2017-3 — Summary
Headache after micturition – paraganglioma of the urinary bladder
DOI: 10.22591/magyurol.2017.3.varghaj.117
Authors:
Vargha Judit dr.1, Keszthelyi Attila dr.1, Tóth Miklós dr.2, Nyirády Péter dr.1
1Semmelweis Egyetem Urológiai Klinika és Uroonkológiai Centrum, Budapest (igazgató: Nyirády Péter dr.)
2Semmelweis Egyetem II. Belgyógyászati Klinika, Budapest (igazgató: Igaz Péter dr.)
Summary
Objective: Paraganglioma of the urinary bladder is very rare disease, only several cases are mentioned in the literature.
Case report: The authors present the diagnosis of the paraganglioma of the urinary bladder through the case of a 35-year-old male patient.
Conclusion: Most cases are asymptomatic, in symptomatic cases there are silent haematuria and sickness after voiding urine. Urine analysis detecting excreted vanil-almond acid and CT imaging of the urinary bladder are necessary to set up diagnosis. Surgical treatment is suggested, considering that the bladder muscles also affected: bladder resection or cystectomy. Transurethral surgery, whether resection or biopsy are contraindicated, because the catecholamines released from the tumour may cause hypertensive crisis.
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Saint Liborius – the patron of urology
DOI: 10.22591/magyurol.2017.3.kopazs.120
Authors:
Kopa Zsolt dr., Nyirády Péter dr.
Semmelweis Egyetem, Urológiai Klinika és Andrológiai Centrum, Budapest (igazgató: Nyirády Péter dr.)
Summary
At the time of the end of Christian’s persecution in the Roman Empire lived Liborius in Gallia, in the city of Le Mans. He was deeply influenced by Latin culture and became priest. Later on he became the bishop of the city and held this position for 49 years. Besides bishop’s activity due to primary evangelisation and establishing of churches he strongly worked for Christianity. After his death lot of miracles and miraculous recoveries happened at his tomb, mainly to urolithiasis patients. Therefore, in 835 his bone relics were placed into the altar of the Cathedral in Le Mans. One year later by the instructions of Emperor Louis the Pious a huge pilgrimage transferred the relics in a decorated shrink to Paderborn to spread the Christian religion into Northern-Germany with this charity. From this charity arosed „Love bond of lasting brotherhood” is the oldest and live contract concluded between two cities. In the 13th century the miraculous recovery of a most famous pilgrim with urolithiasis was documented. From this time St. Liborius is shown with pontifical clothing and three stones placed on his Bible. St. Liborius has a significant respect in France, in Germany, but also in Italy, Spain and in the historical Hungary and several churches and communities wear his name and tend his respect in the USA and Australia. In Hungary he is the patron Saint of two churches, part of his body relics can be find at the altar of Almásfüzítő. By the survey of several archaeological and urological publications the conclusion can be drawn that St. Liborius should be considered as the patron saint of urology.
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Plaque incision, grafting and penile prosthesis implantation in Peyronie’s disease
DOI: 10.22591/magyurol.2017.3.kiralyi.106
Authors:
Király István Előd dr., Bajory Zoltán dr.
Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Általános Orvostudományi Kar, Urológiai Klinika, Szeged (igazgató: Bajory Zoltán dr.)
Summary
Introduction: Peyronie’s disease (PD) is an acquired, benign connective tissue disorder that involves the tunica albuginea of the penis and can cause penile deformity and shortening.
Objective: To show when we use other operation techniques than plication in PD and to show a case report using plaque incision by Egydio technique, grafting and implantation of penile prosthesis at the same time.
Patient and method: The 62-year-old patient had a serious, dorsal curvature. His IIEF-5 score was 6. After the degloving of the penis, we separated the neurovascular bundle from the cavernous bodies and measured the correct place of the double Y shape incision using Egydio technique. After the incision we inserted an AMS Spectra penile implant in the usual way. We used tunica vaginalis parietalis wall of the testis to cover the defect of the tunica albuginea. We closed the Buck fascia and the skin.
Results: No intra- and postoperative complication. The patient started sexual intercourses two month after the operation. The penis is straight, long and wide. The cosmetic and functional results are excellent.
Discussion: Surgery represents the gold standard of treatment of the PD. The indications for surgery are chronic phase of the disease, the sexual intercourse difficult or impossible, failure of conservative management and erectile dysfunction. The main preoperative factors contributing to the decision of the surgical approach are the severity of the curvature, the quality of the erection and the penile length. The main indications of the implantation of penile prosthesis and incision of the plaque plus grafting are severe penile curvatures (above 60 degrees), large dorsal plaques, ventral curvature, and the presence of residual curvature following penile prosthesis implantation and modeling plus tunical incision.
Conclusion: Choosing the right procedure according to the type of deformity, size of the penis, and preoperative erectile function is necessary in order to obtain the best cosmetic and functional results in PD patients.
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Nocturia in clinical practice
DOI: 10.22591/magyurol.2017.3.kenyeresb.101
Authors:
Kenyeres Balázs dr., Pytel Ákos dr.
Pécsi Tudományegyetem, Klinikai Központ, Urológiai Klinika, Pécs (igazgató: Szántó Árpád dr.)
Summary
Nocturia is a lower urinary tract symptom, defined as the report of waking up at least once from sleep to void. It has a great impact on quality of life and leads to development of metabolic related comorbidities and increased mortality due to the impairment of sleep quality. Nocturia has a multifactorial aetiology most important causes are nocturnal polyuria, global polyuria and primary sleep disorders. The heterogenic nature of nocturia leads to the need of multidisciplinary approach of diagnosis and treatment. This paper aims to maintain the awareness for this underdiagnosed and undertreated symptom, and to summarize the diagnostic and treatment approaches in a fashion, that can benefit the everyday clinical practice.
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Priapism – case report of two high flow priapism patients
DOI: 10.22591/magyurol.2017.3.huttla.113
Authors:
Hüttl András Béla dr.1, Kopa Zsolt dr.1, Dósa Edit dr.2, Hüttl Kálmán dr.2, Nyirády Péter dr.1, Riesz Péter dr.1
1Semmelweis Egyetem, Urológiai Klinika, Budapest (igazgató: Nyirády Péter dr.)
2Semmelweis Egyetem, Városmajori Szív- és Érgyógyászati Klinika, Budapest (igazgató: Merkely Béla dr.)
Summary
Background: High flow priapism is a relatively rare disease in Central Europe. Making the correct diagnosis and the management of high flow priapism is not well established yet in Hungary.
Case report: In this paper we present the diagnosis and the treatment of two cases of high flow priapism that were treated at Semmelweis University Hospitals (Budapest). We also review the related European Urology Guidelines (EAU).
Conclusion: We conclude that the treatment of high flow priapism needs to be centralized in Hungary in order to make the right diagnosis and to be able to choose the best treatment for the given patient.