Penile epidermal cyst in a patient with augmentation penoplasty

A 44-year-old male patient who had undergone augmentation penoplasty 20 years previously presented with a slowly growing penoscrotal mass. The penile mass was excised totally and the pathologic diagnosis was an epidermal cyst. Epidermal cysts are benign disorders that can occur in any part of the body. However, an epidermal cyst as a late complication of augmentation penoplasty is extremely rare. We report this case of a penile epidermal cyst that developed after augmentation penoplasty.

46 XY gonadal dysgenesis in adulthood 'pitfalls of late diagnosis'

Disorders of sex development (DSD) include congenital conditions where developments of chromosomal, gonadal or anatomical sex are atypical. Ostrer in 2000, reported a prevalence of 1:20 000 for 46 XY DSD and complete gonadal dysgenesis. A 21-year-old patient consulted for sexual ambiguity at the out-patient department of the Philippine general hospital. At birth, the perceived female external genitalia and clitoromegaly, led the parents to register and eventually rear the patient as a female. At puberty, he developed masculine features and growth of phallus. Patient was more interested in male activities and began to identify himself as male in the community. The discrepancy between his birth certificate and his male gender jeopardised his ambition to become a policeman; this led him to seek medical consult. On physical examination, he was phenotypically male. The external genitalia showed the phallus length of 3.5 cm and perineoscrotal hypospadias. Chromosomal sex was normal 46 XY with neither numerical nor structural aberrations in all cell lines, serum testosterone was low and gonadotrophins were elevated. Whole abdominal CT scan showed bilaterally undescended testes and a 4.5 cm blind vaginal pouch seen on genitogram. Bilateral orchidectomy with first stage repair of hypospadias was performed. On histopathology, the right testis was fibrotic and the left testis showed minimal testicular tissue with absent spermatids. The clinical, endocrine, cytogenetic and histopathologic data are consistent with gonadal dysgenesis syndrome.

Initial clinical experience of simultaneous robot-assisted bilateral partial nephrectomy and radical prostatectomy

A 62-year-old male patient with prostate cancer and bilateral renal cell carcinoma underwent a simultaneous robot-assisted bilateral partial nephrectomy and radical prostatectomy. We describe our initial experience of combined operation with a port strategy allowing reuse of ports and surgical considerations because of prolonged pneumoperitoneum.

Significance of perineural invasion, lymphovascular invasion, and high-grade prostatic intraepithelial neoplasia in robot-assisted laparoscopic radical prostatectomy

BACKGROUND

Recently, more detailed histopathological variables such as perineural invasion (PNI), lymphovascular invasion (LVI), and high-grade prostatic intraepithelial neoplasia (HGPIN) have been investigated as prognostic factors for adverse pathologic findings on the radical prostatectomy specimen. We aim to determine whether these pathological factors are associated with adverse pathologic features after robot-assisted laparoscopic radical prostatectomy (RALP).

METHODS

All 407 patients who underwent RALP with pelvic lymphadenectomy between July 2005 and December 2009 were analyzed, retrospectively. We investigated the association of these three pathological parameters with adverse pathological findings in RALP specimen and biochemical recurrence using Kaplan-Meier analysis with log-rank test and a multivariate Cox proportional hazard model.

RESULTS

The PNI and LVI were significantly associated with a higher pathological stage, a higher pathological Gleason score, a higher tumor volume in RALP specimen, a higher frequency of positive surgical margins, and a higher frequency of seminal vesicle invasion. In addition, PNI correlated with preoperative PSA, clinical stage, and Gleason score on needle biopsy. However, the HGPIN was not significantly associated with the clinicopathological characteristics studied. Using log-rank test, presence of PNI (P < 0.001) increases the probability of biochemical recurrence. On multivariate analysis, all three pathological parameters were not significantly correlated with biochemical recurrence.

CONCLUSION

Although presence of PNI and LVI in RALP specimen correlated with multiple adverse clinicopathological factors, it did not predict biochemical recurrence, thus limiting its clinical usefulness. HGPIN was not significantly associated with the clinicopathological characteristics studied.

A case of Kallmann syndrome

Kallmann syndrome (KS), a rare genetic disorder, refers to the association between hypogonadotropic hypogonadism and anosmia or hyposmia due to abnormal migration of olfactory axons and gonadotropin-releasing hormone producing neurons. The authors report a case of a 26-year-old Filipino male who presented with eunuchoid body proportion, absence of facial and axillary hair and sparse pubic hair, micropenis and bilaterally descended prepubertal testes. Associated findings were hyposmia, high pitched voice, absence of puncta and smooth philtrum. Hormonal assay showed hypogonadotropic hypogonadism. He has normal male karyotype. Ultrasonography revealed no renal abnormalities. MRI of the brain showed hypoplastic left olfactory bulb and aplastic right olfactory bulb. These findings are characteristic of KS. Androgen replacement with testosterone was started to induce virilisation. Our patient is now on regular follow-up to monitor response to treatment.

Laparoendoscopic single-site surgeries: a single-center experience of 171 consecutive cases

PURPOSE

We report our experience to date with 171 patients who underwent laparoendoscopic single-site surgery for diverse urologic diseases in a single institution.

MATERIALS AND METHODS

Between December 2008 and August 2010, we performed 171 consecutive laparoendoscopic single-site surgeries. These included simple nephrectomy (n=18; robotic surgeries, n=1), radical nephrectomy (n=26; robotic surgeries, n=2), partial nephrectomy (n=59; robotic surgeries, n=56), nephroureterectomy (n=20; robotic surgeries, n=12), pyeloplasty (n=4), renal cyst decortications (n=22), adrenalectomy (n=4; robotic surgeries, n=2), ureterolithotomy (n=10), partial cystectomy (n=3), ureterectomy (n=1), urachal mass excision (n=1), orchiectomy (n=1), seminal vesiculectomy (n=1), and retroperitoneal mass excision (n=1). All procedures were performed by use of a homemade single-port device with a wound retractor and surgical gloves. A prospective study was performed to evaluate outcomes in 171 cases.

RESULTS

Of the 171 patients, 98 underwent conventional laparoendoscopic single-site surgery and 73 underwent robotic laparoendoscopic single-site surgery. Mean patient age was 53 years, mean operative time was 190.8 minutes, and mean estimated blood loss was 204 ml. Intraoperative complications occurred in seven cases (4.1%), and postoperative complications in nine cases (5.3%). There were no complications classified as Grade IIIb or higher (Clavien-Dindo classification for surgical complications). Conversion to mini-incision open surgery occurred in seven (4.1%) cases. Regarding oncologic outcomes, no cancer-related events occurred during follow-up other than one aggressive progression of Ewing sarcoma.

CONCLUSIONS

Laparoendoscopic single-site surgery is technically feasible and safe for various urologic diseases; however, surgical experience and long-term follow-up are needed to test the superiority of laparoendoscopic single-site surgery.