(EUSP) [3-Month Visit: 2 November 2015 – 12 February 2016]

Total Page:16

File Type:pdf, Size:1020Kb

(EUSP) [3-Month Visit: 2 November 2015 – 12 February 2016] EUROPEAN UROLOGICAL SCHOLARSHIP PROGRAMME (EUSP) [3-month visit: 2 November 2015 – 12 February 2016] Department of Urology of the Siloah St. Trudpert Klinikum Pforzheim, Germany Dr. Amelia Pietropaolo MD Resident in Urology Dept. of Urology, University of Perugia, Santa Maria della Misericordia Hospital Perugia, Italy The city The urology department that I chose for my scholarship program is settled in a quite big city called Pforzheim, which is part of the Baden-Württemberg state in the southwest of Germany. Pforzheim, a town of nearly 120,000 inhabitants, is known for its jewellery and watch-making industries. It is situated between the cities of Stuttgart and Karlsruhe at the junction of the three rivers Enz, Nagold and Würm. During World War II, Pforzheim was bombed a number of times. The largest raid, and one of the most devastating area bombardments was carried out by the Royal Air Force on the evening of 23 February 1945. Nearly a third of the town's population was killed during the air raid. About 83% of the town's buildings were destroyed. In the 20 years after the war, Pforzheim was gradually rebuilt, giving the town a quite modern look. Incredibly beautiful natural landscapes and very important cities distinguish the region. Pforzheim is located at the northern rim of the eastern part of the Black Forest (Schwarzwald). I attended the Pforzheim clinic for a period of about three months, from the 2nd of November to the 12th of February. The stay included comfortable accommodation in a residence near the hospital. The department The head of t h e department is Prof. Med Sven Lahme, member of Eulis, assistant medical director of the Department of Urology, and a professor at the University of Tübingen. The staff is composed of four consultants, two specialists and eight residents. Prof. Dr. med. Sven Lahme Dr. med. Volker Zimmermanns Theodosios Antonopoulos Dr. med. Philipp Ober Dr. med. Carsten Lange The fourth floor has two stations with a total of 65 beds, four of which are for intermediate care for the first days of recovery after major surgery operations like cystectomy or radical prostatectomy. The fifth floor has the secretary’s, professors’, meeting, lithotripsy, and diagnostic Rx rooms, and three ambulatories provided of ultrasound. On the same floor, there are the endourologic operating rooms: TUR, Endo-omnia, Uro-endo and cystoscopy rooms. ® The first floor has the robotic room with the latest model of the da Vinci Xi System and the open surgery room. I had the opportunity to attend each of these services which improved my knowledge a lot thanks to a full, daily operating plan. Outpatient Therapies - Renal and ureteral stones - Incontinence, bed wetting - Bladder Dysfunction - Erectile Dysfunction - Unfulfilled Fertility - Vasectomy (sterilization) - Circumcision - Cystoscopy (bladder) - Prostate biopsy (tissue samples) - Aging Male - Venoport - Implantation to chemotherapy - Sperm-cells Extraction (TESE) - Treatment of varicoceles Inpatient Therapies □ Andrology - Man's infertility - Erectile dysfunction - Operative treatment of Peyronie's disease (IPP) - Micro surgery (microsurgical repair of obstructive azoospemie) □ Bladder - Bladder cancer resection (TUR B) - Da Vinci® computer-assisted radical prostatcetomy - Open cystectomy - Urinary diversion (neobladder and ileal conduit) - Systemic and local chemotherapy - Laser treatment of urethral strictures - Open urethral reconstruction for Hypospadia orstricture (with oral mucosa or foreskin) □ Ureter - Laparoscopic nephroureterectomy - Ureteral reimplantation after injury - Ureteral stricture - Rigid and flexible endoscopy of the entire urinary tract - Ureteropelvic junction obstruction - URS+RIRS □ Testis - Surgical removal of the testicles (Orchiectomy) - Testicular biopsy - Epididymectomy - Enucleation of the testicles - Hydrocele (hydrocele testis) - Excision of spermatocele - Torsion - Chemotherapy for testicular tumours □ Continence - Female and male urinary incontinence - Bladder prolapse and bladder lift - Stress incontinence - Artificial Devices for continence (i.e. Male sling, artificial sphincter) Kidney - Laparoscopic radical nephrectomy and adrenalectomy - Nephron-sparing laparoscopic or robotic-assisted (Da Vinci®) kidney tumour surgery - Laparoscopic nephrectomy - Immunotherapy, chemotherapy - Robot-assisted pyeloplasty - Extracorporeal shock wave lithotripsy (ESWL) - Minimally invasive Percutaneous nephrolitholapaxy (MINI PCNL) □ Prostate - Laparoscopic and robot-assisted (Da Vinci ®) radical prostatectomy - Medical treatment for benign prostatic hyperplasia - TURP (transurethral resection of prostate) □ Other - Chemotherapy, immune system and treatment of all urologic tumours - Outpatient chemotherapy, oncological follow-up and Pain Management The daily practice On my first day, I’ve been immediately welcomed by the staff during the morning meeting which takes place at 7:30 am. It lasts for about 45 minutes. The staff talks about the planned and emergency operations of the day, and about the patients admitted in the clinic watching the relative CT and ICV radiologic images or laboratory examinations. It's also a good way to stay all together and to exchange clinical opinions before starting the always-full program of the day. Immediately after the morning meeting, the professor and a part of the staff make the morning round visit, checking all emergency room and operated patients. The remaining staff are split among different operating rooms, four of which are always active at the same time. I spent the main part of the day attending the operating plan that was very full, so I could attend to the endoscopic theatre or just changing floor I could join the interesting world of open and robotic surgery as well. When I arrived, Prof. Lahme asked me what my favourite field of interest was, so I started to attend the endourologic room every day. The fifth floor was only dedicated to endoscopic procedures and included four different rooms and an area for relaxing. The first room was dedicated to transurethral resections (TUR) procedures. Every day at least five TURP or TURB procedures were performed. I already had a moderate experience in these procedures before, but I found their method very interesting particularly because of the special technique of suction they use during the monopolar TUR which allows a continue in-out irrigation from the bladder. The twin endourologic rooms : Endo-omnia and Uro-endo are two-paired operating rooms dedicated to endourology. For this reason, they are provided with UROSKOP Access: a high-performance table for endourology and urodiagnostics that includes an intensifier based x-ray system, movable with a remote control. It allows the user to look at the x-ray and the endoscopic intraoperative images at the same time, enabling the physicians to control everything with his foot without the need for a technician. In this room, we can also find all the most modern equipments for endourology as rigid and flexible ureteroscopy including the new digital Richard Wolf flexible ureteroscopy (COBRA), guidewires, ureteral access sheats, Holmium laser, catheters and others accessories. In these two rooms, I could attend a lot of operations. The daily plan was composed of three to four rigid or flexible URS (ureteroscopy and endoscopic lithotripsy) or RIRS (retrograde intrarenal surgery) and very often, one or two mini PCNL (Minimally invasive Percutaneous nephrolithotomy). During the operations all consultants gave me the translated information about the clinical cases and then the trips and tricks of flexible and rigid URS. The very big amount of patients affected by steno disease in this department allowed me to learn a lot about this pathology and specifically, about the way of solving it thanks to a great tool of endoscopic management. In the same rooms, I also attended very interesting procedures of anterograde ureteroscopies and stenting with percutaneous access using the Amplatz sheath and the ureteral access sheath used to reach the distal part of the ureter in cases of stenosis or suspicious of malignancies. Considering the elevated number of patients admitted with an ureteral stone and renal colic, it is necessary to guarantee an adequate system to manage the emergencies. For this reason, in this room, the physicians also make procedures as retrograde pyelography and double J stenting in general anaesthesia of patients that will subsequently be operated. In the last room, they routinely perform video urodynamic examinations, nephrostomy tubes access, prostate biopsies with stranrectal approach and under general anesthesia, then diagnostic flexible cistoscopies. This part is very important in order to join the moment of the diagnosis with the moment of therapy. The first floor was dedicated to major surgery. This is a big floor where all the other fields of surgery take place. One urologic room was daily dedicated to the robotic surgery. For about three years now, this room has the latest da Vinci Xi® robot. Two procedures per day are performed with the da Vinci system. This is a form of intuitive surgery that allows to operate the patient without the necessity to stay at the table. The operation must be performed by the first operator who controls the mechanical arms movements with a remote-controlled console and from an assistant that helps the operator at the side of the patient. The Xi model also has some advantages than the previous model because it is smaller, trocar placements are easier thanks to target
Recommended publications
  • Landeszentrale Für Politische Bildung Baden-Württemberg, Director: Lothar Frick 6Th Fully Revised Edition, Stuttgart 2008
    BADEN-WÜRTTEMBERG A Portrait of the German Southwest 6th fully revised edition 2008 Publishing details Reinhold Weber and Iris Häuser (editors): Baden-Württemberg – A Portrait of the German Southwest, published by the Landeszentrale für politische Bildung Baden-Württemberg, Director: Lothar Frick 6th fully revised edition, Stuttgart 2008. Stafflenbergstraße 38 Co-authors: 70184 Stuttgart Hans-Georg Wehling www.lpb-bw.de Dorothea Urban Please send orders to: Konrad Pflug Fax: +49 (0)711 / 164099-77 Oliver Turecek [email protected] Editorial deadline: 1 July, 2008 Design: Studio für Mediendesign, Rottenburg am Neckar, Many thanks to: www.8421medien.de Printed by: PFITZER Druck und Medien e. K., Renningen, www.pfitzer.de Landesvermessungsamt Title photo: Manfred Grohe, Kirchentellinsfurt Baden-Württemberg Translation: proverb oHG, Stuttgart, www.proverb.de EDITORIAL Baden-Württemberg is an international state – The publication is intended for a broad pub- in many respects: it has mutual political, lic: schoolchildren, trainees and students, em- economic and cultural ties to various regions ployed persons, people involved in society and around the world. Millions of guests visit our politics, visitors and guests to our state – in state every year – schoolchildren, students, short, for anyone interested in Baden-Würt- businessmen, scientists, journalists and numer- temberg looking for concise, reliable informa- ous tourists. A key job of the State Agency for tion on the southwest of Germany. Civic Education (Landeszentrale für politische Bildung Baden-Württemberg, LpB) is to inform Our thanks go out to everyone who has made people about the history of as well as the poli- a special contribution to ensuring that this tics and society in Baden-Württemberg.
    [Show full text]
  • Online Story: Meet Your Neighbour – Young European Adults German
    Online story: Meet Your Neighbour – Young European Adults German contribution: It’s a rainy day in the south of Germany in the city of gold, Pforzheim. It's the beginning of July. As a German student you don`t know what to do in a weather like this - especially two weeks before the long summer holiday of six weeks - because usually at this time of the year the weather is quite good. Sarah has to get up early at 6am, five days a week. The 17-years-old girl eats her sausages, leaves the house at 7 am, like every morning. She is walking along the biggest river of Pforzheim, the Enz, like every morning. While she is looking at the running water, she is thinking about how to escape from her daily life into an exciting adventure. Suddenly, when she sees a poster of “The Economist” she is jerked out of her thoughts: “Oh…, my English homework, I wanted to reread my summary!” During her walk to school she takes out her homework and reads through it. It reads like this: ”The article is about the migration of workers from Romania and Bulgaria to rich countries in the EU after restrictions on the free movement of workers were lifted on January 1st 2014. Britain, Germany, the Netherlands, France and Austria are afraid of the consequences of unrestricted migration. The press and the public worry how many migrants will come. Will they take away low skill jobs? Will this create tensions? Will begging and sleeping rough shoot up, especially in big or industrial cities? Will the immigrants live off the black market, begging and petty crime? Will they be a burden on the welfare state by demanding access to social benefits? For the first time there is a mixture of anti-EU feelings and anti-immigration feelings.
    [Show full text]
  • Prostate Cancer Metastatic Spinal Cord Compression
    Urology Prostate cancer Risk factors ➢ PSA isn’t specific for prostate cancer but it’s • Increasing age useful in follow-up & monitoring TTT ➢ Before PSA test, men should NOT have: • Male, black Afro-Caribbean - An active UTI st • 1 degree relative with prostate cancer - Ejaculated in the past 48h Presentation - Exercised vigorously in the past 48h • Lower urinary tract symptoms (LUTS) are NOT specific for - Had a prostate biopsy in the last 6 weeks prostate cancer • LUTS include voiding or obstructing symptoms such as hesitancy, urgency, poor and/or intermittent stream, straining, prolonged micturition, feeling of incomplete bladder emptying, dribbling Investigation • Initial → DRE (hard, irregular & nodular) + PSA Biopsy-related prostatitis • Normal ⟶ E. coli - ≥2 ng/ml at age 40-49 years • Immunocompromised ⟶ Pseudomonas aeruginosa - ≥3 ng/ml at age 50-69 years - ≥5 ng/ml at age 70 years or older • Definitive → Biopsy Leuprolide is a GnRH analog: • If used in pulsatile fashion → agonist Management • If used in a continuous fashion → antagonist ➢ Leuprolide, used in a continuous manner Local disease Locally invasive Metastatic • Raised PSA on screening • Hematuria • Bone metastasis → hypercalcemia → thirst • LUTS • Hematospermia • Bone pain or sciatica • • • ry UTI Obstruction of ureters, Paraplegia 2 to spinal cord compression causing loin pain, anuria, • LN enlargement symptoms of AKI or CKD • Lethargy (anemia, uremia) • Weight loss ➢ KUB US ➢ MRI Metastatic spinal cord compression ➢ An oncological emergency and an urgent MRI should be requested within 24h ➢ 20% of patients with spinal metastasis Features • Neurological symptoms like radicular pain, limb weakness, difficulty in walking, sensory loss or bladder or bowel dysfunction • Neurological signs of spinal cord or cauda equina compression ➢ DO NOT confuse between metastatic spinal cord compression and spinal • Spinal metastasis + symptoms of → metastasis.
    [Show full text]
  • Black Forest Black Forest
    Black Forest Black Forest A BCDEFGH 1 1 2 2 3 3 4 4 5 5 6 6 All locations and regions, listed alphabetically 7 7 PLAN PAGE PLAN PAGE Impressum Black Forest 4-15 St. BlasierLand D12/E13 29 (Dachsberg, Häusern, Höchenschwand, Ibach, St.Blasien- Herausgeber Cities & villages 22-39 Menzenschwand, Weilheim) Bad Bellingen A12 35 Todtmoos C12 39 Bad Liebenzell H3 31 Schwarzwald Tourismus GmbH Wolfach/Oberwolfach E7 39 8 8 Baden-Baden E3 35 Ludwigstraße 23 Baiersbronn E/F6 35 Zweitälerland D8/C9 39 79104 Freiburg Blumberg F/G11 36 (Biederbach, Elzach, Gutach im Breisgau, Simonswald, Tel.: + 49 (0) 761.896460 Bühl-Bühlertal D/E4 36 Waldkirch, Winden im Elztal) Fax: + 49 (0) 761.8964670 Dornstetten F6 36 [email protected] Donaueschingen und Hüfingen F10 22 www.schwarzwald-tourismus.info Enztal F/G3 32 All forms of accommodation 9 9 (Bad Wildbad, Enzklösterle, Höfen) Hotels and guesthouses 40-60 Geschäftsführer: Christopher Krull Ferienland im Schwarzwald E9 37 Apartments and holiday rentals 46, 61-64 (Furtwangen, Schönwald, Schonach, St. Georgen, Triberg) Projektleitung: Jochen Laufer, Sascha Hotz/Berg- Freiburg C10 37 werk Marketing Freudenstadt und Lossburg F6 23 Redaktion: STG 10 10 Hochschwarzwald D/E10/11 24 (Breitnau, Eisenbach, Feldberg, Friedenweiler, Fotonachweis: Hinterzarten, Lenzkirch, Löffingen, St. Märgen, St. Peter, Düpper, Eberle/qu-int, Hotel Auerhahn Schluch- Schluchsee,Titisee-Neustadt) More information and reservations: see, Raach, Spiegelhalter, Erdenbrink, U. Klumpp Hornberg E8 37 (S.6), Archiv der STG sowie der
    [Show full text]
  • An Autopsy Case of Thyroid Carcinoma with Wide-Spread
    THE KURUME MEDICAL JOURNAL Vol.11, No.1, 1964 AN AUTOPSY CASE OF THYROID CARCINOMA WITH WIDE-SPREAD METASTASIS YASUTO IWANAGA Second Department of Pathology, Kurume University School of Medicine , Kurume-shi, Japan (Received for Publication February 29, 1964) It is well known that metastasis of thyroid carcinoma frequently occurs in the bone. However, cases are rare in which severe general skeletal metastasis are de monstrated and small primary thyroid carcinoma can not be detected clinically. The author will report here an autopsy case of clinically latent thyroid carcinoma with intensive bone and lung metastases. CASE HISTORY The patient: 66 year-old Japanese male. Chief complaint: Complete paralyses of both lower extremities . Past history: Not remarkable. Family history: His wife died at the age of 51 from carcinoma of the uterus . History of illness: In the spring of 1959, the patient first noted motoric paralyses of both lower extremities. He was given physical treatment for about two months at home. But, the disorders did not subside. In the spring of 1960, he noted hypesthesia of both lower extremities. These symptoms gradually increased . In the spring of 1961, he had urinary incontinence and hydrocele testis . In October of 1961, ha was admitted to Beppu National Hospital, the chief complaint being para- lyses of both lower extremities. Condition at time of hospital admittance: Physical examination revealed a 64 year-old, emaciated, chronically ill patient. Pulse was 80, and regular, axillary temperatute was 36.8 degree C. The patient could not walk . Both lower extremi- ties were spastic. Knee and ankle reflexes were negative.
    [Show full text]
  • Benigne Skrotale Sygdomme
    VIDENSKAB Benigne skrotale sygdomme Anders Thomsen1, Sabrina Toft Hansen1 & Lars Lund1, 2 Lidelser i scrotum er et vidt begreb og dækker over stre testikel beliggende lidt lavere end den højre. Bag STATUSARTIKEL medfødte lidelser, infektioner, cancer samt komplice­ testiklerne kan man palpere epididymis, hvis funktion 1) Urinvejskirurgisk rede smerteproblematikker. Det, der som oftest får pa­ er at modne og opbevare spermierne indtil ejakulation. Afdeling, tienten til at søge læge, er smerter, eller at han mærker Ved testis’ øvre pol kan man finde de embryonale rudi­ Odense Universitetshospital noget, som er anderledes, i scrotum. menter appendix testis og appendix epididymis. Funi­ 2) Klinisk Institut, Pludseligt opståede testissmerter er en almindelig culus spermaticus er den struktur, som kan palperes Syddansk Universitet henvisningsårsag til akut urologisk vurdering. Korrekt som en forlængelse af epididymis op mod ingvinalka­ diagnosticering er vigtig, da nogle af tilstandene kræ­ nalen og indeholder ductus deferens, kar og nerver. Ugeskr Læger ver akut kirurgisk intervention, mens andre kan be­ Testis og epididymis forsynes af a. testicularis, som 2018;180:V11170869 handles med antibiotika eller konservativt. afgår fra aorta abdominalis ud for anden lumbalhvir­ Kroniske smerter i scrotum er en frustrerende til­ vel. Venerne samler sig som plexus pampiniformis i stand for patienten og kan medføre mange bekymrin­ uniklen og ender som v. testiscularis, som på venstre ger. Behandlingen kan være udfordrende, fordi tilstan­ side indmunder i v. renalis og på højre side i v. cava den ofte er multifaktoriel og ikke særlig velbelyst i inferior. litteraturen. Nerveforsyningen foregår primært gennem n. ilio­ Målet med denne artikel er at give danske klinikere inguinalis og n.
    [Show full text]
  • Vaihingen (Enz) - Mühlacker - Pforzheim - Karlsruhe Fahrplanauszug 770
    Kursbuch der Deutschen Bahn 2018 www.bahn.de/kursbuch 770 Stuttgart - Vaihingen (Enz) - Mühlacker - Pforzheim - Karlsruhe Fahrplanauszug 770 Gültig vom 19. Oktober 22 Uhr bis 21. Oktober 2018 Betriebsende Zug b SEV e 5 b SEV RE b SE770 b SEV b SEV b SEV b SEV b SE770 RE b SE770 b SEV b SE770 b SEV RE 85656 19562 19520 19500 f f f Ẅ von Stuttgart Hbf 0 19 5 19 6 14 Stuttgart Hbf (tief) ᵸ ᎪᎪᎪ Ludwigsburg ᵸ 0 29 5 28 6 23 Bietigheim-Bissingen ᵸ ܙ 0 35 5 35 6 29 Bietigheim-Bissingen 0 36 5 36 6 30 Ellental 0 38 5 38 6 33 Sachsenheim 0 43 5 43 6 37 Sersheim 0 47 5 47 6 40 Vaihingen (Enz) ܙ 0 52 5 51 6 44 Vaihingen (Enz) 0 52 5 51 6 45 Illingen (Württ) 0 55 5 54 6 48 Mühlacker Rößlesweg 0 59 5 59 6 52 Mühlacker ܙ 1 00 6 00 6 54 Mühlacker 0 45 1 01 6 01 Enzberg 0 49 1 04 6 04 Niefern 0 52 1 07 6 08 Eutingen (Baden) 0 55 1 10 6 10 Pforzheim Hbf ܙ 0 59 1 13 6 14 Pforzheim Hbf / ZOB ᵛ 0 05 1 05 1 23 2 05 3 05 4 25 5 25 ܥ 5 36 6 24 6 25 6 50 6 55 Wilferdingen-Singen / Bahnhof ᵛ ܙ 0 33 1 33 1 45 2 33 3 33 4 53 5 53 ܥ 5 58 6 46 6 53 Ꭺ 7 23 Wilferdingen-Singen / Bahnhof ᵸ ᵛ 1 41 1 45 2 41 3 41 5 01 6 01 ܥ 5 58 6 46 7 01 Ꭺ Karlsruhe-Durlach / Bahnhof ᵸ ᵛ ܙ 2 01 2 07 3 01 4 01 5 19 6 19 ܥ 6 20 7 08 7 21 Ꭺ Karlsruhe Hbf / Südausgang ᵛ ܙ 2 17 ܥ 6 30 7 18 7 45 nach Rot-Malsch Ẅ 20.
    [Show full text]
  • Preisliste Transportbeton Stand 1.1.2019 Zentral-Dispo: 07141/7020369
    Werk Nürnberg Nürnberg Werk Ansbach ZEMENTWERK Heilbronn Werk Unterrödel LAUFFEN Werk Walheim Union Beton Werk TBE Eichstätt Ludwigsburg Nördlingen Regensburg TB Vahingen/Enz Werk Möglingen Werk Aalen Werk Wemding Ingolstadt Stuttgart Werk Ingolstadt ZEMENTWERK Werk Burgheim HARBURG Werk Bäumenheim Werk Meitingen Werk Schrobenhausen LTB Lindermayr Ulm Augsburg Werk Freising Werk Thannhausen Werk München Nord Werk Hurlach München TB Landsberg Werk München Ost Memmingen Rosenheim Preisliste Transportbeton Stand 1.1.2019 Zentral-Dispo: 07141/7020369 Unsere Werke Ludwigsburg | Mundelsheim | Möglingen Vaihingen-Roßwag | Walheim | Freiberg Ludwigsburg | Mundelsheim | Möglingen | Vaihingen-Roßwag | Walheim | Freiberg Kontakte Vertrieb Klaus Krentz Marco Moradian Maximilian Späth Gerhard Friess Telefon 07141 / 70 20 340 Telefon 07141/ 70 20 350 Telefon 07141/ 70 20 360 Telefon 07141 / 70 20 320 Mobil 0172 / 71 05 431 Mobil 0160 / 47 66 20 9 Mobil 0151 / 16 71 27 35 [email protected] [email protected] [email protected] [email protected] Zentraldisposition Verwaltung Joachim Fischer Neckar Enz Transportbeton GmbH Uwe Grötzinger & Co. KG Thomas Clauß Steinheimer Straße 3 71691 Freiberg a. N. Telefon 07141 / 70 20 369 Fax 07141 / 70 20 334 Telefon 07141 / 70 20 30 [email protected] Fax 07141 / 70 20 333 [email protected] 2 3 Ludwigsburg | Mundelsheim | Möglingen | Vaihingen-Roßwag | Walheim | Freiberg Kontakte Beton richtig bestellen! Wählen Sie die Expositionsklassen A Expositionsklassen für die Bewehrung Umgebung Expositions- Mindestdruck- und die Feuchtigkeitsklassen aus klasse festigkeitsklasse Wählen Sie zuerst mindestens eine Expositionsklasse für die X0 Kein Korrosions- oder Angriffsrisiko Bewehrung A und dann eine Expositionsklasse für den Beton ohne Bewehrung X0 C8/10 Beton B aus.
    [Show full text]
  • Effects of Hydrocele on Morphology and Function of Testis
    OriginalReview ArticleArticle Effects of Hydrocele on Morphology and Function of Testis Bader Aldoah1 and Rajendran Ramaswamy2* 1Department of Surgery, University of Najran, Saudi Arabia; 2Department of Pediatric and Neonatal Surgery, Maternity and Children’s Hospital (MCH) (Under Ministry of Health), Najran, Saudi Arabia Corresponding author: Abstract Rajendran Ramaswamy, Department of Pediatric and Neonatal Surgery, Hydrocele is generally believed as innocent. But there is increasing evidence of noxious Maternity and Children’s Hospital influences of hydrocele on testis resulting in morphological, structural and functional (MCH) (Under Ministry of Health), Najran, Saudi Arabia, consequences. These effects are due to increased intrascrotal pressure and higher Tel: +966 536427602; Fax: temperature-exposure of the testis. Increased intrascrotal pressure can cause testicular 0096675293915; E-mail: [email protected] dysmorphism and even testicular atrophy. The testicular dysmorphism is reversible by early hydrocele surgery, but when persist, possibly indicate negative influence on future spermatogenesis. Spermatic cord compression by hydrocele is responsible for testicular volume increase. Such testes lose 15%-21% volume after hydrocele surgery. Tense scrotal hydrocele can cause acute scrotal pain from testicular compartment syndrome, which is relieved by evacuation of hydrocele. Higher resistivity index of subcapsular artery of testis and higher elasticity index of testicular tissue are caused by large hydrocele. As an aftermath, testis suffers ischaemia with long-term effect on spermatogenesis. High pressure of hydrocele along with ischaemia and oedema is found to result in histopathological damage to testis like total/partial arrest of spermatogenesis, small seminiferous tubules, disorganized spermatogenetic cells, basement membrane thickening and low fertilty index in children. Higher temperature exposure of testis interferes with spermatogenesis.
    [Show full text]
  • Management of Hydrocele in Adolescent Patients Marcello Cimador, Marco Castagnetti and Enrico De Grazia
    REVIEWS Management of hydrocele in adolescent patients Marcello Cimador, Marco Castagnetti and Enrico De Grazia Abstract | Hydrocele is defined as an abnormal collection of serous fluid in the potential space between the parietal and visceral layers of the tunica vaginalis. In the majority of affected adolescents, hydrocele is acquired and is idiopathic in origin. The pathogenesis of idiopathic hydrocele is thought to be an imbalance in the normal process of fluid production and reabsorption. The diagnosis is usually clinical. Taking a thorough history is essential to rule out any fluctuation in size, which is an indication of a patent processus vaginalis. Scrotal ultrasonography is mandatory in nonpalpable testicles to rule out a subtending testicular solid mass requiring inguinal exploration. Otherwise, open hydrocelectomy via a scrotal incision is the standard treatment of idiopathic hydroceles. The second most common cause of hydrocele in adolescents is varicocelectomy. The risk of hydrocele formation is higher with non-artery-sparing procedures or those performed without microsurgical aid, and in surgery requiring cord dissection. If hydrocele occurs after varicocelectomy, initial management should include observation with or without hydrocele aspiration. Large persistent hydroceles are best served by open hydrocelectomy. Cimador, M. et al. Nat. Rev. Urol. advance online publication 15 June 2010; doi:10.1038/nrurol.2010.80 Introduction Hydrocele testis was described as early as the 15th the possible etiologies of hydrocele in adolescents, con­ century by Ambroise Pare, and is defined as an abnor­ ventionally defined as patients aged between 13 and mal collection of serous fluid in the space between 18 years, and to discuss the available treatment options the parietal and visceral layers of the tunica vaginalis, for this patient population.
    [Show full text]
  • Forløbsbeskrivelse Af Urologiske Sygdomme Uiopasdfghjklzxcvbnmqwertyui
    qwertyuiopasdfghjklzxcvbnmq wertyuiopasdfghjklzxcvb nmqw ertyuiopasdfghjklzxcvbnmqwer tyuiopasdfghjklzxcvbnmqwertyForløbsbeskrivelse af urologiske sygdomme uiopasdfghjklzxcvbnmqwertyui Udarbejdet af de kliniske sygeplejespecialister; Gitte Petersen, Gry opasdfghjklzxcvbnmqwertyuiopMedonos, Liselotte Vitoft og Stina Lindedam asdfghjklzxcvbnmqwertyuiopas dfghjklzxcvbnmqwertyuiopasdf ghjklzxcvbnmqwertyuiopasdfgh jklzxcvbnmqwertyuiopasdfghjkl zxcvbnmqwertyuiopasdfghjklzx cvbnmqwertyuiopasdfghjklzxcv bnmqwertyuiopasdfghjklzxcvbn mqwertyuiopasdfghjklzxcvbnm qwertyuiopasdfghjklzxcvbnmq wertyuiopasdfghjklzxcvbnmqw i df hjkl b i Urologisk specialsygepleje – Patientforløbsbeskrivelse Indhold Cancer prostata ............................................................................................................................................... 2 Blærecancer .................................................................................................................................................... 7 Nyrekirurgi ...................................................................................................................................................... 14 Cancer renis .................................................................................................................................................. 14 Nyrepelviscancer og uretercancer............................................................................................................... 15 Nyrecyster ..................................................................................................................................................
    [Show full text]
  • HOME SEARCH STRATEGY Or the Art of Finding an Apartment in the Stuttgart Region
    LUXOFT GMBH T: +49 711 49049 200 Stadionstr. 66 F: +49 711 49049 299 70771 Leinfelden-Echterdingen www.luxoft.com HOME SEARCH STRATEGY Or the Art of finding an apartment in the Stuttgart Region Developed by the Relocation Team in Germany Geschäftsführerin: Bankverbindung: Jitka Steinmetz HRB 745973 Amtsgericht Stuttgart BNP Paribas S.A. Niederlassung Deutschland Steuer-Nr.: 99028/09891 IBAN: DE54 5121 0600 4220 7200 17 UST-ID: DE199671990 BIC: BNPADEFFXXX LUXOFT GERMANY T: +49 711 49049 201 Stadionstr. 66 F: +49 711 49049 299 70771 Leinfelden-Echterdingen www.luxoft.com Contents General Recommendations: .................................................................................... 3 List of required documents / Bewerbungsunterlagen: ......................................... 4 The Stuttgart Region (Stuttgarter Raum): .............................................................. 4 Stuttgart City ......................................................................................................... 5 Landkreis Böblingen ............................................................................................ 8 Landkreis Esslingen ............................................................................................. 9 Landkreis Ludwigsburg ..................................................................................... 10 Searching on Your Own: ....................................................................................... 12 Search via Internet sites ...................................................................................
    [Show full text]