LASER prostatectomy in cardiac patients

A 75 year old gentleman came with the history of lower urinary tract symptoms not responding to medical line of the therapy.The investigations showed the prostate was of 60 gm size and residual urine of 200 ml.

The patient was a case of cardiac illness and had pacemaker being inserted in 2009.He was on acitrom and clopilet for anticoagulation.

The clopilet was stopped 5 days before the surgery and the acitrom 3 days before the surgery and was started on clexane injection subcutaneously 60 mg once a day.The cefazolin was used pre-operatively as the surgical prophylactic medication.

The median lobe (prominently enlarged) was tackled with enucleation technique and lasovaporisation was done for rest the prostate.The procedure was uneventful with no bleeding.

Post-operatively there was no hematuria and 18 Fr double lumen was used without the need for irrigation.

This case is brought forward to show how safely LASER prostatecomy can be done in such cases.The routine TURP method in cardiac patient is frought with the danger of fluid overload,TUR syndrome and risk of bleeding.The present case was done with antiplatelt agent aspirin continuance.

LASER PROSTATECTOMY IN CHRONIC RENAL FAILURE PATIENT

A 72- year- old gentleman came with retention of urine and altered renal parameters (Blood Urea 100 mg% and serum creatinine 7.6 mg%).The bladder was distended above the umbilicus and ultrasound showed the upper tracts showing bilateral backpressure changes ( cortical thickness on both sides was papery thin).The catheter was intoduced and the bladder was decompressed slowly and he developed post obstructive diuresis which was managed with proper fluid institution.

His creatinine dropped to 5 mg%.His prostate was 80 gm in size and serum PSA was within normal limits.The patient was a case of hypertrophic cardiomyopathy and has ejection fraction of 50%.

He was taken up for Laser prostatectomy and trilobar enucleation and morcellation was done uneventfully.Post-operatively the patient did well.

This case shows the safety of LASER prostatectomy in chronic renal failure patients.The advantage of LASER in such cases would be lesser bleeding, less chance of dyselectrolytemia( NS irrigation is used in contrast to Glycine in TURP)

Role of Interferon in mumps orchitis

In andrological practice it is common practice to see mumps orchitis or infertility due to mumps orchitis.
In men orchitis represents the most common complication of mumps infection and occurs in 5 to 37% of this population. Bilateral manifestation is observed in 16 to 65% of the patients. The most important danger is the risk of testicular atrophy which results in sterility.
There are conflicting reports of role of systematic interefron-alpha-2 B in mumps orchitis.Some studies supporting its usage and some disputing its utility.
The usual dosage is 3 Millions units administered daily parenterally intravenous form for 7 days. Keeping in view with the low complication rate with systemic interferon therapy (flu like symptoms which can be tackled by paracetamol administration) the andrology department here uses this therapy and strongly advocates it in case of bilateral affection of the testes.

MICRODISSECTION TESE : HOPE FOR NON OBSTRUCTIVE AZOOSPERMIC PATIENTS

A 35 year old gentleman came with history of azoopsermia/primary infertility.The work up showed he suffered from Sertoli cell only syndrome with FSH within normal limits.

He had history of mumps orchitis in childhood.

He underwent Microdissection TESE procedure in Dr Ramayyas Hospital in lieu with Oasis Centre for Fertility.The procedure was done in spinal anaesthesia with addition cord block with bupivacaine.The total time duration was 45 minutes and sperms could be retrieved although the motility of the retrieved sperm was feeble.The magnification which was used was 20 X and 5/0 DOUBLE ARMED PROLENE was used for closure of the tunica afterwards.

Radical Nephrectomy

A 50 year old gentleman came with incidentally detected mass in right kidney measuring 8X6 cm in dimensions.He was a diabetic and hypertensive and COPD patient also.Because poor pulmonary function he was taken up for open radical nephrectomy.

The staging work up was essentially normal.