A 15-year-old boy presented to the emergency department with acute left scrotal pain of 12 hours duration. He had previous intermittent pain, without scrotal swelling. Physical examination revealed a normal right testis. The left testis was palpable within the hemiscrotum, but there was a tender indurated mass in continuity with the epididymis. There was minimal swelling of the left side of the scrotum without erythema. Bilateral cremasteric reflexes were present. All laboratory values were unremarkable. Scrotal ultrasonography (US) was performed. IMAGING FINDINGSUS demonstrated one normal right testis and two left testes, one in the upper hemiscrotum and one in the lower hemiscrotum (Figs 1-4). The right testis was unremarkable in echogenicity, with normal blood flow on the color Doppler flow image (Fig 1). Both left testes demonstrated similar homogenous echogenicity; however, there was no color flow in the left upper testis, a finding that is compatible with testicular torsion. This finding corresponded to the tender indurated mass found at physical examination (Figs 2, 5). Figures 4 and 5 also show a part of the epididymis attached to the upper testis. The lower testis had normal blood flow (Fig 3). A moderate hydrocele was seen in the upper portion of the hemiscrotum (Fig 2). DISCUSSIONFollowing US examination of the scrotum, the patient underwent urgent left scrotal exploration. The intraoperative findings revealed a duplicated testis within the left portion of the scrotal sac, which was complicated by torsion of the upper testis (Fig 6). The lower testis was normal (Fig 3). The head of the epididymis was attached to the upper testis, and it had also undergone torsion (Figs 4 -6). The remaining body and tail of the epididymis was attached to the lower testis, which had not undergone torsion (Fig 6). The upper testis was believed to be viable after torsion was treated, and orchiopexy was performed. Biopsy of the upper testis revealed normal spermatogenesis and seminiferous tubules. Since the US examination revealed a single normal right testis with normal blood flow and the results of physical examination were unremarkable, surgical exploration of the right hemiscrotum was not performed.The differential diagnosis for a painful scrotal mass includes-in descending frequency-inflammation, hydrocele, torsion, varicocele, spermatocele, cysts, and malignant or benign tumor (1). US is the modality of choice in the evaluation of the acute scrotum. In particular, the differentiation of intraand extratesticular masses has a sensitivity of 80%-95% (1). In this case, the absence of abnormal focal intratesticular echotexture excluded intratesticular tumor. There is no US finding suggestive of varicocele, spermatocele, or cysts. There is also no indication of increased Doppler flow suggestive of inflammation. The most salient finding is the presence of a well-defined mass that has echotexture similar to that of the adjacent normal testis, and it has no blood flow. Although there is a moderate hydrocele, the presence of th...

Benign prostatic hyperplasia (BPH) is a common disease in males older than 50 years of age. 75-80% of this population is considered to have some degree of BPH causing clinical symptoms and requiring urological treatment. Transurethral resection of the prostate (TUR-P) is currently the standard surgical treatment modality for BPH. In an attempt to minimize the need for hospitalization and the associated perioperative and postoperative morbidity, alternatives have been sought. Various types of Laser techniques such as interstitial Laser coagulation and side-firing technology have been proposed. Numerous studies have shown that Laser procedures safely and effectively reduce the volume of the prostate. Intra-and postoperative bleeding are nearly unknown complications for Laser procedures, whereas this is the most relevant complication for the TUR-P. Due to significant tissue edema after Laser treatment, patients commonly show delayed time to void adequately and, therefore, catheter drainage is often necessary for 3 to 21 days. Retrograde ejaculation is reported to occur less (0-10%) compared to TUR-P (> 60%). Urinary tract infections are very common after interstitial laser coagulation. Although not many long-term clinical data are available, various studies have shown that BPH patients improve in symptom score, flow rate and post-void residual up to 3 years after Laser treatment. This paper presents a concise review of efficacy, advantages and disadvantages of the most frequently used Laser techniques as well as the long-term clinical data compared to TUR-P.

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The use of minimally invasive treatments for benign prostatic hyperplasia (BPH) have been introduced into the medical community. Over the last decade several minimally invasive treatment techniques have been approved for use. In particular, interstitial laser coagulation (ILC) has shown promise as an alternative to the current gold standard, transurethral resection of prostate (TURP). Studies show ILC to have equal efficacy as TURP while causing less side effects. Future technical advances as well as increased physician experience with ILC could lead to the replacement of TURP as the gold standard in treatment of BPH.