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Urogenital neoplasms spreading to the inguinal lymph nodes are penile carcinoma (the most frequent), urethral and scrotum cancers, tumors of the testis with scrotal violation. Penile carcinoma is an uncommon malignant disease and accounts for as many 0.4-0.6% of male cancers. Most patients are elder...ly. It rarely occurs in men under age 60 and its incidence increases progressively until it reaches a peak in the eighth decade 1. The risk of a lymph node invasion is greater with high grade and high stage tumors 2. Some investigators have reported the inaccuracy of the sentinel node biopsy 3, 4, described by Cabanas 5. Patients with metastatic lymph node penis cancer have a very poor prognosis if penectomy only is performed. Ilioinguinal lymphadenectomy is basically carried out as a treatment modality and not only as a staging act. Patients with lymph node invasion have a 30-40% cure rate. Ilioinguinal lymphadenectomy should be also performed in patients with disseminated neoplasms for the local control of the disease. The 5 years survival rate of patients with clinically negative lymph nodes treated with a modified inguinal lymphadenectomy is 88% versus 38% in patients not initially treated with lymphadenectomy 6. This video-tape clearly shows a therapeutic algorithm, the anatomy of the inguinal lymph nodes, according to Rouviere 7 and Daseler 8, the radical ilioinguinal node dissection with transposition of the sartorius muscle and the modified inguinal lymphadenectomy proposed by Catalona 9. References: 1. Lynch D.F. and Schellhammer P: Tumors of the penis. In Campbell’s Urology Seventh Edition, edited by Walsh P.C., Retik A.B., Darracott Vaughan E. and Wein A.J. W.B. Saunders Company, Vol. 3, chapt. 79, p. 2458, 1998. 2. Pizzocaro G., Piva L., Bandieramonte G., Tana S. Up-to-date management of carcinoma of the penis. Eur. Urol. 32: 5-15, 1997 3. Perinetti E., Crane D.B. and Catalona W.J. Unreliability of sentinel lymph node biopsy for staging penile carcinoma. J. Urol. 124: 734, 1980 4. Fowler J.E. Jr. Sentinel lymph node biopsy for staging penile cancer. Urology 23: 352, 1984 5. Cabanas R.M. An approach for the treatment of penile carcinoma. Cancer 39: 456, 1977 6. Russo P. and Gaudin P. Management strategies for carcinoma of the penis. Contemporary Urology;5:48-66, 2000 7. Rouviere H. Anatomy of the human lymphatic system. Edwards Brothers, p. 218, 1938 8. Daseler E.H., Anson B.J., Reimann A.F. Radical excision of the inguinal and iliac lymph glands: a study based on 450 anatomical dissections and upon supportive clinical observations. Surg. Gynecol. Obstet. 87: 679, 1948 9. Catalona W.J. Modified inguinal lymphadenectomy for carcinoma of the penis with preservation of saphenous veins: technique and preliminary results. J. Urol. 140: 306-310, 1988
This video clip shows an upper track endoscopy of A 75 year-old female, presented with severe adominal pain since three days. Endoscopy displays a deep ulcer at the lesser curvature of the stomach. This patient has a klatskin´s tumor (bile duct bifurcation).
Internal hemorrhoids and loose rectal mucosa may block the exposure during the purse string suturing in stapled hemorrhooidopexy, and this may cause some complications. To retract the prolapsing rectal mucosa we modified the purse string anoscope of the PPH01 kit (Ethicon-Endosurgery, Cincinnati, O...H, USA) and produced a special anoscope. The open part of the purse string suture anoscope is covered by transparent acrylic (Orthoacryl�, Dentaurum, Pforzheim, Germany). The covering material had complete cylindrical outer and inner surfaces and was thin enough to let the anoscope easily rotate in the anal dilator and to let the 26 mm curved, round bodied needle of the 2/0 polypropilene suture move in the anoscope. A window, 3 cm long and 3-4 mm wide, was opened at the angled part of the anoscope 2 cm to the tip of the anoscope. This special anoscope was used for the purse string suture during stapled hemorrhoidopexy procedure in five patients. No postoperative complications, early or late, were encountered, and we propose that stapled hemorrhoidopexy procedure can be applied more easily by using this special anoscope.
Transurethral resection of the prostate (also known as TURP, plural TURPs and as a transurethral prostatic resection TUPR) is a urological operation. It is used to treat benign prostatic hyperplasia (BPH). As the name indicates, it is performed by visualising the prostate through the urethra and removing tissue by electrocautery or sharp dissection. This is considered the most effective treatment for BPH. This procedure is done with spinal or general anesthetic. A large triple lumen catheter is inserted through the urethra to irrigate and drain the bladder after the surgical procedure is complete. Outcome is considered excellent for 80-90% of BPH patients. Because of bleeding risks associated with the surgery, TURP is not considered safe for many patients with cardiac problems. As with all invasive procedures, the patient should first discuss medications they are taking with their doctor, most especially blood thinners or anticoagulants, such as warfarin (Coumadin), or aspirin. These may need to be discontinued prior to surgery. Postop complications include bleeding (most common), clotting and hyponatremia (due to bladder irrigation).
Additionally, transurethral resection of the prostate is associated with low but important morbidity and mortality.