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Study Type – Therapy (case series)
Level of Evidence 4 OBJECTIVE To present our experience with single‐port transvesical enucleation of the prostate (STEP) in 34 patients with large‐volume benign prostatic hyperplasia (BPH). PATIENTS AND METHODS We performed STEP in 34 patients with large volume (>60 g) BPH (mean age 69 years, body mass index 26 kg/m2, and American Society of Anesthesiology class 2). The mean prostate volume estimated by transrectal ultrasonography was 102.5 mL and the mean baseline prostate‐specific antigen level was 6.7 ng/mL. A novel single‐port device was inserted percutaneously into the bladder through a 2–3 cm incision in the suprapubic skin crease. After establishing pneumovesicum, the prostate adenoma was enucleated transvesically using standard laparoscopic instruments, and the adenoma was extracted in pieces through the port. Digital assistance expedited enucleation of the apical adenoma in 19 (55%) cases. RESULTS Transvesical enucleation was completed in all 34 cases; the mean operative duration was 116 min, and the estimated blood loss was 460 mL. There was one death from postoperative bleeding from uncontrolled coagulopathy in a Jehovah’s Witness who refused a transfusion of blood and blood products. There were three complications during STEP (one death, one bowel injury and one haemorrhage) and five afterwards (four bleeding, one epididymo‐orchitis). Open conversion was necessary in two patients for complications, and extension of the skin incision by 1–2 cm was necessary in two to expedite apical digital enucleation. The mean hospital stay was 3 days and mean analogue pain score at discharge was 2. All 33 patients (excluding the patient who died) were voiding spontaneously at a maximum follow‐up of 8 months, with a mean American Urologic Association symptom score of 3, a maximum urinary flow rate of 44 mL/s, and a postvoid residual of 30 mL at the latest follow‐up. No patient developed urinary incontinence. CONCLUSIONS STEP is an effective treatment option for selected patients with large‐volume obstructive BPH. Under pneumovesicum using laparoscopic visualization, the entire adenoma can be effectively enucleated and expeditiously extracted through the novel single port. Comparison of the STEP procedure with other open and transurethral techniques will determine its place in the surgical treatment of large‐volume BPH.

Spontaneous regression of a primary testicular germ-cell tumour (GCT), over time known as ‘Burned out’, ‘Shrinking Seminoma’, ‘pT0’, ‘Burnout’ or ‘Spontaneous Regression’, is an uncommon, generally metastatic phenomenon, which may present elevated tumour markers and a suspicious testicular ultrasound image. The histological study of the testicle demonstrated morphological changes of complete or partial tumour regression and found fibrous scarring and other characteristic changes of this phenomenon, which in some cases include vestiges of GCT.There are few publications on testicular GCT tumour regression and those that exist present limited data on the biology of the disease and its etiopathogenesis. This entity was recently recognised in the latest edition of the World Health Organization’s (WHO) Classification of Tumours.We present our clinical, imaging, laboratory, cytohistological and management experience, as well as a historical review of the literature.

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