Posts made in March, 2017

Does index tumor predominant location influence prognostic factors in radical prostatectomies?

Vol. 43 (x): 2017 March 3.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2016.0335


ORIGINAL ARTICLE

Athanase Billis 1, Leandro L. L. Freitas 1, Larissa B. E. Costa 1, Camila M. de Angelis 1, Kelson R. Carvalho 1, Luis A. Magna 2, Ubirajara Ferreira 3
1 Departamento de Patologia, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil; 2 Departamento de Genética Médica/Bioestatística, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil; 3 Departamento Urologia, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil

ABSTRACT

Purpose: To find any influence on prognostic factors of index tumor according to predominant location.

Materials and Methods: Prostate surgical specimens from 499 patients submitted to radical retropubic prostatectomy were step-sectioned. Each transverse section was sub­divided into 2 anterolateral and 2 posterolateral quadrants. Tumor extent was evalu­ated by a semi-quantitative point-count method. The index tumor (dominant nodule) was recorded as the maximal number of positive points of the most extensive tumor area from the quadrants and the predominant location was considered anterior (antero­lateral quadrants), posterior (posterolateral quadrants), basal (quadrants in upper half of the prostate), apical (quadrants in lower half of the prostate), left (left quadrants) or right (right quadrants). Time to biochemical recurrence was analyzed by Kaplan-Meier product-limit analysis and prediction of shorter time to biochemical recurrence using univariate and multivariate Cox proportional hazards model.

Results: Index tumors with predominant posterior...

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Ten cases with 46,XX testicular disorder of sex development: single center experience

Vol. 43 (x): 2017 March 3.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2016.0505


CHALLENGING CLINICAL CASES

Akinsal, Emre Can 1, Baydilli, Numan 1, Demirtas, Abdullah 1, Saatci, Cetin 2, Ekmekcioglu, Oguz 1
1 Department of Urology, Erciyes University Medical Faculty, Kayseri, Turkey; 2 Department of Genetics, Erciyes University Medical Faculty Medical, Kayseri, Turkey

 

ABSTRACT

Objective: To present clinical, chromosomal and hormonal features of ten cases with SRY-positive 46,XX testicular disorder of sex development who were admitted to our infertility clinic.

Cases and Methods: Records of the cases who were admitted to our infertility clinic between 2004 and 2015 were investigated. Ten 46,XX testicular disorder of sex development cases were detected. Clinical, hormonal and chromosomal assessments were analized.

Results: Mean age at diagnosis was 30.4, mean body height was 166.9cm. Hormonal data indicated that the patients had a higher FSH, LH levels, lower TT level and normal E2, PRL levels. Karyotype analysis of all patients confirmed 46,XX karyotype, and FISH analysis showed that SRY gene was positive and translocated to Xp. The AZFa, AZFb and AZFc regions were absent in 8 cases. In one case AZFb and AZFc incomplete deletion and normal AZFa region was present. In the other one all AZF regions were present.

Conclusion: Gonadal development disorders such as SRY-positive 46,XX testicular disorder of sex development can be diagnosed in infertility clinics during infertility workup. Although these cases had no chance of bearing a child, they should be protected from negative effects of testosterone deficiency by replacement therapies.

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A case of retroperitoneal fibrosis responding to steroid therapy

Vol. 43 (x): 2017 March 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2016.0520


CHALLENGING CLINICAL CASES

Ryuta Watanabe 1, Akira Ozawa 1, Tokuhiro Iseda 1
1 Department of Urology, Matsuyama Shimin Hospital, Ehime, Japan

ABSTRACT

A 69-year-old man presented at the hospital with complaints of prolonged stomach pain extending from the week prior. Enhanced computed tomography (CT) revealed a low density area in the retroperitoneal space. A radiologist diagnosed the patient with retroperitoneal fibrosis. One week later, an enhanced CT revealed an exponential increase of the low density area and slight right hydronephrosis. Upon admission, prednisolone administration was initiated at a dose of 40mg/day. The size of the retroperitoneal soft tissue mass decreased gradually. Although the dose of prednisolone was tapered to 5mg, the patient is doing well without any sign of recurrence.

Keywords: Retroperitoneal Fibrosis; Therapeutics; Steroids

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Towards development and validation of an intraoperative assessment tool for robot-assisted radical prostatectomy training: results of a Delphi study

Vol. 43 (x): 2017 March 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2016.0420


ORIGINAL ARTICLE

Christopher Morris 1, Jen Hoogenes 1, Bobby Shayegan 1, Edward D. Matsumoto 1
1 Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada

ABSTRACT

Introduction: As urology training shifts toward competency-based frameworks, the need for tools for high stakes assessment of trainees is crucial. Validated assessment metrics are lacking for many robot-assisted radical prostatectomy (RARP). As it is quickly becoming the gold standard for treatment of localized prostate cancer, the development and validation of a RARP assessment tool for training is timely.

Materials and methods: We recruited 13 expert RARP surgeons from the United States and Canada to serve as our Delphi panel. Using an initial inventory developed via a modified Delphi process with urology residents, fellows, and staff at our institution, panelists iteratively rated each step and sub-step on a 5-point Likert scale of agreement for inclusion in the final assessment tool. Qualitative feedback was elicited for each item to determine proper step placement, wording, and suggestions.

Results: Panelist’s responses were compiled and the inventory was edited through three iterations, after which 100% consensus was achieved. The initial inventory steps were decreased by 13% and a skip pattern was incorporated. The final RARP stepwise in­ventory was comprised of 13 critical steps with 52 sub-steps. There was no attrition throughout the Delphi process.

Conclusions: Our Delphi study resulted in a comprehensive inventory of intraoperative RARP steps with excellent consensus. This final inventory will be used to develop a...

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Laparoscopic donor nephrectomy in unusual venous anatomy – donor and recepient implications

Vol. 43 (x): 2017 February 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2016.0309


ORIGINAL ARTICLE

Avinash Bapusaheb Patil 1,Tarun Dilip Javali 1,Harohalli K. Nagaraj 1, S. M. L. Prakash Babu 1, Arvind Nayak 1
1 Department of Urology, M.S. Ramaiah Hospital, Bangalore

ABSTRACT

Objectives: Laparoscopic donor nephrectomy is now a commonly performed procedure in most of renal transplantation centers. However, the suitability of laparoscopy for donors with abnormal venous anatomy is still a subject of debate.

Materials and methods: Between August 2007 and August 2014, 243 laparoscopic donor nephrectomies were performed in our institution. All donors were evaluated with preoperative three-dimensional spiral computed tomography (CT) angiography Thirteen (5.35%) donors had a left renal vein anomaly. A retrospective analysis was performed to collect donor and recipient demographics and perioperative data.

Results: Four donors had a type I retroaortic vein, seven had type II retroaortic vein and a circumaortic vein was seen in three donors. The mean operative time was 114±11 minutes and mean warm ischemia time was 202±12 seconds. The mean blood loss was 52.7±18.4mL and no donor required blood transfusion. Mean recipient creatinine at the time of discharge was 1.15±0.18mg/dL, and creatinine at six months and one year follow-up was 1.12±0.13mg/dL and 1.2±0.14mg/dL, respectively. There were no significant differences in operative time, blood loss, warm ischemia time, donor hospital stay or recipient creatinine at 6 months follow-up, following laparoscopic donor nephrectomy in patients with or without left renal vein anomalies.

Conclusion: Preoperative delineation of venous anatomy using CT...

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