction was 53.8 (p 0.0001).These data show that the possibility to significantly reduce the obstruction grade with even a single Rezūm procedure is concrete and seems to be independent from the degree of the obstruction grade.

Chyluria occurs in all its forms with milky urine, recurrent episodes of acute urinary retention, left renal colic and proteinuria. In non-parasitic or iatrogenic diseases, it is secondary to communicate between the cisterna system of the chyli and the lymphatics of the calyx system of the left urinary tract with a retrograde passage of a kilo and its appearance in the urine which therefore take on a milky appearance [1, 2]. Sometimes, episodically, especially after the ingestion of a high-fat meal, the quantity of kilo is so abundant that it can cause obstruction of the upper urinary tract and of the bladder, resulting in renal colic or acute urinary retention that may require their unblocking with double J stent or bladder catheter [3, 4]. After conservative attempts with a fat-free diet or with the parenteral diet, in case of their failure, surgery must be performed by performing a para-aortic and renal hilum lymphadenectomy and, in severe cases, with intraperitonealization of the kidney and left ureter. This is the case of the patient reported below and successfully treated recently with an innovative “open” surgical technique.

Objective: To present a retrospective analysis on the oncological and functional outcomes of a single-center experience on a large series of extraperitoneal laparoscopic radical prostatectomies (eLRP) with an extended follow-up. Materials and methods: Herein we present a retrospective review of patients who underwent eLRP. Oncological and functional follow-up data were collected by means of outpatient visits and telephone interviews, assessing overall mortality and biochemical recurrence-free survival. Patients with clinical T4 stage prostate cancer (PCa), previous surgery for benign prostatic hyperplasia (BPH), previous androgen deprivation, radiotherapy, concomitant chemotherapy and/or experimental therapies, and with insufficient follow-up data were excluded. Preoperative data recorded were age, body mass index, ultrasound prostate volume, preoperative PSA and clinical stage of PCa. Operative data (operative time, nerve sparing technique and any perioperative complication) and pathological findings were obtained by consulting the surgical and pathological reports. Oncological and functional follow-up were collected during follow-up visits and telephone interview. Results: Between January 2001 and December 2019, overall 938 eLRP were performed at our Institution. The median follow-up was 132 months. 69.7% of the patients had complete dataset. The estimated overall biochemical recurrence (BCR)-free survival was 71.4% at 5 years and 58.9% at 10 years. Cancer specific survival was 84,5%. Erectile function was preserved in the most of patients as postoperative IIEF-5 score within 12 months after surgery was > 12 in the 82.1%. About the urinary incontinence, 0.76% of the patients presented severe incontinence (continued and persistent loss of urine) and 7.0% were mildly incontinent (using up to one pad per day). Conclusions; eLRP has shown oncological and functional results comparable to other minimally invasive techniques and to open radical prostatectomy (ORP), with favorable perioperative outcomes than the open technique and a reduced complication rate.

Background: The most commonly used treatment modality for urethral strictures is the direct visual internal urethrotomy method according Sachse cold knife, but with low long-term success rate. Alternative method after failure is isurethroplasty with preputial flap or Buccal mucosa. The aim of this presentation is to report the efficacy of the Internal Urethrotomy with Holmium Laser (Sachse laser).Material and methods: We report three cases of urethral stenosis after trauma which treated with Internal Urethrotomy with Holmium Laser (Sachse laser) after failure of multiple treatments with Sachse cold knife. We evaluated and compared the uroflowmetry parameters before and after Sachse laser.Results: The average of uroflowmetry parameters before incision were: Q max 4.5 ml/sec, Q med 3 ml/sec. Voided Volume 323 cc, while after incision with Sachse laser were: Q max 30 ml/sec, Q med 12 ml/sec. Voided Volume 363 cc.No patients relapsed during follow-up time from 3 to 24 months.Conclusion: Even though these are only a few cases, we think that Sachse laser is a valid alternative after unsuccessful Sachse cold knife and before Urethroplasty, even in patients with urethral stricture after trauma.

Background: Laparoscopic or robotic assisted prostatectomy has become common world wide. However, to our knowledge, laparoscopic radical prostatectomy has not been reported in Albania. Objective: To analyze the early perioperative and oncologic results obtained with the extraperitoneal laparoscopic prostatectomy (ELRP). Patients and Method: A retrospective study of all the patients operated at Salus Hospital Tirana, Albania. All data were collected and evaluated retrospectively on the basis of thorough clinical and pathological examination. For data management and statistical analysis, all variables pre-, intra- and perioperative data were collected in a spreadsheet. Results: In the 4-year period ( outline the period), 25 patients underwent the ELRP procedure. The average age of patients was 65 year-old and the PSA of 17.5 ng/dl. The total surgery time was 168 minutes on average. Only one patient was transfused after surgery, and limfocele was present in 2 patients. No other complications occured. Pathological examination revealed pT2 and pT3 cancers in 72% (18/25) and 25% (6/25) of patients, respectively. One patient had regional lymph nodes infiltration. The incidence of positive surgical margins and biochemical relapse rate was 16 % (4/25) and 32 % (8/25), respectively. Conclusion: The ELRP technique is safe and effective procedure in the treatment of prostate cancer, with low morbidity.

We retrospectively compared 50 patients treated with open retropubic prostatectomy (RRP) with 50 patients treated with laparoscopic extraperitoneal radical prostatectomy (LRP) at our institution, in the same time period, with a follow-up up to 7 years. We focused on operative data, complications, pathological outcome and mid-term outcome and follow-up in terms of oncological results. The same surgeons performed both operations. The 2 groups were similar with respect to mean patient age, mean prostate specific antigen value, median Gleason score. No previous transurethral resection of the prostate nor neoadjuvant treatment, had been undertaken in both groups of pts. Mean operating time was significantly shorter after open surgery (126 minutes, range 90-185 minutes) [p = 0.03] compared to the laparoscopic group (188 minutes, range 130-250) but it did not differ significantly from the last 20 laparoscopic procedures, in which the time of procedure was reduced to a mean of 155 minutes group (range 140-184 minutes) [p = 0.1]. Mean blood loss (1,150 versus 800 cc) and transfusion rates (55.7% versus 19.6%) in the 2 groups significantly favored the laparoscopic group. Number of lymphnodes dissected during the procedures favoured, but not significantly, the RRP group: for RRP a mean 11 lymphnodes right side, 13 left side (ranges 2-20 and 2-19 respectively), while for LRP a mean of 9 lymphnodes right side, 11 left side (ranges 2-15 and 2-13 respectively) were collected. The complication rate was almost the same in both groups, with no major adverse events nor deaths, (19.2% versus 14.7%) but the spectrum differed. The laparoscopic group had a higher incidence of fever (1.8% versus 3.2% respectively) and subcutaneous or scrotal emphysema, whereas more lymphoceles (6.9% versus 0%), wound infection (2.3% versus 0.5%), embolism/pneumonia (2.3% versus 0.5%) and anastomotic strictures (15.9% versus 4%) occurred after open surgery. Median catheter time was longer after open retropubic prostatectomy (22 versus 8.9 days, respectively) but the continence rates (intended as complete continence with no use of pads) were similar in both groups at 12 months (90.3% versus 91.7%). The rate of positive margins did not differ significantly in groups, and was in all cases very low (8.2% versus 7.0%), prostate specific antigen biochemical recurrence was equivalent (10% vs 10%). Data regarding postoperative sexual function favoured the laparoscopic group, even if no statistical significance was recorded (55% vs 67%). No statistical differences were observed in terms of oncological results, with a 24 months mean follow-up. Laparoscopic radical prostatectomy is technically demanding, with an initially longer operative time and learning curve. The overall outcome in our series favours the laparoscopic approach regarding catheterization time, recover of continence and impotence, hospital stay, transfusion rate. The open approach is favoured for the still shorter time necessitating for the procedure. Consequently, at our institution laparoscopic radical prostatectomy is becoming the method of choice.

Staghorn stones have been treated, up to 30 years ago, with open surgery. With the introduction of percutaneous procedure (PNL) and the use of shock wave lithotripsy (SWL) together with flexible instrumentation and Holmium Laser lithotripsy the indication for open surgery is actually very limited. On the other hand conservative treatment of staghorn calculi will result in a complete destruction of the kidney associated to a mortality rate up to 30%. The best results of surgical treatment have been obtained after anatrophic nephrolithotomy, with stone-free rates of 71 to 100%. In 1955 was first described the method of percutaneous nephrostomy insertion, and 20 years later was first reported on percutaneous nephrostolithotomy. Initially, only calculi no larger than the diameter of the nephrostomy tract were removed. Treatment of complex staghorn stones remained controversial because of the very high stone burden and it was also debated the choice between a single tract percutaneous approach, or a multiple tract approach in order to obtain a complete stone clearance. In our study we have compared the percutaneous approach with a single tract and the use of a flexible nephroscope in order to reach all the calices with the percutaneous approach with multiple accesses.

Actually ureteroscopy represents the therapy of choice for the treatment of ureteric stones. In the case of bilateral synchronous ureteric calculi the options are between a staged or a synchronous procedure; the last would potentially reduce costs and the need for a second anesthetic in comparison with a staged procedure. We reviewed our experience with bilateral same session ureteroscopy and compared with staged bilateral or unilateral procedure in the same series. The size and site of the stones were similar in all groups with a mean of 8.5 x 6.51 mm (15-7 x 10-5 mm). Symptoms were compared between the groups both before and after surgery, like painful urination, flank pain, urgency, nocturia, frequency, lower abdominal pain and urinary incontinence were assessed. A slight prevalence in the presence of hematuria was present in the bilateral same session URS group, probably due to the presence of the DJ stent. Urinary discomfort was more common in this group without reaching statistical significance (p0.05). In no case differences between groups were statistically significant. No statistically significant differences were reported between the groups regarding postoperative pain (p0.5). In our series, bilateral synchronous ureteroscopy is a safe procedure, with high stone free rate even compared with staged bilateral and monolateral treatment. It has the advantage of saving multiple procedures and the need of a second anesthesia and hospitalization. It can be performed safely with minimal risks. The positioning of a DJ stent at the end of the procedure adds little time, preventing post-operative complications with little discomfort for the patient.