Objective: To present the results of the largest series of patients with bladder diverticula > 4 cm managed with an endoscopic approach and give tips about the execution of the procedure. Materials and methods: Data of male patients undergone the endoscopic approach for an acquired bladder diverticula > 4 cm from December 2004 to August 2018 were prospectively collected and retrospectively analyzed. The description of the monopolar and bipolar techniques are provided. The success of the procedure was defined as the reduction of the diverticula for more of the 80% of its initial diameter documented at the 3- months follow-up imaging. Continuous variables with nonparametric distribution were compared using the Mann-Whitney test, while frequencies of categorical variables were compared between groups by Fisher’s exact test with significance level set at 0.05. Results: Thirty-nine patients with a mean (+/- SD) age at surgery of 69.4 ± 8.8 years were enrolled, for an equal number of diverticula managed. The mean diverticular size was 75.1 ± 24.5 millimeters. The mean operative time was 65 ± 21.9 minutes including the prostate surgery. Twelve patients (30.8%) were managed with bipolar energy, the others with monopolar. The success of the procedure was achieved in 30 patients (76.9% - 7 bipolar and 23 monopolar - p = 0.66). Conclusions: The endoscopic approach might be considered as a useful option for patients with a large bladder diverticulum who are at risk for major or laparoscopic procedure.

Kaposi's sarcoma (KS) of the penis is a very rare lesion and it is usually observed in HIV-infected patients. We introduce a case of KS of the penis in a 75 years old HIV negative patient with a peripheral T-cell lymphoma. He came to our attention with a painful ulcerated red lesion on the glans that stretched from the urethral meatus to the coronal skin. This lesion was found to be a KS balanopreputial in the classical variant. Penile KS must be included in the differential diagnosis of genital diseases especially when the clinical features of the lesion are aspecific and diagnosis can be made histologically by performing a biopsy.KEY WORDS: Kaposi sarcoma; Penile lesion; HIV negative; HHV-8; T-cell lymphoma. The abdominal CT scan showed no inguinal lymph nodes or other suspected lesions. Due to an extended lesion and to the absence of a clear diagnose it was decided to perform a glansectomy. The histopathology examination described a classical balanopreputial KS. Six months later the patient was negative for local recurrence but a secondary gastrointestinal lesion was detected during a whole body CT scan and a gastric biopsy was performed. The patient is currently under therapy with interferon.

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Before starting the isolation of renal mass a careful identification of the aorta was attempted. However, after exposure of the left gonadal vein, the aorta was identified laterally to the isolated renal artery. Therefore, the surgeon realized that the isolated artery was the right renal one. The vessel loop was removed, the left renal artery identified and isolated and the PN with warm ischemia was performed.RESULTS: Operative time was 240 min, estimated blood loss was 300 ml and no complications occurred. Final pathology revealed a clear cell RCC with eosinophilic variant, pT1b-pNx-R0.Follow-up period was uneventful and 2-y postoperative GFR was 52 ml/min. After a specific surgical audit the predisposing factors for our NM were identified: suboptimal evaluation of preoperative CT scan, no 3D reconstructions available, abundant visceral fat, left-sided surgery and direct access to the renal pedicle without identification of gonadal vein.CONCLUSIONS: Procedural errors in the OR may come along with tremendous complications for the patient. The identification of the anatomical landmarks is mandatory and the discussion of the potential NM helps the prevention of adverse dangerous events. In our case, failure to recognize the error would result in serious complications, especially if a radical nephrectomy had been planned.

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