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Effect of a high-fat diet on the rat bladder wall and bioactive action of Brazil nut oil

Vol. 44 (x): 2018 December 12.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0547


ORIGINAL ARTICLE

Aline Costa de Souza 1, Carla Braga Mano Gallo 1, Magna Cottini da Fonseca Passos 2, Carolina Croccia 3, Glauciane Lacerda Miranda 3, Francisco José Barcellos Sampaio 1, Bianca Martins Gregório 1
1 Unidade de Pesquisa Urogenital, Centro Biomédico, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; 2 Departamento de Nutrição Aplicada, Instituto de Nutrição, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; 3 Instituto de Nutrição Josue de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil

ABSTRACT

High-fat diet-induced obesity is associated with metabolic disorders. The Brazil nut has bioactive substances and has been used to control the damage caused by obesity in several organs. The work intended to show the damage caused by high-fat diet in the bladder wall and if the Brazil nut oil added to the diet could ameliorate or reverse this effect. Sixty-day-old rats were divided into two groups: C (control, n = 30) and HF (high-fat, n = 30) diets. At 90 days, 10 animals of each group were sacrificed. The others were divided into 4 groups: C and HF (animals that maintained their previous diet, n = 10 for each group) and C / Bno and HF / Bno (animals whose control or high-fat diet was supplemented by Brazil nut oil, n = 10 for each group). Sacrifice occurred at 120 days, and the bladders were removed and analyzed. Epithelial height was increased in the HF compared to the C group. In contrast, the C / Bno had a lower epithelial height compared to the others. The percentage of collagen between the detrusor muscle fibers was significantly greater in C / Bno, HF and HF / Bno than in control group. The HF had a larger muscle fiber diameter than the C group, while the C / Bno presented lower values than the HF and HF / Bno groups. HF diets induced bladder wall damage. These changes in the rat’s bladder wall were partially reversed by the Bno.

Keywords: Bladder; Nuts; Diet, High-Fat; Rats

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Small cell bladder cancer: should we consider prophylactic cranial irradiation?

Vol. 44 (x): 2018 October 10.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0242


ORIGINAL ARTICLE

Tara Nikonow Morgan 1, Robert M. Turner II 1, Julian Baptiste 2, Timothy D. Lyon 1, Jodi K. Maranchie 1, Ronald L. Hrebinko 1, Benjamin J. Davies 1, Jeffrey R. Gingrich 1, Bruce L. Jacobs 1
1 Department of Urology, University of Pittsburgh, Pennsylvania, U.S.A; 2 School of Medicine, University of Pittsburgh, Pennsylvania, U.S.A

ABSTRACT

Purpose: To describe the clinical characteristics, treatment patterns, and outcomes in patients with small cell bladder cancer at our institution, including those who received prophylactic cranial irradiation (PCI) for the prevention of intracranial recurrence.

Materials and Methods: Patients with small cell bladder cancer treated at a single institution between January 1990 and August 2015 were identified and analyzed retrospectively for demographics, tumor stage, treatment, and overall survival.

Results: Of 44 patients diagnosed with small cell bladder cancer, 11 (25%) had metastatic disease at the time of presentation. Treatment included systemic chemotherapy (70%), radical surgery (59%), and local radiation (39%). Six patients (14%) received PCI. Median overall survival was 10 months (IQR 4 – 41). Patients with extensive disease had worse overall survival than those with organ confined disease (8 months vs. 36 months, respectively, p = 0.04). Among those who received PCI, 33% achieved 5 – year survival.

Conclusion: Outcomes for patients with small cell bladder cancer remain poor. Further research is indicated to determine if PCI increases overall survival in small call bladder cancer patients, especially those with extensive disease who respond to chemotherapy.

 Keywords: Prophylactic Surgical Procedures; Urinary Bladder Neoplasms; Carcinoma, Small Cell

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Immunohistochemical expressionof sodium-dependent glucose transporter – 2 (SGLT-2) in clear cell renal carcinoma: possible prognostic implications

 Vol. 44 (x): 2018 October 10.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0271


ORIGINAL ARTICLE

Minoru Kobayashi 1, Toshitaka Uematsu 2, Yuumi Tokura 2, Kohei Takei 2, Kazumasa Sakamoto 2, Takahiro Narimatsu 2, Akinori Nukui 3, Takao Kamai 2
1 Department of Urology, Utsunomiya Memorial Hospital, Tochigi, Japan; 2 Department of Urology, Dokkyo Medical University, Tochigi, Japan; 3 Department of Urology, Nasu Red Cross Hospital, Tochigi, Japan

ABSTRACT

Purpose: Glucose is a major energy resource for tumor cell survival and growth, and its influx into cells is mainly carried out by facilitative glucose transporters (GLUTs). Sodium – dependent glucose transporters (SGLTs) have been highlighted as playing important roles in diabetic treatment. However, their potential roles in cancer remain unclear. We examined expression patterns of SGLTs in tumor tissues together with conventional pathological variables to determine prognostic significance in patients with renal cell carcinoma (RCC).

Materials and Methods: Nephrectomy specimens were obtained from 68 patients. GLUT – 1, – 2 and SGLT – 1, – 2 expression in tumor and adjacent normal tissues were ana­lyzed by immunohistochemical staining, and intensity was quantified using an image analyzer.

Results: The four glucose transporters evaluated were broadly distributed in tumor tissues as well as throughout the normal parenchyma. There was no significant corre­lation between transporter expression and conventional pathological variables. How­ever, increased SGLT – 2 expression was significantly associated with shorter overall survival (p < 0.01), regardless of metastatic status.

Conclusions: We propose possible prognostic significance of SGLT – 2 expression in human RCC. Given that glucose is a major energy resource for tumor cells and that glucose transport is largely mediated by SGLT, SGLT – 2 may serve as a possible thera­peutic target in RCC.

Keywords: Immunohistochemistry; Glucose Transport Proteins, Facilitative; Carcinoma, Renal

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Implant of ATOMS® system for the treatment of postoperative male stress urinary incontinence: results of a single centre

Vol. 44 (x): 2018 October 10.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0171


ORIGINAL ARTICLE

Alessandro Giammò 1, Enrico Ammirati 2, Annarita Tullio 3,Gianni Bodo 1, Alberto Manassero 1, Paolo Gontero 2, Roberto Carone 1
1 Department of Neuro-Urology, CTO – Spinal Unit, Città della Salute e della Scienza di Torino, Turin, Italy; 2 Department of Urology, Molinette Hospital, Città della Salute e della Scienza di Torino, Turin, Italy; 3 Hygiene and Clinical Epidemiology Unit, S. Maria della Misericordia University Hospital of Udine, Udine, Italy

ABSTRACT

Purpose: The aim of our study is to evaluate the efficacy and safety of ATOMS® system for the treatment of postoperative male stress urinary incontinence (SUI).
Materials and methods: We retrospectively evaluated all patients treated at our institution for postoperative male SUI with ATOMS® implant. We excluded patients with low bladder compliance (< 20 mL / cmH2O), uncontrolled detrusor overactivity, detrusor underactivity (BCI < 100), urethral or bladder neck stricture and low cystometric capacity (< 200 mL).
Results: From October 2014 to July 2017 we treated 52 patients, mean age 73.6 years. Most of them (92.3%) had undergone radical prostatectomy, 3.85% simple open pros¬tatectomy, 3.85% TURP; 28.8% of patients had undergone urethral surgery, 11.5% ad¬juvant radiotherapy; 57.7% had already undergone surgical treatment for urinary in¬continence. The average24 hours pad test was 411.6 g (180 – 1100). The mean follow-up was 20.1 months (8.1 – 41.5) 30.8% of patients were dry, 59.6% improved ≥ 50%, 7.7% improved < 50% and 1.9% unchanged. In total 73.1% reached social continence. There was a significant reduction of the 24 hours pad test and ICIQ – UI SF scores (p < 0.01).
In the postoperative follow-up we detected complications in 8 patients (19%): 5 cases of displacement of the scrotal port, in 2 cases catheterization difficulties, one case of epididimitis and concomitant superficial wound infection; no prosthesis infection, nor explants.
Radiotherapy, previous urethral surgery,previous incontinence surgery were not statistically related to social continence rates (p 0.65;p 0.11;p 0.11).
Conclusions: The ATOMS® system is an effective and safe surgical treatment of mild and moderate male postoperative SUI with durable results in the short term.

Keywords: Suburethral Slings; Urinary Incontinence; Surgical Procedures, Operative

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Related Post

Predictors of surgical complications of nephrectomy for urolithiasis

Vol. 44 (x): 2018 October 10.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0246


ORIGINAL ARTICLE

Alexandre Danilovic 1, Thiago Augusto Cunha Ferreira 1, Gilvan Vinícius de Azevedo Maia 1, Fabio Cesar Miranda Torricelli 1, Eduardo Mazzucchi 1, William Carlos Nahas 1, Miguel Srougi 1
1 Divisão de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil

ABSTRACT

Objectives: Nephrectomy due to stone disease may be a challenging procedure owing to the presence of significant inflammation and infection, involving high complication rate. The objective of our study was to identify predictors for complications of nephrectomy for urolithiasis.
Patients and Methods: A retrospective review of 149 consecutive patients > 18y submitted to simple nephrectomy for urolithiasis from January 2006 to July 2012 was performed. Clinical data, computed tomography findings and pathology report were analyzed. Postoperative complications were categorized based on Clavien – Dindo classification.
Logistic multivariate regression models assessed the predictors for surgical complications of nephrectomy for urolithiasis.
Results: Eighty-three (55.7%) patients were submitted to laparoscopic nephrectomy and 66 (44.2%) to open procedure. Conversion to open surgery was necessary in 19.2% (16 / 83). On univariable analysis, higher preoperative chronic kidney stage (p = 0.02), Charlson comorbidity index ≥ 2 (p = 0.04), higher ASA score (p = 0.001), urgency due to sepsis (p = 0.01), kidney size ≥ 12 cm (p = 0.006), renal and perirenal abscess (p = 0.004 and 0.002 respectively) and visceral adhesion (p = 0.04) were associated with Clavien – Dindo score > 1. On multivariate analysis, higher ASA score (p = 0.01), urgency due to sepsis (p = 0.03), kidney size ≥ 12 cm (p = 0.04) and preoperative abscess (p = 0.04) remained significantly associated with complications. End – stage renal disease with dialysis was needed post – operatively in 3.4% (5 / 144) of patients.
Conclusions: We identified that higher ASA score, urgency due to sepsis, kidney size ≥ 12 cm and preoperative abscess were associated with Clavien – Dindo score > 1.

Keywords: Nephrectomy; Urolithiasis; Postoperative Complications

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Prognosis of patients with prostate cancer and middle range prostate – specific antigen levels of 20 – 100 ng / mL

Vol. 44 (x): 2018 October 10.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0143


ORIGINAL ARTICLE

Hiroaki Iwamoto 1, Kouji Izumi 1, Yoshifumi Kadono 1, Atsushi Mizokami 1
1 Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan

ABSTRACT

Introduction: Prostate – specific antigen (PSA) is a useful biomarker for detection of prostate cancer (PCa) and for risk classification in addition to TNM classification and
Gleason score (GS). We reported the role of PSA in patients with low (< 20 ng / mL) and extremely high (≥ 100 ng / mL) PSA levels. However, it is unclear whether a correlation
exists between middle range PSA levels (20 – 100 ng / mL) at diagnosis and prognosis.
Materials and Methods: Between January 2000 and December 2014, 1873 patients underwent prostate biopsy at Kanazawa University Hospital. Of 802 patients who were diagnosed with PCa, 148 patients with middle range PSA levels (20 – 100 ng / mL) were retrospectively analyzed.
Results: The percentage of patients with T3 – 4 consistently increased as PSA levels increased from 20 to 100 ng / mL. Although the percentage of patients with GS ≥ 8 or metastases increased as PSA levels increased up to approximately 70 ng / mL, there was no significant increase between 70 and 100 ng / mL. PCa – specific and castration – resistant PCa – free survivals were adversely associated with PSA levels up to 70 ng / mL, but not between 70 and 100 ng / mL.
Conclusion: PSA is a useful biomarker for predicting prognosis at levels between 20 and 70 ng / mL. However, PSA cannot be used as a prognostic factor in patients with PCa and PSA levels ≥ 70 ng / mL. When the PSA level reaches approximately 70 ng / mL, prognosis might bottom and reach a plateau.

Keywords: Biomarkers; Prognosis; Prostatic Neoplasms

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The importance of histopathologic review of biopsies in patients with prostate cancer referred to a tertiary uro-oncology center

Vol. 44 (x): 2018 October 10.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0099


ORIGINAL ARTICLE

Wagner Eduardo Matheus 1, Ubirajara Ferreira 2, Elimilson A. Brandão 2, Aline A. Ferruccio 3, 4, Athanase Billis 5
1 Departamento de Cirurgia, Hospital das Clínicas da Universidade Estadual de Campinas – UNICAMP, Campinas, SP, Brasil; 2 Departamento de Urologia da Universidade Estadual de Campinas – UNICAMP, Campinas, SP, Brasil; 3 Departamento de Urooncologia da Universidade Estadual de Campinas – UNICAMP, Campinas, SP, Brasil; 4 Pontifícia Universidade Católica de Campinas – PUC, Campus II, Campinas, SP, Brasil; 5 Departamento de Anatomia Patológica da Universidade Estadual de Campinas – UNICAMP, Campinas, SP, Brasil

ABSTRACT

Introduction: In view of the detailed histologic evaluation of prostate cancer (PC), it is usually advisable to provide a “second opinion” to confirm diagnosis. This study aimed to compare the Gleason score (GS) of initial diagnosis versus that of histopathologic review of patients with PC. The secondary objective was to compare initial GS versus histopathologic review versus post – surgical histopathology.
Material and methods: Retrospective study based on chart review of patients with PC that attended the Uro – oncology Department of Hospital das Clínicas – UNICAMP – Campinas, Brazil, from April, 2002, to April, 2012. Data were divided in groups: patients with biopsies performed elsewhere, biopsies after pathological review and histopathological results following retropubic radical prostatectomy (RRP). These were evaluated in relation to GS difference using Fleis’s Kappa concordance coefficient.
Results: 402 PC patients, with a median age of 66 years, were evaluated. Reviewed GS showed worsening, with accuracy of 61.2%, and Kappa concordance value = 0.466. Among 143 patients submitted to surgery, GS varied widely, regarding initial evaluation, review and post – surgical RRP. Joint concordance of evaluations was weak (Kappa = 0.216), mainly due to almost no existence concordance between initial evaluation and following RRP (Kappa = 0.041).
Conclusion: There is a great histopathological variation of initial GS versus reviewed GS. There is also a better correlation of reviewed GS and post – surgical GS than with initial GS. The second opinion by an uropathologist improves diagnosis and should be advised for better therapeutic decision.

Keywords: Prostatic Neoplasms; Neoplasm Grading; Pathology

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A rare case of prostato – symphyseal fistula after GreenLight photovaporization of the prostate

Vol. 44 (x): 2018 September 9.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0209


RADIOLOGY PAGE

Pablo Garrido-Abad 1, Manuel Ramírez-Sánchez 1, Luis García-Martín 1, Manuel Fernández-Arjona 1
 1 Department of Urology. Hospital Universitario del Henares, Coslada, Madrid, Spain

ABSTRACT

Not available

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Related Post

Micro-ureteroscopy for treatment of pelvic ureteral stone in pediatric patient

Vol. 44 (x): 2018 October 10.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0223


VIDEO SECTION

Diogo Nunes-Carneiro 1, João Ferreira Cabral 1, Avelino Fraga 1, Vítor Cavadas 1
1 Departamento de Urologia de Centro Hospitalar do Porto, Instituto de Ciências Biomédicas de Abel Salazar, Porto, Portugal

ABSTRACT

Introduction: During the last years there has been an effort in miniaturizing the endoscopic devices.

The video presents an alternative for the management of distal ureteral stone, using a ureteral access of 4.85 Fr and 27 cm of length, previously described as micro-ureteroscopy.

Material and Methods: This procedure was performed through a 3-part all-seeing needle, consisting of micro-optics 0.9 mm in diameter with a 120-degree angle of view, an irrigation channel and an integrated light.

Clinical Case: Seven year-old boy, with history of preterm birth (29 weeks) was referred to our consultation complaining of left back pain and an elevation of serum creatinine.

The renal ultrasound revealed a left ureterohydronephrosis, caused by a 10 mm stone located 13 mm from the uretero­vesical junction.

The patient underwent a micro-ureteroscopy with laser lithotripsy. The stone was fragmented with an average energy of 0.5 J with 12 Hz of frequency. The total energy spent was 12514 J. At the end of the procedure, a double J stent was placed.

The procedure lasted 45 minutes and was uneventful. The patient was discharged 24h after the procedure without com­plaints and remained stone free.

Conclusion: Micro-ureteroscopy is a safe and effective technique in distal ureteral lithiasis treatment in children. The small dimensions of the equipment increase the safety of the procedure making this a good option for the treatment of ureteral stones in children.

 ARTICLE INFO

Available at: http://www.intbrazjurol.com.br/video-section/20180223_Nunes-Carneiro_et_al

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Related Post

Robotic surgery in the management of complex pelvic endometriosis

Vol. 44 (x): 2018 October 10.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0718


VIDEO SECTION

Guillermo Velilla 1, Roberto Ballestero 1, Marcos Gómez 2, Sergio Zubillaga 1, Ernesto Herrero 1, Elena Yllera 3, José Luis Gutiérrez 1
1 Department of Urology, Hospital Universitario Marqués de Valdecilla, Santander, Spain; 2 Department of General Surgery, Hospital Universitario Marqués de Valdecilla, Santander, Spain; 3 Department of Radiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain

 

ABSTRACT

Introduction: Endometriosis consists in the proliferation of endometrial tissue outside of the uterine cavity, predominantly in the ovaries but also in the urinary bladder or bowel. About 10% of fertile women are affected and the main symptoms are pain, menstrual disorders and infertility. Surgery is the treatment option for those symptomatic patients in which medical treatment had no success.

Material and Methods: We report on a case of a 43 – years – old patient without urologic personal history submitted to our office because of a grade – III right – hydronephrosis. The patient, with an endometriosis diagnosis since years, presents chronic pelvic pain with the daily necessity of strong opioids intake. CT scan revealed several endometriosis implants in the uterine wall and rectum that caused right ureteral entrapment. Renography revealed a 24% function in the right kidney. After right nephrostomy a multidisciplinary committee decided surgical intervention. With robotic approach, we performed an hysterectomy with right salpingo – oophorectomy; release, resection and right ureteral reimplantation; anterior resection of the rectum and protective ileostomy. Vaginal extraction of the specimen. In this video we show the key steps of the procedure.

Results: Total operative time: 330 minutes. Total bleeding: 250 cc. Nephrostomy removal: 4 th day. Urethral catheter removal: 5 th day. Patient was discharged in the 7 th day. Ureteral JJ – stent removal: 30 th day. CT urography reveals a permeable ureteral tract with no urine leakage. Renography shows a progressive improvement of the kidney function.

Conclusions: Robotic surgery allows a correct handling of endometriosis, mainly in complex cases. It is a safe and reproducible technique with correct outcomes in selected patients. A multidisciplinary team is required.

ARTICLE INFO

Available at: http://www.intbrazjurol.com.br/video-section/20170718_Velilla_et_al

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Comparative study of percutaneous nephrolithotomy performed in the traditional prone position and in three different supine positions

Vol. 44 (x): 2018 October 10.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0191


ORIGINAL ARTICLE

Petronio Augusto de Souza Melo 1, Fabio Carvalho Vicentini 1, Rodrigo Perrella 1, Claudio Bovolenta Murta 1, Joaquim Francisco de Almeida Claro 1
1 Divisão de Urologia do Centro de Saúde Masculina do Hospital Brigadeiro, São Paulo, SP, Brasil

ABSTRACT

Purpose: To compare the outcomes of percutaneous nephrolithotomy (PCNL) performed in the prone position (PRON) and in three variations of the supine position.

Materials and Methods: We performed a retrospective analysis of patients that underwent PCNL at our institution from June 2011 to October 2016 in PRON and in three variations of the supine position: complete supine (COMPSUP), original Valdivia (VALD), and Galdakao – modified Valdivia (GALD). All patients had a complete pre – operative evaluation, including computed tomography (CT). Success was defined as the absence of residual fragments larger than 4 mm on the first post – operative day CT.

Results: We analyzed 393 PCNLs: 100 in COMPSUP, 94 in VALD, 100 in GALD, and 99 in PRON. The overall success rate was 50.9% and was similar among groups (p = 0.428). There were no differences between groups in the number of punctures, stone – free rate, frequency of blood transfusions, drop in hemoglobin level, length of hospital stay, and severe complications (Clavien ≥ 3). COMPSUP had a significantly lower oper­ative time than the other positions. COMPSUP had lower fluoroscopy time than VALD.

Conclusion: Patient positioning in PCNL does not seem to impact the rates of success or severe complications. However, COMPSUP is associated with a shorter surgical time than the other positions.

Keywords: Nephrolithotomy, Percutaneous; Prone Position; Kidney Calculi

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Dramatic polarization in genitourinary expert opinions regarding the clinical utility of positron emission tomography (PET) imaging in prostate cancer

Vol. 44 (x): 2018 October 10.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0208


ORIGINAL ARTICLE

Kiri A. Sandler 1, Shearwood McClelland III 2,3, Catherine Degnin 4, Yiyi Chen 4, Timur Mitin 3
1 Department of Radiation Oncology, University of California at Los Angeles, Los Angeles, CA, USA; 2 Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA; 3 Department of Radiation Medicine, Oregon Health and Science University, Portland, OR, USA; 4 Biostatistics Shared Resource, Oregon Health and Science University, Portland OR, USA

ABSTRACT

Objectives: To ascertain the opinions of North American genitourinary (GU) experts regarding inclusion of technologies such as prostate – specific membrane antigen (PSMA) and C – 11 choline positron emission tomography (PET) into routine practice.

Materials and Methods: A survey was distributed to North American GU experts. Ques­tions pertained to the role of PSMA and C – 11 PET in PCa management. Participants were categorized as “supporters” or “opponents” of incorporation of novel imaging techniques. Opinions were correlated with practice patterns.

Results: Response rate was 54% and we analyzed 42 radiation oncologist respondents. 17 participants (40%) have been in practice for > 20 years and 38 (90%) practice at an academic center. 24 (57%) were supporters of PSMA and 29 (69%) were supporters of C – 11. Supporters were more likely to treat pelvic nodes (88% vs. 56%, p < 01) and trended to be more likely to treat patients with moderate or extreme hypofractionation (58% vs. 28%, p = 065). Supporters trended to be more likely to offer brachytherapy boost (55% vs. 23%, p = 09), favor initial observation and early salvage over adjuvant radiation (77% vs. 55%, p = 09), and to consider themselves expert brachytherapists (69% vs. 39%, p = 09).

Conclusions: There is a polarization among GU radiation oncology experts regarding novel imaging techniques. A correlation emerged between support of novel imaging and adoption of treatment approaches that are clinically superior or less expensive. Pre – existing biases among GU experts on national treatment – decision panels and leaders of cooperative group studies may affect the design of future studies and influence the adoption of these technologies in clinical practice.

Keywords: Prostatic Neoplasms; Positron- Emission Tomography; Radiotherapy

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The effect of urethroplasty surgery on erectile and orgasmic functions: a prospective study

Vol. 44 (x): 2018 October 10.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0276


ORIGINAL ARTICLE

Ahmet Urkmez 1, Ozgur H. Yuksel 2, Emrah Ozsoy 1, Ramazan Topaktas 1, Aytac Sahin 2, Orhan Koca 1, Metin I. Ozturk 1
1 Department of Urology, University of Health Sciences, Haydarpasa Numune Research & Training Hospital, Istanbul, Turkey; 2 Department of Urology, University of Health Sciences, Fatih Sultan Mehmet Research & Training Hospital, Istanbul, Turkey

 

ABSTRACT

Objectives: to examine the effects of urethroplasty surgery on sexual functions by tak­ing into account age, location of stenosis, length of stenosis and surgical technique parameters.

Materials and Methods: The prospective study was conducted between January 2015 and August 2017 with 60 cases. Patients were categorized according to age groups (19-65 / 65-75 years), surgery technique and stricture localization and length. Before the urethroplasty operation and postoperative 6th month follow-up, the international index of erectile function (IIEF) form (15 questions), was filled, the relevant domains of sexual function; erectile function (Q1,2,3,4,5,15), orgasmic function (Q9,10) and overall satisfaction (Q13,14) were assessed.

Results: The mean age of the cases is 54 ± 13. However, preoperative IIEF, sexual sat­isfaction and orgasmic function averages of patients with a stenosis segment length of 1-3 cm was found to be significantly higher than that of patients with a stenosis segment length of 4-7 cm. Between stenosis segment length groups, there was no statistical difference in terms of preoperative and postoperative sexual functions. And also, there was no statistically significant change in patients’ preoperative and post­operative sexual function scores in terms of localization of stricture and surgery tech­niques. However, there were statistically significant change in the postoperative IIEF and sexual satisfaction averages according to preoperative averages.

Conclusion: Our study suggests that urethroplasty surgery itself does not significantly affect erectile function, orgasmic function, and general sexual satisfaction regardless of the type of surgery, localization and length of stenosis. Besides, there was a signifi­cant decrease in erectile function in senior adults.

Keywords: Erectile Dysfunction; Prospective Studies; Orgasm

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Re: Incidence and treatment of malignant tumors of the genitourinary tract in renal transplant recipients

Vol. 44 (x): 2018 October 10.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0406


LETTER TO THE EDITOR

Michael S. Floyd Jr. 1, Altaf Q. Khattak 1

1 Department of Reconstructive Urology, St Helens & Knowsley Hospital NHS Trust Whiston Hospital, Liverpool, United Kingdom

Not available

[Full Text]


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Does the experience of the bedside assistant effect the results of robotic surgeons in the learning curve of robot assisted radical prostatectomy?

Vol. 44 (x): 2018 October 10.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0184


ORIGINAL ARTICLE

Haci Ibrahim Cimen 1, Yavuz Tarik Atik 1, Serkan Altinova 2, Oztug Adsan 1, Mevlana Derya Balbay 3
1 Department of Urology, Sakarya University, School of Medicine, Sakarya, Turkey; 2 Ankara Ataturk Training and Research Hospital, Ankara, Turkey; 3 American Hospital, Istanbul, Turkey

ABSTRACT

Introduction: The success of the robot assisted radical prostatectomy (RARP) proce­dures depend on a successful team, however the literature focuses on the performance of a console surgeon. The aim of this study was to evaluate surgical outcomes of the surgeons during the learning curve in relation to the bedside assistant’s experience level during RARP.

Materials and Methods: We retrospectively reviewed two non – laparoscopic, beginner robotic surgeon’s cases, and we divided the patients into two groups. The first surgeon completed the operations on 20 patients with a beginner bedside assistant in February – May 2009 (Group-1). The second surgeon completed operations on 16 patients with an experienced (at least 150 cases) bedside assistant in February 2015 – December 2015 (Group-2). The collected data included age, prostate volume, prostate specific antigen (PSA), estimated blood loss, complications and percent of positive surgical margins. In addition, the elapsed time for trocar insertion, robot docking, console surgery, speci­men extraction and total anesthesia time were measured separately.

Results: There were no significant differences between the groups in terms of age, co­morbidity, prostate volume, PSA value, preoperative Gleason score, number of positive cores, postoperative Gleason score, pathological grade, protection rate of neurovascu­lar bundles, surgical margin positivity, postoperative complications, length of hospital stay, or estimated blood loss. The robot docking, trocar placement, console surgery, anesthesia and specimen extraction times were significantly shorter in group 2 than they were in group 1 (17.75 ± 3.53 min vs. 30.20 ± 7.54 min, p ≤ 0.001; 9.63 ± 2.71 min vs. 14.40 ± 4.52 min , p = 0.001; 189.06 ± 27.70 min vs. 244.95 ± 80.58 min, p = 0.01; 230.94 ± 30.83 min vs. 306.75 ± 87.96 min, p = 0.002; 10.19 ± 2.54 min vs. 17.55 ± 8.79 min, p = 0.002; respectively).

Conclusion: Although the bedside assistant’s experience in RARP does not appear to influence the robotic surgeon’s oncological outcomes during the learning curve, it may reduce the potential complications by shortening the total operation time.

Keywords: Prostatic Neoplasms; Robotics; Prostatectomy

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The iranian model as a potential solution for the current kidney shortage crisis

Vol. 44 (x): 2018 August 8.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0441


LETTER TO THE EDITOR

Bahar Bastani 1
1 Division of Nephrology, Saint Louis University Health Science Center, Saint Louis, MO, USA

Not available

[Full Text]


Related Post

Laparoscopic approach for intravesical surgery using pneumovesicum in the management of anterior colporrhaphy mesh erosion and stones around the bladder neck

Vol. 44 (x): 2018 September 9.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0046


VIDEO SECTION

Young Dae Bae 1, Hoon Choi 1, Jae Hyun Bae 1, Bum Sik Tae 1
1 Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Korea

ABSTRACT

Introduction and objective: Perforation of the bladder or urethra and erosion of the mesh after cystocele repair surgery are not uncommon and have potentially serious complications. Traditionally, surgical management of such complications has involved excision of the mesh using either a transurethral approach or open surgery. In this video, we present our experience of laparoscopic transvesical surgery for exposed mesh and stone.

Materials and methods: Patient was placed in the lithotomy position under general anesthesia and a 30° operating cystoscope was inserted under direct vision. After filling the bladder with 300 mL normal saline, a 5 – mm VersaStepTM bladeless trocar was placed 2 cm above the pubic symphysis. Two more 5 mm trocars were placed bilaterally at 3 cm intervals from the initial trocar site. The pneumovesicum state was maintained at 8 – 12 mmHg and a 5 mm telescope was introduced. Using a curved dissector and curved Mayo scissors, the exposed mesh was mobilized and removed. Interrupted 4 – 0 Vicryl sutures were used to close the defect. To localize the ureteral orifice, intravenous Indigo Carmine was used. The bladder stones were removed through the urethra using a stone basket, guided using a ureteral stent pusher.

Results: Total operation time was 55 min and the Foley catheter was removed at post – operative day 5 after postoperative cystography.

Conclusions: Excellent visualization of mesh exposure and ureteral orifice was possible under laparoscopic transvesical surgery, and reconstruction including the mucosa and muscle layer was able to be achieved. This method is useful and feasible, with minimal invasiveness and an early post – operative recovery.

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Related Post

Safety and effectiveness evaluation of open reanastomosis for obliterative or recalcitrant anastomotic stricture after radical retropubic prostatectomy

 Vol. 44 (x): 2018 October 10.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0681


ORIGINAL ARTICLE

Carlos Roberto Giúdice 1, Patricio Esteban Lodi 1, Ana Milena Olivares 1, Ignacio Pablo Tobia 1, Gabriel Andrés Favre 1
1 Department of Urology, Reconstructive Surgery Area, Hospital Italiano de Buenos Aires, Argentina

ABSTRACT

Purpose: To evaluate safety, efficacy and functional outcomes after open vesicourethral re – anastomosis using different approaches based on previous urinary continence.

Materials and Methods: Retrospective study of patients treated from 2002 to 2017 due to vesicourethral anastomosis stricture (VUAS) post radical prostatectomy (RP) who failed endoscopic treatment with at least 3 months of follow-up. Continent and incontinent patients post RP were assigned to abdominal (AA) or perineal approach (PA), respectively. Demographic and perioperative variables were registered. Follow-up was completed with clinical interview, uroflowmetry and cystoscopy every 4 months. Success was defined as asymptomatic patients with urethral lumen that allows a 14 French flexible cystoscope.

Results: Twenty patients underwent open re-anastomosis for VUAS after RP between 2002 and 2017. Mean age was 63.7 years (standard deviation 1.4) and median follow-up was 10 months (range 3 – 112). The approach distribution was PA 10 patients (50%) and AA 10 patients (50%). The mean surgery time and median hospital time were 246.2 ± 35.8 minutes and 4 days (range 2 – 10), respectively with no differences between approaches. No significant complication rate was found. Three patients in the AA group had gait disorder with favorable evolution and no sequels.

Estimated 2 years primary success rate was 80%. After primary procedures 89.9% remained stenosis – free. All PA patients remained incontinent, and 90% AA remained continent during follow-up.

Conclusion: Open vesicourethral re – anastomosis treatment is a reasonable treatment option for recurrent VUAS after RP. All patients with perineal approach remained incontinent while incontinence rate in abdominal approach was rather low.

 

Keywords: Erectile Dysfunction; Prostatectomy; Urinary Incontinence

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Related Post

Moderate or severe LUTS is associated with increased recurrence of non – muscle – invasive urothelial carcinoma of the bladder

Vol. 44 (x): 2018 October 10.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0068


ORIGINAL ARTICLE

Austin Lunney 1, Allan Haynes 1, Pranav Sharma 1
1 Department of Urology, Texas Tech University Health Sciences Center, Lubbock, TX, USA

ABSTRACT

Purpose: Non – muscle – invasive bladder cancer (NMIBC) can recur despite transurethral resection (TURBT) and adjuvant intravesical therapy. Tobacco products excreted in the urine are hypothesized to cause tumor – promoting effects on urothelial cells through direct contact. We determined if moderate or severe lower urinary tract symptoms (LUTS) (defined as International Prostate Symptom Score [IPSS] ≥ 8) was associated with increased tumor recurrence.

Materials and Methods: We retrospectively identified 70 consecutive men initially diagnosed with NMIBC at our institution from 2010 – 2016. Means were compared with independent T – test and proportions with chi – square analysis. Multivariate logistic regression was performed to determine independent predictors of recurrence.

Results: The majority of patients had Ta disease (58.6%) followed by T1 (28.6%) and Tis (12.9%). Forty – one (58.6%) patients had moderate or severe LUTS upon presentation within 30 days of initial TURBT with mean IPSS of 13.2 vs. 5.2 in the control group (p < 0.01). Biopsy – proven tumor recurrence occurred in 24 (34.3%) patients at mean follow-up of 31.7 months. Mean time to recurrence was 14.6 months. Moderate or severe LUTS was an independent predictor of tumor recurrence (odds ratio [OR]: 19.1, 95% confidence interval [CI]: 2.86 – 127; p = 0.002). Voiding or storage symptoms based on the IPSS did not independently correlate with tumor recurrence (p = 0.08 and p = 0.31, respectively) although total mean IPSS score did (OR: 1.26, 95% CI: 1.07 – 1.47, p = 0.005).

Conclusions: The presence of moderate or severe LUTS may be an important prognostic factor in NMIBC. Patients with significant urinary symptoms could be monitored more aggressively due to higher recurrence risk.

Keywords: Urinary Bladder Neoplasms; Lower Urinary Tract Symptoms; Carcinoma, Transitional Cell

[Full Text]


 

Related Post

Removal of intramural trapped intrauterine device by cystoscopic incision of bladder wall

Vol. 44 (x): 2018 September 9.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0056


VIDEO SECTION

Abbas Basiri 1, Behnam Shakiba 1, Niloufar Rostaminejad 1
1 Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

ABSTRACT

_______________________________________________________________________________________

A healthy 37 – year – old woman referred to our clinic with one – year history of recurrent urinary tract infection, dy­suria and frequency. Her past medical history informed us that an IUD (Copper TCu380A) had been inserted 11 years ago. Eleven months after the IUD insertion she had become pregnant, unexpectedly. At that time, she had undergone gynecological examination and abdominal ultrasound study. However, the IUD had not been found, and the gynecologist had made the diagnosis of spontaneous fall out of the IUD. She had experienced normal pregnancy and caesarian section with no complications.

On physical examination, pelvic examination was normal and no other abnormalities were noted. Urinalysis revealed microhematuria and pyuria. Urine culture was positive for Escherichia coli. Ultrasound study revealed a calculus of about 10 mm in the bladder with a hyperdense lesion. A plain abdominal radiograph was requested which showed a metallic foreign body in the pelvis. We failed to remove the IUD by cystoscopic forceps because it had strongly invaded into the uterine and bladder wall. Despite previous papers suggesting open or laparoscopic surgeries in this situation (1, 2), we performed a modified cystoscopic extraction technique. We made a superficial cut in the bladder mucosa and muscle with J – hook monopolar electrocautery and extracted it completely with gentle traction.

This technique can decrease the indication of open or laparoscopic surgery for extraction of intravesical IUDs. In the other side of the coin, this technique may increase the risk of uterovesical fistula. Therefore, the depth of incision is important and the surgeon should cut the bladder wall superficially with caution. Although present study is a case report which is normally classified as with low level of evidence, it seems that our modified cystoscopic extraction technique is a safe and useful method for extraction of partially intravesical IUDs.

ARTICLE INFO

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The impact of single positive surgical margin features on biochemical recurrence after robotic radical prostatectomy

 Vol. 44 (x): 2018 September 9.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0702


ORIGINAL ARTICLE

Ismail Evren 1, Ahmet Hacıislamoğlu 1, Mithat Ekşi 1, Abdullah Hızır Yavuzsan 1, Fırat Baytekin 2, Yunus Çolakoğlu 1, Didem Canoğlu 2, Volkan Tugcu 1
1 Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey; 2 Department of Pathology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey

ABSTRACT

Objective: Parameters predictive of biochemical or clinical recurrence after Radical Prostatectomy (RP) were determined as pre-treatment PSA value, pathologic tumor stage, tumor grade and presence of Positive Surgical Margin (PSM), extracapsular ex­tension and seminal vesicle invasion and the status of pelvic lymph nodes. The aim of our study is to evaluate the effect of additional features in patients undergoing RP in our clinic.

Materials and Methods: We studied 556 RP operations performed between 2009 and 2016 for prostate cancer at this clinic. Preoperative and postoperative data of the pa­tients were retrospectively reviewed. RP specimens were examined by two pathologists specialized in this subject. Of these patients, 78 (14.02%) patients with PSM were in­cluded in the study. The pathology slides of these patients were reassessed. The length of PSM (mm), localization (apex, basis and posterolateral) and Gleason pattern at this margin was determined and statistical correlations with BCR were calculated.

Results: The mean follow-up after the RP of 41 patients included in the study was 37.4 ± 13.2 months. During the follow-up period of the patients, BCR was observed in 16 patients (39.02%). No statistically significant difference was observed in age and prostate volume between the groups with and without BCR development (p > 0.05). Preoperative PSA level was found to be statistically significantly higher in the group with BCR development compared to the group without recurrence (p = 0.004). In-group comparisons in each aforementioned Gleason score groups were performed in terms of BCR development and the preoperative Gleason score in the group with development of recurrence was found to be statistically significantly higher compared to the group without recurrence (p = 0.007). The length of the surgical margin was measured as 7.4 ± 4.4 mm in the BCR-developing group and 4.7 ± 3.8 mm in the no-BCR- developing group; it was statistically significantly higher in the group with development of recur­rence (p = 0.03).

Conclusion: Length and location of the PSM and the Gleason score detected in the PSM region could not predict biochemical recurrence according to the results of this present study. However high preoperative PSA value is an independent prognostic factor for biochemical recurrence.

Keywords: Margins of Excision; Prostatectomy; Pathology

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First – line, non – cryopreserved autologous stem cell transplant for poor – risk germ – cell tumors: Experience in a developing country

Vol. 44 (x): 2018 September 9.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0562


ORIGINAL ARTICLE

Eucario Leon-Rodriguez 1, Monica M. Rivera-Franco 1, Dennis Lacayo-Leñero 2, Andrea Campos-Castro 2, Monica I. Meneses-Medina 3
1 Stem Cell Transplantation Program, Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; 2 Stem Cell Transplantation Program,Hematology Section, Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; 3 Stem Cell Transplantation Program, Oncology Section, Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran Mexico City, Mexico

ABSTRACT

Purpose: The current first – line treatment for non – seminomatous germ cell tumor (NSGCT) consists of four cycles of cisplatin, etoposide, and bleomycin (BEP), which results in 5 – year overall survival < 60% in patients with poor – risk features. Autolo­gous hematopoietic stem cell transplantation (auto – HSCT) as a method for overcom­ing high toxicity after high dose chemotherapy (HDC) has been explored in different solid tumors, but has remained standard practice only for NSGCT. Our objective was to describe outcomes of patients with poor – risk NSGCT who underwent first – line autologous HSCT in a tertiary center in Mexico.

Patients and Methods: Twenty nine consecutive patients with NSGCT who received first – line, non – cryopreserved autologous HSCT at the National Institute of Medical Sciences and Nutrition Salvador Zubiran in Mexico City, Mexico, from November 1998 to June 2016, were retrospectively analyzed.

Results: The median age at transplantation was 23 (15 – 39) years. Most patients (n = 18, 62%) had testicular primary tumor, and 23 had metastases (79%). Complete re­sponse after auto – HSCT was observed in 45%. Non – relapse mortality was 0. Five – year relapse / progression free and overall survival were 67% and 69%, respectively.

Conclusions: This small single limited – resource institution study demonstrated that patients with poor – risk NSGCT are curable by first – line HDC plus autologous HSCT and that this procedure is feasible and affordable to perform using non – cryopreserved hematopoietic stem cells.

Keywords: Stem Cell Transplantation; Neoplasms; Cryopreservation

[Full Text]


 

Related Post

Anterograde irrigation – assisted ureteroscopic lithotripsy in patients with percutaneous nephrostomy

Vol. 44 (x): 2018 August 8.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0238


VIDEO SECTION

Jemo Yoo 1, Seung-Ju Lee 1, Hyun-Sop Choe 1, Hee Youn Kim 1, Joon Ho Lee 1, Dong Sup Lee 1
1 St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea

ABSTRACT

In complicated urinary tract infection with ureteral calculi, urinary diversion is inevitable. So, stenting or percutaneous drainage can be an option. In hemodynamically unstable patients, percutaneous drainage is superior to ureteral stenting (1). Once acute infection is controlled, definite treatment of the stone is necessary. According to a guideline, semirigid ureteroscopy is recommended for lower and mid – ureter stone and flexible ureteroscopy for upper ureter stone (2). Semi – rigid ureteroscopy can migrate stone to kidney, especially in upper ureter stone, lowering stone free rate (3). Not only flexible ureteroscopy creates additional costs but also is barely available in developing countries (4, 5). So, the authors would like to introduce anterograde irrigation – assisted ureteroscopic lithotripsy in patients with percutaneous nephrostomy.

Retrograde irrigation was connected and flowed minimally enough to secure visual field. Once stone is noted, another saline irrigation, which is placed above 40 cm over the patient is connected to nephrostomy. Retrograde irrigation is disconnected from ureteroscope and the previous connected channel on ureteroscope is opened. Actual pressure detected by barometer from the opened channel of ureteroscope is usually about 30 cmH2O while anterograde irrigation is administered in maximal flow, which means fully opened anterograde irrigation is not hazardous to kidney. There was no complication in 17 patients submitted to this method.

Video shows advantages of our practice: clear visual field; reduced risk of stone migration into kidney; induced spontaneous passage of fragments without using instrumentation; and decreased operation time. In short, most of surgeons, even unexperienced, can perform an excellent procedure with less time consuming using our method.

ARTICLE INFO

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Related Post

Vascular injuries during laparoscopic donor nephrectomy and proposed risk reduction strategies

Vol. 44 (x): 2018 August 8.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0281


VIDEO SECTION

Parag Sonawane 1, Arvind Ganpule 1, Abhishek Singh 1, Ravindra Sabnis 1, Mahesh R. Desai 1
1 Department of Urology, Division of Laparoscopic and Robotic Surgery, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India

ABSTRACT

 Introduction: Laparoscopic donor nephrectomy (LDN) has become the standard of care and popular among most of the transplant centres across the globe.

Objective of this video is to report different vascular injuries, their management during LDNs and propose risk reduction strategies.

Patient and methods: This was a retrospective analysis of all the LDNs performed between January 2011 and March 2016. All donor nephrectomies were performed laparoscopically by transperitoneal route, under ideal operative conditions by expert laparoscopic surgeons and by novice surgeons.

Results: 858 LDNs (left, n = 797; right, n = 61) were performed during the study period with 5 cases of vascular injuries. Mean (SD) donor age was 45.5 (± 10.76) years and the operative time was 165 (± 44.4) min. Of these five cases, two had renal vein injury, while the three others had renal artery, inferior vena cava and aortic injury (one each). Four injuries occurred during left LDN and only one during a right LDN. Vascular injuries were managed using the Rescue stitch or metallic clips as indicated. Risk reduction strategy was developed to avoid vascular injuries during LDN, which include – meticulous attention to port placement, addition of fourth port, complete dissection of upper pole and pedicle before clipping, and judicious use of ultrasonic diathermy.

Conclusions: Careful evaluation of computed tomography angiography just before surgery will act like a global position­ing system (GPS) for the operating surgeon. Rescue stitch is a saviour. Not to panic and being well versed with the risk reduction strategies of laparoscopy and rescue measures is of paramount importance.

 ARTICLE INFO

Available at: http://www.intbrazjurol.com.br/video-section/20180281_Sonawane_et_al

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Robot – assisted laparoscopic local recurrence resection after radical prostatectomy

Vol. 44 (x): 2018 August 8.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0503


VIDEO SECTION

Fabio C. M. Torricelli 1, Paulo Afonso de Carvalho 1, 2, Giuliano B. Guglielmetti 1,2, William C. Nahas 1, 2, Rafael F. Coelho 1, 2, 3
1 Serviço de Urologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil; 2 Instituto do Cancer do Estado de Sao Paulo (ICESP), São Paulo, SP, Brasil; 3 Hospital Israelita Albert Einstein, São Paulo, SP, Brasil

ABSTRACT

Introduction and objective: Local prostate cancer recurrence is usually treated with salvage radiation (sRDT) with or with­out adjuvant therapy. However, surgical resection could be an option. We aim to present the surgical technique for robot – assisted laparoscopic resection prostate cancer local recurrence after radical prostatectomy (RP) and sRDT in 2 cases.

Patients and method: First case depicts a 70 year – old man who underwent RP in 2001 and sRDT in 2004. Following ad­juvant therapy, patient had biochemical recurrence. MRI showed a solid mass in the prostatic fossa close to vesicourethral anastomosis, measuring 2.1 cm and PET / CT revealed hyper caption significant uptake in the prostatic fossa. Second case is a 59 year – old man who underwent RP in 2010 and sRDT in 2011. Again, patient presented with biochemical recur­rence. PET / CT showed hyper caption in the prostatic fossa. Biopsy conformed a prostate adenocarcinoma. Both patients underwent robot – assisted extended pelvic lymph nodes dissection and local recurrence resection. A standard 4 robotic arms port placement was utilized.

Results: Both procedures were uneventfully performed in less than 3 hours and there were no complications. Pathologi­cal examination showed a prostate adenocarcinoma Gleason 7 and 8 in the first and second case, respectively; surgical margins and lymph nodes were negative. After 6 months of follow-up, continence was not affected and both patients presented with PSA < 0.15 ng / mL.

Conclusion: Robot – assisted laparoscopic resection of prostate cancer local recurrence after RP and sRDT detected by PSMA PET / CT seems to be safe in experienced hands. It may postpone adjuvant therapy in selected cases.

Available at: http://www.intbrazjurol.com.br/video-section/20170503_Torricelli_et_al

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Related Post

A severely encrusted forgotten double – J ureteral catheter with giant stone formation

Vol. 44 (x): 2018 August 8.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0330


RADIOLOGY PAGE

Gaurav Garg 1, Deepanshu Sharma 1, Siddharth Pandey 1, Manoj Kumar 1
1 King George’s Medical University, Lucknow, India

Not available

[Full Text]


 

Related Post

A novel “six stitches” procedures for pediatric and adult buried penis

Vol. 44 (x): 2018 July 7.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0688


VIDEO SECTION

Junhao Lei 1, Chunhua Luo 1, Xinghuan Wang 1,2, Xinjun Su 1
1 Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China; 2 Center for Evidence-based and Translational Medicine, Wuhan University, Wuhan, China

ABSTRACT

Introduction: The buried penis, if not treated before adolescence, will lead to psychological and physical disorders in adulthood. Therefore, early surgical intervention is necessary. At present, the common surgical methods include the penile corpus fixation, the Johnson’s operation, the Devine’s method, the modified Devine’s method, Shiraki’s method, etc. However, we found that these traditional surgeries showed various postoperative complications, such as long-term prepuce edema, avascular necrosis of skin flaps, stenotic prepuce, scarring, and poor appearance. This video shows the main technical steps of our innovative surgical procedure “Six Stitch” (SS) method for the buried penis.
Materials and Methods: The designation of the so-called SS method was based on the total knots made (six knots were made for the SS procedure).
After the crura penis was fully exposed via a longitudinal incision at the penoscrotal junction, at the 2 o’clock position (around the penis), the superficial layer of albuginea of the crura penis was sutured to the prepubic ligament with 2-0 non-absorbable sutures to prevent the retraction of the penis (the 1st knot). The same procedure was used for the 10 o’clock position (the 2nd knot); At the 2 o’clock position, the skin and subcutaneous tissue at the pubic mound were sutured to the prepubic ligament to reconstruct the appearance of dorsum penis (the 3rd knot). The same procedures were used for the 10 o’clock position (the 4th knot). At the 5 o’clock position, the ventral albuginea was sutured to the tunica dartos and subcutaneous tissue at the penoscrotal junction to reconstruct the penoscrotal angle (the 5th knot). The same procedures were used for the 4 o’clock position (the 6th knot). Finally, the gloved prepuce was reset and circumcision was conducted if the redundant prepuce existed.
Results: We have done a total of 64 cases of SS procedures for concealed penis; mean length improvement was 3.8 ± 0.5 cm, with a satisfying 95 percent (61 / 64), which was much longer than the outcome of the above-mentioned methods.
Mean operative time was 62.3 ± 12.1 minutes, and there was no serious intraoperative or postoperative complication (only 2 presented scar hyperplasia at the incision site).
Conclusions: In conclusion, after the SS procedure, patients with buried penis can acquire an almost 4 cm improvement of penile length and covert incision at the midline of the scrotum, with an acceptable and low incidence of adverse events.
This safe and effective procedure may be a viable option for the surgical management of pediatric and adult buried penis.

ARTICLE INFO
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Related Post

Easy, reproducible extraperitoneal pelvic access for robot – assisted radical prostatectomy

Vol. 44 (x): 2018 July 7.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0175


VIDEO SECTION

Antonio Rebello Horta Gorgen 1, Christian P. Pavlovich 2
1 Hospital de Clínicas de Porto Alegre, Porto Alegre, Brasil; 2 Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

ABSTRACT

Robot – assisted radical prostatectomy is commonly performed transperitoneally (tRARP), although the extraperitoneal (eRARP) approach is a safe and effective alternative that may be preferred in certain situations. We developed a novel method of direct access into the space of Retzius with a visual obturator port (VisiportTM) for laparoscopic or robotic prostatectomy.

We present an instructional video of extraperitoneal pelvic access for eRARP with both internal and external camera views. The patient is first placed in lithotomy and 15° Trendelenburg position. The camera is inserted infraumbilically and angled caudally. The pre-peritoneal space is accessed through the anterior rectus fascia using a VisiportTM (Covidien, $ 60 www.esutures.com), and the working space is developed with a kidney – shaped balloon OMSPDBS2TM (Covidien, $ 49 www.esutures.com). After the space is insufflated, subsequent trocars are angled in extraperitoneally under direct vision. The average time from incision to final port placement after a learning curve of about 50 cases is 8 minutes (IQR 7-10).

We have performed over 1.000 cases using this technique and eRARP has become our procedure of choice. Our last 500 + cases were performed robotically. Approximately 10% of the time peritoneotomies were noted, but rarely did these require conversion to tRARP. There have been no bowel or other abdominal organ injuries, major vascular or other complications in any of these cases.

 

ARTICLE INFO

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Related Post

Evaluation of incidence and histolopathological findings of soft tissue sarcomas in genitourinary tract: Uludag university experience

Vol. 44 (x): 2018 June 6.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0048


ORIGINAL ARTICLE

Berna Aytac Vuruskan 1, Mıne Ozsen 1, Burhan Coskun 2, Ulviye Yalcinkaya 1
1 Department of Surgical Pathology, Uludag University, Faculty of Medicine, Bursa, Turkey; 2 Department of Urology, Uludag University, Faculty of Medicine, Bursa, Turkey

ABSTRACT

Purpose: In this study we aimed to review urological soft tissue sarcomas of genito­urinary tract that were diagnosed in our institution and their prognostic factors for survival.

Materials and Methods: The clinical and pathological records of 31 patients who had diagnosis of soft tissue sarcomas primarily originating from the genitourinary tract between 2005-2011 were reviewed.

Results: The most common site was kidney (17 cases, 54.8%), and most common di­agnosis was leiomyosarcoma (11 cases, 35.4%). A total of 24 patients (77.4%) had surgical excision. The surgical margins were positive in 7 patients who presented with local recurrence after primary resection. Twelve patients developed metastatic disease. During follow-up (range 9-70 month), 26 of the 31 patients (88.9%) were alive. Sig­nificant survival differences were found according to histological type (p: 0.001), with lower survival rates for malignant fibrous histiocytoma. The tumor size, the presence of metastasis at the time of diagnosis and tumor localization were not statistically significant for overall survival.

Conclusions: In our series, prostate sarcomas, paratesticular rhabdomyosarcoma and malignant fibrous histiocytoma had poor prognosis, especially in patients presenting with metastatic disease.

Keywords: Genitourinary Tract Anomalies [Supplementary Concept]; Sarcoma; Survival

[Full Text]


 

Related Post

Comparison of renal function after robot – assisted laparoscopic radical prostatectomy versus retropubic radical prostatectomy

 Vol. 44 (x): 2018 April 4.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0103


ORIGINAL ARTICLE

Giray Ergin 1, Omer Gokhan Doluoglu 2, Mustafa Kıraç 1, Muhammet Fatih Kilinc 2, Burak Köprü 1, Bugra Bilge Keseroglu 2, Mustafa Burak Hoscan 3
1 Department of Urology Clinic, Yuksek Ihtisas University, Medical Faculty, Koru Hospital, Ankara, Turkey; 2 Department of Urology Clinic, Ankara Training and Research Hospital, Ankara, Turkey; 3 Department of Urology Clinic, Medstar Topcular Hospital, Antalya, Turkey

ABSTRACT

Purpose: To investigate the effect of robot assisted laparoscopic radical prosta­tectomy (RALP) and open retropubic radical prostatectomy (RRP) on early renal function in this study.

Materials and Methods: Preoperative and postoperative urea, creatinine, Hb, eGFR values of patients who had undergone RALP and RRP with prostate cancer (PCa) diagnosis were recorded in our clinic. The percentages of change in these values are calculated. Preoperative and postoperative urea, creatinine, Hb and eGFR changes were compared with each other. Student-t test was used for intergroup comparison, and paired sample t test was used to compare changes between preoperative and postoperative values of the same group.

Results: There were 160 and 93 patients in the RALP and RRP group, respectively. In the RALP group, postoperative urea and creatinine increased significantly com­pared to preoperative baseline values while eGFR was decreased (p = 0.0001, p = 0.001, p = 0.0001, respectively). Except for Hb in the RRP group, the changes in these values were statistically insignificant (p = 0.50, p = 0.75, p = 0.30, respec­tively).

Conclusions: We should be more careful when we perform RALP in patients at risk of impaired renal function despite being a minimally invasive surgical method with superior visual characteristics.

Keywords: Prostatic Neoplasms; Prostatectomy; Video-Assisted Surgery

[Full Text]


 

Related Post

Supposed pituitary-production of human chorionic Gonadotropin induced by androgen deprivation therapy

Vol. 44 (x): 2018 April 4.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0654


ORIGINAL ARTICLE

Koji Yoshimura 1, Yoshiharu Nakashima 1, Kyohei Sugiyama 1, Naoki Kohei 1, Akitoshi Takizawa 2
1 Department of Urology, Shizuoka General Hospital, Shizuoka, Japan; 2 Department of Urology, International Goodwill Hospital, Yokohama, Japan

 

ABSTRACT

 

Introduction: The main cause of slightly elevated human chorionic gonadotropin (HCG) after successful treatment of male germ cell tumors is considered to be pituitary-derived HCG. It is well known that pituitary-derived HCG is frequently detected in postmenopausal women. We evaluated the status of serum HCG in men with elevated gonadotropins, which were induced by androgen deprivation therapy, using commercially available assays.

Materials and Methods: We enrolled 44 patients with prostate cancer, who underwent luteinizing-hormone releasing hormone agonist treatment. We measured serum follicle-stimulating hormone (FSH), serum luteinizing hormone (LH), serum total HCG, serum free HCGβ subunit, and urine total HCG 3 times per patient, on the day of treatment initiation, the next day, and 3 months after.

Results: On the day after treatment initiation, serum and urine HCG was detected in 61% and 73% of patients, respectively. Markedly strong correlations were observed between serum/urine HCG and FSH/LH. In particular, receiver operating characteristic curve analysis indicated excellent area under the curve (0.977, 95% confidence interval 0.951–1.003)) for serum HCG-detectable LH. At the cutoff value of 21.07 mIU/mL for serum HCG-detectable LH, the sensitivity and specificity were 96.7% and 95.3%, respectively. Serum HCG-β was not detectable at any times in any patients.

Conclusions: Suggested pituitary-derived HCG can be frequently detected in patients with elevated gonadotropins, and there is a firm association between HCG detection and gonadotropin levels.

Keywords: Chorionic Gonadotropin; Neoplasms, Germ Cell and Embryonal; Androgens; Luteinizing Hormone

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Prognostic significance of the dynamic changes of systemic inflammatory response in metastatic renal cell carcinoma

Vol. 44 (x): 2018 March 3.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0500


ORIGINAL ARTICLE

Beihe Wang 1, 2, Weijie Gu 1, 2, Fangning Wan 1, 2, Guohai Shi 1, 2, Dingwei Ye 1, 2
1 Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China; 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

 

ABSTRACT  

Purpose: To elucidate the prognostic value of systemic inflammatory response in pa­tients with metastatic renal cell carcinoma (mRCC) who are treated with sunitinib, we evaluated the prognostic role of C-reactive protein (CRP) kinetics. This study also compared prognostic models containing CRP kinetics and neutrophil-to-lymphocyte ratio (NLR) kinetics.

Materials and Methods: A consecutive cohort of 94 patients with mRCC who were treated with sunitinib was retrospectively included from Fudan University Shanghai Cancer Center. According to dynamic changes in CRP and the NLR, patients were divided into three groups for analysis of CRP and NLR kinetics. The associations between survival and potential prognostic factors were assessed. The incremental value of prognostication was evaluated.

Results: A significant difference (P<0.001) in overall survival (OS) was observed among the three groups of CRP kinetics. The median OS of the non-elevated group was nearly 1.3-fold longer than that of the normalized group (33.0 vs. 26.3 months), and two times longer than that of the non-normalized group (33.0 vs. 14.0 months). Multivari­ate analysis showed that CRP and NLR kinetics were independent prognostic indica­tors. The model containing CRP kinetics had a better predictive accuracy than that with NLR kinetics, which was supported by the C-index (0.731 vs. 0.684) and the likelihood ratio χ² test (79.9% vs. 44.9%).

Conclusion: Our study suggests that dynamic changes in CRP can better predict surviv­al in patients with mRCC who are treated with sunitinib. Routine assessment of CRP be­fore and after targeted therapy would help identify patients at risk of a poor outcome.

Keywords:  Carcinoma, Renal Cell; Molecular Targeted Therapy; Prognosis

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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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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.


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