Aktuelle Urologie最新文献

Anatomical enucleation of the prostate (AEEP) is an established treatment option for benign prostatic hyperplasia (BPH), regardless of prostate size. While advancements in laser technology have significantly improved the enucleation phase, the morcellation process has remained relatively unchanged, with limited innovations in morcellation devices. This study aimed to compare the efficiency of two morcellators in an ex-vivo model: the Piranha morcellator (Richard Wolf GmbH, Knittlingen) and a newly introduced, yet-to-be-commercialized device, the ActiveCut morcellator (Active Fiber Systems GmbH, Jena).The two morcellators were tested in a newly developed ex-vivo model. In both groups, reusable blades were tested ten times at comparable speed settings. For each trial, 60 grams of raw bovine heart tissue were morcellated. The efficiency of the morcellation was then analyzed. Primary endpoints included morcellation efficiency (g/min) and an evaluation of blade deterioration over repeated use. The mean values of continuous variables were compared using a t-test with standard deviation.A total of ten consecutive morcellation trials were conducted with each device. The ActiveCut demonstrated higher morcellation rates at 12.43 g/min, compared to 7.09 g/min with the Piranha morcellator (p<0.05). However, the ActiveCut showed a decline in efficiency over ten trials. In two cases, tissue had to be manually removed from the blade coupling during morcellation, whereas the Piranha morcellator maintained consistent performance without malfunctions.In this ex-vivo study, comparing the ActiveCut and Piranha morcellators, the ActiveCut exhibited higher morcellation efficiency. However, as the ActiveCut has not yet undergone clinical testing, future clinical studies are necessary to assess its safety and potential malfunctions before clinical implementation.

Bladder neck contracture (BNC) is a common complication following surgical treatment of benign prostatic hyperplasia (BPH), with incidence rates varying depending on the therapeutic approach. Numerous techniques for managing BNC have been described in the literature. For the initial presentation of BNC, endoscopic treatment is generally recommended as the first-line therapy. In cases of recurrent BNC, however, open surgical reconstruction, such as YV or T-plasty, is considered the preferred treatment option. Additionally, robot-assisted surgery is increasingly being integrated into the surgical management of BNC. Currently, no standardized treatment protocol exists for this condition. This review provides a systematic overview of bladder neck contracture and the current therapeutic strategies available.

Introduction: Adult hydrocele is a benign enlargement of the scrotum seen in approximately 60/100,000 men >18 years of age. Surgical resection of the hydrocele has been established as the gold standard for the treatment of symptomatic hydroceles. Postoperative complications are common with this surgery. Due to the lack of guidelines for the therapy of hydrocele, treatment is based primarily on clinical experience. The aim of the study was to conduct a randomised study on the influence of drains on complications in hydrocele resection according to von Bergmann.

Material and methods: A total of 60 patients were prospectively randomised into three groups. The groups each received an Easy-Flow drainage, a Cuti-Med Sorbact drainage, or no drainage. Haematoma and swelling, postoperative bleeding, infection, epididymal injury and revision surgery were clinically diagnosed as complications.

Results: A complication was observed in 31.6% (n=19/60) of all patients. The complication rate was 50% (n=10) for the easy-flow drainage, 30% (n=6) for the Cuti-Med-Sorbact and 15% (n=3) for the group without drainage. Overall, a haematoma with swelling was observed most frequently, in 20% (n=12) of the cases. Revision surgery was required in 5% (n=3) of cases. Epididymal injuries were found histologically in 10% (n=6). Comparing the collective with the Easy-Flow drainage with the collective without drainage, the occurrence of complications was observed significantly more frequently in the drainage group (p<0.018). A statistically significant correlation regarding complications between the group of Cuti-Med-Sorbact and no drainage could not be shown (p<0.25).

Conclusions: Hydrocele resection is a complicated procedure. Based on the data presented here, the insertion of a drain is associated with an increased risk of postoperative complications. If the decision to insert a wound drainage is made intraoperatively, the Cuti-Med-Sorbact drainage appears to be associated with fewer complications.

Epidemiological data demonstrate a clear association between age, prostatic enlargement, and the associated symptoms. Benign prostatic syndromes usually take a chronic progressive course, and a significant share of BPS patients faced with the decision "conservative vs. surgical treatment" are of advanced age and suffer from numerous comorbidities, which means that the principle of "nihil nocere" must be given special consideration. A benefit-risk assessment must be carried out very carefully both for pharmacological and surgical treatment. Having reviewed the literature, including the relevant guidelines, the author concludes that, if a relevant indication exists, there are hardly any reasons to deny geriatric patients one of the numerous interventional options, perhaps with the exception of a patient population that is already in need of long-term care.