Despite the constant technological advances achieved during the past decades, large size benign prostatic hyperplasia (BPH) pathology continues to raise questions concerning the most appropriate therapeutic approach. Interestingly enough, the classical open prostatectomy still represents the standard option for this type of cases despite the substantial perioperative morbidity [1]. [...]

Genital prolapse is a frequent pathology in women associated with different urological and gynecological complications affecting women `s normal life [1]. It is defined as pelvic organ slipped from their anatomical position through vagina. The pelvic structures which might slip are uterus, bladder, rectum, small intestine or vaginal vault. Each one of these benefits of a specific surgical procedure [1].

Benign prostatic hyperplasia (BPH) is one of the most common pathologies in aging men, associated with lower urinary tract symptoms (LUTS). This pathology has a multimodal approach depending on different factors like age, prostate size, prostate-specific antigen level, and severity of the symptoms [1]. Medical treatment is the first option in what patients with low or moderate LUTS are concerned. There are two major drug classes already established in all international treatment guidelines, 5 alpha-reductase inhibitors and alpha-blockers. 5 alpha-reductase inhibitors block the transformation of testosterone in dihydrotestosterone within the prostate, leading to the decrease of prostate volume, increased peak urinary flow rate, improvement of symptoms, decreasing the risk of acute urinary retention. Their main secondary effects are the erectile dysfunction, the decreasing of libido and of the ejaculate volume, and also gynecomastia [2]. Alpha-blockers act on alpha-adrenoceptor sites found particularly at the bladder neck, at the trigone and within the prostate. They have a fast action on the prostate gland, leading quickly to symptom relief, but without reducing the risk of acute retention or surgical treatment. As secondary effects, alpha-blockers can affect blood pressure [3-5].

Over the past few years, the conventional transurethral resection of bladder tumors (TURBT) has undergone increasing criticism among the international urological community due to its’ inability to achieve a complete tumor ablation [1]. This substantial oncologic drawback has been mainly related to the limited sensitivity of the classical white light cystoscopy (WLC) [2]. In other words, the standard endoscopic assessment of the bladder was often outlined as insufficiently capable of accurately identifying all of the existing tumor formations [3].

Digestive manifestations due to uremia and uremic toxins are multiple in patients with chronic kidney disease (CKD) on hemodialysis (HD). As much as 79 percent of these patients report gastrointestinal symptoms manifested as nausea, vomiting, dry mouth, dysgeusia, halitosis, pyrosis, abdominal pain, bloating, diarrhea (1,2). Due to many pathogenic mechanisms, the prevalence of gastro-duodenal peptic ulcer disease is higher in HD subjects than in general population, but comparable in frequency with nondialyzed CKD patients (3-5). A recent published 10 years-study presented that the incidence of peptic ulcer disease is 4 times higher in patients with CKD and 9.4 times higher in individuals on chronic HD compared to the general population (6). Regarding localization, gastric ulcers are twice more frequent documented than duodenal ulcers (6-8). An imbalance between protective and aggressive mucosal factors in favor of the last ones is noticed in HD patients. Chronic dialysis stress, intradialysis hypotension (causing mucosal hypo-perfusion), anemia, intra-dialysis anticoagulant, metabolic acidosis, potentially ulcerogenic medication (steroids, non-steroid anti-inflammatory and antiplatelet drugs) lead to high frequencies of peptic ulcer disease (9). Since the appearance of ulcerous lesions, the risk of their complications (e.g.: hemorrhages, perforations, penetrating injuries) is much higher than in general population. One recent cohort study in Taiwan showed that the incidence of gastro-duodenal bleedings is double in CKD patients and 5 times higher in HD ones (2). Subsequently, common comorbidities such as diabetes, liver cirrhosis and ischemic heart disease participate as pathogens in digestive bleedings (10).
An adequate diagnosis and monitoring of peptic ulcer disease in dialysis patients represent a constant concern of our clinical practice, because of the high prevalence of this kind of pathology, the life-threatening potential complications and the complexity of the treatment. Therefore, further on we discuss the case of an atypical peptic ulcer disease in a chronic HD patient.

Lentigo maligna (LM) is a type of melanocytic proliferation, the term being used by clinicians and pathologists for melanoma in situ on chronically sun damaged skin (1) in case that the lesion is confined to the epidermis. The pathology in question is classified as lentigo maligna melanoma (LMM) when it invades the dermis (2), over a protracted period of time (3). They both represent a subtype of malignant melanocytic proliferation according to the World Health Organization criteria (4). Once the dermis is invaded, the prognosis of the lesion is similar to that specific for other types of melanoma (5). Most LM patients display a slowly enlarging pigmented macula or patch which tends to occur in middle aged and older individuals (6), with a slight female preponderance (2).
The preferred method for diagnosing LM is excision (7), secondary to dermatoscopy (8) and biopsy (9). Distinguishing LM from a background of increased melanocytes on chronically sun damaged skin in a small biopsy specimen remains one of the most serious diagnostic challenges for dermatopathologists (10). Histology shows proliferation of atypical melanocytes at the epidermal-dermal junction in small nests or single cells (11).

Bladder cancer represents the most common malignancy of the urinary tract and the 7th most frequent cancer in men and 17th in women. The prevalence of this malignancy varies between regions and countries. In Europe for example, the highest age-standardized incidence rate has been reported in Spain and the lowest in Finland (1). In the United States, the incidence and mortality due to bladder cancer is also high (more than 60,000 new cases and up to 13,000 deaths annually) (2). Therefore, in the last decades, it has been noticed an increased prevalence of bladder cancer, probably caused by tobacco abuse, industrial carcinogens risk factors and overall aging process of the population (3). 75-85% of all newly diagnosed bladder tumors is represented by non-muscle-invasive bladder cancer (NMIBC), a multifocal disease, that includes stages pTa, pT1 and carcinoma in situ (CIS) (4). Furthermore, this pathology has a high recurrence rate within the first 5 years after the initial diagnosis (5), despite the recent technological advances (6).