Marios Fiolitakis

Urologist

[Marios Fiolitakis @DrFiolitakis]

@Mohamedendourol @sbinhamrii @fgomsan @FCAFigueiredo @Urologeman @KarinLehrich @amy_krambeck @ZoltanKissDr @scoffonecesare @Dmitry_Enikeev @trwherrmann @lfredosanchez @JnsHerrmann My Chief did a urethroscopy and describes no pathological findings.. pelvic MRI also with no pathological findings ..we offered tetrazepam but he refused

[Marios Fiolitakis @DrFiolitakis]

Anyone ever had a patient with pelvic pain and urethra pain after HoLEP?
Cystoscopy and pelvic MRI shows no pathological signs! Patient describes no connection between pain and voiding!
Postoperative UTI was treated but no improvement, Painkillers did not help!
Any ideas!

[Marios Fiolitakis @DrFiolitakis]

@Mohamedendourol @sbinhamrii @fgomsan @FCAFigueiredo @Urologeman @KarinLehrich @amy_krambeck @ZoltanKissDr @scoffonecesare @Dmitry_Enikeev @trwherrmann @lfredosanchez @JnsHerrmann Since then he complains about pains with no connection to voiding

[Marios Fiolitakis @DrFiolitakis]

@Mohamedendourol @sbinhamrii @fgomsan @FCAFigueiredo @Urologeman @KarinLehrich @amy_krambeck @ZoltanKissDr @scoffonecesare @Dmitry_Enikeev @trwherrmann @lfredosanchez @JnsHerrmann No intraoperativ complications.. everything went according to the plan .. went home with no problems.
After around 3 weeks started with pain and pollakisuria.. got an infection with staphylococcus haemolyticus which was treated succesfully

[Marios Fiolitakis @DrFiolitakis]

@Mohamedendourol @sbinhamrii @fgomsan @FCAFigueiredo @Urologeman @KarinLehrich @amy_krambeck @ZoltanKissDr @scoffonecesare @Dmitry_Enikeev @trwherrmann @lfredosanchez @JnsHerrmann 2 months ago

[Marios Fiolitakis @DrFiolitakis]

@sbinhamrii @fgomsan @FCAFigueiredo @Urologeman @KarinLehrich @amy_krambeck @ZoltanKissDr @scoffonecesare @Dmitry_Enikeev @Mohamedendourol @trwherrmann @lfredosanchez @JnsHerrmann So we start to believe that much of what he describes is psychogenic !

[Marios Fiolitakis @DrFiolitakis]

@sbinhamrii @fgomsan @FCAFigueiredo @Urologeman @KarinLehrich @amy_krambeck @ZoltanKissDr @scoffonecesare @Dmitry_Enikeev @Mohamedendourol @trwherrmann @lfredosanchez @JnsHerrmann Urethrocystoscopy showed everything is ok.
I cannot actually say that he is really having the pain he describes .. or at least not at the moment he is in the hospital. He refuses any medication we suggest cause he fears it will kill him!

[Marios Fiolitakis @DrFiolitakis]

@ZoltanKissDr @GoumasUrologia @mzawadzk1 @oangerri @uropatrick @vdconinck @StefaniaFerret @kpetik1 @OJWiseman Happy new year Zoltán.. nice and interesting case! Maybe first ultrasound in both positions to check in which one and if you get a intestine free window for the puncture

[Marios Fiolitakis @DrFiolitakis]

@Mohamedendourol @Tariqaaminia @alshinqeti @adeelanwaar3 @sajjadtmg1 @dr_avreen @ZubeirBare @drbabakri @Shamimullah101 @MElmousili @mohamme17537511 @Yasseruro @abdullahdbk @TheGeorgeHabib @dr_hhq @ryanmauckmd 1) How to save bladder neck?

[Marios Fiolitakis @DrFiolitakis]

@Mohamedendourol @Tariqaaminia @alshinqeti @adeelanwaar3 @sajjadtmg1 @dr_avreen @ZubeirBare @drbabakri @Shamimullah101 @MElmousili @mohamme17537511 @Yasseruro @abdullahdbk @TheGeorgeHabib @dr_hhq @ryanmauckmd I’ ve changed to 3 or 2 lobe enucl. and I don’t keep the scope only at 6 or 12, but i rotate it in order to try to reduce the deflection,it seems that is working better with the SUI
But I also believe that the Age, pre-OP status influence that a lot and also the operating time

[Marios Fiolitakis @DrFiolitakis]

@Mohamedendourol @abdullahdbk @Tariqaaminia @alshinqeti @adeelanwaar3 @sajjadtmg1 @dr_avreen @ZubeirBare @drbabakri @Shamimullah101 @MElmousili @mohamme17537511 @Yasseruro @TheGeorgeHabib @dr_hhq @ryanmauckmd How should we avoid the deflection specially in large size prostate with more than 100gr morcellation‘s weight?
Specially in en block enuclation !

[Marios Fiolitakis @DrFiolitakis]

@GoumasUrologia @fgomsan @FCAFigueiredo @ZoltanKissDr @amy_krambeck I checked it and it was connected properly. What I did not checked was if both irrigation bags were open at the Y connection to the inflow, but next time I’ll have to check everything alone before I start the OP
I hope it s not the scope, it s brand new 🤦🏼‍♂️

[Marios Fiolitakis @DrFiolitakis]

First Holep in the new hospital, new OP Team with no experience. I faced a huge problem with the camera view (almost looked like a desert storm) every time I was using the laser to enucleate specially close to the Sphinkter.

[Marios Fiolitakis @DrFiolitakis]

@fgomsan Thank you Fernando .. I will definitely do it if I face the same problem again

[Marios Fiolitakis @DrFiolitakis]

So any ideas or suggestions what the problem could be ???
@fgomsan @FCAFigueiredo @GoumasUrologia @ZoltanKissDr @amy_krambeck

[Marios Fiolitakis @DrFiolitakis]

I lowed the energy and tried different settings but nothing really happened .. the only thing that helped a little bit was pressing manually the inflow bag. Things got better after I managed to enucleate 2 of the 3 lobes.

[Marios Fiolitakis @DrFiolitakis]

@fgomsan @a_andreou75 @AthensMedical Ok 😉