T

he epididymis is the conductive tube that connects the testicles with the vas deferens through which semen circulates with sperm. It measures about two inches as a whole and is wound on itself at the back of the testicle, forming a comma-shaped conglomerate that adheres largely to the testicular wall. In it, the sperm accumulates, where they mature until they leave the male organ to be expelled along with the semen.

Epididymal Cyst

An epididymal cyst is a small mass that is located in the testicle, which in most cases does not present more complications than its simple appearance, with some exceptions in which it can cause a small pain or feeling of heaviness of the testicles. This type of cyst is usually benign, in which case it does not require treatment for its disappearance.

How do you treat epididymal cyst?

The proposed intervention is intended to remove a cyst with a liquid content, located in the scrotum at the level of the epididymis.

The proposed intervention, due to an increase in the volume of the scrotum and/or local discomfort or pain caused by this benign tumour, aims to remove the cyst by the surgical opening of the scrotum. In most cases, it is a single cyst that develops in relation to the thickened part or head of the epididymis, but there may be several cysts within the same epididymis.
Lack of treatment exposes you to the risk of increased scrotal volume and the appearance or flare-up of clinical problems.

Are there other treatments?

Only simple surveillance can be proposed, especially if the cyst is small, stable, and painless.

Preparation for this procedure

As for all surgical procedures, it is necessary to carry out a pre-anaesthesia evaluation a few days before the operation.
The choice of the type of anaesthesia (general, local-regional or local) depends on the opinion of the surgeon and the anaesthetist doctor. The operative area is shaved and disinfected before the intervention.

The surgical technique

A small incision is made at the level of the scrotum, after verifying the underlying testicle, the cyst is removed by opening the epididymis envelope and dissection is performed very close to the cyst wall.
The different layers are successively closed after placing, eventually, a provisional drain.
In rare cases of multiple epididymal cysts, the surgeon may be forced to remove part or all of the epididymis.

R

EZUM is an innovative treatment for benign prostatic hyperplasia (BPH). BPH is an age-associated disorder and increasingly common among men between the ages of 50 and 60. In men over 80 years, this condition rises to 90%, so a significant increase in diagnoses is expected due to the ageing of the population.

Treatment of benign prostatic hypertrophy

In recent years, progress has been made in the development of new techniques for the treatment of benign prostatic hyperplasia. Previously, treatments such as open surgery or transurethral resection (TURP) of the prostate were applied, which could have side effects such as urinary incontinence, bleeding requiring transfusion or erectile dysfunction and retrograde ejaculation.

Less invasive techniques such as laser vaporization or enucleation of the prostate provide many benefits compared to classic surgeries (open or TURP), in particular the enucleation with which excellent long-term functional results are obtained, however, these techniques can produce retrograde ejaculation in a high number of cases (between 60-90%).
Aquablation (robotic prostate hydroablation) and REZUM (steam therapy) are distinguished from other alternatives in that they are capable of preserving ejaculation, something that many patients consider important. These are two complementary techniques with each other and therefore with different patient profiles.

What is REZUM?

REZUM consists of injecting water vapour into the prostate, causing tissue necrosis (cell death). The body itself will eliminate the intervened tissue, solving the problems caused by the growth of the prostate in the patient.

Advantages of REZUM

According to experts, one of the most important advantages of this minimally invasive technique is the short surgical time, since it only takes between three to seven minutes to perform, and the low rate of complications. After the intervention, the patient can return home, usually the same day, but will have to carry a urinary catheter for the three to four days that the recovery takes. This is due to the fact that inflammation occurs that can obstruct the flow of urine. The clinical improvement is experienced two weeks after the treatment and the definitive results can be seen 30-90 days after the procedure.

The procedure manages to preserve antegrade ejaculation in up to 97% of cases because it is less radical than other techniques previously used.

Limitations of REZUM

It is a technique that also has its limitations. It can only be applied in patients with prostates that do not exceed 90-100 grams, however, the best results are obtained in medium or small prostates. And those who take anticoagulants could not be treated without prior suspension of treatment.

Is a reintervention necessary?

Only a minority of patients have to undergo retreatment during the four-year follow-up. As it is a less invasive technique, it may also be necessary to repeat the procedure after a while. The prostate can grow again, but with a correct indication of the technique, until at least ten years have passed, it is probably not necessary to intervene again. However, it is much more annoying to be on a pharmacological treatment that must be taken daily and that it may have side effects that the patient is not willing to assume. In these cases, before a much more radical procedure, it is interesting to have more conservative options such as Rezum.

U

rodynamics is a urological test that aims to simulate a voiding cycle (passing urine), that is, filling the bladder and emptying it to measure and evaluate how the muscles that make it up work.

Who can be a candidate for urodynamics?

This is a test performed more frequently on patients who have a disease called mixed urine incontinence, which means that they have stress urinary incontinence and, at the same time, urge urinary incontinence.

Stress urinary incontinence implies that the patient has involuntary urine leaks that are associated with efforts such as coughing, laughing, lifting weight or climbing stairs, among others. Whereas, in the case of urge urinary incontinence, you feel a sudden urge to urinate, which is impossible to postpone. Sometimes the latter is related to overactive bladder problems.

Benefits of Urodynamics

Thanks to urodynamics, specialists can detect, in these cases, which of the two types of incontinence is prevailing in the patient, and thus offer a better treatment to promote their quality of life.

In addition, this test is used in patients who have other problems related to urination such as emptying problems, that is, patients who find it difficult or unable to urinate (urine retention). It is also useful for evaluating the results of a treatment or surgery, in some neurological diseases, etc.

What does urodynamics consist of?

It is an invasive examination, so specialists try to request it only in strictly necessary cases. Despite this, it is not painful.

It consists of putting a tube through the patient’s urethra, which will carry the liquid with which the bladder will be filled and will measure its pressure. In addition, another probe is inserted into the rectum to measure abdominal pressure throughout the process.

Once the probes are in place, the patient should sit on a structure called a uroflowmeter, which is very similar to a toilet, which will measure possible urine leakage.

The uroflowmeter, in turn, is connected to a machine that displays the results of the exam and allows the specialist to make all the calculations that he considers pertinent.

K

idney stones (also known as renal lithiasis) form from substances that are part of the urine and that the kidney itself eliminates. They can be as small as a grain of sand or several centimetres and the reasons why they occur are various. Genetic, environmental factors and eating habits influence its appearance. The stones are composed of different minerals such as calcium, oxalate, uric acid, and others.

Treatment

The treatment of kidney stones comprises three different aspects:

1) The treatment of acute renal colic.

2) The removal of the stone.

3) The actions to prevent recurrences since in 50-70% of cases patients can re-experience new episodes.

Treatment of Renal Colic

Kidney colic is a very intense pain situation that requires emergency treatment. Doctors hydrate parenterally with dextrose solution and apply anti-inflammatory drugs (ibuprofen, ketoprofen) and antispasmodics intravenously. In addition, local heat and/or hot tub baths are advised. Most of the patients are relieved by these measures. However, when pain persists, it is advisable to administer an opiate such as Demerol and hospitalization to better manage the situation.

When we eliminate the stone spontaneously or instrumentally, you get to feel totally healthy with the disappearance of all the symptoms of intoxication and pain.

Removal of the Stone

To extract stones we now have the following therapeutic measures: observation, oral dissolution, open surgery, endoscopic extraction, and extracorporeal lithotripsy.

Observation and Medical Treatment

Stones less than 0.4 cm, especially ureteral stones, usually come out spontaneously over a period of hours to weeks. After treating renal colic, hydration, administration of antispasmodics and oral anti-inflammatories are indicated continuously every 8 or 12 hours. If after around 15 days there are no positive results, other methods may be prescribed. In addition, light exercises and the intake of vegetables and fruit rich in citrates are recommended to raise the urinary pH.

Oral Dissolution

The long-standing hope of being able to dissolve urinary stones through oral medications has been successfully achieved in uric acid lithiasis.

Dissolution of uric stones can be achieved in almost all cases, in any location. The dissolution of other types of stones has not been possible until today.

Open Surgery

All kidney stones can be extracted through open surgery. However, these have been replaced by modern endoscopic surgery and / or extracorporeal lithotripsy treatments. Today, only about 10% of stones with an indication of extraction are operated, and it is reserved for large stones.

Endoscopic Surgery and/or Endourology

Extracorporeal Lithotripsy

The principle is to concentrate mechanical and ultrasonic waves at a point in space that must correspond to the location of the stone to be treated. The stones are disintegrated with this method and the produced tiny stones are eliminated naturally. This system is quite efficient.

Pigtail Catheters

It can be used first as a system to solve very intense renal colic and not manageable with medical methods. It is also used in certain complicated cases caused by the obstruction of ureteral lithiasis.

The Prevention Treatments

It depends on the composition of the stones:

Calcium: Consists of a diet low in sodium and protein, normal in calcium and without supplements. In specific cases, potassium citrate is recommended.

Uric acid: Diet low in proteins and with allopurinol if necessary and alkalizing the urine with sodium bicarbonate or citrate supplement.

As a general measure to avoid new episodes of kidney stones, we insist on changing eating habits. Patients must drink more than two litres of water daily. The diet must be specially balanced (eating abundant vegetables and citric fruits).