Seminal Vesiculoscopy:recent case in prostatic utricular cyst

MRI SHOWING SEMINAL VESICULAR DILATATION

We operated a total 8 cases of seminal vesicle obstcruction over last year.

All had low volume ejaculate,azoospermia or severe oligospermia or hematospermia.Out of them;two cases of hematospermia totally resolved after the surgery.

Out of six cases of azoospermia(out of six); four improved- one couple even concieved.Two patients didnot improve.

This shows a great future for seminal vesiculoscopy in obstructive azoopsermia and also hematospermia.It helps in hematospermia.In one case it abated as we did removal of the seminal vesicle calculus in other case there was only congestive hematospermia.It probably helps in idiopathic hematospermia by decreasing the intraseminal vesicular pressures.

Ureterosigmoidostomy Follow up

We had operated 45 year old lady - radical cystectomy and ureterosigmoidostomy for TCC bladder.She underwent the surgery uneventfully.

Post-operatively on 1 year follow up she underwent CECT urogram.Here is the scan photograph showing the ureteral anatomy.

Her hematological/biochemical and VBG analysis was essentially normal.She was passing urine every 1 hourly as per our instrcutions and was leading a very good quality of life.

The ureterosigmoidostomy had fallen out of favour recently due to advent of newer continent diversions like orthotopic diversions.But in select cases ureterosigmoidostomy can offer equal quality of life like orthotopic diversion.

transitional cell carcinoma with staghorn calculus

We operated a case of renal tumor invading the descending colon .He underwent left radical nephrectomy with En Bloc Resection of the intestinal segment.

The patient was having staghorn calculus and nonfunctioning kidney.He was asymptomatic.

He underwent periodic imaging and blood biochemistry studies.This time he presented with signs of constitutional symptoms and dull continuous pain in the left flank.

His ultrasound showed mass in the kidney.He was further evaluated with Triphasic CT scan which revealed left renal mass with obscured planes with the descending colon and staghorn calculus.

He was taken up for surgery in view of his metastatic work up was essentially normal.

In 2 months postoperative period he is doing well and planned for palliative chemo/radiotherapy.

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)