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Papers by Evangelos Zacharakis

Trends in Urology & Men's Health

Scandinavian journal of urology, Jan 26, 2017

The aim of this study was to report surgical and functional outcomes in patients who underwent im... more The aim of this study was to report surgical and functional outcomes in patients who underwent immediate penile fracture repair following location of the tunical tear with ultrasonography. Patients' clinical notes from September 2005 to October 2015 were reviewed. The inclusion criteria were the documented presence of an albugineal laceration at the preoperative ultrasonography and during surgical exploration. In total, 76 patients were enrolled in the study. The aetiology, presentation, imaging results, intraoperative findings, functional outcomes and complications of surgical repair were retrospectively extrapolated from the clinical notes. Patients were questioned about their erectile and urinary function 12 months after the traumatic event. Validated questionnaires were administered to enquire about sexual and urinary function. Finally, the accuracy of the ultrasound in detecting the site of the tunical defect was evaluated. The mean age was 39.5 years (range 21-72 years) an...

Journal of surgical case reports, Jan 24, 2016

Papillary cystadenomas of the epididymis are known to occur in association with Von Hippel-Lindau... more Papillary cystadenomas of the epididymis are known to occur in association with Von Hippel-Lindau (VHL) disease. The development of a papillary cystadenocarcinoma, its malignant counterpart, is rare with only a few sporadic cases reported in the literature. Metastatic deposits are exceedingly uncommon; in fact, only a single case report has documented metastases to the paraureteral region, but metastases to the testis have never been reported. A 43-year-old gentleman with VHL disease presented with non-obstructive azoospermia, a right epididymal mass, and an atrophic surgically corrected undescended left testis. The epididymal mass was reported as a papillary cystadenocarcinoma on biopsy. The patient was managed with a radical inguinal orchidectomy and bench microTeSE with successful sperm retrieval. Metastatic papillary cystadenocarcinoma of the epididymis to the testis has never been previously reported. This case was managed by radical orchidectomy and subsequent onco-microTeSE, ...

Prosthetic Surgery in Urology, 2016

Southern Medical Journal, Feb 1, 2008

We report an unusual case of a patient with strangulated Meckel diverticulum in a femoral hernia.... more We report an unusual case of a patient with strangulated Meckel diverticulum in a femoral hernia. A 65-year-old woman presented with a nonradiating, constant pain in the right groin with associated nausea and anorexia. Physical examination revealed a tender, irreducible lump in the right groin area. At operation, a hernia sac containing a strangulated Meckel diverticulum was clearly recognized going through the femoral ring. A diverticulectomy was performed, and the femoral ring was closed with a polypropylene plug. No recurrence has been observed during the 3 year follow-up. Strangulated Meckel diverticulum in a femoral hernia remains a challenging diagnosis due to its extremely rare occurrence. Surgical exploration provides definite diagnosis of this rare condition.

European Urology Supplements, 2010

European Urology Supplements, 2010

European Urology Supplements, 2011

European Urology Supplements, 2011

Scandinavian journal of urology, Jan 26, 2015

Early insertion of a penile prosthesis in prolonged ischaemic priapism is easier to perform than ... more Early insertion of a penile prosthesis in prolonged ischaemic priapism is easier to perform than late prosthesis placement, and preserves the penile length. The aim of this study was to assess whether a delayed exchange to an inflatable implant allows upsizing of the cylinders in patients who have undergone early insertion for refractory ischaemic priapism. Over a 30 month period, 10 patients with ischaemic priapism underwent an early insertion of a malleable penile prosthesis. The mean age was 41.3 years and the mean duration of priapism was 188 h. Following a median period of 130.5 days, all of these patients underwent exchange of the malleable to an inflatable prosthesis. At the time of penile implant exchange, a median upsize in the length of the cylinders of 1 cm in either one or both corporal bodies (range 0-3 cm) was recorded. Five patients had deliberate downsizing at the initial operation owing to a previous shunt. The mean score on the five-item International Index of Erec...

BJU international, 2015

To describe the a robotic assisted intracorporeal Pyramid neo-bladder (NB) reconstruction techniq... more To describe the a robotic assisted intracorporeal Pyramid neo-bladder (NB) reconstruction technique and report operative and peri-operative metrics, post-operative upper tract imaging, neo-bladder functional outcomes and oncological outcomes. A total of 19 male and 1 female patients with a mean age 57.2±12.4 years (range: 31.0-78.2 years) underwent robotic assisted radical cystectomy (RARC). Most cases were ≤pT1 (n=17), while the remaining three patients had muscle invasive bladder cancer (MIBC) at RARC histopathology although 50% (n=10) actually had MIBC at transurethral resection histopathology. All patients underwent RARC, bilateral pelvic lymphadenectomy and intracorporeal NB formation using a pyramid detubularised folding pouch configuration. Median estimated blood loss was 250 ml and median operating time was 5.5 hours. The mean number of lymph nodes removed was 16.5±7.8 and median hospital stay was 10 days. Early postoperative complications include urinary tract infection (UT...

European Urology Supplements, 2011

European Urology Supplements, 2011

Techniques in coloproctology, 2007

Medical science monitor : international medical journal of experimental and clinical research, 2006

Spigelian hernia is a rare partial abdominal wall defect in the transversus abdominus aponeurosis... more Spigelian hernia is a rare partial abdominal wall defect in the transversus abdominus aponeurosis or Spigelian fascia. We here report the case of a patient with incarcerated greater omentum in a Spigelian hernia. The patient presented with a six-hour history of nausea, constant abdominal pain, and a palpable mass in the left lower quadrant. Abdominal computed tomography revealed that omentum was strangulated in a Spigelian hernia that was successfully treated by plug and mesh repair. No recurrence has been observed during three-year follow-up. In our case, plug and mesh repair was a safe and effective method of repairing an incarcerated Spigelian hernia with durability through three years of follow-up.

World journal of surgical oncology, Jan 25, 2005

Metastases from hepatocellular carcinoma (HCC) can be found in the lung and adrenal gland. We rep... more Metastases from hepatocellular carcinoma (HCC) can be found in the lung and adrenal gland. We report case of a patient who presented with adrenal metastasis as the first clinical manifestation of HCC. A patient was referred for surgical treatment for a tumor in retro-peritoneal space. The computerized tomography (CT) scan revealed a mass originating from the left adrenal gland. The patient underwent left adrenalectomy and the exploration of abdominal cavity did not reveal any other palpable lesions. Histologically, the resected lesion was a poorly differentiated metastatic tumor from HCC. Seven months later patient was readmitted complaining of cachexia, icterus, and significant weight loss. CT scan revealed hyperdense lesions of the liver. HCC may have atypical presentations like in present case. Fine needle aspiration/tru-cut biopsy might be useful in the investigation of an accidentally discovered adrenal mass regardless of the size and can lead to the detection of a primary tumor.

International seminars in surgical oncology : ISSO, Jan 30, 2005

The aim of this study is to report the outcome after surgical treatment of 32 patients with ampul... more The aim of this study is to report the outcome after surgical treatment of 32 patients with ampullary cancers from 1990 to 1999. Twenty-one of them underwent pancreaticoduodenectomy and 9 local excision of the ampullary lesion. The remaining 2 patients underwent palliative surgery. When the final histological diagnosis was compared with the preoperative histological finding on biopsy, accurate diagnosis was preoperatively established in 24 patients. The hospital morbidity was 18.8% as 9 complications occurred in 6 patients. Following local excision of the ampullary cancer, the survival rate at 3 and 5 years was 77.7% and 33.3% respectively. Among the patients that underwent Whipple's procedure, the 3-year survival rate was 76.2% and the 5-year survival rate 62%. In this series, local resection was a safe option in patients with significant co-morbidity or small ampullary tumors less than 2 cm in size, and was associated with satisfactory long-term survival rates.

European Urology Supplements, 2010

Trends in Urology & Men's Health

Scandinavian journal of urology, Jan 26, 2017

The aim of this study was to report surgical and functional outcomes in patients who underwent im... more The aim of this study was to report surgical and functional outcomes in patients who underwent immediate penile fracture repair following location of the tunical tear with ultrasonography. Patients' clinical notes from September 2005 to October 2015 were reviewed. The inclusion criteria were the documented presence of an albugineal laceration at the preoperative ultrasonography and during surgical exploration. In total, 76 patients were enrolled in the study. The aetiology, presentation, imaging results, intraoperative findings, functional outcomes and complications of surgical repair were retrospectively extrapolated from the clinical notes. Patients were questioned about their erectile and urinary function 12 months after the traumatic event. Validated questionnaires were administered to enquire about sexual and urinary function. Finally, the accuracy of the ultrasound in detecting the site of the tunical defect was evaluated. The mean age was 39.5 years (range 21-72 years) an...

Journal of surgical case reports, Jan 24, 2016

Papillary cystadenomas of the epididymis are known to occur in association with Von Hippel-Lindau... more Papillary cystadenomas of the epididymis are known to occur in association with Von Hippel-Lindau (VHL) disease. The development of a papillary cystadenocarcinoma, its malignant counterpart, is rare with only a few sporadic cases reported in the literature. Metastatic deposits are exceedingly uncommon; in fact, only a single case report has documented metastases to the paraureteral region, but metastases to the testis have never been reported. A 43-year-old gentleman with VHL disease presented with non-obstructive azoospermia, a right epididymal mass, and an atrophic surgically corrected undescended left testis. The epididymal mass was reported as a papillary cystadenocarcinoma on biopsy. The patient was managed with a radical inguinal orchidectomy and bench microTeSE with successful sperm retrieval. Metastatic papillary cystadenocarcinoma of the epididymis to the testis has never been previously reported. This case was managed by radical orchidectomy and subsequent onco-microTeSE, ...

Prosthetic Surgery in Urology, 2016

Southern Medical Journal, Feb 1, 2008

We report an unusual case of a patient with strangulated Meckel diverticulum in a femoral hernia.... more We report an unusual case of a patient with strangulated Meckel diverticulum in a femoral hernia. A 65-year-old woman presented with a nonradiating, constant pain in the right groin with associated nausea and anorexia. Physical examination revealed a tender, irreducible lump in the right groin area. At operation, a hernia sac containing a strangulated Meckel diverticulum was clearly recognized going through the femoral ring. A diverticulectomy was performed, and the femoral ring was closed with a polypropylene plug. No recurrence has been observed during the 3 year follow-up. Strangulated Meckel diverticulum in a femoral hernia remains a challenging diagnosis due to its extremely rare occurrence. Surgical exploration provides definite diagnosis of this rare condition.

European Urology Supplements, 2010

European Urology Supplements, 2010

European Urology Supplements, 2011

European Urology Supplements, 2011

Scandinavian journal of urology, Jan 26, 2015

Early insertion of a penile prosthesis in prolonged ischaemic priapism is easier to perform than ... more Early insertion of a penile prosthesis in prolonged ischaemic priapism is easier to perform than late prosthesis placement, and preserves the penile length. The aim of this study was to assess whether a delayed exchange to an inflatable implant allows upsizing of the cylinders in patients who have undergone early insertion for refractory ischaemic priapism. Over a 30 month period, 10 patients with ischaemic priapism underwent an early insertion of a malleable penile prosthesis. The mean age was 41.3 years and the mean duration of priapism was 188 h. Following a median period of 130.5 days, all of these patients underwent exchange of the malleable to an inflatable prosthesis. At the time of penile implant exchange, a median upsize in the length of the cylinders of 1 cm in either one or both corporal bodies (range 0-3 cm) was recorded. Five patients had deliberate downsizing at the initial operation owing to a previous shunt. The mean score on the five-item International Index of Erec...

BJU international, 2015

To describe the a robotic assisted intracorporeal Pyramid neo-bladder (NB) reconstruction techniq... more To describe the a robotic assisted intracorporeal Pyramid neo-bladder (NB) reconstruction technique and report operative and peri-operative metrics, post-operative upper tract imaging, neo-bladder functional outcomes and oncological outcomes. A total of 19 male and 1 female patients with a mean age 57.2±12.4 years (range: 31.0-78.2 years) underwent robotic assisted radical cystectomy (RARC). Most cases were ≤pT1 (n=17), while the remaining three patients had muscle invasive bladder cancer (MIBC) at RARC histopathology although 50% (n=10) actually had MIBC at transurethral resection histopathology. All patients underwent RARC, bilateral pelvic lymphadenectomy and intracorporeal NB formation using a pyramid detubularised folding pouch configuration. Median estimated blood loss was 250 ml and median operating time was 5.5 hours. The mean number of lymph nodes removed was 16.5±7.8 and median hospital stay was 10 days. Early postoperative complications include urinary tract infection (UT...

European Urology Supplements, 2011

European Urology Supplements, 2011

Techniques in coloproctology, 2007

Medical science monitor : international medical journal of experimental and clinical research, 2006

Spigelian hernia is a rare partial abdominal wall defect in the transversus abdominus aponeurosis... more Spigelian hernia is a rare partial abdominal wall defect in the transversus abdominus aponeurosis or Spigelian fascia. We here report the case of a patient with incarcerated greater omentum in a Spigelian hernia. The patient presented with a six-hour history of nausea, constant abdominal pain, and a palpable mass in the left lower quadrant. Abdominal computed tomography revealed that omentum was strangulated in a Spigelian hernia that was successfully treated by plug and mesh repair. No recurrence has been observed during three-year follow-up. In our case, plug and mesh repair was a safe and effective method of repairing an incarcerated Spigelian hernia with durability through three years of follow-up.

World journal of surgical oncology, Jan 25, 2005

Metastases from hepatocellular carcinoma (HCC) can be found in the lung and adrenal gland. We rep... more Metastases from hepatocellular carcinoma (HCC) can be found in the lung and adrenal gland. We report case of a patient who presented with adrenal metastasis as the first clinical manifestation of HCC. A patient was referred for surgical treatment for a tumor in retro-peritoneal space. The computerized tomography (CT) scan revealed a mass originating from the left adrenal gland. The patient underwent left adrenalectomy and the exploration of abdominal cavity did not reveal any other palpable lesions. Histologically, the resected lesion was a poorly differentiated metastatic tumor from HCC. Seven months later patient was readmitted complaining of cachexia, icterus, and significant weight loss. CT scan revealed hyperdense lesions of the liver. HCC may have atypical presentations like in present case. Fine needle aspiration/tru-cut biopsy might be useful in the investigation of an accidentally discovered adrenal mass regardless of the size and can lead to the detection of a primary tumor.

International seminars in surgical oncology : ISSO, Jan 30, 2005

The aim of this study is to report the outcome after surgical treatment of 32 patients with ampul... more The aim of this study is to report the outcome after surgical treatment of 32 patients with ampullary cancers from 1990 to 1999. Twenty-one of them underwent pancreaticoduodenectomy and 9 local excision of the ampullary lesion. The remaining 2 patients underwent palliative surgery. When the final histological diagnosis was compared with the preoperative histological finding on biopsy, accurate diagnosis was preoperatively established in 24 patients. The hospital morbidity was 18.8% as 9 complications occurred in 6 patients. Following local excision of the ampullary cancer, the survival rate at 3 and 5 years was 77.7% and 33.3% respectively. Among the patients that underwent Whipple's procedure, the 3-year survival rate was 76.2% and the 5-year survival rate 62%. In this series, local resection was a safe option in patients with significant co-morbidity or small ampullary tumors less than 2 cm in size, and was associated with satisfactory long-term survival rates.

European Urology Supplements, 2010