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Laparoscopic dismembered pyeloplasty combined with port entrance flexible renoscopic lithotripsy

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0401


VIDEO SECTION

Kaan Gokcen 1, Gokhan Gokce 1, Gokce Dundar 2, Resul Cicek 1, Halil Gulbahar 1, Emin Yener Gultekin 1
1 Department of Urology, Cumhuriyet University Faculty of Medine, Sivas, Turkey; 2 Department of Urology, Cizre State Hospital, Cizre, Turkey

ABSTRACT

 

Introduction: Ureteropelvic junction obstruction and concomitant calculus disease may coexist. We demonstrate our use of flexible renoscopy during laparoscopic pyeloplasty for caliceal stone removal.

Patient and methods: A 28-year-old female patient presented with recurrent attacks of flank pain of two years duration.

When noncontrast-CT and DTPA were performed, the patient was diagnosed with ureteropelvic junction stenosis and 3 stones with a total burden of 14mm in the lower pole of right kidney. After pneumoperitoneum was established in right flank position, three 10mm trocars were placed including one camera port. 5mm trocar was placed for convenience to retraction and dissection. The surgery was uneventful, with no operative complications or evidence of intra-abdominal bleeding.

Results: The duration of the surgery was 110 minutes. The amount of bleeding was 30ml. On the postoperative 2nd day, the urethral catheter was removed and the patient was discharged on the fourth day postoperatively. Stent removal was done on the 3rd postoperative week and retrograde pyelogram showed normal ureter. Post-operative follow-up with ultrasound showed that hydronephrosis had regressed.

Conclusıons: Laparoscopic pyeloplasty and concomitant flexible renoscopy through lowermost trocar with basket extraction is a simple, attractive alternative for the simultaneous treatment of ureteropelvic junction obstruction presenting with coexisting nephrolithiasis. This method is useful and feasible, with minimal invasiveness and an early post-operative recovery.

 

ARTICLE INFO

Available at: http://www.intbrazjurol.com.br/video-section/20170401_Gokcen_et_al

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Vaginal cuff recurrence after radical cystectomy: an under – studied site of bladder cancer relapse

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0376


ORIGINAL ARTICLE

Fabio Zattoni 1, 2, Alessandro Morlacco 1, 2, Avinash Nehra 1, Igor Frank 1, Stephen A. Boorjian 1, Prabin Thapa 3, R. Jeffrey Karnes 1
1 Department of Urology, Mayo Clinic, Rochester, Minnesota, USA; 2 Clinica Urologica, Dipartimento di scienze Chirurgiche, Oncologiche e Gastroenterologiche, Azienda Ospedaliero – Universitaria di Padova, Padova, Italy; 3 Health Sciences Research, Mayo Clinic, Rochester, MN, USA

ABSTRACT

Introduction: Vaginal cuff recurrence of tumor following radical cystectomy is a rare site of disease recurrence, however it has never been specifically studied. The aim of the study is to evaluate incidence, risk factors, and long-term oncologic outcomes of vaginal cuff recurrence in a cohort of female patients treated with radical cystectomy for invasive urothelial carcinoma of the bladder.

Materials and Methods: From 1985 to 2012, a prospectively maintained institutional bladder cancer registry was queried for vaginal cuff recurrence post radical cystectomy. Overall mortality and cancer-specific mortality were reported using the Kaplan-Meier method for patients with vaginal cuff recurrence, recurrence at another local or distant site, and those without evidence of recurrence. Comparisons were performed using the log-rank test. Cox proportional hazards regression model was performed to assess predictors of vaginal cuff recurrence.

Results: From 469 women treated with radical cystectomy for bladder cancer, 34 patients (7.3%) developed vaginal cuff recurrence, 130 patients (27.7%) had recurrence involving either a local or distant site, and 305 patients (65%) had no evidence of recurrence. The 5-year overall mortality-free survival rate was 32.4% for vaginal cuff recurrence, but 25.0% for other sites of recurrence. Cancer-specific mortality-free survival rate was 32.4% for vaginal cuff recurrence, and 30.3% for the other sites of recurrence. Multivariate Cox proportional hazards regression analysis demonstrated that the presence of tumor in posterior location at radical cystectomy (Hazard Ratio [HR], 0.353 [95% CI, 0.159-0.783]) and anterior vaginectomy, compared to no vaginectomy (HR, 2.595 [95% CI, 1.077-6.249]) were independently associated with vaginal cuff recurrence.

Conclusion: Anterior vaginectomy, despite our best attempts, is perhaps not sufficient to prevent vaginal cuff recurrence. Therefore, follow-up evaluation is essential, and further studies are necessary to address the optimal approach for initial management.

Patient Summary: Although vaginal cuff recurrence is an unusual site of recurrence, careful evaluation is needed before cystectomy and during follow-up to identify patients at risk.

Keywords: Urinary Bladder Neoplasms; Female; Neoplasm Metastasis; Recurrence

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Current trends of percutaneous nephrolithotomy in a developing country

Vol. 43 (x): 2017 December 12.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0292


ORIGINAL ARTICLE

Carlos A. Batagello 1, Fabio Carvalho Vicentini 1, Giovanni Scala Marchini 1, Fabio Cesar Miranda Torricelli 1, Miguel Srougi 1, Willian Carlos Nahas 1, Eduardo Mazzucchi 1
1 Divisão de Urologia, Grupo de Endourologia Hospital das Clínicas Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil

ABSTRACT

Introduction: To present the current practice patterns on percutaneous nephrolithotomy (PCNL) in a developing country.

Materials and Methods: a survey was offered to Brazilian urologists during the II International Endourology Symposium held in Sao Paulo, in 2015. The first seven questions were related to demographic data while the 20 remaining were directed to urologists who performed PCNL. Results: From 250 participants, 100 replied to the survey, 81% performed PCNL and 60.4% of performers had been in practice for less than 15 years. Eighty-one percent were trained in the prone position and 64% in supine. PCNL was learned during the residency in 66.7% and 2.5% had fellowship training. Prone position was the preferred decubitus for simple or complex calculi, though for obese patients there was no difference.

Younger surgeons prefer supine while older surgeons prefer prone. The access was obtained by the surgeon in all cases, 96.3% use fluoroscopy and 3.7% prefer ultrasonography. Forty-seven percent use ultrasonic lithotripters and 4.1% laser. For kidney drainage, 71.6% place a nephrostomy tube. Double J stent is left in 77%. The postoperative image method was CT for 50%. Colonic injury was reported by 25%, predominantly in the senior group without statistically difference between positions.

Conclusions: from a selected group of urologists, we observe that Brazilian urologists usually gain their own access for PCNL guided by fluoroscopy. They predominantly prefer the prone position, use fascial dilators, ultrasonic lithotripters and place a nephrostomy tube when exiting the kidney. Fellowship programs, ultrasonography, flexible nephoscopy and tubeless procedures could be encouraged.

Keywords: Calculi; Nephrostomy, Percutaneous; Epidemiology

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REPLY BY THE AUTHORS: Re: An unanswered question in pediatric urology: the post pubertal persistence of prepubertal congenital penile curvature correction by tunical plication

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0055.2


LETTER TO THE EDITOR

Unsal Ozkuvanci 1, Orhan Ziylan 1, M. Irfan Donmez 1, Omer Baris Yucel 1, Tayfun Oktar 1, Haluk Ander 1, Ismet Nane 1
1 Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey

 

No abstract available

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Re: An unanswered question in pediatric urology: the post pubertal persistence of prepubertal congenital penile curvature correction by tunical plication

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0055.1


LETTER TO THE EDITOR

Daniel Yachia 1
1 Department of Urology Hillel Yaffe Medical Center in Hadera, Affiliated to theB. Rappaport School of Medicine of the Technion  Israel Institute of Technology, Haifa, Israel
No abstract available

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Does a previous prostate biopsy-related acute bacterial prostatitis affect the results of radical prostatectomy?

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0270


ORIGINAL ARTICLE

Hakan Türk 1, Sitki Ün 2, Erkan Arslan 3, Ferruh Zorlu 4
1 Department of Urology, Kutahya, Dumlupinar University Evliya Celebi training and Research Hospital, Turkey; 2 Department of Urology, Sivas State of Hospital, Sivas, Turkey; 3 Department of Urology, Harran University Medical School, Sanliurfa, Turkey; 4 Senior Urologist, Izmir, Turkey

ABSTRACT

Objective: To The standard technique for obtaining a histologic diagnosis of prostatic carcinomas is transrectal ultrasound guided prostate biopsy. Acute prostatitis which might develop after prostate biopsy can cause periprostatic inflammation and fibrosis. In this study, we performed a retrospective review of our database to determine whether ABP history might affect the outcome of RP.

Materials and Methods: 441 RP patients who were operated in our clinic from 2002 to 2014 were included in our study group. All patients’ demographic values, PSA levels, biopsy and radical prostatectomy specimen pathology results and their perioperative/ postoperative complications were evaluated.

Results: There were 41 patients in patients with acute prostatitis following biopsy and 397 patients that did not develop acute prostatitis. Mean blood loss, transfusion rate and operation period were found to be significantly higher in ABP patients. Hospitalization period and reoperation rates were similar in both groups. However, post-op complications were significantly higher in ABP group.

Conclusion: Even though it does not affect oncological outcomes, we would like to warn the surgeons for potential complaints during surgery in ABP patients.

Keywords: Prostatitis; Prostate; Prostatectomy

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Comparison of perioperative outcomes with or without renorrhaphy during open partial nephrectomy: A propensity score-matched analysis

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2016.0581


ORIGINAL ARTICLE

Hidekazu Tachibana 1, Toshio Takagi 1, Tsunenori Kondo 1, Hideki Ishida 1, and Kazunari Tanabe 1
1 Department of Urology, Tokyo Women’s Medical University, Tokyo, Japan

ABSTRACT

Purpose: Renorrhaphy in partial nephrectomy may damage intraparenchymal vessels and compress the renal parenchyma, which may lead to the formation of renal artery pseudoaneurysms or vascularized parenchymal volume reduction. Using propensity score matching, we compared surgical outcomes following non-renorrhaphy and renorrhaphy techniques for open partial nephrectomy (OPN) for T1a renal tumors.

Materials and Methods: We retrospectively analyzed data from 159 patients with normal contralateral kidneys who underwent OPN for T1a renal tumors and pre- and postoperative enhanced computed tomography between 2012 and 2015. Patient variables were adjusted using 1:1 propensity score matching between the two Groups: renorrhaphy (inner and outer layer sutures) and non-renorrhaphy (inner layer sutures only). Postoperative complications and renal function were compared between the two groups.

Results: We matched 43 patients per Group. Operative time, estimated blood loss, cold ischemic time, and postoperative hospital stay were not significantly different between the two Groups. Urine leakage (Clavien-Dindo grade ≥3) occurred in 0 renorrhaphy cases and 2 non-renorrhaphy cases (0% versus 4.6%, P=0.49). Renal artery pseudoaneurysm (RAP) occurred in 6 renorrhaphy cases and in 0 non-renorrhaphy cases (13% versus 0%, P=0.02).

Conclusions: The non-renorrhaphy technique may result in a lower risk of RAP but a greater risk of urine leakage. This technique needs further refinement to become a standard procedure for OPN.

Keywords: Complications, non-renorrhaphy, partial nephrectomy, renal cell carcinoma, renal function

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Comparative differences between T1a/b and T1e/m as substages in T1 urothelial carcinoma of the bladder

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0424


ORIGINAL ARTICLE

Turgay Turan 1, Özgür Efiloğlu 1, Bilal Günaydin 1, Şeyma Özkanli 2, Emrah Nikerel 3, Gökhan Atiş 1, Turhan Çaşkurlu 1, Asif Yildirim 1
1 Department of Urology, Istanbul Medeniyet University, Faculty of Medicine, Istanbul, Turkey; 2 Istanbul Medeniyet University, Faculty of Medicine, Department of Pathology, Istanbul, Turkey; 3 Yeditepe Universitesi, Genetics and Bioengineering Istanbul, Turkey

ABSTRACT

Objective: To evaluate the prognostic value of the depth of lamina propria invasion in patients with T1 bladder cancer and to display comparative differences between the T1a/b and T1e/m substaging systems.

Patients and Methods: This study included 106 patients with primary stage T1 urothelial bladder tumours who underwent surgery between January 2009 and December 2014. Pathologic specimens were re-evaluated to confirm the diagnosis of T1 and substaging by the same pathologist using two systems: T1a and T1b, and T1m and T1e. Age, tumour size, multiplicity, associated carcinoma in situ, tumour grade, and T1 substaging system were investigated to detect the relation between disease progression and recurrence.

Results: The recurrence rate was 52% for T1a (n=42) vs. 76% for T1b (n=20) (p=0.028) and 55% for T1m (n=32) vs. 62% for T1e (n=30), respectively (p=0.446). There was no significant difference between the substaging groups for disease progression: T1a (n=12, 15%) vs. T1b (n=7, 27%), and T1m (n=8, 13.8%) vs. T1e (n=11, 23%) (p>0.05).

In the multivariate analysis, tumour size >3 cm (p=0.008), multiplicity (p=0.049), and substaging T1b (p=0.043) were independent predictive factors for tumour recurrence.

According to the Kaplan-Meier actuarial method, recurrence-free survival was significantly different in patients with pT1a tumours compared with those with pT1b tumours (p=0.033).

Conclusions: Substaging T1 provides a prediction of disease recurrence. Regarding recurrence, T1a/b substaging can provide better knowledge of disease behaviour because it is predicted as more superior than T1 m/e, and it can help in determining the requirement for early cystectomy.

Keywords: Carcinoma; Urinary Bladder; Urinary Bladder Neoplasms

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Validation of the urgency questionnaire in Portuguese: A new instrument to assess overactive bladder syndrome

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0147


ORIGINAL ARTICLE

Rodolfo Pacheco de Moraes 1, Jonas Lopes da Silva 2, Adriano Almeida Calado 2, Geraldo de Aguiar Cavalcanti 2, 3
1 Divisão de Urologia, Hospital da Polícia Militar de Pernambuco (PMPE), Derby, Recife, PE, Brasil; 2 Divisão de Urologia, Hospital Universitário Oswaldo Cruz – Universidade de Pernambuco (HUOC-UPE) Santo Amaro, Recife, PE, Brasil; 3 Divisão de Urologia, Departamento de Cirurgia – Universidade Federal de Pernambuco (UFPE) Cidade Universitária, Recife, PE, Brasil

ABSTRACT

Purpose: Overactive Bladder (OAB) is a clinical condition characterized by symptoms reported by patients. Therefore, measurement instruments based on reported information are important for understanding its impact and treatment benefits. The aim of this study was to translate, culturally adapt and validate the Urgency Questionnaire (UQ) in Portuguese.

Materials and Methods: Initially, the UQ was translated and culturally adapted to Portuguese.

Sixty-three volunteers were enrolled in the study and were interviewed for responding the Portuguese version of the UQ and the validated Portuguese version of the Overactive Bladder Questionnaire short-form (OABq-SF), used as the gold standard measurement for the validation process. Psychometric properties such as criterion validity, stability, and reliability were tested. Results: Forty-six subjects were included in the symptomatic group (presence of “urgency”), and seventeen were included in the asymptomatic group (control group). There was difference between symptomatic and asymptomatic subjects on all of the subscales (p≤0.001). The UQ subscales correlated with the OABq-SF subscales (p≤0.01), except the subscale “time to control urgency” and the item “impact” from the visual analog scales (VAS). However, these scales correlated with the OABq-SF – Symptom Bother Scale. The UQ subscales demonstrated stability over time (p<0.05), but the subscale “fear of incontinence” and the item “severity” of the VAS did not. All of the UQ subscales showed internal consistencies that were considered to be good or excellent.

Conclusion: The Portuguese version of the UQ proved to be a valid tool for the evaluation of OAB in individuals whose native language is Portuguese.

Keywords: Urinary Bladder, Overactive; Validation Studies [Publication Type]; Urinary Incontinence; Psychometrics

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Impact on sexual function of surgical treatment in rectal cancer

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0318


ORIGINAL ARTICLE

Pedro Costa 1, João M Cardoso 2, Hugo Louro 2, Jorge Dias 1, Luís Costa 1, Raquel Rodrigues 1, Paulo Espiridião 1, Jorge Maciel 2, Luís Ferraz 1
1 Department de Urologia, Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal; 2 Departmento de Cirurgia Geral, Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal

 

ABSTRACT

 

Introduction: The development of new surgical techniques and medical devices, like therapeutical multimodal approaches has allowed for better outcomes on patients with rectal cancer (RCa). Owing to that, an increased awareness and investment towards better outcomes regarding patients’ sexual and urinary function has been recently observed.

Aim: Evaluate and characterize the sexual dysfunction of patients submitted to surgical treatment for RCa.

Materials and Methods: An observational retrospective study including all male patients who underwent a surgical treatment for RCa between January 2011 December 2014 (n=43) was performed, complemented with an inquiry questionnaire to every patient about its sexual habits and level of function before and after surgery.

Discussion: All patients were male, with an average of 64yo. (range 42-83yo.). The surgical procedure was a rectum anterior resection (RAR) in 22 patients (56%) and an abdominoperineal resection (APR) in 19(44%). Sixty three percent described their sexual life as important/very important. Sexual function worsening was observed in 76% (65% with complains on erectile function, and 27% on ejaculation). Fourteen patients (38%) didn’t resume sexual activity after surgery. Increased age (p=0.007), surgery performed (APR) (p=0.03) and the presence of a stoma (p=0.03) were predictors of ED after surgery. A secondary analysis found that the type of surgery (APR) (p=0.04), lower third tumor’s location (p=0.03) and presence of comorbidities (p=0.013) (namely, smokers and diabetic patients) were predictors of de novo ED after surgery.

Conclusions: This study demonstrated the clear negative impact in sexual function of patients submitted to a surgical treatment for RCa. Since it is a valued feature for patients, it becomes essential to correctly evaluate/identify these cases in order to offer an adequate therapeutical option.

Keywords: Surgical Procedures, Operative; Rectal Neoplasms; Diagnosis

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Transperitoneal vs. extraperitoneal radical cystectomy for bladder cancer: A retrospective study

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0441


ORIGINAL ARTICLE

Jagdeesh N. Kulkarni 1, Himanshu Agarwal 1
1 Department of Urology, Bombay Hospital and Medical Research Centre, Mumbai, India

 

ABSTRACT

Purpose: Conventional transperitoneal radical cystectomy (TPRC) is the standard approach for muscle invasive bladder cancer. But, the procedure is associated with significant morbidities like urinary leak, ileus, and infection. To reduce these morbidities, the technique of extraperitoneal radical cystectomy (EPRC) was described by us in 1999.

We compared these two approaches and the data accrued forms the basis of this report.

Materials and Methods: All patients who underwent radical cystectomy for bladder cancer by the author (JNK) with follow-up for at least 5 years were included. A total of 338 patients were studied, with 180 patients in EPRC group and 158 in TPRC group.

Results: There were 3 mortalities within 30 days in TPRC group and one in EPRC group. Early complication rate was 52% and 58% in EPRC and TPRC groups. Urinary leak occurred in 31 (9.2%) patients (13 in EPRC, 18 in TPRC, p=0.19). Gastrointestinal complications like ileus occurred in 9 (5%) patients in EPRC group and in 25 (15.8%) patients in TPRC group, (p<0.001). Wound dehiscence occurred in 29, and 36 patients in EPRC and TPRC groups respectively. The reoperation rate was 6.1% and 12% in EPRC and TPRC groups, (p=0.08). Intestinal obstruction were significantly less in EPRC group (1.7% vs. 7.8% in TPRC group, p=0.002). Uretero-enteric anastomosis stricture was seen in 10 patients (4 in EPRC, 6 in TPRC, p=0.39).

Conclusions: The EPRC is associated with decrease gastrointestinal complications, ease of management of urinary leaks, and low reoperation rates. Thus EPRC appears safe functionally and oncologically.

Keywords: Urinary Bladder Neoplasms; Cystectomy; Retrospective Studies

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Use of photodynamic inactivation for in vitro reduction of prevalent bacteria in Fournier’s Gangrene

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0312


ORIGINAL ARTICLE

Nalisson Marques Pereira 1, Luciano Santos Feitosa 1, Ricardo Scarparo Navarro 1, Dora Inés Kozusny- Andreani 1, Naacia Marques Pereira Carvalho 1
1 Departamento de Engenharia Biomédica, Universidade Brasil, São Paulo, SP, Brasil

ABSTRACT

Fournier’s Gangrene (FG) is an infectious disease caused by several synergic microbes, with high morbidity and mortality rates; therefore, the search for new less invasive and mutilating treatments, with faster recovery, has been proposed. Surgical intervention, the use of several systemic and topic antibiotics, and hyperbaric oxygen therapy are currently the best approach for the treatment of these patients. The use of Photody­namic Inactivation (PDI) aims to lower morbidity and mortality, by reducing bacterial microbiota and speeding wound healing. In the present study, viable bacteria were separated in four groups: Group L-/F- (no irradiation with red laser and absence of me­thylene blue photosensitizer), Group L-/F+ (no irradiation with red laser and presence of methylene blue), Group L+/F- (irradiation with red laser and absence of methylene blue) and L+/F+ (irradiation with red laser associated to methylene blue). In all groups, exposure time to treatment was 5, 10 and 15 minutes. The concentration of methylene blue photosensitizer was 0.1mg/L, and the dose of red laser (660nm wave length) was 176.9mW/cm2. Following irradiation, the reduction of number of bacteria was evalua­ted, and the results were expressed in colony forming units (CFU) and as exponential reduction. As the main results, in the L+/F+ group, there were no Clostridium perfrin­gens and Staphylococcus aureus CFUs and there was a reduction of Escherichia coli that was not observed in the other groups.

Keywords: Fournier Gangrene; Methylene Blue; Clostridium perfringens

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Clinical features of carriers of reciprocal chromosomal translocations involving chromosome 2: report of nine cases and review of the literature

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0233


REVIEW ARTICLE

Xinyue Zhang 1, Hongguo Zhang 1, Cong Hu 1, Ruixue Wang 1, Qi Xi 1, Ruizhi Liu 1
1 Center for Reproductive Medicine and Center for Prenatal Diagnosis, First Hospital, Jilin University, Changchun, China

ABSTRACT

Objective: To explore the clinical features of carriers of chromosome 2 translocations, enabling informed genetic counseling of these patients.

Materials and Methods: Eighty-two male carriers of a translocation who were infertile or receiving fertility counseling were recruited. Cytogenetic analyses were performed using G-banding. A search of PubMed was performed to determine whether the identi­fied translocations on chromosome 2 are involved in male infertility. The relationships of translocation breakpoints with male infertility and recurrent pregnancy loss were analyzed.

Results: Of the 82 translocation carriers, 9 (11%) were carriers of a chromosome 2 translocation. Four cases had oligozoospermia or infertility, while five had normal se­men. In an analysis of the literature, 55 patients who were carriers of chromosome 2 translocations were also reviewed. Breakpoints at 2p13 and 2q31 were observed in six patients each, and were the most common. Breakpoints at 2p23, 2p13, 2p11.2, 2q31, and 2q37 were associated to both pre-gestational and gestational infertility, while other breakpoints were associated with gestational infertility.

Conclusions: All breakpoints at chromosome 2 were correlated with gestational infer­tility. Carriers of chromosome 2 translocations should therefore receive counseling to continue with natural conception and use of different technologies available via as­sisted reproductive technology, such as preimplantation genetic diagnosis.

Keywords:  Infertility, Male; Chromosomes, Human, Pair 2; Genetic Counseling

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Prostate cancer incidentally discovered at the time of radical cystoprostatectomy does not decrease overall survival: Results from a large Chinese medical center

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0430


ORIGINAL ARTICLE

Shiying Tang 1, Han Hao 1, Dong Fang 1, Wei Zheng 1, Peng Ge 1, Xiaohong Su 1, Qun He 1, Xinyu Yang 1, Qi Shen 1, Xuesong Li 1, Wei Yu 1, Jian Lin 1, Liqun Zhou 1
1 Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China

ABSTRACT

Purpose: To investigate the incidence and pathologic characteristics of prostate can­cer (PCa) incidentally discovered at the time of radical cystectomy and its impact on overall survival.

Materials and Methods: A single center retrospective study of 762 male patients who underwent radical cystoprostatectomy from Jan 1994 to Dec 2012.

Results: Of all included patients, 132 (17.3%) were found to have PCa. Patients with in­cidental PCa had a significantly higher mean age (69.2 vs. 62.2 years, P=0.015). Among the 132 patients with PCa, prostate specific antigen (PSA) analysis was available in 76 patients (57.6%), with a median value of 1.06ng/mL, and 61 (80.3%) patients had a PSA value below 4ng/mL. Four hundred and thirty-six patients (57.1%) were successfully followed, with a median duration of 46.5 months. The overall 5-year survival rate was 62.1%, and the 5-year cancer–specific survival rate was 72%. PCa recurrence was de­fined by two consecutive PSA values of >0.2 ng/mL and rising, and no PCa recurrence occurred. According to a univariate analyses, incidental PCa was not associated with cancer-specific survival (P=0.192) or overall survival (P=0.493). According to univari­ate analyses, the overall survival of patients with PCa was not associated with prostate cancer staging, PSA value, or Gleason score (All P values>0.05).

Conclusions: Prostate cancer incidentally discovered at the time of radical cystectomy does not decrease overall survival. Patients with incidental PCa were older than those without. The PSA value before operation is not helpful for predicting incidental pros­tate cancers.

Keywords: Urinary Bladder Neoplasms; Prostatic Neoplasms; Carcinoma

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Endourologic strategies for a minimally invasive management of urinary tract stones in patients with urinary diversion

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0431


ORIGINAL ARTICLE

FangLing Zhong 1, Gurioli Alberto 2, GuangMing Chen 1, Wei Zhu 1, FuCai Tang 1, Guohua Zeng 1, Ming Lei 1
1 Department of Urology, Minimally Invasive Surgery Center, the First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou, China; 2 Department of Urology, Turin University of Studies, Turin, Italy

ABSTRACT

Objective: To present our experience in minimally invasive management of urinary tract stones in patients with urinary diversion.

Materials and Methods: We retrospectively reviewed 26 patients with urinary tract stones after cystectomy and urinary diversion. The types of urinary diversion were ileal conduit, colon conduit, ileal orthotopic neobladder in 19, 4, and 3 patients, re­spectively. At postoperative days 2, a plain KUB and urinary ultrasonography were performed in order to assess stone fragmentation or hydronephrosis. According to postoperative imaging, stone free rate (SFR) was defined as complete absence of frag­ments or residual stones less than 4mm.

Results: 19 patients were treated with minimally invasive percutaneous lithotripsy (MPCNL) and 2 patients required second-look MPCNL. Anterograde flexible ureteros­copy was performed in 2 patients, while in 2 patients a combined anterograde and retrograde approach was required. Three reservoir stones were treated by transurethral neo-bladder lithotripsy. Postoperative significant complications occurred in 2 patients (7.7%). The highest percentage of stone composition was struvite, as a result of chronic urinary tract infection (UTI). SFR was 88.5% (23 of 26).

Conclusions: Our experience showed that MPCNL is a safe and effective treatment modality with little morbidity for renal and upper ureteral stones in patients with urinary diversion. For middle and lower ureteral stones, an anterograde approach could be also considered as a first line treatment, but a combined anterograde and retrograde approach was required when the anterograde access alone cannot pro­vide acceptable results.

Keywords: Urinary Calculi; Urinary Diversion; Cystectomy

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Synchronous abdominal tumors: is combined laparoscopic surgery in a single approach a safe option?

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0429


ORIGINAL ARTICLE

Marcelo Cartapatti 1, Roberto Dias Machado 1, Roberto Lodeiro Muller 1, Wesley J. Magnabosco 1, Alexandre César Santos 1, Brian Francis Chapin 2, Armando Melani 1, Antonio Talvane 1, Marcos Tobias-Machado 3, Eliney Ferreira Faria 1
1 Hospital de Câncer de Barretos, Barretos, SP, Brasil; 2 MD Anderson Cancer Center, Houston, TX, USA; 3 Faculdade de Medicina do ABC, Santo André, SP, Brasil

 

ABSTRACT  

Background and Purpose: Recent advances in cancer treatment have resulted in bet­ter prognosis with impact on patient’s survival, allowing an increase in incidence of a second primary neoplasm. The development of minimally invasive surgery has provided similar outcomes in comparison to open surgery with potentially less mor­bidity. Consequently, this technique has been used as a safe option to simultaneously treat synchronous abdominal malignancies during a single operating room visit. The objective of this study is to describe the experience of two tertiary cancer hospitals in Brazil, in the minimally invasive treatment of synchronous abdominal neoplasms and to evaluate its feasibility and peri-operative results.

Materials and Methods: We retrospectively reviewed the data from patients who were submitted to combined laparoscopic procedures performed in two tertiary hospitals in Brazil from May 2009 to February 2015.

Results: A total of 12 patients (9 males and 3 females) with a mean age of 58.83 years (range: 33 to 76 years) underwent combined laparoscopic surgeries for the treatment of at least one urological disease. The total average duration of surgery was 339.8 minutes (range: 210 to 480 min). The average amount of intraoperative bleeding was 276.6mL (range: 70 to 550mL) and length of hospitalization was 5.08 days (range: 3 to 10 days). Two patients suffered minor complications regarding Clavien system during the immediate postoperative period.

Conclusions: Combined laparoscopic surgery for the treatment of synchronous tumors is feasible, viable and safe. In our study, there was a low risk of postoperative morbidity.

 Keywords: Laparoscopy; Neoplasms; Neoplasms, Multiple Primary

[Full Text]


Bilateral testicular torsion in an adolescent: a case with challenging diagnosis

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0371


CHALLENGING CLINICAL CASES

Lorenzo 1, E. Martínez-Cuenca 1, E. Broseta 1
1 Hospital Universitario y Politécnico La Fe, Valencia, Espanha

ABSTRACT

Bilateral testicular torsion is a very uncommon emergency, with a challenging dif­ferential diagnosis. We describe the case of a 15-year-old patient with a left testicular torsion of 48 hours of duration and a sudden onset of right scrotum pain during his stay at the emergency area. Bilateral testicular torsion was diagnosed after repeat physical examination and doppler ultrasound, which had been normal for right testis in a first evaluation. Surgical exploration was performed with orchiectomy in left testis and fixation in right testis. In previous literature, there are reported bilateral torsion only in four adolescents and five adults. With this case, we demonstrate that bilateral spermatic cord torsion may be easily overlooked in a patient with acute scrotum and we emphasize the importance of bilateral exploration in testicular torsion.

Keywords: Testis; Spermatic Cord Torsion; Adolescent

[Full Text]


 

Long-term results of the implantation of the AMS 800 artificial sphincter for post-prostatectomy incontinence: a single-center experience

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0165


ORIGINAL ARTICLE

Carlos Alberto Ricetto Sacomani 1, Stênio de Cássio Zequi 1, Walter Henriques da Costa 1, Bruno Santos Benigno 1, Rodrigo Sousa Madeira Campos 1, Wilson Bachega Jr. 1, Gustavo Cardoso Guimarães 2
1 AC. Camargo Cancer Center– Fundação Antonio Prudente, São Paulo, SP, Brasil

 

ABSTRACT

Objectives: Report the long-term outcomes of the AMS 800 artificial sphincer (AS) for the treatment post-prostatectomy incontinence (PPI) in a single center in Brazil.

Materials and Methods: Clinical data from patients who underwent the procedure were retrieved from the medical records of individuals with more than 1 year of follow-up from May 2001 to January 2016. Continence status (number of pads that was used), complications (erosion or extrusion, urethral atrophy, and infection), malfunctions, and need for secondary implantation were evaluated. The relationship between com­plications and prior or subsequent radiation therapy (RT) was also examined.

Results: From May 2001 to January 2016, 121 consecutive patients underwent AS implantation for PPI at an oncological referral center in Brazil. At the last visit, the AS remained implanted in 106 patients (87.6%), who reported adequate continence status (maximum of 1 pad/day). Eight-two subjects (67.8%) claimed not to be using pads on a regular basis at the final visit (completely dry). Revision occurred in 24 patients (19.8%).Radiation therapy (RT) for prostate cancer following radical prostatectomy was used in 47 patients before or after AS placement. Twelve patients with a history of RT had urethral erosion compared with 3 men without RT (p=0.004).

Conclusion: Considering our outcomes, we conclude that AS implantation yields satis­factory results for the treatment of PPI and should remain the standard procedure for these patients. Radiation therapy is a risk factor for complication.

Keywords:  Urinary Incontinence; Urinary Sphincter, Artificial; Therapeutics

[Full Text]


High-intensity Focused Ultrasound (HIFU) as salvage therapy for radio-recurrent prostate cancer: predictors of disease response

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0025


ORIGINAL ARTICLE

Shawn Dason 1, Nathan C. Wong 1, Christopher B. Allard 1, Jen Hoogenes 1, William Orovan 1 and Bobby Shayegan 1
1 Division of Urology, McMaster University, Hamilton, ON, Canada

 

ABSTRACT

Background: Some men with localized radio-recurrent prostate cancer may benefit from salvage high-intensity focused ultrasound (HIFU). Herein, we describe oncologic outcomes and predictors of disease response after salvage whole gland HIFU from our prospective cohort.

Materials and Methods: Patients with localized radio-recurrent prostate cancer were prospectively enrolled from January 2005 to December 2014. Participants had to meet both biochemical and histological definitions of recurrence. Exclusion criteria included the receipt of prior salvage therapy, presence of metastatic disease, and administration of ADT in the 6-months prior to enrollment. Participants were treated with a single session of whole-gland HIFU ablation with the AblathermTM device (EDAP, France). The primary endpoint was recurrence-free survival (RFS), defined as a composite endpoint of PSA progression (Phoenix criteria), receipt of any further salvage therapy, receipt of ADT, clinical progression, or death. Kaplan-Meier survival analysis was used to deter­mine the primary end-point and stratifications were used to determine the significance of 6 pre-specified predictors of improved RFS (TRUS biopsy grade, number of study entry TRUS biopsy cores positive, palpable disease at study enrollment, pre-HIFU PSA, an undetectable post-HIFU PSA nadir, and receipt of prior hormone therapy). Survival analysis was performed on participants with a minimum of 1-year follow-up.

Results: Twenty-four participants were eligible for study inclusion with a median fol­low-up of 31.0 months. Median PSA at study entry was 4.02ng/ml. Median time to PSA nadir was 3 months after treatment and median post-HIFU PSA nadir was 0.04ng/ ml. Median 2-year and 5-year RFS was 66.3% and 51.6% respectively. Of our 6 pre-specified predictors, an undetectable PSA nadir was the only significant predictor of improved RFS (HR 0.07, 95% CI 0.02-0.29, log-rank P<0.001). One participant under­went an intervention for a urethral stricture. No participants developed osteitis pubis or rectourethral fistulae.

Conclusions: Salvage HIFU allows for disease control in selected patients with localized radio-recurrent prostate cancer. An undetectable PSA nadir serves as an early predictor of disease response.

Keywords: High-Intensity Focused Ultrasound Ablation; Prostatic Neoplasms; Erectile Dysfunction

[Full Text]


Can preoperative neutrophil lymphocyte ratio predict malignancy in patients undergoing partial nephrectomy because of renal mass?

 Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0225


ORIGINAL ARTICLE

Sacit Nuri Gorgel 1, Kutan Ozer 1, Osman Kose 1, Ahmet Selçuk Dindar 1
1 Department of Urology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, , Izmir,Turkey

ABSTRACT

Purpose: To evaluate the importance of preoperative neutrophil lymphocyte ratio (NLR) predicting malignancy in patients who undergo partial nephrectomy due to renal mass.

Materials and Methods: Seventy nine patients who underwent open partial nephrec­tomy for renal masses were included in this retrospective study. In preoperative routine blood tests, renal ultrasonography and contrast-enhanced computed tomography were performed for all patients. Preoperative neutrophil lymphocyte ratio were compared in patients with clear cell renal cell carcinoma (Group1, 65 patients) and benign lesions (Group 2, 14 patients). The predictive ability of NLR was analyzed by ROC curves and Youden Index method was used to identify the cut-off value for NLR.

Results: The mean age of patients was 59.8±11.7 years in Group1 and 57.4±12.6 years in Group 2 (p=0.493). The mean tumor size was 3.8±1.2 cm in Group 1 and 3.3±1.0 cm in Group 2 (p=0.07). The median NLR was 2.48 (1.04) in Group 1 and 1.63 (0.96) in Group 2 (p<0.001). The area under a ROC curve was 0.799 (p<0.001).

Conclusions: Preoperative neutrophil lymphocyte ratio may predict renal masses that can not be distinguished radiologically. Our results must be confirmed by large and properly designed prospective, randomized trials.

Keywords: Carcinoma, Renal Cell; Neutrophils; Lymphocytes

[Full Text]


Management of long segment anterior urethral stricture (≥ 8cm) using buccal mucosal (BM) graft and penile skin (PS) flap: outcome and predictors of failure

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0083


ORIGINAL ARTICLE

Gamal A. Alsagheer 1, Atef Fathi 1, Mohamed Sayed Abdel-Kader 1, Ahmed M. Hasan 1, Omar Mohamed 1, Osama Mahmoud 1, Ahmad Abolyosr 1
1 Department of Urology, Qena Faculty of medicine, South Valley University, Egypt

ABSTRACT

Purpose: To evaluate the surgical outcome and predictors of failure of substitution urethroplasty using either dorsal onlay buccal mucosal (BM) graft or ventral onlay penile skin flap (PS) for anterior urethral stricture ≥ 8cm.

Patients and methods: Between March 2010 and January 2016, 50 patients with anterior urethral stricture ≥ 8 cm were treated at our hospital. The surgical outcome and success rate were assessed. The predictors of failure were analyzed using mul­tivariate analysis. Failure was considered when subsequent urethrotomy or urethro­plasty were needed.

Results: Dorsal onlay BM graft was carried out in 24 patients, while PS urethroplasty in 26 patients. There was no significant difference between both groups regarding patients demographics, stricture characteristics or follow-up period. One case in the BM group was lost during follow- up. Stricture recurrence was detected in 7 (30.4%) patients out of BM group while in 6 (23.1%) patients out of PS group (p value= 0.5). No significant differences between both groups regarding overall early and late complica­tions were observed. Occurrence of early complications and the stricture length were the only predictors of failure in univariate analysis, while in multivariate analysis the occurrence of early complications was only significant.

Conclusion: On short-term follow-up, both dorsal onlay BM graft and ventral onlay PS flap urethroplasty have similar success rates. However, BM graft has a potential advantage to reduce operative time and is also technically easier. The surgeon should avoid early local complications as they represent a higher risk for failure.

Keywords: Urethral Stricture; Oral Mucosal Absorption; Penis

[Full Text]


The role of fetal-maternal microchimerism as a natural-born healer in integrity improvement of maternal damaged kidney

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0324


ORIGINAL ARTICLE

Abdol-Mohammad Kajbafzadeh 1, Shabnam Sabetkish 1, Nastaran Sabetkish 1
1 Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children’s Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran

ABSTRACT

Purpose: To identify the fetal stem cell (FSC) response to maternal renal injury with emphasis on renal integrity improvement and Y chromosome detection in damaged maternal kidney.

Materials and Methods: Eight non-green fluorescent protein (GFP) transgenic Sprague- Dawley rats were mated with GFP-positive transgenic male rats. Renal damage was induced on the right kidney at gestational day 11. The same procedure was performed in eight non-pregnant rats as control group. Three months after delivery, right ne­phrectomy was performed in order to evaluate the injured kidney. The fresh perfused kidneys were stained with anti-GFP antibody. Polymerase chain reaction (PCR) assay was also performed for the Y chromosome detection. Cell culture was performed to detect the GFP-positive cells. Technetium-99m-DMSA renal scan and single-photon emission computed tomography (SPECT) were performed after renal damage induction and 3 months later to evaluate the improvement of renal integrity.

Results: The presence of FSCs was confirmed by immune histochemical staining as well as immunofluorescent imaging of the damaged part. Gradient PCR of female rat purified DNA demonstrated the presence of Y-chromosome in the damaged maternal kidney. Moreover, the culture of kidney cells showed GPF- positive cells by immuno­fluorescence microscopy. The acute renal scar was repaired and the integrity of dam­aged kidney reached to near normal levels in experimental group as shown in DMSA scan. However, no significant improvement was observed in control group.

Conclusion: FSC seems to be the main mechanism in repairing of the maternal renal injury during pregnancy as indicated by Y chromosome and GFP-positive cells in the sub-cultured medium.

Keywords:  Fetal Stem Cells; Y Chromosome; Technetium Tc 99m Dimercaptosuccinic Acid; Green Fluorescent Proteins

[Full Text]


Sonographic patterns of Peyronie’s disease in patients with absence of palpable plaques

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0298


ORIGINAL ARTICLE

Lucio Dell’Atti 1, Andrea Benedetto Galosi 1
1 Department of Urology, Polytechnic University of Marche Region, University Hospital “Ospedali Riuniti”, Ancona, Italy

ABSTRACT

Purpose: Non-palpable isolated septal plaques of the penis are likely present in a significant number of patients affected by erectile dysfunction (ED) and penile pain without deformity or curvature. The aim of this study was to evaluate the ultrasound (US) patterns observed in patients investigated for ED or penile pain without curvature.

Materials and Methods: We reviewed the medical records of 386 patients who underwent an initial colour-Doppler ultrasonography (CDU) of the penis for DE and/or penile pain without curvature. After satisfying inclusion criteria, 41 patients were individualized.

All patients had a non-palpable plaque with involvement of the penile septum.

Three US patterns were identified: focal hyperecoic thickening of the intercavernosum septum (IS) with acoustic shadow (pattern 1), non-calcified thickening (isoechoic or slightly hyperechoic (pattern 2), and microcalcifications in the IS without associated acoustic shadow (pattern 3).

Results: Patients’ mean age was 51.3±16.7. ED was the predominant disorder in 73.2% of patients, followed by penile pain and length loss in 19.5% and 7.3% of patients, respectively. 32(78.1%) patients showed the pattern 1, 6 (14.6%) pattern 2, and 3 (7.3%) pattern 3. Plaques size varied from 3 to 13 mm. The penile hemodynamic response to CDU reported abnormal findings distally to the septal plaques in 20 patients (<25cm/ sec). Median left and right cavernosum artery flows measured a peak systolic velocity of 31cm/sec and 33 cm/sec, respectively.

Conclusions: We believe that an US study with CDU provides a way to characterize, localize, and deliver treatment choice in patients with Peyronie’s Disease.

Keywords: Erectile Dysfunction; Ultrasonography; Penis

[Full Text]


Extrarenal Angiomyolipoma: differential diagnosis of retroperitoneal masses

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2016.0670


RADIOLOGY PAGE

Marcelo Wroclawski 1, Willy Baccaglini 2, Cristiano Linck Pazeto 2, Cristina Carbajo 2, Chaline Matushita 2, Arie Carneiro 2, Alexandre Pompeo 2, Sidney Glina 2, Antonio Carlos Lima Pompeo 2, Lívia Barreira Cavalcante 3
1 Hospital Israelita Albert Einstein, São Paulo, SP, Brasil; 2 Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil; 3 Centro de Imuno-Histoquímica, Citopatologia e Anatomia Patológica (CICAP) São Paulo, SP, Brasil
No abstract available

[Full Text]


Robot-Assisted Nephropexy

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0390


VIDEO SECTION

Marcelo Langer Wroclawski 1, 2, Guilherme Andrade Peixoto 2, Marcio Covas Moschovas 2, Arie Carneiro 1, Milton Borrelli Jr. 1, José Roberto Colombo Jr. 1
1 Hospital Israelita Albert Einstein, São Paulo, SP, Brasil; 2 Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil

ABSTRACT

Introduction: Renal ptosis is defined as the renal descent when there is a change from supine to orthostatic position, usu­ally with a change of two vertebral bodies or more than five cm apart. Although rare, it is one of the causes of chronic flank pain or of upper abdomen. The typical patient of renal ptosis is young, female, thin, with complaint of pain when in an upright position (1, 2).

Objective: Demonstrate a robot-assisted nephropexy technique in a young woman diagnosed with symptomatic renal ptosis on the right kidney, confirmed by imaging tests.

Materials and Methods: A 29-year-old female patient with a history of chronic right-sided pain and palpable renal mo­bility on physical examination. The diagnosis of renal ptosis was confirmed by ultrasound imaging, excretory urography (Figure -1), and renal scintigraphy with 99mTc-DTPA (Figure-2). She was submitted to a robotic-assisted right nephro­pexy with a polypropylene mesh fixing the right kidney to the ipsilateral psoas muscle fascia.

Result: We reported a 96-minute surgical time. The patient was discharged in the first postoperative day. At the one-month follow-up, there was an important improvement of the symptoms, with normality renal function and imaging tests describing adequate renal positioning.

Conclusions: Robotic-assisted nephropexy is feasible and can be an excellent minimally invasive alternative technique for the proposed surgery. We reported a shorter hospital stay and a faster postoperative recovery compared with the opened procedure.

ARTICLE INFO

Available at: http://www.intbrazjurol.com.br/video-section/20170390_wroclawski_et_al

Int Braz J Urol. 2017; 43 (Video #X): XXX-X

[Full Text]


 

OAB score: a clinical model that predicts the probability of presenting overactive detrusor in the urodynamic study

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0213


ORIGINAL ARTICLE

Leandro Cristian Arribillaga 1, Marta Ledesma 1, Ariel Montedoro 1, Florencia Pisano 1, Rubén Guillermo Bengió 1
1 Centro Urológico Profesor Bengió, Córdoba, Argentina

ABSTRACT

Purpose: To create a predictive model of involuntary detrusor contraction (IDC) to improve the diagnostic accuracy of overactive detrusor (OAD), associating overactive bladder (OAB) symptoms with other clinical parameters in the female population.

Materials and Methods: A total of 727 women were studied retrospectively. In all of them, urodynamic study was conducted for urogynecological causes. Demographics information, personal history, symptoms, physical exam, a 3-day frequency/volume chart and urinary culture, were collected in all patients and they subsequently underwent uroflowmetry and urodynamic studies. A logistic regression model was performed in order to determine independent predictors of presence of IDC. Odd ratio (OR) estimation was used to assign a score to each one of the significant variables (p≤0.05) in the logistic regression model. We performed a ROC curve in order to determine the predictive ability of the score in relation to the presence of OAD.

Results: presence of OAD was evident in 210 women (29%). In the logistic regression analysis, independent predictors of OAD were urgency, urgency incontinence, nocturia, absence of SUI symptoms, diabetes mellitus, reduction of vaginal trophism and bladder capacity below 150 mL. The probability of IDC diagnosis increases as the score raises (Score 0: 4% until Score ≥10: 88%). Sensitivity was 71% and specificity 72%. The area under the curve of OAB score was 0.784 (p>0.001).

Conclusions: OAB score is a clinical tool that shows higher diagnostic accuracy than OAB symptoms alone to predict overactive detrusor.

Keywords: Urinary Bladder, Overactive; Urodynamics

[Full Text]


The effect of AST/ALT (De Ritis) ratio on survival and its relation to tumor histopathological variables in patients with localized renal cell carcinoma

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0173


ORIGINAL ARTICLE

Lütfi Canat 1, Hasan Anil Ataly 1, Samir Agalarov 1, İlter Alkan 1, Fatih Alturende 1
1 Department of Urology, Okmeydani Training and Research Hospital, Istanbul, Turkey

 

ABSTRACT

Purpose: To assess the relationship between De Ritis (aspartate aminotransaminase [AST]/Alanine aminotransaminase [ALT]) ratio and pathological variables and whether it is an independent prognostic factor.

Materials and Methods: We analyzed 298 consecutive patients who underwent radical or partial nephrectomy for non-metastatic renal cell carcinoma (RCC) between 2006 and 2015. The association between De Ritis ratio and pathological variables including tumor size, presence of renal vein invasion, vena cava invasion, renal capsule infiltration, Gerota fascia invasion, renal sinus involvement, renal pelvic invasion, angiolymphatic invasion, adrenal gland involvement, lymph node involvement, tumor necrosis, and Fuhrman’s grade was tested. Multivariable Cox analysis was performed to evaluate the impact of this ratio on overall survival and cancer-specific survival.

Results: An increased preoperative De Ritis ratio was significantly associated with renal vein invasion, renal capsule infiltration and renal pelvis involvement (p<0.05) in non-metastatic RCC. On multivariate analysis we found that tumor size, Fuhrman grade and lymph node involvement were independent prognostic factors for cancerspecific survival. AST/ALT ratio had no influence on the risk of overall and cancerspecific survival.

Conclusion: An increased preoperative AST/ALT ratio had a significant association with renal vein invasion, renal capsule infiltration and renal pelvis involvement in patients with non-metastatic RCC. However, it does not appear to be an independent prognostic marker in non-metastatic RCC.

Keywords: Prognosis; Survival; Pathology

[Full Text]


Efficacy of targeted therapy for advanced renal cell carcinoma: a systematic review and meta-analysis of randomized controlled trials

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0315


REVIEW ARTICLE

Chao Wei 1, 2, Shen Wang 1 ,2, Zhangqun Ye 1, 2, Zhiqiang Chen 1, 2
1 Department of Urology and 2 Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

 

ABSTRACT

We conducted a systematic review and meta-analysis of the literature on the efficacy of the targeted therapies in the treatment of advanced RCC and, via an indirect com­parison, to provide an optimal treatment among these agents. A systematic search of Medline, Scopus, Cochrane Library and Clinical Trials unpublished was performed up to Jan 1, 2015 to identify eligible randomized trials. Outcomes of interest assessing a targeted agent included progression free survival (PFS), overall survival (OS) and ob­jective response rate (ORR). Thirty eligible randomized controlled studies, total twenty-fourth trails (5110 cases and 4626 controls) were identified. Compared with placebo and IFN-α, single vascular epithelial growth factor (receptor) tyrosine kinase inhibitor and mammalian target of rapamycin agent (VEGF(r)-TKI & mTOR inhibitor) were as­sociated with improved PFS, improved OS and higher ORR, respectively. Comparing sorafenib combination vs sorafenib, there was no significant difference with regard to PFS and OS, but with a higher ORR. Comparing single or combination VEGF(r)-TKI & mTOR inhibitor vs BEV + IFN-α, there was no significant difference with regard to PFS, OS, or ORR. Our network ITC meta-analysis also indicated a superior PFS of axitinib and everolimus compared to sorafenib. Our data suggest that targeted therapy with VEGF(r)-TKI & mTOR inhibitor is associated with superior efficacy for treating advanced RCC with improved PFS, OS and higher ORR compared to placebo and IFN-α. In summary, here we give a comprehensive overview of current targeted therapies of advanced RCC that may provide evidence for the adequate targeted therapy selecting.

Keywords:  Carcinoma, Renal Cell; Therapeutics; Meta-Analysis as Topic; Interferons

[Full Text]


 

Retroperitoneal approach for robot-assisted partial nephrectomy: technique and early outcomes

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0104


ORIGINAL ARTICLE

Porreca 1, D. D’Agostino 1, D. Dente 1, M. Dandrea 1, A. Salvaggio 1, E. Cappa 1, A. Zuccala 1, A. Del Rosso 1, F. Chessa 2, D. Romagnoli 2, F. Mengoni 2, M. Borghesi 2 , R. Schiavina 2
1 Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy; 2 Department of Urology, University of Bologna, Bologna, Italy

 

ABSTRACT

Objectives: The aim of our study is to present early outcomes of our series of retroper­itoneal-RAPN (Robot Assisted Partial Nephrectomy).

Materials and methods: From September 2010 until December 2015, we performed 81 RAPN procedures (44 at left kidney and 37 at right). Average size was 3cm (1-9). Average PADUA score 7.1 (5-10). Average surgical time (overall and only robot time), ischemia time, blood loss, pathological stage, complications and hospital stay have been recorded.

Results: All of the cases were completed successfully without any operative complica­tion or surgical conversion. Average surgical time was 177 minutes (75-340). Operative time was 145 minutes (80-300), overall blood loss was 142cc (60-310cc). In 30 cases the pedicle was late clamped with an average ischemia time of 4 minutes (2-7). None of the patient had positive surgical margins at definitive histology (49pT1a, 12pT1b, 3pT2a, 2pT3a). Hospital stay was 3 days (2-7).

Conclusions: The retroperitoneal robotic partial nephrectomy approach is safe and al­lows treatment of even quite complex tumors. It also combines the already well known advantages guaranteed by the da Vinci® robotic surgical system, with the advantages of the retroperitoneoscopic approach.

Keywords:  Nephrectomy; Video-Assisted Surgery; Laparoscopy

[Full Text]


Left ureteral appendiceal interposition: Exercise caution and do not be mislead By postoperative radiological obstruction

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0295


RADIOLOGY PAGE

Aderivaldo Cabral Dias Filho 1, Carlos Alberto Toledo Martinez 1, Maria Bianca Côrte 2, Marcus Vinicius Osorio Maroccolo 1
1 Unidade de Urologia, Hospital de Base do Distrito Federal, Brasília, DF, Brasil; 2 Unidade de Proctologia, Hospital de Base do Distrito Federal, Brasília, DF, Brasil

 

ABSTRACT

Postoperative imaging after appendiceal ureteral interposition may be difficult to interpret, misguiding the urologist towards intervention. We present a case in which radiological obstruction was not endorsed by a 99TcDTPA nephrogram, with favorable outcome after conservative treatment.

[Full Text]


Ureteroileal bypass: a new technic to treat ureteroenteric strictures in urinary diversion

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0014


SURGICAL TECHNIQUE

Guilherme P. Padovani 1, Marcos F. Mello 1, Rafael F. Coelho 1, Leonardo L. Borges 1, Adriano Nesrallah 1, Miguel Srougi 1, William C. Nahas 1 Guilherme P. Padovani 1, Marcos F. Mello 1, Rafael F. Coelho 1, Leonardo L. Borges 1, Adriano Nesrallah 1, Miguel Srougi 1, William C. Nahas 1
1 Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil

 

ABSTRACT

Objective: To present our technique of ureteroileal bypass to treat uretero-enteric strictures in urinary diversion.

Materials and Methods: One hundred and forty-one medical records were reviewed from patients submitted to radical cystectomy to treat muscle-invasive bladder cancer between 2013 and 2015. Twelve (8.5%) patients developed uretero-enteric anastomotic stricture during follow-up. Five patients were treated with endoscopic dilatation and double J placement. Four were treated surgically with standard terminal-lateral implantation.

Three patients with uretero-enteric anastomotic stricture were treated at our institution by “ureteroileal bypass”, one of them was treated with robotic surgery.

Results: All patients had the diagnosis of uretero-enteric anastomotic stricture via computerized tomography and DTPA renal scan. Time between cystectomy and diagnosis of uretero-enteric anastomotic stricture varied from five months to three years. Mean operative time was 120±17.9 minutes (98 to 142 min) and hospital stay was 3.3±0.62 days (3 to 4 days). Mean follow-up was 24±39.5 months (6 to 72 months). During follow-up, all patients were asymptomatic and presented improvement in ureterohydronephrosis. Serum creatinine of all patients had been stable.

Conclusions: Latero-lateral ureter re-implantation is feasible by open or even robotic surgery with positive results, reasonable operation time, and without complications.

Keywords: Urinary Diversion, Cystectomy, Urinary Bladder

[Full Text]


The impact of metformin use on the risk of prostate cancer after prostate biopsy in patients with high grade intraepithelial neoplasia

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0046


ORIGINAL ARTICLE

Lucio Dell’Atti 1, Andrea B. Galosi 2
1 Department of Urology, University Hospital “St. Anna”, Ferrara, Italy; 2 Department of Urology, Marche Polytechnic University, Ancona, Italy

 

ABSTRACT

 

Purpose: We report our experience on metformin use in diabetic patients and its impact on prostate cancer (PCa) after a high-grade prostatic intraepithelial neoplasia (HGPIN) diagnosis.

Materials and Methods: We retrospectively analyzed 551 patients with a diagnosis of HGPIN without PCa in a first prostate biopsy. The cohort of the study consisted of 456 nondiabetic subjects, and 95 diabetic patients. Among the patients with diabetes 44 were treated with metformin, and 51 with other antidiabetic drugs. A transrectal ultrasound prostate biopsy scheme with 22 cores was carried out 4-6 months after the first diagnosis of HGPIN.

Results: Among 195 (35.4%) patients with cancer, there were statistically significant differences in terms of PCa detection (p<0.001), Gleason score distribution (p<0.001), and number of positive biopsy cores (p<0.002) between metformin users and non-users.

Metformin use was associated with a decreased risk of PCa compared with neveruse (p<0.001). Moreover, increasing duration of metformin assumption (≥2 years) was associated with decreasing incidence of PCa and higher Gleason score ≥7 compared with assumption <2 years.

Conclusions: This preliminary experience suggests that metformin use may have some beneficial effects in patients with diabetes and HGPIN; metformin should not be overlooked in these patients because it is neither new nor expensive.

 Keywords: Diabetes Mellitus; Prostatic Neoplasms; Prostatic Intraepithelial Neoplasia

[Full Text]


Overactive bladder syndrome and bladder wall thickness in patients with obstructive sleep apnea syndrome

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0253


ORIGINAL ARTICLE

Zahide Yilmaz 1, Bekir Voyvoda 2, Pinar Bekdik Şirinocak 1
1 Clinic of Neurology, Health Sciences University, Kocaeli Derince Training and Research Hospital, Turkey; 2 Clinic of Urology, Health Sciences University, Kocaeli Derince Training and Research Hospital, Turkey

 

ABSTRACT  

Objective: The main objective of the present study was to evaluate the presence of overactive bladder (OAB) syndrome, nocturia, urgency, and urge incontinence in pa­tients with obstructive sleep apnea syndrome (OSAS), and measure bladder wall thick­ness (BWT) in these patients.

Materials and Methods: The patient group was composed of 38 patients with OSAS. The control group was composed of 15 healthy individuals. All patients were evalu­ated using the Epworth Sleepiness Scale (ESS) and Overactive Bladder Symptom Score (OABSS). The bladder wall thickness was measured by transabdominal ultrasound (US). The presence of nocturia, urinary urgency, and urge incontinence were also evaluated.

Results: The mean OABSS was significantly higher in the patient group compared with the control group (p=0.048). The minimum oxygen saturation (Min.SO2) of patients with urgency was found to be significantly lower (p=0.014). The time spent below 90% of oxygen saturation (SO2) was significantly longer in patients with urinary urgency (p=0.009). There was no difference in BWT measurements between the patient group and the control group. There was a significant relationship between BWT values and OABSS in patients with OSAS (p=0.002).

Conclusion: The results of the present study suggest that OSAS is associated with OAB syndrome. As a key symptom of OAB, urgency correlates with hypoxia in cases with OSAS. Although the present study did not observe any difference in BWT measure­ments between the patients and the control group, there was a correlation between BWT measurements and OABSS in patients with OSAS.

 Keywords: Urinary Bladder, Overactive; Urinary Bladder; Nocturia

[Full Text]


Single perineal incision placement of artificial urinary sphincter with cadaveric correlation of sub-dartos pump placement

 Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0097


ORIGINAL ARTICLE

Cooper R. Benson 1, Hajar I. Ayoub 1, O. Lenaine Westney 2
1 University of Texas Health Science Center At Houston McGovern Medical School, USA; 2 University of Texas MD Anderson Cancer Center, USA

ABSTRACT

 

Purpose: We present a novel AUS implantation technique using a single perineal inci­sion for single device placement or in combination with an inflatable penile prosthesis (IPP). Urinary and sexual dysfunction following the management of prostate cancer has a significant impact on the quality of life of our patients. While there are marginal changes in the prosthetic devices, we strive to reduce post-operative morbidity while maximizing efficacy.

Materials and Methods: We retrospectively reviewed the outcomes of 6 patients who underwent single perineal incision placement of a virgin AUS in 2014, 3 with simulta­neous IPP placement. In all cases, the pressure regulating balloons (PRB) were placed in a high sub-muscular ectopic position and the pumps were placed into a sub-dartos pouch through the perineal incision, which was also validated using a cadaveric model.

Results: The mean patient age was 61 (SD, 7.5 years) with mean body mass index of 31 (SD, 5.9). The average pre-operative pad usage was 7.7 (SD 1.63) pads per day. The mean follow-up was 13.9 months (SD 9.45). Four out of the six patients reported uti­lizing ≤1 pad daily at follow-up. The one patient who was not initially dry required downsizing of his cuff to 3.5cm; the remaining patient was lost to follow-up. There were no identifiable perioperative or post-operative complications.

Conclusions: We present our initial report of using a single perineal incision for AUS implantation with a validated sub-dartos pump location, which is safe and effective for implantation of an AUS as a single or double implantation in well-selected patients.

Keywords: Urinary Incontinence, Stress; Urinary Sphincter, Artificial; Prostatic Neoplasms

[Full Text]


Is circumferential urethral mobilisation an overdo? A prospective outcome analysis of dorsal onlay and dorso – lateral onlay BMGU for anterior urethral strictures

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2016.0599


ORIGINAL ARTICLE

Gaurav Prakash 1, Bhupendra Pal Singh 1, Rahul Janak Sinha 1, Ankur Jhanwar 1, Satyanarayan Sankhwar 1
1 Department of Urology, King George’s Medical University, Lucknow, India

 

ABSTRACT

Introduction: For dorsal onlay graft placement, unilateral urethral mobilization is less in­vasive than standard circumferential urethral mobilization. Apart from success in terms of patency of urethra, other issues like sexual function, overall quality of life and patient satisfaction remain important issues while comparing outcomes of urethroplasty.

Aim: To prospectively compare the objective as well as subjective outcomes of two approaches.

Materials and Methods: Between July 2011 and January 2015, 136 adult males having anterior urethral stricture with urethral lumen ≥ 6 Fr. were prospectively assigned between two groups by alternate randomization. Operative time, complications, success rate (no obstructive symptoms, no need of any postoperative intervention, Q max > 15mL/sec), sexual functions (using Brief Male Sexual Function Inventory) were compared.

Results: Baseline parameters were similar in both groups (68 in each group). Overall success rate was similar in both groups (89 % and 91 % respectively). Improvement in total LUTS scores was similar in groups. Changes in overall health status (VAS and EQ 5D) was equal in both groups. Erectile function score was significantly decreased in DO than DL group while ejaculatory function and sexual desire remained stable after urethroplasty in both groups.

Conclusions: In anterior urethral stricture buccal mucosa graft provides satisfactory results as onlay technique. No technique whether dorsolateral and dorsal techniques is superior to other. Dorsolateral technique needs minimal urethral mobilization and should be preferred whenever feasible.

Keywords:  Urethral Stricture; Lower Urinary Tract Symptoms; Buccal mucosa

[Full Text]


Tissue-based molecular markers in upper tract urothelial carcinoma and their prognostic implications

 Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0204


REVIEW ARTICLE

Ricardo L. Favaretto 1, Stenio C. Zequi 1, Renato A. R. Oliveira 1, Thiago Santana 1, Walter H. Costa 1, Isabela W. Cunha 2, Gustavo C. Guimarães 1
1 Departamento de Cirurgia Pélvica, Serviço de Urologia AC Camargo Cancer Center, São Paulo, Brasil, São Paulo, Brasil; 2 Departamento de Patologia, AC Camargo Cancer Center, São Paulo, Brasil

ABSTRACT

Upper tract urothelial carcinoma (UTUC) is a rare and aggressive disease that is associated with high rates of recurrence and death. Radical nephroureterectomy (RNU) with excision of the bladder cuff is considered the standard of care for high-risk UTUC, whereas kidney-sparing techniques can be indicated for select patients with low-risk disease. There is a significant lack of clinical and pathological prognostic factors for stratifying patients with regard to making treatment decisions. Incorporation of tissue-based molecular markers into prognostic tools could help accurately stratify patients for clinical decision-making in this heterogeneous disease. Although the number of studies on tissue-based markers in UTUC has risen dramatically in the past several years—many of which are based on single centers and small cohorts, with a low level of evidence—many discrepancies remain between their results. Nevertheless, certain biomarkers are promising tools, necessitating prospective multi-institution studies to validate their function.

Keywords: Carcinoma; Biomarkers; Prognosis

[Full Text]


 

Costs analysis of surgical treatment of stress urinary incontinence in a brazilian public hospital, comparing burch and synthetic sling techniques

 Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0232


ORIGINAL ARTICLE

Leo Francisco Limberger 1, Fernanda Pacheco Faria 1, Luciana Silveira Campos 1, Karin Marise Jaeger Anzolch 2, Alexandre Fornari 2, 3
1 Serviço de Ginecologia do Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brasil; 2 Hospital Moinhos de Vento, Porto Alegre, RS, Brasil; 3 Ambulatório de Disfunções miccionais da Santa Casa de Porto Alegre, Porto Alegre, RS, Brasil

ABSTRACT

Introduction: Surgical treatment of urinary incontinence progressed significantly with the introduction of synthetic slings. However, in some public Brazilian hospitals, the costs of these materials prevent their routine use.

Objective: To compare the costs of ambulatory synthetic sling surgery with an historical series of patients submitted to Burch surgery in a Brazilian public hospital.

Materials and Methods: Twenty nine incontinent patients were selected to synthetic sling surgery. Demographic data were prospectively collected and also the costs of the procedure, including drugs and materials, use of surgical and recovery wards, medical staff and hospitalization. These data were compared to the costs of 29 Burch surgeries performed before the introduction of synthetic slings.

Results: Demographic data were similar, although median age was lower in the group submitted to Burch surgery (46.3±8.6 versus 56.2±11.3 (p<0.001)). Cost was signifi­cantly lower in patients submitted to sling in all items, except for time spent in recov­ery ward. Total value of 29 Burch surgeries was R$ 217.766.12, and of R$ 68.049.92 of 29 patients submitted to sling surgery (p<0.001).

Conclusion: Burch surgery was more expensive than ambulatory synthetic transobtu­rator sling surgery, even when the cost of the synthetic sling was considered.

Keywords:  Urinary Incontinence; Suburethral Slings; Costs and Cost Analysis

[Full Text]


 

Laparoscopic nephrectomy outside gerota fascia and En bloc ligation of the renal hilum for management of inflammatory renal diseases

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0363


ORIGINAL ARTICLE

Liang Ma 1, Yanlan Yu 1, Guangju Ge 1, Gonghui Li 1
1 Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China

 

ABSTRACT

Objectives: This study aims to improve laparoscopic nephrectomy techniques for inflammatory renal diseases (IRD) and to reduce complications.

Materials and Methods: Thirty-three patients underwent laparoscopic nephrectomy for IRD, with a method of outside Gerota fascia dissection and en-bloc ligation and division of the renal pedicle. Operative time, blood loss, complications, analgesia requirement, post-operative recovery of intestinal function and hospital stay were recorded.

The degrees of perinephric adhesion were classified based on the observation during operation and post-operative dissection of the specimen, and the association of different types of adhesion with the difficulty of the procedures was examined.

Results: Among 33 cases, three were converted to hand-assisted laparoscopy, and one was converted to open surgery. Mean operative time was 99.6±29.2min, and blood loss was 75.2±83.5 mL. Postoperative recovery time of intestinal function was 1.6±0.7 days and average hospital stay was 4.8±1.4 days. By classification and comparison of the perinephric adhesions, whether inflammation extending beyond Gerota fascia or involving renal hilum was found to be not only an important factor influencing the operative time and blood loss, but also the main reason for conversion to hand-assisted laparoscopy or open surgery.

Conclusions: In laparoscopic nephrectomy, outside Gerota fascia dissection of the kidney and en-bloc ligation of the renal pedicle using EndoGIA could reduce the difficulty of procedure and operative time, with satisfactory safety and reliability. Inflammation and adhesion extending beyond Gerota fascia or involving renal hilum is an important predictor of the difficulty related to laparoscopic nephrectomy for IRD.

Keywords: Kidney Diseases; Laparoscopy; Nephrectomy

[Full Text]


Super-selective robot-assisted partial nephrectomy using near-infrared flurorescence versus early-unclamping of the renal artery: results of a prospective matched-pair analysis

Vol. 43 (x): 2017 November 11.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0311


ORIGINAL ARTICLE

Cecilia Lanchon 1, 2, Valentin Arnoux 1, Gaëlle Fiard 1, 2, Jean-Luc Descotes 1, 2, Jean-Jacques Rambeaud 1, Jean-Benjamin Lefrancq 1, Delphine Poncet 1, Nicolas Terrier 1, Camille Overs 1, Quentin Franquet 1, Jean-Alexandre Long 1, 2
1 Department of Urology, Grenoble University Hospital, Grenoble, France; 2 UJF-Grenoble 1, CNRS, INSERM, TIMC-IMAG UMR 5525, 38041 Grenoble, France

 

ABSTRACT

 

Introduction: Super-selective clamping of tumor-specific segmental arteries was developed to eliminate ischemia of the remnant kidney while limiting hemorrhage during partial nephrectomy. The objective is to evaluate the benefice of super-selective clamping on renal functional outcome, compared to early-unclamping of the renal artery.

Materials and Methods: From March 2015 to July 2016, data from 30 patients undergoing super-selective robot-assisted PN (RAPN) for a solitary tumor by a single surgeon were prospectively collected. Tumor devascularization was assessed using indocyanine green near-infrared fluorescence. A matched-pair analysis with a retrospective cohort undergoing early-unclamping was conducted, adjusting on tumor complexity and preoperative eGFR. Perioperative, oncologic and functional outcomes using DMSA-renal scintigraphy were assessed. Multivariate analysis was performed to identify predictors of postoperative renal function and de novo chronic kidney disease (CKD).

Results: Super-selective RAPN was successful in 23/30 patients (76.7%), 5 requiring secondary main artery clamping due to persistent tumor fluorescence. Matched-pair analysis showed similar operating time, blood loss, positives margins and complication rates. Super-selective clamping was associated with an improved eGFR variation at discharge (p=0.002), 1-month (p=0.01) and 6-month post-op (-2%vs-16% p=0.001).

It also led to a better relative function on scintigraphy (46%vs40% p=0.04) and homolateral eGFR (p=0.04), and fewer upstaging to CKD stage ≥3 (p=0.03). On multivariate analysis, super-selective clamping was a predictor of postoperative renal function.

Conclusion: Super-selective RAPN leads to an improved preservation of renal function and a reduced risk of de novo CKD stage≥3, while keeping the benefit of main artery clamping on perioperative outcomes.

Keywords: Nephrectomy; Kidney; Ischemia

[Full Text]


Double inlay plus ventral onlay buccal mucosa graft for simultaneous penile and bulbar urethral stricture

Vol. 43 (x): 2017 November 10.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0067


VIDEO SECTION

Luciano A. Favorito 1, Paulo P. Conte 1, Ulisses G. Sobrinho 1, Rodrigo G. Martins 1, Tomas Accioly 1
Seção de Urologia, Hospital Federal da Lagoa – Rio de Janeiro, RJ, Brasil

 

ABSTRACT

Objectives: Buccal mucosa grafts and fascio-cutaneous flaps are frequently used in long anterior urethral strictures (1). The inlay and onlay buccal mucosa grafts are easier to perform, do not need urethral mobilization and generally have good long-term results (2-4). In the present video, we present a case where we used a double buccal mucosa graft tech­nique in a simultaneous penile and bulbar urethral stricture.

Materials and Methods: A 54 year-old male patient was submitted to appendectomy where a urethral catheter was used for two days in May 2015. Three months after surgery, the patient complained of acute urinary retention and a supra­-pubic tube was indicated. Urethrocystography was performed two weeks later and showed strictures in penile and bulbar urethra with 3.5 cm and 3 cm in length respectively. Urethroplasty was proposed for the surgical treatment in this case. We used a perineal approach with a ventral sagittal urethrotomy in both strictures. Penile urethra stricture measuring 3.5 cm in length was observed and a free graft from the buccal mucosa was harvested and placed into the longitudinal incision in the dorsal urethra and fixed with interrupted suture as dorsal inlay. Bulbar urethra stricture measuring 3 cm was observed and a free graft from the buccal mucosa was harvested and placed into the longitudinal incision in the ventral urethra and fixed with interrupted suture as ventral onlay. The ventral urethrotomy was closed over a 16Fr Foley catheter and the skin incision was then closed in layers.

Results: No intraoperative or postoperative complications occurred. The patient could achieve satisfactory voiding and no complication was seen during the six-month follow-up. Postoperative imaging demonstrated a widely patent urethra, and the mean peak flow was 12 mL/s.

Conclusion: The BMG placement can be ventral, dorsal, lateral or combined dorsal and ventral BMG in the meeting of stricture but the first two are most common (5, 6). Ventral location provides the advantages of ease of exposure and good vascular supply by avoiding circumferential rotation of the urethra (7). Early success rates of dorsal and ventral onlay with BMG were 96 and 85%, respectively. However, long-term follow-up revealed essentially no difference in success rates (8-11). Anterior urethral stricture treatments are various, and comprehensive consideration should be given in selecting individualized treatment programs, which must be combined with the patient’s stricture, length, complexity, and other factors. Traditionally, anastomotic procedures with transection and urethral excision are suggested for short bulbar strictures, while longer strictures are treated by patch graft urethroplasty preferably using the buccal mucosa as gold-standard material due to its histological characteristics. The current management for complex urethral strictures commonly uses open reconstruction with buccal mucosa urethroplasty. However, there are multiple situations whereby buccal mucosa is inadequate (pan-urethral stricture or prior buccal harvest) or inappropriate for utilization (heavy tobacco use or oral radiation). Multiple options exist for use as alternatives or adjuncts to buccal mucosa in complex urethral strictures (injectable antifibrotic agents, augmentation urethroplasty with skin flaps, lingual mucosa, colonic mucosa, and new developments in tissue engineering for urethral graft material). In the present case, our patient had two strictures and we chose to correct the first stricture with a dorsal graft and the bulbar stricture with a ventral graft because of our personal expertise. We can conclude that the double buccal mucosa graft is easier to perform and can be an option to repair multiple urethral strictures.

ARTICLE INFO
Available at: http://www.intbrazjurol.com.br/video-section/20170067_Favorito_et_al
Int Braz J Urol. 2017; 43 (Video #X): XXX-X

[Full Text]


Dusting utilizing suction technique (DUST) for percutaneous nephrolithotomy: use of a dedicated laser handpiece to treat a staghorn stone

Vol. 43 (x): 2017 July 7.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0266


VIDEO SECTION

Khurshid R. Ghani 1,2, Ali H. Aldoukhi 2, William W. Roberts 2
1 Department of Surgery, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; 2 Department of Urology, University of Michigan, Ann Arbor, MI, USA

 

No abstract available

[Full Text]


Acquired Hemophilia presenting as Gross Hematuria following Kidney Stone – A Case Report and Review of the Literature

Vol. 43 (x): 2017 August 8.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0172


CHALLENGING CLINICAL CASES

Max Schmidt-Bowman 1, Lael Reinstatler 2, Eric P. Raffin 2, Joseph E. Yared 2, John D. Seigne 2, Einar F. Sverrisson 2
1 Geisel School of Medicine at Dartmouth, Hanover, NH; 2 Department of Surgery, Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH

 

ABSTRACT

A rare condition in itself, acquired hemophilia A, seldom presents as isolated gross he­maturia. It is a serious condition with a high mortality rate and thus clinical suspicion followed by prompt diagnosis is imperative (1). In fact, only 8 cases of such presen­tation of this condition have been reported thus far in the literature. Of these, none describe the initial presentation of hematuria with the inciting event of a kidney stone. We present a case of a 67-year-old man with signs and symptoms of nephrolithiasis accompanied by profuse hematuria, who was subsequently found to have developed expression of factor VIII inhibitor leading to acquired hemophilia A.

Keywords: Hematuria; Nephrolithiasis; Factor 8 deficiency, acquired [Supplementary Concept]

[Full Text]


 

Retzius-sparing robot-assisted radical prostatectomy is safe for patients with prior transurethral prostate surgery

Vol. 43 (x): 2017 October 30.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0316


VIDEO SECTION

Lawrence H. C. Kim 1, Glen Denmer Santok 1, Ali Abdel Raheem 1, 2, Kidon Chang 1, Trenton Lum 1, Byung Ha Chung 1, Young Deuk Choi 1, Koon Ho Rha 1
1 Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea; 2 Department of Urology, Tanta University Medical School, Egypt

 

No abstract available

[Full Text]


Re: Serum tissue factor as biomarker for renal clear cell carcinoma: a comment

Vol. 43 (x): 2017 October 30.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0530


LETTER TO THE EDITOR

Beuy Joob 1, Viroj Wiwanit 2,3,4
1 Sanitation 1 Medical Academic Center, Bangkok Thailand; 2 Hainan Medical University, China; 3 Faculty of Medicine, University of Nis, Serbia; 4 Joseph Ayo Babalola University, Nigeria

 

No abstract available

[Full Text]


Re: Simplified Fournier’s gangrene severe index score (SFGSI)

Vol. 43 (x): 2017 October 30.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0535


LETTER TO THE EDITOR

Sora Yasri 1, Viroj Wiwanitkit 2
1 KMT Primary Care Center, Bangkok Thailand; 2 Hainan Medical University, China

 

No abstract available

[Full Text]


Retroperitoneoscopic nephrectomy for huge autosomal-dominant polycystic kidney disease using morcellator

Vol. 43 (x): 2017 October 30.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0258


VIDEO SECTION

Dong Sup Lee 1, Hee Youn Kim 1, Seung-Ju Lee 1
1 Department of Urology, The Catholic University of Korea, St. Vincent’s Hospital, South Korea

 

No abstract available

[Full Text]


Laparoscopic transperitoneal repair of retrocaval (circumcaval) ureter

Vol. 43 (x): 2017 October 30.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0409


VIDEO SECTION

Kaan Gokcen 1, Gokce Dundar 2, Gokhan Gokce 1, Emin Yener Gultekin 1
1 Cumhuriyet University Faculty of Medine, Department of Urology, Sivas, Turkey; 2 Cizre State Hospital, Department of Urology, Cizre, Turkey

 

No abstract available

[Full Text]


Surgical repair in case of covered exstrophy of bladder with complete duplication of lower genitourinary tract and visceral sequestration

Vol. 43 (x): 2017 July 7.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2016.0634


VIDEO SECTION

Sachin Sarode 1, Sunil Mhaske 2, Vinayak G. Wagaskar 1, Bhushan Patil 1, Sujata K. Patwardhan 1, Ganesh Gopalakrishnan 3
1 Department of Urology, Seth GSMC and King’s Edward Memorial Hospital, Mumbai, India; 2 Department of Urology, Dr. D. Y. Patil Medical College Pimpri, Pune, India; 3 Department of Urology, Vednayagam Hospital, Coimbatore, India

 

No abstract available

[Full Text]


The association between the outcomes of extraperitoneal laparoscopic radical prostatectomy and the anthropometric measurements of the prostate by magnetic resonance imaging

 Vol. 43 (x): 2017 October 10.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0260


ORIGINAL ARTICLE

Sompol Permpongkosol 1, Supanun Aramay 2, Thawanrat Vattanakul 2, Sith Phongkitkarun 2
1 Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; 2 Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Introduction and objective: To determine the association between the anthropometric measurements by magnetic resonance imaging (MRI) and perioperative outcomes of extraperitoneal laparoscopic radical prostatectomy (ELRP).

Materials and Methods: From 2008 to June 2016, 86 patients underwent preoperative MRI prior to undergoing ELRP for localized prostate cancer. We analyzed the associa­tions between anthropometric measurements of MRI and the perioperative outcomes of patients who underwent ELRP.

Results: The mean patient age was 69.61±8.30 years. The medians of operating time and blood loss were 2.30 hours and 725.30ml, respectively. The total post-surgical complication rate was 1.16%. The median hospital stay was 6.50 days. The pathologi­cal stages for T2 and T3 were 45.74% and 34.04%, respectively. The rate as positive surgical margins (PSMs) was 18.09% (pT2 and pT3; 6.38% and 9.57%). The angles between pubic bone and prostate gland (angle 1&2), were significantly associated with operative time and hospital stay, respectively (p<0.05). There was no correlation be­tween the pelvimetry and positive surgical margin.

Conclusions: The findings of the present study suggest that anthropometric measure­ments of the MRI are related to operative difficulties in ELRP. This study confirmed that MRI planning is the key to preventing complications in ELRP.

Keywords: Prostatectomy; Prostatic Neoplasms; Magnetic Resonance Imaging, Laparoscopy

[Full Text]


Stage effect of chronic kidney disease in erectile function

 Vol. 43 (x): 2017 October 10.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0228


ORIGINAL ARTICLE

Márcio Rodrigues Costa 1, Viviane Campos Ponciano 2, Théo Rodrigues Costa 3, Caio Pereira Gomes 1, Enio Chaves de Oliveira 1
1 Escola Médica da Universidade Federal de Goiás, GO Brasil; 2 Mercy Holy House, Goiânia, GO, Brasil; 3 Hospital Geral de Goiânia Doutor Alberto Rassi, GO, Brasil

ABSTRACT

Purpose: The study aims to assess the influence of the stage of chronic kidney disease and glomerular filtration rate on prevalence and degree of erectile dysfunction.

Materials and Methods: This transversal study, conducted from May 2013 to Decem­ber 2015, included patients with chronic kidney disease in conservative treatment, stages III/IV/V. Erectile dysfunction was evaluated by the International Index of Erec­tile Function. Data classically associated with erectile dysfunction were obtained by medical record review. Erectile dysfunction, degree of erectile dysfunction, and other main variables associated with erectile dysfunction were compared between patients with chronic kidney disease on conservative treatment stages III versus IV/V using the Chi-square test. The relationship between score of the International Index of Erectile Dysfunction and glomerular filtration rate was established by Pearson correlation coef­ficient.

Results: Two hundred and forty five patients with chronic kidney disease in con­servative treatment participated of the study. The prevalence of erectile dysfunction in patients with chronic kidney disease in stages IV/V was greater than in stage III. Glomerular filtration rate positively correlated with score of the International Index of Erectile Dysfunction.

Conclusions: The study suggests that chronic kidney disease progression (glomerular filtration rate decrease and advance in chronic kidney disease stages) worsen erectile function. Hypothetically, diagnosis and treatment of erectile dysfunction may be an­ticipated with the analysis of chronic kidney disease progression.

Keywords:  Renal Insufficiency, Chronic; Kidney Failure, Chronic; Erectile Dysfunction

[Full Text]


 

Saphenous-sparing laparoscopic inguinal lymphadenectomy

Vol. 43 (x): 2017 October 10.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0120


VIDEO SECTION

Gaetano Chiapparrone 1, Sebastiano Rapisarda 2, Bernardino de Concilio 2, Guglielmo Zeccolini 2, Michele Antoniutti 2, Antonio Celia 2
1 Department of Urology, Ospedale do Cattinara, Trieste – Italy; 2 San Bassiano Hospital – Urology, Bassano del Grappa, Italy

ABSTRACT

Introduction: Inguinal lymphadenectomy is an integral part in the management of penile cancer. Video endoscopic in­guinal lymphadenectomy (VEIL) is emerging as a minimally invasive treatment to reduce postoperative complications.

Materials and Methods: 62 years old man underwent glansectomy for a squamous cell carcinoma (pT1b). At the physical examination one left inguinal lymph node was detectable (cN1). The chest-abdomen-pelvis CT was negative for me­tastasis. A 10-mm optical trocar and two 5mm operating trocar were placed. The optical trocar was placed in the apex of Scarpa’s triangle after a skin incision and after the creation of a subcutaneous space by blunt finger dissection. The pCO2 was 8-10mmHg. The surgical technique involved the removal of superficial lymph nodes according to the scheme described by Deseler and of the deep lymph nodes. Sparing main venous structures and closing lymphatic vessels is im­portant to reduce post operative complications. At the end of the procedure, a suction drain was placed per side.

Results: Operative time was 90 minutes per side. Drains were removed on the seventh postoperative day. Hospital stay was 8 days and no postoperative complications occurred. The total number of nodes removed was 16 (8 per side) with 2 superficial positive nodes on the left side.

Conclusion: ILND is burned by a high complication rate. VEIL provides a less invasive approach and a saphenous-sparing technique ensures a lower complication rate, reducing lymphorrhea, skin necrosis and wound complications (1-3). In experienced laparoscopic hands, VEIL is a safe and effective treatment.

[Full Text]


An unusual presentation of urethral duplication presenting with chronic bladder retention, left scrotal transposition and left renal agenesis

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

doi: 10.1590/S1677-5538.IBJU.2016.0119


VIDEO SECTION

Antonio Macedo Jr. 1, Marcela Leal da Cruz 1, João Luiz Gomes Parizi 1, Gustavo Marconi Caetano Martins 1, Riberto Liguori 1, Sérgio Leite Ottoni 1, Bruno Leslie 1, Gilmar Garrone 1
1 Universidade Federal de São Paulo, São Paulo, Brasil

ABSTRACT

Introduction and objective: Urethral duplication is a rare congenital anomaly, with roughly 200 cases reported in the literature (1). It is more frequent in males, with few cases reported in females. The clinical presentation differs according to the anatomical variant present. The duplication most commonly occurs in the sagittal plane with one urethra located ventrally and the other dorsally (2). Usually the ventral urethra is the more functional of both. Duplications occurring in the coronal plane are quite rare and they are usually associated with bladder duplication (3). The purpose of this paper was to present a video of a boy with an unusual urethral duplication form.

Materials and Methods: Patient was born premature due to oligohydramnios at 7 months-gestational age and he has initial diagnosis of hypospadia. Since then, he presented at least 7 febrile UTI and mother complained of difficult micturition and a presence of a mass at lower abdomen. Patient was referred to our institution and we identified urethral duplication with a glandar and scrotal meatus, palpable bladder and left penile-hemiscrotum transposition. US and CT-scan showed left kidney agenesis and overdistended bladder. VCUG and retrograde urethrography showed duplication, presence of contrast in the seminal vesicles and complete catheterizing of both urethras was not possible.

Results: The topic urethra was dysplastic and not patent to a 4Fr plastic tube so we were unable to access it endoscopically.

We performed initially a Mitrofanoff procedure to allow CIC and treat chronic retention. Six months later, we assessed both urethras surgically and concluded that dorsal urethra was dysplastic after 3cm still in the penile area and scrotal urethra was not possible to be catheterized. We excised the ventral urethra because of dribbling complaints up to bulbar area and reconstructed the scrotal transposition, keeping the topic urethra for cosmetic issues. Patient had excellent outcome, performs CIC every 4 hours and has not presented further UTI episodes.

Discussion and conclusion: The urethral duplication is an anomaly that has multiple anatomical presentations. There are several theories about the etiology, but none can explain all types of presentations. There is also more than one rating available, and the Effmann classification is the most detailed. The case exemplifies this varied spectrum of anatomic urethral duplication. It resembles the urethral duplication type IIa-Y, however, ventral urethra meatus was located in penoscrotal area and both urethras were at least partially hypoplastic/dysplastic associated with obstruction and bladder retention. In determining how to best manage a patient with Y-type urethral duplication, the caliber and quality of the orthotopic urethra must first be assessed. Published reports suggest that best outcomes are those using the ventral duplicated urethra for the reconstruction (4). In this case, none of urethras were functional and a supravesical outlet channel had to be provided. The treatment of this condition requires an individualized planning and a vast technical knowledge of reconstructive surgery.

[Full Text]


Prostate cancer recurrence in vas deferens – fusion image guide as an important tool in dignosis

 Vol. 43 (x): 2017 August 8.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0071


CHALLENGING CLINICAL CASES

Leonardo Guedes Moreira Valle 1, Antônio Rahal Jr. 1, Priscila Mina Falsarella 1, Juliano Ribeiro de Andrade 1, Oren Smaletz 2, Akemi Osawa 3, Rodrigo Gobbo Garcia 1
1 Departamento de Radiologia Intervencionista, Hospital Israelita Albert Einstein, São Paulo, Brasil; 2 Departamento de Oncologia, Hospital Israelita Albert Einstein, São Paulo, Brasil; 3 Departamento de Medicina Nuclear e Radiologia, Hospital Israelita Albert Einstein, São Paulo, Brasil

ABSTRACT

The biochemical recurrence after local treatment for prostate cancer is an often chal­lenging condition of clinical management. The aim of this report is to demonstrate the importance of the association of various imaging methods in the identification and subsequent accurate percutaneous biopsy in patients with recurrence of prostate cancer, especially in unusual sites.

An 86 years old male with biochemical recurrence, during radiological investigation a PET-MRI was noted the presence of an asymmetry of the vas deferens with PSMA- 68Ga uptaken, suggesting the recurrence. A percutaneous fusion biopsy with PET-MRI and ultrasound was performed using transrectal access using ultrasound confirming infiltrating adenocarcinoma of the wall of the vas deferens, compatible with neoplastic prostate recurrence.

The fusion image technique combines the real-time view of the US to the possibility of higher definition and higher specificity, methods more anatomical detail as tomography and magnetic resonance imaging, simultaneously.

High resolution acquired in PET / MR associated with image fusion allows orienta­tion procedures, even in areas of difficult access, with greater accuracy than con­ventional techniques.

Keywords: Prostatic Neoplasms; Vas Deferens; Therapeutics

[Full Text]


Impact of testicular sperm extraction and testicular sperm aspiration on gonadal function in an experimental rat model

Vol. 43 (x): 2017 July 7.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2016.0652


ORIGINAL ARTICLE

Leocácio Venícius Sousa Barroso 1, Ricardo Reges 1, João Batista Gadelha Cerqueira 1, Eduardo P. Miranda 1, Rafael Jorge Alves de Alcantara 1, Francisco Vagnaldo F. Jamacaru 2, Manoel Odorico de Moraes 2, Maria Angelina da Silva Medeiros 2, Lúcio Flávio Gonzaga-Silva 1
1 Divisão de Urologia, Universidade Federal do Ceará, CE, Brasil; 2 Departamento de Farmacologi, Universidade Federal do Ceará, CE, Brasil

ABSTRACT  

Purpose: To assess the impact of sperm retrieval on the gonadal function of rats with impaired spermatogenesis by comparing testicular sperm extraction (TESE) to aspira­tion (TESA). The efficacy of these procedures to sperm obtainment was also compared. Materials and Methods: A pilot study showed impaired spermatogenesis, but normal testosterone (T) production after a bilateral orchidopexy applied to 26 rats, which were randomly assigned into four groups: TESE (n=7), TESA (n=7), SHAM (n=6) and Control (n=6). The T levels were measured through comparative analysis after the orchidopexy. Results: There was no statistical difference in the animal’s baseline T levels after orchi­dopexy in comparison to the controls: the TESE and TESA groups, 6.66±4.67ng/mL; the SHAM group (orchidopexy only), 4.99±1.96ng/mL; and the Control, 4.75±1.45ng/ mL, p=0.27. Accordingly, no difference was found in the postoperative T levels: TESE, 5.35±4.65ng/mL; TESA, 3.96±0.80ng/mL; SHAM, 3.70±1.27ng/mL; p=0.4. The number of sperm cells found through TESE (41.0±7.0) was significantly larger than that found through TESA (21.3±8.1, p=0.001). Moreover, higher tissue weight was found through TESE (0.09±0.02g versus 0.04±0.04g, p=0.04).

Conclusions: The testicular sperm capture performed in rats through extraction or as­piration, after orchidopexy, did not significantly decrease the T levels. The amount of sperm found through testicular sperm extraction was higher than that through testicu­lar sperm aspiration.

Keywords:  Infertility; Hypogonadism; Testosterone

[Full Text]


Effectiveness and durability of solifenacin versus percutaneous tibial nerve stimulation versus their combination for the treatment of women with overactive bladder syndrome: a randomized controlled study with a follow-up of ten months

 Vol. 43 (x): 2017 August 8.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2016.0611


ORIGINAL ARTICLE

Carlo Vecchioli-Scaldazza 1, Carolina Morosetti 2
1 Division of Urogynecology, ASUR, Jesi, Italy; 2 Clinical Pathology, ASUR, Jesi, Italy

ABSTRACT

Purpose: To assess effectiveness and durability of Solifenacin (SS) versus tibial nerve stimulation (PTNS) versus combination therapy (PTNS + SS) in women with overactive bladder syndrome (OAB).

Materials and Methods: 105 women with OAB were divided randomly into three groups of 35 patients each. In group A women received SS, in group B women under­went PTNS, in group C women underwent combination of PTNS + SS. Improvements in OAB symptoms were assessed with OABSS questionnaire; patients’ quality of life was assessed with OAB-q SF questionnaire. Evaluation of effectiveness of treatments was performed with PGI-I questionnaire. OABSS and PGI-I were also assessed monthly for ten months.

Results: All treatments were effective on symptoms. PTNS showed a greater effective­ness than SS, but PTNS + SS was more effective than SS and PTNS. Furthermore, PTNS + SS showed a greater duration of effectiveness than PTNS and SS.

Conclusions: Combination of PTNS with SS showed more effectiveness and more du­rability than PTNS and SS alone.

Keywords:  Urinary Bladder, Overactive; Combined Modality Therapy; Solifenacin Succinate

[Full Text]


The demographic features, clinical outcomes, prognosis and treatment options for patients with sarcomatoid carcinoma of the urinary bladder: a single centre experience

 Vol. 43 (x): 2017 August 8.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2016.0347


ORIGINAL ARTICLE

Simon Paul Robinson 1, Assad Farooq 2, Marc Laniado 3, Hanif Motiwala 3
1 Frimley Health Foundation Trust – Urologia, Wexham Street, Slough, United Kingdom, UK; 2 Heatherwood and Wexham Park Hospitals NHS Trust, Wexham Park Hospital Wexham Slough, Slough, United Kingdom, UK; 3 Department of Urology, Heatherwood and Wexham Park Hospitals NHS Trust – Slough, Berkshire, United Kingdom, UK

ABSTRACT

Introduction: Carcinosarcoma of the bladder is a very rare neoplasm. The pathogenesis of carcinosarcomas is not clearly understood and remains a subject of debate. Whilst there is some research conceptualizing the histopathological findings of bladder car­cinosarcomas, the demographic features, clinical outcomes, prognosis and treatment options remain unclear.

Materials and Methods: We analyzed 12 consecutive cases of patients with sarco­ma-toid bladder cancer who were treated surgically at a single Urology Department be-tween 1999 and 2015. Radiology, pathology and surgical reports were reviewed to determine the pathological staging at the time of cystectomy. These were directly compared with 230 patients having cystectomies for urothelial cell carcinoma. The sarcomatoid patients, were compared to patients with urothelial cell cancers. The other histological sub types, squamous cell (17), neuroendocrine (9), metastatic (7), mixed (4), adenocarcinoma (3), were not included.

Results and conclusion: Carcinosarcoma of the urinary bladder is often described in the literature as a highly malignant neoplasm that is rapidly lethal. We found that the sarcoma does not offer a worse prognosis than conventional high-grade urothelial car-cinoma. There is no significant difference in grade, stage, positive surgical margin rate, nodal involvement, associated prostate cancer or incidence rates of progression, all cause or disease specific mortality. There was a barely significant difference in car­cinoma in-situ. However, carcinosarcomas are three times the volume of urothelial cell tumors which may contribute to its reputation as an aggressive tumour (44cc v 14cc). Sarcomatous elements do not appear, from our small study, to bestow a worse prognosis.

Keywords: Urinary Bladder; Sarcoma; Carcinoma

[Full Text]


Biochemical recurrence after radical prostatectomy: what does it mean?

Vol. 43 (x): 2017 May 5.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2016.0656


REVIEW ARTICLE

Rafael Tourinho-Barbosa 1,2, Victor Srougi 1,3, Igor Nunes-Silva 1, Mohammed Baghdadi 1, Gregory Rembeyo 1, Sophie S. Eiffel 1, Eric Barret 1, Francois Rozet 1, Marc Galiano 1, Xavier Cathelineau 1, Rafael Sanchez-Salas 1
1 Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France; 2 Divisão de Urologia, Faculdade de Medicina ABC, São Paulo, Brasil; 3 Divisão de Urologia, Universidade de São Paulo, São Paulo, Brasil

ABSTRACT

Background: Radical prostatectomy (RP) has been used as the main primary treatment for prostate cancer (PCa) for many years with excellent oncologic results. However, approximately 20-40% of those patients has failed to RP and presented biochemical recurrence (BCR). Prostatic specific antigen (PSA) has been the pivotal tool for recurrence diagnosis, but there is no consensus about the best PSA threshold to define BCR until this moment. The natural history of BCR after surgical procedure is highly variable, but it is important to distinguish biochemical and clinical recurrence and to find the correct timing to start multimodal treatment strategy. Also, it is important to understand the role of each clinical and pathological feature of prostate cancer in BCR, progression to metastatic disease and cancer specific mortality (CSM).

Review design: A simple review was made in Medline for articles written in English language about biochemical recurrence after radical prostatectomy.

Objective: To provide an updated assessment of BCR definition, its meaning, PCa natural history after BCR and the weight of each clinical/pathological feature and risk group classifications in BCR, metastatic disease and CSM.

 

Keywords: Prostatic Neoplasms; Prostate-Specific Antigen; Prostatectomy

[Full Text]


Effects of Copaiba oil in the healing process of urinary bladder in rats

Vol. 43 (x): 2017 August 8.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0143


ORIGINAL ARTICLE

Denilson José Silva Feitosa Junior 1, Luan Teles Ferreira de Carvalho 1, Ingrid Rodrigues de Oliveira Rocha 1, Camila Noura de Brito 1, Rodrigo Alencar Moreira 2, Carlos Alberto Villacorta de Barros 3
1 Laboratório de Cirurgia Experimental, Universidade Estadual do Pará, Belém, PA, Brasil; 2 Departamento de Pesquisa Cirúrgica e Experimental, Universidade Estadual do Pará, Belém, PA, Brasil; 3 Departamento de Cirurgia Experimental e Anestesiologia, Universidade Estadual do Pará, Belém, PA, Brasil

ABSTRACT

 

Introduction: The appropriate closure of the urinary bladder is important to many uro­logic procedures to avoid the formation of fistulas and strictures by excessive fibrosis. This paper presents the alterations in the bladder healing process of rats after the topi­cal use of Copaiba oil (Copaifera reticulata).

Material and Methods: Ten male Wistar rats were used and randomly divided into two groups: Control group (CG): injected 1ml/kg of saline solution on the suture line; and Copaiba group (CpG): 0.63ml/kg of copaiba oil applied to the suture line. Euthanasia was performed on the seventh day after surgery. The criteria observed were adherences formation, histopathological modifications and stereology for collagen.

Results: Both groups showed adhesions to the bladder, with no statistically significant difference (p=0.1481). The microscopic evaluation revealed a trend to more severe acute inflammation process on the CpG, but there was statistical difference only in the giant cells reaction (p=0.0472) and vascular proliferation (p=0.0472). The stereology showed no difference.

Conclusion: The copaiba oil modified the healing process, improving the quantity of giant cells and vascular proliferation, but not interfered in the collagen physiology.

Keywords: Urinary Bladder; Wound Healing; Plants, Medicinal; Collagen

[Full Text]


Step by step male to female transsexual surgery

Vol. 43 (x): 2017 July 7.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0044


VIDEO SECTION

Rodrigo Uliano Moser da Silva 1, Fernando Jahn da Silva Abreu 1, Gabriel M. V. Da Silva 1, João Vitor Quadra Vieira dos Santos 1, Nelson Sivonei da Silva Batezini 1, Brasil Silva Neto 1, Tiago Elias Rosito 1
1 Departamento de Urologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil

 

ABSTRACT

Introduction: After the diagnosis of transsexualism is confirmed therapy commences with psychotherapeutic preparation for the conversion, and after conversion, long-term patient rehabilitation is maintained for at least two years. The indication for surgery is chronic discomfort caused by discord with the patient’s natural gender, intense dislike of developing secondary sex characteristics and the onset of puberty. The surgical conversion of transsexuals is the main step in the complex care of these problematic patients (1). This surgery was first described by Benjamin H, using a flap of inverted penile skin (2) and is considered the gold standard since then. Male-to-female transsexual surgical techniques are well defined and give good cosmetic and functional results. Sex reassignment surgery promotes the improvement of psychological aspects and social relationships as shown in the World Health Organization Quality of Life Assessment applied in the patients submitted to this procedure (3). Techniques include the creation of a normal appearing female introitus, a vaginoplasty allowing sexual intercourse and the capability of clitoral orgasm (4). Various methods for neovaginoplasty have been described and can be classified into five categories, i.e. pedicled intestinal transplants, penile skin grafts, penile skin flaps, non-genital skin flaps and non-genital skin grafts (5). In our Hospital, we use penile and scrotal skin flaps.

Until now, 174 procedures have been performed by our team using this technique with high rates of satisfaction (3).

Patients and methods: We present a step-by-step male to female transsexual surgery.

Conclusion: Surgical gender reassignment of male transsexuals resulted in replicas of female genitalia which enabled coitus with orgasm (1). With this video we show step by step that a surgery using penile skin flaps is able to be performed with good cosmetic results.

[Full Text]


Laparoscopic – assisted percutaneous nephrolithotomy as an alternative in the treatment of complex renal calculi in patients with retrorenal colon

Vol. 43 (x): 2017 July 7.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0043


VIDEO SECTION

Petronio Augusto de Souza Melo 1, Fabio Carvalho Vicentini 1, David Jacques Cohen 1, Marcelo Hisano 1, Claudio Bovolenta Murta 1, Joaquim Francisco de Almeida Claro 1
1 Divisão de Urologia, Centro de Referência da Saúde do Homem, Hospital Brigadeiro, São Paulo, SP, Brasil

No Abstract available

[Full Text]


Robot-assisted laparoscopic bladder diverticulectomy and greenlight laser anatomic vaporization of the prostate

Vol. 43 (x): 2017 July 7.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0016


VIDEO SECTION

Luca Cindolo 1, Manuela Ingrosso 1, Michele Marchioni 2, Ambra Rizzoli 2, Francesco Berardinelli 2, Luigi Schips 1
1 Department of Urology, ASL Abruzzo 2, Chieti, Italy; 2 Department of Urology, SS Annunziata Hospital, “G. D’Annunzio” University of Chieti, Chieti, Italy

No Abstract available

[Full Text]


Robot-assisted single port radical nephrectomy and cholecystectomy: description and technical aspects

Vol. 43 (x): 2017 June 6.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2016.0560


VIDEO SECTION

Francisco Hidelbrando Alves Mota Filho 1,2, Luis Felipe Sávio 1, Rafael Eiji Sakata 1, Renato Fidelis Ivanovic 1,2, Marco Antonio Nunes da Silva 1, Ronaldo Soares Maia 1, Carlo Camargo Passerotti 1,2
1 Centro de Cirurgia Robótica do Hospital Alemão Oswaldo Cruz, São Paulo. Brasil; 2 Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil

ABSTRACT

Introduction: Robot-Assisted Single Site Radical Nephrectomy (RASS-RN) has been reported by surgeons in Europe and United States (1-3). To our best knowledge this video presents the first RASS-RN with concomitant cholecystectomy performed in Latin America.

Case: A 66 year-old renal transplant male due to chronic renal failure presented with an incidental 1.3cm nodule in the upper pole of the right kidney. In addition, symptomatic gallbladder stones were detected.

Results: Patient was placed in modified flank position. Multichannel single port device was placed using Hassan’s tech­nique through a 3cm supra-umbilical incision. Standard radical nephrectomy and cholecystectomy were made using an 8.5mm camera, two 5mm robotic arms and an assistant 5mm access. Surgery time and estimated blood loss were 208 minutes and 100mL, respectively. Patient did well and was discharged within less than 48 hours, without complications. Pathology report showed benign renomedullary tumor of interstitial cells and chronic cholecystitis.

Discussion: Robotic technology improves ergonomics, gives better precision and enhances ability to approach complex surgeries. Robot-assisted Single Port aims to reduce the morbidity of multiple trocar placements while maintaining the advantages of robotic surgery (2). Limitations include the use of semi-rigid instruments providing less degree of motion and limited space leading to crash between instruments. On the other hand, it is possible to perform complex and con­comitant surgeries with just one incision.

Conclusion: RASS-RN seems to be safe and feasible option for selected cases. Studies should be performed to better un­derstand the results using single port technique in Urology.

[Full Text]


Risk factors for mortality in fournier’s gangrene in a general hospital: use of simplified founier gangrene severe index score (SFGSI)

Vol. 43 (x): 2017 August 8.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0193


ORIGINAL ARTICLE

Carlos Eugênio Lira Tenório 1, 2, Salvador Vilar Correia Lima 1, 3, Amanda Vasconcelos de Albuquerque 3, Mariana Pauferro Cavalcanti 2, Flávio Teles 2
1 Serviço de Urologia do Hospital das Clínicas, Departamento de Cirurgia do Centro de Ciências da Saúde da Universidade Federal de Pernambuco, UFPE, Recife, PE, Brasil; 2 Faculdade de Medicina da Universidade Estadual de Ciências da Saúde de Alagoas (UNCISAL), Maceió, AL, Brasil; 3 Núcleo de Cirurgia Experimental, Programa de Pós-Graduação em Cirurgia, Departamento de Cirurgia, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, UFPE, Recife, PE, Brasil

ABSTRACT

Objective: To evaluate risk factors for mortality in patients with Fournier’s gangrene (FG), with emphasis in the Simplified Fournier Gangrene Severe Index Score (SFGSI).

Materials and Methods: This was a cross-sectional study that was carried out from January 2010 to December 2014, with 124 patients treated for FG in a General Hospital. Several clinical and laboratory variables, including SFGSI, were evaluated and corre­lated with mortality through univariate analysis and logistic regression.

Results: Of the 124 patients, 99 were men (79.8%), the mean age was 50.8±19.5 years and the main comorbidity was diabetes mellitus (51.6%). The mortality rate was 25.8%. Variables that presented independent correlation with mortality were the extension of the lesion to the abdomen (OR=4.0, CI=1.10-14.68, p=0.03), hematocrit (OR=0.81, CI=0.73-0.90, p<0.0001), potassium (OR=2.41, CI=1.13-5.10, p=0.02) and creatinine (OR=2.15, CI=1.04-4.41, p=0.03). When hematocrit, potassium and creatinine were tested together, as part of the SFGSI, a >2 result was the largest of the independent predictors of mortality (OR=50.2; CI=13.18-191.47; p<0.0001).

Conclusion: The SFGSI >2 presented a higher correlation with mortality than any variable tested alone. It seems to be a promising alternative to evaluate predictors of mortality in Fournier’s gangrene. The main advantage is easy applicability because it contains only three parameters and can be used immediately after patient’s admission.

Keywords: Fournier Gangrene; Risk Factors; Mortality; Fasciitis, Necrotizing

[Full Text]


Spermatozoa retrieval for cryopreservation after death

Vol. 43 (x): 2017 August 8.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0249


CHALLENGING CLINICAL CASES

Fernando Lorenzini 1, Eduardo Zanchet 1, Gustavo M. Paul 1, Ricardo T. Beck 1, Mariana S. Lorenzini 1, Elisângela Böhme 1

1 Centro de Reprodução Humana Curitiba, PR, Brasil

ABSTRACT

Objectives: To describe the retrieval spermatozoa technique for cryopreservation after death, including the proximal part of vas deferens.
Material and Methods: A 28-years old man, with previous history of infertility, who died 12 hours ago, was submitted to spermatozoa retrieval for cryopreservation, with surgical bilateral resection in bloc of the proximal part of vas deferens, testicle and epididymis. At the laboratory, by milking the epididymis and vas deferens, the ex¬tracted fluid was collected; also, three samples of each testicle parenchyma were also harvested.
Results: The fluid from the vas deferens showed spermatozoa, mostly with in situ motility. Testicular fragments also presented spermatozoa, mostly with small tail movements or immobile.
Conclusion: The inclusion of the proximal part of vas deferens during spermatozoa retrieval after death must be performed, since it contains high concentration of sper¬matozoa, and even in the presence of previous infertility, as was with this patient, it is possible to retrieve spermatozoa.

Keywords: Cryopreservation; Spermatozoa; Vas Deferens; Testis

[Full Text]


Incidentally detected tuberculous prostatitis with microabscess

 Vol. 43 (x): 2017 July 7.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0190


RADIOLOGY PAGE

Eduardo Kaiser Ururahy Nunes Fonseca 1, Oskar Grau Kaufmann 1, Layra Ribeiro de Sousa Leão 1, Cassia Franco Tridente 1, Fernando Ide Yamauchi 1, Ronaldo Hueb Baroni 1
1 Hospital Israelita Albert Einstein, São Paulo, Brasil

ABSTRACT  

Tuberculous prostatitis is a rare and often overlooked entity that may mimic prostatic adenocarcinoma on imaging exams, especially multiparametric magnetic resonance imaging (MRI) of the prostate. Detection of a prostatic abscess is a clue to the correct diagnosis.

Keywords: Prostate; Tuberculosis; MRI; Radiology

[Full Text]


A Safe teaching protocol of LRP (laparoscopic radical prostatectomy)

Vol. 43 (x): 2017 August 8.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0137


ORIGINAL ARTICLE

Marcos Tobias-Machado 1, Cristiano Linck Pazeto 1, Oseas Castro Neves-Neto 1, Igor Nunes-Silva 2, Hamilton de Campos Zampolli 2
1 Departamento de Urologia, Faculdade de Medicina ABC, Santo André, SP, Brasil; 2 Instituto do Câncer Arnaldo Vieira de Carvalho – IAVC , São Paulo, SP, Brasil

Purpose: The LRP has a steep learning curve to obtain proficiency during which patient safety may be compromised. We present an adapted modular training system which purpose to optimize the learning curve and perform a safe surgery.

Materials and Methods: A retrospective analysis of the LRP safe learning protocol ap­plied during a fellowship program over eight years (2008-2015).

The surgery was divided in 12 steps and 5 levels of difficulty. A maximum time interval was stipulated in 240 minutes. After an adaptation, the fellows had 120 minutes to perform all the corresponding modules to its accumulated skill. The participants gradually and safely pass through the steps and difficulty levels. Surgeries performed by fellows were analyzed as a single group and compared to a prior series performed by tutor.

Results: In eight years, 250 LRP were performed (25 per apprentice) during fellowship program and 150 procedures after completion. The baseline characteristics were com­parable. Most cases operated were of intermediate risk. Mean operative time was longer in the fellow group when compared to the tutor (150 min). Mean estimated blood loss were similar among the groups. Functional and oncological outcomes were better in the Tutor´s group. No conversion to open surgery was performed.

Conclusions: The LRP safe learning protocol proved to be an effective method to opti­mize the learning curve and perform safe surgery. However, the tutor’s functional and oncological results were better, showing that this is a procedure with a steep learning curve and proficiency demands more than 25 cases.

Keywords: Prostatectomy; Education; Surgical Procedures, Operative

[Full Text]


 

Magnetic resonance imaging and clinical findings in seminal vesicle pathologies

Vol. 43 (x): 2017 July 7.[Ahead of print]

10.1590/S1677-5538.IBJU.2017.0153


ORIGINAL ARTICLE

Zafer Ozmen 1, Fatma Aktas 1, Nihat Uluocak 2, Eda Albayrak 1, Ayşegül Altunkaş 1, Fatih Çelikyay 1
1 Department of Radiology, School of Medicine, Gaziosmanpaşa University, Tokat, Turkey; 2 Department of Urology, School of Medicine, Gaziosmanpaşa University, Tokat, Turkey

ABSTRACT

Purpose: Congenital and acquired pathologies of the seminal vesicles (SV) are rare dis­eases. The diagnosis of SV anomalies is frequently delayed or wrong due to the rarity of these diseases and the lack of adequate evaluation of SV pathology. For this reason, we aimed to comprehensively evaluate SV pathologies and accompanying genitouri­nary system abnormalities.

Materials and Methods: Between March 2012 and December 2015, 1455 male patients with different provisional diagnosis underwent MRI. Congenital and acquired pathol­ogy of the SV was identified in 42 of these patients. The patients were categorized ac­cording to their SV pathologies. The patients were analyzed in terms of genitourinary system findings associated with SV pathologies.

Results: SV pathologies were accompanied by other genitourinary system findings. Congenital SV pathologies were bilateral or predominantly in the left SV. Patients with bilateral SV hypoplasia were diagnosed at an earlier age compared to patients with unilateral SV agenesis. There was a significant association between abnormal signal intensity in the SV and benign prostate hypertrophy (BPH) and patient age.

Conclusion: SV pathologies are rare diseases of the genitourinary system. The asso­ciation between seminal vesicle pathology and other genitourinary system diseases requires complete genitourinary system evaluation that includes the seminal vesicles.

Keywords: Seminal Vesicles; Pathology; Magnetic Resonance Imaging

 

[Full Text]


 

Can hydrophilic coated catheters be beneficial for the public healthcare system in Brazil? – A cost-effectiveness analysis in patients with spinal cord injuries

Vol. 43 (x): 2017 July 7.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0221


ORIGINAL ARTICLE

José Carlos Truzzi 1,2, Vanessa Teich 3, Camila Pepe 3
1 Escola Paulista de Medicina, Universidade Federal de São Paulo, SP, Brasil; 2 Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil; 3 Sense Company, São Paulo, SP, Brasil

ABSTRACT

Introduction: Detrusor sphincter dyssynergia affects 70% to 80% of all spinal cord in­jury patients, resulting in increased risk of urinary tract infections (UTIs) and potential exposure to antimicrobial resistance. In Brazil, local guidelines recommend intermit­tent catheterization as the best method for bladder emptying, and two catheter types are available: the conventional uncoated PVC and the hydrophilic coated catheters.

Objective: To evaluate the cost-effectiveness of two types of catheters for intermittent catheterization from the perspective of the Brazilian public healthcare system.

Materials and Methods: A Markov model was used to evaluate cost-effectiveness in those with spinal cord injuries. A primary analysis was conducted on all possible ad­verse events, and a secondary analysis was performed with urinary tract infections as the only relevant parameter. The results were presented as cost per life years gained (LYG), per quality-adjusted life years (QALY) and per number of urinary tract infections (UTIs) avoided.

Results: The base scenario of all adverse events shows a cost-effective result of hydro­philic coated catheters compared to uncoated PVC catheters at 57,432 BRL (Brazilian Reais) per LYG and 122,330 BRL per QALY. The secondary scenario showed that the use of hydrophilic coated catheters reduces the total number of UTIs, indicating that an additional cost of hydrophilic coated catheters of 31,240 BRL over a lifetime will reduce lifetime UTIs by 6%.

Conclusions: Despite the higher unit value, the use of hydrophilic coated catheters is a cost-effective treatment from the perspective of the Brazilian public healthcare system.

Keywords: Cost-Benefit Analysis; Spinal Cord Injuries; Intermittent Urethral Catheterization; Urinary Tract Infections

[Full Text]


 

Early term effect of ureterorenoscopy (URS) on the Kidney: research measuring NGAL, KIM-1, FABP and CYS C levels in urine

Vol. 43 (x): 2017 July 7.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2016.0638


ORIGINAL ARTICLE

Erdal Benli 1, Sema Nur Ayyildiz 2, Selma Cirrik 3, Tevfik Noyan 2, Ali Ayyildiz 4, Abdullah Cirakoglu 1
1 Department of Urology, Faculty of Medicine, Ordu University, Ordu, Turkey; 2 Department of Biochemistry, Faculty of Medicine, Ordu University, Ordu, Turkey; 3 Department of Physiology, Faculty of Medicine, Ordu University, Ordu, Turkey; 4 Department of Urology, Research and Training Hospital, Ankara, Turkey

ABSTRACT

Aim: URS is a very commonly used procedure for treatment of ureter stones. Increased hydrostatic pressure in the collecting system linked to fluids used during the procedure may cause harmful effects on the kidney. The aim of this study is to determine whether the URS procedure has a negative effect on the kidney by investigating NGAL, KIM-1, FABP and Cys C levels in urine.

Material and Methods: This study included 30 patients undergoing ureterorenoscopy (URS) for ureter stones. Urine samples were collected 5 times; before the URS procedure (control) and at 1, 3, 5 and 12 hours following the procedure. NGAL, KIM-1, FBAP and Cys C levels were measured in urine and compared with the control values.

Results: The NGAL levels in urine before the procedure and at 1, 3, 5 and 12 hours after the procedure were 34.59±35.34; 62.72±142.32; 47.15±104.48; 45.23±163.16 and 44.99±60.79ng/mL, respectively (p=0.001). Similarly, the urinary KIM-1, FABP and Cys C levels were found to increase compared to control values; however this increase did not reach statistical significance (p >0.05).

Conclusions: After the URS procedure, there were important changes in NGAL, FABP, KIM-1 and Cys C levels. These changes reached statistical significance for NGAL, but did not reach significance for the other parameters. In conclusion, the URS procedure significantly affects the kidney; however, this effect disappears over time.

Keywords: Acute Kidney Injury; Kidney; Lithotripsy

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Retroperitoneal access for robotic renal surgery

Vol. 43 (x): 2017 June 6.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2016.0633


VIDEO SECTION

Barrett G. Anderson 1, Alec J. Wright 1, Aaron M. Potretzke 1, R. Sherburne Figenshau 1
1 Washington University School of Medicine, Division of Urology, Saint Louis, Missouri, USA

Introduction and Objective: Retroperitoneal access for robotic renal surgery is an effective alternative to the commonly used transperitoneal approach. We describe our contemporary experience and technique for attaining retroperitoneal access.

Materials and Methods: We outline our institutional approach to retroperitoneal access for the instruction of urologists at the beginning of the learning curve. The patient is placed in the lateral decubitus position. The first incision is made just inferior to the tip of the twelfth rib as described by Hsu, et al. After the lumbodorsal fascia is traversed, the retroperitoneal space is dilated with a round 10 millimeter AutoSutureTM (Covidien, Mansfield, MA) balloon access device. The following trocars are used: A 130 millimeter KiiR balloon trocar (Applied Medical, Rancho Santa Margarita, CA), three robotic, and one assistant. Key landmarks for the access and dissection are detailed.

Results: 177 patients underwent a retroperitoneal robotic procedure from 2007 to 2015. Procedures performed include 158 partial nephrectomies, 16 pyeloplasties, and three radical nephrectomies. The robotic fourth arm was utilized in all cases. When compared with the transperitoneal approach, the retroperitoneal approach was associated with shorter operative times and decreased length of stay (1). Selection bias and surgeon preference accounted for the higher proportion of patients who underwent partial nephrectomy off-camp via the retroperitoneal approach.

Conclusions: Retroperitoneal robotic surgery may confer several advantages. In patients with previous abdominal surgery or intra-abdominal conditions, the retroperitoneum can be safely accessed while avoiding intraperitoneal injuries. The retroperitoneum also provides a confined space that may minimize the sequelae of potential complications including urine leak. Moreover, at our institution, retroperitoneal robotic surgery is associated with shorter operative times and a decreased length of stay when compared with the transperitoneal approach (2). In selected patients, the retroperitoneal approach is a viable alternative to the transperitoneal approach for a variety of renal procedures.

ARTICLE INFO

Available at: http://www.intbrazjurol.com.br/video-section/20160633_anderson_et_al/

[Full Text]


WITHDRAWN: Comparison of vacuum-assisted closure therapy and debridement with primer surgical closure for fournier’s gangrene treatment: 10 years’ experience of a single centre

Vol. 43 (x): 2017 July 7.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0052


ORIGINAL ARTICLE

Mustafa Ozan Horsanali 1, Utku Eser 2, Burcu O. Horsanali 3, Omer Altaş 3, Huseyin Eren 4
1 Department of Urology, Izmir Katip Celebi University Ataturk Training and Research Hos-pital, Izmir, Turkey; 2 Department of Family Medicine, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey; 3 Department of Anesthesiology and Reanimation, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey; 4 Department of Urology, Recep Tayyip Erdogan University, Rize, Turkey.

ABSTRACT

The International Brazilian Journal of Urology will retract this article because the authors were not authorized to publish the data according to the Department of Urology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey, where the paper was done.


Can baseline serum creatinine and e-GFR predict renal function outcome after augmentation cystoplasty in children?

Vol. 43 (x): 2017 June 6.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0078


ORIGINAL ARTICLE

Prempal Singh 1, Ankur Bansal 1, Virender Sekhon 1, Sandeep Nunia 1, M. S. Ansari 1
1  Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

ABSTRACT

Objective: To assess cut-off value of creatinine and glomerular filtration rate for aug­mentation cystoplasty (AC) in paediatric age-group.

Materials and Methods: Data of all paediatric-patients (<18 years) with small capac­ity bladder, in whom AC was advised between 2005-2015 were reviewed. All patients were divided in two-groups, AC-group and control-group (without AC). Creatinine and e-GFR were assessed at the time of surgery, at 6 months and at last follow-up. Renal function deterioration was defined as increase in creatinine by ≥25% from baseline value or new-onset stage-3 CKD or worsening of CKD stage with pre-operative-CKD stage-3. ROCs were plotted using creatinine and e-GFR for AC.

Results: A total of 94 patients with mean-age 8.9 years were included. The mean cre­atinine and e-GFR were 1.33mg/dL and 57.68mL/min respectively. Out of 94 patients, AC was performed in 45 patients and in the remaining 49 patients AC was not done (control-group), as they were not willing for the same. Baseline patient’s characteris­tics were comparable in both Groups. 22 underwent gastro-cystoplasty (GC) and 25 underwent ileo-cystoplasty (IC). Decline in renal function was observed in 15 (33.3%) patients of AC-group and in 31 (63.3%) patients of control-group. Patients having creatinine ≥1.54mg/dL (P=0.004, sensitivity (S) 63.6% and specificity (s) 90.5%) at baseline and e-GFR <46mL/min (P=0.000, S=100% and s=85.7%) at the time of surgery had significantly increased probability of renal function deterioration on follow-up after AC.

Conclusion: e-GFR <46mL/min and creatinine ≥1.54mg/dL at time of surgery could serve as a predictor of renal function deterioration in AC in paediatric patients.

Keywords: Serum; Delayed Graft Function; Creatinine

[Full Text]


Inflammatory pseudotumor of kidney: a challenging diagnostic entity

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

doi: 10.1590/S1677-5538.IBJU.2017.0063


RADIOLOGY PAGE

Anudeep Mukkamala 1, Robin M. Elliott 2, Nicholas Fulton 3, Vikas Gulani 3, Lee E. Ponsky 1, Riccardo Autorino 1
1 Department of Urology, UH Case Medical Center, Cleveland, Ohio, USA; 2 Department of Pathology, University Hospitals Case Medical Center, Cleveland, Ohio, USA; 3 Department of Radiology, University Hospitals Case Medical Center, Cleveland, Ohio, USA

No abstract available

[Full Text]


Serum tissue factor as a biomarker for renal clear cell carcinoma

Vol. 43 (x): 2017 May 5.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0007


ORIGINAL ARTICLE

Daniel D’Oliveira Silva 1, Jorge A. P. Noronha 1, Bartira E. Pinheiro da Costa 2, Pedro Caetano Edler Zandona 1, Gustavo F. Carvalhal 1
1 Departamentos de Urologia, Pontifícia Universidade Católica, Porto Alegre, RS, Brasil; 2 Instituto de Pesquisas Biomédicas (BEP), Pontifícia Universidade Católica, Porto Alegre, RS, Brasil

 

ABSTRACT

Purpose: to determine the usefulness of serum TF as a potential marker for patients with clear cell RCC.

Materials and Methods: prospective study of 30 patients with clear cell RCC submit­ted to nephrectomy and 16 controls without clear cell RCC treated surgically for other conditions. TF is a endothelium marker that was correlated with worse prognosis in a variety of solid tumors including RCC. Serum TF was collected before surgery at the operating room and in the postoperative setting after at least four weeks. Serum samples were analyzed with a commercial ELISA kit for human TF (R&D Systems®).

Results: Mean preoperative serum TF levels in clear cell RCC patients and in controls were 66.8 pg/dL and 28.4 pg/dL, respectively (p<0.001). Mean postoperative serum TF levels in clear cell RCC patients were 26.3 pg/dL. In all patients with clear cell RCC postoperative serum levels of TF were lower, with a mean reduction of 41.6 pg/dL in the postoperative setting (p<0.001). Linear regression revealed that tumor size was cor­related with the postoperative reduction of serum TF levels (p=0.037).

Conclusions: We have shown a 3-fold reduction in the median preoperative serum levels of TF in patients with clear cell RCC after surgery. We have also shown a differ­ence of the same magnitude in the serum levels of TF compared with those of a control group of patients with benign diseases. TF appears to be a useful serum marker for the presence of clear cell RCC. Further studies are needed to validate these findings.

Keywords: Kidney Neoplasms; Thromboplastin; Biomarkers

[Full Text]


 

A new technique, combined plication-incision (CPI), for correction of penile curvature

Vol. 43 (x): 2017May 5.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2016.0578


SURGICAL TECHNIQUE

Hamed Abdalla Hamed 1, Mohamed Roaiah 1, Ahmed M. Hassanin 1, Adham Ashraf Zaazaa 1, Mahmoud Fawzi 1
1 Department of Andrology, Faculty of Medicine, Cairo University, Cairo, Egypt

ABSTRACT

Introduction: Penile curvature (PC) can be surgically corrected by either corporoplasty or plication techniques. These techniques can be complicated by post-operative: penile shortening, recurrent PC, painful/palpable suture knots and erectile dysfunction.

Objective: To avoid the complications of corporoplasty and plication techniques using a new technique: combined plication-incision (CPI).

Materials and Methods: Two groups (1&2) were operated upon: group 1 using CPI and group 2 using the 16-dot technique. In CPI, dots were first marked as in 16 dot tech­nique. In each group of 4 dots the superficial layer of tunica albuginea was transverse­ly incised (3-6mm) at the first and last dots. Ethibond 2/0, passed through the interior edge of the first incision plicating the intermediate 2 dots and passed out of the interior edge of the last incision, was tightened and ligated. Vicryle 4/0, passed through the exterior edges of the incisions, was tightened and ligated to cover the ethibond knot.

Results: Twelve (57.1 %) participants in group 2 complained of a bothering palpable knot compared to none in group 1 with statistically significant difference (P=0.005). Postoperative shortening (5mm) of erect penis, encountered in 9 participants, was dou­bled in group 2 but with insignificant difference (P>0.05). Post-operative recurrence of PC, was encountered in only 1 (4.8%) participant in group 2, compared to none in group 1, with insignificant difference (P>0.05). Post-operative erectile rigidity was normally maintained in all participants.

Conclusion: The new technique was superior to the 16-dot technique for correction of PC.

Keywords:  Penile Induration; Penis; Erectile Dysfunction

[Full Text]


Hilar Parenchymal Oversew: a novel technique for robotic partial nephrectomy hilar tumor renorrhaphy

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

doi: 10.1590/S1677-5538.IBJU.2017.0049


VIDEO SECTION

Jaya Sai S. Chavali 1, Ryan Nelson 1, Matthew J. Maurice 1, Onder Kara 1, Pascal Mouracade 1, Julien Dagenais 1, Jeremy Reese 1, Pilar Bayona 1, Georges-Pascal Haber 1, Robert J. Stein 1
1 Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA

ABSTRACT

Introduction: A renorrhaphy technique which is effective for hemostasis but does not place undue tension on the branch vessels of the renal sinus remains one of the challenging steps after hilar tumor resection during robotic partial nephrec­tomy (RPN). The published V-hilar suture (VHS) technique is one option for reconstruction after an RPN involving the hilum. The objective of this video is to show a novel renorrhaphy technique, Hilar Parenchymal Oversew that has been effective for such cases.

Materials and Methods: We present two cases of RPN for renal hilar tumors. The first case depicts use of the VHS renor­rhaphy technique for a tumor that abuts the renal hilum along 20% of its diameter. The second case demonstrates tumor resection and reconstruction for a tumor that has >50% involvement of the hilum along its diameter. After tumor resec­tion, individual sinus vessels can be selectively oversewn with 2-0 Vicryl suture on SH needle. The remaining exposed parenchyma is controlled using the Hilar Parenchymal Oversew technique with a #0 Vicryl on CT-1 needle.

Results: For the Hilar Parenchymal Oversew surgery operative time was 225 min, estimated blood loss was 140 ml, warm ischemia time was 19 minutes, and there were no intraoperative complications. Pathology was consistent with clear cell renal cancer with negative margins.

Conclusion: Robotic partial nephrectomy with the Hilar Parenchymal Oversew technique is a good alternative to VHS renorrhaphy in the management of renal hilar tumors “bulging” into the renal sinus with >50% of the tumor diameter abutting the hilum.

ARTICLE INFO

Available at: http://www.intbrazjurol.com.br/video-section/20170049-Chavali_et_al

[Full Text]