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Introduction: Ureteral anomalies often represent a great challenge for physicians regarding their diagnostic and the therapeutical management, ureteral duplication being one of the most frequent urogenital congenital malformations. Material and methods: We present the case of a patient with complete right pyelo- ureteral duplication, upper right hydronephrotic destroyed renal unit secondary to a large ureterocele, patient for whom we have practiced right partial heminephroureterectomy. Results: The postoperative evolution was favorable without any immediate complications. During the periodic postoperative follow-up intravenous urography was performed, investigation that revealed a normal right renal function. Conclusions: Imagistic investigations such as contrast CT examination, magnetic resonance urography and even intravenous urography have a major role in clarifying this pathology and helping guiding the therapeutical protocol. [ABSTRACT FROM AUTHOR]

Iatrogenic ureteral injuries account for over 75% of all ureteral injuries and according to literature the incidence of iatrogenic ureteral lesions during abdomino-pelvic surgery ranges from 0.5% to 10%. Undiagnosed and untreated on time, this pathology could lead to severe complications, possible fatal. Gynecological surgeries are responsible for more than 50% of all ureteral iatrogenic injuries, followed by colo-rectal surgery, vascular surgery and urological procedures. The risk of ureteral injury is enhanced by previous surgery, radiotherapy, abdomino-pelvic neoplasia that infiltrates and deforms the pelvic structures, disrupting the normal pelvic anatomy, retroperitoneal fibrosis, and endometriosis. Imaging investigations such as ultrasonography, intravenous urography, contrast CT and ureteropyeloghraphy are essential in the diagnostic process of ureteral injuries and as well as in establishing a proper therapeutic management. We present the management applied in the case of a female patient with an iatrogenic ureteral injury after radical hysterectomy for cervical cancer, for whom we have performed ureteroneocystostomy using the Politano-Leadbetter approach, after failing inserting a ureteral double J catheter. The gold-standard treatment for this type of pathology is represented by minimally invasive endoscopic procedures due to excellent results, fewer complications and lower morbidity and mortality rates when compared to open surgery. When endoscopic approach fails, classic surgery or the laparoscopic approach remain the viable solution. Several studies have presented good results in the cases where ureteral catheters were inserted before surgery, suggesting that the identification, isolation and dissection of the ureters is easier and that risk of iatrogenic ureteral injury is significantly reduced. [ABSTRACT FROM AUTHOR]

Premature ejaculation is an important sexual dysfunction, with a prevalence rate estimated at approximately 20 to 30%. Despite the fact that many men may complain of premature ejaculation, only a small percentage of them will actually seek medical advice, the majority presenting symptoms similar to premature ejaculation, but with normal intravaginal ejaculatory latency time. Due to continuously research regarding this challenging sexual problem, interesting and effective therapeutical options have emerged over the last 30 years. Many treatment options are now available for patients complaining of premature ejaculation: psychotherapy, behavioral therapy, selective serotonin reuptake inhibitors, phosphodiesterase 5 inhibitors, topical anesthetics, tramadol and surgery. Psychotherapy should be considered the first line treatment for patients with natural variable premature ejaculation and premature like ejaculatory dysfunction, whereas pharmacotherapy should be recommended for patients with lifelong and acquired premature ejaculation. The efficacy and safety of selective serotonin reuptake inhibitors have been evaluated in numerous studies, making them the first line option in the management of patients with premature ejaculation. Alternatives such as topical anesthetics, tramadol, phosphodiesterase 5 inhibitors and alpha 1 adrenergic antagonist therapy should be considered for the patients with poor results after selective serotonin reuptake inhibitors treatment. [ABSTRACT FROM AUTHOR]

Cystic renal cell carcinoma represents 5 to 7% of all malignant renal lesions and approximately 6% of the renal cystic masses are malignant. Imaging investigations such as ultrasonography, CT, MRI and contrast enhanced ultrasonography are essential in the evaluation process of the renal cystic masses in order to establish a proper therapeutic management. We present the case of a patient with a giant renal cystic mass for which we have performed radical nephrectomy considering it was a morpho-functional damaged kidney or a renal abscess but the histopathologic examination established the diagnosis of type I papillary renal cell carcinoma. Despite general considerations that type I pRCC metastasis are rare and uncommon, our patient developed secondary lung determinations which were found at six months after surgery. [ABSTRACT FROM AUTHOR]

Introduction: Spontaneous rupture of the urinary collecting system is a rare urologic pathology, which involves the existence of an obstacle that causes urinary stasis with increasing retrograde pressure, that may lead to the appearance of a breach upstream the obstacle with extravasation of urine into the retroperitoneal space. There are many pathologies that can cause spontaneous rupture of the urinary collecting system, but the most common cause cited in urologic literature is represented by urinary lithiasis obstruction. Perforation can occur at any level of the urinary collecting system, but it is more frequently seen at the level of the renal pelvis and upper ureter. Due to the severity of its possible complications (urinoma, retroperitoneal abscess formation and sepsis) adequate treatment should be instituted as soon as possible. Materials and methods: We present two cases of spontaneous rupture of the urinary collecting system, cases in which the endourological procedures have failed and the viable solution was open surgery. The first case is a 47 years old man, who was diagnosed with spontaneous rupture of the left superior lumbar ureter and retroperitoneal urinoma after transurethral resection of a small bladder tumor. The second case is a 46 years old female with lithiasic history who was diagnosed with spontaneous rupture of the left renal pelvis and left uroretroperitoneum, probably secondary to a temporary obstructive urinary stone (the imaging investigations that have been performed haven't revealed the presence of any obstructive urinary stones). Conclusions: Spontaneous rupture of the urinary collecting system is an urological emergency due to the severity of its complications. The imaging investigations have an essential role in establishing the diagnosis, because the symptoms can mimic many other abdominal pathologies and even an experienced physician can be misled. The first line treatment is represented by minimally invasive endoscopic procedures which offer excellent results and fewer complications than open surgery, but when endourology fails, classic surgery remains the solution. [ABSTRACT FROM AUTHOR]

Introduction: Ureteral anomalies often represent a great challenge for physicians regarding their diagnostic and the therapeutical management, ureteral duplication being one of the most frequent urogenital congenital malformations. Material and methods: We present the case of a patient with complete right pyelo- ureteral duplication, upper right hydronephrotic destroyed renal unit secondary to a large ureterocele, patient for whom we have practiced right partial heminephroureterectomy. Results: The postoperative evolution was favorable without any immediate complications. During the periodic postoperative follow-up intravenous urography was performed, investigation that revealed a normal right renal function. Conclusions: Imagistic investigations such as contrast CT examination, magnetic resonance urography and even intravenous urography have a major role in clarifying this pathology and helping guiding the therapeutical protocol. [ABSTRACT FROM AUTHOR]

Iatrogenic ureteral injuries account for over 75% of all ureteral injuries and according to literature the incidence of iatrogenic ureteral lesions during abdomino-pelvic surgery ranges from 0.5% to 10%. Undiagnosed and untreated on time, this pathology could lead to severe complications, possible fatal. Gynecological surgeries are responsible for more than 50% of all ureteral iatrogenic injuries, followed by colo-rectal surgery, vascular surgery and urological procedures. The risk of ureteral injury is enhanced by previous surgery, radiotherapy, abdomino-pelvic neoplasia that infi ltrates and deforms the pelvic structures, disrupting the normal pelvic anatomy, retroperitoneal fi brosis, and endometriosis. Imaging investigations such as ultrasonography, intravenous urography, contrast CT and ureteropyeloghraphy are essential in the diagnostic process of ureteral injuries and as well as in establishing a proper therapeutic management. We present the management applied in the case of a female patient with an iatrogenic ureteral injury after radical hysterectomy for cervical cancer, for whom we have performed ureteroneocystostomy using the Politano-Leadbetter approach, after failing inserting a ureteral double J catheter. The gold-standard treatment for this type of pathology is represented by minimally invasive endoscopic procedures due to excellent results, fewer complications and lower morbidity and mortality rates when compared to open surgery. When endoscopic approach fails, classic surgery or the laparoscopic approach remain the viable solution. Several studies have presented good results in the cases where ureteral catheters were inserted before surgery, suggesting that the identifi cation, isolation and dissection of the ureters is easier and that risk of iatrogenic ureteral injury is signifi cantly reduced. [ABSTRACT FROM AUTHOR]

Cystic renal cell carcinoma represents 5 to 7% of all malignant renal lesions and approximately 6% of the renal cystic masses are malignant. Imaging investigations such as ultrasonography, CT, MRI and contrast enhanced ultrasonography are essential in the evaluation process of the renal cystic masses in order to establish a proper therapeutic management. We present the case of a patient with a giant renal cystic mass for which we have performed radical nephrectomy considering it was a morpho-functional damaged kidney or a renal abscess but the histopathologic examination established the diagnosis of type I papillary renal cell carcinoma. Despite general considerations that type I pRCC metastasis are rare and uncommon, our patient developed secondary lung determinations which were found at six months after surgery. [ABSTRACT FROM AUTHOR]

Premature ejaculation is an important sexual dysfunction, with a prevalence rate estimated at approximately 20 to 30%. Despite the fact that many men may complain of premature ejaculation, only a small percentage of them will actually seek medical advice, the majority presenting symptoms similar to premature ejaculation, but with normal intravaginal ejaculatory latency time. Due to continuously research regarding this challenging sexual problem, interesting and effective therapeutical options have emerged over the last 30 years. Many treatment options are now available for patients complaining of premature ejaculation: psychotherapy, behavioral therapy, selective serotonin reuptake inhibitors, phosphodiesterase 5 inhibitors, topical anesthetics, tramadol and surgery. Psychotherapy should be considered the fi rst line treatment for patients with natural variable premature ejaculation and premature like ejaculatory dysfunction, whereas pharmacotherapy should be recommended for patients with lifelong and acquired premature ejaculation. The effi cacy and safety of selective serotonin reuptake inhibitors have been evaluated in numerous studies, making them the fi rst line option in the management of patients with premature ejaculation. Alternatives such as topical anesthetics, tramadol, phosphodiesterase 5 inhibitors and alpha 1 adrenergic antagonist therapy should be considered for the patients with poor results after selective serotonin reuptake inhibitors treatment. [ABSTRACT FROM AUTHOR]

Introduction: Spontaneous rupture of the urinary collecting system is a rare urologic pathology, which involves the existence of an obstacle that causes urinary stasis with increasing retrograde pressure, that may lead to the appearance of a breach upstream the obstacle with extravasation of urine into the retroperitoneal space. There are many pathologies that can cause spontaneous rupture of the urinary collecting system, but the most common cause cited in urologic literature is represented by urinary lithiasis obstruction. Perforation can occur at any level of the urinary collecting system, but it is more frequently seen at the level of the renal pelvis and upper ureter. Due to the severity of its possible complications (urinoma, retroperitoneal abscess formation and sepsis) adequate treatment should be instituted as soon as possible. Materials and methods: We present two cases of spontaneous rupture of the urinary collecting system, cases in which the endourological procedures have failed and the viable solution was open surgery. The fi rst case is a 47 years old man, who was diagnosed with spontaneous rupture of the left superior lumbar ureter and retroperitoneal urinoma after transurethral resection of a small bladder tumor. The second case is a 46 years old female with lithiasic history who was diagnosed with spontaneous rupture of the left renal pelvis and left uroretroperitoneum, probably secondary to a temporary obstructive urinary stone (the imaging investigations that have been performed haven't revealed the presence of any obstructive urinary stones). Conclusions: Spontaneous rupture of the urinary collecting system is an urological emergency due to the severity of its complications. The imaging investigations have an essential role in establishing the diagnosis, because the symptoms can mimic many other abdominal pathologies and even an experienced physician can be misled. The fi rst line treatment is represented by minimally invasive endoscopic procedures which offer excellent results and fewer complications than open surgery, but when endourology fails, classic surgery remains the solution. [ABSTRACT FROM AUTHOR]

There are several studies which link the ubiquitously Human Papilloma Virus (HPV) to several malignancies. Some of them like cervix cancer had already been proven but others are still opened to discussions. One of them which we refer in this topic is the bladder cancer. We shall try to discuss it in a general and particularized manner given the fact that bladder cancer includes several types of neoplasia. The general term bladder cancer include urothelial carcinoma, squamous cell carcinoma, adenocarcinoma, inverted urothelial neoplasia and last but not the least a mix between urothelial neoplasia with squamous cell carcinoma differentiation. Another concern seems to be related to a possible marker that can be used for this type of neoplasia and if it can be linked to HPV or not. There are studies which try to link p16 or p53 to HPV with conflictual results. There are also manny papers which try to find out if there is or not any role for HPV in bladder cancer. [ABSTRACT FROM AUTHOR]

There are several studies which link the ubiquitously Human Papilloma Virus (HPV) to several malignancies. Some of them like cervix cancer had already been proven but others are still opened to discussions. One of them which we refer in this topic is the bladder cancer. We shall try to discuss it in a general and particularized manner given the fact that bladder cancer includes several types of neoplasia. The general term bladder cancer include urothelial carcinoma, squamous cell carcinoma, adenocarcinoma, inverted urothelial neoplasia and last but not the least a mix between urothelial neoplasia with squamous cell carcinoma differentiation. Another concern seems to be related to a possible marker that can be used for this type of neoplasia and if it can be linked to HPV or not. There are studies which try to link p16 or p53 to HPV with conflictual results. There are also manny papers which try to fi nd out if there is or not any role for HPV in bladder cancer. [ABSTRACT FROM AUTHOR]

Alcoholism is a common condition and frequently clinicians are forced to confront its complications in general hospital settings. There are an estimated 3 million alcohol-dependent people in Romania alone, from which a significant number suffers episodes of withdrawal severe enough to require pharmacologic treatment. Alcohol withdrawal syndrome is a clinical diagnosis, with symptoms that range from minor (anxiety/palpitations) to severe (delirium tremens/hallucinations). Benzodiazepines have the best evidence in treating this disease. A symptom-triggered therapy approach is favored using a validated tool, such as CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised), for shorter periods of hospitalization and for using lower doses of sedatives. [ABSTRACT FROM AUTHOR]

Endometriosis is a heterogeneous disease, affecting women during their reproductive period. The most frequent clinical manifestations include dysmenorrhea, dyspareunia, chronic pelvic pain and infertility. Endometriosis interferes in all the steps of the reproductive process, from folliculogenesis till implantation. Medical treatment of women who desire fertility is contraindicated as it delays conception. Surgery has proven to be an important step in managing these patients along with IVF. Despite the detrimental effects of endometriosis upon the reproductive process, IVF represents the best option when dealing with infertility. [ABSTRACT FROM AUTHOR]

Malpractice is a relatively new term in terms of litigation. Prior to the early 18th century, medical malpractice lawsuits were mainly limited to cases that resulted in severe injury and death. At the beginning of the 19th century, things started to change for the medical practitioners, unfortunately not in a good way. What seemed to have started in the USA, spread like fire throughout the Western Europe. This state of affair prompted physicians to practice the socalled "defensive medicine". It is well known that surgery in general and urologic surgery in particular is associated with iatrogenic injury and high-risk procedures that do not always have a positive outcome. Moreover, office urology seems to also imply a high degree of litigation risk. The aim of this paper was to determine the fields in Urology that are most prone to litigation and malpractice lawsuits. [ABSTRACT FROM AUTHOR]

This article is a literature review that emphasis the impact of testicular cancer on fertility and current management to prevent and treat infertility. Foreign literature has a lot of multicenter prospective longitudinal and retrospective studies of negative effects on fertility in men with teticular cancer. Testicular cancer has a negative impact on fertility because of its high incidence (7.52 cases per 100000 of the population) in young men with age between 15 and 35 years old. At the time they discover they have testicular cancer, many man have few or no sperm. In addition, all of the treatment for testicular cancer can directly or indirectly cause fetility problems. Sperm abnormatilies are frequent in men with testicular cancer. Patiens who underwent chemotherapy with bleomicin, doxorubicin, cisplatin or radiotherapy have a high risk to develop sperm aneuploidy. Genetic and psychological counseling should be done before choosing any treatment for testicular cancer. Sperm and embryo cryopreservation should be considered as early as possible before any treatement for testicular cancer. [ABSTRACT FROM AUTHOR]

Malpractice can be defined as a form of doctor's guilt, as he has not prescribed or he ignored the end result of his actions, although he could anticipate and prevent it. Professional malpractice is defined as the error committed in the exercise of the medical or medical-pharmaceutical, tortious the patient, involving civil liability of medical personnel and medical products and services provider, healthcare or pharmaceutical. Subjective error lies in the misunderstanding of reality caused by poor medical training and the misapplication of specialized techniques and maneuvers, while objective error occurs frequently due to imperfections of medical science at a time. We present a 54 years patient with a recent transient ischemic stroke treated in a territorial service which was mounted a Foley auto static catheter, shortly after admission. After about eight days, meanwhile the patient accused pelviperineal pain, treating physicians noted the presence of a neglected paraphimosis. Nearly a month later, the patient has gland necrosis and surgical removal of devitalized tissue is recommended. We wanted to present only two issues we believe essential: to inform the medical fellows about the current regulations regarding medical malpractice and to warn, while noting a possible future case of this kind. [ABSTRACT FROM AUTHOR]

Alcoholism is a common condition and frequently clinicians are forced to confront its complications in general hospital settings. There are an estimated 3 million alcohol-dependent people in Romania alone, from which a significant number suffers episodes of withdrawal severe enough to require pharmacologic treatment. Alcohol withdrawal syndrome is a clinical diagnosis, with symptoms that range from minor (anxiety/palpitations) to severe (delirium tremens/hallucinations). Benzodiazepines have the best evidence in treating this disease. A symptom-triggered therapy approach is favored using a validated tool, such as CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised), for shorter periods of hospitalization and for using lower doses of sedatives. [ABSTRACT FROM AUTHOR]

Malpractice is a relatively new term in terms of litigation. Prior to the early 18th century, medical malpractice lawsuits were mainly limited to cases that resulted in severe injury and death. At the beginning of the 19th century, things started to change for the medical practitioners, unfortunately not in a good way. What seemed to have started in the USA, spread like fire throughout the Western Europe. This state of affair prompted physicians to practice the socalled "defensive medicine". It is well known that surgery in general and urologic surgery in particular is associated with iatrogenic injury and high-risk procedures that do not always have a positive outcome. Moreover, office urology seems to also imply a high degree of litigation risk. The aim of this paper was to determine the fields in Urology that are most prone to litigation and malpractice lawsuits. [ABSTRACT FROM AUTHOR]

This article is a literature review that emphasis the impact of testicular cancer on fertility and current management to prevent and treat infertility. Foreign literature has a lot of multicenter prospective longitudinal and retrospective studies of negative effects on fertility in men with teticular cancer. Testicular cancer has a negative impact on fertility because of its high incidence (7.52 cases per 100000 of the population) in young men with age between 15 and 35 years old. At the time they discover they have testicular cancer, many man have few or no sperm. In addition, all of the treatment for testicular cancer can directly or indirectly cause fetility problems. Sperm abnormatilies are frequent in men with testicular cancer. Patiens who underwent chemotherapy with bleomicin, doxorubicin, cisplatin or radiotherapy have a high risk to develop sperm aneuploidy. Genetic and psychological counseling should be done before choosing any treatment for testicular cancer. Sperm and embryo cryopreservation should be considered as early as possible before any treatement for testicular cancer. [ABSTRACT FROM AUTHOR]

Penile conditions represent a relatively rare but „delicate” pathology. Unfortunately penile neoplasia often involve both physically and mentally mutilating surgery. Penile cancer (PC) represent an uncommon pathology which if remains untreated has a bleak outcome. It benefits from different therapeutic approaches starting from topical treatment and ending with surgery. Entirely removal of the disease is the aim of the treatment with maximal functional preservation. Given the mutilating therapy it is mandatory that the patient is well informed of all possible functional outcomes in order to avoid the forensic aspects. We favor the individualisation of the therapeutic approach in order to maintain at least a decent functionality. Unfortunately usually the neoplasia is in an advanced stage at the time of presentation to the physician so the oncological aspects become priority. [ABSTRACT FROM AUTHOR]

Malpractice can be defined as a form of doctor's guilt, as he has not prescribed or he ignored the end result of his actions, although he could anticipate and prevent it. Professional malpractice is defined as the error committed in the exercise of the medical or medical-pharmaceutical, tortious the patient, involving civil liability of medical personnel and medical products and services provider, healthcare or pharmaceutical. Subjective error lies in the misunderstanding of reality caused by poor medical training and the misapplication of specialized techniques and maneuvers, while objective error occurs frequently due to imperfections of medical science at a time. We present a 54 years patient with a recent transient ischemic stroke treated in a territorial service which was mounted a Foley auto static catheter, shortly after admission. After about eight days, meanwhile the patient accused pelviperineal pain, treating physicians noted the presence of a neglected paraphimosis. Nearly a month later, the patient has gland necrosis and surgical removal of devitalized tissue is recommended. We wanted to present only two issues we believe essential: to inform the medical fellows about the current regulations regarding medical malpractice and to warn, while noting a possible future case of this kind. [ABSTRACT FROM AUTHOR]

Penile conditions represent a relatively rare but „delicate” pathology. Unfortunately penile neoplasia often involve both physically and mentally mutilating surgery. Penile cancer (PC) represent an uncommon pathology which if remains untreated has a bleak outcome. It benefi ts from different therapeutic approaches starting from topical treatment and ending with surgery. Entirely removal of the disease is the aim of the treatment with maximal functional preservation. Given the mutilating therapy it is mandatory that the patient is well informed of all possible functional outcomes in order to avoid the forensic aspects. We favor the individualisation of the therapeutic approach in order to maintain at least a decent functionality. Unfortunately usually the neoplasia is in an advanced stage at the time of presentation to the physician so the oncological aspects become priority. [ABSTRACT FROM AUTHOR]