PurposeThe aim of the study was to evaluate the applicability of the modified Clavien classification system (CCS) in grading perioperative complications of transurethral resection of the prostate (TURP).MethodsAll patients with benign prostatic hyperplasia submitted to monopolar TURP from January 2006 to February 2008 at a non-academic center were evaluated for complications occurring up to the end of the first postoperative month. All complications were classified according to the modified CCS independently by two urologists, and the final decision was based on consensus. If multiple complications per patient occurred, categorization was done in more than one grade. Results were presented as complication rates per grade.ResultsForty-four complications were recorded in 31 out of 198 patients (overall perioperative morbidity rate: 15.7%), and their grading was generally easy, non-time-consuming and straightforward. Most of them were classified as grade I (59.1%) and II (29.5%). Higher grade complications were scarce (grade III: 2.3% and grade IV: 6.8%, respectively) There was one death (grade V: 2.3%) due to acute myocardial infarction (overall mortality rate: 0.5%). Negative outcomes such as mild dysuria during this early postoperative period or retrograde ejaculation were considered sequelae and were not recorded. Nobody was complicated with severe dysuria. There was one re-operation due to residual adenoma (0.5%).ConclusionsThe modified CCS represents a straightforward and easily applicable tool that may help urologists to classify the complications of TURP in a more objective and detailed way. It may serve as a standardized platform of communication among clinicians allowing for sound comparisons.

Purpose: To evaluate the outcome of endoscopic management of upper-tract transitional-cell carcinoma (TCC). , 40 patients with upper-tract TCC were treated by an endoscopic approach as the primary management: 37 (90.2%) by ureteroscopy and by percutaneous techniques or both approaches in 2 cases each (5%). Follow-up was between 5 and 115 months (mean 41.6 months). Most of the patients, 26 (65%), had a normal contralateral kidney, and the indication for conservative management was low tumor grade or tumor size (Ͻ2 cm) and patient commitment to a rigorous followup protocol. Absolute and relative indications for conservative management such as solitary kidney were met in 14 patients (35%).Results: Treatment consisted of electrocautery only in 15 cases (36.6%), neodymium:YAG or holmium:YAG laser only in 11 (26.8%), and combinations in 15 (36.6%). Most of the patients (74.3%) had an upper-tract recurrence. The renal-preservation rate was 70.7%, and the survival rate was 80%.Conclusions: Conservative treatment is preferred in patients with bilateral disease, a solitary kidney, or comorbidities that contraindicate major surgery. Patients with low-grade, low-stage disease and normal contralateral kidneys also benefit from this approach provided adequate endoscopic follow-up can be achieved and the surgeon has a low threshold for carrying out ablative surgery.

Urethral hemangiomas are rare benign vascular tumors with varying size and usually present as urethral bleeding and/ or hematuria. Treatment depends on the size and site of the lesion. We present a 27 year old male with a two year history of intermittent episodes of urethral bleeding. Cystourethroscopy showed a solitary hemangioma in the penile urethra. The patient was treated with simple transurethral excision with the biopsy forceps. The catheter was removed 48 hours later. He remains symptom free four months later. Simple excision of small hemangiomas may be an effective treatment especially for young patients in order to avoid the side effects of diathermy and when facilities such is laser are not available.

Application of constricting devices on the external male genitalia for increasing sexual performance is an unusual practice that can potentially lead to penile strangulation with severe consequences. In this case report we describe a case of a 48 year old male who presented in our hospital with a steel ring on his external genitalia which led to penile strangulation and a short review of the literature. The foreign body was successfully removed by an angle grinder which was not immediately available in the operating theatre. The patient had an uneventful recovery.

Objectives: Use of urinary bladder markers in daily practice is still under debate. Our study assessed the diagnostic yield of the BTA stat test in comparison to histology, in patients presenting with hematuria. Methods: One hundred and twenty-two consecutive patients who presented with painless macroscopic hematuria and were evaluated for primary bladder cancer from November 2006 to November 2008 were retrospectively studied. Patients with a history of bladder cancer, pelvic irradiation or malignancies were excluded from the study. Patients with obvious or suspicious lesions were treated with transurethral resection of the bladder tumor and bladder biopsy was done. The test’s specificity, sensitivity, negative predictive value, positive predictive value and sensitivity in relation to tumor macroscopic features and histology were calculated. Results: Mean age was 68.1 years. Bladder cancer was diagnosed in 34 (27.8%) patients. In 30 patients (24.5%) the cause was undefined and 58 (48.3%) had benign causes of hematuria. The test was positive in 16/34 cases with bladder cancer, 12/30 with no visible cause and 12/58 of the cases with benign causes. Sensitivity was 47% and specificity 72.7%. Positive predictive value and negative predictive value were 40 and 75.6% respectively. Sensitivity was increased for high grade, nodular and invasive lesions (66, 80 and 75%, respectively). Two patients with an initial negative diagnostic work-up were later proved to have bladder cancer. The most common cause of a false positive test was cystitis. Conclusions: BTA stat, has low sensitivity for the diagnosis of bladder cancer and is not useful for the diagnosis of bladder cancer in patients with hematuria. False positive results can be minimised if patients with known or obvious benign conditions are excluded de novo from the test.