The use of 3D laparoscopic partial nephrectomy has emerged as a cornerstone in the surgical arsenal for addressing renal tumors, particularly in managing challenging cases characterized by deeply seated tumors embedded within the renal parenchyma. In these intricate scenarios, the utilization of intraoperative ultrasound (IOUS) acquires paramount importance, serving as an indispensable tool for guiding and meticulously monitoring the surgical process in real time. To further explore the efficacy of IOUS-guided techniques, we conducted a retrospective study comparing outcomes in patients who underwent partial nephrectomy with IOUS guidance (n = 60) between 2020 and 2022 with a cohort from 2018 to 2019 without IOUS guidance (n = 25). Our comprehensive analysis encompassed various post-operative parameters, including the duration until food resumption, analgesia requirements, and length of the hospital stay. While these parameters exhibited comparable outcomes between the two groups, notable distinctions emerged in the intraoperative metrics. The IOUS-guided cohort demonstrated significantly reduced blood loss, a shorter median operative duration, and diminished ischemia time (p = 0.001). These compelling findings underscore the undeniable benefits of IOUS-guided techniques in not only facilitating the attainment of negative surgical margins but also in enhancing procedural safety and precision, thereby contributing to improved patient outcomes in the management of renal tumors.

In this study, we investigated the outcomes of laparoscopic approaches for adrenal tumor resection in 67 patients from a single center with a median age of 51 (range 40–79). Predominantly comprising women, the majority of patients were overweight or obese. Adrenal tumors larger than 6 cm were mostly treated using the laparoscopic transperitoneal method (p < 0.001). Our results revealed that patients subjected to the retroperitoneal approach exhibited quicker recovery, as evidenced by faster resumption of oral intake and ambulation, along with reduced intraoperative blood loss and shorter hospitalization (p-value < 0.05). In contrast, patients subjected to the transperitoneal approach experienced minimal complications, though not statistically significant, despite the technique’s intricacy and slower recovery. These findings emphasize the significance of tailoring the surgical approach to individual patient characteristics, with particular emphasis on the tumor size. The choice between the retroperitoneal and transperitoneal methods should be informed by patient-specific attributes to optimize surgical outcomes. This study underscores the need for a comprehensive evaluation of factors such as tumor characteristics and postoperative recovery when determining the most suitable laparoscopic approach for adrenal tumor resection. Ultimately, the pursuit of individualized treatment strategies will contribute to improved patient outcomes in adrenal tumor surgery.

Acute ischemia of the glands is a severe complication after circumcision. We outline the challenging case of a seventeen-year-old boy with glandular ischemia (GI) that appeared shortly after circumcision. Methods: We present a case report and literature review related to glans ischemia, and the complications of circumcision are reviewed. We note that there are very few cases described in the literature. Our patient was successfully treated with hyperbaric oxygen therapy (HBOT) after four days of no positive effect after all medical and surgical treatments written in the literature: Subcutaneous enoxaparin, local application of a glyceryl trinitrate, continuous epidural perfusion, intravenous pentoxifylline, alprostadil, intraoperative drainage, and aspiration with saline solution and epinephrine. Clinical improvement was noted at the first session of HBOT. A number of days after the operation, the penis looked normal and was healing. Complete healing of the penile glans was successfully realized one month after surgery. Conclusion: Based on the review and the case presented, we conclude that HBOT is the treatment of choice for acute ischemia of the penile glans, especially when other treatments do not work.

Stress urinary incontinence (SUI) is a significant global health issue that particularly affects females, leads to notable societal and economic challenges and significantly affects the quality of life. This study focuses on the comparative analysis of two established surgical interventions, tension-free vaginal tape (TVT) and transobturator tape (TOT), at a single center and applied to 455 women suffering from SUI, with a mean follow-up period of 102 ± 30 months for TVT and 80.4 ± 13 months for TOT. Our findings indicate that, in comparison to TVT, the TOT procedure demonstrates fewer early and late post-operative complications in patient outcomes (1.41% vs. 17.64% and; 5.66% vs. 12.74%, both respectively). However, the TVT procedure shows a modestly favorable outcome in the risk of recurrence of SUI, compared to TOT (0% vs. 3.7%); the TOT procedure has also proven to be more effective in alleviating of urgency symptoms, although not at a statistically significant level (p = 0.072). Univariable and multivariable analysis of factors that predict late complications showed that only obesity can predict a worse outcome [OR]: 1.125 CI 95%: 1.105–1.533, p = 0.037), when adjustments are made for symptoms presented before surgery and procedure type. While both methods are safe and effective, the choice between them should be based on the specific characteristics of each case.

Background: This study aimed to evaluate the advantages of integrating intraoperative ultrasound (IOUS) into laparoscopic adrenal surgery by assessing its impact on perioperative outcomes and identifying potential complications. Methods: This retrospective study analyzed 128 patients with adrenal gland tumors who underwent a laparoscopic adrenalectomy by comparing those who received intraoperative ultrasound guidance with those who did not. The procedures were performed using either the transperitoneal or the lateral retroperitoneal approach. Results: The IOUS-guided group had significantly lower blood loss (p < 0.001) and a shorter hospitalization duration (p = 0.005) compared with the non-IOUS group. No intraoperative complications were observed in the IOUS group, whereas three complications occurred in the non-IOUS group, including peritoneal breaches and minor liver damage. The retroperitoneal approach demonstrated superior perioperative outcomes, with a shorter operative time (p < 0.001), reduced blood loss (p < 0.001), earlier resumption of oral intake and lower postoperative analgesia requirements (p < 0.001). Conclusions: Intraoperative ultrasound enhanced the surgical precision in laparoscopic adrenalectomy, which reduced the blood loss, shortened the hospital stays and minimized the intraoperative complications.

Background: Fournier’s gangrene (FG) is a severe necrotizing infection requiring urgent resuscitation, empirical broad-spectrum antimicrobials, and radical debridement. We evaluated established severity scores, Sepsis-3-defined organ dysfunction, and malignancy status in a single-center cohort with surgically confirmed FG. Methods: This retrospective observational study analyzed 21 consecutive adult patients treated between 1 January 2019 and 31 January 2025 at a Romanian tertiary referral center. Pre-treatment baseline FGSI, SFGSI, LRINEC, NLR, SOFA, and qSOFA were calculated. All patients received intravenous antimicrobials within 90 min and underwent surgical debridement within 6 h. In-hospital mortality was assessed via ROC curves, Fisher’s exact test, Haldane–Anscombe odds ratios (ORs), and Firth penalized logistic regression. Results: In-hospital mortality was 19.0% (4/21). Admission Sepsis-3 sepsis (SOFA ≥ 2) was present in 7/21 patients (33.3%) and accounted for all four deaths, whereas zero deaths occurred among the 14 patients without organ dysfunction (Fisher’s exact p = 0.006; OR 37.33, 95% CI 1.60–866.90). All nine qSOFA-positive patients without SOFA dysfunction (42.9%) and five patients without organ dysfunction (23.8%) survived. FGSI showed the highest discrimination (AUC 0.934, 95% CI 0.76–1.00), followed by SFGSI (AUC 0.919, 95% CI 0.78–1.00) and LRINEC (AUC 0.860, 95% CI 0.68–0.99); NLR showed poor discrimination (AUC 0.574, 95% CI 0.13–1.00). Metastatic solid malignancy was present in 2/4 non-survivors versus 0/17 survivors (Fisher’s exact p = 0.029; OR 35.00, 95% CI 1.27–961.40). All four non-survivors met Sepsis-3 criteria (two with and two without metastases). Seven patients required ICU admission (all four non-survivors and three survivors). Conclusions: Admission Sepsis-3-defined organ dysfunction was strongly associated with in-hospital mortality. FGSI and SFGSI demonstrated the highest point-estimate discrimination, LRINEC also showed good discrimination, and NLR demonstrated limited standalone discriminative value. Metastatic malignancy occurred exclusively among non-survivors but overlapped with Sepsis-3-defined sepsis. These findings support the combined assessment of Sepsis-3-defined organ dysfunction and established severity scores for early risk stratification, warranting validation in larger cohorts.